HEALTHY FOOD OPTIONS FOR DIABETES

Published by Dr Gigi on December 11, 2018

One of the lifestyle adjustments to make after being diagnosed with diabetes is diet modification. Smart dieting will keep your blood sugar under control and prevent future complications such as kidney failure, blindness and heart disease.

In diabetes -both types 1 and 2, there is impairment of blood sugar control, especially after consuming foods rich in carbohydrate, hence, low carbohydrate diets are commonly prescribed. Keeping your blood sugar under control may reduce your requirement of insulin or other diabetic medications.1,2

Often, newly diagnosed individuals get overwhelmed having to adjust to the newly prescribed diet. Following a diabetic diet does not have to be tedious and boring. While dieting to keep your blood sugar under control, it is important to follow a diet consisting of several healthy food options, that will provide the necessary nutrients and antioxidants needed to improve your overall health status, mood, and weight.

There are several foods you may have to replace with others, eat more or less of, to ensure you are getting the most out of your diet. In general, portion control is always advocated.

Individuals who are prediabetic or anyone with family history of diabetes, or simply want to stay healthy will benefit from following these tips.

Carbs.

Yes, the culprit!

The first thing you are told after diagnosis is to stay away from carbs, how they are bad for you and all the scary stuff. Generally, carbs when converted to glucose provide bursts of energy to the body. However, in people with diabetes, glucose uptake and utilization are impaired.

To keep your blood sugar under control, several studies suggest the following measures; following a low carb diet, checking carbohydrate content of the food on your plate and their glycemic index (how high and how fast it raises your blood sugar).3, 6 7 8

The best type of carbs to add to your pantry are whole grains, such as whole oats, barley, quinoa, farro. Opt for whole grain pasta, breads and cereal. Replace white pasta, white rice with quinoa, sweet potatoes, zucchini pasta. They are great sources of soluble fiber, vitamin B, iron, magnesium, chromium and folic acid. The high soluble fiber content helps keep you full longer, minimize blood sugar spikes and improve insulin sensitivity. 

According to a 2013 study, taking inulin, a prebiotic fiber daily will improve your fasting blood sugar, HbA_1c, total cholesterol, triglyceride, LDL and increased HDL. 9

Individual difference in energy requirement, level of insulin insensitivity, basal metabolic rate should be considered while following a low carb diet. Research studies suggest consuming between 20-90 mg of carbs daily (Low carb diet).1,13. 

When initiating the low carb diet, remember to monitor your blood sugar before food and 2 hours after each meal to make sure your blood sugar levels are within the normal values (70 – 140 mg/dl).

If your blood sugar falls lower than 70 mg/dl, you may be at risk of hypoglycemia, and may have to follow your doctor’s orders on how to treat your hypoglycemia. This in many cases involves, eating about 15-20 grams of fast-acting carbs like fruit juice, regular soft drinks, glucose tablets, sweets. Check your blood sugar every 15 minutes using your glucometer till it stabilizes at a value above 70 mg/dl and then visit a nearby hospital if necessary. 

Note that when following low carb diet, you may need to review your medications with the doctor. This is because your daily dosage may have to be reduced to prevent your blood sugar from dropping to dangerously low levels.

Protein foods

These are foods high in protein, they also may contain fats and carbohydrate in varying degrees. The important distinction to note among them is their fat content. It is advised to consume foods low in fat and to avoid meats that are high in saturated fats, as they may increase your risk of heart disease.

Meats.

According to the American Diabetes Association, diabetics should opt for lean meats and limit their intake of red meats such as beef, pork, veal, lamb and processed meat such as ham, bacon, hot dogs, which are high in saturated fat and sodium. Meats high in saturated fat may increase your cholesterol level and calories if eaten regularly.

Note. 1 ounce (~ 28 g) of meat = 7 grams of protein, 3-5 grams of fat (depending on the type)

If you must have any of these, chose meat options that have been trimmed of fat and not fried; including, ribs, rump roast, sirloin, cubed, T-bone steak, lamb and veal chops and roasts.

Opt instead for, skinless poultry- chicken, turkey, Cornish hen.

Fish and Seafood

They are high in protein, heart healthy omega-3 fatty acids and so do not spike your blood sugar after meals. Omega-3 fatty acids protect the heart by lowering your cholesterol levels and blood pressure. It is important for people with diabetes, because they are at a greater risk for cardiovascular diseases such as coronary artery disease.  

The American Diabetic Association recommends having fish with your meals at least 2x  a week. Among the recommend fish and seafood protein are salmon, tuna, sardines, herring, mackerel, shrimp, oysters, crabs, tilapia, lobster, scallops and cod.

Plant based proteins

• Quinoa. It is a protein rich, gluten free, whole grain super-food. It is high in dietary fiber, vitamin B,  iron, magnesium, and all the essential amino acids required to build the muscles. Each 100g (3.4 oz) of cooked quinoa contains about 4%protein, 72% water, 21% carbohydrates, 2% fat, 120 calories, 30% DV manganese, 22% DV phosphorus. Its high fiber and protein content keep you full as it digests slowly, preventing your blood sugar from spiking after meals. As such, quinoa is a great substitute for rice, white pasta and other high carb foods.

• Milk and yogurt. These are high in protein, calcium and vitamin D. They also contain carbohydrates and fats, and as a result, will affect your blood sugar. These foods should be consumed in small portions. Opt for products that are fat free with no added sugar. Other healthy milk options include; soy milk, almond milk, cashew milk, these may be incorporated into the diet without the extra calories and effect on blood sugar.

• Beans. Beans are packed with fiber, vitamins and minerals (potassium,  magnesium), low in carbs with high protein. It keeps you full for long and prevents blood sugar spike after meals.4 It is the perfect alternative to meat as it provides as much protein ( 1/2 cup of beans = protein/ounce of meat)without the saturated fat. Note. When using canned beans, it is important to drain and rinse out the salt before consuming them. Examples of beans to incorporate into your diet are; kidney, pinto, black beans.
• Other healthy plant based protein foods include Hummus (chickpeas) and falafel (chickpea/fava beans), lentils, peas, black-eyed or split peas, pigeon peas, edamame, soy beans (tofu, tempeh).

Herbs and Spices

Some herbs and spices have been found to be high in polyphenols, a substance that reduces inflammation, improves insulin sensitivity, lowers blood sugar. Spices and herbs have been deemed beneficial by several studies. They also make food tasty/savory and less boring. 

Cloves. Cloves are high in phenols, contain the antioxidants quercetin and anthocyanins.  Cloves have been found to be anti-inflammatory, provide pain relief and improve digestion in diabetics.12 

Cinnamon. Cinnamon has both antioxidant and anti-inflammatory properties and has been shown by multiple studies to improve insulin sensitivity and reduce fasting blood sugars. Some researchers believe it functions very similar to insulin in the body.17  It is pleasantly flavorful and may be used in cereals, oatmeal, pastries, stews and soups. 10 11 12

Cayenne pepper.This spice plays an anti-inflammatory role in the body, improves blood sugar control and aids glucose absorption in the gut. This is true for the different varieties of pepper.17

Ginseng. Is a popular Chinese herb that has been found to reduce insulin resistance and lower Hemoglobin A1C levels.  It contains ginsenoside, an anti-obesity compound that suppresses food intake, improves glucose and fat metabolism. Panax Ginseng is a variety that has been studied for its role in improving the symptoms of diabetes and alzheimer’s disease. 17

Fenugreek seeds. Several studies by Sharma et al. suggest that Fenugreek seeds reduce fasting blood sugar, increase insulin in the body.14,15,16 17. It has also been reported to delay digestion and absorption of carbs in the small intestine. Their action on the gut is mimic the diabetic prescription drug Acarbose.

Other herbs/spices of anti-diabetic benefits include, green tea, rosemary, oregano, sage, garlic , ginger, turmeric, thyme, Italian seasoning, tarragon, and mint. 

Fruits

These provide vitamins and minerals, however, they may also contain carbs, as a result it will spike your blood sugar after meal and may get in the way of your weight loss goals.They should be eaten as part of your regular meal and every portion should count. 1/3 cup of whole fruit or 1/2 cup of frozen/canned  fruits (no added sugar) contain about 15 grams of carbs and each serving should not exceed 2/3 – 1 cup, while the serving for fruit juices should not exceed 1/2 cup. Recommended fruits  with low glycemic index include; apples, blueberries, strawberries, grapes, cherries, grapefruit, apricots, pears, sweet potatoes (good source of vitamin C and potassium). Fruits to be wary off include; dates, bananas, watermelons, pineapples.  

Vegetables

Veggies are loaded with vitamins and minerals, are low in carbohydrate, do not cause blood sugar spike after meals. Due to their numerous benefits, individuals with diabetes should eat lots of vegetables. Because they are low in calories, they can form the bulk of your meal, filling you up and staving off your craving for other high calorie foods. Dark green leafy veggies (such as kale, collard greens and spinach) are high in calcium, potassium, iron, vitamins A, K, C, E. You may also incorporate them into salads and soups.

Nuts 

Nuts are high in the good’ kind  of fats, unsaturated fats- mono/polyunsaturated fats. They are also high in fiber, protein, low on carbs, keep you full longer and help stabilize your blood sugar.  According to a study by Mejia et al, consuming two servings of nuts daily, will lower blood triglycerides and stabilized blood sugar levels in people with type 2 diabetes.5 Excellent nut options include; walnuts, hazelnuts, pecans, cashews, almonds, pistachios. Nuts are loaded with lipids and have high calories as such, portion control is advised. (Note, peanuts are not regarded as nuts)

Fats

They are foods considered as high calorie foods. Even though they do not cause a spike in blood sugar, they may increase your risk of heart disease. Nuts, meats, milk, cheese, butter are all sources of fat and each gram of fat yields 9 calories, putting it at the top of the list of high calorie foods.

Opt for skim, 1%, or plant based milk such as soy, almond, cashew, non fat or low fat plain yogurt, and reduced fat cheeses. Swap butter/margarine for plant based bread spreads like almond butter.

For cooking oils go for healthy fats such as vegetable oils, light mayonnaise, trans-free margarine, plant based margarine, avocado oil, olives and olive oil.

In Summary

• Use a carb counter and watch your calories
• Control your food portion even when eating healthy foods
• Swap rice, pasta and other starchy carbs for whole grain foods.
• Read food labels carefully
• Eat lots of non starchy vegetables and fruits
• Eat only lean proteins, especially plant based proteins
• Choose skim, 1%, or plant based milk such as soy, almond, cashew
• Eat non fat or low fat yogurt, plain
• Reduced fat cheeses are the best for you
• Swap egg whites for whole eggs
• Swap butter/margarine for plant based bread spreads like almond butter
• Opt for healthy fats such as vegetable oils, light mayonnaise, trans-free margarine, plant based margarine, avocado oil, olives and olive oil, nuts, and seeds.
• Ditch high calorie snacks and drinks like chips, cakes, regular ice cream, cookies
• Drink alcohol in moderation.

References

1. Feinman RD et al. Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base. Nutrition 31 (2015) 1–13
2. Westman EC, Vernon MC. Has carbohydrate-restriction been forgotten as a treatment for diabetes mellitus? A perspective on the ACCORD study design. Nutr Metab (Lond) 2008;5:10.
3. http://diabetes.diabetesjournals.org/content/53/9/2375.long
4. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1384247
5. Blanco Mejia S, Kendall CWC, Viguiliouk E, et al Effect of tree nuts on metabolic syndrome criteria: a systematic review and meta-analysis of randomised controlled trials BMJ Open 2014;4:e004660. doi: 10.1136/bmjopen-2013-004660
6. Nielsen JV, Joensson EA. Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up. Nutr Metab (Lond). 2008;5:14. Published 2008 May 22. doi:10.1186/1743-7075-5-14
7. Mayer SB, Jeffreys AS, Olsen MK, McDuffie JR, Feinglos MN, Yancy WS. Two diets with different haemoglobin A1c and antiglycaemic medication effects despite similar weight loss in type 2 diabetes. Diabetes Obes Metab. 2013;16(1):90-3.
8. Westman EC, Yancy WS, Mavropoulos JC, Marquart M, McDuffie JR. The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus. Nutr Metab (Lond). 2008;5:36. Published 2008 Dec 19. doi:10.1186/1743-7075-5-36
9. Dehghan P, Pourghassem Gargari B, Asgharijafarabadi M. Effects of high performance inulin supplementation on glycemic status and lipid profile in women with type 2 diabetes: a randomized, placebo-controlled clinical trial. Health Promot Perspect. 2013;3(1):55-63. Published 2013 Jun 30. doi:10.5681/hpp.2013.007
10. Richard A. Anderson, Zhiwei Zhan, Rencai Luo, Xiuhua Guo, Qingqing Guo, Jin Zhou, Jiang Kong, Paul A. Davis, Barbara J. Stoecker. Cinnamon extract lowers glucose, insulin and cholesterol in people with elevated serum glucose. Journal of Traditional and Complementary Medicine, Volume 6, Issue 4, 2016. Pages 332-336. ISSN 2225-4110

11. Ashley Magistrelli, Jo Carol Chezem. Effect of Ground Cinnamon on Postprandial Blood Glucose Concentration in Normal-Weight and Obese Adults. Journal of the Academy of Nutrition and Dietetics, Volume 112, Issue 11, 2012, pp. 1806-1809

12. Allyson Bower, Susan Marquez & Elvira Gonzalez de Mejia (2016) The Health Benefits of Selected Culinary Herbs and Spices Found in the Traditional Mediterranean Diet, Critical Reviews in Food Science and Nutrition, 56:16, 2728-2746, DOI: 10.1080/10408398.2013.805713
13. https://www.ncbi.nlm.nih.gov/pubmed/16454166
14. Sharma R.D. Effect of fenugreek seeds and leaves on blood glucose and serum insulin responses in human subjects. Nutr. Res. 1986;6:1353–1364. doi: 10.1016/S0271-5317(86)80020-3.
15. Sharma R., Sarkar A., Hazara D., Mishra B., Singh J., Sharma S., Maheshwari B., Maheshwari P. Use of fenuqreek seed powder in the management of non-insulin dependent diabetes mellitus. Nutr. Res. 1996;16:1331–1339. 
16.  Sharma R.D.a.R.T.C. Hypoglycemic effect of fenugreek seeds in non-insulin dependent diabetic subjects. Nutr. Res. 1990;10:731–739. 
17. Jung HS, Lim Y, Kim EK. Therapeutic phytogenic compounds for obesity and diabetes. Int J Mol Sci. 2014;15(11):21505-37. Published 2014 Nov 21. doi:10.3390/ijms151121505