Bread Choices

Q: My husband has diabetes and we always eat whole wheat bread but wanted something different for a change.  Is rye bread or sourdough bread as good of an option as whole wheat?

A: The simple act of buying a loaf of bread can be a very intimidating chore these days due to the extremely large number of brands, varieties, labels, and advertisements! In many supermarkets, entire aisles are dedicated to selling bread. So what is the optimal choice in terms of nutrition and health?

First of all, you need to start checking the food panel and ingredient list on different bread products. Because ingredients are listed on food labels in order of predominance by weight, you should opt for brands that list “whole grain” among the top three ingredients. Whole grains are an excellent source of fiber which has been shown to play an important role in regulating blood glucose levels. As a general rule of thumb, choose bread varieties that offer at least 3 grams of fiber per serving.

Don’t fall in the trap of buying brands that offer “multi-grain” bread. Multi-grain just means that the flour used to make the bread is made from multiple grains, not necessarily whole grains.

As a matter of preference, I always look for bread that contains no high fructose corn syrup. This compound is found in virtually all commercially prepared goods such as chips, cookies, tomato sauce, and even yogurt and has been linked to overweight and obesity.

Variety is certainly an important characteristic of an overall healthy diet. Because of that, it is definitely possible to incorporate rye and sourdough bread into your diet as long as your choose options that use “whole”, not “refined” flour. In fact, a study published in the American Journal of Clinical Nutrition concluded that rye bread may be a better choice than wheat bread for individuals with diabetes because it induces a lower insulin response.


Protein Needs & Sources

Q: Since I’ve been diagnosed with diabetes, a lot of people have given me advice about how much carbohydrate and fat to eat.  I’m wondering about protein.  How much protein should I get in my diet and from what foods besides meat?

A: According to dietary recommendations, the Average Macronutrient Density Range (AMDR) for protein is 10 to 20% of your total daily caloric expenditure. For a 2,000 calorie diet, this adds up to 50 to 100 grams of protein per day.

Dietary protein is found in foods of plant and animal origins. Examples of animal-based proteins include beef, pork, lamb, poultry, dairy, eggs, and seafood whereas plant-based proteins are found in beans, quinoa, lentils, tofu, and legumes. When choosing protein sources in your diet, go for low or non-fat cheese, milk, and yogurt and buy lean cuts of meat and poultry. It is also recommended to remove the skin and trim excess fat from meat and poultry before cooking to reduce your overall intake of fat. If you are a vegetarian, make sure you are meeting your protein needs by consuming combinations of foods that compliment each others’ amino acid content. For example, consume beans along with rice or pasta with cheese.

Ideal Blood Glucose Range

Q: I have diabetes and my blood sugar is all over the map.  Could you please tell me the ideal blood sugar level?

A: According to the American Diabetes Association, the typical blood glucose levels for adults with diabetes are as follows:

– Before a meal or pre-prandial blood glucose levels: 70 to 130 mg/dl

– After a meal or post-prandial blood glucose levels: <180 mg/dl

To check your blood glucose levels, consult your physician or certified diabetes educator. You can also use a special device known as a glucometer to measure your glucose levels. The American Diabetes Association recommends keeping a log of your glucose measurements to assess how well your condition is being controlled.

You can find a sample log at this link :

Popcorn and Pre-diabetes

Q: I have pre-diabetes and enjoy having an afternoon snack.  Is microwave popcorn ok for me to have?

A: Popcorn belongs to a class of carbohydrates known as whole grains, which are considered a rich source of fiber. Fiber is important for diabetic patients because it helps in regulating blood glucose (sugar) levels. In addition, having snacks at regular intervals will ensure steady blood glucose levels and prevent sudden bouts of hyperglycemia (low blood sugar).

However, microwavable popcorn varieties are mostly high in sodium and fat. To enjoy the benefits of popcorn, pay attention to food labels and go for brands with little or no added salt and fat. Better yet, air pop your own popcorn at home with garlic and fresh herbs!

Counting Carbs

Q: I was diagnosed with type 2 diabetes last month.  I’m having difficulty understanding how many carbs and sugar I can have each day.  I’m finding that nearly everything contains carbs and sugar!  Can you help me with this?

A: Counting and controlling your intake of carbohydrates is an essential element in managing diabetes. Carbohydrate or carbs are found in many food groups including grains, cereals, starches, fruits, vegetables, and milk. According to dietary recommendations, carbohydrates should account for 50 to 60% of your total daily calories. For a 2,000 calorie diet, this adds up to 250 to 300 grams of carbs per day. The American Diabetes Association recommends consuming 50 to 60 grams of carbohydrates at one meals to avoid sudden spikes or crashes in blood glucose (sugar) levels. 1 cup of milk (12 grams) , 2 slices of toast (30 grams) , and an apple (15 grams) supply around 60 grams of carbs.

The Diabetes exchange list is an extremely useful resource when it comes to counting carbs. In fact, the exchange list was originally created to serve the purpose of assisting diabetic patients in planning meals and making healthier food choices. You can find the exchange list online or in any introductory nutrition text.

According to the exchange list, carbohydrate-containing food groups are divided as follows:

– Milk group: Each serving in this group contains 12 grams of carbs

– Fruit: Each serving in this group contains 15 grams of carbs

– Vegetables: Each serving contains 5 grams of carbs

– Starches: Each serving contains 15 grams of carbs

Diabetes & Weight Management

Q: I have pre-diabetes and my doctor has told me if I don’t lose weight I will end up with type 2 diabetes.  I have about 75 pounds to lose.  Could you tell me the best way to do this?

A: It is true, strong evidence has shown an association between overweight and Type 2 diabetes mellitus (T2DM). In fact, diabetic patients can often bypass their prescribed medication if they succeed in controlling their weight through diet and exercise. Losing weight is by no means an easy task. However, a little determination and discipline can go a long way.

– Start out by setting a realistic goal. The best and most successful way to lose weight is to do so on a steady and gradual pace. Keep in mind that your main objective should be keeping the weight off long term rather than just losing weight short term. Aim for a weight loss rate of 1 to 2 pounds per week.

– Keep a food diary for 3 days (preferably 2 week days and 1 week end) of your daily intake. Don’t forget to include beverages. Try to be as detailed as possible in order to figure out the areas that require modification in your diet. A helpful tip is to change your daily eating pattern to include 5 or 6 small meals instead of 3 large ones. This will help in maintaining your blood glucose (sugar) level at a steady rate and will prevent sudden crashes that may cause over eating. Consult a registered dietitian if you need extra help with meal planning and calorie counting.

– Consult your physician to make sure that you are healthy enough for physical activity. After getting the OK from your doctor, start out slowly and gradually. For example, take a 10 minute stroll during your lunch hour every day for a week, then increase the duration and intensity. Other easy ways to incorporate activity in your daily schedule include parking your car in a far location and taking the stairs instead of the elevator. According to the Dietary Guidelines for Americans, it is recommended to by physically active for at least 30 minutes per day. However, if your schedule does not allow for 30 minutes of continuous activity, break it up into 10 or 15 minutes intervals. Exercising on a regular basis will help boost your mood, tone your muscles, and manage your weight.

The Scoop on Fats

Q: I have pre-diabetes and am confused about fats.  A friend was telling me there are “healthier fats” I should be including in my diet.  I thought all fats were bad?  Could you tell me which fats I should include in my diet (if any)?

A: Fats or lipids constitute an essential class of nutrients in our diet. It is definitely not true that all fats are bad. Some of the important functions that fats perform in our body include cushioning vital organs such as the the kidneys, insulating our body against extreme temperatures, and transporting fat-soluble vitamins.

However, not all fats are created equal! Fats are classified into two types: saturated and unsaturated fats. This classification is based on the lack (saturated) or presence (unsaturated) of double bonds in the chemical structure of the fat molecule. Saturated fats are found in foods originating from animal sources including fatty cuts of meat and poultry, butter, full-fat dairy products, chocolate, and pastries. On the other hand, unsaturated fats are found in foods of plant origin such as oils, seeds, nuts, olives, and avocados.

Research has shown a strong relationship between cardiovascular disease and the intake of saturated fats. This is true because this type of fat tends to accumulate along the inner walls of arteries in the form of plaque, thereby increasing the risk of blockage. To reduce your risk of heart disease and stroke, lower your intake of saturated fats as much as possible. In fact, the American Heart Association recommends limiting the intake of saturated fats to no more than 7% of total calories. Trans fats are another type of fats that are found in commercially prepared foods such as baked goods, processed foods, and margarine. Those fats act in a very similar way as saturated fats. Watch out for trans fats by checking food labels for “partially hydrogenated oils”.

Unsaturated fats play an important role in maintaining our health and well being. Specifically, omega-3 fats are a class of unsaturated fats that are shown to  reduce the risk of heart disease.  This is true because omega-3 fatty acids play a role in dilating blood vessels and thus lowering the risk of blocked arteries. Omega-3 fats are predominantly found in fatty fish such as tuna, mackerel, salmon, sardines, Atlantic herring, swordfish, and lake trout. The American Heart Association recommends eating fish at least twice a week to ensure an adequate intake of omega-3.

To increase your intake of unsaturated fats in general, follow these simple tips:

– Add nuts such as almonds, walnuts, or pecans to your morning oatmeal or yogurt

– Sprinkle toasted sesame, pumpkin or sunflower seeds on your salads

– Use oils instead of butter and margarine whenever possible

– Substitute frying for healthier cooking techniques such as grilling or sauteing