Truth About the So-Called "Diabetes Diet"
all the publicity surrounding new research and new nutrition guidelines, some
people with diabetes still believe that there is something called a
"diabetic diet." For some, this so-called diet consists of avoiding
sugar, while others believe it to be a strict way of eating that controls
glucose. Unfortunately, neither are quite right.
"diabetes diet" is not something that people with type 1 or type 2
diabetes should be following. "That just simply isn't how meal
planning works today for patients with diabetes," says Amy Campbell, MS,
RD, LDN, CDE, a nutritionist at Joslin and co-author of 16
Myths of a Diabetic Diet.
important message is that with proper education and within the context of
healthy eating, a person with diabetes can eat anything a person without
the truth about diabetes and diet?
know now that it is okay for people with diabetes to substitute sugar-containing
food for other carbohydrates as part of a balanced meal plan. Prevailing beliefs
up to the mid-1990s were that people with diabetes should avoid foods that
contain so-called "simple" sugars and replace them with
"complex" carbohydrates, such as those found in potatoes and cereals.
A review of the research at that time revealed that there was relatively little
scientific evidence to support the theory that simple sugars are more rapidly
digested and absorbed than starches, and therefore more apt to produce high
blood glucose levels.
many patients are being taught to focus on how many total grams of carbohydrate
they can eat throughout the day at each meal and snack, and still keep their
blood glucose under good control. Well-controlled blood glucose is a
top priority because other research studies have concluded that all people with
diabetes can cut their risk of developing diabetes complications such as heart
disease, stroke, kidney and eye disease, nerve damage, and more, by keeping
their blood glucose as closely controlled as possible.
does this mean for people with diabetes?
means that a person who has worked with a dietitian and a diabetes treatment
team to figure out how many grams of carbohydrate they can eat throughout the
day can decide at any given meal what they will eat. Those with diabetes who are
not on insulin need to focus on keeping the amount of carbohydrate they eat
consistent throughout the day. Those on insulin can decide both what and how
much to eat at a given meal (as long as it doesn't exceed their daily
allotment), and can then adjust their insulin accordingly. "There aren't
any foods that are 'off-limits,'" says
. "Rather , one just needs to learn how to spend
his or her grams of carbohydrate wisely over the course of the day."
blood glucose monitoring is then used to keep track of the effects of meals
and activity levels on their blood glucose. They work with their healthcare team
to make adjustments in their food intake, physical activity, and
medication to keep their blood glucose as close to normal as possible.
does carbohydrate counting work?
foods--except meat and fat--contain some carbohydrate, and carbohydrate
increases blood glucose faster than any other food. The number of grams of
carbohydrate that a person can eat each day or at each meal is determined by:
Weight and weight loss goals
How physically active an individual is (because physical activity will
lower their blood glucose)
What diabetes medication or insulin they are taking, and when
Other factors such as age or the presence of high blood fats (or any other
medical issue, for that matter)
example, a 6' 2" tall man with diabetes who weighs 180 pounds and wants to
maintain his current weight might be told he could eat 350 grams of carbohydrate
spread out over the day. His goal would be to spread those grams out over the
course of the day so that he doesn't send his blood glucose too high at any
one time. If he is taking insulin or oral diabetes medication, he might also
have to manage when he eats his carbohydrate in such a way that there is enough
sugar from his meals in his bloodstream when his medication is working its
now know that in general, a sugar-containing food like a brownie may have 30
grams of carbohydrate in it, but that brownie will have the same effect on your
blood glucose as 2/3 cup of rice or one cup of applesauce, both of which
have 30 grams of carbohydrate in them," says Campbell. "So, if this
man's meal plan developed with a dietitian states that he can eat 60 grams of
carbohydrate at a meal, he can decide how he 'spends' those 60 grams.
One time he may have 2/3 cup of rice and one cup of peas. Another time he may
decide, for his carb choices, to eat a small baked potato, a cup of
milk and have the brownie for dessert."
who develop diabetes when they are over 40 frequently develop diabetes in part
because they are overweight. Being overweight makes it more difficult for their
bodies to use insulin to convert food into energy. For this reason, many
patients with diabetes also have weight loss as a goal. Because each gram of fat
contains 9 calories (while a gram of protein or carbohydrate contains only 4
calories), fat gram counting as a means of losing weight becomes an additional
nutritional tool for many patients.
people with diabetes also have problems with high blood fats and/or cholesterol
levels, and will be prescribed a meal plan that is low in fat as well. So even
if they aren't overweight, some patients may be counting grams of fat eaten at
each meal or over the course of the day, as well as how many grams of
are many food lists available that show how many grams of carbohydrate and fat
are in most foods. Also, most any food you purchase in a grocery story lists
carbohydrate and fat content as part of the food label requirements mandated by
the federal government.
a do-it-yourself project
using nutrition as part of an overall diabetes treatment plan is not an entirely
do-it-yourself project," notes
. It's best, she states, if you work with
a dietitian to determine which type of meal planning approach will
work best for you.
then the rest of it is pretty much up to you," she adds. "You get your
meal plan 'budget,' and then you decide how to spend it at each meal. And
just like people without diabetes, you need to eat a variety of foods in order
to be healthy.
Glycemic Index and Diabetes
glycemic index indicates the after-meal response your body has to a
particular food compared to a standard amount of glucose. If that sounds
complicated — it is! Many factors come into play, including your age and
activity level, the amount of fiber and fat in the particular food, how
refined (processed) the food is, what else was eaten with the food, what
the composition of the food is in terms of carb, protein and fat, how the
food was cooked, and how quickly your body digests the food (which varies
from person to person).
general, fiber-rich foods are often the same foods that are thought to be
low glycemic foods and seem to have less effect on blood glucose. Sucrose
(table sugar) also has a lower effect on blood glucose than some
starches, such as potatoes. There are lists of such "high" and
"low" glycemic index foods.
professionals agree that the more complex a meal plan is,
the less likely people are to follow it. The glycemic index is a fairly
complex meal planning tool, and the fact that people's blood glucose
can react differently to so-called "low" and "high"
glycemic index foods has limited the usefulness of the index in teaching
patients with diabetes how to manage their food intake to keep their blood glucose
under control. However, the glycemic index may be be
used as an additional tool together with a patient's current meal planning
system. Registered dietitians often encourage patients to determine their
own individual glycemic index of foods based on how their blood glucose
responds to the various meals and snacks they tend to eat.
dietitians and other healthcare professionals working with patients prefer
to talk in terms of the number of grams of carbohydrate in a food, rather
than the "glycemic index" of a food. Carbohydrate has the
greatest effect on blood glucose, so in general two foods that have the
same number of grams of carbohydrate in them will have a similar effect on
your blood glucose level. Your dietitian works with you to determine
— based on your weight, how active you are, and other factors — how
many grams of carbohydrate you can eat at each meal and snack to keep your
blood glucose under control. This type of meal planning is simpler to
use, offers greater flexibility, and enables many people to manage their
is carbohydrate counting?
does fiber affect blood glucose levels?
much carbohydrate should I be eating in a day?
‘Cravings’ and Diabetes
you have type
you may have been advised by your healthcare team to change your diet, and
incorporate healthier foods. In addition, you may have visited with a dietitian
and mapped out a personalized meal plan to help you reach weight-loss or
glucose-control goals. But what happens when despite your best efforts, you
still crave a food that’s not so healthy? For people with diabetes, this can
be a serious problem.
experiences cravings for foods," states
Hanson Chalmers, M.S., R.D., CDE, and Joslin's Amy E. Campbell, M.S., R.D., CDE,
in their book, 16
Myths of a Diabetic Diet. However,
Chalmers and Campbell say that it is crucial to learn how to manage these
cravings before they become a more serious problem. Here are a few of their
the difference between hunger and appetite.
According to Chalmers and Campbell, few people understand the difference between
real hunger and appetite. "Hunger is more physiological, whereas appetite
is more psychological," they state. The authors advise that it may take
some time to distinguish one from the other, but eventually, it can be done. So
the next time you experience a "craving," remember to ask yourself
whether it is hunger talking, or your brain only imagining it needs food. Also,
it is important to check your blood glucose (sugar) when you experience these
feelings to make sure you’re not low.
your "emotional triggers." Many
people use food as a source of comfort, which can lead to the consumption of
excess calories, and, as the authors point out, eating for comfort doesn’t
really solve the problems that cause us to eat in the first place. If stress
causes you to eat, Chalmers and Campbell recommend channeling
that energy elsewhere—such as going for a walk, calling a friend, or
participating in any other activity you enjoy.
when to give in.
Yes, you read that statement correctly. Chalmers and Campbell don’t recommend
completely cutting out your favorite foods, or always denying yourself what you
truly crave. They say this is especially true when you’ve tried all other
measures, and still feel the need to indulge. The authors recommend you indulge
with reservation, however, and only eat a small portion of what you crave, since
satisfying a craving and binging on a particular food is not the same thing.
you need help, don’t hesitate to talk with a therapist or counselor who
specializes in the area of eating disorders. He or she can help you change how
you think about and react to food and eating," state Chalmers and Campbell.
with diabetes should also check their blood sugar frequently in order to
differentiate between low glucose and a craving. Be sure to always carry your
glucose meter with you and test when you can’t tell if your craving is
actually low blood glucose.