Menu planning for diabetics

There is no single diet for diabetics—so how can you craft a balanced menu?

The American Diabetes Association (ADA) estimates that 21 million Americans have diabetes (high fasting blood sugar of at least 126), and 41 million more have a condition that may lead to diabetes. Obesity increases risk.

The Centers for Disease Control and Prevention (CDC) predicts diabetes will rise 165% by 2050. Type 2 diabetes (90% of cases) is increasing rapidly, especially in children and teenagers.

High blood sugar can lead to many complications, including heart disease (leading cause of death), stroke, kidney and eye disease (e.g., blindness), nerve damage, limb amputations, cognitive decline, sexual impotence, incontinence, infections, gum disease and birth defects (in babies born to women with diabetes). A heart-healthy diet, exercise, weight control (weight loss if overweight), lifestyle changes (e.g., no smoking) and medications (e.g., insulin therapy) can help control or reduce risk of diabetes.

Diabetes affects the way the body uses energy from sugar and other foods. Sugar does not cause diabetes, but it can lead to weight gain, which increases risk. In Type 1 diabetes, no insulin (hormone) is produced. In Type 2 diabetes, insulin is insufficient or does not work correctly. Insulin allows blood sugar (glucose) to enter cells where it’s stored or burned for energy.

Diabetic diet: There is no single diabetic diet. Individual meal plans are based on weight, age, activity and medical factors (e.g., low-fat/low-cholesterol diet for high lipids, low-sodium diet for hypertension). A balanced diet consisting of a variety of foods with moderate amounts of sugar, salt and fat is advised.

A “Food Pyramid for Diabetes” with seven food groups has been created for daily meal planning. The groups are:

  • Milk and yogurt (2-3 servings).
  • Protein (2-3 servings) including meat, poultry, fish, eggs, peanut butter, cheese or tofu.
  • Fruits (2-4 servings).
  • Vegetables (3-5 servings).
  • Starches (6-11 servings) including whole grains, breads, cereals, legumes like beans, and starchy vegetables including potatoes.
  • Fats and oils (small amounts) including nuts and margarine.
  • Sugary foods (small amounts).

Since equal amounts of carbohydrates (sugars and starches) in a meal raise blood glucose equally after eating, sugar and sweets can be substituted for starches, but in moderation.

Glycemix index: ADA recently advised that it may be beneficial also to consider the type of carbohydrate and its glycemic index (how much blood glucose rises after a specific food is eaten). Eating high-fiber foods with a low glycemic index like beans and whole grains may help control blood sugar. Foods rich in “soluble” fiber like oats, beans, barley, apples and citrus fruits slow glucose absorption.

Meal plans can be based on ADA “food exchanges”—foods grouped according to similar content of carbohydrates, protein, fat and calories. Any food in a list can be substituted for another in the same list.

Non-nutritive (no-calorie) sweeteners approved for safety by the Food and Drug Administration (FDA) include saccharin, aspartame, sucralose, acesulfame-K and neotame. Sugar alcohols (e.g., sorbitol, isomalt) used in sugar-free gum, candy and processed foods are also safe. They’re low in calories (2 calories per gram), since they’re partly absorbed. “Sugar-free” foods like cake, cookies and ice cream may still be high in fat and calories, and thus may not be prudent for weight control.

Menu tips: Serve small portions with standard measuring tools. Also:

  1. Season foods with herbs and spices instead of salt. Limit fats and sugars in food preparation. Substitute unsaturated fats (e.g., soft tub margarine, canola, peanut, safflower or olive oil) for saturated fats (e.g., butter, solid shortening).
  2. Serve lean cuts of meat (e.g., sirloin). Trim fat from meat and skin from poultry.
  3. Grill, broil, bake, stew, microwave, stir-fry or steam foods instead of frying.
  4. Offer sugar-free jam, jelly and syrup. Serve low-fat or fat-free mayonnaise, salad dressing, sour cream, sauces and other condiments “on the side.”
  5. Offer low-fat or nonfat dairy products and low-fat, sugar-free frozen dairy desserts.
  6. Serve fish (containing heart-healthy omega-3 fats) at least twice a week.
  7. Top foods like cereals, pancakes, salads and desserts with fresh fruits. Offer canned fruits packed in juice, water or light syrup.
  8. Add vegetables to soups, salads, stews, casseroles, sauces, sandwiches and pizza.
  9. Serve high-fiber whole grain breads and cereals (e.g., oatmeal, bran), low-fat bran muffins, whole-wheat pasta, brown rice and legumes (e.g., beans in Mexican dishes).
  10. Serve low-calorie or no-calorie beverages including water, sugar-free soda, cocoa, iced tea or drink mixes, vegetable juices and unsweetened 100% fruit juices.