One of the biggest challenges many people face when they find out they have diabetes is figuring out what they can eat and when. Fortunately, healthy eating when you have type 1 or type 2 diabetes (or prediabetes) isn’t substantially different from how we all should eat. Diabetes-friendly meals feature the same healthy foods ― whole grains, colorful non-starchy vegetables, whole fruits, lean protein, fish, low-fat dairy, nuts and healthy fats ― recommended for everyone.
”If you have prediabetes or diabetes, your meals can still be (and should be) enjoyable,” emphasizes Denise Arthurs, MS, RD, a clinical dietitian/nutritionist at the Frances Stern Nutrition Center at Tufts Medical Center. “In the past, diabetes diets were fairly rigid. Today, the guidelines of the American Diabetes Association (ADA) focus on healthful eating patterns that feature a variety of nutrient-dense foods in appropriate portion sizes to help you meet your weight goals.”
Healthy Body Weight and Diabetes
Underlying diabetes diet guidelines is the importance of following a heart-healthy eating plan and maintaining a healthy body weight. People with diabetes have two to three times greater risk of cardiovascular disease, including heart attack and stroke, compared to people without diabetes.
To learn more, see: Healthy Fats Reduce Diabetes Risk
Modest weight loss, if you’re carrying extra weight, reduces risk of cardiovascular issues. It also can delay progression from prediabetes to type 2 diabetes. “In people with prediabetes or type 2 diabetes who are overweight or obese, losing at least 5 percent ― and ideally 7 percent or more ― of body weight (and sustaining that loss) can significantly improve blood sugar control,” Arthurs says. When your blood sugar is under better control, you feel better, too.
Carbohydrates and Controlling Blood Sugar
Carbohydrate is in the spotlight in diabetes meal planning. That’s because the carbohydrate you eat is ultimately broken down and converted to glucose in the body (if not consumed directly as glucose), which raises blood sugar, also called blood glucose. In type 1 diabetes, there is a complete absence of insulin needed to lower blood sugar, while in type 2 diabetes, the body doesn’t produce enough insulin and the body’s cells aren’t responsive enough to it.
”That doesn’t mean a person should completely avoid carbohydrate-containing foods; they’re an important source of energy, essential nutrients and fiber,” Arthurs says. “But, you do need to pay attention to the amount and timing.” That requires knowing which foods contain carbs and which ones don’t (see “Carbohydrate Foods,” right).
“The carbohydrate-containing foods we encourage people with diabetes to eat are those that are the least refined or processed because they’re generally gentler on blood sugar,” Arthurs says. For example, steel-cut oats (oat kernels simply broken into a few pieces) or rolled oats are a better choice than instant oatmeal, especially if flavored and sweetened.
“However, that doesn’t mean you can never eat a piece of pie or a serving of ice cream,” Arthurs says. “Those foods can fit in small portions, but they should be a treat, not everyday foods.” If you know you’re going to eat a scoop of ice cream at a birthday celebration, for example, then skip a carbohydrate-rich food you’d normally eat at that meal, such as the dinner roll or mashed potatoes. That can help prevent a big rise in your blood sugar.
Best Foods for Diabetes, Counting Carbohydrates, and Diabetes Meal Planning
Best Foods for Diabetes
As you think about a diabetes diet, Arthurs encourages you to first look at how you normally eat. Are some of your meals mainly carbohydrate-rich foods and little else? Have you aimed for a balance of different types of food at meals ― for example, non-starchy vegetables, a whole grain, lean protein and a small amount of heart-healthy fat, such as a drizzle of olive oil? If you increase one component of a meal, be sure to decrease another so your total caloric intake doesn’t exceed your needs.
Don’t overlook beverages in your assessment. Are you drinking empty-calorie, sugary carbs, such as soda? The ADA advises avoiding sugar-sweetened drinks to help with weight control and reduce risk of cardiovascular disease and fatty liver disease (also a common companion to type 2 diabetes). Even drinking 100 percent fruit juice can make it more challenging to control blood sugar and fatty liver risk. A better choice is whole fruit, which comes in nature’s own portion-controlled packages and with fiber to slow digestion.
One approach that can help you put dietary recommendations together is the diabetes plate method. If you already use Tufts MyPlate for Older Adults (or the regular MyPlate), planning what to put on your plate in diabetes is not very different. The main change is that fruit is moved off the plate as an optional dessert, as your meal plan allows, and its place on the plate is filled by non-starchy vegetables. This approach makes it easy to plan healthful meals and not over-do meat and starchy foods.
The diabetes plate method also easily accommodates healthy eating patterns such as the Mediterranean diet, which encourages non-starchy vegetables, whole grains, legumes, whole fruit, nuts and olive oil while limiting red or processed meat and sweets. Not only has the Mediterranean diet been shown to reduce risk of type 2 diabetes, but a recent review of clinical trials published in the European Journal of Clinical Nutrition found the diet was associated with improved blood sugar control, body weight, blood pressure, blood cholesterol and triglycerides, compared to control diets (which covered a range, including low-fat, low-carb to high-carb or simply usual dietary habits) in people with type 2 diabetes.
Counting Carbohydrates and Diabetes
If you’re ready to take diabetes meal planning to the next level, you can count your carbohydrate grams or carbohydrate servings, sometimes called carb counting, in addition to planning a balanced plate with nutrient-rich foods. Look up the carb grams in foods by using nutrition labels, recipe nutrition information, books, restaurant websites, smartphone apps and online food databases such as from the USDA or the ADA .
In diabetes meal planning, one carbohydrate “serving” or “choice” has an average of 15 grams carbohydrate. So, if you eat an English muffin that has 30 grams carb, it counts as 2 carb servings.
How many carb servings should you eat at a meal or snack? This is best determined with the help of a registered dietitian or diabetes educator while considering your body size, activity level and weight goals (and insulin regimen, if applicable). These experts can also help you master carb counting.
To learn more, see: Choose the Right Carbs to Help Control Your Diabetes Risk
Food Patterns, Healthy Fats, Probiotics, Very Low Carb Diets
In addition to types and amounts of carbs, the evidence and guidelines support focusing on a healthier overall eating pattern, such as a Mediterranean-type diet rich in minimally processed, bioactive foods like fruits, non-starchy vegetables, nuts, beans, and fish. Controlled trials show that eating more healthy fats, in particular polyunsaturated fats from plants and plant oils, leads to better glucose control and improved insulin sensitivity. Emerging science suggests that yogurt and probiotics may also help, perhaps through maintaining a healthy gut microbiome ― more research is needed. There is also growing clinical and public interest in very low carbohydrate diets (e.g., 10-15 percent or less of calories from carbs): assuming the rest of your diet is composed of minimally processed, bioactive foods and healthy fats and proteins, this is a diet pattern that could be considered together with your doctor.
Diabetes Meal Planning
Keep regular eating times distributed across the day (and coordinated with diabetes medication and insulin regimens, as applicable). Whether or not you eat snacks is up to you and will depend on what time you eat meals and should be aligned with your weight goals. If you eat breakfast at 9 a.m. and lunch at noon, you probably don’t need a morning snack. But if you don’t eat again until 6 p.m., a mid-afternoon snack may help control hunger and blood sugar.
”Blood sugar rises after meals (and snacks), so spacing out eating times gives blood sugar a chance to come back down between meals,” Arthurs says. “It’s also important not to eat too much at a time. It would be really hard for people with diabetes to control their blood sugar levels if they ate one big meal a day and didn’t eat at any other time. Blood sugar would be really high after the large meal.” Over the long run, high blood sugar can increase risk of diabetes-related damage to blood vessels, such as in the cardiovascular system, eyes and kidneys.
Don’t skip breakfast, as eating your morning meal may be particularly helpful for blood sugar control. In research, skipping breakfast has been consistently associated with higher A1C (a measure of average blood sugar over about 3 months) in type 2 diabetes.
So, whether you’re new to managing diabetes or have been working on it for a while, there’s a lot you can do from a dietary standpoint to help you live well with diabetes. You don’t have to master diabetes guidelines overnight, and many health practitioners are available to help.
This article has been adapted from the February 2017 edition of the Tufts Health & Nutrition Letter, a publication of the Friedman School of Nutrition Science & Policy at Tufts University: Editor-in-Chief, Dariush Mozaffarian, MD, DrPH, and Executive Editor, Alice H Lichtenstein, DSc. It is written with your needs in mind but is not a substitute for consulting with your physician or other health care providers. The publisher and authors are not responsible for any adverse effects or consequences resulting from the use of the suggestions, products or procedures that appear in this magazine. All matters regarding your health should be supervised by a licensed health care physician.
The Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy is the only graduate school of nutrition in the United States. The mission of the school is to generate trusted science, educate future leaders, and produce real world impact.