Not so long ago, a diagnosis of diabetes meant losing some of life’s great pleasures: No sugar. No fat. Your favorite foods likely slashed from the menu. But no more.
“We don’t even talk about a ‘diabetic diet’ anymore, ” said Regina Linehan, a registered nurse who coordinates Outpatient Diabetes Education at Pennsylvania Hospital in Philadelphia.
That’s good news, because U.S. health experts are calling the rise in new diabetes cases an epidemic.
Already, one in five Americans age 65 and older has been diagnosed as diabetic. And a recent study by the Centers for Disease Control and Prevention showed diabetes escalating through the 1990s by more than 35 percent, with a jump of 40 percent among people in their 40s and nearly 70 percent among those in their 30s.
Yet new drugs and research are allowing more effective management of the disease.
Perhaps the biggest change has been in the realm of diet. Everyone should follow a healthful food plan, Linehan says, especially people with diabetes. Yes, there are foods to avoid, but nothing is ruled out if you’re willing to “exchange ” one food for another.
Everybody stay calm
“The first thing I tell people is to take a deep breath, relax, and don’t be too anxious. For every individual, there’s an individualized diet plan, ” Linehan said.
“In the beginning, though, we do ask people to avoid concentrated sweets–candy, cake, fruit juice and soda, the empty calories. “
In diabetes, the pancreas fails to produce enough insulin (Type 1 diabetes, which usually begins during childhood) or the pancreas produces enough insulin but the body doesn’t use it efficiently or doesn’t process sugar properly (Type 2, or adult-onset). In turn, blood sugar increases.
Sweets and other refined foods (such as white flour) send a rush of glucose (sugar) into the bloodstream soon after eating. Less processed foods (such as whole grains) are digested slowly, stimulating an even flow of glucose that someone with limited insulin can process more easily.
Then comes advice on healthful food choices, but it’s up to patients to tailor their eating plans.
“We can give people lists and menus until the cows come home, ” Linehan said, “but that doesn’t mean they’ll adjust to a new diet. “
Even major changes in diet reflect personal tastes. That was certainly the case for Ethel English, who turned to Pennsylvania Hospital’s diabetes classes after her diagnosis seven years ago.
“I was always a bread eater, but I’ve gone from three or four slices at a meal down to just one slice a day, which I save for dinner, ” said English, 73, who lives in Philadelphia. “If I have pasta or a starchy food, I won’t have bread at all. “
English indulges her love of fruit with just three servings a day, with her 3-ounce glass of orange juice at breakfast counting as one. For another, she might choose half a banana or 12 — count ’em — 12 grapes. Meat portions are 3 ounces each, about the size of a woman’s palm.
“We’re taught that there are no bad foods, ” English said, “just bad portions and too much food. “
The typical Type 2 patient
English fits the diabetes profile. She has nearly all the risk factors: Over age 45. Overweight. Inactive. And with high blood readings of “bad ” cholesterol (triglycerides and LDL, or low-density lipoprotein) and little “good ” cholesterol (HDL, or high-density lipoprotein).
As an African American, she also is in the group (with Latinos and American Indians) whose members are roughly twice as likely to develop Type 2 diabetes, which accounts for 95 percent of known U.S. cases.
English was diagnosed at age 66. During a medical checkup, she says, blood tests revealed her high glucose level. She had none of the symptoms: unusual thirst, extreme hunger, excessive fatigue, blurred vision, irritability, weight loss, frequent infections, slow-healing cuts or bruises, or tingling to numbness in the hands or feet.
For the first year, English was on a diet and exercise regimen that proved insufficient to manage her condition. Now she takes Glucophage, one of the newer oral medications, each day before breakfast and dinner.
Long linked to excess weight, Type 2 recently was traced to a hormone, resitin, released by fat cells. About 85 percent of people with Type 2 diabetes are overweight. Weight loss, exercise and diet are sometimes sufficient to manage the disease.
For more information
American Diabetes Association Information Hotline, Alexandria, Va; 800-232-3472, or www.diabetes.org. Get information on books, programs and local contacts.
Juvenile Diabetes Foundation International, 800-533-2873 or www.jdf.org. Information on Type 1 diabetes.
Cookbooks for diabetics
These cookbooks–some new, others enduring–will help meet the needs of diners with diabetes.
– “Cooking with the Diabetic Chef, by Chris Smith (American Diabetes Association, $19.95). Smith trained at the Culinary Institute of America and apprenticed at Le Cirque in New York before he was diagnosed with Type 1 diabetes. He created and adapted recipes for home cooking that have restaurant flair.
– “Express Lane Diabetic Cooking, ” by Robyn Webb (American Diabetes Association, $16.95). Quick, yet healthful recipes prepared with a few convenience foods from the salad bar, deli and freezer sections.
– “Forbidden Foods Diabetic Cooking, ” by Margaret A. Powers and Joyce L. Hendley (American Diabetes Association, $16.95). Recipes for 150 foods you may have thought weren’t permitted in a diabetic diet, including fried chicken, devil’s food cake and cheesecake.
– “The Good Carb Cookbook: Secrets of Eating Low on the Glycemic Index, ” by Sandra Woodruff (Avery/Putnam, $15.95). The latest word on the glycemic index, which ranks carbohydrate foods based on their potential to raise blood-sugar levels and demand for insulin.
– “The Joslin Diabetes Gourmet Cookbook: Heart-Healthy, Everyday Recipes for Family and Friends, ” by Bonnie Sanders Polin, Frances Towner Giedt and Edward Horton (Bantam Doubleday Dell, 1993). A keeper with input from the nation’s leading diabetes research and care facility.
– “The New Soul Food Cookbook for People with Diabetes, ” by Fabiola Demps Gaines and Roniece Weaver (American Diabetes Association, 1999). More than 150 recipes for slimmed-down versions of shrimp jambalaya, barbecued pulled pork, fried okra, and more.
— Marilynn Marter
Chicken sauteed with roasted garlic, mushrooms and onions
Preparation time: 30 minutes
Cooking time: 55 minutes
Yield: Four 1-cup servings
Adapted from “Cooking with the Diabetic Chef, ” by Chris Smith, this recipe is an example of a balanced approach to food preparation that doesn’t rely on a lot of fat, sugar or processed ingredients for flavor. Once roasted, the garlic doesn’t overwhelm, even though the recipe contains an entire head.
1 head garlic
5 1/2 teaspoons olive oil
1 pound chicken tenders or boneless skinless chicken breasts cut into 3/4-inch strips
1 teaspoon each: salt, freshly ground pepper
1/2 cup flour
1 onion, sliced
3 green onions, sliced
1/2 pound mushrooms, sliced
1/2 cup chicken broth
1. Heat oven to 350 degrees. Slice off the top of the garlic head so the garlic cloves are just exposed. Place in a baking dish and rub 1 teaspoon of the olive oil over the skin. Bake until soft, 20-30 minutes. Let cool slightly and squeeze garlic pulp from each clove, discarding the skins. Mash garlic into a paste; set aside.
2. Season chicken with salt and pepper. Coat chicken evenly in flour in a shallow bowl.
3. Add 11/2 teaspoons olive oil to the pan along with onion and white parts of green onions. Cook onions until tender, about 7 minutes. Add mushrooms; cook 3 minutes longer. Remove mixture from pan; reserve.
4. Heat remaining 3 teaspoons olive oil in same pan over medium-high heat. Add chicken; cook, turning occasionally, until golden brown on all sides and cooked through, 8-10 minutes.
5. Stir in onion mixture and garlic puree. Add chicken broth to pan and stir to dissolve any brown bits stuck to pan. Heat to boiling to reduce slightly. Serve garnished with green part of green onions.
Nutrition information per serving:
285 calories, 30% calories from fat, 9 g fat, 1.7 g saturated fat, 60 mg cholesterol, 740 mg sodium, 22 g carbohydrate, 28 g protein, 2.4 g fiber
Exchanges per serving: 2 lean meat, 2 vegetable, 1 fat, 1 starch
