Top Nutrition Tips from Registered Dietitian Rachel Stahl Salzman

The health benefits of eating right are endless. A well-balanced eating pattern provides the energy and nutrients the body needs for growth and repair and to ward off diseases. Individuals with type 1 diabetes (T1D), an autoimmune disorder, have compromised immune systems that require additional diligence and protection. A simple way to do this is to watch what we eat.

The World Health Organization cites balancing a healthy diet significantly lowers the risk of obesity, heart disease, stroke, diabetes, and certain types of cancer and greatly improves blood glucose levels, which reduces your risk of diabetes-related complications.

When you receive a diagnosis of type 1 diabetes–you have so much thrown at you all at once. Beyond watching your blood sugar, diet, and exercise habits, there’s the additional technology of insulin pumps, pens, continuous glucose monitors (CGMs) and apps to track it all.

Seeking additional support from a trained nutritionist and clinician certified in insulin pump/CGM integration is beneficial for treatment. Fortunately, the diabetes community has specialists like Stahl Salzman, who are willing and able to answer questions and offer solutions.

We consulted Stahl Salzman about her path to becoming a dietitian and what healthy living tips we can apply right now.

About Rachel Stahl Salzman

Not everyone has a clear, immediate vision for what they want to do with their life. Sometimes, the heart beckons us in a different direction than we intended. Rachel Stahl Salzman, MS, RD, CDN, CDCES, had a brief detour into finance and economics but swiftly found her niche as a nutritionist.

Stahl Salzman was intrigued by health and science from a young age. Her mother’s work in medical sales exposed her to the healthcare setting. She also participated in a three-year Science Research Program in high school.

In college, she began researching the role of registered dietitians (RD) and shadowed several RDs in New York. “I remember meeting with Sari Greaves, RDN. In her practice, I saw how she worked with compassion with the people that she cared for. I watched her interact with the other medical team members and advocate for the role of nutrition. I left that day and said, “I can totally see myself doing this.”

Stahl Salzman received her Bachelor of Arts degree from Colgate University, graduating summa cum laude and Phi Beta Kappa. She obtained her Master of Science degree in clinical nutrition from New York University.

Stahl Salzman has spoken at national conferences such as the American Diabetes Association’s Scientific Sessions and the ADCES Annual Conference and also serves as the Diabetes Technology Chair for the Diabetes Dietetic Practice Group and President-Elect of the ADCES New York City Chapter. She received the Rising Star Award through ADCES and the Recognized Young Dietitian of the Year award through the New York State Academy of Nutrition and Dietetics (NYSAND).

Additionally, Stahl has been featured in numerous print and online resources, including US NEWS, Runner’s World, Prevention and Weight Watchers. She has also co-authored an article on diabetes apps in the peer-reviewed journal Diabetes Spectrum. 

Today, Stahl Salzman has over ten years of experience working for New York Presbyterian Hospital/Weill Cornell Medical Center as a registered dietitian nutritionist specializing in medical nutrition therapy for conditions such as prediabetes, diabetes, cardiovascular disease, obesity, and chronic kidney disease.

Stahl Salzman said early in her RD training, “No matter what units I was working on, diabetes was everywhere—cardiac, burn ICU, pediatrics, GI, medical-surgical, and oncology units. I saw firsthand the impact that diabetes can have on people of all ages, backgrounds, and health conditions. I knew it was an area where I could truly make a difference.”

Healthy Eating Patterns

Medical nutrition therapy (MNT) involves working with an RDN who can develop a tailored nutrition care plan to improve health outcomes. “Every individual and their diabetes experience is unique, Stahl Salzman said. “Working with an RDN can ensure a personalized dietary plan that fits your specific needs and preferences while still allowing you to enjoy the foods you love.”

MNT can be delivered individually or in groups in person or through telehealth. “The goal of medical nutrition therapy for all people with diabetes is to promote healthful eating patterns, not a specific diet. It’s important to emphasize a variety of nutrient-dense foods in appropriate portion sizes based on the individuals’ needs.”

Stahl Salzman recommends making simple adjustments to your daily meal plan:

• Choose whole foods over highly processed foods.
• Eat plenty of nonstarchy vegetables (salad greens, tomatoes, spinach, Brussels sprouts, mushrooms, cucumbers, celery, and peppers).
• Increase fiber intake.
• Minimize added sugar and refined grains.
• Limit sugar-sweetened beverages.

“There is no ‘one-size-fits-all’ nutrition approach for people living with diabetes,” she said. “A variety of approaches can be used to create a personalized meal plan that helps the person reach and maintain overall diabetes management goals.”

While some individuals with T1D benefit from lower-carb meal plans, Stahl Salzman said others can do well on vegetarian or Mediterranean eating patterns. “The key is for the RDN to collaborate with each person to develop a sustainable and personalized healthy eating pattern and equip them with the practical tools to follow it safely and effectively. And the person’s choice can change over time, or it can blend between eating patterns. The goal is to support them in finding the approach that works at each stage of their diabetes journey.”

Three Easy Tips for Better Health

1. Eat Whole Foods

Try to eat more whole, unprocessed plant foods. Whole foods are higher in nutrients like fiber, vitamins and minerals. 

2. Practice Food Order

When possible, practice food order. “I learned this from my colleague, Dr. Alpana Shukla, who researches this behavioral strategy,” said Stahl Salzman.

1. First, eat non-starchy vegetables
2. Followed by protein
3. Last, carbohydrates

Eating vegetables followed by protein at meals has been shown to increase fullness and can help improve blood sugar management. Stahl Salzman said that carbohydrates should be consumed in moderation towards the end of the meal.

3. Practice Mindful Eating

Mindful eating can help you become more aware of your physical hunger and satiety. She advises us to “Slow down when eating and savor each bite. This allows your body to register fullness cues, helping you to eat more intuitively and promoting better digestion.”

SMART Goals to Improve Lifestyle Habits 

“Recognizing that modifying lifestyle habits takes effort, I collaborate with people with diabetes on setting SMART goals (specific, measurable, achievable, relevant, and time-bound) to empower them to make sustainable and meaningful changes to improve their health,” said Stahl Salzman.

When providing nutrition counseling for individuals with type 1 diabetes, Stahl Salzman takes into account their unique individual circumstances, including personal and cultural preferences, food security, health literacy and numeracy, other medical history, and social determinants of health. For example, a nutrition plan for someone with type 1 diabetes who also has cardiovascular disease will differ from someone with type 1 diabetes and Celiac disease.”

T1D and Celiac disease 

T1D Strong: There seems to be an overlap between T1D and Celiac disease. Should gluten be avoided or limited by those with T1D?

Stahl Salzman: While there is a link between these autoimmune conditions, a gluten-free diet isn’t recommended for all people with T1D unless diagnosed with Celiac disease. If you are concerned you may be at risk, ask your healthcare team if you should get screened for Celiac disease after a diagnosis of type 1 diabetes, and vice versa.

Best Late-Night Snacks to Avoid Lows

T1D Strong: What are the best late-night snacks to avoid low blood sugar at night?

Stahl Salzman: There isn’t a single “best” snack for everyone with T1D, as individual needs vary. However, I encourage slow-digesting carbs with protein and healthy fats to help keep blood glucose levels steady overnight.

Some examples include:

• Greek yogurt with berries and nuts or seeds
• Apple with almond or peanut butter
• Slice of cheese or ¼ avocado on whole-wheat or whole-grain toast
• Handful of nuts
• Plain popcorn with a few mixed nuts for some added protein

If someone is concerned about their blood sugar dropping low at night, they should contact their healthcare team. “It’s possible they could be taking too much insulin or engaging in vigorous exercise right before bed which could be contributing,” Stahl Salzman said. “If you’re unsure whether you need to have a bedtime snack to begin with, speak with your healthcare team.”

T1D Strong: Are there certain foods T1Ds should avoid altogether? 

Stahl Salzman: While there aren’t any foods completely off-limits for individuals with type 1 diabetes, understanding how different foods affect blood glucose (sugar) levels is crucial for effective management. Instead of focusing on what to “avoid,” I like to focus on what to add – e.g., more plant foods, such as whole grains, non-starchy vegetables, beans/lentils, fruits, nuts, and seeds in proper portions.

“As healthcare professionals, we need to avoid labeling foods as ‘good’ or ‘bad’ as it can create negative associations and unhealthy relationships with food. Instead, we need to focus on empowering individuals with T1D to find ways to integrate their favorite foods into a healthy and sustainable eating pattern.”

Stahl Salzman says including protein and fiber in every meal/snack isn’t strictly required, but eating foods containing these nutrients regularly is helpful to support a well-balanced and healthy meal plan. 

Intermittent Fasting and T1D

T1D Strong: Is intermittent fasting safe for individuals with type 1 diabetes?

Stahl Salzman: Intermittent fasting is gaining popularity as a weight-loss strategy; however, its effectiveness for T1D individuals requires careful consideration and individualization. While intermittent fasting is a strategy for weight loss, it’s equally important to optimize food choices within the specific eating window.

Close collaboration with their healthcare team is important for people with T1D who are considering intermittent fasting. There can be blood glucose fluctuations and the need for insulin dosing adjustments. The healthcare team can offer guidance and monitor potential risks. According to the American Diabetes Association’s Standards of Care in Diabetes, intermittent fasting or time-restricted eating has been shown to be safe for adults with type 1 or type 2 diabetes. However, more research is needed, especially in more longer-term studies and diverse populations.

New Diabetes Technologies

The technological side of diabetes management has advanced exponentially from traditional insulin pumps and smart insulin pens to automated insulin delivery (AID) systems with CGM-informed algorithms. The newer devices are more fine tuned and accessible to learn.  

Obtaining the ADCES Continuous Glucose Monitoring (CGM) Certificate Program allotted Stahl Salzman advanced knowledge and skills in applying technology to the care of individuals with diabetes. She also has training from ADCES on the topics of connected insulin delivery devices and the clinical application of data.

T1D Strong: You have extensive experience working with CGMs, smart insulin pens and insulin pumps. How important are these features if someone has the opportunity to afford them?

Stahl Salzman: These devices can be incredibly helpful to manage diabetes and improve quality of life. Access still remains a challenge but has significantly improved over the years.

T1D Strong: Learning the tech side of diabetes, including the apps and CGM application, can be overwhelming to someone newly diagnosed. How do you encourage patients to use them?

Stahl Salzman: To make the learning process less overwhelming, I provide hands-on guidance. For example, with diabetes apps, we can download the app together during appointments and set up their profile. I start by showing them one or two features at a time and prioritizing the most important ones.

Pro Tip: Seek support from your diabetes care team about insulin pump therapy and CGM integration options. The American Diabetes Association (ADA) offers resources to help patients use time-in-range (TIR) data to make informed treatment and lifestyle decisions.

Stahl Salzman provides training on inserting the CGM sensor, troubleshooting, and interpreting the data. “There’s no set time period for the length of training; it really depends on the individual. My goal is to make it feel as comfortable and manageable as possible. Ongoing support is also important.”

The Best Apps for Diabetes Management

T1D Strong: Are there specific apps that you recommend to clients? Also, do you find a particular pump/CGM integration highly effective?

Stahl Salzman: I don’t have a favorite diabetes app because there is no one-size-fits-all solution. The best app for a person with diabetes depends on their individual needs and preferences. Instead of recommending a specific diabetes app, I focus on educating people with diabetes about the different types of apps available and helping them choose an app that is right for them. I also encourage them to try out different apps to see which ones they like best, especially if they are free.

Stahl Salzman recommends considering these factors when choosing a diabetes app:

• What features are most important to the individual? Some apps focus on tracking glucose levels, while others focus on food logging, exercise tracking, or medication management.
• How easy is the app to use? Some apps are more user-friendly than others. Choose an app that is easy to navigate and understand.
• Is the app compatible with your diabetes devices? Choosing an app compatible with your diabetes devices can be beneficial. This integration can help consolidate data, alleviating the need to access multiple apps where data is often siloed.

 “The current FDA-approved hybrid closed-loop systems work incredibly well for many people with type 1 diabetes. Their choice depends on many factors,” Stahl Salzman said. “I schedule an appointment for the person to come to my office to see all the different options. I place them all out on my desk, where they can gain a hands-on understanding of each system, and we can talk about the similarities and differences.” 

Undermyfork 

One diabetes management app gaining popularity is Undermyfork. The app automatically combines glucose data from CGMs or BGMs with meal photos and physical activity and calculates the after-meal TIR. Stahl Salzman is an Undermyfork consultant and resides on their Clinical Advisory Board.

T1D Strong: Please tell us about your role with Undermyfork.

Stahl Salzman: My involvement with Undermyfork began organically. I was using the app with individuals with diabetes, and they found it really helpful in managing their diabetes. This, combined with my passion for educating other healthcare professionals on the benefits of utilizing technology and mobile health apps in clinical practice, led me to reach out to Undermyfork to learn more about the product.

“Mike Ushakov, one of the co-founders, responded, and we met over Zoom. We quickly realized we shared a similar mission: to make living with diabetes easier and advance technology to meet this need. This initial engagement evolved into a collaborative partnership. They later approached me to consult on Undermyfork Care, their platform that allows healthcare professionals to access and interpret patient data provided by the Undermyfork app to help make informed treatment decisions.”

“Now, in my role as a clinical advisor, I contribute to the app’s design and features, ensuring it meets patients’ needs and supporting research efforts to evaluate Undermyfork’s effectiveness in improving outcomes for people with diabetes. The Co-Founders, Mike Ushakov and Eugene Molodkin, are incredibly talented. I’m constantly learning from them, and feel lucky to be part of the team. We are passionate about improving the lives of people with diabetes, and it’s inspiring to be part of that.” 

Advice for Newly Diagnosed T1Ds

Facing the new learning curves of diabetes management can be challenging.

“From a young age, I saw close family and friends navigate the daily realities of diabetes—the constant fingerpricks, the insulin injections, and having to be so careful with their diet,” said Stahl Salzman. “Diabetes was on their minds all the time. I saw how it affected their sense of freedom and well-being, and that’s one reason why I decided to pursue my career in helping people with diabetes thrive.”

Stahl Salzman advises the newly diagnosed to start small. “It can be overwhelming! Don’t feel like you need to learn everything all at once. There are many free online resources on diabetes technology that I encourage someone newly diagnosed with T1D to check out:

• American Diabetes Association Consumer Guide: https://consumerguide.diabetes.org/
• DiabetesWise: https://diabeteswise.org/
• Taking Control of Your Diabetes for Life: https://tcoyd.org/
• diaTribe: https://diatribe.org/
• Juvenile Diabetes Research Foundation: http://www.jdrf.org/
• The Diabetes Link: https://thediabeteslink.org/ 

Also, talk with your healthcare team. Share your interests, concerns, and goals. Your diabetes care team is there to support you every step of the way.