Joslin: There is no such thing as a diabetic diet
Eat anything, but counting carbs is the key
Test yourself with the following true-or-false statement: People with diabetes can’t eat sugar. False. Totally cutting out all sugar is one of the most common myths clinicians and patients follow in planning healthy eating programs for diabetics.
"With proper education and within the context of healthy eating, a person with diabetes can eat anything a nondiabetic eats," says Karen Chalmers, RD, MS, CDE, director of nutrition services at Joslin Diabetes Center in Boston.
Guidelines for the management of diabetes issued five years ago state it is OK for people with diabetes to substitute sugar-containing foods for other carbohydrates as part of a balanced meal plan. But many patients and even clinicians and educators aren’t up to date on those dietary recommendations.
The Arlington, VA-based American Diabetes Association committee on nutrition reports there is little scientific evidence to support the old theory that simple sugars are more rapidly digested and absorbed than starches, and therefore, both are apt to produce higher blood glucose levels.
Instead, over the past five years, diabetics have been advised to focus on their total daily grams of carbohydrates so they can keep their blood sugars under closer control.
Clinicians frequently receive requests from patients for lists of foods they can and cannot eat. "There aren’t any foods that are off-limits," says Chalmers. "Rather the patients just need to learn how to spend their grams of carbohydrate wisely over the course of the day."
She recommends patients and dietitians sit down together and look at diet, food preferences, and weight loss goals, if appropriate. Then they can come design an individualized food plan aimed at even carbohydrate distribution during the day.
A carbohydrate bank account
For example, Chalmers says, if the patient is a 6’2" man with diabetes who weighs 180 pounds and wants to maintain his current weight, the dietitian may recommend he eat 350 grams of carbohydrate spread over the day. The goal is to spread those grams over the course of the day so blood sugar doesn’t shoot up at any one time.
"We now know that, in general, a sugar-containing food like a piece of angel food cake may have 30 grams of carbohydrate in it. But that piece of cake will have the same effect on your blood sugar as a 2/3 cup of rice or one cup of applesauce, both of which have about 30 grams of carbohydrates in them," she explains.
"So, if this man’s meal plan that he’s developed with a dietitian says he can eat 60 grams of carbohydrates at a meal, it’s his choice to decide where he spends’ them."
It’s not a matter of having your cake and eating it, too, Chalmers cautions, because the meal plan must fall within the boundaries of healthy eating. Therefore, a piece of angel food cake at every meal isn’t a particularly healthy choice.
She also says those who are on weight-loss plans or patients with cholesterol concerns need to reduce calories as well by eating low-fat diets, since one gram of fat contains nine calories while a gram of carbohydrate or protein contains only four calories.
"You get your meal plan budget and then you decide how to spend it at each meal," Chalmers says. "Just as a nondiabetic can’t eat cookies and cake all day long and expect to be healthy, if you have diabetes, you have to eat a balanced diet to remain healthy. But within limits, and with proper education, if you have diabetes, you can eat whatever anybody else does."
[Joslin Diabetes Center has a Web-based discussion group at www.joslin.org, hosted by Chalmers. Joslin moderates discussion and answers questions from people with diabetes.
The diabetes center has also published a cookbook, Joslin Diabetes Quick and Easy Cookbook.
Karen Chalmers can be reached at the Joslin web page, www.joslin.org or by phone at (617) 732-2415.]
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content