People with diabetes often fear that they'll never be able to eat good-tasting food again. That's what registered dietitian and exercise physiologist Ann Albright found when working with those patients. "They sometimes felt like they were going to prison, and they were only going to drink water and eat toothpicks for the rest of their lives," she says.
She quickly assured them that this wasn't the case but told them they would have to learn to make more healthful choices.
Albright, who has type 1 diabetes, now works full time trying to help people with diabetes improve their diets. She's head of the diabetes division at the Centers for Disease Control and Prevention in Atlanta, and the American Diabetes Association's president of Healthcare and Education.
Diabetes is a condition in which the body does not make enough of the hormone insulin, or it doesn't use the insulin properly. Insulin helps glucose (sugar) get into cells, where it is used for energy. If not enough insulin is produced or it doesn't function normally, sugar builds up in the blood, damaging nerves and blood vessels.
There are two major forms: type 1 and type 2. The latter accounts for 90 percent of diabetes cases and is associated with obesity and inactivity. Most people with type 2 diabetes could benefit from weight loss, experts say. Even losing as little as 5 percent to 10 percent of body weight and keeping it off can help, Albright says.
Healthful eating and regular physical activity are crucial for patients with diabetes because controlling blood sugar can prevent such complications as heart disease and kidney failure, experts agree. But there's no one single diet that works for everyone, Albright says. "Gone are the days of being one diabetic diet. We try not to teach that any longer."
Most people need an individual nutrition plan, she says, and should work with a registered dietitian or other health professional to figure out what will work best for their lifestyle, schedule and tastes. "There are decisions and nuances in diets that need to be considered for each patient."
Some people use meal-planning exchange lists, which group foods that have similar amounts of carbohydrates, protein, fat and calories. Some count carbs or calories.
Many patients need to pay closer attention to carbohydrates, which are found in whole grains, vegetables, fruits, desserts and other sweets, Albright says. Carbohydrates have the biggest impact on blood sugar, but that doesn't mean that everyone with diabetes should adopt a low-carbohydrate diet, she says. The general recommendation is 45 percent to 55 percent of calories from carbs, but this is only a guideline, she says.
Albright tells people that they have only so many carbohydrate bucks to spend in their daily diets, so it's better if they spend them wisely on foods such as vegetables and fruits that are rich in fiber, vitamins and other nutrients than on candy, cake, cookies and other highly processed foods.
People with diabetes can have some sweets, but how much they can eat depends on their blood sugar and weight goals, she says. The amount should be worked into an overall healthful diet.
Most patients also need to limit their saturated (animal) and trans fat intakes because those contribute to heart disease, she says.
Lots of Fiber and Protein
Christine Gerbstadt, a physician in Sarasota, Fla., and a registered dietitian who specializes in diabetes education, advises patients to eat a diet high in fiber (25 to 30 grams a day) and relatively high in protein, because "fiber and protein are the best weapons against hunger."
Some research suggests that eating plenty of protein-rich foods (fish, lean meat, chicken, beans, nuts) may help people feel full longer, which may help prevent overeating. Guidelines from the Institute of Medicine suggest a range of 10 percent to 35 percent of calories from protein. Gerbstadt has some patients with healthy kidneys consume about 25 percent of their calories from protein.
Many people are afraid they won't be able to cook healthful meals, and they are anxious about eating at restaurants, Gerbstadt says. She suggests that they look through cookbooks written for diabetics and find one that has foods they will enjoy.
She also tells patients to pick two or three restaurants they like and review the nutrition information on the menu or website. She advises them to find three or four entrees that work into their eating plan, write those choices down on a card and keep the card in their wallet.
Says Albright: "The more people learn about their choices, the more flexibility and enjoyment they will have."