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By Jane Harrison, R.D., Staff Nutritionist, myOptumHealth

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A diagnosis of diabetes used to mean a lifetime of no sugar, no alcohol and a rigid diet. Not so anymore.

A good diabetic meal plan is simply a healthy meal plan. The plan is high in fiber and rich in healthy fats, whole grains, lean proteins, fruits and vegetables. The menu is much like a prevention diet for heart disease, cancer or other chronic diseases. The chief difference is that diabetics need to pay closer attention to meal timing and carbohydrate intake. This is on top of careful monitoring of daily blood sugars.

Taking control of your diet is an effective way to steer off dangerous complications. If you are diabetic, consistently high blood sugars can lead to many serious problems, including blindness, kidney and heart disease, nerve problems or stroke.

To date, there is no one perfect mix of carbs, protein and fat for diabetics. But by working with your diabetes care team, you can figure out how different foods and carb levels affect your control.

Planning your meals

Current guidelines from the American Diabetes Association (ADA) advise the following:

Carbohydrates

• Aim to get about half your daily calories from carbohydrates (carbs) (this can vary from 40 to 65 percent).
• Aim to eat about the same amount of carbs from day to day. It's important to be consistent. Carbohydrate counting and/or exchange lists are helpful tools to monitor carb intake.
• Focus on the healthiest carbs. These include fruits, vegetables, whole grains, legumes (beans, peas, lentils) and low-fat dairy.
• Enjoy a piece of cake or glass of wine once in a while. You don't have to avoid sugar entirely, but balance calories and total carbs - fiber, starch and sugar.

Protein

• Diets should provide about 15 to 20 percent of their calories from protein.
• Though higher protein diets (over 20 percent or more) may kick-start weight loss, they may not be safe in the long run.

Fats

• Limit fat to no more than 30 percent of total calories.
• Limit saturated fat to less than 7 percent of total calories. Strictly limit or avoid trans fats.
• Limit dietary cholesterol to less than 200 mg per day.
• Increase omega-3 fats. Aim for two or more servings of fatty fish per week. If you are pregnant, there are certain fish that you should avoid. Ask your obstetrician for more details.
• Replace saturated and trans fats with healthy fats from nuts, seeds, olive and canola oils and avocado.

Other dietary factors

Glycemic index

• Eating carbs with a low glycemic index seems to have a modest benefit over those foods with a high glycemic index.
• Low-glycemic foods include: oats, barley, bulgur, beans, lentils, legumes, apples, oranges and low-fat dairy.

Fiber

• Aim for at least 14 grams of fiber per every 1,000 calories.
• Fiber-rich foods usually have a host of important vitamins and minerals.
• Good fiber sources are legumes, high-fiber cereals, fruits, veggies and whole-grain products (oats and barley)

Plant sterols

• Plant sterols and stanol esters block the absorption of cholesterol. This can help lower LDL (bad cholesterol).
• ADA recommends an intake of 2 grams per day of plant sterols and stanols. These can be found in a wide range of foods and beverages, such as butter substitutes, yogurt drinks, orange juice and special chocolate bars.

Alcohol

• Alcohol can interfere with some diabetic medications. Make sure you check with your doctor before you have a drink.
• People with diabetes who choose to drink should not consume more than one alcoholic drink at a sitting. And, they should have this drink along with food, not on an empty stomach. Men should limit any alcohol consumption to no more than two drinks a day, and women no more than one.
• Excess amounts of alcohol contribute to high blood sugar.

Benefits of weight loss

• ADA guidelines stress the importance of moderate weight loss for people who are overweight or obese. Even a modest weight loss of 5 percent to 7 percent of total body weight can improve blood sugar control.
• Best results are achieved with a weight loss that combines lifestyle changes and regular exercise. About 150 minutes per week of moderate to vigorous physical activity is ideal if your doctor says this is safe for you.
• Low-fat or low-carbohydrate diets have been shown to be effective for many if used short-term or less than one year. Avoid fad diets, including extreme low-carb or high-protein diets. There is no evidence that these diets help keep the weight off. They also lack the fiber, vitamins and minerals you can get from wholesome carbohydrates.
• If diet and lifestyle changes alone are not enough, talk to your doctor about other weight loss options. These may include medications or surgery in some cases.
• Do not attempt weight loss if you are pregnant. Instead talk to your doctor about a healthy eating plan

A nutritionist who is a certified diabetes educator (CDE) can be of great help if you need guidance on meal planning. A CDE can help to identify problem eating and lifestyle behaviors, as well as create a realistic meal plan that you can live with - and love.

View the original Eating with diabetes: revisiting the guidelines article on myOptumHealth.com 

SOURCES:

• American Diabetes Association. Position statement: Standards of medical care in diabetes - 2009. Diabetes Care. 2009;32:S13-S61. Accessed: 02/10/2009

• American Diabetes Association. Carbohydrate counting. Accessed: 02/02/2009

• Chandola T, Brunner E, Marmot M. Chronic stress at work and the metabolic syndrome: prospective study. British Medical Journal. 2006;332(7540):521-525. Accessed: 03/25/2009