Historical accounts of the origin of the sandwich are varied, but many food historians give credit to John Montagu (aka the 4^th Earl of Sandwich), an avid gambler who in 1762 requested something he could eat with his hands and was brought two pieces of bread with meat in the middle. Fast-forward almost 300 years, and according to the USDA’s What Do We Eat in America? survey, 47% of Americans report eating a sandwich daily. For the record, Merriam Webster defines a sandwich as either two or more slices of bread or a split roll having a filling in between, or one slice of bread covered with food. However, there are many sandwich variations, and most restaurants have some version of a sandwich on their menu. If you are among those who regularly consume sandwiches and you happen to have diabetes, or you are simply interested in learning about sandwich alternatives that minimize blood sugar spikes, then keep reading. 

Sandwich alternatives: Choosing a healthy sandwich bread

With the craze for low-carb and gluten-free continuing to trend, bread has gotten a bit of a bad rap the last several years. But as we explored in our What Is the Healthiest Bread To Eat? guide, not all breads are created equally. For those who enjoy sandwiches on a regular basis and are looking for sandwich alternatives to minimize blood sugar spikes, it’s best to choose a bread made from nutrient-dense whole grains. Here’s why:

The Glycemic Index (GI) is a measurement of individual foods and their effects on blood sugar, and typically the more fiber a food contains, the lower the GI value. For example, white bread is considered a high-glycemic food as it typically has a GI value of higher than 70. White breads and traditional sandwich rolls are made with refined white flour, which has been stripped of fiber, vitamins and minerals. On the other hand, bread made with 100% whole grain is considered a low-glycemic food as it has a GI of less than 55. The lower GI of breads made from whole grains is attributed to their fiber content. According to the Center for Disease Control (CDC), because the body is not able to absorb and break down fiber, foods with a higher fiber content will not elevate blood sugar the way foods with refined carbohydrates can. Breads with the recommended two to four grams of fiber per slice, and with the lowest amount of sugars or no added sugar, should be considered to minimize blood sugar spikes. Bread that contains sprouted grains, such as Ezekiel 4:9 breads from Food 4 Life, contain all the fiber and bran of the original grains, are easily digestible and add a sizable increase in vitamin and mineral content.

Sandwich alternatives: Healthy “sandwiches” without bread

Traditional bread is not the only option for a hand-held meal that will minimize blood sugar spikes. Try some of these healthy sandwich alternatives: 

• Whole-grain wraps and tortillas: Same logic applies here as with bread; look for wraps or tortillas that are made with whole-grain wheat, corn, or rice. Often you will be able to find brands like La Tortilla Factory and Food 4 Life that have alternatives with less carbs and double the fiber of white bread.

• Lettuce or greens: A leaf of lettuce can be loaded with your favorite filling for a healthier sandwich vehicle that is naturally rich in fiber, vitamins and minerals. You can also lightly blanch collard greens, Swiss chard, kale and cabbage to make those greens more pliable and easier to use as a wrapping. 

• Roasted veggies: Thinly sliced zucchini or eggplant can be brushed with olive oil, roasted in a 425-degree oven for a few minutes until pliable, cooled, spread with a filling such as hummus or ricotta cheese, sprinkled with seasonings, and then rolled into yummy bite size snack sandwiches. Likewise, sweet potato slices, Portobello mushrooms, and bell peppers (raw or roasted) can be used as healthier sandwich alternatives to bread.

• Cauliflower wraps: This low-carb bread substitution has cauliflower as a base and is typically mixed with herbs, spices, eggs. The Sandwich Thins from the Outer Aisle brand come in four flavors and have 10 grams of protein, 5 grams of total carbs, 1 gram of fiber and the equivalent of two servings of vegetables per two pieces. Thus, these are a good option for a sandwich alternative that minimizes blood sugar spikes. 

• Cucumbers and jicama: Add your favorite contents to thinly sliced cucumber or jicama or scoop the insides out of the cucumber and you’ve got yourself a ready-to-fill cucumber sub that will minimally impact blood sugar levels.

Sandwich alternatives: Fillings

Regardless of whether you choose bread or an alternative for your variation of a sandwich, the options for healthy fillings are endless. As described in the guide, How Protein, Fat, Carbs, and Fiber Affect Blood Sugar, these components of food all play a role in how your body regulates glucose. Ideally, healthy sandwiches should include fiber-rich complex carbohydrates combined with protein and healthy fat — to boost your energy, slow the body’s rate of carbohydrate digestion (to minimize blood sugar spikes) and help keep you full until it’s time for the next meal. Sandwich fillings can be basically anything that you can stuff, layer, or spread. The following are some tasty options to consider for minimizing blood sugar spikes: 

• Tuna, salmon, chicken, egg or tofu salad: Any one of these lean proteins can be combined with Greek yogurt or mayo, chopped onion, celery and any additional seasonings you prefer — for a sandwich filling that is loaded with flavor and balanced nutrition.

• Leftovers: Whether you had chicken, meatloaf, or roasted veggies for dinner last night, leftovers can make great sandwich fillings for lunch the next day. For a well-rounded sandwich that will minimize blood sugar spikes, add your leftovers to a whole-grain tortilla smothered with your favorite spread (such as hummus); then layer with cucumber, tomato and lettuce or spinach for a nutrient-rich flavor and texture boost. 

• Meatless sandwich options: With many consumers turning to the health benefits of a plant-based diet, the gamut of options runs wide for meatless sandwich fillings, many of which contain complete protein. Layer on roasted or raw veggies, slice or spread some avocado for healthy fat, or get creative with a sandwich slaw chock full of shredded cabbage, carrots and beets — colorful vegetables that provide a rainbow of healthful benefits. Vegetables aside, falafels, veggie burgers, tofu, seitan, tempeh bacon and many more meatless proteins that can be used for sandwich fillings are readily available in most local markets.

• Deli meats: Many consumers have a hard time thinking beyond deli meats for their sandwich fillings. A wide variety of options are available ranging from minimally-processed, organic, grass-fed, hormone- and additive-free turkey to its polar opposite —  ultra-processed bologna that is loaded with undesirable additives. Word to the wise is to choose the least processed deli meat you can find, as some of the additives (used to improve shelf-life, flavor, color and flavor) in ultra-processed meats have been linked to increased risk for various cancers, as well as heart disease and diabetes. Deli meat will not greatly impact blood sugar and the occasional intake of a sandwich with ultra-processed meat is unlikely to significantly harm your health. However,  if deli meats such as bologna and salami are creeping onto your sandwich more than a few times per month, make sure you use nitrite- and nitrate-free versions (such as those from Boars Head.)  

• Cheese: Like deli meats, most cheeses are healthy sandwich ingredients that will minimize blood sugar spikes. Stick to real cheese, and steer away from anything labeled “pasteurized cheese product” (such as the notorious American cheese slices). Although there is some concern about the high fat and sodium content of cheese, minimally processed natural cheese is an excellent source of protein and calcium. Both mozzarella and Swiss cheese are lower in sodium and saturated fat than most other cheeses. 

• Spreads and condiments: Spreads like hummus and guacamole or soft cheeses such as ricotta or cream cheese will not only add flavor, but can also add a bit of protein and fat to a sandwich to help minimize blood sugar spikes. As far as condiments, shoot for mayo that is made with avocado or olive oil as they both contain healthy fats that have been shown in research to improve insulin sensitivity. Before adding any sauce, dressing, or spread, check the label to make sure it does not contain added sugars, such as the honey found in honey mustard sauce, that will spike blood sugar.

Sandwich alternatives: Deconstructed “sandwiches”

Another out-of-the-box sandwich alternative that technically doesn’t fit the definition of two pieces of bread with a filling in between is a deconstructed sandwich. Take any combination of the breads, fillings, and spreads mentioned above and make yourself a meal, perhaps just combined in a bowl or layed out on a board or plate,  reminiscent of the traditional English Ploughman’s lunch  (bread, meat, cheese and condiments).  

Are peanut butter and jelly sandwiches healthy?

The infamous PB & J is popular for a reason: it offers the perfect balance of sweet and salty that most people love, not to mention it is super easy to pack in any lunchbox, and affordable. In 2017, ESPN magazine referred to the PB & J as the NBA’s secret addiction for boosting the game. But are peanut butter and jelly sandwiches healthy and do they fit into the category of sandwich alternatives that minimize blood sugar? Well, it depends on the components. Here’s how to make a PB & J that is healthier:

• Choose a healthy sandwich bread (as described above).
  
• Opt for “jelly” without added sugar, such as St. Dalfour 100% fruit spreads, or substitute fresh berries or sliced bananas for a fresher and more vibrant flavor and texture.
  
• Select natural peanut butter that does not contain added sugar or swap with any other nut or seed butter. The healthy fat and protein in the peanut butter will help minimize blood sugar spikes from the naturally occurring sugar in the jelly. (Learn more about these and the other health benefits of peanut butter.) Try adding chia, ground flax or hemp seeds to boost the protein content and add a bit of crunch, or you could lose the bread component and use thinly sliced apple pieces instead.

Key takeaways

While traditional sandwiches tend to be carb-laden and can quickly elevate blood sugar, you can minimize blood sugar spikes by pairing an outer layer with a filling that both contain healthy fat, lean protein and fiber. With a little creativity and by following some of the guidelines presented here, you should be able to build a healthier sandwich alternative that will sustain you until your next meal. Bear in mind that blood glucose responses to foods vary amongst individuals; so to determine how a particular food specifically affects you, consider the use of a continuous glucose monitor (CGM) to assess the metabolic impact of your sandwich components.