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)