Diabetes Q&A #4: Meal Timing, Gaining Weight, Low Fat or Full Fat, and More

Dr. Jedha, Host

Hello there, Dr Jedha here, and thanks for joining me for episode 47.

Today we’ve got a Q&A session and well be recapping a couple of things around morning blood sugar levels, looking closer at whether including snacks helps keep blood sugar levels steady, chatting about making diet and nutrition changes, exploring what to do to gain weight, and covering whether full fat or low fat dairy products are a better choice. 

Alright, let’s dive right in with a question from Marie. 

02:44

Marie asked:

“Why is my blood sugar high in the morning?”

Well Marie, I’m not going to answer that question here as we explained high morning levels in episode 38, along with providing effective strategies to help lower morning levels. I’d highly recommend listening to episode 38, it’s been a very popular episode because high fasting numbers are a common problem among people with prediabetes and type 2 diabetes. 

03:21

In relation to that podcast, Paul asked: 

“Is it safe to take ALL the supplements above every day?”

Just to put that into context, there were a variety of proven strategies shared in episode 38 to help lower morning levels, and among those strategies we covered some natural therapeutics, six or so supplements scientifically-proven to lower fasting levels. So, Paul asked whether it would be safe to take all the supplements every day.

While it could be safe, as I responded to Paul, it is not a good strategy to simply go and take every supplement all at once. It is better to begin with one to examine the effect, then add additional support if necessary. 

For example, Berberine has been shown to provide the most effective reduction for fasting glucose. When people with type 2 diabetes were given 500 mg of berberine per day, 3 times per day, for 13 weeks, fasting blood glucose was reduced by 68 mg/dL or 3.78 mmol/l. 68 mg/dL is quite a large reduction, so if you were considering the supplement options, you may start with Berberine and then evaluate from there. We have all the info on fasting levels and these therapeutic supplements on our website with episode 38. 

And first and foremost, before looking at supplements, make sure you’ve addressed your nutrition plan and have your daily numbers tracking in the normal healthy range because those things will have a big impact on morning levels too. Always make sure to start with the fundamentals before seeking. Listen to episode 11 for info on normal blood sugar levels. 

05:22

The next question we’re going to cover today is from Tom. 

Tom asked: 

“Should I eat 3 normal meals and let my blood sugar fluctuate, or eat snacks between meals to keep my blood sugar steady? I’ve heard both recommended. What does the science say?”

Tom, thanks for this great question. Let’s unpack this a bit.

First off, it’s important to understand that it’s normal for blood sugar to fluctuate throughout the day. That’s going to happen to us whether we have diabetes or not. After we eat, our blood sugar naturally rises as our body digests the food, and then it gradually comes back down as insulin helps move glucose from our bloodstream into our cells. This fluctuation, the rise and fall, is a normal part of how our body regulates blood sugar. With pre and T2diabetes, the key is managing these fluctuations so they stay within a healthy range. We talked about healthy blood sugar levels in episode 11. 

Also, even when we are not eating, or in between meals, our blood sugar can still fluctuate, and that’s completely normal too. Think about it: our blood sugar isn’t just going to sit at 80 mg/dl all day, for example. The body is constantly regulating blood sugar to make sure it has the energy it needs to function, whether we’re active, resting, or even sleeping, so fluctuations are normal.

Okay, the idea that eating snacks between meals will keep your blood sugar steady is not entirely accurate. As we’ve just established, your blood sugar is going to rise in response to consuming food, so constantly eating throughout the day can lead to more frequent blood sugar spikes and fluctuations, lead to higher circulating insulin levels in the body and prevent your body from using insulin efficiently.

So, in relation to your question Tom about whether to eat 3 meals or include snacks, what the science shows us is that sticking to three meals a day, without snacks, can actually be a better way to keep blood sugar levels more stable over time. 

Why would this be? Because it allows your body time to process the glucose from your meal, and it encourages a period of fasting between meals, which can improve insulin sensitivity. 

That said, snacking is not all bad and it can depend on where you’re at in your journey. For example, during a dietary transition where you might be moving away from carb-heavy foods to more nutrient dense foods, you may feel you need to snack. We often find that can be the case and that people may move away from snacking and toward core regular meals, but they do this a bit later in their journey, once their overall dietary transition is becoming habitual and they feel comfortable. If that’s the case, it’s fine to snack, but then it comes down to the types of snack foods you choose. 

If you were to snack frequently on high-carb or sugary foods, clearly that’s not going to be good as it can cause your blood sugar to rise and fall more rapidly, leading to greater fluctuations overall. This can create a roller-coaster effect that isn’t helpful for blood sugar control. 

If you feel the need for a snack, it’s important to choose something low carb and nutrient-dense—like nuts, some grilled chicken or a boiled egg, for example—which can help to avoid those spikes and keep your blood sugar more stable, because proteins and fats have little influence on blood sugar levels. 

Of course, there is a lot more to this story on meal timing and meal frequency and we are planning to cover these things in more detail in a future episode. But for now, I hope that helps clarify that it’s normal for blood sugar to fluctuate and that snacking between meals is not a proven strategy to “keep blood sugar steady” so to speak.

Overall, the most important thing, whether including snacks or not, is always making sure your blood sugar levels are staying within the healthy normal range. We talked about healthy blood sugar levels in episode 11 so be sure to head back and listen to that episode. 

10:42

Right, next up, Florence said:

“I would like to achieve and maintain the goal of keeping my HbA1c as low as I can. I am 65 years old and have been diabetic some 30 years ago. I have been on a daily dose of Janumet 100/1000mg, since a month ago the dose has doubled. How can I eat normally and enjoy all my foods without too much effort. Please advise.”

Florence, it sounds like you might be saying that your medication has recently increased in dosage and that you’re concerned about that and want to achieve a and maintain a lower HbA1c. This is certainly a good goal to work toward, regardless of the amount of time you’ve been living with diabetes. If your doctor has increased your medication, it is likely the case that your HbA1c has gone up, so being more proactive with your diet and nutrition will be key to getting your levels back down to the normal range and potentially working with your doctor to reduce your medications again. 

Now, you mentioned that you want to eat normally and still enjoy all your foods without putting in too much effort. That’s completely understandable, but, it depends what you mean by “eat normally and enjoy all your foods.” If your HbA1c levels have gone up, then there’s a high chance that the normal foods you’re enjoying are increasing your HbA1c levels, so the reality is you’re going to have to make some adjustments to your eating plan. You have to look at the types of foods you’re eating and switch some things for more nutrient dense foods. You likely have to look at the amount of carbohydrate foods you’re eating at each meal and either exchange these for more vegetables or start to minimize these foods by portion controlling – for example, the potato, rice, pasta, bread etc. I’d recommend listening to episode 6 on what to eat to treat diabetes as we covered the best types of foods to eat and the ones to avoid. 

And when you say without too much effort, often the place to start is not by completely changing every meal you eat. Just look at the regular meals and foods you’re eating and make some switches. For example, if you’re eating spaghetti bolognese with regular wheat pasta, switch the pasta out for vegetables, zucchini noodles or soybean fettuccine. That’s still giving you the ability to enjoy the same foods but just in a slightly different way. You don’t have to overhaul everything overnight. Start with one or two adjustments that feel 

Thanks again for your question, Florence! 

13:44

Next up is a question from Karima, who asked:

“You provide good information but what do underweight people do? Will your diet help?”

Karima, that’s an important question, and I’m glad you brought it up. We recognize that not everyone needs to lose weight and some people need to gain weight and control their diabetes and achieve better results with blood sugar and A1c, for example. We do focus on weight loss a fair bit, as the majority of people do want to achieve some weight loss, but you can certainly gain weight, we have other members in the same situation. We do have an extensive Weight Gain Guide inside our VIP Membership, so yes, the answer is our diet can help. When you need to gain weight, you’ll still follow our general nutrition guidelines for blood sugar control and then our guide helps you determine how to bring up your calorie intake to the right level to achieve weight gain. Then there’s a range of practical resources to help you achieve that aim. For example, we’ve also got lists of nutrient-dense calorie-rich foods and how to include these in your meal plan. Example meal plans and how you can modify recipes and meal plans. We’ve also got a library of recipes to more easily help you achieve weight gain as well.  Certainly, if you’re underweight, it’s crucial to ensure you’re getting enough nutrients and calories while still managing blood sugar effectively. So if you head to our website, you can find more information about the Weight Gain Program at Type2DiabetesTalk.com/programs.

Before we dive into our last question, let’s hear a testimonial from one of our members.

16:10

The last question we’re going to tackle today is one that came up among a few of our members recently that I thought would make a great addition to this Q&A, one person said:

“Just wondering what is better for me, low fat or regular whole fat food products? I was diagnosed with pre-diabetes and find that a confusing food dilemma.”

Another person asked: “My total cholesterol and LDL are both elevated. My triglycerides are good. My HDL is high and my ratio is normal. Should I try the regular fat dairy or should I stick with low fat?”

The debate between low-fat and whole-fat products can be confusing, especially when you’re trying to manage pre or T2diabetes or elevated cholesterol levels. Let’s break it down with some evidence.

First off, it’s important to understand that the whole low-fat versus full-fat debate has evolved quite a bit over the years. For a long time, low-fat foods were promoted as the healthier option, but recent research is showing that this isn’t usually the case, especially when it comes to managing blood sugar and overall metabolic health.

Several studies have shown that full-fat dairy products are not only safe but may also offer some metabolic benefits. For example, studies have found that higher intake of full-fat dairy was associated with a lower risk of developing type 2 diabetes, compared to low-fat dairy. This suggests that the natural fats in whole-fat products may have protective effects when it comes to blood sugar control and insulin sensitivity. 

Something to consider is that when you opt for low-fat versions of foods, like dairy products, what often happens is that those foods are stripped of their natural fats and sometimes have sugars or other fillers added to make up for the flavor and texture that fat provides. For example, Full fat Greek yogurt has around 6 grams of carbs, while low fat plain yogurt has 25g carbs for the same size serve, depending which brands of course, but that’s just one example. By consuming low fat products and thinking they are healthier for you without considering their overall nutrition, can actually lead to higher blood sugar spikes, which isn’t ideal if you’re trying to manage pre or T2diabetes. 

On the other hand, whole-fat foods, like full-fat yogurt or cheese, tend to be more satisfying and can help keep you feeling full for longer, which may prevent overeating. They also tend to have a lower glycemic impact, meaning they won’t spike your blood sugar as much as low-fat, high-carb alternatives. Research supports this by showing that diets higher in healthy fats, including those from dairy, are associated with better glycemic control and insulin sensitivity. 

Now, when it comes to cholesterol, we covered this topic on episode 42 and episode 44 and it’s essential to understand cholesterol and get your head around the myths so you can realize that fat and even saturated fat found in nutrient dense foods, is not likely to be an issue for cholesterol. In fact, studies have looked at dairy consumption in people with high cardiovascular risk and have found full-fat dairy to be protective with no increased risk. Overall, the research suggests full-fat dairy products are neutral when it comes to cardiovascular risk.

If your total cholesterol and LDL levels are elevated, but your HDL is high and triglycerides are in a healthy range, it’s a good sign that your body is processing fats well. Whole-fat dairy products, in this case, could certainly be included as part of your diet, especially if they’re balanced with plenty of vegetables, proteins, and other healthy fats sources. Research has shown that higher dairy consumption may have a positive effect on cholesterol metabolism in people with T2Dibaetes by modifying a biomarker involved in bile acid synthesis that helps with cholesterol clearance. Overall what the research shows us is that full-fat dairy products are the most suitable choice in most cases.

I think it will probably be worthwhile for us to have a whole episode covering dairy products in the future but for the time being that should help to resolve the confusing dilemma.

Well, that brings us to the end of today’s episode.

Take care until next week, 

Dr. Jedha over and out.