Eating a healthy diet is no easy feat for anyone, but for those with nutritional issues like diabetes, it’s a crucial balancing act.
“Both diet and weight play huge roles in the prevention and treatment of diabetes,” said Natalia Torres-Negron, a registered dietitian and certified diabetes educator for Cleveland Clinic Florida in Weston.
About 30 million Americans have diabetes, or about 9 percent of the U.S. population, according to the American Diabetes Association. About 1.5 million Americans are diagnosed with diabetes every year. The Florida Department of Health estimates that in Florida, more than 2.4 million people have diabetes and more than 5.8 million have prediabetes.
There are two main types of diabetes: In type 1, which impacts about 5 percent of diabetes patients, the body does not produce insulin. Insulin is a hormone that the body needs to get glucose from the bloodstream into the cells.
The other 95 percent of people with diabetes have type 2, which can be controlled through diet and exercise. With type 2, which tends to affect overweight and obese people, the body doesn’t use insulin properly.
Those with prediabetes have blood sugar that is higher than normal but it’s not high enough yet to be diagnosed with diabetes.
“One out of three people have prediabetes,” said Amy Kimberlain, registered dietitian and certified diabetes educator for Baptist Health South Florida. “But nine of 10 people don’t know they have it.”
And those at risk of diabetes are getting younger and younger, said Matthew Naliborski, a registered dietitian and certified diabetes educator at Joe DiMaggio’s Children’s Hospital, part of Memorial Healthcare System. “We’re seeing type 2 diabetes patients as young as 7.”
For those who are overweight or obese, regardless of age, it becomes even more crucial to make changes in diet and activity level, said Dr. Clifford Medina, chief of internal medicine at Mount Sinai Medical Center. People who are oveweight “have a more increased risk of developing diabetes.”
Even a modest weight loss of 5 to 7 percent, in combination with exercise, “can lower the risk of diabetes by 58 percent,” said Kimberlain. “The goal is to exercise at least 150 minutes a week.”
Keeping the weight off is another challenge. For a healthier lifestyle, the challenge is fighting a yo-yo diet, said Naliborski, also a specialist in obesity weight management.
“One of the hardest parts is not just losing weight but preventing weight regain,” he said. “You have to be able to follow a diet that works for you permanently.”
But there is not a ‘one size fits all’ diet when it comes to patients with diabetes, said Torres-Negron. A healthy meal for someone with diabetes type 2 is “generally” the same as a healthy diet for anyone, that is, one that’s low in saturated fat, moderate in salt and sugar, lean protein, nonstarchy vegetables, whole grains, healthy fats and fruit, said Kimberlain.
“The biggest factor is portion control,” she said. “We overeat or tend to overeat. For some people it’s a real shock to find out what a serving size looks like. When people see that a serving of rice is a third of a cup, it looks like nothing,” Kimberlain said. “We’re not saying you can never have rice or pasta. But people with diabetes have to know how food affects them.”
Experts said this includes monitoring and working on an individual plan with a dietitian or doctor. In addition, one effective tool is the U.S. Department of Agriculture’s portion plate for a guideline. One half of the plate is for nonstarchy vegetables, one quarter is for grains and one quarter is for protein.
“Not all carbs are created equal,” said Jacquelyn Baldeon, registered dietitian and diabetes educator at Broward Health North. A piece of white bread and a piece of whole wheat bread both have 15 grams of carbohydrates, for instance, she said, “but how your body handles them is not the same.”
Fiber is “not just for digestion,” Kimberlain said, “but to keep blood sugar more stable and it helps us feel fuller longer.”
Carbs “can sometimes lead to rapid elevations of sugar in the blood,” Medina said. “They should be monitored closely when planning meals. Carbs really are everywhere. It’s about making sure you’re consuming a healthy amount spread out throughout the day.”
Carbs have their place, Kimberlain said. “They’re fuel for the body and you want to get the best fuel for you.”
A diet that’s too low in carbs isn’t healthy either, said Torres-Negron.
Another key to getting the right balance is to read nutrition labels.
“Sugar free does not mean carb free,” Baldeon said. “All sugar-free products still have carbs. Technically, if you eat sugar-free Jell-O, it’s a better option than regular Jell-O, but that doesn’t mean it’s a free food.”
She advised to be especially careful about the entire carbohydrate amount, fat, sodium and sugar contents.
“The goal is to lower the amount of added sugar you have per day, not just for someone for diabetes,” Kimberlain said. “Remember that the body doesn’t distinguish between honey and maple sugar and sugar. It’s still sugar.”
Juices have increased sugar and “no fiber at all,” she said. Smoothies can also be loaded with sugar.
“If I could shout it from the mountain top, I would,” Kimberlain said. “Eat or chew your vegetables.”
Choosing the right foods
Choose lean proteins: Eat chicken, turkey, fish or lean cuts of beef. Have at least two servings of fish a week, said Mount Sinai’s Medina.
Choose whole grains: Choices include whole wheat bread, quinoa, brown rice, rolled or steel cut oats.
Load up on nonstarchy vegetables: A rainbow of vegetables ensures you’re getting the most nutrients, said Baldeon, of Broward Health North. Spinach, kale, broccoli, collard greens, beets, cauliflower, bell peppers, Swiss chard and Brussels sprouts are nutritional stars.
Know your squashes: The summer squashes, like zucchini and crookneck squash, are nonstarchy vegetables. You can eat all you want, but watch your portion control for starchy winter squashes like acorn, butternut, pumpkin and spaghetti squash, said Baptist’s Kimberlain. Yucca and malanga are also starchy.
Watch your fruit intake: Fruits are healthy but are also a source of carbohydrates so consider the amount when planning your carb intake.
Avoid trans fats: These are found in margarine and a lot of baked goods.. A half-gram of trans fat indicates the presence of partially hydrogenated oil even if it’s not on the ingredients list. Snacks, cookies, icings and other desserts can be full of trans fats.
Avoid juices and sodas: One 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrates, about the same amount of carbohydrates as 10 teaspoons of sugar, according to the American Diabetes Association.
Baptist Health South Florida: “Take Control” is a free diabetes prevention program in Miami-Dade and Broward to address weight loss through eating better, being more physically active, and learning tools to reduce stress. The yearlong program (23 sessions) aims to help you reduce your risk of developing type 2 diabetes. Call 786-596-3812.
Cleveland Clinic offers three support groups: The Type 1 group meets at 4 p.m. every second Tuesday. The Type 2 evening support group meets at 4 p.m. every third Tuesday. And the Type 2 daytime group meets at 10 a.m. every fourth Tuesday. The groups meet at the Weston campus, 2950 Cleveland Clinic Blvd., in Jagelman Room 4.
Memorial Hospital Pembroke offers a free lecture series conducted in Spanish and English twice a month and cooking demonstrations twice a year. Classes are held at the hospital, 7800 Sheridan St. Register online at MHS.net or call 954-883-7513. Check MHS.net or Memorial’s calendar for a full listing of diabetes cooking classes.