Nutrition Basics for Diabetes and Heart Health
Diet and nutrition are part of the treatment for both diabetes and heart disease, but what are the differences between these two recommended diets? We talked with diabetes educator Toby Smithson, author of Diabetes Meal Planning and Nutrition for Dummies, founder of DiabetesEveryDay.com and spokesperson for the American Association of Diabetes Educators.
Before we had asked a single question about the subject, Smithson, a registered dietitian nutritionist (RDN) and certified diabetes educator (CDE) who has successfully managed her own diabetes for more than 45 years, said, “Let me start with this statement: The American Heart Association guidelines for a heart healthy diet and the American Diabetes Association guidelines for healthy eating for people with diabetes go hand in hand. I don’t see them as two separate meal-planning systems. I see them working very closely together and, honestly, without any difference really in what I would tell either population.”
Oftentimes, by the time someone is diagnosed with Type 2 diabetes, it may have been developing for some time. “The truth is we often don’t know how long someone’s diabetes has been brewing,” she said. “It may have been 10 years that they’ve had Type 2 diabetes, but it was undiagnosed. What that tells me as an educator is that they are at even higher risk for heart disease because they may not have made any effort to eat a healthy diet.”
The American Heart Association has outlined a healthy eating plan in a recent guideline in association with the American College of Cardiology. This plan is illustrated and made easy to understand by a diagram of a plate subdivided into four portions — grains, vegetables, fruit and protein with a side of dairy. The information in the following four paragraphs is adapted from the USDA Center for Nutrition Policy and Promotion’s ChooseMyPlate.gov website.
Grains can be Whole Grains and Refined Grains. Whole grains contain the entire grain kernel ― bran, germ, endosperm. Examples of whole grains are whole-wheat flour, bulgur (cracked wheat), oatmeal, whole cornmeal and brown rice. Refined grains have been milled to remove the bran and germ, which gives grains a finer texture and improves their shelf life, but it also removes dietary fiber, iron and many B vitamins. Refined grain products are white flour, de-germed cornmeal, white bread and white rice.
The Vegetable Group comprises five subgroups: dark green vegetables, red and orange vegetables, starchy vegetables, beans and peas, and other vegetables.
Any fruit or 100 percent fruit juice counts as part of the Fruit Group. Fruits may be fresh, canned, frozen or dried and may be whole, cut-up, or pureed and should not be packaged in syrup as it adds sugar.
The Protein Foods Group includes meat, poultry, seafood, beans and peas, eggs, processed soy products, as well as nuts and seeds.
Carbs are of concern to people with diabetes because of their effect on blood sugar, and Smithson says there’s a lot of misinformation about them, possibly because of fad diets that demonize carbs. “People don’t realize that there’s more than just potatoes, bread, rice, pasta that’s carbohydrate,” she said. “Fruits and starchy vegetables contain carbohydrates, as do beans and black-eyed peas. Milk and yogurt, too.”
There are three types of carbohydrates — starches, sugars and fiber.
- Sugars (also called simple carbs) generally affect the blood sugar quickly; in diabetes lingo they are “fast-acting.” Sugar, hard candy, white bread or regular soda are examples of simple carbs.
- Starches (also called complex carbs) are sloweracting. Complex carbs tend to have some fiber in them that helps to slow down the absorption. “Those carbs don’t produce spikes in blood sugar the way simple carbs do. You want your blood sugar steady,” Smithson said.
- Fiber is the indigestible part of plants. Even though it is indigestible, it is good for our digestion and elimination. There are two different types of fiber — soluble and insoluble. Both are important for health, digestion and preventing diseases.
- Soluble fiber attracts water and turns to gel during digestion. This slows digestion. Soluble fiber is found in oat bran, barley, nuts, seeds, beans, lentils, peas and some fruits and vegetables. It is also found in psyllium, a common fiber supplement. Some types of soluble fiber may help lower risk of heart disease.
- Insoluble fiber is found in foods such as wheat bran, vegetables and whole grains. It adds bulk to the stool and appears to help food pass more quickly through the stomach and intestines.
On nutrition labels, “total carbohydrate” includes all three types. For people with diabetes who are counting carbs, that is the number they should pay attention to. According to an American Heart Association Scientific Statement from 2015, carbohydrate monitoring is an important strategy. Simple sugar consumption — soft drinks, candy, refined grain products and added sugars should be replaced with eating fruits, legumes, vegetables, whole grains and low-fat dairy products.
Most fruits are almost all carbohydrates with little to no protein or fat (avocado is a notable exception). When eating them, people with diabetes need to consider portion size — 15 carbohydrate grams is considered a serving. “That would be about six to eight grapes. It’s not just a handful, there’s a specific amount,” Smithson said.
“Right now, many people with diabetes are trending towards high-protein, low-carb diets,” she said. “With that eating pattern, people need to pick leaner cuts of meat, skinless chicken and turkey, or fish, and it should either be baked or broiled, never fried. I worry that many of my clients are conveniently forgetting about going with the lean choices.”
The American Heart Association recommends limiting intake of saturated fats — which are found in butter, cheese, red meat and other animal-based foods. In addition, many baked goods and fried foods can contain high levels of saturated fats and trans fats. Some plant based oils, such as palm oil, palm kernel oil and coconut oil, also contain primarily saturated fats. Decades of sound science has proven it can raise your “bad” cholesterol and put you at higher risk for heart disease.
Making the transition to healthy eating
Changing our eating patterns — whether for our heart or our blood sugar — can be challenging and uncomfortable, but it is not impossible. It probably will be slow, and there will likely be backsliding to old habits. Smithson has this advice to make that transition: “People take on too much and get overwhelmed. It’s too big a goal to change your eating habits all at once. When I work with people with diabetes, we set small, achievable goals so that we make baby steps in making changes. We break down the big problem into small steps. Here’s an example: A person wants to eat more vegetables because that’s a healthy choice for managing both blood glucose levels and heart disease. Right now, they only eat vegetables at dinner. Baby step 1, they make a small goal of adding one serving of vegetable at lunch every day. If they achieve that we go to baby step 2; if not, we modify the goal.”
What doesn’t work
One of the things that Smithson is sure doesn’t work in changing eating habits is fad diets. “They are quick fixes, and there aren’t any quick fixes. It takes time to change our eating habits. When you see information or advertisements, check with a dietitian. They have evidence-based information.”
The 2015 American Heart Association Scientific Statement also acknowledges the challenge of changing eating patterns and recommends that people with diabetes consult with a dietitian or diabetes educator to improve their odds of success.
Changing habits is a challenge. Maintaining those changes in the face of your family’s unhealthy choices and the constant barrage of marketing for fad and bad food is also challenging. Smithson’s counsel: “It definitely does take some time to eat healthy. Planning is key, so arm yourself with healthy choices so you can avoid not-so-good choices. Breakfast is a good example.
At night or on the weekend, put together a breakfast pack that you can grab on those mornings you get up too late and have to skip breakfast. That way you’re armed with healthy food choices instead of going to a drive through or eating donuts at the office. I advise my clients to always arm themselves with healthy choices for both breakfast and lunch. That’s what I mean by planning, making the healthy choice the easy choice.”
In the midst of the double diagnosis of diabetes and heart disease, it is easy to feel overwhelmed, so this is a little piece of good news: you don’t have to have different diets for each condition, what is good for one is good for the other.
This information is provided as a resource to our readers. The tips, products or resources listed or linked to have not been reviewed or endorsed by the American Heart Association.