Brunilda Nazario, MD
If you have diabetes, a healthy diet does more than keep your blood sugar under better control. A good diabetes diet can also help prevent or delay the onset of complications such as nerve pain or heart disease.
Although some people talk about a "diabetes diet," there's really no such thing, experts say. The same healthy diet recommended for those without diabetes will help you if you have diabetes, too. You may need to then tailor the meal plan to your specific needs, such as lowering your cholesterol. But the general concepts of healthy eating are the same for you as for someone without diabetes.
Here, what you need to know about eating to feel better now -- and for years to come.
"The diet that used to be termed a diabetes diet is now considered just a healthy diet for all Americans based on the healthy guidelines from the Department of Agriculture," says Ruth S. Pupo, RD, a registered dietitian and certified diabetes educator at the East Los Angeles Center for Diabetes at White Memorial Medical Center.
One slight difference when she counsels those with diabetes: "We might encourage them to be more cautious with concentrated sugars like juices, candy, cake," she says.
Diet plans for people with type 2 diabetes are also more individualized than in the past. Such diet plans follow good nutrition, but also take into account the individual's specific dietary needs, says Angela Ginn-Meadow, RD, a registered dietitian and certified diabetes educator at the Joslin Diabetes Center, in Baltimore.
One person with diabetes may need to lower cholesterol. Another may need to lower high blood pressure.
"One diet [plan] is not going to work for everyone," she says.
Yet, all are based on the same general concepts proven effective for improving blood sugars and controlling diabetes. Eat a diet that is:
Although experts disagree somewhat on the "ideal" meal plan details, they agree that spreading your carbohydrates over the day, or counting them carefully, are good ways to maintain blood glucose control.
How much should you have of each type of food? The American Diabetes Association (ADA) suggests that people with diabetes eat mostly high-fiber complex carbs, limit protein to 20% of the total daily calories, and limit saturated fat to less than 7% of calories.
Experts from the Joslin Diabetes Center issued guidelines directed at those with type 2 diabetes who are overweight or obese -- about 80% of those with type 2 diabetes. Those guidelines suggest fewer carbohydrates and a slight boost in protein.
Fewer carbohydrates and slightly more protein helps people with type 2 diabetes drop unhealthy weight and control their diabetes, says Osama Hamdy, MD, PhD, medical director of the Obesity Clinic and Program, Joslin Diabetes Center, Boston.
"Any diet for a type 2 diabetic who is overweight should be a weight reduction diet," Hamdy says. Modest losses of a pound every one or two weeks, achieved by reducing daily calories by 250 to 500, is recommended for those who are overweight, he says.
One goal of healthy eating is to stabilize blood sugar, and that's done by a "consistent carbohydrate" eating plan, says Pupo.
People with diabetes should take in about the same amount of carbohydrates with every meal. Total carbohydrates in your diet should be based on advice from your doctor.
Try to avoid having blood sugars spike up too high or down too low, she says. This happens with diets high in refined carbs or sugary drinks. Having consistent meals throughout the day is one way to manage blood sugar levels.
There are several ways to manage carbohydrates.
Write down how many carbs you eat. The ADA suggests you start with 45 to 60 grams of carbs per meal. The consult with your doctor, and adjust your carbohydrates per meal based on blood sugar levels and your doctor’s advice.
To learn carb counting, you can read food labels or get a list from your doctor.
The Plate Method for Carbohydrates
The plate method is a simpler way to count carbs and control portion sizes. You visualize a line dividing your plate in half. Then divide one half into two quarters.
Eating healthfully can help you control blood sugars and reduce the risks of complications of diabetes such as nerve pain (diabetic peripheral neuropathy),heart disease, and foot problems.
"Most complications are related to fat and the amount of fat in the diet," says Hamdy. Any diet that can reduce high cholesterol levels [by reducing fat] is good, he says.
Weight loss, plus exercise, can make a difference in helping people with type 2 diabetes get their hemoglobin A1c -- the measure of average blood sugar levels -- to the goal of less than 7%, Hamdy has found.
He reported on results of a program at Joslin Diabetes Center called Why WAIT (Weight Achievement and Intensive Treatment), in which those with type 2 diabetes are encouraged to lose weight by following the Joslin guidelines for overweight patients.
In a report on 85 WAIT participants, he found that they reduced their initial weight by an average of 24 pounds after 12 weeks. About 82% of the participants reached the target A1c of less than 7%.
Their cholesterol levels improved significantly, too. And participants needed less diabetes medicine once they lost weight.
Lifestyle changes are possible, says Ginn-Meadow of Joslin in Baltimore. "I had a patient who came in with an A1c of 8%," she tells WebMD. "By making lifestyle changes, counting carbs, and eating better, he got it down to 5.8%," she says. He was 65 years old and had had type 2 diabetes for over 15 years, she said. And he got results in four months.
SOURCES:Osama Hamdy, MD, PhD, medical director of the Obesity Clinic and Program, Joslin Diabetes Center, and assistant professor of medicine, Harvard Medical School, Boston.Ruth S. Pupo, RD, registered dietitian and certified diabetes educator, East Los Angeles Center for Diabetes, White Memorial Medical Center, Los Angeles.Angela Ginn-Meadow, RD, registered dietitian and certified diabetes educator, Joslin Diabetes Center, Baltimore, and spokeswoman, American Diabetes Association.Constance Brown-Riggs, RD, registered dietitian and certified diabetes educator, Massapequa, NY; spokeswoman, American Diabetes Association; author, "Eating Soulfully and Healthfully with Diabetes."American Diabetes Association: "Diabetes meal plans & a healthy diet."Joslin Diabetes Center: "Joslin Diabetes Center's New Nutrition Guideline for People with Type 2 Diabetes or Pre-Diabetes Who Are Overweight or Obese."Hamdy, O. Current Diabetes Reports; 2008, vol. 8: pp.413-20.National Institute of Diabetes and Digestive and Kidney diseases: "The Diabetes Control and Complications Trial and Follow-Up Study."