Our Community’s Top Picks of Low-Carb Protein Bars

If I was stranded on a deserted island and had to choose 3 foods to get by with, a protein bar would definitely be first on the list. These bars make for an easy-to-grab, healthy and satisfying snack and/or meal replacement and can help keep you on track with your nutritional goals.

There are so many different brands and types to choose from; it can get overwhelming. And I personally like to look for low-carb, high-protein bars that also aren’t too caloric. It is a tall order to fill, so I asked the diabetes online community what their favorites were, and here is what they had to say:

Built Bars

Photo credit: Built Bars

1. Built Bars

Containing between 4-6 grams of carbs in each bar, these tasty treats can easily be used as a meal replacement thanks to their generous amount of protein, ranging between 17-19 grams per bar, which will keep you full for hours. The best part for me is that each bar only contains between 130-140 calories, which is significantly less than a lot of other high-protein bars on the market. There is also a great variety of flavors to chose from, making this a new staple in my pantry.

Muck Pack Keto Bars

Photo credit: Munk Pack

2. Munk Pack Keto Granola Bar and Keto Fruit & Nut Bars

I had never heard of these bars until I reached out to the community for their suggestions. I was pleasantly surprised by the flavor and nutritional information on this product. Munk Pack bars are plant-based and gluten-free and come in a wide variety of flavors. The bars contain natural ingredients such as almonds, flax, plant protein, pumpkin seeds, coconut oil, peanut butter, and allulose, which is a natural sweetener that leaves no aftertaste. Keto Granola Bars and Keto Fruit and Nut Bars all contain a small amount of protein but come in at  2-3 grams net carbs and don’t contain a ton of calories.

Quest and Quest Hero Bars

Photo credit: Quest Nutrition

3. Quest and Quest Hero Bars

This is a great choice that won’t spike your blood sugars, and you can find a flavor for every palate. The consistency is chewy and delicious, and it packs in a ton of protein with bars averaging around 20 grams of protein and 5 grams net carbs or less. Thanks to our community, I also learned about Quest Hero bars, which is a new take on the old favorite, and instead of a chewy bite, it is packed with a tasty crunch. It’s around the same macros as the original, so you can’t go wrong either way.

Ratio Keto Friendly Bars

Photo credit: Ratio Food

4. Ratio Keto-Friendly Snacks

I was excited to learn about this brand as I had never seen it before. Thankfully, I looked and it is offered in a few locations near me. I look forward to trying their protein bars with 12 grams of protein and 2 gram net carbs each! They also offer Greek yogurt in some enticing flavors, and I will definitely be purchasing soon.

Kind Nut Bars

Photo credit: Kind Snacks

5. Kind Bars

In recent years, Kind has really upped their game. Offering many different bars, including thins (which contain a lot fewer calories with a crunchier texture), protein bars, and my favorite- their nut bars, to name a few. The nut bars have 5-6 grams net carbs and 6-7 grams of protein per bar. Also, look out for their latest, Kind Clusters, which is my new favorite bite-sized snack. Mix this with Greek yogurt for a great high-protein snack.

Power Crunch Bars

Photo credit: Power Crunch

6. Power Crunch Bar

This is my favorite protein bar and has been for years. I love the French Vanilla bar with coffee in the morning, and the peanut butter chocolate bar is a perfect sweet treat to end the day. Power Crunch bars average around 14 grams of protein and 5 grams net carbs per bar. The consistency can’t be beaten and is reminiscent of Kit Kat bars with their wafer-like crunch. Look out for some of their newest products, including bars just for kids and their Proto Whey Protein Powder; I am certainly going to give that a try!

Photo credit: Pure Protein

7. Pure Protein

Best known for their protein powder and nutritious shakes, their bars also do not disappoint. With 200 calories or less, this is a delicious treat that contains around 20 grams of protein and 3 grams net carbs or less. Be sure to also check out their newest bars, which stay chilled, and Pure Protein Puffs (a healthy take on cheesedoodles), and Pure Protein Cookie Sandwiches.

NGR Bites

Photo credit: NGR Foods

8. NRG Bites

These protein bites will be sure to keep you satisfied without elevating your blood sugars.  This low-carb, high-protein snack was developed by chef Paul Kahan, who lives with type 1 diabetes himself. I use these bars for a quick breakfast or a snack on the go or before the gym, and I never have to worry about a blood sugar spike.  I was glad to see so many others in our community enjoying them, too, as they were quick to recommend. I recently wrote a review on this company where you can learn more about their offerings.

Nature Valley Protein Bars

Photo credit: Nature Valley

9. Natural Valley Protein Bar

Once again, I am so glad I reached out for the community’s help on this because I had completely forgotten about this bar. I used to enjoy this years ago and will be sure to add them back on my grocery list since they only contain around 7 grams net carbs and 10 grams of protein… and they also happen to be absolutely delicious.

Perfect Bar

Photo credit Perfect Snacks

10. Perfect Bar

I first tried Perfect Bar’s original refrigerated protein bars a few years back and gave it rave reviews. I have watched this company grow so much in the past few years and am happy to see so many new products coming out. If I am watching my carb intake, these are a little high for me, ranging between 19 and 29 grams of carbs, but with some fiber to lower the total net carbs. They have a great flavor and taste like real, rich and creamy peanut butter. They also offer mini-bars, dark chocolate peanut butter cups (my favorite), and kid bars too!

Protein bars are healthy, tasty, and versatile, depending on your nutrition goals. These bars are a great choice for someone looking to get in more protein, less carbs, and enjoy a tasty treat!

Do you take advantage of the benefits of protein bars? Which is your favorite? Share and comment below!

Source: diabetesdaily.com

Debate at the ADA: Should Athletes with Diabetes Go Low-Carb, or High-Carb?

By Maria Muccioli and Ross Wollen

***

Do you need carbohydrates to optimize athletic performance? Or can athletes with diabetes do even better when they fuel their bodies with protein and fat?

By now it’s clear that the low-carb approach to diabetes has largely gained clinical acceptance, for people with both type 2 and type 1 diabetes (T1D). But some questions remain about when carbohydrate restriction is and isn’t appropriate.

One of those big questions: athletics. It’s long been conventional wisdom that athletes – whether elite professionals or weekend warriors – absolutely need carbs to fuel performance. But when you’ve got diabetes, “carb loading” the night before a big race is a tricky proposition.

At this year’s ADA Scientific Sessions, two experts went head-to-head in a debate on “Carbohydrate Intake and Its Impact on Athletics and Health.”

Read on to hear what happened – and who, in our opinion, won the debate.

The Case for a High-Carb Diet

In his presentation titled “High/Normal Carbohydrate Intake Optimizes Performance and Glycemia,” James P. Morton, PhD argued in favor of a normal-to-high carbohydrate approach for athletic performance and blood glucose management. Morton is a professor of exercise metabolism at Liverpool John Moores University.

Morton focused his talk on the importance of fueling high-energy expenditure for elite athletes, such as those on multi-week bicycle races. He presented some data showing that people who consumed a high-carb load were able to exercise for longer periods of time than those who consumed a placebo solution. Morton pointed out that for professionals, even tiny differences can make the difference between victory and defeat.

As an example, Morton presented a case study of Tour de France winner Chris Froome. In 2018, Froome made a very dramatic comeback on the 19th day of a multi-week cycling race. He ate an incredible amount of carbohydrates that day and the day previous, which Morton believes contributed significantly to his victory.

How do carbs fuel performance? The primary explanation centers around the availability of glycogen (branched glucose molecules) in the liver and muscle. The higher the glycogen levels, the more glucose is readily available to power activity.  Morton also presented evidence that those who eat high-carb delay the point at which they begin burning fat for energy, and claimed that delaying this crossover point was important for top performance in endurance athletes.

In addition, Morton cited personal testimonies from some elite endurance athletes, such as audio of interviews from his podcast, claiming that support of high-carb for athletic performance is “unanimous.”

Unfortunately, little of this presentation had much to do with the unique challenges of athletes with diabetes. And for that matter, its focus on truly elite professionals may be of limited relevance to even the most avid part-time athletes. Morton has never worked directly with athletes with type 1 diabetes, but referred to the opinions of his “friend and colleague” Sam Scott, PhD, a researcher at Novo Nordisk. Scott has plenty of firsthand experience with high-performing diabetic athletes: he works with Novo Nordisk’s inspiring all-diabetes pro cycling team.

Morton invited the audience to read Scott’s recent publication concerning type 1 diabetes, carbohydrate intake, and athletic performance. In that paper, Scott concludes that low-carb diets “represent an effective strategy to improve glycaemic control and metabolic health in people with T1D,” but that their effect on athletic performance is basically unknown:

Despite low carbohydrate training being one of the most widely debated topics amongst athletes, coaches and sport scientists, there is very little published research specific to athletes with T1D.

Some evidence suggests that people with type 1 diabetes might especially benefit from “train low” strategies – basically, limiting carbohydrate intake during regular training, and increasing carb consumption for competitions. Beyond that, however, there simply isn’t enough evidence to make concrete claims.

Leaning on his experience with non-diabetic athletes, Morton concluded:

Regardless of whether you have normal glycemic responses or you have type 1 diabetes, the principle of ensuring high carbohydrate availability should always be upheld, because carbohydrate will certainly make you go faster.

The Case for a Low-Carb Diet

In his presentation titled “Low Carbohydrate Intake Optimizes Performance and Glycemia”, Dominic D’Agostino, PhD argued that because low-carbohydrate diets are optimal for blood glucose control, they are therefore also optimal for athletic performance.

D’Agostino, a molecular pharmacologist, is something of a minor rock star in the keto community. He’s a frequent guest on podcasts and Youtube shows, and has a fair personal understanding of keto athletic achievement: he’s an impressive powerlifter to boot.

D’Agostino started by acknowledging that we do not really know the best level of carb intake for athletes. But in his telling, practices even among the elite are far from unanimous, with athletes experimenting with a variety of strategies, ranging broadly from carb restriction to carb loading.

Many athletes choose a low-carb diet because they like the way that it feels – some claim, for example, that keto results in more consistent energy throughout competition, making them much less likely to “bonk” or hit the wall. But for people with diabetes, the primary point in favor of a low-carb diet is the degree to which it optimizes glucose control.

A very low-carb or ketogenic diet doesn’t just steady blood sugar – it also appears to result in some measure of “hypoglycemic resilience”. This isn’t a small matter for diabetic athletes. Hypoglycemia during exercise or competition won’t just ruin athletic performance: it can be very dangerous.

Not only does ketosis protect against hypoglycemia, he explained, but recent research also shows additional benefits of ketosis, such as reduction of oxidative stress. D’Agostino also noted that increased fat utilization can lead to “glycogen sparing”, and that a low-carb diet does not cause glycogen depletion in the muscle. These features may confer additional athletic advantages.

Photo by Adobe Stock

While Morton’s presentation was largely founded on the assumption that athletes with diabetes are fundamentally like athletes without diabetes, D’Agostino emphasized a different principle:

Normal glycemia is optimal for health, performance and recovery.

Of course, normal blood glucose levels are very difficult to achieve for people with type 1 diabetes, especially during exercise. But the low-carb diet has been validated as perhaps the best method of doing so.

D’Agostino explained that his own thoughts on the subject were formed partially by the experience of his former Ph.D. student, Andrew Koutnik, who lives with type 1 diabetes. Initially, D’Agostino believed that type 1 diabetes was “the one condition that I thought you would want to stay away from low-carbohydrate nutrition,” but Koutnik’s success first convinced him otherwise.

I reached out to Koutnik, now a research scientist at Florida Institute for Human and Machine Cognition.

He stressed that most studies comparing high- and low-carb athletic results show mixed or neutral results; when there is a difference, the difference “is often of little meaningful impact to most individuals engaging in physical activity.”

Dr. Koutnik argues that any nutritional program that doesn’t consider glycemic control is missing the most important factor: “Very few will debate that poor health leads to poor performance. Additionally, few will debate that normoglycemia is likely to lead to better performance than hyper- or hypoglycemia.” Therefore, for the T1D athlete, performance is a “consequence” of health.

Who Won the Debate?

Here are our thoughts:

At a diabetes conference, the focus should remain on diabetes. Although Morton presented some evidence to support the performance benefits of high-carbohydrate intake in elite athletes without diabetes, it’s a mistake to assume that the same benefits would occur in athletes with diabetes, or that they wouldn’t be counterbalanced by the known downsides of high-carb consumption. Glycemic management is a huge issue during exercise, and both low and high blood sugars can have dramatic effects on performance.

exercise woman

Photo by Andrew Tanglao (Unsplash)

Most of Morton’s talk also focused on elite endurance athletes. But what we learn from the best athletes on the planet may not be very useful for the rest of us.

In our opinion, D’Agostino showed a better understanding of the balancing act that athletes with diabetes (especially type 1 diabetes) need to perform.

Even if we accept that carb loading can provide a perceptible boost to serious athletes, we have to acknowledge that those carbs (and any accompanying insulin) also make it more likely for the athlete to experience hypo- or hyperglycemia, which can instantly ruin any sports outing. And the more predictable and stable your blood sugar, the more confident you can be, and the less mental space you’ll have to waste on monitoring and micromanaging glycemic changes. And if a ketogenic diet really does provide some protection against hypoglycemia, that’s just even more reason to choose a very low carb diet.

If you’re actually an elite athlete, maybe carbohydrates can help push you to the peak of performance. But maybe not – the scientific evidence is not overwhelming. For the rest of us, blood sugar control remains of paramount importance. It seems to me that a low-carbohydrate diet is more likely to deliver confident performances and strong athletic results.

What are your thoughts on this debate?

Source: diabetesdaily.com

This Is Your Brain on Diabetes (ADA 2021)

The brain affects diabetes, and diabetes affects the brain, a complex relationship that goes in both directions.

For many patients, the brain-metabolism connection means challenges and health declines. Most people that have experienced hypo- and hyperglycemia are well aware of the way that blood sugar troubles can inflict brain fog and other minor short-term malfunctions. Unfortunately, that’s just the start of it. The cognitive dysfunctions associated with diabetes can become permanent.

The first days of the recent American Diabetes Association Scientific Sessions featured several sessions on the intersections between brain health and diabetes. Some presenters sketched out the scope of the problem; others suggested potential solutions. Patients with both type 1 and type 2 have a lot to think about.

The Vicious Cycle

At the heart of the brain-diabetes relationship is a negative feedback loop that pushes people towards bad decision-making and bad health outcomes. Hyperglycemia leads to both short- and long-term cognitive impairment, which leads to increasingly poor glucose management decisions, which leads to more cognitive impairment, a vicious cycle if there ever was one.

Australia’s Dr. Fergus Cameron sketched out this dynamic:

Source: ADA 2021 Presentation

This feedback loop helps define how and why brain issues tend to snowball as the years go by.

The Developing Brain

Diabetes can impact brain function at every age, but perhaps most important is its immense effect on the developing brain. Acute and chronic hyperglycemia during those early, critical years of development can easily cause lasting damage.

Many of the most important negative cognitive effects of type 1 diabetes seem to occur in the first days and weeks leading up to diagnosis. Just days after diagnosis, children already perform more poorly than expected on intelligence tests. “We’re seeing impacts right from the get-go,” said Dr. Ferguson.

The severity of hyperglycemia at diagnosis is also significant: children that are diagnosed during diabetic ketoacidosis (DKA) see much more cognitive impairment than children that never experience that critical state. That difference alone might mean as much as 6 points of IQ, on average.

We don’t like to dwell on immutable factors—today, you cannot change the circumstances around your diagnosis or that of a loved one. It is more important to people with diabetes to learn what they can do now to help improve their health and quality of life. The answer to that is clear: avoid chronic hyperglycemia.

Mental Issues Accumulate

The effect of chronic hyperglycemia is cumulative and comprehensive. As people with type 1 diabetes age, they perform worse on tests of executive functioning, IQ, information processing speed, and memory. The differences are bigger in high school than in elementary school, and the gap just continues to widen throughout adulthood. A 2019 study found that an incredible (and terrifying) 48% of older adults with longstanding diabetes displayed “clinically significant cognitive impairment.”

Dementia and Diabetes

Dr. Anna Marseglia, a neuropsychologist with Sweden’s Karolinska Institutet, took the baton to discuss cognitive impairment and dementia in old age. Most of her talk referred to patients with type 2 diabetes, although it’s possible that patients with other forms of diabetes could still benefit from her conclusions.

Diabetes is a major risk factor for dementia—in fact, the link between metabolic dysfunction and late age mental decline is so clear that Alzheimer’s disease has sometimes been called type 3 diabetes.

But diabetes is not destiny—the risk of dementia is significantly amplified by lifestyle.

The Power of Activity

Dr. Marseglia presented the results from her own study, a look at thousands of older Swedish adults with diabetes, to see if an active lifestyle might prevent progression to dementia. Researchers tried to track both the number of leisure activities that participants enjoyed and the strength and extent of their social connections. Would an active social life reduce the risk of dementia?

The answer was yes, and the correlation was enormous, as you can see in the graph below. “Inactive” adults with diabetes were vastly more likely to develop dementia than “active” adults, whose risk was barely higher than that of people without diabetes. Dr. Marseglia suggested that if all of the adults in the study had led “active” lives, as many as 48% of dementia cases could have been avoided.

Source: ADA 2021 Presentation

The study suggests that while both diabetes and social inactivity are hazards in and of themselves, the real danger is when those two conditions coexist.

Accordingly, Dr. Marseglia highlighted two broad strategies to improve one’s risk of late age cognitive decline. The first is to employ strategies that reduce physical cardio-metabolic burden: improved glucose control, healthier diet, exercise, weight loss, quitting smoking, and so on. The second is to create a kind of resilience within the brain through education, challenging work, and vibrant social activities.

The protective effect of an active life is physically verifiable. Adults labeled “inactive” actually have significantly smaller brains than active adults. Activity, by preserving brain volume, somehow overrides the vascular damage associated with diabetes.

An active life to fight dementia doesn’t just start in old age—good health, mental stimulation, and social activity early in life will also protect the brain from decline decades later.

Executive Functioning in Teens

Teens have a particularly tough go of it; typically, they are the age bracket with the highest A1c.

Anxiety, depression, and diabetes burnout are distressingly common in the teenage years. Such mental health issues can easily throw diabetes decision-making out of whack. As Oregon’s Dr. Danny Duke stated, “When we’re emotionally dysregulated, it affects all of our other executive functions.”

Executive functioning, explained Oregon’s Dr. Danny Duke, is the part of the brain that’s “in charge of making sure things happen when and how they’re supposed to happen.” It’s like “the conductor of the orchestra of our thinking.”

Good executive functioning is of paramount importance to all humans, but especially to those with diabetes, who must almost continually balance short- and long-term costs and benefits. And because executive functioning usually does not fully mature until age 25, it’s no surprise that teens can have so much difficulty managing their conditions.

Some teens have better executive functioning than others, and those that struggle to make good diabetes management decisions need as much help as they can get. Otherwise, the vicious cycle will rear its ugly head once again: poor executive functioning leads to reduced glycemic control, and reduced glycemic control leads to poor executive functioning.

While Dr. Duke focused mostly on the ways that executive functioning failures could lead to dangerous blood sugar swings, he had little doubt that the converse was equally true:

I’ve worked with a lot of these kids that are hanging up there in the mid-300s [mg/dL], doing the bare minimum necessary to stay out of DKA. When we get them back down into range, they’ll often say ‘Wow, I had no idea how bad I felt and how foggy I was thinking.’

A Family Affair

For kids and teens, good diabetes decision-making is a family affair. Dr. Maartje de Wit, of Amsterdam University Medical Center, pointed to several studies assessing the role that parental executive functioning plays in diabetes management success.

Naturally, in younger children, parents will make all significant treatment decisions, but even as children age, parents continue to play a surprisingly big role in treatment success (or lack thereof). Studies show that, for example, maternal executive functioning skills have a significant influence on a child’s A1c levels, and that both the father’s and mother’s involvement played a big role in delivering better glucose control, especially when the children had executive functioning issues themselves. This did not change as children aged, even as they presumably took on more of their own management decisions.

This sounds obvious—less disciplined kids need more help—but it’s not necessarily so easy to determine who needs help, and how to help them.

Identifying and Improving Executive Function Issues

Children and teens with subpar executive function, when asked why they can’t adhere to their diabetes treatment regimen, may say things like “I forget” or “I’m lazy,” or “I don’t know why.”

Whether by nature or nurture, executive function problems are often shared between parents and children. In a presentation aimed at medical professionals, Dr. Rachel Wasserman encouraged practitioners to consider disorganized or scatterbrained parents a real warning sign of potential executive function issues in children.

If you recognize these sorts of behaviors in your child (or in yourself!), it might be worth trying to work with your child to improve his or her executive functioning skills.

Dr. Wasserman recommended activities that require repeated practice and offer progressive challenges. That could describe schoolwork and related academic pursuits; it could also describe athletics like martial arts and yoga.

Today there are also a dizzying number of scheduling apps that people with diabetes can use to help enforce good habits. More old-fashioned techniques, like alarm clocks and post-it notes, can be equally effective. Dr. Wasserman cautioned that advanced diabetes technology, such as insulin pumps and continuous glucose monitors, as helpful as they can otherwise be, do not necessarily lessen the cognitive load on the executive functioning system.

Takeaways

Diabetes has a significant negative effect on cognitive abilities. In type 1 diabetes, this effect can begin very early in life, with the first bouts of acute hyperglycemia leading up to diagnosis. In both type 1 and type 2 diabetes, the damage wrought by high blood sugars is cumulative, and symptoms are likely to get worse over the years.

Hyperglycemia can also set a vicious cycle in motion, whereby high blood sugars cause bad decisions, which just cause more high blood sugars.

The best way for a person with diabetes to avoid cognitive decline, probably, is to avoid chronic and acute hyperglycemia—the more time you spend with your blood sugar in a healthy range, the more likely that you will avoid accumulated damage to your brain.

It also may be possible to strengthen executive functioning skills and make the brain more resilient to age-related decline by enjoying a robust social and intellectual life. Hobbies, education, challenging work, and community involvement—in short, an active and stimulating mental life, at every age—may protect against eventual decline.

Source: diabetesdaily.com

Latest Data Shows that Most People With Diabetes Don’t Meet Glucose Targets. What Can Be Done? (ADA 2021)

The continuous glucose monitor is an extraordinary tool.

Studies have shown that continuous glucose monitoring (CGM) use by people with diabetes can have a multitude of health benefits. Patients on CGM technology often have lower A1c levels, fewer highs and lows, and spend more time in their target blood glucose range. Also, CGM use has been associated with a higher quality of life; users often report a diminished fear of low blood sugar levels, increased self-confidence in making diabetes treatment decisions, and feeling more independent. CGM users are also less likely to experience diabetes distress.

The CGM also gives doctors and researchers an unprecedented wealth of glucose data. It has also given rise to a new statistic, time in range, which assesses how often blood glucose is within a safe range. Looking at comprehensive and real-world data trends in different patient populations can help us understand what is working and what’s not, and over time, adjust recommendations accordingly, and perhaps with a more personalized approach.

Unfortunately, the latest data shows that most people with diabetes fail to reach recommended glucose targets.

The Latest Time in Range Data

A recent study led by expert Richard M. Bergenstal, MD aimed to evaluate just how many people with diabetes in the US are achieving the recommended time in range (TIR), by looking at CGM data from almost 500 people with type 1 and type 2 diabetes over four years (2016-2020). This was an observational study – researchers did not interfere with participants in any way, and simply collected the real-life data. They ended up with close to 5,000 ambulatory glucose profiles (AGPs), and assessed TIR and hypoglycemia trends.

The results, which were just presented at the American Diabetes Association (ADA) 81st virtual Scientific Sessions, offer a unique glimpse into common glucose trends.

Dr. Bergenstal’s team looked at how frequently people with CGMs were able to achieve the most widely accepted TIR targets.

The International Consensus in Time in Range (TIR) … defined the concept of the time spent in the target range between 70 and 180 mg/dL while reducing time in hypoglycemia, for patients using Continuous Glucose Monitoring (CGM).

The team also evaluated how many participants spent less than 1% of the time with severe hypoglycemia (under 55 mg/dL).

Vast Majority Are Not Meeting TIR Goals

On average, only 39% achieved the recommended TIR goal. Only about 32% were able to meet both the TIR goal and meet the goal for minimal time in severe hypoglycemia (less than 1% of glucose readings <55 mg/dL). Of note, there was no appreciable difference between the first AGP evaluated and the average over the four years, suggesting that these trends didn’t change much over time.

The differences between those with type 1 diabetes and type 2 diabetes, however, were staggering.

Only 35% of type 1s achieved the recommended TIR, with fewer than 30% also being able to avoid significant hypoglycemia. In contrast, 53% of type 2s were able to meet the TIR target, with exactly half achieving this without experiencing severe low blood sugar levels frequently.

It may not come as a surprise that the targets were achieved more frequently by those with type 2 diabetes. People with type 1 diabetes, who have little or no insulin production, tend to experience more significant blood sugar swings than those with type 2. Hitting management targets is often more complex in this population, especially given the fear of hypoglycemia, which for so many goes hand in hand with insulin use.

The authors conclude,

Less than half of the population achieved ≥70% TIR, ~30% with ≥70% TIR and <1% time in clinically-relevant hypoglycemia. This indicates an opportunity to improve attainment of TIR goals, and an ongoing need to support the use of CGM data to help optimize care.

What Can Be Done to Improve Outcomes?

This investigation provides a sobering glimpse into the reality of life with diabetes, even as technology becomes more widely used. How exactly do we use this information to begin to help people with diabetes reach their treatment goals and improve their health outcomes?

The answer to this question is complicated. We know that achieving better health outcomes, in the short and the long term, largely rests on optimizing blood glucose levels in people with diabetes. It is well-established that blood sugar levels are directly responsible for the mountain of diabetes-associated complications that patients are repeatedly warned about. It follows, that if it was easy, everyone would be getting an A1c of <7%, and possibly opting for even tighter goals.

Where are we failing in helping people achieve their diabetes management goals?

This is the ultimate question, and one that likely has many components, and varies for different individuals. Leading health organizations should be taking deep dives to figure out these answers so that we can actually begin to develop more effective solutions. Here are just some of my thoughts on the matter:

Some people posit that outdated dietary recommendations are largely to blame. They may have a point. Despite the existence of a slew of literature showing the benefits of lowering carbohydrate intake, there is still a lack of widespread understanding and patient counseling on this approach, especially in the clinic. The quantity and quality of carbohydrate intake is absolutely at the heart of diabetes management, and has a huge role to play in dictating success vs. disappointment.

Carb restriction is not necessarily the only eating pattern that confers glucose benefits, it’s just a prominent example. At the very least, all patients should be educated on a variety of dietary approaches in detail, and understand the pros and cons of their options, so that they can make the best choices for their overall health.

Moreover, there likely needs to be more comprehensive guidance on self-adjusting medications around lifestyle variables. Diabetes is not static. Blood sugar levels are dictated by a complex and extensive array of factors. From our current weight to our exercise patterns, to stress and travel, among many others variables, patients need to feel confident and empowered to self-adjust their management dynamically. Too many people with diabetes rely entirely on a diabetes specialist to change their treatment plan on a quarterly basis, at best. We need to empower people with diabetes to become their own “diabetes specialists”.

Armed with knowledge, the tools they need, along with the support of a well-informed provider, I hope we can begin to see a change in these trends.

Source: diabetesdaily.com

Technology is Great, but Most Kids with Diabetes Still Need More Help (ADA 2021)

Recent decades have brought incredible advances in diabetes technology, but children and teens are still struggling to meet recommended glycemic targets.

There are almost a quarter-million young people in the US with diabetes (more than 75% with type 1 diabetes), according to the American Diabetes Association. For youth especially, early detection and optimal management are of utmost importance; with many decades of life ahead, keeping blood glucose levels in check today can help reduce unpleasant (and deadly) diabetic complications decades down the road. Prudent diabetes management also has immediate benefits and can have a huge impact on quality of life.

What’s the scope of the problem, and what can be done about it? Scientists at the American Diabetes Association (ADA) 81st virtual Scientific Sessions relayed the striking results of several studies on the state of things today for kids and teens with diabetes. Here are some of the most notable findings.

Youth A1c’s Are Not Improving

It has long been the case, unfortunately, that the majority of pediatric diabetes patients routinely do not meet their treatment goals, most often assessed via quarterly A1c testing. A team of researchers across the US reported on recent trends in recently diagnosed youth, as part of the SEARCH for Diabetes in Youth initiative. The major conclusion?

HbA1c levels remained stable but higher than recommended across discrete cohorts of SEARCH youth with type 1 diabetes duration ≤ 30 months, particularly among non-white youth.

In fact, the average A1c levels among young people with diabetes remain quite high; despite rapid advancement in technology use and newer insulin formulations, the report shows no significant change between average A1c levels between 2002 and 2016. The average A1c held steady at about 7.9%.

How Much is Technology Helping?

Now, for some better news. It appears that early use of continuous glucose monitoring (CGM) technology is associated with lower A1c levels. As reported by Dr. Priya Prahalad of Stanford Children’s Health, newly-diagnosed youth (2018-2020) who were offered CGM initiation early on had markedly lower A1c levels than those from a previous cohort that did not initiate CGM therapy.

Unfortunately, while the A1c differences between the two groups were significantly different at 6, 9, and 12 months after diagnosis, the average A1c level was still at or above 7%, for a considerable proportion of study participants. These results underscore the value of CGM use in improving diabetes management in young people, but also demonstrate the need for more effective management strategies in this group.

Trouble at School

A report from Dr. Christine March and her team at the University of Pittsburgh illustrated the unique challenges that children face on school days vs. weekends. In this study, CGM data from hundreds of children with diabetes were analyzed to assess trends in blood glucose levels (specifically, the time-in-range, TIR metric) across hours of the day and night, as well as on weekdays vs. weekends. The main result?

For weekday school hours, median TIR (70-180 mg/dL) was 52.4%; only 34 (15%) of youth met a TIR goal of >70%… Weekday and weekend CGM metrics were clinically similar, though TIR was statistically higher and time high/very high (>180 mg/dL) lower on weekends… Notably, TIR early in the school day was nearly half of TIR during similar weekend hours, perhaps relating to sleep/meal schedules.

Moreover, the team looked at various attributes, like insulin pump use, duration since diabetes diagnosis, and A1c level to see if there was a connection with the time-in-range metric. They report that younger age, shorter diabetes duration, and lower A1c levels were associated with more TIR during school hours. Interestingly, insulin pump use appeared to have no effect in this study.

Technology and Diabetes Distress

Several researchers posited that youths with diabetes and their caregivers have very different perceptions regarding the emotional impact of advanced diabetes technology.

Can Tech Reduce Family Conflict?

One study presented this week sought to determine whether the use of diabetes technology devices improved “family conflict” in teens with type 1 diabetes. In this evaluation of 60 participants, researchers found lower A1c levels in those using closed-loop technology. The technology also led to a significant increase in caregivers reporting lower levels of family conflict surrounding diabetes management. Perhaps surprisingly, the teenagers themselves did not seem to think that family conflict had been reduced by the closed-loop pumps.

Does Tech Alleviate Diabetes Worries, or Exacerbate Them?

A second study suggested that advanced technology use may actually provoke anxiety in children.

Dr. Fatemah Abdulhussein and colleagues from UCSF evaluated whether the use of advanced insulin delivery systems alleviated worry and fear of low blood glucose levels among patients and caregivers. The major findings?

Longer duration of diabetes, duration of pump use, and duration of CGM use were all associated with higher mean worry scores [among children, but not their caregivers].

That’s the cruel paradox of childhood diabetes in a nutshell: the longer a child has had diabetes, the more stress it causes. And superior management tools may only add to the emotional burden, rather than alleviate it.

Management Success Still Leads to Peace of Mind

The UCSF researchers also looked at diabetes treatment satisfaction scores and found that the only variable in the study that was associated with a lower treatment satisfaction score was higher GMI (glucose management indicator). They conclude,

These data suggest that despite recent advancements in diabetes technology, FOH [fear of hypoglycemia] and diabetes treatment satisfaction still remain significant concerns and need to be addressed in clinical contexts.

smartphone to detect depression and loneliness

Photo credit: Adobe Stock

Parents Experience Diabetes Distress, Too.

A lot of burden falls on the diabetes caregiver, too, and understandably so.

A team of researchers based in Washington, DC and Nashville, TN looked at “parental reports of diabetes distress [DD], diabetes-related family conflict, quality of life” along with patient A1c levels. A key finding that that higher A1c levels in young people were associated with a higher incidence of parental diabetes distress, related family conflict, and quality of life. Notably, female caregivers were more likely to experience distress than male caregivers. Researchers summarize,

Importantly, parental DD is related to children’s glycemic control, suggesting that increased psychological support for parents with teens with DD is warranted.

The Takeaways

A1c levels remain steady at about 7.9% for young people with diabetes in the US, still considerably higher than what is recommended by major health organizations. Some research shows that CGM utilization and the use of closed-loop insulin pumps can help improve diabetes management. Of course, cost and access also remain barriers for many when it comes to technology access.

Sadly, even with the use of advanced technology, it appears that patients and caregivers alike experience a considerable amount of distress in dealing with the demanding nature of diabetes management. Perhaps patients and families would benefit from increased emotional support as much as improved access to diabetes technology.

Importantly, A1c levels stood out in several studies as important determinants in patient and caregiver treatment satisfaction, as well as distress levels. Glycemic control should remain a paramount goal, not just for short- and long-term health, but also for emotional wellbeing. Helping youth with diabetes achieve or exceed recommended targets is likely to help lessen the mental burden of diabetes management and improve quality of life and family dynamics in the long term.

Source: diabetesdaily.com

Do Low-Carbohydrate, High-Protein Diets Offer an Advantage? (ADA 2021)

We already know that low-carb diets can be great for glucose control and diabetes management. The evidence is clear: patients with both type 2 diabetes and type 1 diabetes can benefit from the low-carbohydrate approach.

But as the diet has gained acceptance, some specialists have begun to look more carefully at the details and other consequences of the low-carb approach. Does the amount of protein matter? Can carbohydrate restriction have negative effects on lipid profiles, cognition, or mental health parameters?

Here we describe three new study reports just released at the American Diabetes Association (ADA) 81st virtual Scientific Sessions that address some of these topics.

Higher-Protein Diet, Inflammation and Type 2 Diabetes Remission

Many studies have shown that weight loss and improved blood glucose levels can be achieved with a variety of dietary approaches, but does increasing the protein and lowering carbs offer even more advantages for those with diabetes?

Frankie Stenz, MS, PhD, and Associate Professor of Medicine Endocrinology, and her team at the University of Tennessee evaluated the effects of a high-carb (55% CHO and 15% protein) vs. a high-protein (30% protein and 40% CHO) diet in adults with type 2 diabetes for 6 months. They report that the higher-protein approach significantly reduced inflammatory markers (several important cytokines measured in the blood), as compared to the higher-carb group. Inflammation markers are important parameters, especially for those with diabetes, as inflammation is closely linked to insulin resistance. Also, while weight loss was similar between the two groups, those adhering to the higher-protein diet had a significant increase in lean body mass as well as a decrease in fat mass as compared to the higher-carb group.

Moreover, while improved glucose tolerance and and insulin sensitivity occurred in both groups to some degree, diabetes remission occurred in only 16% in the high-carb group, as compared to a striking 100% in the higher-protein group. Remission was defined by the study authors as a lowering of A1c to <6.5%, along with fasting glucose levels of <126 mg/dL and not exceeding 140 mg/dL at two hours post-meal. The researchers conclude,

The HP [High Protein] diet demonstrated improvement in glucose tolerance and insulin sensitivity with 100% remission… and a significant decrease in inflammatory cytokines.

Photo credit: iStock

Lower-Carb, Higher-Protein Diets and Lipid Levels

Effects on blood lipid levels when eating lower-carb (and by extension higher protein and fat) are often a point of controversy, especially when it comes to people with diabetes, who are already at higher risk for heart disease. Heart disease is complex and multifactorial; however, many researchers agree that both blood glucose parameters and lipid profiles can play a significant role. Previous research has produced some mixed results regarding how different diets can affect lipid profiles, with many studies showing improvements in lipid parameters when eating lower-carb.

Most recently, an international team of experts from Denmark and Texas released the results of a new study that evaluated how lower-carb, higher-protein diets affect weight loss and blood lipid profiles in adults with type 2 diabetes. Over a period of six weeks, 72 patients were assigned to a lower-carb, higher-protein diet (30% CHO and 30% protein) vs. a “conventional” eating approach (50% CHO and 17% protein). When weight loss and blood lipid profiles were examined between the groups, the findings demonstrated that while both groups achieved similar levels of weight loss, those in the lower-carb, higher-protein group achieved more of a decrease in their triglyceride and LDL-cholesterol levels, along with a greater increase in HDL-cholesterol levels. Also, they determined that the triglyceride levels in the liver were significantly reduced in this group, as compared to those eating higher-carb. The team concluded that,

Carbohydrate restriction adds to the positive effect of weight loss in T2D patients by inducing greater improvements in atherogenic lipid profile, maybe facilitated by a reduction in intrahepatic fat.

Carbohydrate Restriction, Quality of Life and Cognitive Performance

Do low-carbohydrate eating patterns have effects on cognitive function and mental health?

Nicole J. Jensen and a team from Copenhagen University in Denmark just announced the results of a randomized trial that examined quality of life parameters and cognitive function among “72 adults with type 2 diabetes and overweight and obesity” as a function of diet. One group was assigned to a lower-carb, higher-protein diet (30% CHO and 30% protein) and another to a higher-carb diet (50% CHO and 17% protein) for six weeks. Next, the team looked at weight loss along with mental health parameters and cognitive performance scores between the two groups. While both groups achieved similar weight loss, the study authors reported additional mental health and cognitive benefits in the lower-carb, higher-protein group. They conclude,

Weight loss improves physical health independently of diet composition, and carbohydrate restriction may further benefit mental health, without adversely affecting overall cognition.

Summary

Altogether, these new studies highlight that while weight loss and improvement of blood glucose levels is achievable using various dietary approaches, lower-carb and higher-protein diets appear to confer additional benefits. Namely, lowering carbs and increasing protein consumption can lower inflammation, improve lipid parameters, increase lean muscle mass and fat loss, and further improve glucose levels in adults with type 2 diabetes, as opposed to a more conventional dietary approach. Moreover, a lower-carb, higher protein diet may confer additional mental health benefits and does not negatively affect cognitive performance.

Source: diabetesdaily.com

Bethany’s Story: My Eye Started Bleeding the Day My First Child Was Born

This content originally appeared on Beyond Type 1. Republished with permission.

By Ginger Vieira

“My first bleed was almost 12 years ago — the day my first baby was born,” explains Bethany, who’s lived with type 1 diabetes for nearly 40 years, since she was 3 years old.

Despite receiving preventative laser treatments to the concerning blood vessels in this area of her eye prior to and throughout her pregnancy, the stress of pregnancy and pre-eclampsia (high blood pressure during pregnancy) were enough to cause them to bleed.

“There was a bunch of trauma around that, because the bleed was the catalyst for me to have an emergency c-section. That was the biggest bleed I’ve had and it took a long time to clear up.”

Since then, Bethany has experienced minor bleeds off and on, but has also gone long stretches of time without any new bleeds.

Ginger Vieira

Image Source: Beyond Type 1

“Last October I had another bad one,” says Bethany. “It was so discouraging, because I haven’t had any new abnormal vessel growth, I’m not pregnant, I don’t have blood pressure issues, and my A1C is stellar. It just happened.”

“It’s cleared up since then without traditional treatments like a vitrectomy or steroid shots, but it took quite a while because it leaked more blood and fluid for a few weeks after the initial burst,” she adds. “At this point, I’d say I’m back to where I was pre-October in terms of vision, but maybe it’s a bit messier.”

My Experience With Laser Treatments for Retinopathy

“I’ve only had laser treatments,” says Bethany, who’s been able to manage her retinopathy without more invasive treatments.

“I’m not sure the experience qualifies as ‘pain’ so much as ‘misery’. It’s horribly uncomfortable, and it does begin to be painful as the treatment goes on, but it’s not what I’d describe as particularly painful.”

Eventually, Bethany says she used a low dose of a mild sedative to help take the anxiety out of receiving laser treatments. While it can’t change how it feels physically, it can help make the overall experience a bit less stressful.

“It’s hard to catch your breath, and it feels like being tortured, and my eyes pour with tears, but it’s all more of a dull feeling other than a bit of a sensation that a rubber band is being snapped behind your eye.”

Parenting a Newborn With Low Vision

“Nursing a baby and not being able to see her face clearly when she’s on your left side was heartbreaking,” recalls Bethany.

“Struggling to read a book to a child, wondering if you’ll have another bad bleed when you’re at the store with your child, not being able to lift an older child because it might exacerbate the bleed—it all sucked.”

Fortunately, by the time her second pregnancy began, Bethany’s eyes were ready.

“It was so much easier,” she says. “No pre-eclampsia, no eye issues. It was such a relief after being so terrified to try it all a second time.”

Today, she says she’s careful how much to share with her children about her eye complications.

“After my recent bad bleed, it was my oldest daughter (the one who was born the day of my first bleed) who held me while I sobbed, because she was ready to support me,” recalls Bethany. “That was so bittersweet and beyond meaningful.”

What My Vision Is Like Today

“I wouldn’t say I live with ‘low vision’ today but there is a blobby mess in one eye,” explains Bethany. “My brain has learned to adapt, and I can see around it. I don’t read super fine print very well, but I’m not sure I would even without retinopathy since I’m getting old!”

However, Bethany would say she did have low vision for a period of time — and it wasn’t easy.

“After those two bad bleeds, I did have trouble with the vision in one eye for a while, until the blood cleared. That was hard, but I’m grateful it wasn’t long-term.”

However she says that it’s also affected her life in other ways when there are bleeds.

“My eyes feel strained, I have headaches, and I definitely don’t feel comfortable driving until the bleeding has cleared up.”

The worry and anticipation of a potential new bleed feels like a ticking time bomb.

“I try not to think about what my vision could be like later in life, but I do wonder if I’ll be able to see my grandkids clearly, and if I should retire early so I can make the most of my later years while I still have vision. In day-to-day life it’s pretty minimal, but in terms of mental/emotional load it’s huge and it’s always there.”

How My Diabetes Management Has Changed

“I smartened up with my diabetes management big time since the first time the doc saw something in my eye,” explains Bethany. “Since that day I’ve been highly motivated to do this well.”

Having lived with type 1 diabetes since age 3 in the 1980s with early glucose meter technology and insulin options were severely limited, Bethany feels quite sure the first 25 years of her life with diabetes led to the complications in her eyes.

“My A1c was usually in the low double digits when I was a child, because avoiding low blood sugars was considered the safest way to manage diabetes in a young child back then,” says Bethany.

By the time she was in her 20s, technology and advancements in insulin helped her manage an A1c in the 7s and 8s. Once she started using an insulin pump, she was able to maintain an A1c below 7.0 during both pregnancies.

“I’ve always, always, tried really hard with my diabetes,” adds Bethany, “but it was like I spent 25 years trying to solve a puzzle that finally started to come together in the last 15 with a pump, a continuous glucose monitor (CGM), and eating low-carb.”

While Bethany used an insulin pump for 5 years, she’s managed her diabetes with MDI (multiple daily injections) for the last 8 years, and maintained an A1c below 7 percent, and around 5.8 percent for the last year.

“Using a pump, two pregnancies, and eating mostly low-carb definitely taught me so much more than I knew before I used an insulin pump,” explains Bethany. “But I was having a lot of issues with scar tissue which made infusion sites for pumping complicated. And I hated being tethered to my pump.”

The mental game of diabetes, she adds, is a huge part of it.

“There’s always a fear lurking that it could happen again at any time. More so since this last one,” says Bethany. “You never really escape it because you never know that you’re safe. You can do everything right from a certain point on, but the damage is already done.”

Source: diabetesdaily.com

5 Simple and Healthy Summer Swaps

The warm weather is finally here, and the pandemic is subsiding. For me that means a lot of barbeques and entertaining in my backyard. It is very easy to be a people pleaser and get what you think everyone else wants, but that could leave you dealing with a roller coaster of blood sugars. When you are hosting, it can be hard enough to find time to actually enjoy yourself and the last thing you need is to be worrying about your numbers. So, make sure to get plan on some recipes that are blood sugar friendly so that you can be present and enjoy the day.

The warm weather makes me crave light and refreshing foods. Thankfully, these foods are typically lower in carbs than their hearty winter counterparts. It is also so easy to find lower carb options at the grocery stores nowadays, making swaps super simple! Here are five alternatives to some of everyone’s favorite go-to hearty foods:

1. Zucchini Linguini

Put down the pasta! There are so many healthy alternatives available to us that you really don’t have to take a gamble with your weight or your blood sugar! Zucchini linguini is a great go-to that can also be turned into a cold pasta salad which is perfect for summer barbeques (pro tip: edamame pasta is my personal favorite, check it out here).

healthy summer swaps

Photo credit: Adobe Stock

2. Cauliflower

People love comfort foods and meatloaf and mashed potatoes is a fan favorite. However, being hot and humid doesn’t really make me in the mood for such a rich and filling meal. You can lighten it up by replacing the mashed potatoes with mashed cauliflower. You can also create a cold potato salad, hashbrowns and so much more! Add your seasoning of choice to spice it up!

mashed cauliflower

Photo credit: Adobe Stock

3. Meat and Cheese Roll-Ups

I definitely have a weak spot for mozzarella sticks. Anytime my kids order them at a restaurant, I take an extra unit or so of insulin in the hopes there will be one for me. I decided to make a healthier version at home and it turns out to be something my son loves. I bake clumps of shredded cheese on parchment paper in a 400-degree oven until it looks melted and then throw a pepperoni in the center of each one and wait until the cheese is bubbling which means it’s ready to come out. You can broil it for another minute if you like it extra crisp. And if you need a quick lunch or high protein snack, opt for meat and cheese roll-ups. There are so many variations, you are sure to like one!

Photo credit: Adobe Stock

4. Guacamole

I love cheese and dips but many of them are very fattening and loaded with calories. Avocado, on the other hand, is a fruit full of healthy fats and vitamins. It contains 9 carbs each but 7 of those carbs are fiber leaving it with a total of 2 net carbs. You can prepare guacamole however you like it and I recommend using endive as the “scooper”.

guacamole dip with fresh vegetables

Photo credit: Adobe Stock

5. Make Your Own Low-Carb Pizzas

Pizza is quick and affordable which makes it an easy go-to when you are running around. The only problem is pizza is loaded with carbs and fat making this a food notorious for being hard to bolus for. Why not turn pizza into a fun family activity and make your own using almond flour, egg and mozzarella as the crust? Then everyone can personalize as they see fit. Store them in the freezer and make them on those hectic nights instead of having to make another trip before you head home!

Photo credit: Adobe Stock

It is much easier than you would think to find low-carb alternatives for some of our favorite foods. You just need to take the time and plan ahead. Both your blood sugars and waistline will be glad you did!

Have you found some healthy summer swaps for your heartier winter favorites? Comment and share below!

Source: diabetesdaily.com

Review: Real Good Foods Does Low-Carb Right

Low-carb frozen and quick meal options that use quality ingredients that don’t cost an arm and a leg can be hard to come by!

Real Good Foods is one company that has recently launched a variety of new products ranging from microwavable lunches and breakfast sandwiches to even ice cream. They sent me some products to try out at no cost so that I could relay my perspectives on the taste, convenience, and from a diabetes management perspective. I did not receive additional compensation for this review and all opinions are my own.

Read on for my honest review.

Who They Are

Real Good Foods is a company committed to creating “REAL Food You Feel GOOD About Eating.” The family-owned business was founded in 2017 and today delivers a variety of convenience foods that are all:

  • Made with real, nutrient-dense ingredients
  • High in protein
  • Low in carbohydrate
  • Free of added sugar

Products

Currently, the company carries food items in the following categories:

  • Entrees, including enchiladas, as wells as a variety of bowls; Almost all of these items provide at least 15-20 g of protein per serving, and can contain as little as 2 g net carbohydrates (some are higher, but never over 11 g of net carbs). The enchiladas are made with a tortilla that is made from chicken and cheese, while many bowls incorporate cauliflower rice and non-starchy veggies to keep that carb count down.
  • Breakfast sandwiches, which are made with a cauliflower and cheese bun, and boast 18 g of protein and only 4 g net carbohydrate per sandwich.
  • Stuffed chicken and nuggets (mainly filled with cheese and vegetables) that often deliver over 30 g of protein and virtually no carbohydrates
  • Pizza, which is made with several different types of crusts (caveat: the chicken one has a lot fewer carbohydrates than the other varieties!)
  • Ice Cream, which is primarily sweetened with allulose, a newer sugar substitute that is naturally occurring and preferred by many to other alternatives

My Review

I tried out several products, including beef enchiladas, a chicken lasagna bowl, bacons and egg breakfast sandwiches, and finally, an array of ice creams. Overall, I enjoyed everything I tried, and it was very convenient to have a low-carb high-protein meal available when I am pressed for time. For me personally, I feel that the lunches I tried (enchiladas and bowls) were a little on the small side, although it could just be because I often skip breakfast, so tend to be more hungry at lunchtime.

I like to top the bowls and enchiladas alike with some sour cream and/or guacamole as well. I think the flavors were bold and the meals tasted quite good. Importantly, the ingredients were simple and so the meals were easy to bolus for and did not wreak havoc on my blood sugar levels. For instance, the chicken lasagna bowl was essentially just marinara sauce, ricotta filling, chicken, and cheese!

As far as the breakfast sandwiches, I was pleasantly surprised at the taste and texture. To be fair, the cauliflower and cheese “bun” does not taste anything like an English muffin, to me. But, it delivers a nice flavor and texture, and is a great breakfast or snack for me, on-the-go. My husband and daughter also agreed that these were pretty good!

Bacon and cheese breakfast sandwich (4 g net carbohydrates and 18 g of protein).

Finally, the ice creams, which are available in a multitude of flavors, really were a hit with everyone in my family who tried them! They are:

  • Chocolate
  • Tanzanian Vanilla
  • Peanut Butter Chocolate Chip
  • Mint Chocolate Chip
  • Salted Caramel
  • Mocha Java Chip
  • Cake Batter

Truly something for everyone, and my four-year-old is especially partial to the chocolate. As I often say, it must be good if it passed the toddler test for what is an acceptable dessert!

The ice cream, of all the products, was probably my favorite as well. Is it particularly nutritious as compared to some of the other foods? Of course not; however, I think everyone needs a little ice cream in their life, and this line really delivered on that. You can’t go wrong with whole and simple ingredients when it comes to ice cream, and since it’s sweetened with allulose and a little bit of stevia, it hardly affects my blood sugar levels, even without any additional insulin.

In addition to enjoying the taste and feeling like these foods made it easier to choose healthier options for me, I was also happy with the price point. While not the cheapest convenience foods, this company strikes a very reasonable balance between quality and price. The entrees are right around $7, give or take; the breakfast sandwiches come in at right over ~$2 per sandwich, while a pint of the ice cream is typically priced at $7.99, on the company website. I also noticed they have some items on sale; for instance, last I checked, there were a few ice cream options that cost between $3.99 and $5.99.

You can purchase directly form the website, or use a mapping tool to find the distributor that is closest to you.

Overall, I was happy with the taste, effects on blood sugar levels, and the convenience of the foods I sampled, and was particularly impressed with the ice cream line. I would definitely recommend this to anyone looking for quick meals that are nutritious and blood sugar-friendly.

Have you tried any of these? What are your favorites?

Source: diabetesdaily.com

The Healthiest Choices at the 10 Biggest Fast Food Chains

Fast food: so temptingly convenient, but so fraught with danger. Most fast food joints specialize in exactly the sort of starchy, crispy, greasy food that people with diabetes are supposed to avoid. Nothing triggers those frustrating sticky blood sugar highs like the delicious blend of fat and carbs found in pizza or French fries. And it doesn’t help that they’ve been loaded with lip-smacking sodium, expertly engineered to keep you reaching for more—and why not order a large soda to wash it all down?

There’s no doubt about it, a fast food menu can be a minefield. But despite some notable recent setbacks—like in 2020, when McDonald’s discontinued its salads—the fast food options for healthy eaters are mostly growing. And as diners continue to demand more healthy options, it means you’re less and less likely to get a weird look when you ask for a lettuce-wrapped burger.

We’ve ranked America’s ten biggest fast food chains, from the healthiest to least healthy, and selected the best diabetes-friendly option at each one.

#1 – Panera Bread

Panera Bread must be the only major chain that specializes in food that most Americans would identify as healthy. The chain has grown like crazy in the last decade, proving that we can crave more than just grease and sugar. And while you might not guess it from a restaurant with the word “bread” in its name, it’s also a great option for people with diabetes. There’s a beautiful variety of low- and medium-carb salads and soups, some of which don’t need much customization at all. Skip the pastries—and don’t even think about the mac & cheese bread bowl—and you’ll probably do just fine.

Best choice:

It’s tough to beat a classic Caesar Salad with Chicken. This dose of delicious lean protein only has about 500 calories and 17 grams of net carbohydrates, even with the croutons included.

#2 – Chipotle

Chipotle stands alone in the fast food landscape as an exemplary keto-friendly option. It’s always been easy to customize your order at Chipotle, and as a result the chain has been popular with the low-carb crowd for years. (Double protein? No problem.)

Chipotle has always prided itself on using high quality ingredients prepared fresh on the premises. While doctors may bristle at the characterization of sour cream and slow-cooked carnitas as “healthy,” at least we can be sure that they’re not likely to spike your blood sugar. And Chipotle has embraced the carb-avoiding community to a unique and commendable degree: the latest innovation is cauliflower rice, launched nationally in January 2021.

Best choice:

For easy one-click ordering, choose from Chipotle’s line of “Lifestyle Bowls,” including several different Keto Bowls. Or start with a Salad, which swaps the Burrito Bowl’s white rice for lettuce, and add whichever ingredients you feel comfortable with.

#3 – Subway

It’s very easy to eat low-carb at Subway—any time you can see your food assembled in front of your eyes, it’s going to be easier to control what ends up in your body. Subway has also recently Chipotle-fied their menu and now offer a selection of salads and protein bowls.

Best Choice:

The Black Forest Ham Protein Bowl has only 9 grams of net carbs, and less sodium than other dishes in the category, along with a ton of chopped veggies.

#4 – Wendy’s

Wendy’s has several healthy options, at least as far as fast food burger joints go, and is easily a better choice than the more popular burger chains coming next on this list. The chain offers multiple salads, both as entrees and sides, and savory wraps. (And you can always order a burger without the bun.)

Source: Wendy’s

Best Choice:

The Southwest Avocado Salad is a complete meal that doesn’t require any fuss when you order it. Grilled chicken, bacon, avocado and southwest ranch dressing: all told, it’s 560 calories, and only 10 grams of net carbs.

#5 – Taco Bell

Tortillas everywhere means blood-sugar spiking simple carbs can be tough to avoid here. Taco Bell is one of several joints on this list that have recently de-emphasized salads, but in this case it’s not much of a loss, as the salads here tended to just be tacos and burritos in a slightly different shape. But Taco Bell has always been happy to customize your order, and a newer menu addition has really opened up the possibilities.

Best Choice:

The Power Menu Bowl is Taco Bell’s attempt at Chipotle-style fare, and they want you to customize your order. You can go light on the rice and beans, or omit them entirely, add extra meat: whatever you’d like.

#6 – Chick-fil-A

You might be surprised to learn that the crispy chicken juggernaut, not often associated with prudent dining, has openly courted keto diners. Chick-fil-A has grilled chicken sandwiches and several salad options, and it’s an easier place to find healthy choices than you probably imagined.

 

Source: Chick-fil-A

Best Choice:

Perhaps the single healthiest entry on the entire list, and certainly the simplest, Chick-fil-A’s Grilled Nuggets are pretty much just chunks of marinated chicken breast, served fresh off the grill. Okay, meat on a plate isn’t terribly exciting, but combine with a side salad and some less sugary dressing—try the buffalo or ranch sauces—and you’re in business.

#7 – Dunkin’

Just like Domino’s and its “Pizza”, Dunkin’ has dropped its “Donuts” in a bid to grow its menu and its market share. Good news: that means more options for us. You’ll still want to avoid any donuts, and tiptoe around the rapidly growing menu of super-sugary coffees and teas. But people love Dunkin’s black coffee for a reason, and the newer hot breakfast menu has some diabetes-friendly possibilities.

Best Choice:

Try a Turkey Sausage Wake-Up Wrap. Dunkin’s wraps top out at just 15 grams of carbohydrates, and in addition to the traditional ham, sausage and bacon, you can choose turkey or BeyondMeat’s vegan sausage. They also offer sandwiches on thin multigrain bread—and of course you can ask them to hold the starch entirely.

#8 – Domino’s

Our first real challenge. Domino’s has dropped the “pizza” from its name, but most of the newer entrees remain tricky, like pasta and sandwiches.

Domino’s does have a Caesar’s salad available, but we’ve already recommended two salads, and besides I’m not sure that Domino’s is the first place I’d go for fresh ingredients.

Best choice:

If you’re bored with salads already, try the Chicken Wings. They are dusted with a little starch to make them crispier, but even so don’t pack much of a carby punch. A side of Mild Buffalo Wings clocks in at 260 calories and about 10 grams of net carbohydrates. Some of the other sauces can get pretty sugary—it’s probably best to avoid anything with “sweet” or “pineapple” in the title.

#9 – Burger King

Burger King seems to have mostly removed salads from its menu, which makes healthy ordering a challenge. And while there’s plenty of fish and chicken on the menu, nearly every last scrap of it has been enrobed in breadcrumbs and deep-fried. Grilled chicken may be available at certain locations. Just about the only thing on the national menu within spitting distance of “healthy” is the side of apple sauce—hardly a meal.

Best Choice:

Your best bet is probably to order any Burger with No Bun. The chicken nuggets may be another option—an order of 10 has only 25 grams of carbs. If you’re lucky, your location has Grilled Chicken Sandwiches and Side Salads too, but these are not reliably available.

#10 – McDonald’s

The world’s biggest fast food chain does not make it easy to eat healthy. It was, admittedly, pretty big news in the 80’s when McDonald’s unveiled a line of salads. It was somewhat less noticed more recently when McDonald’s pulled them off American menus entirely. The fast food behemoth no longer has so much as a single side salad on the menu. The grilled chicken was lost to the same purge. It’s slim pickings now!

Best Choice:

Errrr … do we have to pick one? The only really healthy choice at McDonald’s is to eat less instead of more. The simplest burgers, from the Hamburger to the Double Cheeseburger, use a bun with about 28 grams of net carbohydrates. You can manage to put together a keto meal by refusing the bun altogether. Either way, please hold the fries.

Fruit & Maple Oatmeal is a lonely healthy-ish (but high carb) option for breakfast. The Sausage Breakfast Burrito has more potential as a keto option, if you were to scrape the filling off of its tortilla.

Conclusion

In some ways, it’s easier than ever to find healthy and diabetes-friendly fast food. Chipotle has led the way in the protein bowl revolution, and now there are many joints that will dish you up meat and veggies with little or no added starch and sugar. If there’s a single takeaway here, it’s to be wary of the biggest burger chains, which are sliding backwards, contrary to the trends, and making their menus even less healthy. If you choose the wrong restaurant, you might find that there’s no right answer.

Source: diabetesdaily.com

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