A diagnosis of type 2 diabetes—or even prediabetes—usually means the doctor has suggested that you make some changes to your diet or the diet of someone you care for. This is a good time to become wiser about how you are eating on a regular basis.
Fortunately, following a diabetes diet doesn’t mean giving up the joy of eating or avoiding your favorite foods and special family meals. You can still enjoy “pizza night,” celebrate birthdays and anniversaries, and partake in holiday meals and vacation dining. This is more about your routine daily food choices and meal planning.
Use the four sections of a plate as a guide when planning healthy meals for someone with diabetes. Photo: 123RF
Eating to beat diabetes is much more about making wise food adjustments than it is about denial and deprivation. A better way to look at a diet when you have diabetes is one that helps you establish a new normal when it comes to your eating habits and food choices.1
What Should You Eat If You Have Diabetes?
In truth, a diet aimed at reducing the risks of diabetes is really nothing more than a nutritionally-balanced meal plan aimed at supporting maintaining blood sugar levels within range and supporting a healthy weight.
For those with prediabetes or type 2 diabetes, the main focus of a diabetes-focused diet is being attentive to your weight.2 That said, a diabetic diet is simply an eating approach that works to keep you healthy, and so is not reserved only for people with diabetes. Your whole family can enjoy the same meals and snacks, regardless of whether others have diabetes or not.
Yes—There are a few food decisions that will matter more if you do have diabetes. We provide you with some general guidelines to help you understand how much and how often to eat in order to maintain steady blood sugar levels. And, these recommendations hold true for anyone who has diabetes: type 1 diabetes and type 2 diabetes, as well as prediabetes and gestational diabetes.1
Diet really does matter, a lot!
In fact, if you were recently diagnosed with prediabetes or type 2 diabetes, by decreasing your weight by about 10%, you may even reverse your diabetes, putting it into remission.3,4
Adopting a Diabetes Diet Plan for Long-Term Health
By becoming a bit more savvy about the effect that foods, especially carbs, can have on your blood sugar, you will want to know how and why to adjust your food choices; you can feel so much better in the process.
It may ease your mind to know you will be able to incorporate your favorite foods into a healthy diet while being mindful of your diabetes diet goals (eg, healthy weight, steady blood glucose levels, good blood pressure). For many people, at least initially, this may seem harder than it should be and that’s understandable; after all, it can seem very, very challenging to change current eating habits and find the right food rhythm to fit your lifestyle.
You don’t have to go it alone—Seek advice from a registered dietitian (RD) or certified diabetes educator (CDE) who has the right training to help you come up with an individualized meal plan that will help you meet your self-management goals, get the nutrition you need, and show you how you can incorporate some of your favorite foods into your diet so that you continue to enjoy eating. Hopefully, your doctor has someone on the team, but if not, call your health insurer to ask for the names of a few in-network RD/CDEs.2
There are also virtual coaching programs that appear very effective; this means you can get individualized dietary guidance at home or at work. Most health insurance companies will cover the cost of diabetic diet counseling so ask your doctor for a prescription so cost doesn’t hold you back.
“While the idea of changing your diet can be confusing and overwhelming at first, research shows that making healthy lifestyle choices can help you manage your blood sugar levels in the short term and may even prevent many of the long-term health complications associated with diabetes,” says Lori Zanini, RD, CDE, and author of The Diabetes Cookbook and Meal Plan for the Newly Diagnosed.
Although you can include most foods in a diabetic diet, you do need to pay most attention to particularly to the types of carbohydrates you choose in order to prevent spikes, or unhealthy increases, in your blood sugar.
Foods high in simple carbohydrates—mostly from added sugars (ie, cane sugar, brown sugar, maple syrup, honey) and refined grains (especially white flour and white rice)—as foods containing these ingredients will cause your blood sugar levels to rise more quickly than foods that contain fiber, such as 100% whole wheat and oats.
“Everyone is different and, ultimately, you know best how your body responds to different types of foods, so you may have to make individual adjustments when cooking at home, eating out, or attending celebrations,” Ms. Zanini points out. “You may find that some processed, high-carb foods, like commercial breakfast cereals and plain white rice, are just too “spiky” for you and it’s best to stay away from them and find reasonable substitutes.”
Diabetic Diet: All About Making Calculated Food Choices
There are different types of diabetes, determined mainly by your body’s ability to produce and use insulin—the hormone necessary for getting sugar out of your blood and into your cells where it is used to produce energy.
The symptoms of all types of diabetes are similar, so the steps you need to take to control your blood sugar remain the same. Your diet plays a very critical role in managing your diabetes by keeping blood sugar levels stable throughout your lifetime. You are in control of what you eat, so this is one area you can and should learn to manage wisely.
For people with type 2 diabetes, your pancreas produces plenty of insulin that is not sensed by the cells so your body is unable to properly use the insulin you make. Usually, type 2 diabetes can be controlled well with lifestyle changes—particularly shifting from processed carbs to high fiber foods, and walking daily— as needed with the addition of medication.1
“Some people with type 2 diabetes may also need to begin taking insulin at some point,” says Sandra Arevalo, MPH, RD, CDE, a diabetes expert and spokesperson with the Academy of Nutrition and Dietetics. “It can depend on your age and your individual ability to control your blood sugar with diet and exercise.” However, when type 2 diabetes is found early enough and weight loss is achieved, in most cases, insulin is never needed.
A diagnosis of prediabetes means that your blood sugar levels are slightly above the normal range because your body is no longer responding to insulin effectively, but not yet high enough for a diagnosis of type 2 diabetes.
By making some adjustments to your current food patterns, and increasing your level of physical activity, it is possible, even likely, that you can prevent or delay the progression to diabetes, as well as reduce your risk of heart disease and other complications associated with poorly-controlled diabetes.2-4
“You don’t necessarily have to follow a strict food regimen and avoid all kinds of foods when you’re diagnosed with diabetes or prediabetes,” Ms. Arevalo adds. “You just have to learn how to combine different types of foods in the same meal and measure those foods so you eat appropriate amounts.”
Combining foods, by combining a carb with either protein or some fat, is the best trick for controlling blood sugar, and keeping it steady. The food portions, as you might expect, have more to do with meeting your energy needs but not consuming excess calories, which get stored as fat, leading to undesirable weight gain.6
Three Diabetes Diet Strategies: Basic Guidelines for People with Diabetes
Finding your way to a healthy diet can reduce the risks associated with diabetes. There are three main goals, according to the American Diabetes Association (ADA),1 so following these proven strategies will help you to:
1. Achieve a healthy body weight.5,7 Body mass index (BMI) uses your height and weight to determine how much body fat you carry. A BMI of 18.5 to 25 is considered to be a healthy weight range with a healthy amount of body fat. Another measure: waist circumference (WC) is considered by many to be a better measure of excess abdominal body fat. A waist circumference—greater than 40 inches for men, and above 35 inches in women—has been shown to increase the risk of developing health problems such as type 2 diabetes, heart disease, and high blood pressure.
The closer you are to a healthy body weight or at least an acceptable waist circumference, the more likely you will be able to control and, possibly reverse your risks of diabetes.
“Don’t get overwhelmed by thinking about how much total weight you have to lose,” Ms. Arevalo advises. “Studies have shown that losing just 5-10% of your body weight will significantly improve your blood sugar levels as well as your cardiovascular health so set short-term goals of losing just 5-10 pounds to start.”
2. Attain normal lab results. Your physician will work with you to establish individual goals for blood glucose, blood cholesterol, and blood pressure. Regular testing will help ensure that your diet plan, exercise strategies and medication, if necessary, are all working together to keep your blood sugar, lipids, blood pressure, and your body weight, in healthy ranges.
3. Avoid future complications. Lifestyle changes, including adjustments to your diet and the addition of regular physical activity (even if only a 30-45 minute daily walk), can reduce your risk of developing heart disease, kidney disease, nerve damage, stroke, blindness, and other long-term health problems that can commonly occur in people with diabetes.
Adopting a Food Plan for Diabetes
According to the American Diabetes Association (ADA),1,6 a Mediterranean-style diet, a plant-based diet, and a diet known as Dietary Approaches to Stop Hypertension (DASH) are all good starting points for a diabetic eating plan that can be modified to accommodate your personal eating preferences.
These diet approaches have two important factors in common: mostly whole foods, and meals built around vegetables rather than carbohydrates (carbs).
However, contrary to popular belief—A diabetic diet is not necessarily a low-carb diet, nor should it be a high-protein or very low-fat meal plan. In fact, ADA recommends less emphasis on specific requirements for proteins, carbs, and fats, and more emphasis on following a whole foods approach that focuses on the quality of your diet; the less processed, refined, prepared, and fast foods focused, the better.1
What’s the big deal about avoiding processed foods? The more a food has been mechanically handled, and refined, the greater the likelihood that their nutritional value will lower, and typically has more sugar, refined flour, and saturated fats as their main components. By eating foods considered highly refined (ie, empty calories), you are filling up on foods that will make it harder to manage your weight and your blood sugar levels.
“An RD or CDE can look at your usual diet and help you identify where there’s room for improvement,” Ms. Arevalo suggests. “These diet experts can also help you create a diabetes diet plan tailored to your personal needs and food preferences.”
When you meet with a dietitian or CDE, she will consider all of your health concerns, your weekday and weekend schedules, any cultural or religious preferences, and your likes and dislikes, as well as anyone else who usually eats with you. By taking into account all of these factors, you will have the best chance of establishing a workable new approach to eating that will support your ability to manage your diabetes with the least disruption possible.
What You Need to Know About Eating with Diabetes
How much do calories matter? For people with diabetes, the exact number of calories to consume each day is based on the amount and timing of food that assures you can you’re your blood sugar levels stable and your weight within a healthy range. That number can change, depending on your age, activity level, frame size, current versus preferred weight, and other factors.5,7
“When the goal is a healthy weight and blood sugar control, a good starting point for a woman is 1,400-1,600 calories a day, with main meals containing up to 30 grams of fiber-rich carbohydrates, and snacks containing 10-20 grams of fiber-rich carbohydrates,” Ms. Zanini advises. “For men and more physically active women who are already at a healthy weight, you may start with a 2,000-2,200 calorie meal plan, in which you may increase proportionately your carbs.”
Recent research suggests that by eating a big breakfast, and a modest lunch, so you get most of your calories in by 3 pm, you will find it easier to lose weight and achieve better blood sugar control.8,9
Choose Carbohydrates that Keep Blood Sugar Steady
Our wide variety of food products contain different levels and types of carbohydrates making it harder to eat wisely with diabetes. In general, you will want to choose carbs that have the least impact on your blood sugar. That means selecting foods that are high fiber, low sugar foods since these foods are absorbed more slowing so have little impact on blood sugar changes.5
Best carb choices to promote a healthy lifestyle for people with diabetes:
- High fiber foods include: Whole grain breads and cereals, and foods made with 100% whole wheat, oats, quinoa, brown rice, corn and cornmeal
- Dried beans, lentils, and peas
- Fresh (or frozen) fruits like berries, apples, pears, and oranges,
- Dairy products including yogurt, milk, and cheese. The best yogurt is Greek-style or strained yogurt since these contain triple the level of protein.
- Vegetables. Both starchy and non-starchy vegetables are all healthy carbs that have less (glycemic) effect on your blood sugar
As you might guess, sugar-sweetened cookies, cakes, doughnuts, and other baked goods made with white flour as well as candy and soft drinks that contain sugar and high fructose corn syrup have little nutritional value and are likely to send your blood sugar soaring, so should eat them only occasionally, if at all, and only in very small amounts
The same goes for yogurt. Better to avoid so-called fruit-sweetened yogurts because these are mostly added sugar. Instead stir in some fresh or frozen berries, banana, or your favorite seasonal fruit to plain yogurt; and you might even add some granola or chopped walnuts for crunch and a bit of added protein and fiber.
Flour and sugar represent two ingredients most likely to wreak havoc for people with diabetes because they typically add unnecessary calories, and end up leading to a boost in blood sugar and your weight; a double whammy. While you don’t have to avoid flour and sugar altogether, you have to be mindful of when and how often you are eating foods flour-based, sugary foods. Skip foods made with all-purpose white flour and avoid sugary foods, sugar-sweetened drinks.
A Word on Sugar Substitutes. The current belief is that people who need to follow a diabetes diet should avoid added sweeteners of all kinds, including sugar substitutes and artificial sweeteners. Researchers have found that people who consume foods with any form of sweetener typically crave more of these foods, and end up gaining weight.
Your best bet is to begin using fruit to get your sweet fix. By adding fruit to foods, you totally avoid the added sugars and sugar alcohols and get the added benefit of dietary fiber, which is better for blood glucose control.
“Of all the alternative sweeteners, stevia is the one I recommend most often,” says Ms. Zanini. “It’s a great natural and zero-calorie option for blood sugar control when added to beverages, hot cereals, and other foods when you are looking for a little sweetness.” You’ll have to experiment with stevia, she adds, because it works better with some foods than with others.
One of the best changes anyone with diabetes can make is to switch from white food products—white bread, white potatoes in any form, and white rice—which can also cause notable spikes in blood sugar to similar products made from whole grains, like multigrain sourdough bread, shredded wheat or sweet potatoes, and roasted red potatoes which still have the skin on.
Learning to prepare your favorite pancakes or waffles with oat flour or almond flour will go a long way in helping you to enjoy a diabetes-friendly breakfast that the whole family will enjoy.
Keys to Reducing Complications of Diabetes
Fiber, Fiber, Fiber: Best Carb Choices Contain Dietary Fiber
This is the basis of a healthy diet, as well as the key to a diabetic diet plan, and even a good diet for weight loss. After reading the section on carbs, it may be obvious to you now that the one factor that separates healthy carbs from all other carbs is the presence or absence of dietary fiber. Only plant foods contain fiber. Those with the most fiber include dried beans, peas, and lentils, fruits, vegetables, whole grains, nuts, and seeds.
A high fiber diet—one that contains at least 25 to 35 grams of dietary fiber a day—is essential for good health, and is the key for people with diabetes because fiber helps slow down the absorption of all sugars—those that are naturally forming like in fruits and starches, as well as any refined sugars you consume—in your bloodstream.
“When meals are well-balanced (including some protein, fat and fiber-rich carbs), they are generally more satisfying,” Ms. Zanini adds, which means you won’t get hungry between meals and go looking for a quick fix that will cause your blood sugar to soar, and your body to store those unneeded calories as fat.
Protein: Make Your Choices Lowest in Saturated Fat
Unless you are a vegetarian or vegan, you’re likely to get plenty of high-quality protein from lean meats, poultry, seafood, dairy, and eggs.
Both vegetarians and non-vegetarians should also look to plant sources for some or all of your protein needs. Plant foods like soy-based foods: tofu and tempeh are excellent sources of non-animals proteins and fits quite well into a diabetic meal plan because it is also low in carbs. The same can be said for nuts, and legumes such as black beans, chickpeas, lentils, and edamame as well as some whole-grain foods such as quinoa, kamut, teff, even wild rice and couscous contain some protein.
Not All Fats Are Created Equal so Aim for Heart-Healthy Fats
When you have diabetes, you are at higher risk of developing other chronic health problems, such as heart disease, high blood pressure, and kidney disease, so it’s just as important to watch the types and amounts of fat in your diet as it is to monitor your carbs.
What foods contain heart-healthy fats? These include olive oil and oils made from nuts (eg, walnut oil, peanut oil), avocado, fatty fish l(eg, Sockeye salmon, mackerel, herring, and Lake trout), nuts and seeds.
A Cautionary Word about Salt
Some people are sensitive to salt, which causes higher blood pressure when too much sodium is consumed. Since we have no way of testing who is salt-sensitive and who isn’t, the best precaution is to limit salt and avoid sodium-containing foods if you may be at risk for high blood pressure.
Simply put, the excess salt in most people’s diets comes from processed foods so check the package for sodium content. By adopting a diabetes diet that contains mostly whole foods, this issue will no longer present a problem. Also, foods that are flash frozen are as good as fresh.
Canned vegetables usually have added salt as a preservative. Your best bet when buying food products is to check the nutritional label for sodium content. You’ll want to stay well below the upper recommended limit of 2,000 mg/day, and you can certainly look for low-sodium varieties of canned, and processed, prepackaged food products.
Arriving at Healthy Diet that Fits Your Needs with Diabetes
Now that you know what foods are better if you have diabetes, putting the right foods on your plate is a matter of portions. The key to a balanced diet is planning meals using the diabetes plate method—divide the plate into quarters: ¼ protein or meat, 1/4 carbs, and 2/4 (=1/2) vegetable and fruit.6 If you want to lose weight, use 9-inch dinner plates and bowls so you aren’t piling the food on to a large dinner plate.
For example, fill half the plate with non-starchy carbs such as salad greens or steamed broccoli, and fill the remaining half of the plate with equal portions of a grain or starchy vegetable like mashed sweet potato, and a heart-healthy protein such as broiled salmon.
Here are some sample dinner menus to give you an idea of reasonable portion sizes that make up a healthy meal for someone with diabetes (or anyone for that matter!):
Suggestion for Dinner 1:
- 5 or 6 ounces roasted chicken (skin removed)
- 1/2 cup multigrain pasta (Cooked, or Bangz chickpea pasta) tossed with 2 tablespoons olive oil, and a teaspoon of grated Parmesan cheese
- 2 cups sautéed zucchini and/or summer squash and sliced mushrooms
Suggestion for Dinner 2:
- 6-ounce salmon fillet, broiled with lemon
- 1/2 cup lightly steamed broccoli and 1/2 cup halved cherry tomatoes
- 1 cup baby kale and spinach, lightly sautéed in olive oil with chopped garlic and onion
Suggestion for Dinner 3:
- 6 ounces (about 1 1/2 cups) sauteed tofu seasoned with Chinese 5-spice powder
- 1/3 cup quinoa
- 1/4 avocado, sliced and topped with sesame seeds and a squeeze of lime
- 1 cup cucumber, snow pea pods, arugula, and radish salad dressed with vinegar and light soy sauce
How to React When Temptation Strikes with Diabetes
In diabetes diet terms, temptation translates to foods you “shouldn’t” eat because they are loaded with sugar and empty carbs that will send your blood sugar skyrocketing. That piece of cake, cinnamon bun, brownie, or bag of chips usually contain more than just carbs, they usually contribute unhealthy fats too.
The less often you eat these sugary, fatty desserts and snacks, the less you will come to want them. Some people do better allowing yourself an occasional craving. Striking the right balance will depend upon your goals, and urgency. By skipping these calorie-laden artery cloggers, you are voting for long-term health in place of serious medical complications. But you know that already.
Here’s the thing: this word of caution is not just for people with diabetes who need to watch their sugar and fat intake, in truth, it is a red flag for anyone who wants stay healthy and avoid chronic diseases. That’s why the whole family benefits from eating healthy foods and saving small indulgences for special occasions.
How to Participate in Celebrations with Diabetes
Let’s face it, being surrounded by cupcakes and chips while other people get their fill at birthday parties and holiday celebrations, can be very frustrating. There are several things you can do to get through these events without feeling completely deprived. First, you can make sure you have been eating balanced meals earlier in the day, so you arrive at the event with a stabilized blood sugar, and not starving.
“You don’t have to stop eating sweets in order to control your blood sugar and, in fact, if you add these “extras” strategically, you’ll improve your chances of long-term success,” Ms. Zanini says. “Giving yourself permission to enjoy an occasional sweet may empower you to self-manage diabetes in a way that suits your individual needs.”
Updated on: 12/06/19
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