Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes.
Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a significant risk factor for eventually developing type 2 diabetes.
The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
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How diet impacts blood sugar
Blood sugar is attained in two main ways: through the diet and through the liver. When we eat carbohydrate foods, they break down into glucose (sugar) in the bloodstream.
The liver stores some of these sugars as glycogen. Glycogen stores are useful for instances when the body needs more fuel to use as energy, such as prolonged fasting and intense exercise. Without glycogen, low blood sugar could develop.
Foods that are carbohydrates have the most significant impact on blood sugar levels compared to the other macronutrients (protein and fat). Carbohydrates are present in plant-based foods such as grains, fruits, vegetables, legumes, nuts, seeds, and dairy products like milk & yogurt. Carbohydrates consist of starches, sugars, and fiber.
Starches and sugars raise blood sugar when they’re digested because they are broken down into glucose or blood sugar. Fiber doesn’t raise blood sugar because it’s not absorbable by the body. Vegetables are carbohydrates but are mainly composed of water and fiber. This is one reason they don’t raise blood sugar significantly.
Vegetables that are high in starch, such as potatoes, tend to raise blood sugar levels more significantly than non-starchy vegetables like dark leafy green vegetables, which have a minimal effect on blood sugar. Choosing high-fiber, low-starch vegetables is a good strategy to promote healthy blood sugar levels.
Along with other aspects of a diabetes self-management plan, a healthy diet can help improve blood sugars and reduce the risk of complications. However, there is a lot of misinformation and confusion regarding which type of diet someone with diabetes should follow.
With low-carb, ketogenic, Mediterranean, carb counting, and many more eating plans and styles that have emerged over the years, it can get overwhelming to know what foods are best to eat with diabetes. One of the questions people with diabetes may have is whether foods marketed as “for diabetics” are good choices.
I am diabetic; should I eat diabetic food?
Many food distributors and weight loss companies have marketed their products as “diabetes-friendly” or “for diabetics.” This “diabetic food” isn’t necessary for people with diabetes to buy and eat unless that is their preference. These foods are often more processed and less nutritious than more whole foods that can be purchased at the grocery store.
Many diabetic meals are frozen entrees or “TV dinners.” These meals can be marketed as diabetes-friendly simply because the portions are small enough that the carbohydrates aren’t very high.
The drawback of these meals is that they are often very high in sodium, which can worsen high blood pressure. Many people with diabetes already have or at higher risk of developing high blood pressure, so avoiding these sodium-rich processed foods is recommended to promote heart health.
Many diabetic foods are marketed that way because they don’t have as much sugar as regular versions, or they likely use artificial sweeteners in place of regular sugar. These foods can have very little nutritional value to them but are marketed for diabetics simply because they don’t contain real sugar.
For instance, sugar-free muffins can contain very little nutritional value and be loaded with sugar alcohol in regular sugar. Eating large amounts of sugar alcohols can cause digestive upset such as bloating, diarrhea, and severe stomach cramping. People with diabetes may think those muffins are good and healthy to eat because they’re marketed for diabetes when that’s not always the case.
Some meals are marketed as diabetes-friendly because they fall within a certain carbohydrate range. Carbohydrate counting, or carb counting, is one strategy some people with diabetes use to help manage their blood sugars. In general, the recommended range of carbohydrates is around 45-60 grams per meal. A “diabetic-friendly” meal might be labeled that way simply because it falls within that range.
Reading food labels is a useful tool for people with diabetes to help make informed decisions about which foods and drinks to buy. For those with diabetes, there are several important aspects of the label to pay attention to, such as:
The nutrition facts labels are for a single serving, which might not be the entire package or container. The serving size is listed at the top of the label, along with how many servings are in the package. If more than one serving is consumed, the nutrition facts will change based on how much was actually eaten.
For instance, if a serving size for crackers is 10 crackers and the grams of carbohydrates are listed as 25 grams, you’d consume 50 grams of carbohydrates if 20 crackers were eaten. If the food is a single-serving item, then the nutrition information shown is accurate.
Grams of carbohydrates
Grams of total carbohydrates contain the amount of starch, sugar, and fiber combined. Out of all of these, fiber is the only one that doesn’t raise blood sugar because the body can’t absorb it. Therefore, the higher amount of fiber, the less those carbohydrates will actually impact blood glucose levels.
The amount of carbohydrates likely to impact blood sugars is called the net carbohydrate amount. To find out the net carbs, the grams of fiber are subtracted from the total carbohydrate count. For example, a serving of cereal with 20 grams of total carbohydrates and 3 grams of fiber has a net carbohydrate amount of 17 grams. For those keeping track or counting carbs, the 17 grams is the amount that would be used for those purposes.
However, not everyone with diabetes uses net carbs, and some people choose to subtract only half of the amount of fiber from the total grams of carbohydrates.
Recently, food labels started including a line for added sugars. This helps people determine if there are sugars added to their foods or if the sugars are naturally occurring. It’s recommended that women consume no more than 24 grams of added sugars per day (6 teaspoons), and men consume no more than 36 grams of added sugars per day (9 teaspoons).
Along with the added sugar line, a ‘Daily Value’ of 50 grams of added sugars was added to the new nutrition facts label. This means that based on a standard 2,000 calorie diet, no more than 50 grams (200 calories, or 10% of total calories) of added sugars should be consumed per day. However, the average person consumes almost 43 teaspoons of added sugar per day, which is equal to 172 grams!
People with diabetes are more likely to develop high blood pressure and other heart problems such as cardiovascular disease. Sodium (salt) can worsen blood pressure and cause fluid retention if consumed in high amounts. Those with diabetes shouldn’t consume more than 2,300 milligrams of sodium per day, and some may need to eat even less sodium than that.
A food is usually considered very high sodium if it provides more than 20% of the daily value for sodium. While sodium is found naturally in small amounts in many foods, processed, convenience, and fast foods tend to be very high in added sodium.
Some examples of high-sodium foods include:
- Frozen meals
- Fast food & restaurant meals
- Quick bread mixes
- Savory snacks such as chips, pretzels, etc.
- Bread (can become high sodium due to how much is eaten throughout the day)
- Canned soups
- Deli meats
- Salad dressings and sauces
Healthy diet choices for diabetes
There isn’t a one-size-fits-all diet approach that is going to work for everyone with diabetes. People respond differently to different foods and have varying energy requirements. A healthy eating plan should be customized to each person based on their preferences, blood sugar trends, and many other factors.
A Mediterranean-style eating meal plan has been associated with improved health outcomes, including a lower incidence of diabetes and heart disease. A Mediterranean diet is a style of eating that focuses on plant-based foods. It’s based on foods that people eat in countries such as Greece and Italy, but isn’t limited to those countries.
The Mediterranean diet isn’t as much of a diet as it is a lifestyle. Unlike many fad diets, there aren’t foods that are considered not allowed, nor are there any types of point system, measuring, etc. Thus, it tends to be easier to adopt long-term, so it is more effective at providing health benefits.
The Mediterranean diet emphasizes plant-based foods as the backbone of the diet. Fruits, vegetables, whole grains, legumes, nuts, and seeds are abundant in this style of eating, as are healthy plant-based fats such as olive oil and avocados.
Meat, dairy, processed foods, and refined sugar are avoided, and emphasis is put on whole foods. While sugary drinks are avoided, moderate amounts of alcohol such as red wine are included, but of course, this is entirely optional.
The different types of foods in a Mediterranean-style diet include:
- Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, Brussels sprouts, cucumbers, etc.
- Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.
- Nuts and seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds, chia seeds etc.
- Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.
- Tubers: Potatoes, sweet potatoes, turnips, yams, etc.
- Whole grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole-grain bread, and pasta.
- Fatty fish and seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.
- Poultry: Lean meat such as chicken, duck, turkey, etc.
- Eggs: Chicken, quail, and duck eggs.
- Dairy: Cheese, yogurt, Greek yogurt, etc.
- Herbs and spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.
- Healthy Fat: Extra virgin olive oil, olives, avocados, and avocado oil.
Foods not eaten on a Mediterranean diet include:
- Added sugar. The American Heart Association recommends that women consume no more than 6 teaspoons of added sugar per day (24 grams), and men consume no more than 9 teaspoons of added sugar per day (36 grams). However, the average American eats 22 teaspoons of added sugar per day. A diet high in added sugars can lead to increased blood glucose levels and insulin spikes.
- Refined grains: White bread, pasta made with refined wheat, etc.
- Refined oils: Soybean oil, canola oil, cottonseed oil, and others.
- Processed meat: Processed sausages, deli meats, hot dogs, etc.
- Highly processed food: Packaged foods with a long list of ingredients.
In addition to eating more whole, plant-based foods, the Mediterranean diet is also coupled with increased physical activity. Many of the Mediterranean “food pyramids” show physical exercise at the base, meaning it’s the most important and should be the priority. Getting at least 30 minutes of moderate to vigorous activity each day is recommended.
Consistent carbohydrate diet
A consistent carbohydrate diet spreads carbohydrates out evenly throughout the day in meals and snacks. Eating carbohydrates consistently helps promote more steady blood sugar levels than varying carbohydrates from meal-to-meal.
The amount of carbohydrates consumed for meals and snacks will vary, but a general guideline is to aim for 30-60 grams of carbohydrates per meal, with the higher range being better suited for more active people or those with higher energy needs. For snacks, aim for 15-30 grams of carbohydrates.
While there is no set definition of a low-carb diet, one study defines it as a diet consisting of fewer than 27% in calories from carbohydrates or fewer than 130 grams per day based on a 2000 calorie diet.
A “low carb” diet usually avoids obviously starchy foods such as bread, pasta, and rice. People following a low-carb diet usually avoid sweets and desserts and may opt for sugar-free variations of products.
Low carb diets can vary in how restricted carbohydrate intake is. A ketogenic or “keto” diet is a very low-carb diet with fewer than 50 grams of carbs consumed per day. It’s also very high in fat, similar to the Atkins diet, which was popular in the past.
The safety and efficacy of very low-carb diets, such as the keto diet, haven’t been studied long-term. Due to its high-fat content, it would be advisable for someone with diabetes to consider the potential impacts that type of diet may have on cholesterol levels.
Tips when shopping for food
Reading food labels, as mentioned earlier, is one of the best tools for making informed, healthy food choices at the grocery store. However, some of the healthiest foods don’t have labels because they are minimally processed, such as fresh fruits, vegetables, and whole meats.
Staying around the perimeter of the grocery store is one general tip to help avoid processed foods. The produce, dairy, and meat sections are usually around the perimeter, whereas more processed foods are in the aisles. There are definitely exceptions to that rule, but it is a good place to start when navigating the grocery store.
There is a lot of information (and misinformation) about what type of eating style or diet is best for someone with diabetes. Some foods are marketed as “diabetes-friendly” or “for diabetics,” which can add to the confusion when trying to practice blood sugar control.
Not all products labeled for diabetes are necessarily healthy and can be overly-processed and high in sodium. The best way to know if a food might be a good choice is to read the nutrition facts label and make an informed decision based on the person’s health goals and lifestyle habits. In general, opting for minimally processed foods and including plant-based foods is a healthy route to take.