What Should I Eat?
There is no “diabetes diet,” but the ADA does offer top tips for eating well
The so-called diabetes diet is like the Loch Ness Monster and Bigfoot. “Sightings” pop up periodically in headlines and are endlessly discussed on the Internet, but experts say these creatures simply don’t exist.
Indeed, there’s no one-size-fits-all diabetes diet, but a recent position statement from the American Diabetes Association sums up for health care providers general diabetes nutrition guidelines. “Nutrition Therapy Recommendations for the Management of Adults With Diabetes” (Diabetes Care, November 2013) suggests how to shape a healthful eating pattern—along with medication as needed and exercise—to manage diabetes.
To craft the 22-page document, diabetes specialists on the writing committee tracked down proof through the tangled thickets of diabetes nutrition science and eating behavior. These folks—including dietitians, diabetes educators, a doctor, a nurse, and a pharmacist—labored for the love of science and health. They’re not paid for writing the guidelines. No industry funding or other support is allowed, either.
The recommendations are based on the best that science can currently offer. “We have to stay true to the evidence, be sure the recommendations reflect the evidence—regardless of my opinions,” says writing committee cochair Jackie Boucher, MS, RD, LD, CDE, of the Minneapolis Heart Institute Foundation.
The authors rated each recommendation on the strength of the evidence that supports it. Randomized clinical trials (RCTs) are the most trusted way to prove cause and effect (“Studying Fat,” explains RCTs in more detail). But we don’t or can’t have RCTs for all aspects of eating with diabetes or data that are relevant to all ages, types of therapy, or specific health situations. “More research is needed” isn’t a cop-out; there’s much we still don’t know!
The team excluded nutrition studies that had high dropout rates; subjects may have found the eating pattern too difficult or unappealing. The writing team also favored long-term studies lasting for months or years. Because of expense and complexity, many diabetes-specific nutrition studies last only a few weeks, according to Boucher. “Most aren’t long-term enough for us to see meaningful outcomes of nutrition changes over months and years,” she says.
To someone like me who wonders “What should I eat?” the recommendations may sound vague. What about carbohydrate, for example, a focus for people managing blood sugars: Is lower-carb eating ideal? The guideline says: “Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.”
So, in short, there’s no “right” answer. Rather, as the document says, I should consult with a dietitian about what’s best for my health and consider my preferences, culture, and budget to evolve an eating pattern that works for me.
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Cochair Alison Evert, MS, RD, CDE, of the University of Washington Medical Center, notes that such flexible guidelines can be frustrating when it comes to everyday eating. “One challenge, especially with nutrition guidelines, is that people want a list of what to eat, what not to eat,” she says. “Recommendations are very broad; people like very specific recommendations.”
Although the recommendations focus on what’s best for populations as a whole, sections of the document provide specific details, such as coordinating food with types of diabetes medications. For all people with diabetes, it’s important to know what foods contain carbohydrate, for example, and choose fruits, vegetables, and whole grains instead of foods with added sugar, fat, and sodium. For those using insulin, it’s also important to count carbs and “match” mealtime insulin to what you eat.
Throughout the document, the authors stress individual needs and preferences, and say each eating plan should be customized. “So many people overly restrict things by themselves,” Evert says. The guidelines give us more food choices. A healthful eating plan that maintains the pleasure of enjoying food is one that I (and my diabetes) can stick with for a long time.
Top Nutrition Tips
The recent nutrition position statement (see it at diabetes.org/nutritionguidelines) from the American Diabetes Association sets the record straight on some controversial "what to eat with diabetes" topics:
1. Healthful Carb Sources
Eat at least as much fiber and whole grains as are recommended for the general public. Fruits, vegetables, and whole grains help you get the daily fiber (25 grams for women, 38 grams for men) and whole-grain servings (about three) suggested for good health.
2. Sugar-Sweetened Beverages
Limit or avoid sugary beverages to reduce the risk of weight gain and worsening of blood glucose, blood pressure, and cholesterol. “Changing beverage choices makes a huge impact in glycemic control,” says Alison Evert, MS, RD, CDE.
3. Weight Loss
Jackie Boucher, MS, RD, LD, CDE, says there’s no single ideal weight-loss diet, but what does work is “portion control and finding an eating pattern you can follow.” An eating plan itself isn’t enough for weight loss, either. For weight loss, eating less and burning more calories through exercise are most effective. Energy balance is key; the calories we take in should not be more than we burn, or extra calories will build up.
Use food to get the vitamins and minerals you need instead of spending extra on supplements, herbal products, or cinnamon. We have no proof that dietary supplements help to manage diabetes, either. Vitamins and minerals are necessary but are better when eaten in actual food, Evert says.
Aim for no more than 2,300 mg daily, the recommendation for most Americans. Fewer than 2,300 mg daily may be necessary for some people, such as those with high blood pressure.
When eating fatty foods, eat the healthful kind in small amounts. See more fat facts.