Chapter 2: Today’s Healthy Eating Goals for Diabetes
The saying, “We’ve come a long way,” certainly applies to the changes made over the years to the nutrition and eating guidelines for diabetes . . . and that’s not even going all the way back to the pre-insulin days before 1921.
During the 1990s diabetes nutrition and eating goals underwent a major revolution. In fact, the phrase “a diabetic diet” is now outdated, actually extinct. People with diabetes should no longer be told to axe sugary foods and sweets from their list of acceptable foods. If you so desire and it fits into your overall healthy eating plan, you can savor the taste of a few slices of pizza at your local pizza parlor or cruise to the drive-thru for a hamburger or grilled chicken sandwich when time is not on your side. The bottom line: the Nutrition Therapy Recommendations for the Management of Adults With Diabetes (available at http://care.diabetesjournals.org/content/37/Supplement_1/S120.full.pdf+html), published by the American Diabetes Association, echoes the healthy eating goals for everyone—as outlined by the federal government, in the Dietary Guidelines for Americans, and by health associations like the American Heart Association and American Cancer Society.
For people with diabetes, eating healthy can help you achieve both your short- and long-term health goals. Staying healthy for the long haul with diabetes is no longer just about blood glucose control. It’s about what’s called “metabolic control.” Metabolic control includes glucose control (also called glycemic control), control of your blood lipids/fats, and blood pressure. One of the goals of the American Diabetes Association’s Nutrition Therapy Recommendations for the Management of Adults With Diabetes is achieving and maintaining target ranges for these three categories (also known as the diabetes ABCs) in people with diabetes.
Target ABC Goals
*Based on American Diabetes Association: Standards of medical care in diabetes: 2014. Diabetes Care 37 (Suppl. 1): S14–S80, 2014 (http://care.diabetesjournals.org/content/37/Supplement_1/ S14.full.pdf+html)
† Based on your age, years with diabetes, other medical issues, and personal considerations you and your health-care provider may decide on slightly lower or higher goals.
Another major goal of the Nutrition Therapy Recommendations for the Management of Adults With Diabetes is to help people with diabetes reach or maintain a healthy weight. Today, roughly two-thirds of American adults are overweight or obese (about one-third of adults are overweight and one-third are obese). Overweight is defined as the weight range between normal body weight and 30% above normal weight. Obesity is defined as a weight more than 30% above normal body weight. Many children and adolescents are also overweight. Being overweight or obese becomes a significant risk factor for many chronic diseases, including prediabetes—the precursor to type 2 diabetes. Roughly 80% of people with prediabetes and type 2 diabetes are overweight. Research has shown over and over again that losing 5–7% of body weight and, even more critical, keeping as much of this weight loss off over time as possible, goes a long way toward helping people hit those target ABC goals and stay healthy. For people with prediabetes this amount of weight loss has been shown to help them reverse the condition or slow its progression towards type 2 diabetes.
A good diabetes eating plan should be designed to be in sync with your glucose-lowering medications (most people with type 1 require insulin, most people with type 2 require one or more medications) and work around your needs and lifestyle, not vice-versa. Factors to consider include your restaurant eating habits, food preferences, and life schedule. Today, and even more so in the future, health-care providers have (and will have) many glucose-lowering medications, medication delivery devices (like pens and pumps), and monitoring tools (like glucose meters and continuous glucose monitors) available to help you formulate a diabetes plan that fits your lifestyle and enables you to make important behavioral changes. (Be in the know about these newer tools and ask your providers about them!)
The end goal, of course, is to help you stay healthy and prevent or slow down the long-term complications of diabetes, such as heart disease and certain cancers. (Yes, cancers! There’s solid evidence now that people with type 2 diabetes who are overweight are at higher risk of developing certain cancers.)
Diabetes Eating Goals in a Nutshell
Here is an overview of the overarching goals of the American Diabetes Association’s Nutrition Therapy Recommendations for the Management of Adults With Diabetes:
• To promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, in order to improve overall health and specifically to:
* Attain individualized blood glucose, blood pressure, and lipid goals (see above Target ABC Goals)*
* Achieve and maintain healthy body weight
* Delay or prevent the complications of diabetes
• To maintain the pleasure of eating by providing positive messages about food choices while limiting food choices only when indicated by scientific evidence.
• To provide practical tools for day-to-day meal planning. (That’s exactly the goal of this book!)
*A1C, blood pressure, and cholesterol goals may need to be adjusted for the individual based on age, duration of diabetes, health history, and other present health conditions. Further recommendations for individualization of goals can be found in American Diabetes Association: Standards of medical care in diabetes: 2014, Diabetes Care 37 (Suppl. 1): S14–S80, 2014 (http://care.diabetesjournals.org/content/37/Supplement_1/S14.full).
How Much Should You Eat?
Even if you’re trying to make the long-term changes in your eating habits that can help you stay healthy, you can continue to eat and enjoy many of the foods you have loved for years, albeit perhaps less often or in smaller quantities. But you also want to enjoy more of the healthier foods, such as fruits, vegetables, legumes, and whole grains. The quantities of food you eat and how often you eat need to match your lifestyle and schedule. Another critical element of planning your meals is to determine which foods and which times for meals and snacks (if you need or want them) work best to help you keep your glucose, blood lipids, and blood pressure under control.
There is no set number of calories or amount of food or nutrients (carbohydrate, protein, and fat) that is right for everyone with diabetes. Today there are far fewer nutrition “rules” for people with diabetes than ever before. Research shows that there is a range of eating styles—from following a vegan lifestyle to following a diet that includes a low to moderate amount of carbohydrate with lean protein foods and healthy fats—that can help people with diabetes achieve both their short- and long-term health goals. What is critical, however, is that you get all of the nutrients, vitamins, and minerals you need while following your eating plan.
Your individual characteristics, such as your height, age, current weight, your daily activity level, the type of physical activity you do, whether you want to lose weight or maintain your weight, how difficult it is for you to lose weight, and more, will dictate your calorie and nutrient needs. Word to the wise: find an eating plan and style that works for you for the long haul.
To be successful with a healthy eating plan and to adopt a healthy lifestyle, it might be helpful to work with a registered dietitian nutritionist/registered dietitian (RDN/RD) with diabetes expertise or with a certified diabetes educator (CDE). A dietitian can help you learn how to work almost any food or type of restaurant cuisine into a healthy eating plan. These experts can coach you and support your efforts to change your eating habits over time. Several books published by the American Diabetes Association on the topic of food, nutrition, and meal planning, including Diabetes Meal Planning Made Easy, give more in-depth information about what and how much you should eat. Check out these books at shopdiabetes.org.
Singing the Same Healthy Eating Verse
The healthy eating guidelines in this book reflect today’s American Diabetes Association Nutrition Therapy Recommendations for the Management of Adults With Diabetes. As noted, these recommendations echo those from the federal government, as published in the Dietary Guidelines for Americans, and several health-related organizations. In essence, all of these organizations are singing the same healthy eating verse. In fact, the American Diabetes Association collaborates with the American Heart Association and the American Cancer Society on an initiative called the Preventive Health Partnership. These three large organizations have created this partnership and a program called Everyday Choices (everydaychoices.org), which encourages healthy living, because eating healthfully and living a healthy lifestyle reduces the risk of all three diseases—some cancers, heart and circulatory diseases, and type 2 diabetes.
As more people strive to eat healthier and as healthier restaurant foods become available, this effort will become easier. By no means is healthy restaurant eating simple; at times you will feel like a fish swimming upstream because so many Americans chow down on downright unhealthy foods and large portions of them. It’s not always easy to eat healthfully. And that’s particularly true when it comes to restaurant foods—whether you eat in or take out. You’ll gather plenty of tips, tactics, and tricks through the pages of this book and before long you’ll be a pro. Yes, practice makes, well, almost perfect.
The Top 10 Healthy Eating How-Tos
The following chart explains the top 10 healthy eating goals for all Americans, including people with diabetes. You’ll see the Dietary Guidelines in the center column accompanied by a translation of each guideline. In the right column you’ll see a few tips to help you implement this dietary guideline when you eat restaurant meals. The BIG challenge is putting these seemingly straightforward and simplistic nutrition guidelines into practice in your hurried and harried daily life amongst a sea of less than healthy foods.
As you make the effort to change your restaurant eating habits, keep these Top 10 Healthy Eating How-Tos in mind. And when you look at restaurant menus, ask yourself the following questions to help put these how-tos into action:
• How can I fit in more vegetables at this meal?
• Can I ask for olive oil to dip my bread in rather than butter? Better yet, to limit calories, can I skip the oil or butter? Or should I skip the bread or rolls altogether and send them back to the kitchen?
• Are there whole-grain breads I can have a sandwich made on or whole-grain side dishes available?
• Can I reduce my total fat grams by asking for an ingredient or two to be left out of my meal or replaced (e.g., replace mayonnaise with mustard on a sandwich)?
• Is it possible to split the portion of protein and take half home for tomorrow’s lunch or dinner?
• Is there an appetizer, salad and/or cup of broth or bean-based soup that is healthy and can help me eat smaller portions of my main meal?
You get the picture: healthier restaurant eating is all about slowly changing your eating and ordering habits.