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Diabetic diet emphasizes moderation

January 2, 2005 1:06 am

AREADER, overwhelmed by an abundance of dieting advice for diabetics, asks for help sorting it all out.

QI read your article on the Net about the glycemic index. I was diagnosed with type 2 diabetes in November of 2002 and since then have been living in a state of diet confusion. The more information I read about how a diabetic should eat, the more confused I have become. Good carbs, bad carbs, low fat, high fat, extremely low calorie vs. moderate calorie, etc. And to me, it seems that no two doctors or dietitians can agree on any one diet that is healthy for diabetics.

 I am 150 pounds overweight. I am a veteran of the diet wars, and nothing ever really worked short of starvation, which is impractical because most of us cannot sustain such feats of superhuman willpower for very long.

I want to do something, but what? My doctor and a dietitian both wanted me to maintain a 1,200-calorie-a-day diet, which I simply cannot do. I am willing to do my part, but I cannot lie awake in bed at night with my stomach cramping from hunger. I won't do that anymore!

 Because of nerve problems in my feet, I find walking difficult. I do not have access to a swimming pool where I live, but I try to do as much as possible in the way of exercising. But I want a good, sensible diet to follow.

 --M.L.

Maud, Okla.

AThe basic principles of eating to control diabetes are standard: heart-healthy eating, with moderate amounts of carbohydrates spread out throughout the day over a minimum of three meals.

How people meet those standards may vary. For example, someone who loves to cook will choose different foods than a restaurant-goer; an Italian-American may choose different foods than a Chinese-American. Also, people who need insulin injections may eat differently than people who don't; children and pregnant women with diabetes will have additional needs. High blood pressure, high cholesterol and other problems also can affect recommendations. Because a person's quirks complicate how they manage their diabetes, the American Diabetes Association recommends seeing a registered dietitian.

If you weren't happy with the dietitian you saw, try another one. There are dietitians out there who are certified diabetes educators.

Also, there is no reason to starve yourself. Although modest weight loss can help control your blood sugar, you may not need to be so strict to achieve it.

Eating better and being physically active can help, even if you don't lose weight. Physical activity really helps control blood sugar, thus reducing your risk of complications such as kidney failure and amputations, so try to find some gentle exercise you enjoy for about a half-hour daily.

The American Diabetes Association recommends against trendy high-protein, high-fat diets. Most women need a moderate amount--three or four palm-size portions-- of carbohydrate-rich foods (including drinks) at each meal, plus proteins and nonstarchy vegetables. Of course, actual needs depend on a person's height, weight, age, activity level and health.

There are four types of carbohydrate-rich foods:

Starches (grains, such as bread, cereal or rice, plus starchy vegetables such as potatoes, peas, corn, etc.)

Fruits and juices

Milk and yogurt (1 percent low-fat or nonfat recommended)

Sweets (sugar, soda, cookies, etc.)

So for our theoretical woman, each meal would include three to four palm-size portions of starches, fruit or milk. Sweets are OK in small amounts if exchanged for something starchy (for example, trade a cookie for a baked potato).

Also, at least two meals daily should include palm-size portions of protein, such as fish, chicken, soy, nuts, reduced-fat cheeses, eggs or egg substitutes. Small pieces of lean meats, such as an occasional round steak or beef tenderloin are fine, but fatty meats such as hamburger and pork ribs may raise cholesterol.

At least two meals daily should include generous portions of nonstarchy vegetables. Nonstarchy vegetables do not significantly affect blood sugar until you eat about three cups of them. Nonstarchy vegetables are any vegetables that are tender enough to eat raw, such as lettuce, tomatoes, broccoli, green beans, carrots and the like.

(In contrast, most carbohydrate-rich starchy vegetables are hard when raw: You could hurt your teeth by eating a raw potato, dry green peas or dry red beans.)

You don't have to learn the glycemic index or even glycemic load, according to the American Diabetes Association, since the total amount of carbohydrates eaten at each meal has a bigger effect than the glycemic index of those foods.

However, it is wise to choose high-fiber carbohydrates, such as whole grains, beans, fruits and vegetables.

Be careful about sweet drinks: A 16-ounce cola or apple juice has the same amount of carbohydrates as three to four slices of bread, but the drinks are less filling.

People with diabetes have a higher risk of heart attacks and strokes, so choose heart-healthy fats, such as olive or canola oil, rather than butter, cream, lard or vegetable shortening.

Bake, broil or grill foods rather than frying them.

Try for two servings a week of fatty fish such as salmon, tuna, herring, mackerel or sardines. The omega-3 fats in fish are good for your heart. If you don't eat fish, consider eating walnuts or flaxseed, or speak with your doctor about a fish-oil supplement.

If you drink alcohol, limit yourself to one or two drinks daily, with meals. Alcohol on an empty stomach can make your blood sugar drop.

If you're 50 or older, a daily multivitamin-mineral pill plus a calcium supplement may be useful.

I can only skim the surface of the problem in a short column. Consider getting individual advice from a dietitian or diabetes education program. Try calling the American Diabetes Association at 800/342-2383, or the American Dietetic Association at 800/366-1655.

JENNIFER MOTL, a registered dietitian, welcomes reader questions via her Web site, brighteating.com, or mailed to Nutrition, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401.