Deconstructing Diabetes

Simplifying what to eat with diabetes.

Nutrition Consulting. Resources. Blog.

Cam Johnson

Specialist Diabetes Dietitian (APD)

Melbourne, Australia

Addition and Subtraction

Is it more important to add, or subtract?

Many clients think I'm going to tell them what not to eat. The things that need to be subtracted, or removed from the shopping list, or the plate.

I'm more focused on what clients should eat. This means adding foods, and ensuring enough good nutrition. So let me go into this first.


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Add Food. Add enough volume to not feel hungry. Enough real food. I really like the work of Michael Pollan, author of In Defense of Food. His simple message of "Eat Food. Not Too Much. Mostly Plants" is genius in it's simplicity. The idea of eating foods that our grandmother would recognise as food is a take home message from his writing.

The findings from the latest National Nutrition Survey revealed that Australian diets fall short of the Australian Dietary Guidelines. These guidelines recommend minimum serves for vegetables, fruit, dairy products, lean meats and alternatives, and grain-based foods. This can be found in the ABS website.

Add Protein. As well as having a satiating effect (fill you up for longer), one theory which goes further is the Protein Leverage Hypothesis. This theory states that we eat until we are satisfied, and we are only satisfied when we have eaten our requirement for protein. Protein foods also have high amounts of micronutrients, as well as having a muscle sparing/ protein building effect.

Add Fibre. Fibre is essentially the indigestible part of food. As well as having a benefit on bowel health, and lipids, fibre provides bulk to the diet without adding in the calories.

Add Vegetables.  A common theme with the clients I see is that vegetables are eaten too infrequently, in too small an amount. The simple idea of adding more vegetables to the plate compared to the carbohydrate on the plate is a good starting point.

Add Low Glycemic Index Carbohydrate. These are the type of carbohydrates which supply slowly digested release of glucose and a feeling of fullness after eating. Think the heaviest, densest piece of bread compared to light white bread.

Add Options.  Having choices for what to put on the plate or shopping basket is better than being restricted or bored. I often direct clients towards the CSIRO diet recipe books for options of meeting all the above points of what foods to add.



Subtract Calorie Dense, Nutrient Poor Foods. The ABS report on the latest results from the 2011-12 National Nutrition and Physical Activity Survey found that over one-third of the population’s total daily energy intake came from energy-dense, nutrient-poor ‘discretionary foods’ (such as sweetened beverages, alcohol, cakes, confectionery and pastry products).

Subtract Energy Containing Beverages. Fruit juice and soft drinks are the main culprits to adding unnecessary energy. 

Unnecessary Snacking. We are often conditioned to eat between meals, even when not hungry in social situations, work breaks, or when bored. Many clients ask if they need to snack, and no, not if you're not hungry or are on glucose lowering medications that may result in hypoglycemia.

Subtract Alcohol. You don't have to be a teetotaler, but alcohol may decrease inhibitions for dietary restraint, increase appetite, and may slow down weight loss.

Addition + Subtraction = Results.

Start with adding more nutrient dense, and satisfying lower calorie foods first, then once appetite is controlled, start subtracting the high calorie - nutrient poor foods.

At least that's my approach.

What approach works for you? Does it matter if you subtract, or add first?


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Deconstructing Diabetes