En español | Long before the U.S. government replaced its pyramid-shaped nutrition chart with a round one, the American Diabetes Association (ADA) was using a plate to teach prevention and management of that disease.
Although diabetes today affects roughly 1 in 12 Americans — and more than 1 in 4 Americans age 65 and over — there is good news on that ADA plate, says diabetes educator Sue McLaughlin. By combining ADA's carefully balanced diet with regular exercise and weight control, people who have diabetes can prolong good health, says McLaughlin. "And those who don't have the disease but are at increased risk for its development may delay or prevent its onset."
When the human body processes food, it breaks down sugars and starches into glucose — but to take the glucose from the blood into the cells that use it as fuel, the body needs a hormone called insulin. If insulin is scarce or absent, glucose builds up in the blood and can lead to complications including heart disease and stroke, kidney and nervous system disease, and blindness. In Type 2 diabetes, the most common form of the disease, the body either does not produce enough insulin, does not use it well, or both.
To help their bodies use glucose, people with Type 2 diabetes may use oral medications or insulin injections. "But anyone can, so to speak, 'out-eat' their diabetes medication" by consuming too much food or too many calories, McLaughlin says. So diet is critical to achieving the balance that keeps diabetics healthy, and to preventing progression of the disease for the estimated 79 million Americans with prediabetes (blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes).
"What's good for people at risk for diabetes, or who have diabetes, is generally what's good for all of us," McLaughlin says. "It's eating foods that are nutrient-dense, high in vitamins, minerals and fiber. It's eating those that are lower in fat and overall calories, and monitoring our intake of carbohydrate-containing foods that directly cause the blood sugar to rise. It's balancing 'calories in, calories out' by eating with good health in mind, and getting regular exercise so you maintain a good weight, ideally a body mass index of 25 or less." (Don't know your BMI? Use the Body Mass Index Calculator to calculate it.)
The ADA's "create your plate" campaign uses a 9-inch plate to manage portion size and nutritional balance in five steps:
- Imagine a line down the middle of the plate, cutting it in half. Fill one half of the plate with non-starchy vegetables: salad, green beans, tomatoes, cabbage, carrots, cauliflower, broccoli.
- Imagine a second line cutting the other half of the plate into two equal parts. Fill one of those parts with starchy foods: noodles, rice, corn, potatoes, beans, whole-grain bread.
- Fill the remaining quarter of the plate with meat or meat substitute: lean beef or pork, poultry, fish, seafood, eggs, low-fat cheese, tofu.
- Add one piece of fruit (or a ½-cup serving of fresh, frozen or canned-in-juice fruit).
- Add an 8-ounce glass of non-fat or low-fat milk (or, if you don't want milk, another small serving of a carbohydrate such as a 6-ounce container of low-fat yogurt or a small roll).
(For breakfast, the plate is divided the same way but filled somewhat differently: starches in half the plate, fruit in one quarter of it and meat/meat substitute in the other quarter.)
In each part of the plate, specific food choices will depend on an individual's primary health concern, McLaughlin says. "If I'm a person with Type 2 diabetes, or at risk for Type 2, my primary focus might be on reducing my intake of total calories and saturated fats because fat contributes more calories to the diet than either carbohydrate or protein. For most of us, as long as our intake includes nutrient-dense choices a majority of the time, small amounts of foods that contain a bit more sugar or fat can also be included.
Upon learning they have or are at risk for diabetes, people generally "try to make dietary and other lifestyle changes, but they can get overwhelmed with all the things they have been advised to do," McLaughlin says. In that situation, she advises turning to old stand-bys: the family slow-cooker, and familiar recipes. Loading a slow-cooker with recipe ingredients in roughly the same proportions as on the ADA plate — light on the starch and protein, heavy on the veggies — "is a great way to come home and know you'll have a healthful meal ready when you're hungry or need to eat," McLaughlin says. "And while lots of people still use church cookbooks or old family recipes with ingredients that should be limited, in most of them, there are simple ways to reduce the calories and fat and increase the fiber," she says. "Things like using an artificial sweetener in place of all or part of the sugar; using egg whites instead of whole eggs, and using whole-wheat flour to replace half the white flour." One of McLaughlin's favorite cookbooks — Diabetes Meals on $7 a Day — or Less!, published by the ADA — has the dual benefits of helping diners keep calories in line and live on a budget. (McLaughlin especially recommends the "Eating Out on a Lean Budget" tips on page 67, and the Crunchy Oriental Coleslaw recipe on page 104.)
In McLaughlin's view, "the tough part for any of us, no matter our family or ethnic or cultural background, is that we come to the table with things we've been brought up on and lived with all our lives." But changing eating and physical activity patterns can be key, she says, "to preventing or delaying Type 2 diabetes. It's important to know what we can do to help ourselves maintain good health for a lifetime."
Who Is at Risk?
According to the American Diabetes Association (ADA), you are at higher risk for developing prediabetes or Type 2 diabetes if you:
- Are over age 45
- Are overweight
- Do not exercise regularly
- Have low HDL cholesterol, high triglycerides or high blood pressure
- Had gestational diabetes or had a baby weighing 9 pounds or more at birth
- Are African American, Latino, Native American, Asian American, or Pacific Islander (including Native Hawaiian)
The ADA website offers a brief online quiz to determine your risk factors for developing diabetes. Risk and prevention information also is available on the website of the National Institutes of Health’s National Diabetes Education Program. And the ADA offers a free 12-month program through which people can receive information (by postal mail or email).
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