Healthy Eating

Without healthy eating (including good food choices and appropriate numbers of calories), the likelihood of successfully managing your diabetes is, ahem, slim.
These are just some of the benefits to you if you have diabetes and you eat healthfully:

  • Lower blood sugar levels
  • Lower LDL cholesterol, lower trigerlyercides, higher HDL (that is, the healthy) cholesterol
  • Lower blood glucose levels
  • Better blood pressure control
  • Better weight control
  • Better bowel habits
  • Lower risk of heart disease

Your daily calories should be divided up as follows:

Carbohydrates 45 to 60 %
Protein 15 to 20 %
Fat Less than 35 %

Carbohydrates are found in foods grown in the ground (examples are rice, potatoes, grains, fruits, sugar) and milk products. Their main role is to provide energy to fuel your body. Fibre, which is also a carbohydrate, does not contribute energy, but does have many other benefits including helping you avoid constipation, helping lower your blood glucose and your bad (LDL) cholesterol.

Proteins are found in meat, fish, poultry, eggs, cheese, soybeans, legumes, nuts, seeds, and tofu amongst other places. Their main role is to maintain healthy body tissues; especially muscles.

Fats are found in meats, butter, margarine, oil, avocado, salad dressings, maynnaise, and sour cream amongst other places. Although fats have a bad rap, not all fats are bad (in terms of promoting heart disease or other circulation problems); indeed some are good. Unhealthy fats include cholesterol-rich foods, saturated fats (such as is found in meat, cream, and butter) and trans fats (found in many processed foods such as potato chips, doughnuts, and French fries although manufacturers are now making a point of eliminating trans fats from more and more of their products). Good fats include polyunsaturated fats (as is found in sunflower oil, corn oil, soybean oil and soft margarines), omega-3 fatty acids, and monounsaturated fats (as is found in avocados, olive oil, almonds, and peanuts). As you can see even "healthy" fats still contain caloreis and thus need to be consumed only in appropriate quantities.

Now on the off chance you found the preceding discussion to be a "yada yada yada" dissertation, here are some perhaps more colourful (and editorially rich) ponouncements. IMHO:

  1. There is no such thing as a "diabetic diet." A so-called diabetic diet is simply a well-balanced, nutritious eating plan (one that anyone - whether or not they have diabetes - can benefit from).
  2. There is no such thing as "cheating" on your diet. "Cheating" is a patronizing term that should not be used.
  3. Feel free to tell the "diabetes police" (that is, those many well-meaning people who insist on telling you what, in their estimation, you can and cannot eat) that you are not a "diabetes criminal" in need of unsolicited correcting and that you are fully aware of what and how to eat, but you appreciate their concerns and hope they have a very nice day (if, ahem, you know what I mean).
  4. Most important of all: Cake is not a four letter word! Well, okay, I guess "cake" technically is a four letter word, but you know what I mean. The point is that no food is forbidden (but some things - such as "sweets" should be eaten in limited quantities- as is true for everyone, whether or not you have diabetes). Indeed, the CDA advises that up to 10 percent of one's daily calories can be in the form of "sweets."
The Glycemic Index: You may have heard about the glycemic Index and are wondering if this is something you should concern yourself about. The premise behind the Glycemic Index is that certain foods are more likely than others to make your blood sugar go up after you eat them. And so, of course, one would think it is best to avoid (or at least restrict) such things. Indeed, medical organizations in a number of countries in the world have found sufficient merit to this that they advocate following a diet based on Glycemic Index principles. There are, however, some buts; for instance, a low Glycemic Index diet:
  • is not proven to improve overall blood glucose control (as reflected by A1C values)
  • is not proven to improve overall health
  • may be too much hassle for many (possibly most) people to follow day after day after day after...
  • (this next point is my favourite); the ADA web site, on January 10, 2003 had an article that notes "based on glycemic index, M & M candies are held to be the equivalent of low fat yogurt with fruit. And Snickers bars rate more favourably than Cheerio's or cornflakes." Makes one pause to reflect on the merits of the GI diet, does it not?

My opinion? Simply this: A diet based on Glycemic Index may turn out to be the best diet in the world to treat diabetes, but for now we do not have proof of this. Once again, only time (in the company of more research and, in particular, clinical trials) will tell. If you are having problems with blood glucose elevation after meals despite diligently adhering to healthy eating prinicples and taking appropriate amounts of appropriate medications then by all means do speak to your registered dietitian to see if following a low GI diet may be of some merit to you.

Low Carb Diets: Another issue about dietary therapy is whether it is a good idea to follow a low carbohydrate/high protein diet. My concern about this type of diet is that the benefits seemingly achieved with such diets are either short-lived (weight loss is almost always temporary) or, in some cases, offset by disadvantages (constipation, fatigue, dizziness, possible worsening of cholesterol levels as well as a theoretically increased risk of osteoporosis and kidney stones).

Aspartame: Few substances known to mankind have met with as much misinformation as aspartame, an artifical sweetener used in many diet soft drinks and other products. Is it safe to consume?  The short answer is 'yes.' For the full, ahem, scoop, have a look at André Picard's excellent article in the Globe and Mail, published December, 2013.


Cynthia Payne is a dietitian and diabetes educator par excellence. Here are her...

Top Ten Ways To Manage Your Diabetes Through Nutrition

Not only is there no such thing as a “diabetic diet,” we consider the whole notion of a “diet” to be a four letter word. The key thing is to eat healthfully, just like everyone should, whether or not they have diabetes. Treating diabetes with healthy eating strategies can lower your A1C by up to 2 percent. This is a huge reduction and greatly reduces your risk of damage to your body. (Indeed, healthy eating is much more potent than are most drugs at lowering blood glucose.)

Here are my Top Ten Tips to help you control your diabetes through healthy eating strategies:

1. Eat three balanced meals a day. Eating three balanced meals a day will help you keep your blood glucose levels stable. Skipping a meal typically makes you extra hungry by the time the next meal comes along and leads most people to then eat to excess at that meal followed by too much snacking. All that extra eating makes blood glucose levels go up and makes it harder for weight to go down.

2. Timing is everything. Avoid going longer than six hours between meals during your waking hours. If it is going to be longer than six hours before your next meal, eat a small snack to hold you over. Consistency in meals, timing and regularity (see, regularity is not just for the bowels), helps control blood glucose and weight.

3. Balance is important. It’s important to include 3 or 4 of the four food groups in Canada’s Food Guide at a meal. The four food groups are: Vegetables and Fruits, Grain Products, Milk and Alternates, and Meat and Alternates. Following Canada’s Food Guide will provide you with the carbohydrate, protein and fat that you need for the day.

Carbohydrates often get a bad rap, especially when it comes to weight gain. But not only are carbohydrates not “bad,” in fact they are essential for our body to function properly. Carbohydrates provide the body with energy. In particular, the brain uses carbohydrates for fuel. Sugar is the simplest form of carbohydrate and is present naturally in fruits, vegetables, milk and milk products. Starch is a more complex form of sugar and occurs naturally in grains, potato, corn and cooked dry beans, peas and lentils. Fibre is a carbohydrate that is not absorbed into the body and therefore does not give us calories.

Protein helps build and repairs tissues like muscles, and is needed for making enzymes, hormones and other body chemicals.

A little fat is okay because it helps with absorption of fat soluble vitamins, provides energy, and slows down the rate at which glucose is absorbed into the body (which helps prevent blood glucose levels from rising overly rapidly).

4. Get plenty of fibre. Fibre is found in most fruits, vegetables and grains. There are two types of fibre: soluble and insoluble. Soluble fibre is found in oatmeal, eggplant, beans, peas and lentils, berries, and psyllium. Ingesting soluble fibre helps lower blood glucose and cholesterol. Insoluble fibre is found in whole grains, wheat bran, and potato and apple skin. Ingesting insoluble fibre helps prevent constipation, can make you feel full, and helps with weight loss. You should slowly increase the amount of fibre in your diet so as to avoid flatulence (gas) and diarrhea. Also, make sure you drink plenty of water. The Canadian Diabetes Association recommends you ingest 25-50 grams of fibre per day.

5. Drink lots of water. Water is the cheap, calorie-free beverage. Drinking water is an easy way to reduce appetite: drink a glass just before your meal and you will get a feeling of fullness. When it comes to water, the goal is to drink a minimum of 6 cups (1.5 L) of water a day…whether or not you feel thirsty.

6. Eat the right portion sizes. Many people underestimate what is an appropriate portion size and end up consuming excess amounts (and therefore extra calories). Canada’s Food Guide and the Canadian Diabetes Association give examples of portion sizes and the number of servings recommended per day. Don’t fall into the trap of “portion distortion.” Get out the measuring cups and measure how much food you have on your plate or in your bowl (or how much fluid you have in your glass). That is the only reliable way to determine how much you’re actually ingesting and therefore how many calories you are consuming.

7. Sort out snacks. Not too long ago, people living with diabetes were routinely told to have three snacks a day. Nowadays, however, with the contemporary diabetes medications that are available, this is no longer necessary. The Canadian Diabetes Association advises that the need for snacks and the number of snacks should be individually determined. The need for a snack is based on personal preference, diabetes medications, activity level, and whether or not you are pregnant. Be sure to speak to a dietitian to work out a snack routine best suited to you.

8. Slash the salt. Many people living with diabetes have high blood pressure. Lowering your intake of salt can help you lower your blood pressure. Take a look at the DASH eating plan. This plan stands for Dietary Approaches to Stop Hypertension. New research has shown this eating plan helps control blood pressure. Also, remember that reducing your salt intake doesn’t simply mean cutting back on the table salt you use when cooking or add to your food after. It also means reducing the salt-rich prepared foods you consume.

9. Don’t forget the fish. Canada’s Food Guide recommends you consume at least 2 servings of fish per week. Fish are one of the best sources of omega-3 fatty acids, a healthy fat that helps protect against cardiovascular disease. Because having diabetes increases your risk of heart disease, consuming omega-3 fatty acid-rich foods is especially important. Fish that are particularly rich in omega-3 fatty acids are salmon, herring, mackerel, trout, halibut, sardines and tuna. (Remember: don’t undo the benefit of eating these foods by deep fat frying them.)

10. Choose variety.You are likely familiar with the expression that variety is the spice of life. When it comes to foods this is as much literal as it is figurative. All foods can fit into a diabetes meal plan. A diabetes nutrition program does not exclude anything, not even sweets (consumed in moderation of course). Expand your eating horizons with colour as well. Many colourful vegetables and fruits are rich in vitamins, minerals and antioxidants. Try meatless meals weekly as a healthy, nutritious choice.

 Keep meals interesting, experimenting with new foods and new recipes. A good dietitian will not suggest you follow a regimented, unrealistic, unpleasant meal plan. A good dietitian will suggest a culturally appropriate, tasty, interesting, nutritious and varied eating plan suited just to you.

Cheers to managing your diabetes deliciously!

Cynthia Payne RD, CDE is the co-author (with Ian) of Diabetes Cookbook for Canadians for Dummies.