DOCTOR'S VIEW ARCHIVE

Diabetes and the Holidays: Eating Well-- Elaine Magee, MPH, RD-- 11/19/03

By Elaine Magee
WebMD Live Events Transcript

The holidays are nearly here, but you're looking ahead with mixed feelings -- so much great food, but so many diet restrictions! Take heart; our own special needs diet guru, Elaine Magee, MPH, RD, served up recipe ideas and eating tips from her book, Tell Me What to Eat When I Have Diabetes, as part of our WebMD University: Take Charge of Your Diabetes.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this WebMD University course provided by GSK.

Member question: Down here in Louisiana, fried turkeys are a staple for Thanksgiving. They are fried in peanut oil. OK or not?

Magee: I just finished writing a cookbook about how not to fry, so I'm laughing at your question. I think it's fine for this once in a while, special occasion. Clearly the turkey is going to absorb some of the oil into the surface, but I think if you follow the directions and make sure the temperature is right, it's supposed to not absorb as much when you use the right temperature of oil.

In terms of peanut oil, I personally would suggest using canola, because of the vegetable oils it has the highest amount of omega-3 fatty acids and is one of the highest in monounsaturates, which are our two smart fats.

Member question: I've been taught that a carb is a carb and that I can eat pumpkin pie made with real sugar, but wouldn't it be a better choice to eat my regular dinner meal with allowed carbs and go for a sugar-free dessert? I'm so confused.

Magee: Great question, and I would say both techniques are appropriate. That's the good thing about counting carbs as a diabetic. First of all, the important thing is spreading out your carbs throughout your day and working with your dietitian to find a good amount for you at the various meals to control your personal blood sugars.

After that, the choice is yours, whether you want to use pumpkin pie carbs as part of your allowed carbs in the meal or to have a low-carb or no-carb dessert later on. I've never tasted a sugar-free pumpkin pie, but if it tastes satisfying to you, then that might be a great option.

I was just looking in my book, Tell Me What to Eat If I Have Diabetes, and the light Libby's pumpkin pie recipe contains 21 grams of carbs and 6 grams of fat and 170 calories for a pretty reasonably sized slice.

Member question: My husband was diagnosed with diabetes type 2 a couple of months ago. We are adjusting his portions and types of food throughout the day. At night, he always has a small bowl of ice cream. As long as his numbers are still in range, is this OK?

Magee: I would say yes. Important is the serving size and the amount of carbohydrate in that ice cream. My husband likes ice cream at the end of the night. He has either ice cream or yogurt, but he's a petite ice cream eater and has literally a quarter cup to half a cup of ice cream. The bottom line is how many carbs at that time of night your body can handle.

Interestingly enough, though, many type 2 diabetics are most insulin resistant in the morning, so what we choose for breakfast becomes vital.

Member question: The only way I can control my blood sugar is to reduce my carb intake to 30 or less a day, as prescribed by Dr. Richard K. Bernstein. Fats do not affect my blood sugar, and actually help to stabilize it. Why hasn't the ADA come to the table with these results?

Magee: Probably because a high-protein, low carb diet tends to increase the risk of kidney disease and diabetics are at a higher risk of kidney disease, plus there's a larger unbiased study on the high-protein, low-carb diet being conducted right now, and I think a lot of organizations are waiting for those results. When it comes to high protein, low carb, there are so many studies showing health benefits of the high-carb, low- to moderate-fat diet when people are making smart carbohydrate and smart fat choices. So there are results on both ends to report.

Let me also say the crucial problem with a low-carb diet for a diabetic is the fact that it is low fiber and that you aren't getting important antioxidants and phytochemicals that come to us from smart carbohydrate choices.

Member question: When talking about counting "carbs," are you really counting carbohydrate grams or something different?

Magee: You are counting carbohydrate grams. What I tell people in my book is I actually encourage them to count carbohydrate, fiber, and fat grams. Not that any of them are bad; it's really an important step to find the proper balance of the three for you, personally. In other words, you want to find out a good amount of carbs at a particular meal for you in partnership with a certain amount of fat grams, hopefully smarter fats, and fiber grams.

Fiber tends to help the body manage the carbohydrates better. So you want some fiber and you want some fat, but you have to figure out the right amount of fat and the right amount of carbs for you. There are exercises and forms in the book that help you become your own detective and help figure it out, because there is no right amount for all diabetics. Each diabetic is different.

If your blood lipids are normal, then many experts suggest you aim for 50% to 60% calories from carbohydrates, which, for a 1,600 calorie-a-day woman, would be 200 to 240 grams of carbs for the day. And if you have high triglyceride levels and high LDL (low-density lipoprotein cholesterol) you may benefit from including more monounsaturated fats (like olive and canola oil and avocados) -- up to 35% calories from fat and 45% to 50% calories from carbohydrates.

Keep in mind that type 2 diabetics are at four times the risk of heart disease. That's why you cannot write a book about type 2 diabetes without considering important diet suggestions for reducing the risk of heart disease.

Member question: So is counting carbs just like doing the Weight Watchers point system?

Magee: Not exactly. I suggest that people figure out the amount of meals per day that works for them, based on eating when you're hungry and stopping when you're comfortable. Make that your holiday mantra. You have to figure out, given your exercise and work schedule, how many meals that ends up being, and then work closely with a professional to help you, based on your particular medications, which need to be considered, what the carbohydrate prescription might be. Then you have to play on the fiber and fat grams.

Here's the good part: Once you figure out what meals work for you at certain times of day, you don't have to be as diligent at counting, because you know that that amount of food and type of food produces normal blood sugars for you. Once you figure it out, you get freedom from the counting.

It's fun for me to add that I'm making sure any recipe I do now for my books and my column include Weight Watcher points. I'm getting really good at that slide rule.

Member question: I've noticed that my glucose level shoots way up after eating something I know I shouldn't have eaten (like apple pie). So for Thanksgiving I'm concerned that I will have that "once in a while" slice of pie, etc. What is considered a normal glucose range for a non-diabetic within the first two hours after eating something like this? And what about diabetics? I know the rule of thumb is to take a reading no sooner than two hours after eating, but I'm wondering what the immediate effect of carbs, sugars, etc. is on non-diabetics.

Magee: Well, that's a very sophisticated question. There's a lot of individual fluctuation, even for non-diabetics, on how each body processes a meal and how fast the carbohydrate hits the blood. It's also based on the other things in the meal and the size of the meal for non-diabetics, as well.

Fat in a meal, for example, slows down the movement of food from the stomach to the small intestines, where carbohydrates are then absorbed. The larger the meal size, the longer it stays in the stomach, which is why we are so uncomfortable for several hours after we eat such a large meal.

In terms of your apple pie concern, it would be important for you to compensate for those carbs with other foods you might be eating close to it; in other words, skip the mashed potatoes if you're going to have the pie, and really try to have a sliver and not a huge wedge. Portion is power. You might want to have a sliver shortly after dinner and then a sliver the next morning. Spread it out.

It would also help if the person making the apple pie used less sugar in the filling. I do it and nobody ever notices.

Member question: Do you have a light recipe for stuffing?

Magee: I have a cornbread dressing in the Tell Me What to Eat If I Have Diabetes book, and let me tell you the before and after numbers: It went from 415 calories in the original recipe to 209, from 33 grams of fat to 6.5; and the carbohydrates in a serving of the light cornbread stuffing is 30. Those are pretty generous servings.

Basically what I did was sauté the onions and celery in 1 tablespoon of canola oil and then proceeded with the cornbread and regular bread. This recipe calls for both. And added the chicken broth to moisten it. It produces a very nice cornbread dressing. You can use the same technique with the non-cornbread stuffing. You're basically adding more chicken broth to moisten, rather than a stick or two of butter. You're keeping the fat down to 1 to 2 tablespoons. I try to estimate a teaspoon of fat per serving.

In this case I was able to make 10 servings, and I used less oil because I'm using cornbread, and that is also going to contribute some fat, but in a non-cornbread stuffing you can estimate approximately a teaspoon of fat per serving and you won't get in trouble that way.

Another stuffing tip for diabetics is to use a whole-grain or whole-wheat bread for the stuffing. It gives it a nice color contrast visually, and the added fiber is going to help your body handle some of those carbs a little bit better.

Member question: Where do I get your book?

Magee: Many of the major book chains carry it, but I would urge you to call ahead and make sure they have a copy for you, or you can order it at amazon.com or any of the Internet bookstores. It's a revised edition of the book, which has happily sold very well. There is a Spanish translation available, too.

Member question: Couldn't you raise insulin dosage to eat more for this special occasion?

Magee: Yes. I am not qualified to help you do that, since I am not a certified diabetes educator, but I would encourage anyone who is interested to speak with your dietitian or doctor so you know what to do. Depending on the diabetic, you could be more sensitive to a reaction to the higher amount and you'd want to get that information from your doctor to know exactly how to do that. You have to be more careful to avoid low blood sugar, and some type 2s have low blood sugars and others rarely do. So again, it's individual.

Member question: With Thanksgiving around the corner, what should my plate have on it? I was just diagnosed with type 2 in September 2003. I'm still learning and experimenting.

Magee: The good news is that there's never been a better time to be diagnosed as a diabetic. We are closer to a cure and there are better testing tools and more products. So hang in there.

On your plate it's really up to you because I would not tell anyone to deprive themselves of favorite foods. You would, in general, want a nice balance of vegetables and grains and turkey. The important issue is going to be choosing your carbs carefully. In other words, if you don't care about the roll, skip the roll. If you're looking forward to the mashed potatoes and gravy, make that part of your carbohydrate allowance.

For example, there's a recipe for light green bean casserole in the book. One serving only has 13 grams of carbs. So that would be one to definitely enjoy. It will give you some fiber and 115 calories. The light hash brown casserole has 24 grams of carb.

So it's really about choosing what you want, finding out what are your favorites and planning that in, making sure you've got some fiber, and getting those veggies and meat to balance it out. Only eat until you're comfortable. The size of the meal can put you over.

Member question: Can't I just exercise more if I MUST have the roll and the mashed potatoes?

Magee: Yes, yes, and yes. I'm so glad you brought that up, because exercise acts like insulin in our bodies. During the holidays, I cannot stress enough how important it is to exercise. Exercise, exercise, exercise and monitor, monitor, monitor, now more than ever, because everything we do during the holidays goes against what we're supposed to do as type 2 diabetics.

Member question: How do we know if we have a "smart" dietitian? Mine seems questionable, but my doctor thinks she is great. What do we look for?

Magee: It's ideal to work with a dietitian who has a CDE after his or her name. This means that they're a certified diabetes educator. I am personally not one, because I write books on many subjects, and it is quite a rigorous training process. If I personally needed to go, I would find a CDE because they are specifically trained on this. That would be ideal.

Beyond that, I would get a really good book that you trust and see how well the dietitian matches the guidelines in that book. For example, I wrote my book to help a type 2 diabetic gather information and tools so that they can be a more informed patient who then works with their doctor or dietitian on fine-tuning their personal diet prescription. My book is not meant to stand alone; it is meant to be a tool to help.

I tried to write the book so as not to lecture, but to hold the hand of the type 2 diabetic and slowly walk them through the process in a caring and loving way. My father was a type 2, and I wrote the book as if I was helping him personally. So I think there's a loving voice in the book, which I probably am most proud of.

Moderator: Here's a follow-up to the earlier response to what to put on your Thanksgiving plate:

Moderator: Can you give us some final survival tips for the rest of the year, Elaine?

Magee: Let me start off by reminding ourselves that the recent jump in diabetes in the U.S. is fueled mostly by two things: eating more and moving less. Largely this has what has gotten us into trouble. We need to do the opposite, particularly during the holidays, which is eat less and move more. We talked about the importance of exercising during the holidays because it helps keep blood sugar levels down by decreasing insulin levels. Try to get 30 minutes of exercise on most or all the days of the week. You can do it!

  • Get your daily dose of fiber, 20 to 35 grams a day. When you have sugary foods, substitute them for other carb sources in your meal plan.
  • Stuff the turkey, not yourself. Make this your holiday mantra; eat when you are hungry, stop when you're comfortable. Notice I didn't say full. If you do this, you will end up eating approximately every three hours. So you don't have to miss out on a particular food. Just put it away for later.
  • No seconds. I repeat, step away from the table after the first plate. Most hosts will not mind if you make yourself a plate instead of having seconds to take home with you, and you can look forward to having that second meal at home.
  • Keep in mind the total amount of carbohydrates that you eat is more important than the foods they come from, generally speaking. So you can have what you want; you just have to make allowances for it, like trading the mashed potatoes or roll in order to have the pie later.
  • Offer to do the shopping or the cooking of some of your favorite foods so that you can lighten them or boost the fiber, and you'll know what the nutrient content is, as well.
  • Beware of beverages. During the holidays, we get into fancy drinks, and these drinks can add up quickly with calories from sugar, fat, or alcohol, or all of the above.

I also wanted to let you know about my flaxseed cookbook, called The Flax Cookbook. It's the only cookbook available using ground flaxseed. It makes for a fun gift for Christmas with a package of flaxseed to get people started. Flaxseed is particularly powerful for type 2 diabetics because it contains fiber, omega-3 fatty acids, and phytochemicals.

Moderator: Thanks to WebMD's own special needs diet expert, Elaine Magee, MPH, RD, for being our "Take Charge of Your Diabetes" WebMD University instructor for this discussion. For more information, pick up a copy of her book, Tell Me What to Eat When I Have Diabetes, or The Diabetes Sourcebook, by our course leader, Richard Guthrie, MD.



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