Nutrition to Control Diabetes

Food is so important to most people, and what we choose to eat has an effect on our health.  If you have diabetes, you need to manage your weight, blood glucose (BG), blood pressure (BP), and cholesterol levels.  Food choices can help us to do this.  Do you need a nutrition makeover?  I don’t know about you, but I love dietitians and all the helpful information that they have to share with us!

Recently I went to a conference for diabetes educators, and using nutrition to manage these issues was THE topic of one of the sessions.  Nutrition needs are individual, so the goals for nutrition depend upon many things:

• Personal and cultural preferences
• Health Literacy and numeracy
• Access to healthful food choices
• Willingness to change
• Ability to make behavioral changes
• Barriers to change

That’s a lot more complicated than it seems at first glance, isn’t it?  I know I think of it as “this is just how I eat,” but the way we eat is personal and making a change can be hard.  After all, when you are diagnosed with diabetes, it changes your relationship with food.  I wish I could go back to the days when I didn’t carb count every bite I put in my mouth, or think about the effect that the food would have on my BG.  I do miss food just being food.  But knowledge is power, and it helps to be able to lower your risks through making smart food choices wherever you can.  Besides, whether or not you have diabetes, we are all supposed to follow healthy eating guidelines!  And this stuff applies to Type 1 and Type 2 alike.

It’s also important to maintain the pleasure of eating when you have diabetes.  After all, food is one of the great pleasures in life for many of us!  Food choices should only be limited when there is scientific evidence of a need to do so.

To manage weight, BG, BP, and cholesterol, there are some tips that we should all be aware of, and incorporate into our eating patterns as much as possible.

Limit added sugars in the diet; these should represent less than 10% of your calories each day.  There are a lot of foods that contain sugar that might surprise you! Sugar-sweetened beverages are best avoided (unless BG is low of course!).  Research shows us that these drinks increase our cardio-metabolic risk, and that’s something every person with diabetes needs to manage.

The fewer calories and carbs that come in at once, the better your BG control will be.  To that end, it’s best to divide your calories into three moderate meals or 4 smaller meals per day.  It can be hard for the body to deal with large amounts of food all at once.  That’s why it’s also important for those meals and snacks to be spaced apart, rather than “grazing.”  Consistent timing and even spacing of meals and carbohydrates can really help with BG management.  If you count carbs to match them to insulin, be as accurate as possible on a consistent basis for best results.

We should eat a variety of foods in part to ensure that we get the recommended amount of vitamins and minerals.  However, there’s no evidence of benefit from supplementation for people with diabetes who do not have a documented deficiency of a vitamin or mineral.  Supplementing without deficiency causes harm and can increase cardiometabolic risk.  But if you have a blood deficiency of a particular nutrient, this increases this risk.  So the trick is to only take supplements if you have been found to be deficient and have a need to supplement.

Practice portion control.  This helps with both weight and BG management.  Eating fewer calories and getting regular physical activity improves BG control independent of body weight and weight loss.

If you are overweight or obese, work towards weight loss.  If your body mass index (BMI) is 25 or above (or 23 or above if you are Asian), it is recommended to lose weight.  Modest sustained weight loss of 5% of your starting weight can improve BG, increase insulin sensitivity and reduce the need for medication.  Sustained weight loss of 7% is optimal.  Excess weight makes you more insulin resistant and so it contributes to higher BG levels.

With diabetes, the blood pressure needs to be kept below 140/90, and for some people, the goal may be to keep it under 130/80.  Smoking cessation and engaging in regular physical activity are important ways to help with this.  So are limiting alcoholic beverages to a moderate amount, losing excess body weight, and following a DASH (Dietary Approaches to Stop Hypertension) diet eating plan.  It’s a flexible and balanced food plan for heart-healthy eating, emphasizing fruits, vegetables, whole grains, low or no-fat dairy, fish, poultry, nuts, beans, and vegetable oils.  It’s low to moderate in fat and high in fiber, following US guidelines for sodium.  Reducing sodium intake can help with blood pressure management.  When potassium, calcium, and magnesium levels go down, BP goes down, so be sure to eat foods containing these important nutrients on a regular basis.

The best carbs come from fruits, vegetables, whole grains, legumes, and low/no fat dairy, and are rich in fiber and lower in glycemic index.  These are especially preferred to carbs containing added sugars. Many refined foods contain added sugar and these are easy to identify because they are typically in a package. Look for grains that have at least 5g of dietary fiber per serving and contain Whole Grains as the first ingredients.

To help your cardiometabolic risk, cholesterol, and BG, decrease saturated fat to less than 5-6% of your daily calories and replace it with MUFAs–monounsaturated fatty acids.  Saturated fat is hard at room temperature, and it hurts BG control.  Mono and polyunsaturated fats are liquid at room temperature and are much healthier for you.  Trans fats should make up than less than 1% of your calories and are best avoided altogether.  It’s also recommended to limit red meat…, that’s a tough one for me!

Consume anti-oxidant rich fruits, veggies, nuts, and whole grains.  Oxidation releases free radicals and leads to oxidative stress, which affects the cardiovascular system and causes cell damage.  Dietary antioxidants inhibit oxidation.  The good guys include Vitamins A, C, and E, beta carotene, lycopene, lutein, flavones, and green tea, to name a few.  Just be sure you are getting the right amounts of these through a varied diet, not through supplements.  Research shows us that high doses of these antioxidants above the Recommended Dietary Allowances do NOT provide cardiovascular benefit and may cause harm.

Foods that contain plant and marine omega 3 fats are encouraged, so make sure fatty fish and nuts and seeds are a regular part of your diet.  Research does not support a benefit to taking omega 3 dietary supplements, however, unless prescribed by a physician to decrease elevated triglyceride levels. One reason for a supplement may be if you are pregnant or breast feeding as these Omega 3’s can help with baby brain development in-utero as well as during the first year after birth.

So what do you think–would your diet benefit from a makeover?  Is there something that you could tweak to improve your health and decrease your risk?  I’m all for getting the most out of non-drug interventions.  It’s worth thinking of food as medicine and making smarter choices more often.  Small changes can add up! If you feel your habits could use a bit of tweaking OR you could add some healthier options call the office and set up a visit with our Registered Dietitian.