There was a time when a diagnosis of diabetes meant a patient’s favorite dishes were expected to disappear from the plate. But a better understanding of the disease and how our bodies metabolize different foods has led to an improved, and more relaxed, outlook for a diabetic’s diet.
“It all goes so much more deeply than counting calories and carbs,” says Lois Exelbert, director of the Diabetes Care Center at Baptist Hospital. “We used to think that every calorie was created equal, but that’s not true, and the manner in which we metabolize isn’t equal, either.”
In a world where sugary sodas are a staple and desserts a regular temptation, eating correctly can be a daily struggle. This is especially true for diabetics, who must monitor their blood sugar levels with vigilance. And yet, certified diabetes educators insist that a little practice and the right attitude can go a long way.
“What we teach is a healthy lifestyle instead of a diet,” explains Sonia Angel, coordinator of the Diabetes and Nutrition Center at Memorial Regional Hospital. “Diets don’t work. They are temporary, but diabetes is for life.”
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In other words, you can still whip up — and eat — delicious, homemade food as long as you know the basics of proper meal planning, eat a variety of foods and practice self-restraint. In fact, these dietary tenets are beneficial for everyone, regardless of diagnosis or condition.
Diabetic patients now focus on how many totals grams of carbohydrates they can eat throughout the day while still keeping their blood glucose under control. This is important because good management of blood sugar levels in diabetes can reduce complications.
More than 29 million people in the U.S. have diabetes, according to a report released earlier this year by the Centers for Disease Control and Prevention. That’s up from 26 million in 2010. Even more disturbing, one in four of them don’t know they have it.
Another 86 million — or one in three Americans — are pre-diabetic, which means their blood sugar levels are above normal but not quite high enough to classify as diabetic. Without proper nutrition, weight loss and physical activity, about 15 to 30 percent of those will develop Type2 diabetes within five years.
Type2 diabetes used to be termed adult-onset diabetes because the majority of new cases were diagnosed among people 45 to 64. (The risk of developing Type2 increases with age.) But the demographics of the disease have been changing. About 5,000 people 20 and younger are now diagnosed annually. In 2012 alone, about 370,000 new cases were diagnosed among the 20-to-44 set.
Medical care and lost wages related to diabetes cost an estimated $245 billion, so prevention and management of the disease have never been more important. If it goes untreated, diabetes can cause blindness. Over time, it can also result in amputations because circulation to the limbs is reduced. What’s more, the likelihood of developing heart disease quadruples for people with diabetes.
Despite these alarming numbers, health experts say there’s plenty you can do to manage — and even prevent — the disease. Proper nutrition, along with exercise, weight loss and regular medical care, are the cornerstones to a better life with diabetes. A person with diabetes should think about his food intake in this way:
“Variety, balance and moderation,” said Amy Kimberlain, a registered dietitian with the Diabetes Research Institute at the University of Miami Miller School of Medicine. “Portion control is essential, and I can’t say it enough."
An easy-to-follow rule of thumb: one-fourth of a medium-sized plate should be devoted to a starch, another one-fourth of the plate to a lean protein and the remaining half to vegetables.
Diabetes educators cringe at processed foods, sodas and juices. They also suggest checking food labels, monitoring carbs and looking for stealth ingredients that can spike blood glucose.
“Watch out for hidden sugars,” warns South Miami Hospital executive chef Richard Plasencia. “People don’t realize how much sugar some things like a dressing may have.”
Plasencia, who was raised on Cuban foods, adds that it is possible to adapt long-held habits. He has made it a point of making Latin food healthier by changing cooking methods, such as baking plantains instead of frying, and using brown rice or quinoa instead of white rice. Being able to transform ethnic dishes is particularly important because there is a higher incidence of diabetes among Hispanics and African Americans.
Diabetes educators acknowledge that banning certain dishes seems to make people crave them more. In addition to substituting, they also suggest small splurges, balancing carbs and testing a couple of hours after a meal to see how certain foods have affected blood sugar levels.
Kimberlain says that carb counting “allows for an indulgence every once in a while. There are ways to work something special into the total carb intake.”
Angel, from Memorial Regional, says the balancing act is particularly important during the holidays. “It’s OK to eat pumpkin pie, but limit yourself to a tiny piece and don’t go for the mashed potatoes.”
But managing diabetes is not just about watching what you eat. It’s also about knowing what your blood sugar levels are at different times of the day, particularly before and after meals. If you’re trying a different type of meal, dietitians suggest testing yourself about two hours after a meal to determine how blood sugar levels were affected.
For Reynol Rodriguez, 48, this was an important lesson. He admits he hasn’t always been diligent about managing it.
“I eat the typical Cuban diet, lots of rice and beans, especially rice,” says the road maintenance supervisor, with a rueful laugh. “But I know I can work around that.”
Earlier this month, he attended a class led by Kimberlain at UM. What he heard — about portion control, balance and variety — was uplifting. “I’m feeling more confident now that I can do this,” he says. “They explain things in layman’s terms.” He plans to eat less, lose more weight and switch to healthier alternatives.
Replacing high-glycemic foods — foods that raise blood glucose — with low-GI substitutes can help tremendously. High GI foods include white bread, white rice, pasta, Russet potatoes, even melons and pineapple. But white rice, for instance, can be replaced with brown rice or, better yet, quinoa. White bread replaced with stone-ground whole wheat or pumpernickel bread, and regular pasta switched with whole wheat pasta.
Balancing also comes into play in this way: If you’re indulging in a high-GI food, combine it with a low-GI food. Ultimately, however, carb counting is still king. No one single diet or meal plan works for everyone, and research has consistently shown that the type of carb and the amount consumed affect blood glucose levels.
Exelbert, from Baptist, is a fan of trying new things to learn how a patient may react to a certain food. “Experiment,” she says. “Eat a certain meal, and then measure [glucose levels] two hours later to see if it’s below 140. You might be pleasantly surprised.”
And when shifting eating gears, do so slowly.
“Make the change gradually when you begin substituting,” Angel adds. “It’s easier than going cold turkey, and you won’t feel deprived.”
How to eat right
▪ Eat lean protein. Cut the visible fat from your meats. Roast on a rack to let the fat drip off. Make soups a day ahead so you can chill them and remove the fat that has risen to the top.
▪ Exercise portion control: 1/2 of a medium plate should consist of vegetables, 1/4 of lean protein, 1/4 of starch.
▪ Reduce sodium intake, which can help with high blood pressure, a condition often found in diabetics.
▪ Choose the right fats. Limit trans fat and saturated fat found in processed snacks, baked goods, high fat dairy products and high-fat meats.
▪ Practice a healthy cooking method, such as broiling, microwaving, baking, roasting, steaming or grilling foods. Avoid frying foods in lots of oil, lard or butter.
▪ Stick to homemade and fresh. Restaurant foods, as well as packaged foods, tend to be high in calories, unhealthy fats and sodium.
▪ Experiment with herbs and spices to punch up your meals. Use onion and garlic on meats and vegetables, salt-free lemon pepper or mesquite seasoning on chicken, fresh lemon juice or lime on broiled fish, steamed vegetables, salads, pasta or brown rice. Marinate meats.
▪ Switch to low-fat dairy.
▪ Skimp on sugar. Most recipes will still be tasty even when sugar is decreased by 30 to 50 percent.
▪ Exercise will keep the pounds off, as well as control your blood sugar level.
▪ Know your blood-sugar level. When trying different dishes, test yourself two hours after eating.
▪ Take medication as prescribed and follow your doctor’s orders.
▪ Consult with a certified diabetes educator. Join a support group and attend the free classes offered at area hospitals.
Get rid of the bad, substitute the good
Substitute ground turkey breast for ground beef.
Substitute nonfat plain yogurt for sour cream.
Substitute butter, shortening or oil with half applesauce. Use olive oil or canola spray.
Substitute 1 percent or skim milk or reduced fat cheese for whole milk dairy products.
Substitute whole wheat for flour, bread and pasta.
Substitute brown rice or quinoa for white rice.
For more information, visit:
http://www.foodnetwork.com/topics/diabetic.html# (For recipes)
Rosemary Grilled Pork Tenderloin with Black Bean Quinoa and Broccolini
This recipe is adapted from South Miami Hospital Executive Chef Richard Plasencia
1 cup quinoa
2 (8-ounce) pork tenderloins
2 sprigs rosemary
Salt and pepper to taste
2 plum tomatoes, seeded and diced
1 avocado, seeded and diced
2 tablespoons olive oil, divided
2 tablespoons red pepper, diced
2 tablespoons green pepper, diced
2 tablespoons red onion, diced
1 tablespoon garlic, diced
1/3 cup low-sodium black beans
4 cups broccolini, stems trimmed slightly
2 tablespoons sherry vinegar
Salt and pepper to taste
Boil 1 1/2 cups of water and pour it over the quinoa blend, wrap tightly with plastic wrap and set aside.
Preheat oven to 350 degrees. Rub pork tenderloins with rosemary, salt and pepper.
In an ovenproof sauté pan over medium to high heat, sear the tenderloins on all sides and then finish them in the preheated oven for 10 to 14 minutes, or until the temperature registers 145 degrees on an instant-read thermometer.
While the pork is cooking, mix tomatoes and avocado together. Drizzle with 1 tablespoon olive oil and salt and pepper. Set aside.
In a sauté pan over medium heat, heat remaining olive oil and sauté peppers, onions and garlic for about 3-4 minutes. Add the quinoa and black beans. Heat through until only a small amount of moisture is left.
In a sauce pan, bring water to a boil, add broccolini and remove after 3-4 minutes, until just aldente.
To plate, place broccolini on half of the plate, quinoa mixture on a quarter of the plate, and pork tenderloin on the remaining quarter of the plate. Top tenderloin with the tomato avocado mixture and a splash of sherry vinegar.
Per serving: 555 calories, 14 g fat (3 g saturated fat), 76 mg cholesterol, 45 g protein, 66 g carbohydrate, 6 g sugar, 13 g fiber, 586 mg sodium.