Diabetic diet and nutrition tips
Food plays such a huge role in the life of a family. The dinner table is where we sit down to catch up at the end of a long day and holidays would not be the same without the usual spread of delicious eats. Recipes for those dishes might be passed down from generation to generation. But when you come home with a diabetes diagnosis, it can feel like a roadblock to participating in these important traditions. The truth is that you can still enjoy these times with your family. The only thing that changes is how you support your blood sugar management with food and activity.
What foods are good for diabetes?
These foods are extra healthy for people with diabetes, because they have near-zero net carbs and help stabilize your blood sugar.
- Beans are packed with fiber, magnesium and potassium
- Tomatoes are an amazing, low-carb source of vitamins C and E and iron
- Dark, green vegetables deliver a powerful dose of fiber, proteins, vitamins and minerals
- Salmon reduces triglcerides, blood pressure and inflammation
- Citrus fruits contain generous amounts of vitamin C and fiber
- Whole grains have folate, omega-3s, magnesium, chromium, fiber and potassium (white bread doesn’t)
- Sweet potatoes contain more healthy fiber, antioxidants and vitamin A than white potatoes
- Raw nuts are full of healthy fats and fiber
- Berries are packed with antioxidants, fiber and vitamins
- Fat-free dairy delivers vitamin D. Yogurt’s probiotic bacteria helps keep intestines healthy and boosts immunity.
Diabetes and carbs
When we think about cooking with the family, it is common to think of food that gives you a feeling of emotional comfort when eating it. Whether it is grandma’s meatballs or mom’s homemade pierogis, the smell and taste of these dishes can make you feel warm and at home. However, these recipes are often centered around not-so-healthy ingredients, and may contain high levels of carbs, starches, fat, or sugars. Some of the most popular foods like this are:
- Noodles (25-40g carbs per serving)
- Dumplings (10-30g carbs per serving)
- Potatoes (32g carbs per serving)
- Pizza (26-30g carbs per serving)
Thankfully, there are plenty of easy substitutions, both in terms of ingredients and preparation, that can help to reduce the blood sugar impact of these dishes
- Instead of using rice or wheat noodles, try using zucchini and other veggies to make noodles. They are better for you and add fun and color to your meal.
- Stuffed veggies are a great alternative to dumplings. And while we may be used to a soft dough, you can also use cabbage as a wrapper for dumplings.
- If you are looking for an easy source of extra vegetables in your diet, consider swapping out shredded cheese for shredded butternut squash.
- Cauliflower is a versatile ingredient. You can easily mash, roast, or fry it for a potato substitute. It also works well as a pizza crust!
- Choose snacks that are made from fresh, naturally low-carb ingredients. A fresh tomato with some feta cheese, black pepper, and olive oil can provide some quick energy and good nutrients.
You can learn more about how carbohydrates affect diabetes in our "Diabetes and carbohydrates" article.
Cutting down on trans and saturated fats is an important aspect of any healthy diet. That is because these types of fats can raise your blood cholesterol levels.1 Individuals with diabetes are already at a higher risk for heart disease, heart attack, or stroke, so reducing trans and saturated fat intake is a great way to reduce these risks. Try starting by replacing trans fats, ingredients like butter or lard. These hydrogenated oils are actually worse than saturated fats. Luckily, you can easily replace these by cooking with canola oil, sunflower oil, avocado oil or olive oil.2
Saturated fats and trans fats are lurking in many foods that seem healthy. Here are a few examples:
- Salad dressing All those crisp, delicious vegetables are great for you—high in vitamins, minerals and fiber. But at 20 grams of fat per 1 tablespoon serving, full-fat dressing can diminish the benefits of eating a salad—especially since many people consume as much as 3 or 4 times the recommended amount. Choose dressing made with extra virgin olive oil, canola oil, or yogurt, and measure your servings with a spoon.
- Sandwiches Before you prepare a sandwich, think about which condiments you really need. Instead of loading up on mayonnaise, use it sparingly or skip it altogether and try mustard. Try to avoid prepared chicken or tuna salads—they’re often made with loads of full-fat mayonnaise. Create your own sandwich recipes using tuna or chicken packed in water and adding sliced vegetables, pickle relish or fresh herbs.
- Packaged baked goods Any kind of commercial bakery or snack item is a potential source of trans fat: pies, cakes, cookies, snack chips, even healthy-sounding wheat crackers. Why? Because trans fat helps products stay fresh longer. Check the nutrition information and look for “partially hydrogenated” or “hydrogenated” oil. If you see it, the product has trans fat.
- Not in peanut butter Contrary to popular belief, peanut butter contains only a few grams of saturated fat and a trace amount of hydrogenated oil. It contains no grams of trans fat. Be sure to check the label and avoid brands with added sugar and oils.
So now that you know where bad fats can be found, try to limit your intake of foods that contain them and make healthier choices instead.
One reason we love carbs is because they leave us feeling full and satisfied after a meal. But there are other options to satiate your hunger without ruining your nutrition plan. Fiber is a fantastic nutrient to seek out because while it fills you up, it is not actually broken down by the body, meaning it will not raise your blood sugar a single point.3 Great sources of fiber come from fruits, vegetables, whole grains, and legumes, so mealtime can still be a varied feast.4
For many people living with diabetes, celiac disease or a gluten sensitivity can add to the challenge of eating healthy meals every day. Here's a quick guide to what it means to live gluten-free.
Gluten sensitivity vs. celiac disease
The symptoms of celiac disease and gluten sensitivity can be the same―stomach pains, headache, joint pain, fatigue or other symptoms that occur after a person eats a food containing gluten. If you suspect that you have gluten sensitivity or celiac disease, talk to your doctor about getting tested. Celiac disease can be diagnosed by a doctor performing a blood test. If the results come back negative for celiac, gluten sensitivity may be the diagnosis. Either way, if your body has difficulty processing gluten, you may need to incorporate a gluten-free diet into your self-care.5
Gluten-free diets and diabetes
People with type 1 diabetes are at a higher risk for celiac disease, as both are autoimmune diseases. So be sure to talk to your doctor about switching to a gluten-free diet. And remember that "gluten free" does not equal "low carb," and many processed gluten-free foods are packed with other types of sugars. They may not be the healthiest choices for your blood sugar.6
What can you not eat on a gluten-free diet?
If you and your healthcare provider have determined that you need a gluten-free diet, it's time to take wheat, barley and rye grains off your plate. But there are many other sources of gluten you may not have imagined, including beer, oats, processed dressings and sauces, soy sauce and seasonings that you'd find on potato chips or in dry pasta mixes. The American Diabetes Association (ADA) has compiled a helpful list of foods that contain gluten to look out for.
What can you eat on a gluten-free diet?
As you can see from the list mentioned above, fresh fruits and vegetables are the way to go. Other gluten-free goodies to keep in your pantry include beans, yogurt, cheese, corn, flax, sweet potatoes and gluten-free eaters' best friends, quinoa and rice.
Need ideas? The ADA offers great suggestions for delicious diabetes-friendly, gluten-free meals to get you started.
Vegeterian choices and Meatless Mondays
Make a change for the environment and your health—think about going vegetarian one day a week, without missing out on protein or piling on the carbs.
The Meatless Monday and VB6 (vegan before 6:00pm) movements aim to shift our thinking away from meat as the center of the meal—with the intent of improving people's health as well as the environment.
Let's start by saying we're not anti-meat. We wanted to think about how eating can affect a person's carbon footprint.
Meat and the environment
As it turns out, the impact of meat production can be pretty great. For example, it takes about 300 pounds of grass or grain feed, and about 2,000 gallons of water, to produce one pound of beef.7,8 In addition those lost resources, manure, fertilizers and other factors contribute significantly to greenhouse gases.8 So if we all cut back a little, we can have a very real, positive effect.
Meat and your health
Meat can be a great source of protein, but many Americans eat about 1.5 times the average protein requirement. Plus, as protein sources go, meat can be high in fat and cholesterol.8 Of course, for many people with diabetes, eating lean protein is key to keeping blood sugar in line. But it makes sense to try to mix up the types of protein we eat.
Shifting away from meat
Whether you want to try going vegetarian one day a week, or you'd like to try cutting out animal products before 6pm, the key is to find satisfying alternatives that don't send your blood sugar flying. Sticking with whole grains and beans or lentils can help, as they take longer to digest. Including healthy fats such as olive oil, nuts and avocado can also help you feel full.9
Alcohol and diabetes
When consumed in moderation, alcohol can be a fine way to kick back and have fun. In fact, research has shown that the occasional adult beverage might lower the risk of heart disease, heart attack, or stroke10. However, there are still elevated risks for people drinking with diabetes, even when it is just one beer or cocktail. When alcohol is taken into the body, it is processed by the liver. Since alcohol is a toxin, this sends the liver into detox mode, which temporarily stops the release of glucose even if it is needed to fuel the body. On average, the liver can only breakdown one drink of alcohol per hour.11 Additionally, many beers, wines, and spirits are high in sugars, calories, and carbohydrates that can cause rapid spikes in blood sugar.
If you choose to imbibe, there are a few rules you will want to follow whenever possible.
- Avoid drinking on an empty stomach. It might seem like a good idea to swap out the carbs and calories but drinking without eating first may lead to low blood sugar, or even increased intoxication. It can also interact with diabetes medication you may be on to increase the chances of low blood sugar.12
- Avoid calorie-heavy beers. Craft brews like IPAs or stouts may have a taste you prefer, but they also have a higher alcohol content and are loaded with calories. An average IPA contains 200 calories and up to 20 grams of carbohydrates per 12-ounce (350 mL) bottle.13 If beer is your drink of choice, consider something lighter.
- Swap out the sweet mixers for something else. Instead of ordering a cocktail with fruit juice, soda, or cream, consider tonic water, club soda, or diet soda.
- Beware of the late-night munchies. Alcohol can lower decision making skills and inhibitions, and this could easily lead to you making poor dietary decisions when drinking. Eating before drinking is always a good way to curb this concern, but you might also consider packing a small diabetes-friendly snack in case you get a craving after a few drinks.14
- Wear a medical alert bracelet indicating you have diabetes. The symptoms of hypoglycemia can mimic the effects of being drunk15, so it is important that those around you know what to do in case you faint or fall ill.
Alcohol is high in carbs and calories, but individuals with diabetes can still enjoy the tradition of a beer or glass of wine. By keeping your blood sugar in mind and staying on track in your day-to-day treatment, saying “Yes!” to a night out with family or friends is something you can still look forward to.
Diabetic diet tips
Eating is one of the great pleasures we share with the people we love. For both the members of your family living with diabetes and those living without it, choosing healthy foods to prepare together can add a new layer of fun and wellness to something you already enjoy.
- Use a smaller plate. A healthy portion can look depressingly small on a giant plate, making it easy to overeat.16 With stores selling plates over 11" across, you don't stand a chance. Whether you're eating at home or prepping food to take to work, choose a container or plate that just fits your meal, and you won't feel shortchanged.
- Flip your meals. Research shows that eating the biggest meal at mid-day may make it easier to drop weight.17 What's more, some people find that this helps them sleep better and have more energy in the afternoon, not to mention enjoying more time in the evenings.
- Trade up. Look for little opportunities to make a difference. Eating quinoa instead of white rice or pasta, for example, will give you more protein and fiber for the same serving size. That can help you feel full for longer.18 Reach for the whole-grain version of anything you buy. Sneak veggies into everything, from a veggie omelet in place of your bacon and eggs to cauliflower in your mashed potatoes. Opt for homemade over processed foods wherever possible.
- Eat protein at every meal and snack. You may find that you're staying full longer and craving fewer sweet and salty snacks. Yogurt, nuts, a hard-boiled egg, lean meat or beans can all help keep hunger pangs from coming right back.
- Make water your habit. Alcohol and sugary drinks add up fast, but don't make you feel full. Try increasing your water intake by just a few ounces a day, then raise it as you go. Drinking it before you eat or snack can also take the edge off, so you don't overdo it.
- Know what you're eating. Use paper and pen or a mobile app to keep track of what you're actually putting in your mouth. After all, if you don't have a clear picture of what you're eating, how can you change it?
Many people with diabetes learn how to count carbohydrates in order to manage their blood sugar. But even old pros occasionally slip up and find their blood glucose levels out of balance. One of the easiest ways to miscount carbs is by underestimating portion sizes, so here are a few handy tips.
Use a food scale and measuring cups
Using a food scale and measuring cups can save you a lot of worry. This way, you'll know that you had exactly a half-cup of brown rice with 22 carbs,19 instead of "about" that much and "20-ish carbs." Over the course of a day, small inaccuracies can add up and throw off your carb count.
How to approximate portion size
Don't have a food scale or measuring cup with you? Here are some ways to approximate:20
- 1 serving of meat should be 3 ounces, about the size of the palm of your hand
- 1 cup is about the size of a small fist or cupped hand
- A half-cup is about the size of a tennis ball
- The tip of your thumb, from the first knuckle up, is about 1 teaspoon or 1 ounce of cheese
- A handful is about 1 to 2 ounces of snack food
Serving size and portion size
Look at food labels to see what they consider a serving size. Often, we eat way more than the serving size on the package. Microwave popcorn is a perfect example―the bags typically say they hold 3 servings. But how many of us only eat a third of the bag? So if you eat more than the serving size noted, make sure you count all the carbs you take in.
Plan your plate
The American Diabetes Association has a great guide for healthy eating, based on how much of your plate should be devoted to each type of food. Imagine a line down the center of your plate. Fill 1 side with non-starchy vegetables like greens, beets or tomatoes. Now split the remaining half into 2 smaller halves. In one quarter, put grains or starchy foods like brown rice, quinoa or beans. Save the last quarter for proteins such as lean turkey, salmon or eggs.21
How to read a nutrition label
Shopping for groceries for a family means thinking about the nutritional needs of everybody in the household—especially those with special dietary requirements. When you or someone you love lives with diabetes, you may find yourself checking labels more often to make sure your food choices are well-rounded and help with effective carb management. So, how do you use a nutrition label to pick healthy, well-rounded foods?
Here is a look at the basic elements of a nutritional label—with a special look at the carbohydrates section—to help you make better food decisions for yourself and your family every day.
As you may have experienced, nutrition labels do not always speak to an entire package.22 You may buy a 16 oz (453 grams) bag of crackers, for example, but the nutrition label might define one “serving” as a cup (226 grams) of crackers, which is only half the bag. Why are labels like this? It really comes down to giving you the ability to compare foods; by establishing “one serving” of certain, similar foods, it is easier to compare nutrition labels to see how one serving of another similar food stacks up.
The basic unit of energy in food is known as a kilocalorie or calorie.22 The calories in the foods you eat are made up of fat, protein, and carbohydrates. Nutrition labels are typically made based on the assumption that you have a daily diet of 2,000 calories (kilocalories). Some labels will have a footnote that expand on this concept, providing numbers for both 2,000 and 2,500-calorie (kilocalorie) diets.
In between the line on a nutritional label for calories (kilocalories) and the footnote at the bottom is an accounting of the different nutrients in the food.22 Typically, a nutrition label will have different lines for:
- Total fat, with breakdowns of both saturated fat and trans fat
- Total carbohydrates, with breakdowns of dietary fiber, sugar, and sugar alcohol
- Vitamins & minerals, which are presented as a list of all the vitamins and minerals contained in the food, such as vitamin A, vitamin C, calcium, and iron
Daily values (reference intake)
On many nutrition labels, you will also find a column representing daily values (reference intake). This is often presented as a percentage, labeled % DV, and represents how much of a person’s daily intake of a given nutrient is contained in the food. For some nutrients, this percentage indicates a minimum amount you should try to get in a day. For others, it represents the maximum amount you should limit yourself to in one day.22
- What to make sure you get enough of: Vitamins and minerals, total carbohydrates (though this number may be different for people with diabetes—more on that below), and dietary fiber
- What to limit as much as possible: Total fat, saturated fat, cholesterol, and sodium—too much of these can be unhealthy
With this basic understanding of food labels, you can start making more informed choices about the balance of nutrients you consume.
How not to diet with diabetes
Fad diets make losing weight sound so easy (if not necessarily appealing—we're talking about you, baby food diet).
Ask someone who's successfully lost a fair amount of weight and the answer is bound to be something like, "I ate better and exercised more." Bummer.
Year after year, new miracle diets come and go, each one promising to help shed pounds effortlessly. Here are a few diet tips that you should not try.
Skipping meals or cutting too many calories
For people who don't have diabetes, doctors have found that skipping meals may actually make you gain weight. Seriously. When your body goes too long between eating or doesn't get enough, it slows down your metabolism to conserve calories. You may wind up eating less and storing more. When you have diabetes, skipping meals can make it harder to control your blood glucose, which can also affect your appetite.23
Focusing on one type of food or no food at all
There are diets that suggest lots of protein and no carbohydrates. Diets that limit you to liquids, grapefruit or cabbage soup. And others that just seem weird, like the aforementioned baby food diet. You may lose a few pounds quickly, but you can't eat like that forever.24 Besides, cut out the foods you like, and you may wind up resenting your diet and packing the pounds back on.
Going completely fat-free
Fat isn't the bad guy—some fat in your diet is good. It helps you feel full longer, helps you digest and absorb vitamins, promotes a variety of body functions and can help temper blood glucose spikes after meals.25 Just don't go crazy with it.
Letting your blood sugar levels run high
Okay, this isn't a diet fad, but we know it can be tempting to cut back on insulin to lose weight. This can be pretty dangerous, though, as high blood sugar can lead to diabetic ketoacidosis or long-term complications, or snowball into a full-fledged eating disorder.26 It's just not worth putting yourself at risk—there are safer ways to lose weight.
What is the best diabetic diet?
Stick to colorful, flavorful, healthful meals that will help rev up your metabolism and give your body the nutrients it needs without lots of extra fat or calories. If you want to take steps to manage your weight, talk to your doctor or educator. There may be ways to adjust your self-care routine to achieve the results you're looking for.
How to dine out with diabetes
One of the most important aspects of managing your diabetes — or your health in general — is balanced and healthy nutrition. You are working to cut carbs and sugar, increase your protein and vegetable intake, and control your portion size so you don’t overeat. It might seem counterintuitive to step out for a dinner with your friends and family at your favorite local restaurant; high calorie ingredients, a lack of nutritional information on the menu, and unpredictable portion sizes can turn mealtime into a guessing game.
With just a little planning, you can easily enjoy nights out with the ones you love without the guilt or worry—and maybe even set a healthy example for others who join you at the table.
Research the menu’s nutritional information
In this health-conscious day and age, it is becoming more commonplace for restaurants to provide their nutritional information. Recent studies have even shown that people could possibly cut their calorie consumption by 12% if restaurants included nutritional information with their offerings27,28. Because this information is often extensive, those calories and carbs may be provided on the company’s website and not on the menu. It helps to come up with a plan before you step through the doors. Take a look at their online menu and do your best to plan out what you will order. If nutritional facts are not available online, it may be best to call ahead or ask a server for further information.
Time your meal with your diabetes medication
It is a daily job to keep blood sugar in a healthy range, and even when you are doing a great job with diet and exercise it can be tough to stay consistent. Timing also plays a role in managing diabetes; keep in mind that It takes 15-20 minutes for insulin to start working29, so if you are taking insulin you will want to be sure to time your dose appropriately with the food coming out to the table. If you are planning to be active before eating, avoid needing a snack before your food arrives by staying on top of your sugar and not skipping meals.
Substitute carbs and sugars
Just like you would do at home, you can make healthy substitutions in just about any dish you order at a restaurant. Try these ordering tricks to make sure you have a healthy and delicious option.
- Ditch the bun. If you’re interested in a sandwich or burger option, try going with a lettuce wrap or even without any bread. Besides, you’ll look super classy eating that turkey club with a fork and knife.
- Ask for vegetables instead of starchy sides. It is common for restaurants to include legumes or potatoes as a side dish; switch those out for steamed or roasted broccoli or cauliflower that can fill you up without letting you down.
- Fiber is filling. A great thing about fiber-filled foods is that fiber is not broken down by the body, and therefore does not raise your blood sugar30. It also keeps you feeling full without overeating. Look for avocados, lentils, or artichokes (as long as they are prepared in a healthy manner).
Restaurant portion control
Everywhere you go in the world, restaurant portion sizes can be quite large31. It often happens that you find yourself picking at the last few bites of your meal, even when you are feeling totally full. But fear not! We have a few ideas to share to ensure you are eating the ideal portion size even when you are not in control of the plate size.
- Box it up. Before your meal comes out, ask the server to bring out a take-away box. Then, put half of your order in the box to ensure you do not overeat.
- Sharing is caring. By offering to split an entrée or large plate with a dining guest, you can cut your consumption by half.
- Water is key. By drinking plenty of water during your meal, you will find yourself feeling fuller and less tempted to overdo it. A recent study showed that dieting patients lost 30% more weight when hydrating32, so there’s a definite science to it.
Dining out is a great way to get the family together for a fun evening. Every member of the family—even those with diabetes—can enjoy a tasty meal without all the guilt by planning ahead and being mindful of what is on your plates.
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WebMD. Healthy eating with diabetes: Your menu plan. Manage your diabetes head2toe [Internet]. New York, New York [Cited 2017 Dec 5]. Available from https://www.webmd.com/diabetes/head2toe-15/diabetes-meal-plan?page=2. Accessed April 4, 2019.
Mayo Clinic. Diabetes diet: Create your healthy eating plan [Internet]. Rochester, Minnesota: 2017 March 25 [Cited 2017 Dec 5]. Available from: https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295. Accessed April 4, 2019.
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