Diabetes is on the rise. Approximately three million Canadians are diagnosed in 2010. Ninety per cent of those cases are type 2 diabetes, a chronic disease marked by high levels of glucose in the blood because the pancreas doesn’t produce enough insulin or because the body becomes resistant to insulin. This can result in harmful consequences for several major organs, including the kidneys, eyes, heart and blood vessels. It is important to control the level of blood sugar to avoid these potential problems.
It is believed that most diabetics (80 to 90 per cent) are also overweight or obese. This makes it more difficult to control blood sugar and requires a higher dose of medication to achieve an acceptable level. The good news is that improving your lifestyle can help control and even prevent diabetes, or at least delay the onset of the disease. A major study found that those most at risk of developing type 2 diabetes could reduce their risk by 58 per cent through moderate activity for at least 30 minutes a day and losing five to seven per cent of their body weight. The risk was reduced by 71 per cent for people over 60. It is encouraging that preventing type 2 diabetes also has many benefits for global health by reducing the rate of cardiovascular disease, kidney failure, blindness and premature death.
Can you be just a little bit diabetic?
A diabetes diagnosis is made when a person’s body can no longer control blood sugar. So, no, a person cannot be just a little bit diabetic, although sometimes no symptoms are present in day-to-day life, which explains why many people are unaware of their condition. The problem is that complications will develop over time if the diabetes is not treated. Eating well and being active every day are both integral parts in the treatment of diabetes, just like weight control, taking medication prescribed by a doctor and checking blood sugar daily.
Dietician Isabelle Galibois, a Laval University professor and researcher specializing in diabetes, explains: “When diabetes becomes a part of our daily life, one thing is for certain: the key to successful eating requires knowledge of the role that food plays in our body and by identifying different sources of carbohydrates on the menu. We know that elevated blood sugar after a meal is directly related to the amount of carbs consumed during the meal. Many foods which do not taste sweet contain significant amounts of carbs, including pasta, rice, potatoes, milk and legumes. People need to be able to recognize them when they read a label, visit friends or eat out. ”
What people think about sugar has also changed significantly. “Even in the early 1990s, it was common for doctors to put diabetics on a diet without concentrated sugar, meaning no white sugar, brown sugar, honey, syrup, jam, etc. This is no longer the case since we recognize that these foods do not have as much of an effect on blood sugar as other sources of carbohydrates. Diabetics can therefore consume sweets in moderation,” says Isabelle Galibois. “The terminology has even evolved. You hear less talk about a diabetic diet and more about a diet plan for diabetics. So there is a better understanding that this is not about a life-long diet but more about making better daily food choices that fit each person’s situation. This is much less demoralizing!”
Living with diabetes does not stop you from baking muffins with sugar or brown sugar, or putting some syrup on your pancakes. “A carbohydrate 'budget' has to be made for each meal and, as needed, for each snack,” Galibois explains. According to each person’s preference, the amount can be counted in grams, in number of choices or one choice equals 15 grams of carbohydrates. Some people still use a sugar cube chart (1 cube = 5 grams of carbohydrates). However, this method is becoming less and less used now that the nutrition facts on packaging list the amount of carbohydrates by gram.
Food and advice to better control your blood sugar
There is not one diet for all diabetics and the suggestions presented here should not replace a consultation with a dietician-nutritionist who can help you establish a diet plan tailored to your needs.
- Eat three meals a day at regular times. A hearty breakfast high in protein (milk, eggs, ham, yogurt, cottage cheese, soy milk) gives you a great start to the day and helps control weight.
- Never skip a meal. Eat a nutritious snack if necessary.
- Take the time to enjoy your food by chewing longer and eating more slowly. Watch your portion sizes, put your cutlery down after a few bites and stop eating before you feel full.
- Make it a priority to eat food rich in soluble fibre, like legumes, fruits and vegetables, whole grain products, nuts and seeds. The precious fibre they contain acts like a sieve by slowing down the absorption of sugar in the blood. You also have to chew these foods longer which helps reduce the amount eaten per meal. This can assist you in your quest for a healthy weight.
- Emphasize vegetables and start your meal with a salad or vegetable potage or soup. Make sure you have at least two vegetables with your main course. Snack on raw vegetables to appease your hunger between meals.
- Serve pasta as a side dish with meat, poultry or fish instead of as the main course.
- Quench your thirst by drinking water regularly. Soft drinks play a significant role in weight gain and poor control of diabetes.
- Don’t eat too much chocolate or foods sweetened with sugar alcohol. In addition to containing lots of calories, these foods can cause intestinal discomfort like gas, bloating and diarrhea, even when consumed in small quantities.
- Limit your intake of sweet treats that contain little nutritional value as they are often loaded with saturated fat and calories. These include doughnuts, cookies, cake, pies, candy and sweets (jam, sugar, honey, syrup, caramel, etc.). If you do partake, have a smaller portion.
Recommandations that apply to everyone
We receive lots of mail from diabetics – or who people live with a diabetic – looking for recipes that fit their situation. I spoke with Réjeanne Gougeon, associate professor at the McGill Nutrition and Food Science Centre. She was part of expert committee that came up with the 2008 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada by the Canadian Diabetes Foundation. She told me that the diet regime of diabetics is no different than for others. “Diabetics should follow the same healthy eating principles that are recommended for everyone,” she said. In other words:
- Eat a variety of nutritious food
- Include more fruits and vegetables and opt for whole-grain cereals and breads
- Select reduced-fat dairy products, lean meats and food prepared with little or no fat
- Eat two fish servings each week
- Reach and maintain a healthy weight through regular physical activity and by eating well
- Limit the consumption of food and drinks high in calories, fat, sugar or salt (sodium).
Different ways to reduce sugar and calories
In your drinks
- Addicted to sugar in your coffee or tea? Sucralose or aspartame can help you get your fix if you like the taste. Or replace that spoonful of white sugar with a smaller amount of fructose, a natural sugar that is sweeter while having little effect on blood sugar.
- Have an urge for chocolate milk? Make a half-and-half with 1% milk or skim milk.
- An iced tea fan? A single can contains more than seven teaspoons of sugar! Try the diet version or make your own and sweeten it with some honey or fruit juice. Add fresh mint, ice, cranberries or slices of citrus for flavour.
- Do you like bubbles? Add a bit of fruit juice to some sparkling water or occasionally drink a diet pop. Beware: some drinks (ex. tonic water, bitter lemon) are as sweet as pop. Check the nutrition facts on the label!
- What about happy hour? Avoid piña coladas and other sweet cocktails; opt instead for a glass of dry white, red or rosé wine, a small margarita, or even a light or low-carb beer. You can make half a beer a full glass by adding sugar-free ginger ale or tomato juice.
In your snacks
- A soft oatmeal-raisin cookie instead of a homemade Rice Krispies square contains 10 grams less of sugar and more fibre.
- Unsweetened apple sauce instead of fruit-flavoured gelatine will save you 11 grams of sugar and fill 30 per cent of your daily vitamin C requirement.
- A bunch of 15 grapes instead of a grape punch juice box will save you 15 grams of sugar and lengthen digestion time thanks to the fibre it contains.
- A peanut butter sandwich instead of a chocolate bar with peanuts contains 25 fewer grams of sugar, will save you 100 calories and, at the same time, provide you with more fibre and protein.
And what about alcohol?
According to the 2008 Clinical Practice Guidelines for the Prevention and Treatment of Diabetes in Canada, people with diabetes should follow the same recommendations regarding alcohol consumption as the general population. For women, this means one standard drink a day for a maximum of nine drinks per week. For men, two standard drinks a day are allowed for a maximum of 14 drinks per week. A standard drink means one bottle of beer (341 ml or 12 oz), a small glass of fortified wine like sherry or port (85 ml or 3 oz), a glass of spirits (43 ml or 1.5 oz), or a glass of table wine (150 ml or 5 oz). In addition to increasing the level of inebriation, drinking on an empty stomach can also increase the rate of blood sugar. It is important to accompany alcohol with food intake to both reduce the speed of alcohol absorption and to provide carbohydrates that can counteract the risk of hypoglycaemia. This advice is especially relevant for people who take oral medication of insulin.
And to conclude...
For specialist Réjeanne Gougeon, a diabetic person’s diet is not just numbers and calculations. It’s the perfect excuse to take better care of yourself by doing more fun physical activities and making smarter food choices. “You put the emphasis on quality rather than quantity. You eat bread, you eat good bread. You drink a glass of wine, you drink the good stuff!” she adds philosophically. After all, you only have one life to live.
- Diabetes for Canadians, For Dummies, 2nd edition, 2009, 408 pages.
- Canada’s 150 Best Diabetes Desserts, by Barbara Selley, Robert Rose, 2008, 256 pages.
- Diabetes Comfort Food, by Johanna Burkhard, Robert Rose, 2006, 288 pages.
- The Best Diabetes Slow Cooker Recipes, by Judith Finlayson, Robert Rose, 2007, in association with the Canadian Diabetes Association, 256 pages.