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 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).
 

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Claire Lightfoot, RD, MEd, CDE, a wonderful registered dietitian and the 2004 Canadian Diabetes Association's "Diabetes Educator of the Year" has kindly contributed the following information:

If you have clicked onto this part of the web site you are probably curious about what it means to "eat properly". It could mean something like the following story. It seems there was a man who went to see his doctor. He had a carrot sticking out of one ear, a banana sticking out of the other ear, and a stalk of celery up his nose. He said to the doctor: "Doc, there's something the matter with me and I need your help." The doctor replied: "Well, it's easy to see what the problem is. You're not eating properly." (groan here...)

On the other hand, eating properly for diabetes likely means something else entirely. Eating properly for diabetes management means:

• Eating foods that supply adequate nutrition (protein, vitamins, minerals and such) for good health and to prevent other diet-related health problems. For example, just because you have diabetes you shouldn't stop ensuring that you take adequate amounts of foods that provide calcium and Vitamin D to prevent developing bone-thinning osteoporosis, and high fibre foods to prevent bowel diseases.
• Balancing the amount of foods eaten, especially those that are sources of carbohydrate, with your insulin. If you have type 2 diabetes, that could mean the amount of insulin your body naturally makes and uses. If you have type 1 diabetes or type 2 that is treated with insulin injections, that means balancing food with the amount of insulin you inject. Having the right medical treatment from your physician, who can work with you to determine what medications in what amounts you need to provide adequate amounts of insulin, is essential.
• Choosing foods that also help you reduce your chances of developing diabetes-related complications. In particular, you'll want to make sure you eat in such a way that you control your blood pressure, keep your LDL cholesterol low (under 2.0 mmol/L for most people) and keep your kidneys healthy.
• Eating to control your weight in a healthy weight range. The key word here is control because it means you should be able to avoid big fluctuations. In other words, at Christmas or when you are on a vacation that means that you should be able to keep from gaining too much weight and you should be able to safely and easily lose it afterwards.

Wow - I bet that all sounds like a lot to pay attention to! Let's break this all down to some simple tips, and see how they relate to the above principles.

The 10 Golden Rules for Meal Planning for Diabetes

Golden Rule	Helps to:
	Provide adequate nutrition	Balance food with insulin	Reduce complications of diabetes	Control weight
1. Eat breakfast every day. Breakfast doesn't have to be "breakfast foods", such as cereal or bacon and eggs, so be creative. It should, however, be made up of foods from 3 or 4 of the main food groups in Canada's Food Guide. It's best to 'break your fast' by eating within 2 hours of getting out of bed. To balance carbohydrate-containing foods with your insulin, obtain blood sugar results from your monitor both before you eat and 2 hours after, then talk to a registered dietitian who can develop a meal plan with you using the Canadian Diabetes Association's new Beyond the Basics poster.	x	x		x
2. Pay attention to portions. It is no secret that the amount of different foods we eat makes a big difference to our health, weight and energy levels. There are definitely suggestions for how much we should eat but consider your own needs, too, and make adjustments if it makes sense to do so. (A 94-year old will not likely need the same portions as a 14-year old!)	x	x	x	x
3. Choose whole grains. One dictionary definition of whole is "having all its parts; complete". That is what we want to have when we choose our breads, cereals, pastas, rice and other grains - all the parts, including the bran layer, a great source of nutrients and fibre. Check the ingredients on a grain product label for the word "whole" before listing what grain (such as wheat, oat, rice, barley, etc.) is in the product. A bonus benefit - they raise blood glucose more gradually because the fibre slows down digestion - even if you don't have diabetes.	x	x	x	x
4. Go for colour in your fruit & vegetable choices. Mother Nature didn't give us colourful food by accident. The colours of fruits and vegetables are there to attract us to them. Generally speaking, the darker the colour of certain kinds of produce, the richer the nutrient value. Have a colourful plate or bowl - and feed your eyes as much as your stomach.	x		x
5. Plan to use healthy oils in your menus. North Americans have become 'fat obsessed' to the point that some people think that fat-free is the best way to eat. Instead, make sure you include a few teaspoons a day of healthy oil, such as canola, flax, peanut or olive that provides essential nutrients that are not obtained anywhere else.	x		x
6. Include dairy products if you can. Having diabetes doesn't mean not paying attention to your risk for other health problems so dairy products as a source of calcium should still be included for osteoporosis prevention. Low fat choices are best if you over the age of 2 (and therefore able to read this). See the DASH information below which includes dairy products to manage blood pressure, too.	x		x
7. Aim to have 2-3 meals a week of fish. Diabetes carries with it the increased risk of developing cardiovascular disease. Why not try to minimize that risk with a couple of meals a week of fish, one of the best sources of 'cardioprotective' omega-3 fatty acids. Resist the temptation to have fish and chips, though!	x		x
8. Consider using the DASH eating plan. DASH stands for Dietary Approaches to Stop Hypertension and is an effective way of eating to help manage blood pressure. New evidence is now also showing its use in controlling cholesterol levels, blood glucose and weight. Sounds just about perfect, wouldn't you say?	x		x	x
9. Find ways to include legumes, nuts, and seeds in your menus. "Beans, beans, good for the heart. The more you eat, the more you..." Well, you know the rest. That jingle is more than cute - it tells us what we have known for a long while: legumes (e.g. beans) as a meat replacement are a healthy choice. Nuts and seeds are also getting some well-deserved attention, too. Hummus, anyone?	x	x	x
10. Make water your main beverage. Okay, okay - I don't have any fancy references to direct you to for this advice. I just have 26 years of experience that suggests that those people who choose water as their main beverage each day tend to also drink fewer calorie-laden beverages so tend to manage their weight better. They also have healthier skin, teeth and maybe even toenails.				x