What are Diabetes Superfoods ?

A Healthy, Balanced Diet for Diabetes

Whether you are living with diabetes or not, eating a healthy balanced is important. Following a healthy, balanced diet will help to control blood glucose, blood fats and blood pressure, as well as helping to maintain a healthy weight. This can help to reduce your risk of diabetes complications, including heart disease and stroke.

The amount of carbohydrates you eat has the biggest effect on your blood glucose levels after eating. Therefore, reducing portions can help manage your glucose levels. It is also important to choose better sources of carbohydrates including wholegrains, pulses, fruits and vegetables and some dairy foods.

If you are overweight, reducing your overall portion sizes will also help you to lose weight. Losing excess weight has been shown to be beneficial in managing blood glucose, blood pressure and cholesterol levels. There are different approaches to losing weight.

Healthy eating helps keep your blood sugar in your target range. It is a critical part of managing your diabetes, because controlling your blood sugar can prevent the complications of diabetes.

• The Centers for Disease Control and Prevention has a free recipes ebook for people and their families with diabetes, you download a free copy here ¹.

A registered dietitian can also help you make an eating plan just for you. It should take into account your weight, medicines, lifestyle, and other health problems you have.

• To find out about your body mass index (BMI), you can use a FREE online BMI calculators from the Centers for Disease Control and Prevention (CDC) – for Adults ² and for Children ³

• To find out What and How Much To Eat, you can use a FREE, award-winning, state-of-the-art, online diet and activity tracking tool called SuperTracker ⁴ from the United States Department of Agriculture Center for Nutrition Policy and Promotion ⁴. This free application empowers you to build a healthier diet, manage weight, and reduce your risk of chronic diet-related diseases. You can use SuperTracker ⁴ to determine what and how much to eat; track foods, physical activities, and weight; and personalize with goal setting, virtual coaching, and journaling.
  

SuperTracker website ⁴

• To find out about how many calories you should eat to lose weight according to your weight, age, sex, height and physical activity, you can use a FREE online app Body Weight Planner ⁵

• To find out about the 5 Food Groups you should have on your plate for a meal, you can use a FREE online app ChooseMyPlate ⁶
  

 

The foods you choose to eat in your daily diet make a difference not only to managing diabetes, but also to how well you feel and how much energy you have every day.

• How much you need to eat and drink is based on your age, gender, how active you are and the goals you are looking to achieve.
• Portion sizes have grown in recent years, as the plates and bowls we use have got bigger. Use smaller crockery to cut back on your portion sizes, while making the food on your plate look bigger.
• No single food contains all the essential nutrients you need in the right proportion. That’s why you need to consume foods from each of the main food groups to eat well.

1) Fruit and vegetables

Naturally low in fat and calories and packed full of vitamins, minerals and fibre, fruit and vegetables add flavor and variety to every meal.

They may also help protect against stroke, heart disease, high blood pressure and some cancers.

• Everyone should eat at least five portions a day. Fresh, frozen, dried and canned fruit in juice and canned vegetables in water all count. Go for a rainbow of colors to get as wide a range of vitamins and minerals as possible.

Try:

• adding an apple, banana, pear, or orange to your lunchbox
• sliced melon or grapefruit topped with low-fat yogurt, or a handful of berries, or fresh dates, apricots or prunes for breakfast
• carrots, peas and green beans mixed up in a pasta bake
• adding an extra handful of vegetables to your dishes when cooking – peas to rice, spinach to lamb or onions to chicken.

Vegetarian Diets Linked to Lower Mortality

Adults who eat a more plant-based diet may be boosting their chance of living longer, according to a large analysis.

Researchers studied more than 73,000 Seventh-day Adventist men and women ages 25 and older ⁷. The participants were categorized into dietary groups at the time of recruitment based on their reported food intake during the previous year. Nearly half of the participants were nonvegetarian, eating red meat, poultry, fish, milk and eggs more than once a week. Of the remaining, 8% were vegan (eating red meat, fish, poultry, dairy or eggs less than once a month); 29% were lacto-ovo vegetarians (eating eggs and/or dairy products, but red meat, fish or poultry less than once per month); 10% were pesco-vegetarians (eating fish, milk and eggs but rarely red meat or poultry); and 5% were semi-vegetarian (eating red meat, poultry and fish less than once per week).

Over about 6 years, there were 2,570 deaths among the participants. The researchers found that vegetarians (those with vegan, and lacto-ovo-, pesco-, and semi-vegetarian diets) were 12% less likely to die from all causes combined compared to nonvegetarians. The death rates for subgroups of vegans, lacto-ovo–vegetarians, and pesco-vegetarians were all significantly lower than those of nonvegetarians.

Those on a vegetarian diet tended to have a lower rate of death due to cardiovascular disease, diabetes, and renal disorders such as kidney failure. No association was detected in this study between diet and deaths due to cancer. The researchers also found that the beneficial associations between a vegetarian diet and mortality tended to be stronger in men than in women.

The researchers note several limitations to the study. Participants only reported their diet at the beginning of the study, and their eating patterns might have changed over time. In addition, they were only followed for an average of 6 years; it may take longer for dietary patterns to influence mortality ⁷.

2) Starchy foods

Potatoes, rice, pasta, bread, chapattis, naan and plantain all contain carbohydrate, which is broken down into glucose and used by your cells as fuel. Better options of starchy foods – such as wholegrain bread, wholewheat pasta and basmati, brown or wild rice – contain more fibre, which helps to keep your digestive system working well. They are generally more slowly absorbed (that is, they have a lower glycaemic index, or GI), keeping you feeling fuller for longer.

• Try to include some starchy foods every day.

Try:

• two slices of multigrain toast with a scraping of spread and peanut butter
• rice, pasta or noodles in risottos, salads or stir-fries
• potatoes any way you like – but don’t fry them – with the skin left on for valuable fibre. Choose low-fat toppings, such as cottage cheese or beans
• baked sweet potato, with the skin left on for added fibre
• boiled cassava, flavoured with chilli and lemon
• chapatti made with brown or wholemeal atta.

3) Meat, fish eggs, pulses, beans and nuts

These foods are high in protein, which helps with building and replacing muscles. They contain minerals, such as iron, which are vital for producing red blood cells. Oily fish, such as mackerel, salmon and sardines, also provide omega-3, which can help protect the heart. Beans, pulses, soya and tofu are also good sources of protein.

• Aim to have some food from this group every day, with at least 1–2 portions of oily fish a week.

Try:

• serving meat, poultry or a vegetarian alternative grilled, roasted or stir-fried
• a small handful of raw nuts and seeds as a snack or chopped with a green salad
• using beans and pulses in a casserole to replace some – or all – of the meat
• grilled fish with masala, fish pie, or make your own fish cakes
• eggs scrambled, poached, dry fried or boiled – the choice is yours!

4) Dairy foods

Milk, cheese and yogurt contain calcium, which is vital for growing children as it keeps their bones and teeth strong. They’re good sources of protein, too.
Some dairy foods are high in fat, particularly saturated fat, so choose lower-fat alternatives (check for added sugar, though). Semi-skimmed milk actually contains more calcium than whole milk, but children under 2 should have whole milk because they may not get the calories or essential vitamins they need from lower-fat milks. Don’t give children skimmed milk until they’re at least 5.

• Aim to have some dairy every day, but don’t overdo it.

Try:

• milk straight in a glass, flavoured with a little cinnamon, or added to breakfast porridge
• yogurt with fruit or on curry
• cottage cheese scooped on carrot sticks
• a bowl of breakfast cereal in the morning, with skimmed or semi-skimmed milk
• a cheese sandwich at lunchtime, packed with salad
• a refreshing lassi or some plain yogurt with your evening meal.

Changes you can make are:

• Avoid foods labelled ‘diabetic’ or ‘suitable for diabetics’. These foods contain similar amounts of calories and fat, and they can affect your blood glucose levels. They are usually more expensive and can have a laxative effect. Stick to your usual foods. If you want to have an occasional treat, go for your normal treats and keep an eye on your portions.
• Reduce Fried foods and other foods high in saturated fat and trans fat
• Foods high in salt, also called sodium
• Reduce intake of chips, cookies, cakes, full-fat ice cream, etc.
• Cut back on high calorie snack foods and desserts.
• Sweets, such as baked goods, candy, and ice cream
• Beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks
• Eating too much of even healthful foods can lead to weight gain.
• If you choose to drink alcohol, do so in moderation. (Two or less drinks per day for men and one or less drinks per day for women.)
• Watch your portion sizes.
• Reduce the fat (both saturated and trans fat), sugar or salt content of your food.
• Drink water instead of sweetened beverages. Consider using a sugar substitute in your coffee or tea.

Making gradual and realistic changes over a longer period of time is more likely to lead to success. Be sure to get all of the tools you need to help you achieve these changes – structured education to make sure you have the right information, support from a healthcare professional such as a registered dietitian, and the backing of your family and friends. Although it may feel overwhelming now, it will get easier in the long run.

To successfully manage diabetes, you need to understand how foods and nutrition affect your body. Food portions and food choices are important. Carbohydrates, fat and protein need to be balanced to ensure blood sugar levels stay as stable as possible. (This is particularly important for people with Type 1 diabetes.)

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines. For that reason the American Diabetes Association has created:

• The Diabetic Diet Meal Plans ⁸ and
• A online tool called Create Your Plate ⁹. With Create Your Plate method, you fill your plate with more non-starchy veggies and smaller portions of starchy foods and protein—no special tools or counting required. You can practice with this interactive tool ⁹.

Summary

Healthy eating and an active lifestyle are important for everyone, including people with diabetes. To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious foods and drinks to meet your energy needs. Having a healthy diet and being active is an important part of managing diabetes because it will help manage your blood glucose levels and your body weight.

1. Meals that are recommended for people with diabetes are the same as for those without diabetes.
2. There is no need to prepare separate meals or buy special foods.
3. Everyone including family and friends can enjoy the same healthy and tasty meals together.
4. As a guide, we recommend people with diabetes follow the American Dietary Guidelines Healthy Eating for Adults and Healthy Eating for Children.
5. Everyone’s needs are different so we recommend everyone with diabetes visit a dietitian for personal advice.
6. Enjoy a wide variety of nutritious from these five food groups every day:

a) Plenty of vegetables and different types and colors and legumes/beans.

b) Fruits

c) Grain (cereal) foods, mostly wholegrain and/or high cereal fiber varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, quinoa, oats, and barley.

d) Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans.

e) Milk, yogurt, cheese and/or their alternatives, mostly reduced fat.

And drink plenty of water. Limit intake of foods and drinks containing added salt, sugar and saturated and trans fats.

Vegetarian Diets and Diabetes

Reasons for switching to a vegetarian diet include:

• the health benefits
• ethical and moral reasons
• religious or cultural reasons
• concern for animal welfare
• concern about the environment and sustainability
• taste – some people just don’t like the taste of meat or fish.

A vegetarian diet, based on unprocessed foods, can provide many health benefits for us all, whether or not you have diabetes.

If you have diabetes, it’s important to be more aware of how what you eat affects your body and, in turn, you’ll hopefully become more health conscious.

So what is a vegetarian diet ? Are there any ways it could help manage diabetes ? Does it provide any health benefits for people with diabetes ?

According to the Vegetarian Society ¹⁰, a vegetarian is:

• “Someone who lives on a diet of grains, pulses, legumes, nuts, seeds, vegetables, fruits, fungi, algae, yeast and/or some other non-animal-based foods (e.g. salt) with, or without, dairy products, honey and/or eggs. A vegetarian does not eat foods that consist of, or have been produced with the aid of products consisting of or created from, any part of the body of a living or dead animal. This includes meat, poultry, fish, shellfish*, insects, by-products of slaughter** or any food made with processing aids created from these.”
• * Shellfish are typically ‘a sea animal covered with a shell’. We take shellfish to mean; Crustaceans (hard external shell) e.g. lobsters, crayfish, crabs, prawns, shrimps; Molluscs (most are protected by a shell) e.g. mussels, oysters, winkles, limpets, clams, etc. Also includes cephalopods such as cuttlefish, squid, octopus.
• ** By-products of slaughter includes gelatine, isinglass and animal rennet.
• Eggs: Many lacto-ovo vegetarians will only eat free-range eggs. This is because of welfare objections to the intensive farming of hens. Through its Vegetarian Society Approved trademark scheme, the Vegetarian Society will only license its trademark to products containing free-range eggs where eggs are used.

There are different types of vegetarians:

• Lacto-ovo-vegetarians eat both dairy products and eggs (usually free range). This is the most common type of vegetarian diet ¹¹.
• Lacto-vegetarians eat dairy products, but avoid eggs.
• Ovo-vegetarian. Eats eggs but not dairy products.
• Vegans do not any products derived from animals – no meat, fish, dairy or eggs.

Why you may try a vegetarian diet ?

Plant-based foods, particularly fruit and vegetables, nuts, pulses and seeds have been shown to help in the treatment of many chronic diseases and are often associated with lower rates of Type 2 diabetes, less hypertension, lower cholesterol levels and reduced cancer rates ¹².

These foods are also higher in fibre, antioxidants, folate and phytochemicals, which are all good for our general health.

Vegetarian diets have been shown to be beneficial for people with Type 2 diabetes where weight loss is often the most effective way to manage the condition. A wholefood vegetarian diet often contains fewer calories and can help you to maintain a healthy body weight.

In a review of scientific publications from 1946- December 2013, it was found that the consumption of vegetarian diets was associated with a significant reduction in HbA1c and a non-significant reduction in fasting blood glucose concentration ¹³.

In another randomised study with 74 patients with type 2 diabetes, who were given either calorie restricted (-500 kcal/day) vegetarian diet (37 subjects) or calorie restricted (-500 kcal/day) conventional diabetic diet (37 subjects) over 24 weeks ¹⁴. In the second 12 weeks of the study, the calorie restricted diets were combined with aerobic exercise. Participants were examined at baseline, 12 weeks and 24 weeks. Forty-three per cent of participants in the calorie restricted (-500 kcal/day) vegetarian diet group and 5% of participants in the calorie restricted (-500 kcal/day) conventional diabetic diet group reduce their diabetes medication. Body weight decreased more in the calorie restricted vegetarian diet group (-6.2 kg) than in the calorie restricted conventional diabetic diet group (-3.2 kg). An increase in insulin sensitivity was significantly greater in the calorie restricted vegetarian diet group than in the calorie restricted conventional diabetic diet group. A reduction in both visceral and subcutaneous fat was greater in the calorie restricted vegetarian diet group than in the calorie restricted conventional diabetic diet group. Plasma adiponectin increased (a protein hormone produced and secreted exclusively by adipocytes (fat cells) that regulates the metabolism of lipids and glucose. High blood levels of adiponectin are associated with a reduced risk of heart attack. Low levels of adiponectin are found in people who are obese (and who are at increased risk of a heart attack) and leptin decreased (a hormone produced mainly by adipocytes (fat cells) that is involved in the regulation of body fat. Leptin interacts with areas of the brain that control hunger and behavior and signals that the body has had enough to eat. Leptin tells your brain that you have enough energy stored in your fat cells to engage in normal) in the calorie restricted vegetarian diet group, with no change in the calorie restricted conventional diabetic diet group. Differences between groups were greater after the addition of exercise training. Changes in insulin sensitivity and enzymatic oxidative stress markers correlated with changes in visceral fat ¹⁴.

Diabetes Superfoods

Sources from the American Diabetes Association and the Diabetes UK ¹⁵.

All of the foods in the list have a low glycemic index or low GI and provide key nutrients that are lacking in the typical western diet such as:

• calcium
• potassium
• fiber
• magnesium
• vitamins A (as carotenoids), vitamin C and vitamin E.

There isn’t research that clearly points to supplementation, so always think first about getting your nutrients from foods. Below is our list of superfoods to include in your diet.

Beans

Whether you prefer kidney, pinto, navy, or black beans, you can’t find better nutrition than that provided by beans. They are very high in fiber, a great source of protein, giving you about 1/3 of your daily requirement in just a ½ cup, and are also good sources of magnesium and potassium. Beans soluble fibre can lower your levels of “bad” cholesterol (low-density lipoprotein, or LDL) and lowers blood glucose levels.

They are considered starchy vegetables, beans are fairly high in carbohydrates, although it is a slower-acting carbohydrate but ½ cup provides as much protein as an ounce of meat without the saturated fat. To save time you can use canned beans, but be sure to drain and rinse them to get rid of as much sodium as possible.

Beans not only offer up a hefty variety of vitamins and minerals, but some studies ¹⁶ have shown that eating more beans can help to keep blood sugars lowered and keep HbA1c levels in line.

Incorporating beans into a low GI diet can improve both glycemic control and the risk the heart disease, especially in people with type 2 diabetes ¹⁷.

Healthy examples of beans include:

• Black beans
• White beans
• Navy beans
• Lima beans
• Pinto beans
• Garbanzo beans
• Soy beans
• Kidney beans

2) Dark Green Leafy Vegetables

Spinach, collards, kale – these powerhouse foods are so low in calories and carbohydrate. You can’t eat too much.

Non-starchy vegetables include dark, leafy greens, green beans and peppers (versus starchy veggies like corn and potatoes). Loading up at least a quarter of your plate with non-starchy veggies at each meal can help to fill you up on lots of fiber and fewer calories, which can aid in both blood glucose stabilization and weight reduction. Opting for more non-starchy veggies is also a great way to increase your intake of antioxidants and phytochemicals (a fancy name for healthy plant compounds) that help to ward off disease.

Examples of non-starchy vegetables include:

• Cabbage
• Lettuce
• Spinach
• Carrots
• Courgette
• Cucumber
• Celery
• Broccoli
• Cauliflower
• Mushrooms
• Peppers
• Tomato

3) Citrus Fruit

Citrus fruit is full of vitamin C. One large orange contains all the daily vitamin C you need. Citrus fruits also balance blood pressure.

On the other hand, citrus fruits contain a lot of carbohydrates. A medium grapefruit has 18.5g of carbohydrates, which is about the same amount as two bourbon biscuits.

People following a low-carb diet should eat citrus fruit in moderation. A single Satsuma per meal is about the limit.
Excessive amounts of the acid in citrus fruits can upset your stomach. Some people worry that citrus fruit damages the teeth, eroding the enamel, but this isn’t quite true.

Citrus fruit softens the enamel, which makes it more susceptible to damage from other sources, but doesn’t directly cause any damage. After about an hour, the enamel will harden again.

Citrus fruits offer a lot of benefits, but the carbohydrate content makes it advisable for people with diabetes only in moderation. That said, much of the carbohydrates in citrus fruit is fibre (about 4g of the 21g of carbohydrate in an orange), which lowers cholesterol and blood glucose levels. So it would be wise not to cut citrus fruit out of your diet altogether.

Good examples of citrus fruit include:

• Oranges
• Grapefruit
• Lemon
• Lime

4) Sweet Potatoes

A starchy vegetable packed full of vitamin A and fiber. Try in place of regular potatoes for a lower GI alternative.

Sweet potato comes in many different varieties and their GI values can range from low 45 (Ipomoea batatas) boiled to 94 (Ipomoea batatas) baked ¹⁸.

Table 1. Sweet Potato (Raw Unprepared) Nutrition Content

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹⁹]

5) Berries

Which are your favorites: blueberries, strawberries or another variety ? Regardless, they are all packed with antioxidants, vitamins and fiber.

Several studies have linked berries to a number of health benefits for people with diabetes, particularly type 2 diabetes.

A study published in the Journal of Nutrition indicated that the benefits of berries are due to a group of compounds called anthocyanins ²⁰, ²¹, ²².

The study showed that consumption of 160mg of anthocyanins twice a day led to:

• 7.9 per cent reduction of low-density lipoprotein (LDL): LDL is also known, somewhat simplistically, as ‘bad cholesterol’. Generally, when people talk about “high cholesterol levels” they are referring to low-density lipoprotein
• 19.4 per cent increase in levels of high-density lipoprotein (HDL). HDL is often known as “good cholesterol.” It clears LDL cholesterol out of the arteries
• 8.5 per cent reduction in fasting plasma glucose levels
• 13 per cent less insulin resistance
• 23.4 per cent increase of adiponectin, a hormone that increases insulin sensitivity
• The data suggest an inverse association between intake of anthocyanins and anthocyanin-rich foods (eg, blueberries and apples/pears) and type 2 diabetes in US men and women. It is possible that these findings reflect other dietary components that co-exist in anthocyanin-rich foods, and randomized trials will be needed to establish the effects that can be specifically attributed to anthocyanins. Further research on anthocyanin-rich foods may lead to more specific recommendations on consumption of fruit, which may contribute to the prevention of type 2 diabetes ²¹.

Berries are also a good source of vitamin C and fibre, and they don’t contain many carbohydrates. That said, although the research is promising, it isn’t yet conclusive ²¹. The signs are good, but the research is ongoing.

Berries are best incorporated into breakfast or dessert. They’re a great way of making often unhealthy or carb-heavy meals into something more nutritious.

Good examples of berries include:

• Blueberries
• Strawberries
• Blackberries
• Raspberries
• Cherries

6) Tomatoes

An old standby where everyone can find a favorite. The good news is that no matter how you like your tomatoes, pureed, raw, or in a sauce, you’re eating vital nutrients like vitamin C, iron, vitamin E.

Table 2. Tomato (Red Raw) Nutrition Content

[Source: United States Department of Agriculture, Agriculture Research Service. USDA Food Composition Databases. ¹⁹]

7) Fish High in Omega-3 Fatty Acids

Wild salmon is a favorite in this category. Stay away from the breaded and deep fat fried variety, they don’t count in your goal of 6-9 ounces of fish per week.

Few animal proteins offer up the amount of healthy omega-3 fatty acids quite like wild salmon or tuna. These cold-water fish have been shown to reduce inflammation in the body and have major heart-protecting properties that are particularly important for staving off coronary heart disease, a high risk factor for those living with diabetes.

• Fish high in omega-3 fatty acids like Albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon
• Other fish including catfish, cod, flounder, haddock, halibut, orange roughy, and tilapia
• Shellfish including clams, crab, imitation shellfish, lobster, scallops, shrimp, oysters.

The American Diabetes Association recommends eating fish at least two times per week to reap its omega-3 fatty acids benefits ²³.

8) Whole Grains

It’s the germ and bran of the whole grain you’re after.  It contains all the nutrients a grain product has to offer. When you purchase processed grains like bread made from enriched wheat flour, you don’t get these. A few more of the nutrients these foods offer are magnesium, chromium, omega 3 fatty acids and folate.

Pearled barley and oatmeal are a source of fiber and potassium.

9) Nuts

An ounce of nuts can go a long way in providing key healthy fats along with hunger management. Other benefits are a dose of magnesium and fiber.

Some nuts and seeds, such as walnuts and flax seeds, also contain omega-3 fatty acids. Similar to fatty-fish, nuts have an excellent nutrition profile that research suggests can both reduce HbA1c levels and lower amounts of LDL or “bad” cholesterol in the body. It only takes about 2 ounces of nuts per day to see these great effects.

Try adding a tablespoon of chopped nuts to salads or oatmeal for an extra punch of protein and healthy fats. Or pair a handful of raw almonds or walnuts with a piece of fresh fruit for a great, mid-day snack that won’t send blood sugars surging.

10) Milk and Yogurt

Everyone knows dairy can help build strong bones and teeth. In addition to calcium, many fortified dairy products are a good source of vitamin D. More research is emerging on the connection between vitamin D and good health.

Greek yogurt is a very versatile ingredient that packs almost double the amount of protein of regular yogurt varieties and is typically lower in overall carbohydrates. Better yet, Greek yogurt is an excellent source of probiotics, also known as “friendly” gut bacteria that promote healthy digestion and may play a major role in the prevention and management of both Type 1 and Type 2 diabetes.

Seek out yogurts with few ingredients and no added sugars or thickeners. If you do like your yogurts sweetened, try adding fresh or frozen fruit to avoid spiking blood sugars. It can also be used in baking and as a substitute for sour cream in savory dishes.

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