DIABETIC DIETS

 

Here are the 5 most important points to remember about a good diabetic diet: 1) Diabetics should eat a well-balanced diet with adequate amounts of proteins, fats and carbohydrates so as to attain and maintain an appropriate body weight.  2) A diabetic diet should include at least 3 meals and a bedtime snack daily.  3) Those meals should be consistent from one day to the next, in terms of when the meals are eaten, the number of calories eaten at each meal, and the amount of carbohydrate eaten at each meal.  4) Diabetics should avoid simple sugars, candies, etc. between meals as these concentrated sweets cause rapid swings in blood sugar levels (causing poor control).  5) The diet should be low in fat (<30% fat), particularly saturated fat (<10%).   If you just follow these 5 principles, you will achieve 90% of the important goals of a diabetic diet.

Skipping meals or bedtime snacks will impair your ability to optimally control your blood sugar levels, and could lead to a serious hypoglycemic (low sugar) reaction.  Eating your meals at different times on different days will increase fluctuations in you blood sugar levels (Try to eat your meals within an hour of the same time every day).  Varying your calorie intake from one day to the next will cause variations in your blood sugar too.  If one day you have 3 meat, 1 milk, 2 vegetable and 2 bread exchanges for dinner, then every day for dinner you should have 3 meat, 1 milk, 2 vegetable and 2 bread exchanges.  This will help to keep your calorie intake  and your carbohydrate intake constant from lunch to lunch and dinner to dinner, and improve your ability to control your blood sugar. 

We do know a diet high in animal fat (saturated fat) increases the risk of atherosclerosis (hardening of the arteries).  Studies suggest that regular table sugar may not be harmful to diabetic control as long as it is eaten in the context of a balanced meal (one that contains fat and protein so that it is absorbed through the stomach and intestine more slowly in order to delay any rapid swings in the blood sugar level.)  Again, obviously, the key here is moderation and a balanced diet.  A prudent diet is one that is low in cholesterol and large quantities of saturated fats.  Excessive intake of these foods predisposes to atherosclerosis (hardening of the arteries).  All diabetic patients should have a good general understanding of diets--what proportions of nutrients (proteins, fats, carbohydrates) various foods contain, how to use exchange diets, how to select proper foods when eating out, what foods to avoid, etc.  A reasonable diet for diabetics contains about 12% to 20% protein, 50% to 55% carbohydrate, and 25% to 30% fat.  These percentages are somewhat flexible.  The carbohydrate should be in a complex form such as starch or that found in less than fully cooked vegetables.  Whole grain products are preferred because they have a higher fiber content that is beneficial.  The use of vitamins is optional.  Generally, anyone in the United States eating a balanced diet and consuming 1000 calories or more a day will get enough vitamins and minerals in the foods that they eat that a supplement is not necessary.  A good diet is a way to achieve Ideal Body Weight and minimize rapid or wide swings in the blood sugar levels.  When exercise and a reasonable diet alone cannot control blood sugar, then medication is needed. 

If you are overweight, you should work on losing weight down towards Ideal Body Weight.  We have tables that will tell us your Ideal Body Weight.  Even a 15 or 20 pound weight loss can make a marked difference for many people.  Diet pills do not have proven long term safety.  The effective ones are related to amphetamines, which are stimulants with strong addiction potential.  They tend to increase blood pressure and increase the workload of the heart.  Several drugs had to be taken off the market in the late 1990s because of very serious potential long-term complications.  When diet pills are used to help people lose weight, they must be taken forever.  There is no safety data that indicates they are safe to use for such long periods.  But we know when people stop such medications, they gain the weight they've lost right back.  We do not recommend fad diets.  Diets such as all protein diets, liquid diets, or all fruit diets, are not balanced in terms of nutrients, may not have adequate vitamins so that a supplement will be necessary, and are not sustainable over the long term.  Once a person loses some weight on one of these diets, what happens when they go back to their normal diet?  What has changed so that the weight will stay off?  Studies have shown that seesawing body weight by losing weight and then gaining it back is more unhealthy for people that not losing weight at all!  Only by changing your normal everyday diet "FOR LIFE" will you be able to change your body weight on the long term.  That's what a prudent diabetic diet is meant to accomplish.

Americans are changing their eating habits.  This trend is based upon the public's interest in maintaining good health and on our increasing knowledge of the effects of diet on physical well-being.  Basic diabetic diet principles are nearly identical to the "good nutrition" concepts we now see advertised to the American public at large.  These are often referred to as the Dietary Guidelines for Americans as published by the United States Department of Agriculture and include the following:

EAT A VARIETY OF FOODS

Eating a wide variety of foods will increase the probability of obtaining the proper balance of the 40 or more essential human nutrients as well as reducing the exposure to excessive contaminants and questionable food additives found in any one food.

Food selections should include fresh fruits and vegetables; whole grain and enriched breads, cereals and grain products; nonfat and low fat milk products; lean meats, poultry, fish and eggs; nuts and legumes (dried peas and beans).

It is important to include fresh foods as frequently as possible to avoid the salt, fat, sugar, food additives and low fiber content of processed foods.

MAINTAIN DESIRABLE WEIGHT

Eating too many calories leads to obesity which will worsen diabetes and increase the risk of high blood pressure and heart disease.  A safe weight loss of 1/2 to 2 pounds per week can best be achieved by a combination of a reduced calorie intake and increased exercise.  Increasing your activity level by walking, swimming or just taking the stairs rather than the elevator will enhance your weight loss efforts and help improve your overall diabetic management.  If you are over 40, check with your physician before beginning a more rigorous training program. 

   

AVOID TOO MUCH FAT, SATURATED FAT, AND CHOLESTEROL

There is a strong correlation between total fat in the diet and the incidence of breast cancer, colon cancer, obesity and heart disease.  Dietary fat intake can be lowered by using the following guidelines.  Choose fish and poultry instead of red meats and cheese.  Use plant sources of protein such as legumes, lentils, dried beans and split peas.  Remove visible fat from meat and skin from poultry before cooking or eating it.  Limit the use and amount of butter, margarine, salad dressings and oils.  Roast meat on a rack, bake it, broil it, or stew it rather than fry foods.  Discard all fat drippings from meats.  Be aware of hidden fats in foods such as french fries, chips, cheese, nuts, avocados, luncheon meats, whole milk, chocolate, ice cream, pastries and croissants. 

Blood cholesterol levels influence the amount of fat and cholesterol that deposits on the inner walls of arteries causing them to be inflexible and narrowed which in turn can obstruct the flow of blood.  This may lead to a heart attack or stroke.  Both saturated fat and cholesterol in the diet may lead to increased blood cholesterol levels.  

Cholesterol is found only in animal products and is particularly high in eggs and organ meats.  The fat in red meats, milk products, coconut and palm oils, hydrogenated vegetable shortenings and chocolate are primarily saturated fats and in general should be avoided.

  

EAT FOODS WITH ADEQUATE STARCH AND FIBER

Complex carbohydrates (starches and fiber) are found in fresh vegetables, legumes (dried peas and beans), nuts and whole grains (whole wheat, brown rice, barley, bulgar, oats, rye, millet and cornmeal).  Foods containing these complex carbohydrates are excellent sources of fiber as well as vitamins and minerals. 

A long term low fiber intake may be a causative factor in cancer of the colon, constipation and other intestinal disorders.

  

AVOID TOO MUCH SUGAR

All people, including those with diabetes, should limit their intake of sugar.  The harmful effects of sugar are manifested in dental disease (rampant cavity formation in children and gum disease in adults), diabetes, vitamin and mineral deficiencies and obesity.  Nutrient deficiencies can occur when high sugar content foods which contain calories and few other nutrients are eaten in place of foods higher in nutritional value.  Foods high in sugar include table sugar, honey, syrup, pies, cakes, cookies, pastries, and sugar coated breakfast cereals.  There are 9 teaspoons of sugar in a can of regular soda pop! 

Naturally occurring sugars are found in fruit and milk which are also high in many other nutrients.   

Limiting your intake of simple sugars does not mean eliminating your intake of simple sugars.  In the context of a meal, adding simple sugar, such as a teaspoon of sugar on cereal may be perfectly fine.  Itís the can of Coke on an empty stomach in the middle of the day that creates a problem.  Many people use artificial sweeteners as much as possible in place of sugar all the time,  This is acceptable, but may not be necessary.  You can tell by checking your sugars frequently throughout the day and seeing what happens when you eat certain foods or combinations of foods.  Beware that large amounts of some artificial sweeteners can have side effects,   For instance, sugar alcohols (sorbitol, xylitol) found in diabetic candies and ice cream when consumed in excess will cause bloating, gas and diarrhea.

AVOID TOO MUCH SODIUM (SALT)

Excessive sodium consumption may cause or aggravate high blood pressure.  Even though sodium is an essential nutrient, more than adequate amounts can be obtained from fresh, unsalted foods. 

The primary source of sodium in the American diet is table salt (sodium chloride); although it is also found in MSG, antacids, baking soda, baking powder and some food additives.  It is important to look for the word sodium on food labels. 

In order to reduce sodium intake, it is necessary to decrease the salt added during cooking and at the table and to use sparingly highly salted foods such as cured, canned and processed meats; canned vegetables; canned and dried soups; condiments such as catsup, mustard, soy sauce and steak sauce; pickles; olives; and salty snacks.

IF YOU DRINK ALCOHOLIC BEVERAGES, DO SO IN MODERATION

Alcohol, like fat and sugar, is a dense source of calories.  Excessive alcohol consumption may lower the appetite for foods that contain essential nutrients.  Vitamin and mineral deficiencies may occur because of poor food intake as well as alcohol's ability to alter the absorption and utilization of nutrients. 

Heavy drinking by pregnant women has been linked to birth defects and mental retardation of children.  A safe level of alcohol consumption for pregnant women has not yet been established, so total abstinence from alcohol is the only completely safe decision a pregnant woman can make.   

Cancers of the head and neck are much more common among people who drink and smoke than among those who do not.  Fewer than two drinks per day is considered moderate consumption. 

Food Exchange Lists for Meal Planning are available in bookstores and many supermarkets.  An extensive food exchange list is also available on this web site.  They all use standard measures and portions.  If you would like, we can refer you to a dietitian who can tailor a diabetic meal plan based on the Exchange Lists for Meal Planning to your individual nutritional needs and your specific food preferences.  Good eating habits based on moderation and variety will help improve and maintain optimal diabetic control.

 

Revised 8/08

 

©Ted A. Tobey, M.D., Inc. ~ All Rights Reserved