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This article was originally published in Diabetes Forecast.
 

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The report, which the ADA commissions every five years, gives doctors, dietitians, and other members of your health care team recommendations as they provide therapy and guidance. A committee of clinicians, researchers, and ADA staffers looked at more than 600 diabetes nutrition studies published between January 2014 and February 2018. Nutrition interventions in the studies ranged from programs focused on weight loss to alcohol’s effect on blood glucose levels. Based on high-quality evidence, the committee came to an agreement on specific nutrition therapy recommendations that focus on adults living with prediabetes and type 1 and type 2 diabetes. 

1. There is no “diabetes diet”

Really. Given the wide spectrum of ages, health statuses, diabetes durations, budgets, and eating preferences within the diabetes community, it’s no surprise a buffet of nutrition approaches is needed for managing type 1 and type 2 diabetes. The report encourages providers to make a referral for diabetes-focused medical nutrition therapy, provided by a registered dietitian or registered dietitian nutritionist, at diagnosis and then as needed. Nutrition education has been shown to help people with diabetes achieve blood glucose and weight management goals, and help prevent and treat complications.

2. You have choices—lots! 

A variety of eating patterns can help you manage your diabetes—from Mediterranean-style to vegetarian or vegan. “The report highlights the relative benefits and potential pitfalls of various approaches so that providers and patients can pursue any of them with this information in hand,” says William Yancy, MD, a professor at Duke University School of Medicine, one of the report’s coauthors, and cochair of the committee. Focus on these tips, no matter what eating pattern you choose:

• Eat nonstarchy vegetables.
• Minimize added sugars and refined grains.
• Choose whole foods over highly processed foods as much as possible.

3. Macronutrients may vary

There is no perfect percentage of calories from macronutrients (carbohydrate, protein, and fat) for people with or at risk for diabetes. Instead, the macro percentages can and should be individualized. “The quality and quantity of foods consumed are key,” says coauthor and committee cochair Alison Evert, MS, RD, CDE, a dietitian and certified diabetes educator at the University of Washington Medical Center.

4. Carbs are not one-size-fits-all

“There is growing research to show that low-carbohydrate eating patterns can benefit people with diabetes  and prediabetes,”  Yancy says. There’s no one definition, however, for “low carb.” Studies  of diets in which carbs made up 26 to 45  percent of total calories showed blood glucose benefits, a reduction in diabetes medications, and improvement in heart disease risk factors. Though the brain requires glucose, the report mentions that the body meets that need via other processes: by using carbohydrate stored in the liver, making new glucose from stored fat and protein, or burning stored fat when carb intake is very low (known as ketogenesis).

5. Weight loss works

A wide range of weight-loss strategies, including dietary change, physical activity, medications, and surgery, can improve blood glucose levels and other diabetes outcomes—in type 1 as well as type 2 diabetes. “Important components of effective weight-loss programs or therapy include an individualized eating plan that results in fewer calories in combination with more physical activity,” says Evert. For type 2, the benefits of weight loss are progressive, and even a 5 percent weight loss makes a difference. Even better: 15 percent or more, as needed, if it can be safely achieved.

6. Tweaking your food choices can help reduce risk factors for complications

Food swaps can help people with diabetes reduce the risk for or slow the progression of cardiovascular disease and diabetic kidney disease. For instance, replace foods high in saturated fat (such as butter and beef) with those that are rich in unsaturated fats (such as olive oil and fatty fish). Evidence shows that this type of swap reduces total cholesterol and LDL (“bad”) cholesterol  and reduces your risk for cardiovascular disease. People with type 2 who replace high-carbohydrate foods with low-carb alternatives that are higher in healthy fats can improve blood glucose levels, triglycerides, and HDL (“good”) cholesterol; research is lacking in type 1 diabetes. 

FOOD FOR THOUGHT:

Studies on how food affects health are key, but nutrition research in general isn’t without its challenges. Take, for instance, study length. Research and clinical experience can show the powerful effect of nutritional interventions on diabetes over the short term, but there’s a lack of high-quality, longer-term studies with clear endpoints, such as disease development or death. To fill the void, researchers will sometimes look to observational studies, in which aspects about participants, such as which foods they eat, are observed and analyzed. 

The challenge: A wide variety of eating patterns exist—along with an equally wide variety of study designs and results. “It is difficult to find a large sample of people who are clearly following certain eating plans that have demonstrated benefit,” says William Yancy, MD, a professor at Duke University School of Medicine. “These issues make it difficult to support any one specific approach [over another].” 

What factors influence your food choices every day?

Choosing what to eat may seem straightforward —you do it several times a day after all—but there are hundreds of decisions that we must make every day that shape our food choices. Think about this: What are you going to eat for dinner tonight?

There are probably dozens of questions you have to ask yourself before ultimately deciding what you’ll have for dinner. The truth is, deciding what to eat is incredibly complicated and there are tons of factors that influence our food choices, like time, health, cost, personal preferences, religious or ethical restrictions, medical restrictions, convenience, cooking skills, etc, etc, etc! And everyone prioritizes those factors differently. If you’re managing a disease, health might be the most important factor to you. If you’re on a tight budget, cost might be the biggest influence. If you’re strapped for time, you might prioritize things that are convenient, quick, and easy. Some people also have limited control over their food choices, either because they are preparing foods for someone else, or because someone else is preparing food for them. You get the idea!

To get a better idea of the factors that effect people’s food choices, we asked staff at the American Diabetes Association and our constituents on social media: “What factors influence your foods choices every day?” We created a word cloud with the responses to visualize which responses were most common. The larger a word is in the cloud, the more times that word showed up in people’s responses. 

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1. Time

As you can see, “time”, along with convenience and accessibility, was a common response. While nutrition knowledge is important, no amount of education or awareness will change the fact that some people just don’t have time to prepare fresh, home-cooked meals every day. For these folks who are crunched for time or have limited access to fresh, healthy ingredients, strategies might focus more on time management or making healthy choices on the go, such as:

• Incorporating some prepared ingredients, such as a cooked rotisserie chicken from the grocery store, for “semi-homemade” cooking.
• How to meal prep and get the most out of the limited time you do have to cook at home.
• Making healthier choices at fast food restaurants or other convenience options.

2. Health

Health seems to be the next most important factor, with people looking for options that are healthy, or that will help them manage blood sugar or other health concerns. For the health-conscious folks, recommendations should be based on individualized health goals. Most likely, people may be balancing more than one health concern, making an individualized plan even more important. A general, healthy diet full of nutritious vegetables, fruits, whole grains, healthy fats, and lean protein is a great starting point.

3. Personal Preferences

Also prominent in the cloud is personal preferences, indicated by “taste,” “cravings,” “wants,” and “culture.” Eating is an integral part of living, and for many people, food is tied to family, culture, comfort, and joy. An overly restrictive diet may be a fast track to optimal health outcomes, but if it is unpleasant or too far from what a person normally enjoys, sticking to such a diet will be difficult over time. 

In Summary

As you can see, there are several factors that influence an individual’s food choices, many of which are hard to control or change. In reality, most of us are balancing several of these factors every day. Remember, eating is personal, and what works great for one person may not work for you! The real key to healthy eating is identifying what works for you and your priorities.

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This low-carb crowd-pleaser is perfect for weekends or holidays when you have a houseful. If it’s just one or two of you, make a big batch and freeze the rest. A quick warm-up in the microwave will give you a low-calorie and protein-rich breakfast all week long.

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Fluffy eggs and spicy chiles folded into a tortilla with rich melted cheese make this low-carb breakfast a pleasure! Toasted to perfection, this quesadilla redefines breakfast. You can use a variety of cheeses such as asadero, Monterey jack, and white cheddar. For a chorizo quesadilla, sub the bacon for 4 oz cooked beef or pork chorizo.

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Start your morning off with this refreshing smoothie. This nutrition-packed powerhouse uses berries—which are higher in fiber and lower in carb than other fruits—to keep the carb count lower. Almond milk is also lower in carb than regular milk, and is great for people with milk or lactose intolerance.

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Lower-carb biscuits? This recipe is a great example of how to cut carbs by choosing smaller serving sizes. These gluten-free and bite-sized biscuits taste like they come from a restaurant, and, paired up with the Guilt-Free Breakfast Sausage Patties below, you’ve got everything you need for the perfect, diabetes-friendly breakfast sandwich.

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Keeping sausage patties low in carb isn’t much of a challenge, but boosting the healthy fats can be. Which is why the Mr. Food Test Kitchen traded the traditional pork for heart-friendly ground turkey. Pair with the biscuits above for a perfect start to the day.

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These low-calorie egg and ham cups are absolutely delicious and satisfying, with almost no carb. As an added bonus, you get some veggies, too!

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Frittatas sound fancy, but are incredibly easy to make. If you’re looking to save time during the week by meal prepping, they are perfect for cooking in bulk. Whip up a batch over the weekend, pack them in separate containers, and then grab and go on your way out the door each morning.

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These beautiful baked eggs use a pinch of cumin to impart a smoky flavor that pairs perfectly with the natural sweetness of the tomatoes. If you can get your hands on a fresh heirloom tomato, even better. Best of all, they are super easy to prepare. They are the perfect weekend treat.

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Looking to impress your friends and family? Socca, also known as farinata, is a thin chickpea flour pancake commonly found in both Italian and French cuisines. In this recipe, author Katie Cavuto tops wedges of the warm chickpea crepe with roasted tomatoes, poached eggs, and fresh basil.

For more great breakfast recipes, go here.

D-I-Why?

Not only can you build your own flavor with homemade stock, you also have control over how much salt is added. Store bought stocks are often very high in sodium. While the reduced sodium varieties are a better option if you’re watching your salt intake, even those can still have a lot of sodium. When you make your own stock, you can leave out the salt, and wait to add seasonings to the final dish. And let’s not forget about the cost savings: homemade stock costs $0.00 when you make it from scraps that are destined for the trash!
 
In my house, we eat roast chicken at least once a week, and I make stock from the bones every time. In its simplest form, all it takes is chicken bones and water. If you want more flavor, go ahead and throw in a mixture of basic vegetables like onions, carrots, and celery. Herbs? Sure! Those parsley stems are full of flavor, so why throw them away? Throw them in the pot! You can save vegetable scraps over time—instead of tossing them in the trash, keep them in an airtight container in the freezer until you are ready to make a batch of stock.

Stock vs. Broth: Generally, “stock” is made with bones and cooked for a much longer time to get collagen out of the bones, while “broth” is made with just meat and vegetables and cooked for a shorter time.

How to make your own stock

When I make chicken stock, I simmer it for 30 to 45 minutes. But if I’m making vegetable or mushroom stock, I make it on the fly, letting vegetable scraps and herbs simmer for as little as 10 minutes while I prep the rest of my recipe. No matter which stock you decide to try, you can always make a big batch and freeze it for later.

The technique is easy for all: 

1. Brown the bones (or vegetables, or mushrooms) with a little bit of oil in a large stockpot, making sure to develop crusty bits on the bottom of the pan (those bits will give your stock a major flavor boost). 
2. Add cold water (it has to be cold), enough to cover the ingredients, and stir, being sure to scrape all of the crusty bits from the bottom of the pan with your spoon. Bring to a boil, then lower the heat and simmer gently. You never want to boil a stock violently, you want to simmer it low and slow. 
3. For chicken stock, simmer for at least 30-45 minutes, and up to 2 hours, depending on the amount of bones. Mushroom or vegetable stock only needs to simmer 10-30 minutes. 
4. Let the broth cool, then strain through a fine mesh strainer. Store in airtight containers in the fridge for 3 days, or in the freezer for 3 months.

As simple as it is, there are a few important variables to pay attention to: 

• Check on the stock occasionally and skim off any foam that accumulates on top. Otherwise, your stock could taste slightly bitter. 
• Be sure to strain the liquid really well, using a very fine strainer (called chinois), or a wire mesh strainer lined with cheese cloth, as the pieces of food left in the liquid may spoil the flavor.  
• In the case of chicken stock, I am not too picky if there are little bits of meat left on the bones, but generally speaking, you want the bones to be clean of meat. The bones are the source of the precious gelatin and flavor, not the meat. 

Once you start making stock frequently, it gets easier! Try using your homemade stock in your favorite soup recipe, or try my recipe for Caldo Verde and experience the difference for yourself!

What is a Diabetes Superfood?

Our definition of a Diabetes Superfood is simple: any food that (1) is rich in nutrients that benefit diabetes management or (2) is rich in nutrients that are typically lacking in the American diet. Not surprisingly, most of these superfoods are fruits and vegetables – they are the best “bang for your buck” when it comes to nutrition. We’ve highlighted a few varieties below, but don’t let this list limit you – all fruits and vegetables truly are superfoods!

Berries 

Strawberries, blackberries, raspberries, blueberries, and cranberries…these little gems are packed with antioxidants, which are cancer-fighting molecules that can remove harmful agents from the body. Berries are also a great source of fiber and lower in carbohydrates than other fruits. We like them fresh, but they can be enjoyed frozen (great in smoothies) or in dried form as a tasty snack.

Cruciferous Vegetables

This variety of nutrient-dense veggies includes cauliflower, broccoli, Brussels sprouts, cabbage, bok choy, and more. Cruciferous veggies are rich in fiber, phytochemicals, vitamins, and minerals. What are phytochemicals, you ask? They are chemical compounds found in plants that are not vitamins and minerals but have been associated with positive effects on health, such as reduced risk for cancer and heart disease. 

Dark Leafy Greens

Spinach, collards, kale, romaine lettuce, mustard greens, watercress, and swiss chard…these nutrient powerhouses provide vitamin C, fiber, folic acid, potassium, magnesium, and iron. They are also very low in carbohydrate so the headline here is to eat more! Pair them with other superfoods to create delicious salads, sandwiches, pasta dishes, omelets, or soups.

Fish High in Omega-3 Fatty Acids

We love fish as a healthy protein option, and the American Diabetes Association recommends that most people eat fish at least two to three times per week. Some fish are packed with nutrients called omega-3 fatty acids, which play a role in heart and brain health. Fish and seafood high in omega-3 fatty acids include salmon, trout, sardines, anchovies, herring, Pacific oysters, and Atlantic and Pacific mackerel. In addition to healthy fats, fish also provide vitamin D and calcium.

Legumes – Beans, Peas, and Lentils

These budget-friendly, plant-based proteins are a great choice at mealtime! Legumes also include bean-based foods like hummus, edamame, and soy products. For 1/2 cup of beans, keep in mind that you get about 15–20 grams of carbohydrate, but you also meet approximately 1/3 of your daily fiber needs. When you eat beans, you will also enjoy a boost of magnesium, folate, potassium, and iron. 

Now, let’s put these superfoods to work! These are some of our favorite recipes featuring superfoods from our new book, Diabetes Superfoods Cookbook and Meal Planner:

Garbanzo Bean and Arugula Salad

This salad combine dark leafy greens, beans, and tomatoes for a powerhouse superfood salad that uses only 4 ingredients and takes only minutes to prepare.

Lemon Raspberry Chia Seed Pudding

This “pudding” is a unique snack or dessert that is simple to make and beautiful to serve. Featuring 3 superfoods, chia seeds, citrus juice, and raspberries, it packs omega-3 fatty acids and fiber. 

Salmon with Mango and Tomato Salsa

For a superfoods dinner, serve up this entre that pairs omega-3 fatty acid rich salmon with a fresh fruit salsa creating a delicious blend of spicy and sweet that is perfect for a quick weeknight meal. 

Find these recipes and more, along with a 40-day meal plan in the new cookbook, Diabetes Superfoods Cookbook and Meal Planner. To order directly from the American Diabetes Association, click here.