Eating Well with Diabetes
(How the Haitian "natif natal" can follow a Diabetic Diet)
Nicole Jean, RD, LDN
In the United States, March is National Nutrition Month, of which a particular day is set aside for Diabetes Awareness. In the Haitian-American community, the form of diabetes that is the most prevalent is called type 2. It results from an inability of one’s body to process many nutrients properly. One result is a high level of glucose (sugar) in the blood. This facilitates the development of many long-term complications, the major ones being heart disease, kidney disease and diabetic eye disease. Diabetes is a highly manageable disease but requires a lot of self-care, including watching one’s diet very carefully.
It is important that the person with diabetes meet with a Registered Dietitian (RD). A referral is usually made through the doctor or the health care facility. The RD will suggest a diet that conforms to one’s particular needs, and takes into consideration the personal food habits, the caloric needs, level of activity, medications taken…The discussion that follows centers on the general guidelines of the diet and in no way replaces a diet consultation.
Some Guidelines of the Diabetic diet are:
-Eating regular meals, which helps to prevent wide fluctuations of the blood glucose and is especially important when taking medications for the diabetes.
-Limiting the intake of Fat, Sugar and Salt, by using low fat milk, lean meat, by avoiding excessive use of oil, other fats, salty foods and sugary foods.
-Eating an adequate amount of Fiber, which helps regulate the blood glucose. Fiber is found in plant foods. It goes through the body undigested and does not raise the blood sugar.
-Eating from a variety of foods daily, to ensure exposure to all needed nutrients.
The Food Guide Pyramid is one basic tool that is often used to teach the diabetic diet.
People with diabetes may have different priorities when watching their food intake. For one person it may be to lower the blood glucose, for another to regulate the blood pressure and yet for another it may be to decrease the weight. Today, we establish as priority the control of the blood glucose.
The foods that we consume provide us with nutrients such as Protein, Fats, Carbohydrates, Vitamins, Minerals and Water. Carbohydrates are the nutrient that affects the blood glucose the most. Therefore in diabetes, the intake of Carbohydrates must be restricted.
Some foods are good sources of Carbohydrates, (and therefore cause the blood sugar to go up!). They belong mostly to these three (3) sections of the Pyramid:
- The MILK Group
- The FRUIT Group
- The BREAD/STARCH Group
A dietitian would guide you as to the proper intake of Carbohydrates for you. As suggested on the Food Guide Pyramid and for most adults:
The intake of Milk is restricted to 2-3 servings daily.
1 serving of Milk could be:
- 1 cup of milk
- 1 cup of "let kaye" or yogurt
- ½ cup of evaporated milk
The servings of Fruit are restricted to 3-4 servings daily
Portion sizes of fruit are usually quite small. For example:
1 serving of Fruit could be:
- ½ small mango or papaya
- 1 small banana
- 1 orange, apple, pear or kiwi
- 1/2 grapefruit
- 10 Guineps
- 1 Guava
- 1 Sapodilla
- 1/3 small cantaloupe
- 2 small tangerines
- ¾ cup of Coconut water
- 1/2 cup fruit juice
Eating the fresh fruit is a better choice over the juice (even when homemade).
The servings of Bread/Starch would be restricted to 6-11 servings daily. Note that
1 serving of Bread/Starch is for example:
- 1 slice of Bread
- 1/3 cup of cooked Rice
- 1/4 Plantain
- 1medium Green Banana
- 1/2 cup of Cooked Dried Beans
- 1 small piece of Yam (size of a small, 3oz can of tuna fish)
- 1 small piece of Cassava ( same size as Yam)
- ½ cup cooked Cornmeal, Corn or Pasta
- 2 Tbsp. Cornstarch, Corn flour, or Arrowroot
These are extremely small portion sizes!
In addition, beer, wine,
sugar, honey, molasses, condensed milk,
cakes, cookies, candy, jelly, chocolate,
"douces", and colas are also high in Carbohydrates.
It is still advisable that people with diabetes also avoid using a lot of granulated sugar as it raises the blood sugar but is void of any nutrient.
And how can one eat so little rice???
Let us make the statement that rice is considered a healthful component of the diabetic diet. However, the amount of rice suggested by your dietitian will probably be way less than your usual intake. (Yes, this little bit of rice…)
Rice is high in Carbohydrates. 1 cup of Cooked rice = 3 servings of bread. In other words, each time you eat 1 (measuring) cup of cooked rice, it causes your blood sugar to go up the same as if you had eaten 3 slices of bread. If your diet pattern suggests that you limit yourself to 3 servings of bread at lunch, it would mean a choice between 1 cup of cooked rice and 3/4 of a boiled plantain.
As you are trying to control your blood sugar, limiting the intake of rice becomes essential. Following are a few suggestions that may help.
Tip #1. Cook less rice than you usually do. Preparing the usual amount of rice will result in you consuming the same amount of rice, if not by 6PM, then surely by 9PM.
Tip #2. Try Brown Rice. It’s higher in Fiber, which increases your feeling of fullness.
Tip #3. Use a smaller pot to cook your rice and a larger pot to cook the vegetables.
Tip #4. Find out how many of your serving spoons it takes for a suggested amount of rice. Then you will no longer have to use a measuring cup.
Tip #5. Cook either plantain OR rice at one meal.
Tip #6. Have plantain, potato or an ear of corn as your choice of Bread/Starch when the blood sugar is high. It may not be feasible to cook only the portion of rice or pasta that you intend to eat.
Tip #7. If you are not one to measure your foods, serve yourself using the "plate method", where ¼ of the plate is filled with meat, ¼ with starchy foods and ½ of the plate with vegetables.
Tip #8. If you must go back for seconds, help yourself to more meat and vegetables.
Also, note that while Dried Beans are high in nutrients, they also contribute significantly to the carbohydrate content of one’s diet. ½ cup of cooked Beans is counted as the equivalent of one slice of bread. I would venture that Rice and Beans "kole" would be a better choice over "Di Ri blan ak Sos Pwa". We know that pureeing foods will decrease their fiber content and may cause a faster rise in the blood sugar.
The major obstacle to limiting our intake of carbohydrate foods lies not in our craving for an enormous amount of rice. It lies instead in having vegetables as such a small part of our diet. Vegetables, especially the leafy ones are generally low in carbohydrates. The person with diabetes who does not eat vegetables with his meals is bound to eat a larger than desired amount of starchy foods. The focus should be on eating vegetables at each meal (they can be eaten at breakfast too). And only then, can the intake of starchy foods be kept low.
This Vegetable Soup may help to quell the pangs of rice withdrawal.
Sauté Smoked turkey parts or leftover meat in a little oil. Add seasonings to taste and enough water to cover your vegetables. Add only non-starchy vegetables such as onions, cabbage, chocho (mirliton), carrots, string beans, spinach, okra, watercress…and let simmer until vegetables are cooked.
This vegetable soup will be much lighter than our traditional "bouillon". However, it is low in carbohydrates and can be consumed between or with your meals, with little effect on your blood sugar.
Following are some EXAMPLES OF MEALS that can be used at breakfast, lunch or dinner. The asterisk identifies the foods that cause the blood glucose to rise. Therefore, try limiting their portion sizes to what has been suggested for you.
Cornmeal Porridge made with
*Evaporated Skimmed Milk
Stewed Chicken in Creole sauce
*Rice and Beans
Broccoli and Carrots
Sardines in tomato sauce
Sliced Tomato and Sliced Avocado
Bread Soup made with
Scrambled Eggs with Onions
Stewed Turkey parts
*Cornmeal and Beans
Spinach and Okra
Steamed Codfish and Onions
Lettuce, Watercress and Sliced Beets
"Legume" of Meat and Vegetables
Watercress and Tomato Salad
A Word about Alternative Therapies
When using alternative methods for glucose control such as assorossi (Momordica Charantia, also known as Bitter Melon), aloe, and other herbals, remember that they will very likely increase the effect of your medicines. You may wish to familiarize yourself with the symptoms of low blood sugar as well as the relief measures that one should take. It is a good idea to monitor your blood glucose at home so you can keep track of the fluctuations that may be caused by these herbals. Informing your physician about the herbs that you use is highly recommended.
Watching one’s diet is an important tool in the management of diabetes. To promote adherence, the diet should include different foods that you and your family usually eat. Some favorite foods, high in Carbohydrates, must of course be reserved for occasional use and for when the blood sugar is under good control.
In addition to the diet, a regular program of physical activity, taking medications as prescribed, smoking cessation, and monitoring your blood glucose at home are now considered essential in the management of the disease.
Nicole Jean is a Registered Dietitian who practices currently in Florida.