Online Health Chat with Andrea Dunn, RD, LD, CDE
Wednesday, November 15, 2017
Diabetes is the seventh leading cause of death in the U.S. and an overwhelming public health concern. In 2015, there were 30.3 million Americans (9.4 percent of the population) diagnosed with diabetes; and it was estimated that 7.2 million of these individuals did not know they had diabetes. Newly diagnosed cases in the U.S. accounted for 1.5 million people, and 84.1 million aged 18 years or older had the symptoms of prediabetes.
Diabetes is a concern spreading globally, where it is estimated that 422 million people have diabetes.
One way to control diabetes revolves around nutrition, but there isn’t one diet for people with diabetes. So, what should you be eating to optimize your nutrition health when you have diabetes? Does your diabetes medication impact your eating times and food choices? Do you know how to prevent and/or treat a low blood sugar reaction if you have one?
There are nutritional guidelines from the American Diabetes Association that focus on overall eating patterns and patient preference rather than any particular diet. An evidence-based position statement, "Nutrition Therapy Recommendations for the Management of Adults with Diabetes," was published in 2013 in Diabetes Care. It reviews the evidence for several popular eating plans, including Mediterranean style, vegetarian and Dietary Approaches to Stop Hypertension (DASH), but does not recommend any specific one.
About the Speaker
Andrea Dunn, RD, LD, CDE is a registered dietitian and certified diabetes educator with the Center for Human Nutrition. She focuses patient counseling on diabetes management and prevention, weight and cholesterol/blood pressure management. She takes an individual approach to each patient’s lifestyle, learning needs and readiness to change.
Andrea completed her undergraduate degree at Notre Dame College of Ohio and her internship at Miami Valley Hospital in Dayton. She volunteers with the Academy of Nutrition and Dietetics, currently serving as liaison to the National Diabetes Education Program. She is an associate editor for Diabetes Spectrum Journal and is on the Health Professional Board for the California Walnut Commission.
Let’s Chat About Diabetes and Diet
sinaihospital: I have Type 2 diabetes. Which foods should I eat and which foods should I not eat? Are there any diets for patients with diabetes, yes or no? Thank you for your advice.
Andrea_Dunn,_RD,_LD,_CDE: The style of eating for people with diabetes is a heart-healthy style of eating. There is no one diet for diabetes. The American Diabetes Association recommends seeing a registered dietitian/nutritionist when you are diagnosed with diabetes. The dietitian will help you better understand what to eat.
parce1: What is the latest evidence regarding finding "the best diabetes diet"?
Andrea_Dunn,_RD,_LD,_CDE: There isn't one “best” diet for diabetes. Three of the more popular eating plans being recommended include the Mediterranean style, vegetarian and Dietary Approaches to Stop Hypertension (DASH) diets.
Avie: What is the DASH diet?
Andrea_Dunn,_RD,_LD,_CDE: The Dietary Approach to Stop Hypertension (DASH) is an acceptable eating pattern for people with diabetes. This balanced approach to eating has been shown to help reduce insulin resistance, cholesterol/lipid issues and even weight issues. This style of eating includes a variety of foods (whole grains, low-fat dairy, fruits, vegetables, lean poultry/fish/meat and nuts). See www.nhlbi.nih.gov/health/health-topics/topics/dash/ for more information. You will also find at least 10 or more books at the public library about the DASH style of eating.
Avie: What is the Mediterranean eating pattern?
Andrea_Dunn,_RD,_LD,_CDE: The Mediterranean style of eating (there is not one Mediterranean diet) is a healthful way of eating. Many studies show that this eating pattern can help with blood glucose and cholesterol/lipid risk factors. The Mediterranean plan focuses on high-quality foods and limits processed foods. It is more plant-based (fruits, vegetables, whole grains), and it limits sweets. The primary source of fat is olive oil. Find out more at my.clevelandclinic.org/health/articles/mediterranean-diet-heart-health.
Styles12: Can I follow a vegetarian diet for my diabetes?
Andrea_Dunn,_RD,_LD,_CDE: Studies show that vegetarian diets, especially a vegan diet, can be an effective diet for those with diabetes. This style of eating may also help with weight reduction, as well as blood pressure and cholesterol/lipid management. Learn more at https://my.clevelandclinic.org/health/articles/understanding-vegetarianism-heart-health.
Conrad65: Are there different types of vegetarian diets?
Andrea_Dunn,_RD,_LD,_CDE: There are several types: semi-vegetarian (sometimes known as flexitarian), pesco-vegetarian (includes fish), lacto-vegetarian (includes dairy), ovo-vegetarian (includes eggs), lacto-ovo-vegetarian and vegan (no dairy, eggs, fish/meat/poultry or any foods from animal products).
golfer2: I am a 77-year-old woman with a family history of diabetes but have never had diabetes myself. However, my hemoglobin A1C is now high at 5.9. All my doctor tells me is to lower my carbohydrates. I am very active and a Weight Watchers life member, so I am not overweight. I do have FMD and see a vascular surgeon every six months for arterial scans. My question is: What else can I be doing or changing in my diet to lower the A1C and prevent diabetes? Thank You.
Andrea_Dunn,_RD,_LD,_CDE: The Diabetes Prevention Program (a large National Institutes of Health study) addressed actions to take to prevent diabetes once you have prediabetes. The recommendation included 150 minutes of moderate-intensity exercise a week, as well as weight loss, if overweight. If you are already at a healthy weight, work on weight gain. The original study wasn’t a low-carbohydrate style of eating. It moderated the fat content, keeping it to around 30 percent of calories from fat (about 30 grams for someone who might need 1,200 calories/day). Many diabetes prevention programs are now covered by many insurances; and starting in 2018, the Medicare Diabetes Prevention Program will be covered for those with Medicare coverage. For more on the DPP, go to www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp/Pages/default.aspx.
Focus on Foods
YG: Are there recommendations for weekly egg consumption for someone with diabetes if the person also has concomitant high cholesterol levels? Is daily dark chocolate (1/2 a bar) consumption okay for people with diabetes?
Andrea_Dunn,_RD,_LD,_CDE: Three whole eggs per week is reasonable for those who have elevated cholesterol levels. The cholesterol and fat is in the yolk, not the egg whites. There is no limit to the number of egg whites. Candy bar consumption depends on the size of the bar. Recommendations for heart-healthy eating for people with diabetes (without cardiovascular disease) suggest keeping the saturated fat to less than 10 percent of calories per day. For example, someone who needs 1,500 calories would want to keep the saturated fat to under 17 grams per day. And remember, the higher the cocoa content, the lower the carb/sugar content.
sweetpea: Hi. I am 68 years old and have been diagnosed as prediabetic. I try to eat healthy, but can't curb my desire for sweets. I am a 5'6", 134 pound white female and have read that gut bacteria can drive this but also heard that supplementation of bacteria is not good for heart disease. I have three leaky heart valves, exercise regularly and my cardiologist says I'm healthy. What's a girl to do? How do I stop the cravings?
Andrea_Dunn,_RD,_LD,_CDE: For sweet cravings, have you tried including fruit a few times per day? Not only does fruit have some fiber that helps promote good gut bacteria, but fruit has the natural sugar and chewing satisfaction you might be looking for. Pair the fruit with 1/4 to 1/2 cup of plain yogurt (for something tart) or 1 to 2 tablespoons of peanut butter or nuts (for something savory). Are you craving chocolate? Try one tablespoon of cocoa powder stirred into regular or decaf coffee. This gives you the dark chocolate taste with hardly any calories (about 12).
Avie: Do I need to avoid bananas when I have diabetes? I was told they are high in carbohydrates.
Andrea_Dunn,_RD,_LD,_CDE: One extra-small banana (4 ounce weight, with the peel still on) is about 15 grams of carbohydrates, or one carb choice. Compare this to the same amount of carbs in ¾ cup of blueberries, 1 cup cut up melon or 1 small apple or pear (4 ounce weight with core still in the fruit). Weighing the fruit on a food scale can help you determine how many carbs it has. A recent honey crisp apple weighed in at 13.4 ounces. That would be about 2.5 carb servings or about 50 grams of carbohydrates.
fmdk: Is there a connection between hyperparathyroidism and diabetes? I have been diagnosed with hyperparathyroidism (currently being monitored), and now my A1C has moved into the prediabetes range.
Andrea_Dunn,_RD,_LD,_CDE: There seems to be a higher risk of developing Type 2 diabetes once you have been diagnosed with hyperparathyroidism, compared to someone without hyperparathyroidism. However, there are many other reasons that might contribute to your risk for developing diabetes. Please talk to you doctor regarding your other risk factors.
cooksh: Does feeling cold have anything to do with having diabetes? I just had my thyroid checked to rule that out, but my hands are like ice.
Andrea_Dunn,_RD,_LD,_CDE: Cold hands, warm heart! Please mention your cold hands to your doctor. They may or may not be related to diabetes.
Chrysanthemum: I do a fasting blood check each morning. I'm not on insulin or pills, just watching my diet so far. I notice that it doesn't seem to matter what I've eaten the day before. The result is always about the same. (Sometimes, I play around just to see if the level increases or decreases.) Am I wrong in assuming what I eat in any given day would determine my level the next morning, or is it more cumulative, what I've eaten for several days is what's showing? In that case, if sticking to the right foods is going to work without medications, how long would it typically take until I notice a decrease in the level?
Andrea_Dunn,_RD,_LD,_CDE: There are a number of factors beside what you eat that can affect blood glucose levels. Sleep adequacy, stress levels, exercise, for example, all play roles in your blood glucose levels. It sounds as if you are monitoring your blood sugar only in the morning (fasting). Have you ever monitored at other times; for example, before a meal and then two hours after a meal? Sometimes, being aware of what the after-meal blood sugar spikes are (for example, keeping after-meal blood sugar under 180) can help show you a picture of what is happening at other times during the day. Often, changes in what you eat and how much you exercise will have an immediate effect on your blood sugar.
parce1: Should people with Type 2 diabetes be counting their carbohydrate intake? How many grams of carbohydrates should the patient with diabetes eat with each meal?
Andrea_Dunn,_RD,_LD,_CDE: The amount of carbohydrate to eat at each meal varies from person to person. Most people need about half their calories per day to come from carbohydrates. People with diabetes who follow an insulin-to-carbohydrate ratio will need to count carbohydrates for blood glucose management. People on a set mealtime insulin schedule should be consistent with the amount of carbohydrates they eat at meals. Some people do well with using the plate method of portion control. Your carbohydrate budget each day will also depend on whether you want or need to lose weight. Please see a registered dietitian/nutritionist for an individual assessment of your needs.
derosy: I have a hard time finding cereal that is low in carbohydrates even though it is very low in sugar. Mini-Wheats and Grape-Nuts are low in sugar but extremely high in carbs. Are they that bad for you?
Andrea_Dunn,_RD,_LD,_CDE: Because cereals, even whole-grain cereals, are good carbohydrate sources, you won't find very low-carb cereals (hot or cold). However, you can moderate the amount you pour into your bowl and control the carbohydrates you put on top of the cereal (choose milk and fruit).
That is all the time we have for questions today. Thank you, Ms. Dunn, for taking time to educate us about Diabetes and Diet.
On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.
To make an appointment with Andrea Dunn or any of the other specialists in Cleveland Clinic’s Outpatient Nutrition Department, please call 216. 444-3046, toll-free at 800.223.2273 (extension 43046) or visit us at my.clevelandclinic.org/departments/digestive/depts/nutrition-therapy#appointments-tab for more information.
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