Nutrition & Diabetes

This week’s http://www.foodpicker.org question is: I was recently diagnosed with Pre-Diabetes and I’m trying to follow a low fat diet.  I have a question I hope that you can answer.  Are sweet potatoes considered a vegetable and are they ok to eat in my diet?

Sweet potato is a starchy vegetable, therefore it contains 15 grams of carbohydrates per serving.  Sweet potatoes are okay for your diet as long as you eat it in moderation.  According to the American Diabetes Association and American Dietetic Association “Choose Your Foods: Exchange Lists for Diabetes,”  people with pre-diabetes or diabetes do not require special foods.  It’s all about moderation and making sure you do not eat too much carbohydrate rich foods in a meal.  All foods contribute to your blood glucose, but it is the carbohydrate rich foods that really make your blood glucose levels rise.

Sweet potato is a carbohydrate rich vegetable because it is a starchy vegetable.   Non-starchy vegetables like cucumber, summer squash, zucchini, and tomatoes contain only 5 grams of carbohydrates per serving compared to the 15 grams of carbohydrates per serving in starchy vegetables.

Ideally, you would want to eat more of the non-starchy vegetables over the starchy vegetables.   You can eat more of the non-starchy vegetables because they are lower in carbohydrates compared to the starchy vegetables, and this will help you with managing your pre-diabetes.  Starchy vegetables have important nutrients too, but since they are higher in carbohydrates they should be eaten in moderation.  Consuming too many carbohydrates at one given time can raise your blood sugar levels.

1 serving of a starchy vegetable  = 15 grams of carbohydrates = one carbohydrate exchange

1 serving of a non-starchy vegetable = 5 grams of carbohydrates, therefore 3 servings of a non-starchy vegetable = 15 grams of carbohydrates = one carbohydrate exchange

In other words,

One serving of sweet potato (starchy vegetable) is 1/2 cup = 15 grams of carbohyrdates

1/2 cup of cooked non-starchy vegetable (i.e., broccoli) is one serving = 5 grams of carbohydrates, therefore  1  1/2 cups of cooked non-starchy vegetables = 15 grams of carbohydrates

1 cup of raw non-starchy vegetable (i.e., celery) is one serving = 5 grams of carbohydrates, therefore 3 cups of raw non-starchy raw vegetables = 15 grams of carbohydrates

(Note: Salad greens are considered a free food because it has less than 5 grams of carbohydrates per serving.  There is no serving size for salad greens, therefore you can eat as much of it as you like.  Some examples, of salad greens are chicory, endive, escarole, lettuce, romaine, arugula, radicchio, and watercress.)

It is important to look at those servings sizes because most people eat more than one serving size.  For example, most people eat one cup of rice rather than the serving size of  1/3 cup of rice.  Keep that in mind when you are planning your meals and keeping track of carbohydrate rich foods on your plate.  There should be a balance of carbohydrate, protein, and fat.  If you want to eat sweet potato as part of your meal, then you want to make sure you do not load your plate with other carbohydrate rich foods (i.e., bread).

Below are some examples of one serving size of starchy and non-starchy vegetables:

One serving of starchy vegetables = 15 grams of carbohydrates

1/3 cup cassava

1/2 cup corn

1/2 cob (5 oz) of a  large corn on the cob

3/4 cup canned Hominy

1 cup mixed vegetables with corn, peas, or pasta

1/2 cup parsnips

1/2 cup green peas

1/3 cup ripe plantain

1/4 large (3 oz) potato baked with skin

1/2 cup or 1/2 medium (3 oz) boiled potato

1/2 cup of mashed potato made with milk and fat

1 cup (2 oz) of roasted potato (cubed)

1 cup of canned pumpkin

1/2 cup of spaghetti/pasta sauce

1/2 cup winter squash (acorn, butternut)

1/2 cup succotash

1/2 cup yam, sweet potato

One serving of a non-starchy vegetable = 5 grams of carbohyrdates

1/2 cup cooked = one serving

1 cup raw = one serving

artichoke, asparagus, baby corn, bamboo shoots, green beans, wax beans, Italian beans, beets, borscht, broccoli, brussels sprouts, cabbage, carrots, cauliflower, celery, chayote, packaged coleslaw, cucumber, daikon, eggplant, gourds (bitter, bottle, luffa, bitter melon), green onions (scallions), collard greens, kale, mustard, hearts of palm, jicama, kohlrabi, leeks, mixed vegetables (without corn, peas, or pasta), mushrooms, okra, onions, pea pods, peppers, radishes, rutabaga, sauerkraut, soybean sprout, spinach, squash (summer, crookneck, zucchini), sugar snap peas, swiss chard, tomato, canned tomatoes, tomato sauce, tomato/vegetable juice, turnips, water chestnuts, and yard-long beans

This week’s http://www.foodpicker.org question is: I have recently been diagnosed with diabetes and my wife has pre-diabetes.  New Year’s Eve we always have a large celebration with cocktails and lots of food.  We are growing weary of the party this year given my new diagnosis.  Any tips on how we can still enjoy the party?

There are many tips for you to still enjoy the New Year’s celebration with all those cocktails and foods around.  It is all about moderation and watching in particular the carbohydrate rich foods that are being served.   All foods contribute to to your blood glucose levels, but it is the carbohydrate rich foods like breads, starchy vegetables, crackers, and desserts that really make blood glucose levels rise.  Also, some alcoholic beverages can contain lots of carbohydrates.

This is a time to be excited for a brand new year and you should be excited about the party.  Below I have included some examples of different foods that might be served at the party to give you an idea of what to look out for.  The examples show what one serving of a particular food cost in terms of how carbohydrate rich it is.  I hope this helps.

According to the Choose Your Foods: Exchange Lists for Diabetes by the American Diabetes Association and American Dietetic Association:

One serving (exchange) of starchy foods like breads, cereals, grains, starchy vegetables (i.e., potato, corn), crackers, beans, and peas = 15 grams of carbohydrates per serving.

One serving of dessert = 15 grams of carbohydrates per serving.

One serving of milk = 12 grams of carbohydrates per serving.

Compare the starchy foods, desserts, and milk to non-starchy vegetables like broccoli, carrots, cucumber that have 5 grams of carbohydrates per serving.   The non-starchy vegetables are low in carbohydrates compared to the  desserts, starchy foods, and milk.

Eating too many servings of starchy foods, desserts, and milk can potentially make your blood glucose levels to become too high.  People usually eat more than one serving size of food, so keep that in mind when keeping track of the carbohydrates that are being consumed at a given time.   Try to go more for the protein rich foods and non-starchy vegetables.

Keep in mind that one serving of fruit also has 15 grams of carbohydrates.  Fruits are good for you, but having too much can raise your blood sugar levels.

Lean, medium-fat, and high-fat meat do not have carbohydrates.

Plant-based protein and alcohol varies in carbohydrates.

Examples:

Alcohol (1 alcohol equivalent (1/2 oz absolute alcohol) = 100 calories)

12 fl oz of light (4.2%) beer =  1 alcohol equivalent + 1/2 carbohydrate exchange (7.5 grams of carbs)

12 fl oz regular (4.9&) beer = 1 alcohol equivalent + 1 carbohydrate exchange (15 grams of carbs)

1  1/2 fl oz distilled spirits = 1 alcohol equivalent

1 fl oz Liqueur, coffee (53 proof) = 1/2 alcohol equivalent + 1 carbohydrate exchange (15 grams of carbs)

1 fl oz Sake = 1/2 alcohol equivalent

3  1/2 fl oz Wine, dessert (sherry) = 1 alcohol equivalent + 1 carbohydrate exchange (15 grams of carbs)

5 fl oz Wine, dry, red or white (10%) = 1 alcohol equivalent

Starch examples:

6 crackers or 3 cups of popcorn or 3/4 oz of pretzels = 15 grams of carbohydrates

13 tortilla or potato chips = 15 grams of carbohydrates

1/2 cup of mashed potatoes or 1/3 cup of rice or 1/2 cup of beans = 15 grams of carbohydrates

1 slice of bread or 1/2 of a hot dog bun or 1/2 of a hamburger bun = 15 grams of carbohydrates

Fruit examples:

1/2 cup orange juice or 1/2 cup of pineapple juice = 15 grams of carbohydrates

1   1/4 cup of whole strawberries or 17 small grapes = 15 grams of carbohydrates

Other drinks:

1/2 cup of cranberry juice cocktail = 15 grams of carbohydrates

1 (8.3 oz) can of Energy drink = 30 grams of carbohydrates

1 cup (8 oz) of fruit drink = 30 grams of carbohydrates.

1 can (12 fl oz) can of soda = 37.5 grams of carbohydrates

1 envelope of hot chocolate made with water = 15 grams of carbohydrates

Dessert examples:

1  1/2 inch square brownie that is 7/8 high = 15 grams of carbohydrates

2-inch square frosted cake = 30 grams of carbohydrates

2-inch square unfrosted cake = 15 grams of carbohydrates

2 chocolate chip cookies = 15 grams of carbohydrates

3 gingersnap cookies = 15 grams of carbohydrates

1 small frosted cupcake = 30 grams of carbohydrates

1/2 cup of fruit cobbler = 45 grams of carbohydrates

1/6 of a 8-inch commercially prepared fruit pie with 2 crusts = 45 grams of carbohydrates

1/8 of a 8-inch pumpkin or custard pie = 22.5 grams of carbohydrates

This week’s http://www.FOODPICKER.org question is: “I have diabetes and this time of year is the toughest for me.  It seems holiday treats/sweets are everywhere tempting me!  Is it ok to indulge a little?  If not, how can I build up enough will power to avoid holiday sweets?”

I completely understand where you are coming from and how difficult it can be to stay away from the treats/sweets during the holidays.  My advice would be to not deprive yourself and enjoy some the desserts, but just kept your consumption moderate.  If you deprive yourself, it is only going to make you want the dessert even more and might lead to overeating later.  According to the American Diabetes Association and American Dietetic Association’s “Choose Your Foods: Exchange Lists for Diabetes,” people with diabetes can eat anything and that includes sugar, but the meals have to be balanced.  There has to be a balance of carbohydrate, protein, and fat on your plate.  Sweets/treats are fine as long as there is a balance.

The important thing is to make sure that your blood sugar levels do not skyrocket.  If you want the sweets, then you would have to control the other carbohydrate rich foods that you are eating throughout the day.   All foods contribute to your blood sugar levels, but the carbohydrate rich foods are the ones that raise your blood sugar levels the most.

For example, if there is dessert after dinner, make sure there is more meat, protein, and non-starch vegetables on your dinner plate and go low on carbohydrate rich foods like mash potatoes, bread, or pasta.  This way you do not load up on carbohydrates during dinner and the carbohydrates are saved for the dessert.

Below there is a guide to show how  dessert can still be part of meal by looking at how much desserts cost in terms of carbohydrate choices:

According to the “Choose Your Foods: Exchange Lists for Foods,” one serving of carbohydrate choices like breads, cereals, grains, starchy vegetables, crackers, beans have 15 grams of carbohydrates.

Some examples of one serving of a carbohydrate choice (exchange) is:

1 slice (1 oz) bread = 1 carbohydrate choice (15 grams of carbs)

1/2 cup of mashed potatoes = 1 carbohydrate choice (15 grams of carbs)

1/3 cup of pasta = 1 carbohydrate choice (15 grams of carbs)

People usually eat more than a serving size.  Keep that in mind when eating dessert to ensure that an excess amount of carbohydrates is not being consumed.   For example, a serving size of chocolate chip cookies is 2 cookies, but sometimes people eat more than that.  If 4 cookies are consumed, it’s not the worst thing in the world.  The key is too keep it in moderation and watch the rest of the carbohydrates when considering dessert as part of a meal.

To compare a carbohydrate choice to sweets/desserts:  A dessert choice (exchange) also has 15 grams of carbohydrates.

Examples of one serving size of  sweets/desserts and its equivalent to a carbohydrate choice:

1  1/4-inch square 7/8 high small unfrosted brownie = 1 carbohydrate choice (15 grams of carbs)

2-inch square of frosted cake = 2 carbohydrate choices (30 grams of carbs)

2-inch square of unfrosted cake = 1 carbohydrate choice (15 grams of carbs)

2  (2  1/4-inch across) chocolate chip cookies = 1 carbohydrate choice (15 grams of carbs)

3 gingersnap cookies = 1 carbohydrate choice (15 grams of carbs)

1 small (1  3/4 oz) frosted cupcake = 2 carbohydrate choices (30 grams of carbs)

1/2 cup of fruit cobbler = 3 carbohydrate choices (45 grams of carbs)

1/6 of an 8-inch commercially prepared fruit pie 2 crusts = 3 carbohydrate choices (45 grams of carbs)

1/8 of an 8-inch pumpkin or custard pie = 1  1/2 carbohydrates (22.5 grams of carbs)

1 (2  1/2 oz) sweet roll or danish = 2  1/2 carbohydrate choices (37.5 grams of carbs)

This week’s http://www.foodpicker.org question is: I have pre-diabetes and have just been diagnosed with high blood pressure as well.  My doctor says to watch my sodium intake.  I feel like I’ve been hit with a double whammy!  In addition to trying to lose weight and watch my carb intake, I now have to watch my salt as well.  Could you give me some low salt ideas for dinner meals?

There are so many ways to reduce your salt (sodium) intake and still make delicious dinners.

First, here are some helpful tips to reduce your salt intake.

These tips are part of a No Added Salt (NAS) diet:

1.     Prepare your dishes without salt and do not add any salt to your dishes after they are prepared.   A solution for this is to use different seasonings and spices to season your dish.  For example, Mrs. Dash seasoning is great for this.  You can prepare your food using these seasoning.  If the food needs more flavor after it is cooked, you can add some more Mrs. Dash to the meal. Here is the Mrs. Dash website to learn more about these items http://www.mrsdash.com

2.     Stay away from cured meats because those are preserved with lots of salt.

3.     Stay away from tomato or vegetable juice in a can because again those items can contain a lot of salt.

4.     Avoid breads that have any salt on top

The following tips take the above diet further.  These tips can further reduce your salt intake:

5.     Stay away from canned vegetables, vegetable juices, soups or broths.

6.     Avoid smoked meats

7.     Stay away from commercially prepared rice, potato, or pasta mixes

8.     Avoid salad dressings with pork

9.     Stay away from regular or processed cheese or spread.   A solution for this is reduced sodium cheese.

Note:  Reduced sodium on a food label means 25% less sodium than the original version.  Still look at that food label.

Overall, some simple tips to reduced your sodium intake would be to:

A.    Reduce your canned food intake

B.    Reduce your cured meat intake

C.    Reduce your frozen dinners or microwavable meals

D.    Omit salt when cooking foods

E.     Reduce your processed food intake.  (Processed foods are foods that are different from original forms)

F.     Read those food labels and watch out for the sodium content.

According to the Choose Your Foods: Exchange Lists for Diabetes by the American Diabetes Association and American Dietetic Association foods that are high in sodium have more than 480 milligrams (mg) of sodium per serving.   It was mention combination foods like frozen meals, deli-style potato salad, casserole type foods, soups and stews, and fast foods which had sodium levels of more than 600 mg are considered high in sodium.

Some other good tips to help you control your sodium is to increase your consumption of whole grains, fruits, and vegetables.  Increasing your fiber intake will help you feel fuller.  Reduce your intake of total fat and saturated fat by using lower fat versions of foods like milk, salad dressing, mayo, and cheese.

Here are some low salt dinner ideas:

Tacos prepared with a homemade no salt added taco seasoning. A lot of the store bought taco seasonings contain a lot of salt.  You can also use reduced sodium beans.  Also, you can soak your own beans and this way you can really control the sodium content. (Note: canned refried beans are usually high in sodium).  Reduced sodium low-fat cheese would be recommended.

Black bean burrito using the recommendations above with a side salad made with greens, corn, and low-fat dressing (Note: Regular and Reduced fat dressing are high in sodium)

Meats prepared with Mrs. Dash seasoning, other salt substitutes, or no salt marinades.  Try to select lean meats, trim fat, and remove skin from poultry.   You can serve this with a side salad with a low fat dressing.  Sides dishes can be pasta salad, brown rice, or oven-baked potatoes made with seasonings and spices and no added salt.

Fresh or frozen fish, or shellfish prepared with salt substitutes, maybe some lemon, or marinades that do not use salt.  (Note: smoked fish like herring or lox can be high in sodium)

Believe or not, eggs can make great dinner.  Just find recipes that do not include a lot of salt.

If you decide to eat Asian food as dinner, try to avoid the soy sauce.  Both light and regular soy sauce are high in sodium.  Try to look at the no salt added and healthy menu items.  You can use your own seasoning to give it more flavor, if needed.

Frozen or fast food delivery of pizza are high in sodium.  I would suggest to try to make your own and use reduce sodium low-fat cheese.  If you can’t do this, try to get a plain slice or load the pizza with vegetables.

If you want a bread item like a roll with your dinner, try to eat a whole wheat roll.

For more information about how to control high blood pressure and to get some more low salt meal ideas check out the National Heart and Lung Institute website:

http://www.nhlbi.nih.gov/health/public/heart/index.htm

This website has information on high blood pressure, diabetes, and even the DASH diet, which is the Dietary Approaches to Stop Hypertension (DASH).

Sources for the information I provided:

Lecture notes from my Medical Nutrition Therapy class, which is taught by a Registered Dietitian.

Choose Your Foods: Exchange Lists for Diabetes by the American Dietetic Association and American Diabetic Association

Nelms, M., et al.   Nutrition Therapy & Pathophysiology.