Believe it or not, Norae used to teach my kids tennis. She's all grown up now with her own nutritional clinic and is fast becoming a recognized authority on dietary issues in the Bay Area and beyond.
In response to David Spero's post and reader comments "What to Eat? ADA Speakers Disagree," from June 25th 2008
Fabulous! I am so pleased to know that when addressing the masses, experts continue to disagree. Disagreement sparks debate, encourages more research, and allows for individuality in our treatment options. We differ by genetic makeup, medical history, allergies, medication regimen, gluten tolerance, glycemic tolerance, height, weight, cultural background, and on a more basic level, we all prefer different things to eat! So if all experts agreed we should all be doing exactly the same thing, and we all followed those recommendations accordingly...you can imagine the unhappiness, confusion, and in many cases declining health we would experience as a group. Just as Mr. Spero points out, the basic understanding that we are all uniquely different still holds true with diet—there is no single diet or food that will fit for every diabetic. And there never will be!
In order for you to sift and sort through what you hear, I recommend you keep the following things in mind:
Know ALL your numbers — your kidney status and your heart health
The first step in deciding whose or which diet plan you should follow, is to do a work-up on YOU! Before creating your personalized meal plan, make sure you ask your doctor to have blood tests to evaluate your kidney function, blood cholesterol, and of course, your A1c. You also want to keep in mind your fasting and postprandial blood sugar readings, and all your medications before writing a plan. So when you attend a seminar or read a book discussing a new diabetes diet regimen, medication, or super-food that sounds like a solution for you, take that information back to your personal health care practitioner and let them help you make an informed decision. Some things to keep in mind while you decide on the topics brought up in David Spero's article might be:
What are your diet goals?
In addition to controlling blood sugar, individual goals may vary between or may include all of the following: to lose weight, to slow down kidney disease, to control blood pressure, to lower cholesterol or triglycerides, to complete a healthy pregnancy, or simply to enjoy your food more. These things may be negatively or positively impacted by your new diet and need to be considered.
About resistant starches — they are good for (almost) every diabetic
Legumes (lentils, black-eyed peas, black beans, pinto beans, etc.) are my favorite from this group because they are packed with fiber, protein, and enough carb that they can be a complete meal in themselves. A cup of legumes is very satisfying, contains 14g protein, 30g carbohydrate, and about 10g fiber. They are also high in iron, which makes them a staple in a vegetarian or vegan diet. For those who enjoy eating them, they are very, very satisfying, and you usually only need ½ cup next to your salad and lean chicken breast or fish to feel great. In the place of white rice, potato, and bread (even whole grain), most people find legumes to be more satisfying for their calorie content, and usually yield better blood sugar results because of the fiber and protein content. The small subgroups of people who need to limit legumes are those who may have kidney problems, and are instructed to limit high phosphorus foods. Avoiding beans will not help prevent kidney disease, but once you have it and are advised by your doctor or physician your phosphorus level is too high, legumes (including nuts), will need to be removed from the plate.
High protein works exceptionally well — for some
If your kidneys are in great shape, you enjoy eating protein and vegetables, and don't miss fruit, milk, bread, rice, pasta, and other very high carb foods much, then high protein may be a very appropriate choice to keep your glucose in check.
There is a large group of people who follow a very very low carbohydrate diet (<30g net carbohydrate per day), and do it in a healthful way. What makes it "healthful" is the conscious choosing of extremely lean chicken, fish, or meat, a variety of fresh vegetables and nuts, and the use of vegetable oils instead of butter or cream. If you have high cholesterol or triglycerides, this becomes extremely important. The problem arises when those who don't know their kidney status is compromised, or have high blood levels of cholesterol, are misguided, and take the no-carb diet as a ticket to eat bacon, sausage, and heavy whipping cream on a daily basis. If you do decide to try controlling your blood sugar with a high protein diet, please seek professional advice and have your kidney function checked before making this switch.
Vegan diets improve your health — if you know what you are doing
A diet rich in vegetables, nuts, legumes, fruit, and whole grains is recommended for all of us! And when you cut out animal proteins and increase non-starchy vegetables and nuts in their place, the resulting diet is identical in carb content, higher in antioxidants and fiber, and usually lower in calories. What a great combination! The drawbacks are that it is very far from convenient to eat vegan—you have to really read labels carefully to avoid hidden ingredients like egg white and powdered milk, and will be preparing a lot of foods at home and packing a lot of food as a result. Few restaurants are vegan-friendly. For that reason alone it is not a very practical choice for most. And again, if kidney function is compromised and particularly if you have high phosphorous and potassium, a vegan diet just won't because you will need to avoid nuts, legumes, and have to limit all high potassium fruits and vegetables (most of them!).
The funny thing is:
After all the debates are concluded, studies and definitions are written, we (the experts) tend to gravitate back to the same message we as dietitians have been encouraging since the beginning of the profession... Eat more fresh vegetables, fruits and whole grains, keep your meat lean, and eat less processed, fatty foods. And just about everything can be eaten in moderation.
Norae Ferrara is owner and operator of the San Francisco Nutrition Clinic, and is preparing to launch her own blog on smart eating. She's also a triathlete, and former tennis coach and pro.