Live Chat: Plant-Based Eating for Diabetes with Toby Smithson

Tune in to Sharon’s Live Chat with Toby Smithson, founder of DiabetesEveryDay.com and Diabetes EveryDay YouTube channel, as they talk about how plant-based eating can help prevent and manage diabetes.

If you’re wondering whether a plant-based diet, including vegetarian and vegan diets—is better for preventing and managing diabetes—the answer is yes! It was so great to sit down with my friend and fellow dietitian, Toby Smithson, who is a well-known diabetes expert, in my live video chat. We talked about her best tips for eating a diet rich in whole plant foods to not only help prevent diabetes from taking root, but to help control the symptoms of diabetes and avoid complications later in life. As a nutrition expert who has diabetes, Toby has all the professional and personal skills to help people take control of their health. Check out our fabulous discussion on her best advice on how to eat a plant-based diet for diabetes in this video of our Live Chat. And make sure to see the list of Toby’s resources, the written transcript for our interview, and her favorite plant-based recipe below too!

Toby Smithson, MS, RDN, LD, CDCES, FAND is a certified diabetes care and education specialist and registered dietitian nutritionist (RDN) who has successfully managed her own type 1 diabetes for more than five decades. You can check her out through her videos at DiabetesEveryDay, her website DiabetesEveryDay.com, and on YouTube at Diabetes EveryDay.

Tobi’s Plant-Based Diabetes Resources:

• Diabetes Meal Planning and Nutrition for Dummies
• Diabetes EveryDay YouTube channel
• Diabetes EveryDay

Other Plant-Based Diabetes Resources:

• PCRM (Physician’s Committee for Responsible Medicine)

Things You Will Learn in This Episode:

• How you can help prevent diabetes with a plant-based diet
• Diet-based strategies to deal with both prediabetes, or high risk for diabetes
• Eating plans for managing type 1 and type 2 diabetes
• How to avoid complications of diabetes, such as heart disease
• Plant-based diet tips for managing diabetes
• Role of carbohydrates in plant-based diets and blood glucose

Written Interview with Toby Smithson

Q What was your journey like to becoming an expert in diabetes nutrition?

A My journey started in 8th grade, so that’s a long time ago! In 8th grade, I met a dietetic intern who had type 1 diabetes, and I had been diagnosed with type 1 a couple of years before that. That’s when my life did change around. That’s when I was like, “That’s it, I’m going to become a dietitian.” So, that’s where it started. Then, I started learning more about the dietetics, nutrition, and food science fields. I was so glad that I was on this journey because I had a lot to offer, not only the book science, but also these personal adventures that I was having with managing diabetes. So, I kind of combined the personal experiences and learned knowledge from going to college and getting my undergrad and master’s and becoming a certified diabetes educator. It used to be called certified diabetes educator, now it’s “certified diabetes education and care specialist” is what it is officially called now. I tended to go plant-based, so very early on it was just a personal preference of how you wanted to eat. My sister also did, so at the house that made it easier for getting plant-based options. Then, as I started reading all the research, it was a no-brainer to follow that type of eating plan. Full disclosure: I’m not vegan, I’m a vegetarian and eat plant-based.

Q How has our knowledge evolved on the best way to eat to prevent diabetes? How does plant-based eating fit into that? And what does the research say about plant-based diets for diabetes prevention and treatment?

A As dietitians, the big word that we use is individualization. Everything is individualized. We know that we are all individuals, so our eating plans need to work with what works best for us. So, looking at our conditions, if we have any chronic conditions or there are so many other things involved, just not how you are eating and that everybody should eat the same way. So absolutely, to individualize this. Some of the studies that they’ve done on plant-based, diabetes, and diabetes prevention, they actually looked at the different types of plant-based diets: vegan, lacto-ovo, semi-vegetarian, pescatarian, non-vegetarian. There was a huge study where they looked at the prevention of diabetes. The outcomes were amazing. They followed people for 2 years and saw a huge decrease in risk for those who were non-meat eaters. Just starting to eat more plant-based, there are positive benefits. Just starting with adding more vegetables to your plate or Meatless Monday is good.

Q What are the nutrients and mechanisms of action in plant-based diets that may aid in diabetes prevention?

A When you look at it, a plant-based diet is so much higher in fiber. Which is an area that the numbers are showing that we need a lot of help in, that most people do not get enough fiber. You get twice as much fiber in a plant-based diet than in a traditional American diet. Fiber plays an important role in diabetes management too. So, that’s one of the connections there, and we’re always promoting how fiber slows down the absorption of carbohydrates so then you don’t have as many spikes in blood sugar readings. So, if you’re looking how to get more fiber in the diet; if you look to the sources on how to manage blood sugar, they’re all plant-based. That’s one thing that keeps coming out in the studies. Another thing, people with diabetes are 2-4 times at risk for heart disease. A lot of the studies that I’ve reviewed, some are diabetes-focused, but there’s a lot on heart disease. If it’s heart disease, I’m looking at it because I know that people with diabetes, that’s a red flag for me. Because if we can reduce the risk of heart disease, we need to get on board with that. So, that’s another area to look at. So, what happens is that if following a healthy plant-based diet because we know that we can follow an unhealthy plant-based diet with the chips, candy, and all of that. A healthy plant-based diet is lower in saturated fat which lowers the risk of heart disease, there’s absolutely cause and effect there.

Q What about the management of diabetes—type 1 and 2? How can a plant-based diet help in that area

A The other thing is the increase in phytochemicals and phenols and that are from fruits and vegetables. Your diet is higher in those types of nutrients that you get, so that is positive. What they found is the reduce in intestinal glucose absorption when your diet is higher in phytochemicals and phenols, it protects and enhances the beta-cell function. That’s all dealing with pancreas, and it enhances the peripheral glucose uptake as well. There are also anti-inflammatory effects which goes across so many chronic conditions. Diabetes is also important for anti-inflammation as well.

Q Where can people find resources to eat more plant-based if they have diabetes?

A There’s a group called PRCRM (Physician’s Committee for Responsible Medicine) and they see a lot of people with diabetes. There’s just one clarification that I want to make that they have seen patients with prediabetes, type 1 diabetes and type 2 diabetes, go into remission. Something that I want to clarify, it’s not it’s a cure that you get rid of diabetes, what I say is that once you’ve been diagnosed with prediabetes or diabetes, it’s always in your medical record. So, it’s not that we can just get rid of it, it will always be underlying there, but with their diet plan, which is a whole foods, plant-based, and very low in fat, they are able to see remission for both prediabetes and type 2 diabetes.

Q If you have diabetes and wish to eat a plant-based diet, what should you keep in mind?

A It’s actually very similar in the same way because really when you take a step back and look at people, especially type 1 and prediabetes, in the end, the management is the same. The only one little caveat difference is the type of medication if you are on medication. That’s only the real difference, but people who’ve had type 1, type 2, or prediabetes—it’s the same diet. Generally, it’s the lifestyle habits and management that is the same, so it would be the same benefits of having a higher fiber diet to help manage glucose levels is the bottom line, having more phytochemicals in your eating plan. It all works the same and a lot of people think they’re very different, but in the end, when you take a step back, they are very similar, it’s the medication part.

Q What about carbohydrates? Plant-based foods—even healthy whole ones—can have more carbs, how can you plan for them?

A So people that are taking insulin, whether type 1 or type 2, anybody taking insulin, generally the recommendation is doing the insulin to carb ratio that you have a certain amount of units of insulin that you take per grams of carbohydrate. So, that’s one way of managing it if you’re on insulin. Interestingly, a number of the studies in the PCRM group, and what they say is, don’t limit the number of carbohydrates. They are still finding success because of these side effects. One of my recommendations that I say all the time is if you do have diabetes is to check your blood sugar. That’s where that individualization and personalization comes in. How is your blood sugar reacting to a diet that is higher in carbohydrates? Check before and two hours after eating. The really important thing because when people are asking me those questions about the carbs, let’s find out if you have the opportunity to find out if you have a blood glucose meter or sensor to see how this is working for me. If your blood sugars are on the higher side, and you’re not on insulin, then it may be changing some things when you’re having your carbs or the amount of carbs, or maybe you do need to scale back.

Q Have you worked with somebody who wasn’t as plant-based before and you watched that process with them?

A I have and it worked out really well. It’s interesting. It was an African-American man. Usually, it’s a lot of women asking about plant-based. It was really cool because when holiday time came, all of his family was there and they were like, “What are you eating? Where is all the meat and everything?” He did provide that for everybody else, but it sparked an interest. So, he decided on his own to make the change since he has type 2 diabetes, and he did really well. His blood sugars were very well managed and he checked them. He went in for his A1C checks every 3-4 months, so he was keeping on top of it, as well as his lipids, cholesterol and triglycerides, just to make sure he was on target.

Q What about the impact of fiber? Does it get to the point where carbohydrates don’t matter to the extent we once thought when talking about traditional carbs?

A There’s some great research on beans that I love for people with diabetes, but really it’s for anybody. When we’re talking about people with diabetes, truly it’s for the whole population because it is healthy eating, there’s nothing super special. I know we are more focused on carbohydrates, but it’s good for everybody. Anyways, this bean study, showed that people are able to keep their blood sugar steady up to 4-5 hours after eating the beans. That’s amazing! That’s such good news! Beans are filling and part of the fiber stored too is feeling full. So that’s a huge benefit as well.

Q What about the whole benefit of weight management?

A Increased weight is closely associated with an increased risk of diabetes. So that is all positive, generally at a lower weight, your blood sugars are managed better.

Q What effects might you expect to see if you have diabetes, and switch to a plant-based diet?

A The gut, there is more and more research on that. We’re just starting to look into that and there is a relationship with type 2 diabetes as well. Which this is a whole new area, I didn’t even look at that before and now there’s some research that’s really showing the positive impact on gut health!

Q What are your top tips for those at risk or have diabetes, who want to switch to a plant-based diet in order to better manage their disease and other health factors?

A The first step is adding more vegetables. Starting there. There’s an opportunity for opening a can of vegetables or microwaving frozen vegetables. But taking it a step further and looking for creative recipes. We just went to a friend’s house for dinner and I thought, “Hey, I just saw this recipe and it was so unique.” It had celery, chiles, curry powder, peanut oil, and cashews. Those were the ingredients! This sounds really unique and bringing something interesting, it was a conversation piece as well, bringing it to our friend’s house. I had never made a recipe with cooked celery in this way. I was like a party in your mouth! It was exciting. There are vegetables so that’s a great start, but also investigate some recipes to make them more exciting too.

The next step would be to try to incorporate at least one plant-based meal a week or a day. Whatever you feel comfortable with and that’s slowly moving towards plant-based eating. There is something that I wanted to bring up too. When we talk about protein sources, I have a list of plant-based protein sources, but on my list I highlight the grams of protein, but also the grams of carbs. They all have basically both. But this is an example. There are plant-based milks; more and more are coming out. So, take time to investigate and see what’s the best choice for you. So I always personally always want to get the most for what I’m eating. Since, it’s so high in carbohydrates, the plant-based milks that I look for are those that are lower in carbs. A good source of protein, but lower in carbs. For example, coconut milk there’s a big bandwagon on it, yes it’s low in carbs, but there’s not protein in there. So are you getting the best benefit for it? So, I have found pea protein-based milks. There’s a couple out there that have 8 grams of protein which is equivalent to a glass of dairy milk. That’s equal to an ounce of protein food and less than one gram of carb. There are vegetarian and vegan recipes out there, but not all may not be appropriate for you. So, the number one when I’m looking at recipes, I want to make sure that the nutritional analysis is there and the nutrition facts. So I know what is in that recipe and how to fit it in. It’s all about balancing everything into your eating plan. Not all are for everybody and the recipe that I am sharing with you, the Chocolate Chia Pudding because I am a chocolate fan, that is totally vegan. I developed that recipe on my own because I couldn’t find the right recipe for me as somebody with diabetes. The portion sizes were huge or they were so loaded with carbs. It just didn’t fit with me as well as the chia pudding recipe that I developed. Also, it’s chia pudding so it can be used as a dessert, snack, or even for breakfast. There are times where I’ll eat it for breakfast depending on what my blood sugar level is. So, individualize and customize for what works best for you and balancing it out.

Q What about sweeteners?

A If you want to include a regular sweetener like sugar, honey, or agave, what you need to do is calculate in the carbs that’s coming from it. They will bring along carbohydrates. That’s when low-calorie sweeteners came about is because you were able to eat more for less. It was one of those kinds of exchanges. So, if you want to use a “regular sweetener”, you just have to count for the carbohydrates and do that trial and error with your blood sugars. Check your blood sugar before and after to see how your blood sugars are reacting to it. Is it giving you too much of a spike that stays spiked? Then, that will tell you if it’s working or not working.

Q What about monkfruit or stevia?

A They’re fine. They don’t affect blood sugar readings. They don’t make your blood sugars rise. So they’re absolutely fine.

Q Can you guide us on this healthy vs. unhealthy plant-based diet pattern?

A I made a reference to that earlier that there’s that healthier version vs. the cookies, sodas, candies, and chips. Again, for managing diabetes, its eating a healthy eating plan. It’s the same message as everybody, we wouldn’t give that message about “yeah, eat plant-based and eat chips and candy and soda.” We wouldn’t say that. It’s the same for people with diabetes. For meal planning, I would like to try to include the plate method that we use. There’s a diabetes plate method as well, that half the plate is filled with vegetables, ¼ is your protein source, and the ¼ is the carbohydrates. Keeping that in mind as your framework, we know that the quarter for the protein source will probably be higher in carbohydrates unless you’re doing the semi-vegetarian/ vegetarian diet that you’re including dairy, eggs, or fish, those things are low in carbs. Milk and yogurt aren’t though because they do have carbohydrates, but if you’re including those, then that’s your protein source. Also, nuts and nut butters (although they do have a little bit of carbohydrates), also fall into that protein category. It’s all a balance and I like using that plate as a framework.

Q Do you have any other tips that you recommend for the people that you work with when it comes to getting started in eating a plant-based diet?

A The other thing is the trial and error. If something doesn’t work or you don’t like something, then try something else. That’s one of the huge benefits of living in society that we are now compared to years ago, there’s a lot that’s available. Cooking at home is one of your best opportunities to start investigating. If you’re going out to a friend’s house like we did the other day, make something that you can eat. Not what they’re expecting you’re going to bring. Something that’s appropriate for you to eat, so that you’re assured that you have something good and know what’s in that recipe. The other tip is planning. That’s my number one key for diabetes management. An example for this, if you’re going to somebody’s house, on a trip, or even out for the day, always have something with you so you have something to fall back on. I always carry nuts and seeds with me or some crackers for the carbohydrate portion. I always have snacks with me and that’s all part of diabetes management. Also, on trips, I want to make sure that there are things available for me. I’ll bring oatmeal for every day, they are some things that pack well. I know on a trip, some people may have oatmeal, but they may not. So, I bring my oatmeal and my nuts, so that I know that I’m good. It takes a lot of stress and anxiety out of it, but with healthy eating you need to speak up for yourself and planning, preparing, and adjusting.

Tobi shared one of her favorite plant-based recipes, her Diabetes-Friendly Chocolate Chia Pudding.

Diabetes-Friendly Chocolate Chia Pudding

Ingredients:

• ½ cup plant-based milk (choose one that is 1 gram or less carb and 8-10 grams protein)
• 1 tablespoon cocoa powder
• 2 teaspoon Splenda or any low-calorie sweetener
• 2 tablespoon chia seeds

Instructions:

• Pour the milk into a bowl, add the chia seeds, cocoa powder, low-calorie sweetener and stir.
• Wait about 10 minutes and stir again.
• Then pour into a cup or mason jar and refrigerate overnight.
• The next day, you will see that the chia seeds have gelled the pudding and is ready to eat.

 

About Toby

Toby Smithson, MS, RDN, LD, CDCES, FAND is a certified diabetes care and education specialist (CDCES) and registered dietitian nutritionist (RDN) who has successfully managed her own type 1 diabetes for more than five decades. She has dynamically combined her professional knowledge with her life experiences managing diabetes by producing scores of videos under the banner DiabetesEveryDay, guiding people with diabetes to better understand and practice diabetes self-management at her website DiabetesEveryDay.com, on YouTube at Diabetes EveryDay and on other social media platforms. Toby was recently awarded the 2021 Benedictine University Alumni Achievement Award and the 2020 Diabetes Educator of the Year honor by the Diabetes Dietetic Practice Group of the Academy of Nutrition and Dietetics. She is a former media spokesperson for the Academy of Nutrition and Dietetics, and media spokesperson for the Association of Diabetes Care and Education Specialists. Toby is a frequent resource for nutrition writers and bloggers and writes regularly for U.S. News and type2diabetes.com. She is the principal author of Diabetes Meal Planning and Nutrition for Dummies. She earned her Bachelor of Science in Dietetics, Nutrition and Food Science from Northern Illinois University’s Coordinated Undergraduate Program and her Master of Science in Nutrition and Wellness form Benedictine University. Toby is a Fellow of the Academy of Nutrition and Dietetics (FAND).