Diabetes: What Can I Eat? -- with Elaine Magee, MPH, RD


WebMD Live Events Transcript; Event Date: Thursday, October 14, 2004

By Elaine Magee, MPH, RD
WebMD Weight Loss Clinic - Live Events Transcript

Fall is here, and for many people that means it's eating season, but there are so many diet restrictions! Take heart; our own special needs diet guru, Elaine Magee, MPH, RD, joined us on Oct. 14, 2004, to serve up recipe ideas and eating tips from her books, Tell Me What to Eat If I Have Diabetes and The Good News Eating Plan for Type II Diabetes.

If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Support for this University course is provided by Medical Mutual.

MEMBER QUESTION:
Elaine, I feel so angry about having this condition. I'm so resistant to change and refuse to adopt a new diet. Please help.

MAGEE:
I understand the anger. I worked closely with my father, who had type 2 diabetes, for almost 20 years before he passed away. But if I could offer you some encouragement, the better you manage your diabetes, the better you will physically feel and the longer it will be until you have complications, if at all.

So there is a big payoff to understanding diabetes and managing it for yourself. If I could recommend my book: Tell Me What to Eat if I Have Diabetes. It's a quick read, and it really does not lecture you, but holds your hand and gently guides them through the information with understanding and compassion.

To give you a bottom line, though, today experts agree that the best way to manage type 2 diabetes and to protect against developing it is a healthy diet with:

  • Whole grains
  • Fruits
  • Vegetables
  • Omega-3 fatty acids (from fish and certain plant foods)
  • Plus regular physical activity

In the book there are 10 food steps to freedom and chapters on following those 10 steps in the kitchen, in the supermarket, in restaurants and fast food places. Plus a beginning section to answer your questions about the medical aspect of diabetes and the dietary end of it, as well.

MEMBER QUESTION:
Can you help me learn to control my incredible craving for sweets?

MAGEE:
I have sweet cravings, too...for chocolate. My advice is to kind of roll with your craving instead of resisting it, but the key is to have a sample of the craved food, not to overeat it.

That's the part people have problems with. I've found, for people who don't have disordered eating, for example, that they really can give themselves a sample of a treat and be done with it. Fun size candy bars come in handy for this. Your goal is to be in a place where you can take a fun size Hershey's from the freezer and enjoy it piece by piece and then move on.

Once you tell yourself you can't have the treat, it generally only makes you want it more. Another key to keeping cravings at bay is to avoid being overly hungry. Also, avoiding caffeine helps some people. When they're in that sort of over stimulant caffeine rush, I've found some people end up craving things after that.

So, if you eat a healthy diet, eating when you're hungry, stopping when you're comfortable, mostly choosing healthy foods, whole grains, fruits, veggies, beans, lean meats, low fat dairy, there's no reason why someone with diabetes can't enjoy a reasonably-sized treat.

The key is to keep them reasonably-sized and not to overeat them, and it's best for people with diabetes to enjoy a treat or dessert along with part of a meal, so that the other healthy aspects of that meal, like fiber, and some healthy fats, can temper the effect the sugar may have on their blood sugars later.

The other key is to help compensate for the carbohydrate grams in a treat by decreasing the carbohydrate in the meal. For example, passing up the bread, knowing you're going to have some carbohydrate in your dessert a little later.

MEMBER QUESTION:
When eating a fruit should I also be eating a carbohydrate such as crackers or bread?

MAGEE:
Generally, for people with diabetes, they find success in managing their blood sugars when they keep close track of their grams of carbohydrate, grams of fat, and grams of fiber eaten throughout the day.

The reason you're keeping track of fiber is because fiber helps your body manage the carbohydrate, so it's a good thing. And fat grams, because a reasonable amount of better fats also help your body manage carbohydrates from food. What you're trained to do is find the ideal combination in a particular meal that works for you personally in controlling your blood sugar.

So what you're trying to do is count the grams of carbohydrate from the fruit, like you would any food item that you're eating. Now there are certain fruits that have a higher glycemic index than others, but even still, they're really not too frightening at all.

I'm going to list off the glycemic load, which is a more accurate way to measure the effect of a food on your resultant blood sugar. And you generally want to keep your glycemic load less than 15.

  • Apples have 8
  • Apricots 7
  • Cherries 4
  • Grapefruit 4
  • Grapes 11
  • Kiwi 7
  • Orange 7
  • Peaches 6
  • Pears 6
  • Pineapple is a 10
  • Plums 4
  • Cantaloupe 6
  • Strawberries 1
  • Watermelon 6

The only fruit that got over 15 that's not dried that's on my list is bananas, which is an 18. Dried dates have a glycemic load of 58; dried figs 22; raisins 28.

So you can see that for most fruits, in reasonable amounts, there's no reason why they should be considered off limits to somebody with diabetes. I would encourage everyone, though, if eating a fruit as a snack, to try to balance it with a little bit of protein and healthy fats, just so it's a more satisfying snack, like a tablespoon of nut butter or a couple tablespoons of nuts or a slice of reduced fat cheese or four ounces of low fat yogurt.

It just makes the snack last longer, metabolically speaking. This reminds me of a situation that happened with my dad, who had diabetes. He called me one afternoon and said, "Gosh, I was really confused driving home from the grocery store. I forgot the way home, I felt funny." I immediately asked "What did you eat a couple of hours before that for lunch?"

He described a reasonable lunch and mentioned watermelon. I said, "How much did you have?" He said, "Oh, I had one." I said, "One slice?" He said, "No, one watermelon." Well, no wonder his blood sugar went through the roof. Watermelon does have a reasonably fine glucose load, but that's with a reasonable serving.

If you eat too much of almost anything, you put your blood glucose at risk. It wasn't the watermelon, per se, but the amount of watermelon that he ate that caused him trouble.

MEMBER QUESTION:
How can a beer or two affect your sugar?

MAGEE:
You have to count the carbohydrates in your beer towards your ideal number that works for you. Keep in mind that your best choices are going to be light beers, in terms of number of carbohydrate.

  • Coors Lite has 5 carbohydrate grams per 12 ounce
  • Miller Lite has 3.2 grams of carbohydrate, and about 100 calories per 12 ounces

Some people with diabetes report that a little bit of wine or beer actually seems to help their blood sugar, but the key is one. One glass of wine; one bottle of beer. You can overdo alcohol, just as you can overdo watermelon.

Now, a dry white wine has about 2 grams of carbohydrate in a one-cup serving, but the calories are still going to count toward trying to maintain or lose weight. So it's still something you want to enjoy with caution.

Just to give you a little more information about mixed drinks:

  • A 7 ounce Screwdriver has 18 grams of carbohydrate and 175 calories
  • 1/8th cup of liqueur has 13 grams of carbohydrate and 106 calories

So just keep that in mind when walking the alcohol minefield.

MEMBER QUESTION:
Do you recommend frozen vegetables in your recipes, canned, or veggie juices?

MAGEE:
I personally would rather eat frozen vegetables that were frozen when ripe, than to cook with marginal produce that's fresh. I almost never call for canned vegetables, because I find it completely unappealing.

If I'm lightening a recipe that calls for canned corn, I will always use frozen in my light version. Some of my frozen favorites are frozen chopped spinach, frozen edamame, frozen corn, frozen okra, frozen peas, and frozen green beans. I also like the convenience of frozen, because you can just have them handy and you use what you need and put the rest back in the freezer without spoiling. That's the one technique that gets me through winter -- using the freezer.

MEMBER QUESTION:
Could you please advise where a Canadian could purchase your book?

MAGEE:
Probably the best and most painless way to get the book is over www.amazon.com. Type in the name of the book -- Tell Me What to Eat if I Have Diabetes -- and it will still be delivered to your doorstep, albeit Canada. And thanks for asking.

MEMBER QUESTION:
How does sugar alcohol affect a person?

MAGEE:
It can affect a person strongly in the intestinal region if they have more than a serving, and if that person has a particularly sensitive intestinal constitution, the trick is staying with the serving size on the label.


"The holidays are and can be a difficult time for people with medical issues...[but] you can still enjoy those holiday desserts!"

Keep in mind, too, if you're trying to lose or maintain weight, that many of these no sugar chocolates and candies still have calories. It's not that they can't be useful, it's just that you have to keep that in mind. The no sugar chocolates from Hershey's taste really pretty good, which is why I caution you about the serving size.

MEMBER QUESTION:
Is it still accurate to consider that one serving of carbohydrates, or about 15 grams, will raise your blood sugar roughly 50 points, and also that the foods higher on the glycemic index will raise the blood sugar faster?

MAGEE:
The thing to consider about the glycemic index is that that is the measure of 50 grams of that food without anything else being eaten at the same time.

So in reality we're really eating a mixture of foods with different glycemic indexes, so the true result can only be really measured on yourself by measuring your blood sugar an hour or two after a meal. All types of things influence how the carbohydrates are absorbed and how quickly.

For example, with pasta, slightly undercooking pasta will give it a lower glycemic index. Processing grains into smaller particles will increase the speed with which it is absorbed. To answer your question, though, generally foods with the higher glycemic indexes do tend to raise your blood sugar higher than a food lower on the glycemic index would.

But keep in mind this is just that one food and it's a 50 gram serving. So if you consider a reasonable serving size which may not be 50 grams, depending on the food, that's when you start talking about glycemic load, which is a more accurate measure. And I really wouldn't use 15 grams as my serving because that just varies greatly, depending on the food.

Generally for a meal some people with diabetes stick to 50 grams of carbohydrate in a meal, which leads me to an important point, and that is the importance of each person with diabetes being their own detective. There are great individual differences in blood sugars as a result of food.

The more you take control by writing down your grams of carb, grams of fat, grams of fiber for meals, and testing your blood sugar an hour or two later, that's when you'll know what works for you in managing your blood sugars at that time of day.

The truth shall set you free, because once you figure that out, once you know what amounts of which foods works for you, it becomes less important for you to count at that meal.

For example, once you know that a cup of al dente pasta with a cup of vegetable marinara and a side salad with kidney beans works for you, you can have that meal again without counting. So although the counting and blood testing sounds tedious and frustrating, it's really an initial investment of time and effort, and it will eventually free you.

MEMBER QUESTION:
When at long, slow, holiday meals I have a solution that seems to work for me, and I'm just wondering if I'm asking for trouble. I choose the appetizers, inject, and eat. Then I enjoy the company for a while. Then I pick the first one or two courses, inject and enjoy. Again, a break from food, then back again for the main course, a break, then the dessert. The injections are about half an hour apart, and I've had no low blood sugar reactions. Overall it is a larger meal than a non-holiday meal, but it's not every day it occurs. Am I kidding myself, or have a got a viable solution here?

MAGEE:
The truth is in your blood sugar testing. If it has been working for you when you measure your blood sugars throughout the day and your blood sugars are within the normal limits, I think you've found your solution.

It's probably something you should discuss with your certified diabetes educator or physician, but it does sound to me like this is a plan that will work for you. That's a great solution. Another tip would be for you to make sort of a doggy plate of different things you would love to try the next day, as well, and keep it in the refrigerator, keep collecting, and take it home with you. That way you are not going to miss out even on seconds.

MODERATOR:
While we're on the holiday track, Elaine, what kinds of food strategies do you have up your sleeves for cooking and consuming during the upcoming holiday season?

MAGEE:
Glad you asked, because the holidays are and can be a difficult time for people with medical issues. Let me just give you a few strategies I've come up with over the years. First, know this: You can still enjoy those holiday desserts!

The key is to avoid overeating. Some of us will fare better calorie-wise and emotionally if we have a little bit almost every day. This can work if you are eating healthy the rest of the day. So just plan in those desserts that you might be having by maybe cutting somewhere else in your normal day's intake.

And keep exercising throughout the holidays. This will help keep your metabolism higher. It will also help normalize your blood sugars. Here's a party-time strategy: some of us are dessert samplers. We would much rather sample several holiday goodies instead of having one big slice of something.

As long as you can hold your bite-sized goodies in one hand, you are likely to stick to a 300 calorie dessert goal. I've found that most of the bite-sized things we get during the holidays have about 100 calories each, so the magic number of goodies you can choose is three. Like one large truffle, that would count as one; a pecan pie piece the size of a cupcake; that would count as one; one piece of English toffee.

That gives you an example. Or a one and a half inch square of fudge. Another key to getting through the holidays is to use fiber to your advantage. When you have a choice, go for the higher fiber choice throughout the day.

Keeping your fiber higher can help you not only normalize your blood sugars but turn down your holiday appetite. If you're going to a dinner or party, offer to bring something you really like so you can make it the light way and you'll know generally what the calories and grams of carbs, fat, fiber, are for that dish.

Just try to stay on track as much as you can to measure your blood sugars, exercising regularly, writing down what you're eating, grams of carbs, fat and fiber, and it should help you get through the holidays the more you stay on track.

I wanted to mention snacking. This may be one of those areas during the holidays that you save yourself from. When you're eating during the holidays and you're eating more food in general and more higher calorie foods, you have to cut somewhere generally to keep it balanced.

One way you may want to pay attention to is snacking. So reserve snack time for some of those key healthy foods that you may not be getting through the day. Fruits and vegetables, low fat dairy, that's a good time for those foods. Your orange, like even a fast food side salad with a light dressing can only be 100 calories in some cases.

That way you're sort of filling up with fiber, getting your fruits and vegetables, getting your low fat dairy as a snack. But really watch snack time. This can be what does you in and sends you overboard on calories and such.

MEMBER QUESTION:
Can you give any suggestion for keeping brownies and cookies from turning rubbery when you substitute fake sugar for real sugar? Is there an ideal proportion where it stays chewy?

MAGEE:
I've generally had success using half Splenda and half sugar. I tend to use brown sugar and then substitute Splenda for the granulated sugar called for. This tends to be the ideal balance. So the good news is you're cutting the sugar and calories from sugar in half, and you're still usually getting a baked product that looks and tastes very similar to the regular.

MODERATOR:
Elaine, do you have any final words on eating right with diabetes?

MAGEE:
Have a happy, healthy holiday season everyone. If you get a chance, check out my book on amazon.com. It's available in Spanish and Chinese too, and come visit me on my WebMD Weight Loss Clinic message boards. I'd love to help you.


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