Diabetes and Gut Health
Finding foods that support your body—and agree with your stomach
This article provides general education. It does not replace medical advice, diagnosis, or a personal eating plan from your healthcare team.
Health problems can show up a little at a time. One concern begins, then another. Years later, we may look back and wonder whether they were connected.
That question brought me to my husband Michael’s story. He has given me permission to share it.
When Michael was 19, he went to Thailand for two years. During that time, he recalls eating no milk products. When he returned home, he began eating American foods again, including cheese and other dairy products.
Before long, he developed belly pain, bloating, and diarrhea.
Michael remembers telling his doctor about the symptoms. He did not feel there was much concern at the time. His father had experienced some digestive troubles too and suggested that Michael stop eating milk products.
About three years after returning home, Michael was diagnosed with lactose intolerance. Over the years, he also gained weight. By his early to mid-30s, he was diagnosed with type 2 diabetes.
Looking back, it felt as though one health problem followed another.
His story made me curious.
Could digestive health and diabetes share a connection?
What could we learn that might help us care for ourselves today?
First, what are type 1 and type 2 diabetes?
Diabetes means blood sugar stays too high. Insulin is a hormone that helps move sugar from the blood into cells, where the body can use it for energy.
Type 1 diabetes develops when the immune system attacks the cells that make insulin. The body then makes little or none. People with type 1 need insulin every day to stay alive. Although it often begins in childhood, it can start at any age.
Type 2 diabetes develops when the body does not respond to insulin as well as it should. This is called insulin resistance. The body may also stop making enough insulin to meet its needs.
Treatment for type 2 may include food changes, physical activity, medicines, and sometimes insulin.
Taking insulin does not mean that type 2 has become type 1.
NIDDK: What Is Diabetes?
Both types deserve proper care. Neither is a reason to blame someone for having diabetes.
What does “gut health” mean?
Your gut is the path food takes through your digestive system. It breaks down food so your body can use its nutrients.
Your intestines also contain a community of tiny living things, including bacteria.
This community is called the gut microbiome.
Some microbes break down parts of food that we cannot digest ourselves. As they work, they make substances that can affect the bowel and other parts of the body.
Researchers are studying how food changes this community and how those changes may affect health.
Fiber-containing foods are an important part of that research. www.niddk.nih.gov
Gut health means more than having a bowel movement each day. It also involves how well you digest food, absorb nutrients, and tolerate what you eat.
How is the gut connected to diabetes?
Researchers have found differences in the gut microbes of people with and without type 2 diabetes. They are studying whether some of these differences contribute to problems with blood sugar.
The relationship is complicated. Food choices, medicines, and diabetes itself can all affect the gut.
For example, research shows that metformin can change the gut microbiome. pmc.ncbi.nlm.nih.gov
This gives scientists useful clues. It does not mean that gas, bloating, or diarrhea proves your gut caused your diabetes. It also does not mean that a supplement can cure diabetes by “healing” the gut.
Michael’s experience gives us questions to explore. The order in which his symptoms appeared cannot tell us whether one condition caused another.
Insulin resistance can also occur alongside other health concerns.
To learn about that pattern, read our Faithful Steps article, What Is Metabolic Syndrome?
Where lactose intolerance fits
Lactose is the natural sugar in milk.
An enzyme called lactase helps break it down.
When the small intestine makes too little lactase, some lactose passes into the large intestine without being fully digested. This can cause gas, bloating, belly pain, and diarrhea.
Lactose intolerance is different from a milk allergy.
An allergy involves the immune system reacting to milk proteins. Lactose-free cow’s milk still contains those proteins, so it is not a safe replacement for someone with a milk allergy. www.niddk.nih.gov
We cannot tell from Michael’s story why his symptoms began after returning home. His time without dairy does not prove that avoiding dairy caused his intolerance.
It also does not prove that lactose intolerance caused his later diabetes.
What helped Michael’s loose stools?
Many years ago, while working in a nursing home, I learned that Metamucil could help some patients with diarrhea.
That lesson stayed with me.
After Michael and I started dating, he told me about his lactose intolerance and ongoing loose stools.
I introduced him to Equate sugar-free orange psyllium powder. After he began using it, his diarrhea became much more manageable.
He started to use it twice a day. As his stools became firmer, he reduced the amount because they were becoming too firm.
That was his personal experience, rather than a dosing plan for someone else.
The improvement did not mean he could begin eating lactose-containing foods again.
When he did, his diarrhea became worse. The fiber drink had not cured his lactose intolerance.
Psyllium absorbs water and forms a gel. Doctors sometimes use it for constipation and sometimes for diarrhea. Whether it is appropriate depends on the cause of the symptoms and the person’s health needs.
Ask your doctor before using it for ongoing diarrhea.
Follow the product’s mixing directions, use enough liquid, and ask a pharmacist about spacing it from medicines.
People with swallowing problems or certain digestive conditions need particular care. www.medlineplus.gov
Lactose-free does not mean carb-free
Lactose-free dairy products can make it easier to enjoy milk foods without the same digestive symptoms.
Many use added lactase to break lactose into smaller sugars.
Those sugars still count as carbohydrates.
Breaking them down does not make the carbs disappear.
Some ultra-filtered milks have fewer carbohydrates because of their processing. Plant-based alternatives vary too.
Here are examples from manufacturer labels checked for this article:
Drink—1 cup | Total carbs | Fiber | Calculated net carbs | Protein |
LACTAID 2% lactose-free milk | 13 g | 0 g | 13 g | 8 g |
fairlife 2% ultra-filtered milk | 6 g | 0 g | 6 g | 13 g |
Silk Unsweet Almondmilk | 1 g | 0 g | 1 g | 1 g |
Silk Unsweet Soymilk | 4 g | 2 g | 2 g | 8 g |
Net carbs in this table are total carbohydrate minus fiber. Check your own package because products and labels can change. www.lactaid.com
Almond milk has fewer carbs in this comparison, but it also has less protein. Compare calcium and vitamin D as well.
Some people tolerate yogurt or small amounts of hard cheese. Others need to avoid more lactose. Choose according to your own symptoms and healthcare advice. www.niddk.nih.gov
Understanding total and net carbs
Total carbohydrate includes sugars, starches, and fiber.
“Net carbs” is a calculated figure.
A common method subtracts fiber from total carbohydrates. Some companies also subtract sugar alcohols, but these ingredients do not all affect the body in the same way.
The term does not have a standard legal definition. The American Diabetes Association recommends using total carbohydrate for carb counting.
At Faithful Steps, we show total and calculated net carbs so readers can see both. For medicine or insulin decisions, follow your diabetes team’s instructions rather than relying only on a front-label net-carb claim. diabetes.org
Foods that may support your gut microbiome
Some gut microbes use fiber from plant foods. Eating a variety of foods, you tolerate, can provide different kinds of fiber.
If you have not been told to limit fiber, these are foods to explore:
Food group | Examples |
Vegetables | Zucchini, leafy greens, broccoli, cabbage, asparagus |
Nuts and seeds | Almonds, walnuts, ground flaxseed, chia seeds |
Fruit in measured portions | Raspberries, strawberries, blueberries |
Other foods that may fit your carb plan | Beans, lentils, oats |
These are choices, not a list you must eat every day.
Portions still matter for blood sugar.
Try small amounts and increase fiber slowly. Too much at once may cause gas and bloating.
Keep notes about symptoms and blood sugar so you can learn what works for you. www.niddk.nih.gov
No single food can do everything.
A varied eating pattern is more useful than expecting one “gut health” product to solve every problem.
Foods with live cultures
Some foods contain live microbes.
Plain yogurt with live cultures is one example.
Lactose-free yogurt may be an option for people who cannot tolerate regular yogurt.
Some dairy-free yogurts also contain live cultures.
Check their labels for protein, total carbs, and added sugars.
Fermented foods, such as some refrigerated sauerkraut, may contain live microbes too. However, processing and heating can affect whether those microbes remain alive.
Fermented does not always mean probiotic.
A proven probiotic benefit depends on the specific microbes and the evidence behind them. Not every fermented food has that evidence. ods.od.nih.gov
Start with foods you enjoy and tolerate.
There is no need to force a food that makes you feel worse.
When more fiber is not the answer
Diabetes can sometimes damage nerves that help the stomach move food. This can lead to gastroparesis, meaning the stomach empties too slowly.
A person may feel full after a small meal, feel bloated or sick, or vomit. Delayed digestion can also make blood sugar harder to predict.
For this condition, a doctor may recommend less fat and fiber, smaller meals, and soft, well-cooked foods. Some people need puréed foods or liquid nutrition. www.niddk.nih.gov
That is why general advice to “eat more fiber” does not fit everyone.
Do not add seeds, large salads, or fiber supplements against your prescribed plan.
When a protein shake may help
Low-carb, plant-based protein shakes may be an option when solid food is hard to tolerate.
For some people with gastroparesis, liquids may move through the stomach more easily than solid food. This can make it easier to get needed protein and nourishment. The issue is often how food leaves the stomach, rather than whether the intestines can absorb the nutrients. www.niddk.nih.gov
A plant-based shake can also provide an option for someone avoiding dairy.
However, the label still matters. Compare:
Protein and calories per serving
Total carbohydrates and calculated net carbs
Fat and fiber
Ingredients that do not agree with you
A shake made for a low-carb diet is not automatically suitable for gastroparesis. Some contain more fat or added fiber than your care plan allows.
Also check whether the drink is a protein supplement or a complete meal replacement.
A protein shake may not provide enough calories, vitamins, and minerals to replace a meal.
A registered dietitian can help you choose a product that fits both your digestive needs and your diabetes plan.
How can less fat and fiber fit with low carb?
This is a fair question.
Many people following a low-carb plan use nuts, seeds, cheese, cream, and large portions of vegetables.
Those foods may be difficult to tolerate with gastroparesis.
You can still manage carbohydrates, but the balance of your meals may need to change.
A strict low-carb or ketogenic plan may be difficult to combine with lower-fat and lower-fiber limits while getting enough nourishment.
Your plan might include soft, lean protein, suitable cooked vegetables, and measured portions of easier-to-digest carbohydrate foods. An appropriate liquid meal may help when solid food is difficult.
The goal is to eat enough, reduce symptoms, and manage blood sugar together.
It is not to keep removing foods until very little remains.
Delayed digestion may also require changes in diabetes medicine or insulin timing. Your healthcare team should guide those changes. www.niddk.nih.gov
Ask for a dietitian consultation
Ask your healthcare provider for a referral to a registered dietitian, preferably one experienced in diabetes and digestive conditions.
A dietitian can help you fit your protein, calorie, carbohydrate, fat, and fiber needs together.
Bring your food record, symptoms, blood sugar readings, and labels from drinks or supplements you use.
This is especially helpful when several food restrictions overlap. You do not have to work out every detail alone.
Keep asking when symptoms continue
Michael’s story reminds me that ongoing symptoms deserve attention.
Write down what happens, when it happens, and what you ate or took beforehand.
Ask your healthcare provider what might be causing it and when to follow up.
Do not assume every digestive problem comes from lactose intolerance, diabetes, or a medicine.
Seek prompt medical care for severe pain, repeated vomiting, blood in the stool, or signs of dehydration.
Keep learning, one faithful step at a time
“Intelligent people are always ready to learn. Their ears are open for knowledge.”— Proverbs 18:15, NLT
Michael’s experience led me to ask questions. Research helped me understand more, while also showing how much we are still learning.
Faith does not require us to have every answer.
We can pray for wisdom, listen carefully, and seek help.
Your next step may be checking a label, trying a small portion of a food you tolerate, or asking for a dietitian referral.
Keep learning.
Keep asking.
Give yourself grace as you find what works for your body.
For more diabetes education, recipes, and faith-filled encouragement, visit FaithfulSteps.net.
Learn more
I encourage you to explore these sources and discuss questions with your healthcare team:
AI Transparency Note
This article was developed from my ideas, nursing experience, and Michael’s story, shared with his permission. AI helped with research, organization, and wording. I review the information and sources before publication.
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