How to make healthy changes without giving up all your favorites

By Sylvia Davis
WebMD Weight Loss Clinic - Expert Column

Reviewed By Kathleen Zelman, MPH, RD/LD

Forget the idea of the "diabetic diet" -- a restrictive regime that puts certain foods strictly off-limits. The healthiest diet for people with type 2 diabetes is the same diet that's best for everyone else.

That means eating a wide variety of foods, and including items from all the major food groups represented on the Food Pyramid -- protein, dairy, grains, and fruits and vegetables -- every day. It means watching your portion sizes. It means getting enough fiber, and avoiding an overload of fat, salt, alcohol, and sugar. (Yes, you can have dessert -- in moderation, and with a little planning!)

Following these steps will not only help control your blood sugar, but can also help you reach a healthy weight, something that's especially important for people with diabetes.

Your Healthy Eating Plan

As with any medical condition, people with type 2 diabetes should check with their doctors before starting any diet or exercise program. It's also a good idea to work with a registered dietitian and/or diabetes educator to come up with an eating plan that suits your needs.

Two of the main tools doctors and dietitians use to help you plan healthy meals are:

Food exchanges. This system divides foods into major categories -- starches, fruits and vegetables, dairy, proteins, and fats -- and tells you how many portions of each you should have each day.
Carbohydrate counting. With this system, you keep track of the grams of carbohydrate (starches and sugars) you consume, with the idea of spreading them out through the day to help keep your blood sugar steady.

The end result should be a plan tailored to your needs: one that takes your age, gender, lifestyle, and eating habits into account.

Putting Your Plan Into Action

While you should be able to eat most of the same things as everyone else, people with diabetes often have to limit the amounts they eat, prepare food in different ways than they may have been used to, and think about when they eat.

Consider the issue of consistency: If you have diabetes, you need to eat about the same amount every day, and at about the same times. You shouldn't skip meals, or go more than four or five hours without eating during the day.

Another important element of a healthy diet is portion control. Your health-care team can help you learn to gauge correct portion sizes, which are often smaller than we've come to expect in the age of super-sizing. For example, one serving of meat is about the size of a deck of cards, and a serving of pasta is about the size of half a tennis ball.

But just what should those portions consist of on any given day? Here are some guidelines for various types of foods you may have questions or misconceptions about:

Sugar: Most experts now agree that it's OK for people with diabetes to have a little dessert now and then. Sugar is just another form of carbohydrate, so you can substitute a sweet for another starch (say, bread or pasta) in your eating plan. But keep in mind that most sugary foods have lots of calories, and few of the nutrients your body needs.
Fat: Too much fat is bad for anyone, but especially for people with diabetes. A high-fat, high-cholesterol diet increases your risk of heart and artery disease -- and people with diabetes already are more likely to get these diseases. And, of course, eating too much fat can make you fat. So choose lean cuts of meat, or fish or skinless poultry. Switch to skim or low-fat dairy products. Cut out butter, and substitute low-fat margarine or other seasonings such as broth, herbs, and fruit juices.
Salt: People with diabetes are at higher risk of high blood pressure, which can be affected by the sodium in your diet. To cut down on salt, limit packaged convenience foods and fast food, as well as pickles and salty condiments like mustard. Use herbs, garlic, or fruit juices instead of table salt.
Fiber: Fiber is the non-digestible carbohydrate found in plant-based foods. It keeps you feeling full longer, and may also help lower blood sugar and blood fat levels. Choose whole grains and cereals, and eat lots of fruits and veggies, to help you reach a healthy goal of 25 to 35 grams of fiber per day.
Alcohol: If your doctor approves, you may include small amounts of alcoholic beverages in your healthy eating plan. (The American Diabetes Association recommends no more than two drinks a day for men and no more than one a day for women.) If you do drink alcohol, never have it on an empty stomach. And remember that alcohol tends to be high in calories and has few nutrients. Choose light beer or dry wine, and sugar-free mixers.
Artificial sweeteners: Unlike sugar, artificial sweeteners have no calories, don't raise blood-sugar levels, and don't have to be counted as a starch in your meal plan. But don't overdo it: Many artificially sweetened foods still have plenty of calories and few vitamins and minerals.

While many, many people are living happily and healthily with type 2 diabetes, change doesn't always come easy at first. Here are a few tips to help you get -- and stay -- with the program.

Ask for support. Let your friends and relatives know about the changes you'll be making, and why they're important for your health. Ask them to help you stick with your plan.
Plan ahead for temptation. If you're going to a party, prepare your own healthy dish and bring it along. Or, if you're headed to a restaurant, figure out ahead of time what you'll order and how it fits into your eating plan.
Educate yourself. Learning as much as you can about your condition will help you make informed decisions about it.
Make changes gradually. For example, if your goal is to eat more veggies, add one serving at dinner every day. Once you're used to that change, start sneaking in a second serving at lunch.
Get some exercise. Not only will exercise help control your blood sugar and boost your health in other ways, it can reduce stress and improve your outlook. See your doctor about getting started.

Originally published May 7, 2003.
Medically updated May 2, 2005.

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