Kelsey Marksteiner: Especially for someone with blood sugar issues, I like to use beans because a) if someone is going to be a lacto-vegetarian, they’re probably going to be eating more carbs than somebody who can just do a strict Paleo kind of diet. Just simply from a calorie perspective, they’re usually going to have to eat more carbs to get the amount of calories they need. And beans are slow carbs, meaning there’s a lot of fiber, there’s resistant starch, so it doesn’t spike blood sugar as much as something like white rice would. So I like to use beans in my vegetarian clients. I think it works well for the most part. I really am not on the bad side of beans. I think actually beans can be very healthy. I do think they’re worth taking out and adding back in on an elimination diet to just see what happens. But I find a lot of people do perfectly well with them and I do think that they can be a healthy carbohydrate choice.
So that said, if you do have someone who is lacto-vegetarian and they have blood sugar issues, a lot of their protein is going to come from dairy. They can get some protein from beans; it’s not a whole lot but … or you know, other grains or grain-like things like quinoa, for example. It’s a little bit higher protein. They’re going to have a hard time getting the protein that they need, especially in the morning when you want, like, 40 grams of protein. They can do the protein powders. I will say though that I have not had as much luck with the blood sugar-stabilizing effect of protein powder versus meat. And I’ll say that for the satiation factor as well. Protein powder doesn’t quite hack it in those two ways. So you can experiment with that. They may need more protein than 40 grams to get the same sort of effect as 40 grams coming from meat would do. So you’ve got to play around with it a little bit. But I’d recommend starting somewhere between using 30 and 40 grams of protein coming from the protein powder and some sort of dairy. So I would probably recommend to start maybe make a smoothie that has Greek yogurt in it, full-fat Greek yogurt, and the protein powder to equal about 30 to 40 grams of protein. Using some lower-sugar fruits like berries in there and see how they do with that. For lunch and dinner again, you’re going to have a little bit of a hard time getting the protein you need.
If they eat fish, which is unclear from this question, I would definitely encourage them to eat fish a lot, changing the type of fish as much as possible so that they’re not always eating salmon or anything like that. But that would be a really great way to get protein. If they could do that in the morning, I would recommend that they have one of their meals with fish in it in the morning so that that protein is bare. That’s going to do a lot to stabilize blood sugar for the rest of the day. But for lunch and dinner, if they can do a fish, that would be great. Otherwise, you are going to want to try to use higher protein grains or legumes like I was talking about, like quinoa or any type of beans. Yeah, it’s not perfect, and they’re certainly not going to get as much protein as somebody who’s eating meat would. That’s something you have to talk to them about and see what they’re willing to do.
Obviously in the case of disgust, you know you’re not going to convince someone they want to eat that. But if you can convince them to eat other types of seafood or fish, you could go a long way with the protein coming from those sources. So otherwise, I would encourage the person to a higher fat diet, certainly, because you don’t want a lot of their calories coming from carbohydrates. I would more go toward lower carb, which is going to end up probably being a moderate carb just due to again calories and a high-fat diet and as high protein as you can go essentially. The protein, I don’t think, is going to be easy to accomplish, given what you would normally do for a protein level for somebody with blood sugar issues, but you just have to do the best you can. So as high as possible for the protein basically, and that’s going to, like I said, be a lot of dairy.
So these kinds of patients a lot of time, depending, of course, on what they come to you for, but if it’s just the blood sugar issues, usually I maybe wouldn’t do an elimination diet with them. Like I wouldn’t do a strict Paleo diet because it’s just going to be too hard, like they’re not going to get enough food. So if there’s nothing else going on other than the metabolic syndrome, I would probably just start with trying to get them enough protein, trying to get high-fat, moderate carb so that their blood sugar stabilizes and then they’ll start to see some beneficial effects. If there’s other things going on, like if they have an autoimmune condition or G.I. problems, then it becomes a little bit harder because a lot of times you are going to want to do an elimination diet in that case.
Again, a lot more convincing might have to go into place about maybe incorporating some seafood. So again, unclear if this person is eating seafood. If they are, it’s going to be way, way easier. But otherwise you want to focus on beans, higher protein, pseudo-grains like quinoa, nuts, I forgot to mention nuts. Those are a good option too, or nut butters. We talk about not going crazy with nuts, but again, you know this is not a perfect scenario. So this person is probably going to eat more nuts than somebody on a regular strict Paleo diet would. That’s okay. Not every patient is going to be able to do a perfect Paleo diet. So you just have to be able to go with that and do the best you can.
So between that, all those things, dairy, and possibly seafood, I think you can probably do pretty well in stabilizing their blood sugar as long as you’re focusing on getting as much protein from those sources as possible, keeping carbohydrates at a moderate level. That’s going to depend on this person’s blood sugar. So we’ve talked about blood sugar testing in the past. Basically, you want to have them test in the morning when they wake up, before meals, one hour after, two hours after, and three hours after meals at least to kind of get a sense of what’s going on and anytime you’re changing anything in their diet. So if you implement this high-fat, moderate-carb, as-high-as-possible-protein diet, you want to do that testing and see how they respond to that. If the moderate carb ends up, whatever you decide as being moderate carb, and that really depends on how willing they are to lower carbs at this point and the calorie level that you need to have them on and how much other protein and fat they’re willing to eat.
But if you try a certain carbohydrate level first, you see that they’re not doing too well at that, work on lowering it, increasing fat, increasing protein as much as you can, test again, see how things change and just go from there. You always want to tell patients, especially with blood sugar issues, that we’re kind of experimenting. We’re finding out what works for your body in particular, and to do that we’re going to have to try a couple different things. And the first thing is not guaranteed to work. And especially in a case like this where they’re giving you a limited amount of foods to work within. Just make it very, very clear so they’re kind of in on this process, in on this experiment, and they know that we’re probably going to go through a couple iterations of what their diet looks like before we find something that works for them.