Diabetes: What Should I Eat?
In an era of abundant food choices and endless fad diets, it can be challenging to determine what to eat—but even more so if you have diabetes. There is no one-size-fits-all diet for anyone, including diabetics, but there are some healthier food choices that can help you live well with diabetes.
Diabetes is a metabolism disorder. Metabolism refers to how the body uses and digests food for growth and energy. All types of carbohydrates—healthy and unhealthy—are broken down into glucose, a type of sugar in the blood, which is the main source of fuel for our cells. When people talk about blood sugar levels, they’re referring to glucose in the bloodstream. The cells need that glucose for growth and energy—however, there is a middle step that has to happen for the glucose to reach the cells: insulin.
Insulin is a hormone released by the pancreas to transport glucose into the cells, which results in lower blood sugar levels. In a way, insulin is sort of like a truck that picks up the glucose and delivers it to the cells. After you eat, your pancreas releases an adequate amount of insulin to transport the glucose—unless you have diabetes, in which case this process is disrupted.
There are two types of diabetes. Type 1 diabetes (sometimes referred to as juvenile or childhood diabetes) is an autoimmune disease in which the body has destroyed its own ability to produce insulin. Type 1 diabetes is neither preventable nor reversible. A person with type 1 diabetes did not do anything to cause the disease. Type 2 diabetes, on the other hand, is the result of overfueling and overtaxing the system. Someone who eats too much—and particularly too much food that will consistently raise blood sugar levels—is eventually going to wear out the system and one of two things happens: either the body is no longer able to produce adequate amounts of insulin to keep up with the overconsumption of carbohydrates or the cells start to ignore the insulin, a condition known as insulin resistance.
Food and Diabetes
“Food has everything to do with the management of diabetes,” explains Jody Stanislaw, ND, a naturopathic doctor with type 1 diabetes who specializes in helping people manage the disease. “You can’t have diabetes and not think about food.”
She explains that though the management of type 1 and type 2 diabetes differs, food is an important component in both diseases—and it’s all about blood sugar levels. “The more your blood sugar level is normal, the healthier you are as a person—and you just feel better,” Dr. Stanislaw says.
Dr. Stanislaw explains that the more blood sugar levels fluctuate, the higher the risk of the five major complications of diabetes: blindness, kidney failure, heart disease, stroke, and gangrene.
Everyone—whether they have type 1 or 2 diabetes or no diabetes at all—can benefit from managing blood sugar levels. But how do you do that?
Food and Blood Sugar
The truth is, learning what to eat is a bit like a chemistry experiment. We tend to evaluate food based on its calorie and nutrient density, but it’s also important to remember that food affects our blood sugar level, which in turn affects our insulin level, which in turn can affect our risk of cardiovascular disease, diabetes, and cancer, not to mention our fat storage.
Choosing foods that won’t spike blood sugar is important for mood, energy, weight, and overall health. But how do you know which foods will send your blood sugar soaring and which ones will keep it stable?
One handy tool is the glycemic index (GI), which is a measure of the effects of carbohydrates on blood sugar levels. Carbohydrates that break down quickly, and thus release glucose into the bloodstream quickly, have a high GI, whereas carbohydrates that break down slowly, releasing glucose into the bloodstream gradually, have a low GI. Glucose is considered the reference food and has a value of 100. To put it into perspective, a baguette has a value of 95 and chickpeas have a value of 33.
But not to worry—you don’t have to memorize the glycemic index to successfully manage blood sugar levels. With a little practice, you can learn to discern which foods help you avoid the roller coaster of high and low blood sugar. It all starts with some healthy meal planning—and a controlled carbohydrate intake.
Carbohydrates and Diabetes
Because managing diabetes is all about managing blood sugar levels and because carbohydrates tend to spike blood sugar levels, Dr. Stanislaw recommends a low-carbohydrate diet. “There isn’t a single type 2 diabetic, no matter how early or far along he or she is in the disease, who cannot considerably change the overall health of the body by reducing carbohydrate intake,” she explains. “I’m not saying ‘no carb’—because you need carbs—but you shouldn’t be eating bananas, white rice, sweet potatoes, and orange juice all day.”
Dr. Stanislaw explains that type 1 and type 2 diabetics both need to control their carbohydrate intake but for different reasons.
Type 2 diabetics have an overtaxed system—and the pancreas eventually cannot withstand more stress on the system. In other words, by cleaning up their diet and reducing their carbohydrate intake—and therefore reducing the blood sugar roller coaster—type 2 diabetics can improve their health dramatically.
Type 1 diabetics, on the other hand, can’t do anything to damage an already damaged system. They can eat as many carbohydrates as they want; however, then they constantly have to figure out how much insulin they need to take the right amount of glucose out of the blood. From Dr. Stanislaw’s perspective, type 1 diabetes is much simpler to manage with a low-carbohydrate diet. “As a type 1 diabetic, my life is just easier if I gamble with less money, so to speak,” she explains. “If I eat a lot of carbohydrates, I have to figure out how much insulin to take and hope the insulin will be ready to do its job at the exact same time that the glucose is entering my bloodstream, which is a rather impossible task. When my blood sugar starts to rise from eating a lot of carbohydrates, whether they are healthy carbs or not, I usually end up feeling groggy and grouchy and wanting to take a nap.”
The normal range for blood sugar is between 80 and 140, which sounds like a large margin of error—but Dr. Stanislaw points out that simply eating a banana can spike her blood sugar by 100 points. That’s why it’s so important to choose foods wisely and manage blood sugar from the outset.
Meal Planning with Diabetes
So, what exactly should you eat to live well with diabetes? It will take some personal trial and error to strike the right balance, but Dr. Stanislaw has the following key guidelines.
Low carbohydrates. Dr. Stanislaw recommends 40 to 65 grams (g) of carbohydrates per meal, whether you are diabetic or not. The right carbohydrate intake will differ based on age and activity level, so it’s up to each individual to find the right balance.
Balance carbohydrates and protein. Dr. Stanislaw recommends a 50/50 balance of carbohydrates and protein at every snack and meal. “That makes the digestive process much more complex, so it decreases the ability of the carbohydrates to spike the blood sugar level,” she explains.
Eat whole foods. It’s important to clean up the diet in general and choose whole foods that grow in nature. “If it’s in a box or a bag, it’s a product, not a food,” insists Dr. Stanislaw. Choose vegetables, fruit, beans, nuts, whole grains, fish, chicken, or grass-fed beef.
Protein for breakfast. “The worst thing for a diabetic to do is have fruit or juice first thing in the morning because you have an empty stomach and thus nothing to slow down the blood sugar spike from that food,” Dr. Stanislaw explains. “Diabetics are much better off having protein-based breakfasts such as eggs, a protein smoothie, or an apple and peanut butter.”
Eat lots of vegetables. One of the best ways to maintain a healthy diet is to make nonstarchy vegetables the foundation of every meal.
Eat regularly throughout the day. It’s important to eat at regular intervals to prevent blood sugar from dipping too low. Avoid letting more than four hours go by without having a meal or snack.
Staying Healthy for the Long Term
“The body is constantly trying to heal itself,” Dr. Stanislaw explains. By feeding it nutrient-dense food and managing blood sugar levels, we can help this process. If blood sugar gets too high, you’ll feel angry, depressed, irritated, and tired. If it dips too low, you run the risk of feeling shaky and confused and can even fall into a coma. The bottom line: if you want your blood sugar to remain stable, choose foods wisely. With a little strategic meal planning, you can live well with diabetes for the long term.
Plan Your Plate
“I always recommend a handful of carbohydrates and a handful of protein at every meal,” Dr. Stanislaw says. A handful is not a very technical term, but the good news is that you don’t have to get too technical to strike the right balance at every meal. In fact, all you really have to do is take a look at your plate and divide the portions appropriately.
Simply imagine a line running down the center of your plate. Fill half of the plate with nonstarchy vegetables, such as broccoli, green beans, spinach, lettuce, bok choy, or celery.
Now divide the remaining portion of your plate in half and fill one section with protein such as fish, chicken, eggs, or lean beef. Fill the remaining section with whole grains or starchy vegetables, such as brown rice, quinoa, pasta, beans, or potatoes.
Foods that contain carbohydrates raise blood sugar levels, which is why carbohydrate counting can be a useful tool for diabetics. Limiting carbohydrates can help you to keep your blood sugar levels in a healthy range. Dr. Stanislaw recommends 30 to 60 g of carbohydrates per meal, and she emphasizes that it’s important to aim for the lower end of that range. Eventually, carbohydrate counting will become second nature. In the meantime, here are some basic guidelines.