For a diabetic, what does it mean to "eat right"?
“What can I eat?”
It’s one of the most frequently asked questions I hear when I meet with patients. Some patients are disappointed when I don't hand them a preprinted diet sheet, with exactly when to eat, what to eat, and how much to eat.
But healthy eating for diabetes is not “one size fits all.” The American Diabetes Association does not recommend a single, go-to meal planning approach. Patients with diabetes must learn what foods have the greatest effect on their blood sugar, how much of those foods they should eat, and how to add a variety of nutrient-dense foods in appropriate portion sizes to achieve blood sugar and overall health goals.
Healthy eating is the foundation of self-management for persons struggling with all types of diabetes, and is often the most challenging behavior to manage. Food decisions are influenced by a multitude of factors – emotions, habits, traditions, family and cultural eating patterns, health beliefs (and misconceptions), food preferences, food tolerances/allergies, and food affordability. An individualized approach the only way to make long-lasting changes.
To add to the complexity of our decision-making, we are constantly bombarded with advertisements, news reports, and advice of well-meaning family and friends with what you “can and cannot” eat. There are looks and comments when we make food choices. It makes deciding what to eat feel complicated and overwhelming.
"Healthy" eating is a huge topic, that cannot be covered in a short newsletter article, but I am going to try to review the basics of a healthy meal plan. Think of this the first stepping stone on a pathway leading to the most effective nutrition for your body. You'll have to take more steps, but this will get you going.
First, ANY nutrition plan requires knowledge about what foods have the biggest impact on our blood sugar. Let's begin with the building-blocks.
Food is made up of three macronutrients that provide energy and nutrients for our bodies:
1. Carbohydrates. A carbohydrate is the macronutrient that has the biggest impact on blood sugar. Read that again: Carbohydrates have the biggest impact on blood sugar. It makes up the majority of most diets (45%-50%), including healthy diets! Even persons with diabetes are recommended to eat carbohydrates. The key is to focus on quality carbohydrates.
There are three main types of carbs:
a) Sugar. Sugary foods and drinks — such as pastries, desserts, breakfast cereals, fruit juices and soft drinks — raise blood sugar very quickly after you eat them. You want this low on a nutrition label, especially added sugar. There are:
Sugars that naturally occur, such as in fruit and milk
Sugars that are added to food (desserts, sweetened drinks, etc.)
(Sidebar: I am often asked about low-calorie or no-calorie sweeteners found in diet drinks, baked goods, light yogurt, candy, and chewing gum labeled “sugar-free” or “no-sugar added”. These are sugar alcohols (which can have a laxative effect or other digestive irregularities), and artificial sweeteners. It should be noted that sugar alcohols still raise your blood sugar, but less than sugar or starch. The American Diabetes Association states that nonnutritive sweeteners may be an acceptable substitute for other sweeteners containing calories, and do not appear to effect blood sugar levels. Most research shows benefits to reduce overall carb and calorie intake, when used in moderation.)
b) Starch. Starchy foods raise blood sugar levels, but not as fast as sugar. As a complex carbohydrate, starches can come from:
Starchy vegetables like corn, potatoes
Beans, lentils and peas
Grains like wheat, oats, rice, barley and quinoa
Products made from processing grains, like pasta and bread
c) Fiber. Fiber is the type of carb that slows down digestion, helping your blood sugar levels rise slowly. Your body does not digest fiber, and it may also decrease your cholesterol. Fiber helps you feel full after eating, and have regular bowel movements. You want this high on a nutrition label. The recommendation for all adults is 25 to 30 grams of fiber daily. Most of us only eat half of that! High-fiber foods include:
Whole Grains (oatmeal, whole-grain cereals and breads, whole wheat pasta)
Fruits and vegetables
Nuts and seeds
2. Protein. Our bodies need protein for building tissues & muscle, immune function, energy and for hormone & enzyme production. Protein does not raise our blood sugar significantly. The majority of protein in our diet comes from animal sources, but there are many meat substitutes and non-animal sources of protein, such as nuts and beans. How much protein you should eat on a daily basis should be individualized. While you're aiming to eat enough protein through meats, there may be other counter-productive effects from the meats you choose. To lower the risk of heart disease, every diabetic should:
Eat fish 2 to 3 times a week.
Choose lean cuts of beef & pork.
Remove skin from chicken & turkey.
Choose non-fat or low-fat dairy products.
3. Fat. Our bodies need fat for energy, to protect our organs, and support cell growth. Fat also helps your body absorb vital nutrients. Fat does not raise blood sugar significantly.
While fats should be used sparingly—they are calorie-dense and can increase your weight—a small amount of fat consumed with other nutritious foods will actually help slow the rise of blood sugar. In other words, a diabetic may benefit from pairing a starchy item (say, a baked potato) with a healthy fat (like a dollop of light sour cream). In this example, the fat in the sour cream can slow the sugar spike that would occur from the potatoes on their own. Another example is a banana – you might pair a banana with a tablespoon of peanut butter, or a few raw almonds, which have healthy fats (and fiber) that can reduce the sugar spike from the banana. (They will also keep you fuller, longer!) By understanding these relationships, you can design a better snack.
All foods containing fat have a mix of specific types of fats. There are three types:
a) Unsaturated fat. These are liquid at room temperature, are considered beneficial fats because they can improve blood cholesterol levels, ease inflammation, stabilize heart rhythms, and play a number of other beneficial roles. They are found in foods from plants – you can get monounsaturated fats from avocados, olive or canola oil, almonds, hazelnuts, pecans, pumpkin and sesame seeds; you can get polyunsaturated fats from sunflower, corn, soybean and flaxseed oils, walnuts, and fish. (Omega 3 fats are an important type of polyunsaturated fat. The body can’t make these, so they must come from food such as fish, flaxseeds, canola oil.)
b) Saturated Fat. Saturated fat is mainly found in animal foods, plus a few plant foods such as coconut, coconut oil, palm oil, and palm kernel oil. Some of the biggest sources of saturated fat in the diet are pizza, cheese, whole and low-fat dairy products, meat products (sausage, bacon, beef, hamburgers), cookies and other grain-based desserts and fast food. Cutting back on saturated fat can be good for health if replaced fat with good fats, especially polyunsaturated fats, and not with refined carbs.
c) Trans Fat. Trans fatty acids, more commonly called trans fats, are man-made to prolong shelf life. They can withstand repeated heating, and are the worst type of fat for the heart, blood vessels, and rest of the body.
Understanding these food building-blocks can make a world of difference for customizing your nutrition plan.
A Healthy Eating Plan – For ME
To have success, you have to select a plan that fits your lifestyle and goals. The two most common meal patterns that can help persons with diabetes achieve health and their blood sugar goals are:
Carbohydrate (carb) counting, and
A healthy eating plan, such as The Plate Method.
Carb counting asks you to stay within a target amount of carb grams daily, and allocate them to each meal. For example, "30-45g carbs per meal and 15-20g carbs per snack" might be a target range. Carb counting provides flexibility, and focuses on nutrient dense or “quality” carbs in appropriate portions. Carb counting gives you the most control, and when combined with blood sugar monitoring, it can identify foods that raise your sugar blood sugar the most.
A Sample Meal Plan might be designed like this:
There are also many "healthy eating" plans that do not require reading every food label. They all focus on nutrient-dense food in appropriate portions. The simplest is The Plate Method.
The Plate Method
It’s easy to eat more food than you need to, without realizing it. The plate method is a simple, visual way to make sure you get enough non-starchy vegetables and lean protein, and limit the amount of higher-carb food that has the greatest potential to spike your blood sugar.
Start with a 9-inch dinner plate.
• Fill half with non-starchy vegetables.
• Fill one quarter with a lean protein.
• Fill a quarter with a grain or starchy food.
This method is excellent when you can't read food labels, such as when you're dining out. It can help you decide what side-dishes to order, or encourage you to take home a to-go bag with the extras that don't properly portion your plate.
The Mediterranean Diet, DASH (Dietary Approaches to Stop Hypertension), and plant-based diets are other examples of eating plans appropriate for people with diabetes. Again, you may have to take some time initially to read food labels to become familiar with the carb, fiber, and fat content of foods, but then you can move to something like the plate method.
(If you're interested in guided coaching for weight loss and nutrition planning, CMMD and Associates offers an in-house nutrition expert with a subscription-based program. Check it out here.)
While you must craft a plan that's right for your needs, these are the general principles that every diabetic can count on and every successful diabetic eating plan are based on:
Eat a variety of foods, in the right amounts.
Get familiar with the meaning of calorie, carbohydrate, total fat and sodium amounts on a food label, and what different amounts of these nutrients are going to do to your blood sugar.
Eat small portions, several times a day.
Match how much you eat with your activity level. (We'll cover activity in a later post.)
Eat fewer foods high in calories, cholesterol, saturated fat, trans fat, and sodium.
Non-starchy vegetables (asparagus, bay corn, beans, broccoli, Brussel sprouts, cabbage, carrots, cauliflower, celery, cucumber, eggplant, green onions, leafy greens, mushrooms, onions, peppers, radishes, spinach, squash, tomato)
Lean protein (leaner cuts, fish, and meat without skin)
Non-fat or low-fat dairy products
Water, unsweetened tea, coffee, and calorie-free “diet” drinks, instead of drinks with sugar
Healthy eating involves many variables – and we didn't address them all in this piece. Make an appointment with me to set personal goals and figure out what plan is best for you!
Ready to discuss your nutrition plan for your diabetes? Schedule an appointment with me at any time to discuss personalized goals. Send me a message in the patient portal, request an appointment here, or email firstname.lastname@example.org.