What we eat is among the most important decisions we make. Food influences nearly every aspect of our well-being: not only our own but that of our families, our communities, and our planet. Food is also intensely personal, connected to our moods, social network, culture, and worldview. For those of us fortunate enough to have some choice in what we eat every day, few things are as profound or important.
In my work as a cardiologist, nutrition scientist, and public health advocate, I’ve encountered more and more people who recognize the crucial importance of their food choices. Yet, many also feel deeply confused about what actually constitutes a healthier diet. This is especially true for people struggling to control their weight, blood glucose, or other risk factors. An epidemic of obesity and diabetes is sweeping the world. In the United States, one in eight adults has type 2 diabetes or prediabetes (an earlier stage of the disease), and for Americans born after 2000, one in three will develop type 2 diabetes in their lifetime. And this is not unique to the United States. Risk of type 2 diabetes is even higher in Mexico, where it is the leading cause of death. And China faces the world’s largest diabetes epidemic: Nearly one in two adults in China has diabetes or prediabetes.
Healthier eating is essential to successfully manage, and even potentially cure, prediabetes and type 2 diabetes. Yet, confusion and uncertainty prevent many people from improving their diets. With all the popular diets that are promoted—low-fat, low-carb, paleo, vegetarian, vegan, gluten-free, organic, non-GMO, local—it’s nearly impossible for the average person to sift through the varied and often conflicting recommendations. And things can get even more confusing for individual food choices of grains, fruits, nuts, eggs, meats, cooking oils, and more. In this muddle of uncertainty, the daily crowd of news reports, web blogs, and other voices add to the cacophony of jumbled and often contradictory messages.
Of course, beyond effects on health, a good meal should also nurture the soul. The sights, tastes, aromas, and textures should delight, surprise, and inspire. A good meal can also bring together and bond family and friends, or provide a sanctuary of quiet contemplation when one wishes to dine alone.
Among ways to achieve healthier, more mindful eating, home cooking is one of the most important. By cooking regularly, a person greatly increases the chances of making better choices while decreasing the burden of excessively processed, packaged, and unhealthy products in their diet. This most human of acts—the bringing together of ingredients, creative preparation, and sharing and enjoying a meal—also engages the mind and the senses in ways that are not otherwise easily achieved.
Yet, while cooking is so important for our health, and so beneficial for our spirit, this seemingly simple and ancient task can intimidate and unnerve even the stoutest foodie. How does one juggle health, taste, cost, and convenience and bring them together to form a meal that is both nurturing and enjoyable? For many, cooking can be a real challenge.
With The Complete Diabetes Cookbook, America’s Test Kitchen aims to provide a range of compelling, tasty recipes that are also healthy choices for people with or worried about diabetes. During the creation of this book, America’s Test Kitchen asked me and Tufts dietician Alicia Romano to provide input on the core nutrition principles underlying a healthy diabetic diet. Many of these principles can be found across the resulting recipes. They include:
EMPHASIZE THE GOOD Eat more minimally processed foods like beans, nonstarchy vegetables, nuts, seeds, and fruits rich in vitamins, minerals, antioxidants, phenolics, fiber, and other bioactives. And it’s worth remembering that many veggies—peppers, zucchini, eggplant, tomatoes, cucumbers, avocados, and so on—are actually fruits, naturally rich in nutrients and phytochemicals in their skin, seeds, and flesh that make them great choices.
EMBRACE HEALTHY FATS Unsaturated fats from plant oils improve glycemic control and other important risk factors, like blood cholesterol levels. Foods like nuts, seeds, avocados, extra-virgin olive oil, canola oil, and seafood should be liberally consumed, especially when in place of starches and sugars.
HIGHLIGHT CARBOHYDRATE AMOUNT AND QUALITY While some diabetic diets focus on carb counting, carb quality can be just as important. For example, minimally processed whole grains, beans, and fruits have very different metabolic effects than refined flours, starches, and added sugars. While carb quality is influenced by many factors, a simple rule of thumb is to seek a carbohydrate-to-fiber ratio of 10:1 or lower. In other words: In any food or meal, aim for at least 1 gram of dietary fiber for every 10 grams of total carbohydrate. Most of the recipes in the book achieve this ratio, with plenty of fiber signaling healthful and balancing ingredients. In addition, mixing grains, pasta, rice, and sugars with other healthful ingredients (vegetables, beans, nuts, fruits, plant oils) slows digestion and further reduces spikes in blood sugar.
FOCUS ON FOODS, NOT CALORIES OR SINGLE NUTRIENTS Advances in science increasingly show that different types of foods have complex effects on long-term weight and metabolic health. Judging a food or meal based on its total calories or a single nutrient greatly oversimplifies these complex influences. Instead, one can focus on eating more of the healthful, minimally processed foods like those described above, and less processed meats and foods rich in refined flours, starches, added sugars, and salt.
Where the science is less certain, this cookbook is more flexible in its recipes. For example, evidence on health effects of different dairy products is rapidly evolving, with emerging findings suggesting that there are metabolic benefits from yogurt (with beneficial probiotics), potential benefits from cheese (possibly due to fermentation), and uncertain health differences between low-fat and whole-fat dairy.
By incorporating these advances in nutrition science with their tested approach to pragmatic cooking, America’s Test Kitchen has created engaging, accessible recipes that emphasize not only health but also convenience, taste, color, and creativity. The recipes also recognize that cooking—and eating—should prioritize well-being over weight loss, quality over quantity, and delight over austerity. Read, cook, eat, and enjoy!
Dariush Mozaffarian, MD, DrPH
Friedman School of Nutrition Science and Policy
Tufts University
