Eat Better for Diabetes

Diabetes affects about 17 million Americans, resulting in 200,000 deaths and $132 billion in healthcare costs a year. Type 2 diabetes accounts for 90-95 percent of all cases and is strongly linked to weight gain and physical inactivity.

Diet is crucial in managing diabetes, and advice has improved a lot over the past 10 years. Controlling carbo intake by using the exchange system food lists or by counting grams of carbos remains a key tool, but added attention is now given to actual food choices. However, many people with diabetes still remain confused about diet. Let's look at four common myths that can sabotage a healthy eating plan.

Myth 1: You need a special diabetic diet if you have diabetes.

Fact: There's no special diet just for diabetes. The dietary guidelines that help manage blood sugar and prevent diabetes complications like blindness, kidney failure and limb amputation are basically the same ones that help control weight and lower the risk of chronic diseases like high blood pressure, heart disease, stroke, cancer and osteoporosis.

That's good news, because diabetes more than doubles your risk of heart disease and stroke, and over 80 percent of people with type 2 diabetes are overweight. Here are four general guidelines for eating well for both diabetes and overall health:

1. Emphasize whole grains, fruits, veggies, low-fat dairy foods, legumes (beans, lentils), nuts, baked or broiled fish, and modest amounts of very lean meat.
   
   
2. Portion control is a powerful tool for controlling blood sugar and weight. That means measuring, because most of us greatly underestimate how much we really eat. Use measuring cups and spoons, plus a low-cost diet scale for solid foods like meat and cheese. As your portion savvy improves, you'll need to measure less often.
   
   
3. Spread your carbos out more evenly over the day also may help.
   
   
4. Among its many health benefits, regular exercise improves carbo tolerance and blood sugar control

Myth 2: Cut back on all carbos and eat more protein and fat, because they don't raise blood sugar.

Fact: Carbos aren't your enemy if you choose wisely! In fact, the American Diabetes Association (ADA) recommends eating more of the high-quality, health-promoting carbos found in whole grains, fruits, vegetables, beans and low-fat dairy products. The lower-quality carbos to cut back on are refined, processed grain foods like white bread, white rice and pasta, soda and added-sugar foods.

Replacing some lower-quality carbos with fat can be beneficial, but be careful. Many low-carbo, fatty foods are high in artery-clogging saturated fat (full-fat cheeses, meats, butter) or partially hydrogenated fat (fried chicken, seafood, stick margarine). The healthiest fat sources are olive oil, canola oil, nuts, seeds, avocados, and broiled or baked fish.

As for more protein, most people with or without diabetes already surpass their needs by a good 50 percent. Higher levels may worsen existing kidney problems. Emphasize protein sources low in saturated fat like very low-fat dairy foods, skinless poultry, fish, beans and soy.

In general, a healthy carbo level for people with diabetes ranges from about 45-55 percent of total daily calories. That equals 180-220 grams for a 1600 calorie diet or 270-330 grams for a 2400 calorie diet.
However, your own optimal carbo intake depends on your activity level, weight and height, blood sugar readings, diabetes medications, health status, and your carbo choices (some raise blood sugar more than others). Be sure to seek personal advice from your doctor, registered dietitian, or diabetes educator.

Myth 3: Avoid sugar, and only use sugar substitutes.

Fact: Even a no-sugar diet wouldn't solve blood-sugar problems, because non-sugar carbos (starches) affect blood sugar, too. In fact, many starchy foods (even some very healthy ones) raise blood sugar as much as or more than an equivalent amount of table sugar. Your diabetes medications, portion control, and exercise can usually keep this effect under control.

The best way to handle sugar is to cut back on calorie-rich, nutrient-poor foods high in added sugar. Some, like donuts and snack cakes, are also high in unhealthy types of fat.

There's room for modest amounts of added sugar, but be sure to substitute it for other carbos you normally eat. Otherwise, your blood sugar may worsen. It's smart to emphasize naturally-sweet, nutritious foods like whole fruits, corn, peas and sweet potatoes. Artificial sweeteners like Nutrasweet and Splenda can also help, as well as sugar alcohols like mannitol and sorbitol, but the latter two may cause gas and diarrhea.

Myth 4: Don't eat fruits, because they're too high in sugar.

Fact: Most whole fruits have a relatively modest blood-sugar effect if portions are reasonable, because their sugars are more slowly released and absorbed. These include apples, apricots, berries, cherries, grapes, grapefruit, nectarines, oranges, peaches, pears, plums and prunes. Fruits are rich in vitamins, minerals, fiber, and disease-fighting antioxidants. The ADA recommends up to four servings of fruit daily as well as taking your blood sugar an hour or two later to determine the impact of different fruits (and other foods as well). Keep records, because results vary with portion size, your initial blood sugar level, a full versus empty stomach, foods eaten just before or along with the fruit, after-meal exercise, and individual differences.

Avoid fruits canned in heavy syrup. Whole fruit is superior to juice, because it's much higher in fiber, tends to raise blood sugar less, and satisfies hunger on fewer calories. Keep portions reasonable, and eat a variety of fruits, especially intensely-colored ones, which are exceptionally rich in antioxidants.

By David Leonard, UNH Cooperative Extension Educational Program Coordinator, Nutritions Connection Program UNH Cooperative Extension