It’s a beautiful, sunny Saturday, and you’re at a good friend’s BBQ birthday gathering. On the picnic table sits a big bucket of chips and dip, then several courses of grill-food galore, and the finale, a glowing, ooey gooey chocolate birthday cake. If someone told you that you couldn’t have any of those things, how would you feel?
You’d probably be disappointed, and feel compelled want it even more than if someone told you that you could eat to your heart’s content. It’s human nature. And, it’s a challenge that many people with diabetes face every single day.
But this doesn’t have to be the case, according to Erica Hechler, a Registered Dietitian and Certified Diabetes Educator at the Florida Hospital Diabetes Institute.
“People with diabetes can eat all foods in a healthy way,” says Hechler. “This disease shouldn’t keep you from enjoying a variety of foods and especially the ones you love!” she adds.
The key with diabetes is moderation
“No foods are off-limits for people with diabetes; they key is working with a Registered Dietitian to better understand how certain foods can affect blood sugar levels and how to include them in their meal plan in moderation in a healthy way,” advises Hechler.
She explains further, “Talking to people with diabetes about how to choose foods can help reduce negative feeling surrounding foods. Instead of just providing a list of foods people can and can’t eat we help people with diabetes by teaching them to how to incorporate their favorite foods and still reach their health goals.”
This is a distinguishing component of the Diabetes Institute’s comprehensive lifestyle management approach. “We talk to each patient to understand how food fits into their lives – food and mealtimes are such a big part of our culture, our family get-togethers, social activities and significant milestones — so, we develop diabetes management plans that satisfy patient nutritional needs and goals while also helping patients enjoy what’s important to them,” notes Hechler.
People with diabetes have the same nutritional needs
“Many of my patients arrive with many questions and are often very stressed about eating with diabetes. They’ve been told by people that they have to eliminate sugar, desserts and often ALL carbs and this is definitely not the case,” Hechler says. “People with they don’t have to eliminate entire food groups,” she adds.
“I ask people to tell me about all of the foods they eat including their favorite foods. We work together to map out a plan so that these foods can be incorporated healthfully by keeping within their meal plan and thus supports blood sugar management. Many feel as if a weight has been lifted off their shoulders and many boast, “I can eat again,”” she recounts.
In fact, the Diabetes Institute has several programs that focus on helping patients keep as close to a normal life as possible. Hechler says, “Our goals are to reduce diabetes-related complications and enhance each patient’s quality of life.”
“We do this by teaching the fundamentals of a healthy eating and giving each patient the tools they need to move forward in their care thus empowering patients and providing them with a bigger sense of control over their disease,” she continues.
People with diabetes have the same nutritional concerns
“Diet holds the key to managing diabetes, so it’s really the most important place to start,” says Hechler. “But people with diabetes can have the same nutritional concerns as anyone else,” she adds.
Hechler explains that with age, regardless if you have diabetes or not, the body’s ability to absorb certain nutrients well can decline. One of the most common nutrient deficiencies seen is low B12 levels. Low vitamin D levels can also be low in this population. Knowing this, physicians at the Diabetes Institute may order lab work for their patients to assess for these deficiencies and continue to support their overall health.
“If deficiencies are identified, a physician may order supplements and I will discuss how to replenish depleted stores with food therapy,” says Hechler. In the aging population, a common factor that could impair nutrient absorption is polypharmacy or being on multiple medications. “Polypharmacy is something that is routinely monitored by physicians and pharmacists,” she emphasizes.
Teaching the fundamentals of a healthy diet with diabetes
“In teaching the fundamentals of a healthy diet, we start by talking about the three major macronutrients: carbohydrates, proteins and fats,” Hechler notes.
The one macronutrient that often gets the most attention when trying to manage diabetes is carbohydrates because one hundred percent of carbohydrates that we eat are converted into sugar in the body. And while the amounts eaten do need to be controlled with diabetes, they are also an important part of our diet.
“Carbohydrates that affect the blood sugar the most are divided into two groupings: We have the starches and the sugars,” advises Hechler. “Starches are foods with flour and starch vegetables and sugars are fruits, milk, yogurt, and sweets,” she adds.
“Protein foods are minimally converted into sugar so including these foods can help us by allowing us to feel full and displacing other carbohydrates that may have been eaten at that meal,” explains Hechler.
She adds, “Lastly, fats are important to help us absorb our fat-soluble vitamins and can add to helping us feel full.”
Cash in on your “carb budget”
Carbohydrates (or carbs) come in many different forms in our food supply. “Starches, like flour and grains and starchy vegetables like potatoes, corn and even beans, may not have a high sugar content, but your body still converts these foods to sugar. So, while these foods provide health benefits like vitamins, minerals and fiber, they still need to be eaten in controlled amounts when a person has diabetes.
“We help patients with diabetes understand where their carbs are coming from and we suggest approaching carb management with a “carb budget” — we want patients to know that they have choices about where their carbs are coming from,” advises Hechler.
She explains, “There are some carbs that are better choices than others. Knowing the difference and how they fit into the plan can keep people make choices and keep them from feeling deprived.”
Hechler’s tips to keep your carb budget and diet in check:
- Eat more “whole foods”
- Include more single ingredient foods
- Focus on whole grains
- Look at the nutrition label’s ingredient list for the first ingredient, which should be “whole-wheat” or another whole grain
- Look for 3 grams or more of fiber per serving
- Foods that contain more soluble fibers can help control blood sugar and manage blood fats
- Eat foods such as dried beans and peas, lentils, sweet potatoes, and oatmeal
- Eat lean proteins
- Fill one quarter of your plate with lean proteins
- Include plant-based fats
- Fat sources should be from nuts, seeds, avocados and oils
- Watch for added sugars that sound healthy
- Read your ingredient list and limit foods with ingredients such as honey, molasses, evaporated raisin juice and high fructose corn syrup
The ‘Healthy Plate’ and the concept of the “mixed meal”
Hechler recommends eating three meals per day — one meal every four to five hours — and snacking as determined by hunger cues or if meals are delayed for more than six hours. When it’s time to fill your plate, here’s Hechler’s rule of thumb:
- ¼ plate protein (palm-sized amount)
- ¼ plate carbohydrate
- ½ plate non-starchy vegetables
“The Healthy Plate method helps reinforce the concept of the mixed meal, which involves pairing carbohydrates with proteins and healthy fats to improve satiety and helps support more stable blood sugars,” advises Hechler.
Hechler continues, “The great thing about this mixed meal concept is that if you fill up with non-starchy vegetables (half of your plate), you’re less likely to eat more that your allotted amount of carbohydrates or other higher glycemic foods.”
But she clarifies, “If you really want that slice of birthday cake, you can still have it
(sometimes, not always), you will just need to account for it in your carb budget.”
Managing weight with diabetes
Becoming overweight is a major risk factor in developing type two diabetes. An article published by the Harvard Gazette suggests that roughly 30 percent of overweight people have the disease, and 85 percent of people with diabetes are overweight.
Managing a healthy weight is an important part of controlling diabetes and reducing its associated complications. “For many patients, diet therapy not only about managing blood sugar but it’s also about managing weight,” explains Hechler.
In this case, it’s important to help patients change behaviors and be more aware around food.
“As we age our metabolism slows down, making it harder to maintain a healthier weight.” We all know that as we get busier, it becomes more challenging to exercise, meal plan/prep, and eat healthful home-prepared meals. This is true for anyone, not just those with diabetes.
Take out the take-out
“When we eat out, we lose control over what’s in our food — many are surprised to find out how much extra fat and calories are in restaurant or fast food that they think is healthy,” says Hechler.
Hechler suggests that when eating away from home, it’s important to look for restaurants that share their menu items’ nutritional information. Though, this isn’t fail safe because the preparation and serving of your meal is still subject to human error. Going through the taco line, the happy scooper could give you a double dose of guacamole without you even knowing.
“We teach our patients how to be more aware around food so they can take a more active role in controlling their meals away from home,” Hechler says.
Asking restaurants not to use oil, put sauces on the side, or to only put half of the serving of pasta on the plate — these are little acts that can make a big impact.
Exercise and diet go hand in hand
Like peanut butter and jelly, some things just go together — like diet and exercise.
“Diet is only part of the equation for diabetes and weight management,” says Hechler.
The Diabetes Institute incorporates exercise into every patient’s comprehensive care plan because physical activity boosts your cells’ sensitivity to insulin, allowing it to work more effectively.
The result? Consistent exercise can lower blood glucose and improve A1C. When you lower A1C, a patient may be able to reduce the amount of diabetes medications they are on.
“From the weight management perspective, physical activity can help increase muscle mass, this helps the body burn more calories at a resting state and facilitate weight loss,” explains Hechler.
The list of health benefits from regular physical activity is long. Here are just a few, according to the American Diabetes Association:
- Lowered blood pressure and cholesterol
- Lowered risk for heart disease and stroke
- More calories burned to help you lose or maintain weight
- Increased energy for daily activities
- Improved sleep
- Stress reduction and management
- Strengthened heart and improved blood circulation
- Strengthened muscles and bones
- Improved flexibility of joints
- Improved balance to prevent falls
- Reduced symptoms of depression and improved quality of life
Improve sleep for weight management
“Sleep plays a huge role in diet and weight management,” says Hechler. She explains that hormones released at night while sleeping help regulate appetite and reduce cravings during the day.
“I ask every patient about their sleep patterns and find that many are not getting adequate, good quality sleep for various reasons, so working to improve sleep should be a part of diabetes self-care” Hechler continues.
Customizing a healthy lifestyle for every patient
Managing diabetes involves many facets of life, so creating a diabetes self-management plan is important. “Our diabetes education program provides a safe and supportive environment for people with diabetes to learn how to lead the life they love — our team of health professionals are here to support every individual’s personal journey,” says Hechler.
This customized education can be done one-on-one or in a group setting and helps provide people with diabetes with the tools they need to lead healthy lives. The classes focus on day to day management of diabetes, diet therapy, exercise therapy, complication prevention, and management, how to travel with diabetes, behavioral therapy and blood glucose pattern management.
For those that are interested in weight management, the Diabetes Institute’s six-month program tailors a multidisciplinary care plan for each patient with the goal to achieve and maintain a healthy weight long-term.
“Everything we talk about is based on sound science and research; patients can trust that when they come and see us they get information and strategies that are proven to work,” concludes Hechler.
Diabetes is not the end of eating the foods you love
Learning new ways of eating and living life with diabetes is not easy. There are adjustments you must make, but with the proper professional help from a Registered Dietitian, you can gain the knowledge and skills necessary to enjoy the foods you love, shedding the feelings of deprivation by gaining the right skills for moderation.