Diet and Diabetes
Can watching my diet help me control my diabetes?
Yes. The foods you choose and the timing of your meals can make a big difference in how well you manage your condition, so it's a good idea to work out a plan with your doctor and a dietitian. The main goal will be to avoid fluctuations in the level of sugar, or glucose, in your blood. You'll also need to keep your weight under control and hold down your levels of cholesterol and blood fats called triglycerides. Sticking to a good diet can help you do all of these things.
Do I have to give up sugar?
Not entirely. It's true that sugar is absorbed into the blood quickly, and too much glucose hitting the bloodstream at once is hard on the body. But white sugar has been unfairly singled out. Researchers now know that other carbohydrates like white bread, white rice, and pasta can spike your blood sugar, too. The trick is to eat these foods along with some protein, fat, or fiber, so that the glucose is absorbed into the blood more slowly. Nutrient-rich foods like fruit are still preferable to cookies, but you needn't deprive yourself of sweets altogether as long as you have them with a meal and not alone (and include them in your total carbohydrate count for the day).
What kinds of carbohydrates are best?
Whole grains and other high-fiber foods, such as beans and many fruits and vegetables, are more nutritious than refined carbohydrates. What's more, they're filling -- so you feel satisfied after a meal based on them -- and they may reduce your level of LDL, or bad cholesterol. Those are good reasons to switch to whole wheat bread and brown rice. Try out different grains, like barley or kasha, and legumes like chickpeas. Crunchy fruits and veggies such as apples and carrots are good choices.
Is there anything I should avoid?
As a person with diabetes, you're at a higher-than-average risk of cardiovascular disease. In fact, heart disease is the leading cause of death for people with diabetes, so you'll need to watch your fat intake. Your personal diet plan depends on your specific medical condition, so ask your doctor to refer you to a registered dietitian. If you're overweight, you'll most likely need to cut back significantly on dietary fat. Shedding even a few pounds can make your blood sugar easier to control. The fat in your diet should be mostly monounsaturated fat (found in olive and canola oils, nuts, and avocados), since there is some evidence that this type of fat can reduce the level of harmful triglycerides in your blood and raise your level of HDL, the good cholesterol. Limit artery-clogging saturated fats (found mostly in animal foods) to no more than 7 percent of your daily calories -- this will help keep your bad cholesterol in check. And try to avoid all trans fat (also called "partially hydrogenated oil"), which raises the level of bad cholesterol and lowers the level of good cholesterol in your blood.
The FDA also recommends that you avoid eating raw oysters or clams -- diabetics are more susceptible to infection from the Vibrio vulnificus bacteria that is sometimes found in raw shellfish. Undetectable by taste or smell, the bacteria can cause severe illness and even death. Thorough cooking destroys it and eliminates any chance of infection.
Why is the timing of meals important?
Eating several small meals throughout the day rather than two or three big ones can help keep your blood sugar stable. Don't wait to have a meal until you're starving. Eat three moderate meals a day plus one snack mid-morning and one mid-evening; on such a plan, you'll want smaller portions and you'll eat more slowly. Also, don't wolf down your food; take at least 20 minutes to eat every meal. Your body can handle carbohydrates more easily in a constant trickle than an occasional torrent. You'll also want to work with your doctor to coordinate your meals with your medication and exercise schedule.
Who can help me design a good diet plan?
Ask your doctor for a referral to a registered dietitian (RD), preferably one who is also a certified diabetes educator (CDE). These professionals specialize in helping diabetics manage their disease through diet and can give you tips on meal preparation and timing, how to adapt your diet when you're sick or pregnant, and how to interpret your blood sugar fluctuations. You can also read up on diabetes and diet at the American Diabetes Association Web site.
Note: If you have diabetes, it's important to learn as much as you can about the disease and its potential complications. In addition to diet modifications, most diabetics need to have yearly eye exams, regular foot care, and periodic blood tests to measure glycosylated hemoglobin.
Lopez LR, et al. Monounsaturated fatty acid (avocado) rich diet for mild hypercholesterolemia. Arch Med Res, Vol. 27(4):519-23.
Gumbiner B, et al. Effects of a monounsaturated fatty acid-enriched hypocaloric diet on cardiovascular risk factors in obese patients with type 2 diabetes. Diabetes Care Vol. 21(1):9-15.
Morgan SA, et al. A low-fat diet supplemented with monounsaturated fat results in less HDL-C lowering than a very-low-fat diet. J Am Diet Assoc, Vol. 97(2):151-6.
FDA News. People With Diabetes Should Avoid Eating Raw Oysters or Clams. http://www.fda.gov/diabetes/news.html#shellfish
American Diabetes Association. Complications of Diabetes in the United States. http://www.diabetes.org/diabetes-statistics/complications.jsp
Mayo Clinic. Trans fat: Avoid this cholesterol double whammy. December 2006. http://www.mayoclinic.com/health/trans-fat/CL00032
American Diabetes Association. Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. 31: S61-S78. January 2008. http://care.diabetesjournals.org/content/vol31/suppl_1/