Diabetes Forecast

The Balanced Diet

What it means and why it's so important

By Tracey Neithercott with recipes by Robyn Webb, MS, LN ,


The Balanced Diet
Fresh Greens Soup With White Beans, Basil, and Tomatoes

Rigatoni With Grilled Vegetable Sauce

Zesty Broccolini and Garlic

Quartet of Berries With Fresh Peach Sauce

Low Salt, Full Flavor
Old-Fashioned Chicken Noodle Soup

Chicken Nuggets

Cajun-Spiced Pork Tenderloin

Beyond Brown Rice
Kasha With Caramelized Onions and Cremini Mushrooms

Minted Barley Salad

Amaranth Pudding

Healthy Fats
White Bean, Greek Yogurt, and Sun-Dried Tomato Spread

Avocado Herb Dressing

Spicy Peanut Sauce

Most doctors will tell you that the best way to stay nourished when you have diabetes is to eat a balanced diet. TV commercials proclaim that their cereals are "a healthy part of a balanced diet." Even the government agrees; it publishes dietary guidelines that promote, first and foremost, a balanced diet.

Which begs the question: What's a balanced diet?

The short answer is that it's a diet consisting of a variety of items from all the recommended food groups in the proper amounts. Fair enough. But what does that really mean in practice? We asked the experts to explain the importance of balancing your diet—and how to apply that knowledge in real-life settings.

To read an adapted version of this article in Spanish, click here.

Step 1: Eat More of These

It's a no-brainer that most of us need to eat more fruits and vegetables. They're packed with vitamins and nutrients, and low in calories and fat. But those aren't the only foods you should be focusing on. Also important are whole grains, dairy products, and seafood.

"It's a matter of really shifting away from the foods that are empty calories and to foods that are full of nutrients," says Linda Van Horn, PhD, RD, professor of preventive medicine and associate dean for faculty development at Northwestern University's Feinberg School of Medicine and chair of the 2010 U.S. Dietary Guidelines Advisory Committee. The goal is to spend your calorie and carbohydrate allotments on foods that benefit your body in some way. Your dietitian or diabetes educator can give you target carb and calorie counts; you can also visit www.mypyramid.gov and click "get a personalized plan" for more ideas about how those numbers break down.

Whole grains Unlike refined grains (think white bread), whole grains contain important nutrients like iron, B vitamins, magnesium, and fiber. Adding more whole grains to your diet is a matter of smart substitutions: Replace white bread with whole wheat (look for the word "whole" at the top of the ingredients list), pick unbuttered popcorn over pretzels, and opt for brown rice over white. And take a look at "Beyond Brown Rice," beginning on page 51, to learn about some other tasty grains you might want to bring into the mix.

• Milk Recommendations for dairy can be confusing. Truth is, you should be consuming more—and less. Since dairy can be high in saturated fat (which can raise cholesterol levels), experts advise cutting down. But low-fat or fat-free milk, yogurt, and cheese are excellent sources of calcium and, if fortified, vitamin D. You can add more dairy to your day by drinking fat-free milk instead of soda or by snacking on a Greek-style yogurt, not a candy bar.

• Seafood There's a reason the most recent dietary guidelines recommend that Americans eat more seafood. "It has to do with the fish high in omega-3 fatty acids and protection against cardiovascular disease," says Elizabeth Mayer-Davis, MSPH, PhD, RD, professor in the departments of nutrition and medicine at the University of North Carolina–Chapel Hill and president for health care and education of the American Diabetes Association. "Although the omega-3 fatty acids are important, the overall fat content is low compared to other meats." Since people with diabetes are at a higher risk for heart disease than those without diabetes, it's especially important for them to replace meat with fish.

Not only that, but seafood's high in protein. Most people have no problem working protein into their diet (although people with kidney disease should limit it). Meat's a top source—and a staple of the American diet—but it's important to pay attention to variety. Processed meats are high in saturated fat while seafood's loaded with healthy fats.

A typical diet lacking in fruits, veggies, fish, and grains is deficient in some pretty important nutrients: potassium, dietary fiber, calcium, and vitamin D. That's why it's important to replace empty calories with foods high in these vitamins and minerals.

Calcium, for instance, is important for strong bones and can be found in leafy greens like kale and broccoli as well as in low-fat dairy. Beans, legumes, vegetables, fruit, and whole grains are loaded with dietary fiber, which lowers cholesterol. Since dietary fiber promotes a feeling of fullness, you can feel satisfied with fewer calories. But be warned: In some products, added fibers (look for inulin, maltodextrin, or polydextrose) masquerade as dietary fiber. Research hasn't yet shown whether these ingredients have the same health benefits as dietary fiber.

Potassium, found in foods like potatoes, tomatoes, and halibut, is especially important in an era when most Americans are eating nearly double the amount of sodium recommended. Potassium can blunt the effects of sodium and lower blood pressure. (However, people with kidney disease should talk with their doctors about limiting the amount of potassium they eat.)

Our increasingly sedentary lifestyle is also to blame for a lack of vital nutrients. "We know that many adults are low in vitamin D," says Mayer-Davis. "As they spend more time in front of the screen, they're spending less time in the sun, which is a source of vitamin D." You can up your vitamin D levels by choosing low-fat milk fortified with the vitamin or spending some time outside each day.

Dos and Don'ts
Wondering what a balanced diet looks like? Here's how to turn three square meals into a full day of stellar choices.
  Instead of this . . .
. . . Try this
Breakfast 3 buttermilk pancakes with syrup

2 strips bacon

1 cup coffee with cream
6 oz. nonfat plain yogurt topped with 1 cup blueberries and 1/2 cup bran cereal

2 scrambled eggs with tomato slices

1 cup coffee with skim or 1% milk
Lunch 1 take-out beef burrito

1 can soda
1 cup black bean soup

3 oz. salmon with 1/2 cup brown rice and 1 cup veggies sautéed in olive oil

1 cup strawberries with 1 oz. goat cheese
Dinner 3 oz. hamburger with 1 cup mashed potatoes

1 slice cheesecake
1 cup black bean soup

3 oz. salmon with 1/2 cup brown rice and 1 cup veggies sautéed in olive oil

1 cup strawberries with 1 oz. goat cheese

Step 2: Limit These

Much of the food widely available in America—fast food, packaged goods, and soda, for example—is so processed that any of the ingredients' inherent healthfulness is destroyed. It is also loaded with fat, sugar, and salt, all of which contribute to a host of health problems.

• Added sugar Though added sugar is found in most packaged and fast foods these days, it's the grain-based desserts (think cookies, cake, and granola bars) and sugary drinks, in particular, that are our biggest source of calories. "Those are the foods that are pushing Americans over the edge," says Van Horn.

Part of the problem with added sugar is that it's high in calories, so the more you eat, the greater your risk of obesity. But there's another reason to cut down: "In addition to adding calories, it's also possible that you're replacing . . . nutrients [with sugar]. Instead of having soda, you'd be better having fruit," says Mayer-Davis.

There's another reason you should avoid sugar: It's easy to waste your carb allowance on sugary foods and drinks. But you'd be smarter to eat 25 grams of carbohydrate in fruit (say, a medium apple) than in candy (a meager three Twizzlers). "Even though you can cover the carbs with insulin, you're not doing your body any favor by choosing sugar-sweetened [foods] over more nutritious foods," Mayer-Davis says.

• Sodium Another ingredient that's posing a problem for Americans is sodium, or salt. "Sodium is a major problem in our country," says Van Horn. "We eat twice the amount we should." The recommended daily amount of sodium is 2,400 mg, though experts like Van Horn hope to lower that number to a healthier 1,500 mg eventually. Right now, though, the average person takes in 3,400 mg of sodium a day.

Such high levels can raise blood pressure and increase the risk for cardiovascular disease. (People with diabetes are already at increased risk for high blood pressure and cardiovascular disease.) Not only that, but the more sodium you take in, the more calcium you excrete in the urine—which means your taste for salt could put you at risk for osteoporosis, too. Luckily, there are plenty of ways to give your food a whole lot of flavor without it.

• Fat Most people also eat far too much unhealthy fat. Pre-made desserts, margarine, and snack foods often contain trans fatty acids while full-fat dairy and processed meats and some beef are high in saturated fats. Both types of fat have been linked to a greater risk of high LDL ("bad") cholesterol, a risk factor for cardiovascular disease.

You can improve your diet by replacing saturated and trans fats with healthy unsaturated fats. Monounsaturated fats (found, for example, in canola and olive oils, avocados, and peanuts) can lower cholesterol levels and reduce your risk of having a heart attack or stroke. Polyunsaturated fats (found in vegetable and safflower oils, walnuts, and sunflower seeds) also reduce LDL cholesterol levels. Plus, they contain omega-3 fatty acids, which protect the brain and reduce inflammation. Click here for some ideas on how to put "good" fats into action.

• Refined grains Finally, be smart about the type of grains you eat—and make your carbs count. Yes, you can cover 40 grams of white bread with insulin the same way as you'd cover wheat bread, but you'll miss out on important nutrients. Because they undergo processing that strips the grain, refined grains like white bread, flour tortillas, and cake lack the important nutrients found in whole grains. So instead of foods made with white flour, it's better to eat whole wheat. Or to choose grains that aren't processed, like quinoa or millet.

Step 3: Keep It Balanced

It may be tempting to think you can balance a bad diet by eating fortified foods or swigging "health" drinks. But you can't undo bad diet choices. "It's enticing to buy something and think you can 'fix' your diet," says Van Horn. "People wouldn't need those foods if they ate a healthy diet in the first place." Aside from the fact that products like vitamin-enhanced water and calcium-fortified cookies don't undo a pepperoni pizza dinner, they also contain unnecessary calories.

Instead, it's wise to stick to healthy eating guidelines, like those recommended by the American Diabetes Association (ADA), the American Heart Association, and the U.S. government. "One of the things I've come to notice is how similar these national organizations' guidelines are," says Van Horn. In particular, the ADA's recommendations are in line with the government's, but they've been modified for people with diabetes. They also take into account the needs of people with heart disease, kidney disease, and other complications.

How you put those guidelines into practice is up to you. It doesn't really matter whether you follow a Mediterranean diet high in fruits, vegetables, and fish or the low-sodium DASH diet—or something else. What's important is finding the appropriate plan for your calorie and carbohydrate goals that helps you stick to a balanced way of eating. "There's not a single diet for diabetes," says Mayer-Davis. "These diets we're talking about are a good place to start. In terms of diabetes, work with your care team to optimize your treatment."

You'll want to make sure each meal contains a good mix of fruits, vegetables, whole grains, and healthy fats. So, lunch might be a big salad topped with veggies and salmon plus a side of brown rice. If you eat a balanced diet on a regular basis, give yourself a break now and then. "What's important is the overall diet," says Mayer-Davis. "You can eat foods for special occasions, while you want to be moderate in your choices."

Step 4: Make It a Lifestyle

Following a balanced diet is an important part of staying healthy. But your efforts shouldn't be limited to the dinner table. "It's really a balanced lifestyle," says Van Horn. So don't just eat healthfully; quit smoking and get exercise, too. "Calories only come from food and only go through activity. What you take in needs to be equal to what you put out in order to maintain weight," she adds. Because sedentary behavior (like sitting in front of the TV or computer) puts you at risk for heart disease, it's extra important to get up and move.

It's also important to make sure your children's diet is well balanced. "There's absolutely no question that the current generation is at risk of not outliving its parents," says Van Horn. "Even children as young as 10 [and] 12 are beginning to show up with type 2 diabetes, which is unconscionable." The good news is that by adopting a healthy diet and exercise plan, you can influence your kids and grandkids to make changes, too. "Every single adult in this country [should say], 'I am a role model for the future generation,' " Van Horn says. "What kids see is much more important than what they hear." And what they see you do—like pursuing your own healthy lifestyle—is within your control.



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