Have you recently been diagnosed with diabetes or prediabetes? Or has your doctor warned you that you’re at risk? It can be scary to hear that your health’s on the line, especially if you feel helpless to do anything about it.
Here’s a scenario that may sound familiar: your doctor’s telling you how important it is to lose weight and transform your eating habits, but you’re already discouraged. After all, you’ve tried dieting in the past without success. And counting calories, measuring portion sizes, and following complicated food charts sounds like way too much work.
Small changes equal big results
Whether you’re trying to prevent or control diabetes, there is some good news. You can make a big difference with healthy lifestyle changes. The most important thing you can do for your health is to lose weight—and you don’t have to lose all your extra pounds to reap the benefits. Experts say that losing just 5% to 10% of your total weight can help you lower your blood sugar considerably, as well as lower your blood pressure and cholesterol levels. It’s not too late to make a positive change, even if you’ve already developed diabetes. The bottom line is that you have more control over your health than you think.
Not all body fat is created equal
The biggest risk factor for developing diabetes is being overweight, but not all body fat is created equal. Your risk is higher if you tend to carry your weight around your abdomen—the so-called “spare tire”—as opposed to your hips and thighs. So why are “apple” shaped people more at risk than “pears”?
“Pears” store most of their fat close below the skin. “Apples” store their weight around their middle, much of it deep within the belly surrounding their abdominal organs and liver. This type of deep fat is closely linked to insulin resistance and diabetes. In fact, many studies show that waist size is a better predictor of diabetes risk than BMI (body mass index).
You are at an increased risk of developing diabetes if you are:
- A woman with a waist circumference of 35 inches or more
- A man with a waist circumference of 40 inches or more
To measure your waist circumference, place a tape measure around your bare abdomen just above your hip bone. Be sure that the tape is snug (but does not compress your skin) and that it is parallel to the floor. Relax, exhale, and measure your waist.
The dangers of "sugar belly"
Calories obtained from fructose (found in sugary beverages such as soda, energy and sports drinks, coffee drinks, and processed foods like doughnuts, muffins, cereal, candy and granola bars) are more likely to turn you into an "apple" by adding weight around your abdomen. Cutting back on sugary foods can mean a slimmer waistline as well as a lower risk of diabetes.
Eating right is vital if you’re trying to prevent or control diabetes. While exercise is also important, what you eat has the biggest impact when it comes to weight loss. But what does eating right for diabetes mean? You may be surprised to hear that your nutritional needs are virtually the same everyone else: no special foods or complicated diets are necessary.
A diabetes diet is simply a healthy eating plan that is high in nutrients, low in fat, and moderate in calories. It is a healthy diet for anyone! The only difference is that you need to pay more attention to some of your food choices—most notably the carbohydrates you eat.
Myths and facts about diabetes and diet
MYTH: You must avoid sugar at all costs.
Fact: The good news is that you can enjoy your favorite treats as long as you plan properly. Dessert doesn’t have to be off limits, as long as it’s a part of a healthy meal plan or combined with exercise.
MYTH: A high-protein diet is best.
Fact: Studies have shown that eating too much protein, especially animal protein, may actually cause insulin resistance, a key factor in diabetes. A healthy diet includes protein, carbohydrates, and fats. Our bodies need all three to function properly. The key is a balanced diet.
MYTH: You have to cut way down on carbs.
Fact: Again, the key is to eat a balanced diet. The serving size and the type of carbohydrates you eat are especially important. Focus on whole grain carbs since they are a good source of fiber and they are digested slowly, keeping blood sugar levels more even.
MYTH: You’ll no longer be able to eat normally. You need special diabetic meals.
Fact: The principles of healthy eating are the same—whether or not you’re trying to prevent or control diabetes. Expensive diabetic foods generally offer no special benefit. You can easily eat with your family and friends if you eat in moderation.
Carbohydrates have a big impact on your blood sugar levels—more so than fats and proteins—but you don’t have to avoid them. You just need to be smart about what types of carbs you eat.
In general, it’s best to limit highly refined carbohydrates like white bread, pasta, and rice, as well as soda, candy, and snack foods. Focus instead on high-fiber complex carbohydrates—also known as slow-release carbs. Slow-release carbs help keep blood sugar levels even because they are digested more slowly, thus preventing your body from producing too much insulin. They also provide lasting energy and help you stay full longer.
Choosing carbs that are packed with fiber (and don’t spike your blood sugar)
Try these high-fiber options…
Brown rice or wild rice
White potatoes (including fries and mashed potatoes)
Sweet potatoes, yams, winter squash, cauliflower mash
Whole-wheat or whole-grain bread
Sugary breakfast cereal
High-fiber breakfast cereal (Raisin Bran, etc.)
Steel-cut oats or rolled oats
Peas or leafy greens
Making the glycemic index easy
What foods are slow-release? Several tools have been designed to help answer this question. The glycemic index (GI) tells you how quickly a food turns into sugar in your system. Glycemic load, a newer term, looks at both the glycemic index and the amount of carbohydrate in a food, giving you a more accurate idea of how a food may affect your blood sugar level. High GI foods spike your blood sugar rapidly, while low GI foods have the least effect.
You can find glycemic index and glycemic load tables online, but you don’t have to rely on food charts in order to make smart choices. Australian chef Michael Moore has come up with an easier way to regulate the carbs you eat. He classifies foods into three broad categories: fire, water, and coal. The harder your body needs to work to break food down, the better.
- Fire foods have a high GI, and are low in fiber and protein. They include “white foods” (white rice, white pasta, white bread, potatoes, most baked goods), sweets, chips, and many processed foods. They should be limited in your diet.
- Water foods are free foods—meaning you can eat as many as you like. They include all vegetables and most types of fruit (fruit juice, dried fruit, and canned fruit packed in syrup spike blood sugar quickly and are not considered water foods).
- Coal foods have a low GI and are high in fiber and protein. They include nuts and seeds, lean meats, seafood, whole grains, and beans. They also include “white food” replacements such as brown rice, whole-wheat bread, and whole-wheat pasta.
8 principles of low-glycemic eating
- Eat a lot of non-starchy vegetables, beans, and fruits such as apples, pears, peaches, and berries. Even tropical fruits like bananas, mangoes, and papayas tend to have a lower glycemic index than typical desserts.
- Eat grains in the least-processed state possible: “unbroken,” such as whole-kernel bread, brown rice, and whole barley, millet, and wheat berries; or traditionally processed, such as stone-ground bread, steel-cut oats, and natural granola or muesli breakfast cereals.
- Limit white potatoes and refined grain products such as white breads and white pasta to small side dishes.
- Limit concentrated sweets—including high-calorie foods with a low glycemic index, such as ice cream— to occasional treats. Reduce fruit juice to no more than one cup a day. Completely eliminate sugar-sweetened drinks.
- Eat a healthful type of protein at most meals, such as beans, fish, or skinless chicken.
- Choose foods with healthful fats, such as olive oil, nuts (almonds, walnuts, pecans), and avocados. Limit saturated fats from dairy and other animal products. Completely eliminate partially hydrogenated fats (trans fats), which are in fast food and many packaged foods.
- Have three meals and one or two snacks each day, and don’t skip breakfast.
- Eat slowly and stop when full.
Adapted from Ending the Food Fight, by David Ludwig with Suzanne Rostler (Houghton Mifflin, 2008).
Eating for diabetes doesn’t mean eliminating sugar. If you have diabetes, you can still enjoy a small serving of your favorite dessert now and then. The key is moderation.
But maybe you have a sweet tooth and the thought of cutting back on sweets sounds almost as bad as cutting them out altogether. The good news is that cravings do go away and preferences change. As your eating habits become healthier, foods that you used to love may seem too rich or too sweet, and you may find yourself craving healthier options.
How to include sweets in a diabetes-friendly diet
- Hold the bread (or rice or pasta) if you want dessert. Eating sweets at a meal adds extra carbohydrates. Because of this it is best to cut back on the other carb-containing foods at the same meal.
- Add some healthy fat to your dessert. It may seem counterintuitive to pass over the low-fat or fat-free desserts in favor of their higher-fat counterparts. But fat slows down the digestive process, meaning blood sugar levels don’t spike as quickly. That doesn’t mean, however, that you should reach for the donuts. Think healthy fats, such as peanut butter, ricotta cheese, yogurt, or some nuts.
- Eat sweets with a meal, rather than as a stand-alone snack. When eaten on their own, sweets and desserts cause your blood sugar to spike. But if you eat them along with other healthy foods as part of your meal, your blood sugar won’t rise as rapidly.
- When you eat dessert, truly savor each bite. How many times have you mindlessly eaten your way through a bag of cookies or a huge piece of cake. Can you really say that you enjoyed each bite? Make your indulgence count by eating slowly and paying attention to the flavors and textures. You’ll enjoy it more, plus you’re less likely to overeat.
Tricks for cutting down on sugar
- Reduce how much soft drinks, soda and juice you drink. A recent study found that for each 12 oz. serving of a sugar-sweetened beverage you drink a day, your risk for diabetes increases by about 15 percent. If you miss your carbonation kick, try sparkling water with a twist of lemon or lime or a splash of fruit juice. Reduce the amount of creamers and sweeteners you add to tea and coffee drinks.
- Sweeten foods yourself. Buy unsweetened iced tea, plain yogurt, or unflavored oatmeal, for example, and add sweetener (or fruit) yourself. You’re likely to add far less sugar than the manufacturer would have.
- Reduce the amount of sugar in recipes by ¼ to ⅓. If a recipe calls for 1 cup of sugar, for example, use ⅔ or ¾ cup instead. You can also boost sweetness with cinnamon, nutmeg, or vanilla extract.
- Find healthy ways to satisfy your sweet tooth. Instead of ice cream, blend up frozen bananas for a creamy, frozen treat. Or enjoy a small chunk of dark chocolate, rather than your usual milk chocolate bar.
- Start with half of the dessert you normally eat, and replace the other half with fruit.
Proceed with caution when it comes to alcohol
It’s easy to underestimate the amount of calories and carbs in alcoholic drinks, including beer and wine. And cocktails mixed with soda and juice can be loaded with sugar. If you’re going to drink, do so in moderation (no more than 1 drink per day for women; 2 for men), choose calorie-free drink mixers, and drink only with food. If you’re diabetic, always monitor your blood glucose, as alcohol can interfere with diabetes medication and insulin.
Fats can be either helpful or harmful in your diet. People with diabetes are at higher risk for heart disease, so it is even more important to be smart about fats. Some fats are unhealthy and others have enormous health benefits. But all fats are high in calories, so you should always watch your portion sizes.
- Unhealthy fats – The two most damaging fats are saturated fats and trans fats. Saturated fats are found mainly in animal products such as red meat, whole milk dairy products, and eggs. Trans fats, also called partially hydrogenated oils, are created by adding hydrogen to liquid vegetable oils to make them more solid and less likely to spoil—which is very good for food manufacturers, and very bad for you.
- Healthy fats – The best fats are unsaturated fats, which come from plant and fish sources and are liquid at room temperature. Primary sources include olive oil, canola oil, nuts, and avocados. Also focus on omega-3 fatty acids, which fight inflammation and support brain and heart health. Good sources include salmon, tuna, and flaxseeds.
Ways to reduce unhealthy fats and add healthy fats:
- Cook with olive oil instead of butter or vegetable oil.
- Trim any visible fat off of meat before cooking and remove the skin before cooking chicken and turkey.
- Instead of chips or crackers, try snacking on nuts or seeds. Add them to your morning cereal or have a little handful for a filling snack. Nut butters are also very satisfying and full of healthy fats.
- Instead of frying, choose to grill, broil, bake, or stir-fry.
- Serve fish 2 or 3 times week instead of red meat.
- Add avocado to your sandwiches instead of cheese. This will keep the creamy texture, but improve the health factor.
- When baking, use canola oil or applesauce instead of shortening or butter.
- Rather than using heavy cream, make your soups creamy by adding low-fat milk thickened with flour, pureed potatoes, or reduced-fat sour cream.
If you’re overweight, you may be encouraged to note that you only have to lose 7% of your body weight to cut your risk of diabetes in half. And you don’t have to obsessively count calories or starve yourself to do it.
When it comes to successful weight loss, research shows that the two most helpful strategies involve following a regular eating schedule and recording what you eat.
Eat at regularly set times
Your body is better able to regulate blood sugar levels—and your weight—when you maintain a regular meal schedule. Aim for moderate and consistent portion sizes for each meal or snack.
- Don’t skip breakfast. Start your day off with a good breakfast. Eating breakfast every day will help you have energy as well as steady blood sugar levels.
- Eat regular small meals—up to 6 per day. People tend to eat larger portions when they are overly hungry, so eating regularly will help you keep your portions in check.
- Keep calorie intake the same. Regulating the amount of calories you eat on a day-to-day basis has an impact on the regularity of your blood sugar levels. Try to eat roughly the same amount of calories every day, rather than overeating one day or at one meal, and then skimping on the next.
Keep a food diary
Research shows that people who keep a food diary are more likely to lose weight and keep it off. In fact, a recent study found that people who kept a food diary lost twice as much weight as those who didn’t.
Why does writing down what you eat and drink help you drop pounds? For one, it helps you identify problem areas—such as your afternoon snack or your morning latte—where you’re getting a lot more calories than you realized. It also increases your awareness of what, why, and how much you’re eating, which helps you cut back on mindless snacking and emotional eating.
What about exercise?
When it comes to preventing, controlling, or reversing diabetes, you can’t afford to overlook exercise. Exercise can help your weight loss efforts, and is especially important in maintaining weight loss. There is also evidence that regular exercise can improve your insulin sensitivity even if you don’t lose weight.
You don’t have to become a gym rat or adopt a grueling fitness regimen. One of the easiest ways is to start walking for 30 minutes five or more times a week. You can also try swimming, biking, or any other moderate-intensity activities—meaning you work up a light sweat and start to breathe harder. Even house and yard work counts.
Cooking & Eating Out
Resources & References
Eating right for diabetes
Simple Steps to Preventing Diabetes – Easy-to-understand overview of what diabetes is and how you can control and prevent it through exercise and healthy eating. (Harvard School of Public Health)
The Truth About the So-Called "Diabetes Diet" – Learn the facts about eating for diabetes. For example, it’s okay to substitute sugar-containing food for other carbs as part of a balanced meal plan. (Joslin Diabetes Center)
The Basics of a Healthy Diabetes Diet – A summary of the various factors in a diabetes diet. (WebMD)
Diabetes Myths – Get the facts about diabetes, including the truth about common diabetes diet myths. (American Diabetes Association)
Diabetes nutrition: Including sweets in your meal plan – What you should know about sugar, how to include it in your diet and information on alternatives. (Mayoclinic.com)
Sugar and Desserts – Good information on sugar and including it in your diet (American Diabetes Association)
Carbohydrates – Covers the three main types of carbs: sugars, starches, and fiber. Includes information on making smart carb choices. (American Diabetes Association)
Carbohydrates and Diabetes – Explore a collection of simple tips on managing your consumption of carbohydrates. (UCSF Medical Center).
Fruits – Many people mistakenly assume that fruits aren’t a part of a diabetes-friendly diet. But fruits, like vegetables, are loaded with nutrients and fiber. Learn how to include them in your diabetes diet. (American Diabetes Association)
Fat and Diabetes – Information on the different kinds of fats, as well as what foods they are in. (American Diabetes Association)
Diabetes and weight loss
Keep An Eye on Portion Size – Information on the difference between serving size and portion size, plus a downloadable PDF of a Serving Size Card. (Department of Health & Human Services)
Diabetes and exercise
Exercise Prescription for Diabetes – Learn why exercise matters when it comes to preventing and controlling diabetes and find easy tips for getting started. (Harvard Health Publications)