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Diet for Diabetes

Because food intake affects the cells' need for insulin and insulin's ability to lower blood sugar, diet is the cornerstone of diabetes treatment.

Today, diabetes experts no longer recommend a single diet for all people with diabetes. Instead, they advocate dietary regimes that are flexible and take into account a person's lifestyle and particular health needs.

The American Diabetes Association (ADA) described some common options in a 1994 position paper. A first step, for example, is to encourage people with diabetes to follow the government's Dietary Guidelines for Americans and Food Guide Pyramid.

According to Phyllis Barrier, a registered dietitian and director of program publications for ADA, this step alone may be enough to maintain normal blood glucose, or sugar, levels. Maintaining these levels helps reduce the risks of retinopathy and other diabetes-related complications, such as kidney and heart disease.

Other people use the Exchange Lists for Meal Planning, she said. This system, established by the American Dietetic and American Diabetes associations, separates foods into six categories based on their nutritional makeup. People following this plan choose a set amount of servings from each category daily, depending on their nutritional needs.

A more sophisticated method of meal planning is "carbohydrate counting," in which grams of carbohydrate consumed are monitored and adjusted daily according to blood glucose levels. Some people count protein and fat grams, too. These two nutrients also can affect blood sugar levels, although to a lesser extent.

Whatever method used, ADA recommends these general dietary guidelines for people with diabetes:

• Limit fat to 30 percent or less of daily calories.
• Limit saturated fat to 10 percent or less of daily calories.
• Limit protein to 10 to 20 percent of daily calories. For those with initial signs of diabetes-induced kidney disease, restrict protein to 10 percent of daily calories.
• Limit cholesterol to 300 milligrams or less daily.
• Consume about 20 to 35 grams of fiber daily.

Most of these guidelines are a good idea for the general population, as well.

Those who are overweight also may moderately restrict calories. ADA recommends a calorie reduction of 250 to 500 calories less than normally eaten per day. That should result in a weight loss of about 0.2 to 0.5 kilograms (one-half to 1 pound) a week, ADA's Barrier said. The calorie restriction, along with increased exercise, should help an overweight person achieve a weight loss of 5 to 10 kilograms (11 to 22 pounds) in about six months to one year. The weight loss, although moderate, can help improve diabetes control.

Carbohydrate intake can vary, but, contrary to popular belief, the type of carbohydrate is not a factor. As ADA points out in its position paper, people with diabetes have for years been told to avoid "simple" sugars, such as table sugar and those found in sugary snacks, because they were thought to elevate blood glucose more quickly and more severely than other carbohydrates.

"There is, however, very little scientific evidence that supports this assumption," ADA wrote in its position paper. The organization recommended that the focus be on total carbohydrate — not source of carbohydrate. If sugar and sugar-containing foods are eaten, the amounts must be figured into the daily allotment of carbohydrate.

Get the Nutrition Facts

Considering these factors, how should people with diabetes go about using the food label?

They can begin with the Nutrition Facts panel, usually on the side or back of the package.

Serving sizes now are more uniform among similar products and reflect the amounts people actually eat. The similarity makes it easier to compare the nutritional qualities of related foods.

People who use the Exchange Lists should be aware that the serving size on the label may not be the same as that in the Exchange Lists. For example, the label serving size for orange juice is 8 fluid ounces (240 milliliters). In the exchange lists, the serving size is 4 ounces (one-half cup) or 120 mL. So, a person who drinks one cup of orange juice has used two fruit exchanges.

The label also gives grams of total carbohydrate, protein and fat, which can be used for carbohydrate counting.

The values listed for total carbohydrate include all carbohydrate, including dietary fiber and sugars listed below it. Not singled out is complex carbohydrates, such as starches.

The sugars include naturally present sugars, such as lactose in milk and fructose in fruits, and those added to the food, such as table sugar, corn syrup, and dextrose.

The listing of grams of protein also is helpful for those restricting their protein intake, either to reduce their risk of kidney disease or to manage the kidney disease they have developed.

Tags: Diabetes, Low Sugar Diet, Nutrition

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