There is no Such Thing as a “Diabetic Diet”
New Web Discussion Group To Debunk Myths Around Diet and Diabetes
Despite new nutrition guidelines issued by the American Diabetes Association several years ago, many people with diabetes still believe that there is something called a “diabetic diet.” Many people with diabetes who are receiving inadequate information about how to manage their condition imagine that this so-called “diabetic diet” means they have to “avoid sugar.”
“That just simply isn’t how meal planning works today with patients with diabetes,” says Karen Chalmers, R.D., M.S., C.D.E., Director of Nutrition Services at Joslin in Boston and author of 16 Myths of a Diabetic Diet.
“Simply stated, with proper education and within the context of healthy eating, a person with diabetes can eat anything a non-diabetic eats,” says Chalmers.
In response to this gap in knowledge about what people believe about eating with diabetes, Joslin Diabetes Center has begun a campaign to educate people with diabetes – and the general public — about what the nutrition issues are for people with diabetes.
This campaign includes a new web-based discussion group at http://www.joslin.org/managing/discussion.shtml hosted by Chalmers that will answer questions about diabetes and diet. Anyone can pose a comment or question to the discussion group. Chalmers will moderate the discussion, answering questions herself as well as providing a forum where others with diabetes who participate in the discussion group can offer their thoughts regarding questions and concerns they have about diabetes and food.
It’s Not About Avoiding Sugar
According to Joslin’s Director of Communications Julie Rafferty, the most frequent inquiry her office receives from people with diabetes who call, write or email Joslin Diabetes Center in Boston at email@example.com is to be sent a “diabetic diet,” or “lists of foods they can and cannot eat.”
“If asked for more detail, they will frequently state that they believe that having diabetes chiefly means they have to avoid sugar-containing foods such as cakes, cookies and candies,” says Rafferty, whose office answers 40-50 emails, plus dozens of phone calls and letters each day from people all over the U.S. who contact Joslin looking for help with their diabetes.
Unfortunately, for many people with diabetes – both those who have had the disease for a while, and for newly diagnosed patients – the new concepts around eating and diabetes are still not widely known, says Chalmers.
What’s the Truth About Diabetes and Diet?
New guidelines for people with diabetes were issued in the Spring of 1994 by an American Diabetes Association committee on nutrition co-chaired by Joslin Vice President Edward S. Horton, M.D. Those guidelines state that it is okay for people with diabetes to substitute sugar-containing food for other carbohydrates as part of a balanced meal plan. This liberalizes the eating guidelines that people with diabetes had been following for most of the 20th century.
Prevailing beliefs up to 1994 were that people with diabetes should avoid foods that contain so-called “simple” sugars and replace them with “complex” carbohydrates, such as those found in potatoes and cereals.
The committee, which published its new recommendation in the May, 1994, issue of Diabetes Care, noted that there was relatively little scientific evidence to support the theory that simple sugars are more rapidly digested and absorbed than starches, and therefore more apt to produce high blood sugar levels.
Instead, the emphasis since these guidelines were issued has evolved so that now many patients are being taught to focus on how many total grams of carbohydrate they can eat throughout the day at each meal and snack, and still keep their blood sugars under good control.
Well-controlled blood sugars are a top priority because other research studies have shown conclusively that all people with diabetes can cut their risk of developing diabetes complications such as heart disease, stroke, kidney and eye disease, nerve damage and more, by keeping their blood sugars as closely controlled as possible.
What does this mean for people with diabetes?
This means that a patient who has worked with their dietitian and their diabetes treatment team to figure out how many grams of carbohydrate they can eat throughout the day can decide at any given meal what they will eat. Those with diabetes who are not on insulin need to focus on keeping the amount of carbohydrate they eat consistent throughout the day. Those on insulin can decide both what and how much to eat at given meal (as long as it doesn’t exceed their daily allotment), and can then adjust their insulin accordingly. “There aren’t any foods that are ‘off-limits,'” says Chalmers. “Rather the patient just needs to learn how to spend their grams of carbohydrate wisely over the course of the day.”
Patients then use regular home blood sugar monitoring to keep track of the effects of their meals and activity levels on their blood sugars. They work with their healthcare team to make adjustments in their food intake, exercise program and medication to keep their blood sugars as close to normal as possible.
How does carbohydrate counting work?
Most all foods (except meat and fat) contain some carbohydrate, and carbohydrate has the fastest effect on increasing blood sugars. The number of grams of carbohydrate that a person can eat each day or at each meal is determined by such things as their weight; whether or not weight loss is a goal (which it frequently is in people with adult-onset or type 2 diabetes); when and how much they exercise, because exercise will lower their blood sugar; what diabetes medication or insulin they are taking, and when; and other factors such as age and medical issues such as the presence of high blood fats.
For example, a 6’ 2″ tall man with diabetes who weighs 180 pounds and wants to maintain his current weight might be told he could eat 350 grams of carbohydrate spread out over the day. His goal would be to spread those grams out over the course of the day so that he doesn’t send his blood sugars too high at any one time. If he is taking insulin or oral diabetes medication, he might also have to manage when he eats his carbohydrate in such a way that there is enough sugar from his meals in his bloodstream when his medication is working its hardest.
“We now know that in general, a sugar-containing food like a piece of angel food cake may have 30 grams of carbohydrate in it, but that piece of cake will have the same effect on your blood sugar as 2/3 cup of rice or one cup of applesauce, both of which have 30 grams of carbohydrate in them,” says Chalmers. “So, if this man’s meal plan that he’s developed with a dietitian states that he can eat 60 grams of carbohydrate at a meal, it’s his choice where he ‘spends’ those 60 grams. One time he may have 2/3 cup of rice and one cup of applesauce, because that’s what he feels like eating. Another time he may decide to eat ý cup of applesauce, a cup of milk (12 grams of carbohydrate) skip the rice, and have the small piece of angel food cake for dessert.”
People who develop diabetes when they are over 40 frequently develop diabetes in part because they are overweight. Being overweight makes it more difficult for their bodies to use insulin to convert food into energy. For this reason, many patients with diabetes also have weight loss as a goal. Because each gram of fat contains 9 calories (while a gram of protein or carbohydrate contains only 4 calories), fat gram counting as a means of losing weight becomes an additional nutritional tool for many patients.
Frequently people with diabetes also have problems with high blood fats and/or cholesterol levels, and will be prescribed a meal plan that is low in fat as well. So even if they aren’t overweight, some patients may be counting grams of fat eaten at each meal or over the course of the day, as well as how many grams of carbohydrate.
Joslin Diabetes Center, and many other organizations, sell food lists that show how many grams of carbohydrate, and fat, are in most foods. Also, most any food you purchase in a grocery story lists carbohydrate and fat content as part of the food label requirements mandated by the federal government.
Not a do-it-yourself project
“Obviously using nutrition as part of an overall diabetes treatment plan is not an entirely do-it-yourself project,” notes Chalmers. “That’s why we can’t just send people preprinted diets. You need to work with a dietitian to determine whether carbohydrate counting, fat gram counting, a combination of both, or the older exchange meal planning system will work best for you. And you have to work with a dietitian to develop what your meal planning parameters are – how many grams of carbohydrate, how many grams of fat, etc. you can eat each day.
“But then the rest of it is pretty much up to you,” she adds. “You get your meal plan ‘budget’, and then you decide how to spend it at each meal. Just as a non-diabetic can’t eat cookies and cakes all day long and expect to be healthy, if you have diabetes you have to eat a balanced diet to remain healthy. But within limits, and with proper education, if you have diabetes you can eat whatever anybody else does.”