Diabetes and Heart Disease: Healthy Eating with Diabetes

Hi my name is dawn Cain I'm a registered dietitian with the Harold censer diabetes health center at Oregon Health and Science University today I'm going to talk to you a little bit about diabetes and heart disease healthy eating with diabetes we'll begin by just talking about diabetes and heart disease heart disease is the major chronic complication and leading cause of death for people with diabetes the impact of diabetes and heart disease is such that having diabetes is an independent risk factor for getting heart disease so today we're gonna be talking specifically about healthy eating with diabetes healthy eating with diabetes and heart disease is a little bit beyond the scope of what I'm gonna cover today I think at a certain point in this video montage you'll be able to listen to a dietitian talk to you specifically about heart eating healthy eating for heart disease today we're going to focus on diabetes and blood sugar control so hopefully at the end of our discussion today you'll be able to do three things described a plate of healthy food for a person with diabetes use portion sizes and food labels to assess how much carbohydrate you're consuming and finally prepare a healthy satisfying well balanced carbohydrate controlled meal.

So that's my goal today we'll begin by talking about some fundamentals of healthy eating with diabetes and those fundamentals include having balance controlling portions eating at regular times and the idea of carbohydrate is being key for blood sugar control and will provide you a bit more detail on this as we walk through it so having balanced it's really important for folks with diabetes to eat three well-balanced meals per day a well-balanced meal constitutes some carbohydrate some protein and a small amount of fat at each meal in the plate that you see here is very well balanced it would be a healthy plate for someone with diabetes someone with high blood pressure someone with high cholesterol and really someone who has no medical issues whatsoever this is a healthy plate of food what you see when you look at this plate of food is that half of the plate is covered with vegetables you'll see green beans piles salad they're covering half of that plate a quarter of that plate is in the form of carbohydrates specifically a starch rice and the other quarter of that plate is has a protein serving of about three to four ounces and that's a piece of salmon so we'll refer to this plate periodically as we walk through our our discussion today but that's a healthy plate pretty much for anybody so portion control when we talk about portions we're really talking about three major nutrients we're talking about carbohydrates we're talking about protein and we're talking about fat that constitutes a healthy meal what we like to say generally is that most men should consume about 3 to 5 servings of carbohydrate per meal most women should consume about 2 to 4 servings of carbohydrate per meal the amount of carbohydrate a person needs kind of depends on their their goals if they're very physically active they need more carbohydrate because blood sugar from which carbohydrates broken down into provides fuel for muscles brain cells etc.

so if you're really active you need more carbohydrate if you're relatively sedentary or maybe weight-loss as a goal you don't need quite as much carbohydrate as far as protein goes most men and women in order to be healthy benefit from consuming about 6 to 8 ounces of cooked meat poultry or fish per day we talk about 6 to 8 ounces we're literally talking about something like this this is about 3 ounces of grilled chicken and depending upon who you are it fits in the palm of your hand my general recommendation for people with diabetes healthy eating is to eat a piece of protein about the size of the palm of the hand at lunch and dinner and again this is about a three ounce portion of grilled chicken literally this is half a chicken breast so those are protein servings so men and women in terms of fat should consume about one to two servings per meal this would be an example of a serving of fat this is a tablespoon of salad dressing so if someone was sitting down to dinner and had two tablespoons of salad dressing on their salad as part of that healthy meal that would actually be a very appropriate amount of fat to consume a couple of other examples of fat this is about an eighth of an avocado or two tablespoons of avocado this is equivalent to one serving of fat so if someone sits down and eats a half an avocado at a meal they're looking at about four servings of fat so when you see that one to two servings we just want to illustrate that we're talking about relatively small servings this is a teaspoon of butter or maybe a teaspoon of margarine not a whole lot here this would be one serving of fat so at breakfast time perhaps you have a couple of slices of toast if you had two teaspoons of margarine soft margarine on your toast that would kind of account for your fat at that particular meal okay. 

The next concept is eating at regular times and we don't want to make this more complicated than it needs to be the whole idea behind eating at regular times is just to prevent a person from overeating if they go too long without eating so our recommendation is to try and eat something about every four to five hours if more than five hours is it going to pass you know that more than five hours is gonna pass between feedings if you will then I think it's reasonable to have a small snack maybe a light yogurt at one o'clock because you got behind and weren't able to eat lunch but we like you having something every four or five hours it does help stabilize blood sugar but for the most part eating at regular times prevents you from overeating when you get around to eating again when it's time for the next meal what it says here is carbohydrate is key and it is carbohydrate that raises blood sugar so we've talked a little bit about protein talked a little bit about fat for all intents and purposes protein and fat do not raise blood sugar they have a very minimal effect on blood sugar so this is really all about carbohydrate when we talk about blood sugar and our recommendation is to try and eat the same amount of carbohydrate and about the same time in the day in order to help you control your blood sugar we identify a serving of carbohydrate as containing 15 grams of carbohydrate we'll provide some additional detail on that part of it and a little bit later in the discussion as I said earlier only carbohydrates impact blood sugar protein the function of protein the chicken the fish the eggs the cheese those are building blocks for muscles blood new tissue so protein is an important part of the diet but it doesn't really impact blood sugar as far as fats go when we're looking at that salad dressing for the most part fat makes food taste good a certain amount of fat is important in the diet for absorption and transport of fat soluble vitamins and probably most popularly fat provides food flavor and texture and from a an eating standpoint mixing a little bit of fat into your diet helps the food hang in your stomach a little bit longer.

So that you feel longer if you're we go back to our idea of having balance if your meal contains only carbohydrates you're going to that will exit out of your stomach very reasonably quickly and you're not going to be particularly satisfied so even a little bit of fat a little bit of protein makes those meals just stick with you a little bit longer and that's a positive thing what are the carbs that raise blood sugar when we talk about carbohydrate we're really talking about grains starches in any form of sugar so if we look at starches we're talking about rice bread pasta cereal potatoes peas and corn and some people think of peas and corn is being vegetables but for our discussion about carbohydrates an impact on blood sugar we identify peas and corn as being starches rather rather than vegetables fruits in any shape form or fashion have an impact on blood sugar.

So know that when you consume fruit that's part of your carbohydrate pool surprisingly to some people milk contains carbohydrate the lactose in the milk is a natural milk sugar that contributes to your blood sugar pool so milk and yogurt are carbohydrates and then of course everybody's familiar with table sugar and soda pop and candy and ice cream and and things like that those are all sources of carbohydrate as well a few words about vegetables although vegetables are technically identified as carbohydrates the bulk of the carbohydrate and vegetable is primarily fiber and fiber is the part of plants that human beings don't digest well so it very rarely does fiber actually never does fiber show up as blood sugar human beings lack the digestive enzymes to turn fiber into blood sugar so we don't really put a limit on on carbohydrate from vegetables and we actually encourage it so a fundamental concept that I'll say probably a few more times today is try and eat half of your plate as vegetables lunch and dinner and if you're so inclined there's no worries you can't weave a little bit of vegetable into breakfast as well maybe you saute a few bell peppers mushrooms tomatoes mix those in with some egg whites and have that with a couple of pieces of toast that would be a very healthy breakfast for someone with with diabetes speaking about carbohydrate how much carbohydrate should a person be consuming and we break this down according to carbohydrate servings per meal we don't really talk about carbohydrate servings per day because people will Bank up bank those servings and trying to eat them all at one time and the ideal is with the carbohydrates is to have small amounts of carbohydrate continuing throughout the day at least three times a day so that we don't cause big spikes in blood sugar if we look at this slide here we've got to lose weight to maintain weight and for the very active and again. 

As I said at the beginning of our discussion if you're really really active you're going to need more carbohydrate in your diet as fuel but if a goal is weight loss most people can get away with consuming if you're female two to three servings of carbohydrate per meal and if you're male three to four servings of carbohydrate per meal so that kind of begs the the next question what do we classify as a serving if we look at this slide this slide kind of distinguishes carbohydrate foods from non carbohydrate foods or should or more accurately foods that do not raise blood sugar so looking at this slide the foods that are down the left-hand side of the slide the starches the milk the fruit that's impacting blood sugar and those kind of represents servings of carbohydrate the foods down the right side of this slide non starchy vegetables protein foods and dietary fat for the most part these types of foods are have a negligible effect on blood sugar so you can't eat the stuff down the right-hand side super liberally especially with the protein in fat because a lot of people if you consume protein and fat without without paying attention to how much you're consuming it can contribute to weight gain but the non starchy vegetables you can eat very freely very liberally kind of anywhere anytime when we talk about servings going back to our idea and just for simplicity we'll talk about servings three servings per meal for women and our servings per meal for men so examples of servings single servings of carbohydrate this is a slice of bread this would be one serving of carbohydrate so if someone consumes a tuna fish sandwich for lunch the bread is carbohydrate two slices of bread would be two servings of carbohydrate the tuna fish has got no carbohydrate the mayonnaise the celery the onion none of that is really contributing to blood sugar so again single servings of carbohydrate look like this a slice of bread this is a corn tortilla it's okay to eat flour tortillas we like the corn tortillas because of the consistency in the serving size a corn tortilla is is classified as one serving of carbohydrate just like a slice of bread would be one serving of carbohydrate you'll notice on the slide that it talks about serving of starch equaling fifteen grams of carb again this will become more meaningful when we talk about the food label but a couple of more servings of starch that equate to a single serving of carbohydrate or 15 grams so this is half a cup of cooked peas and the measuring cup that we're talking about is a measuring cup that you'd measure flour with so half a cup of cooked peas would be one serving of carbohydrate or 15 grams and it kind of continues along in that vein what's different about servings is for something like rice or noodles the serving is a third of a cup versus half a cup for the peas and the corn and the B of the beans and so forth so if you were to consume a a cup of cooked rice be it white rice or brown rice we're looking at one-third two-thirds three-thirds or the full cup of rice being three servings of carbohydrate and if we're talking about women consuming carbohydrate at a meal who are trying to lose weight a cup of rice a cup of cooked rice equates to three servings of carbohydrate and that would be the where we would want that particular person to stop consuming carbohydrate categories of food that provide carbohydrate and examples of carbohydrate would be fruit all fruit contains natural sugar which contributes to blood sugar in a human being so an example of a serving of carbohydrate in the form of fruit on the slide.

It says extra small banana the reality is it's hard to find extra small bananas so we're talking about half of a regular-sized banana for one serving a carbohydrate or 15 grams okay another example of a serving of fruit would be this peach and ordinarily I give this speech a little bounce and it bounces back up just to illustrate that a peach the size of a tennis ball it is one serving a carbohydrate or worth 15 grams going back to our measuring cups something like watermelon the easiest way to assess how much carbohydrate is in watermelon is to actually cut it up into chunks and measure it out a cup of watermelon cup and a quarter of watermelon a little bit more than this measuring cup right here would be one serving a carbohydrate or 15 grams again we're keeping in the context of three to four servings of carbohydrate per meal in grams that would equate to 45 to 60 grams of carbohydrate per meal our next category of carbohydrate is is basically milk and yogurt and you'll notice that not all dairy products contain carbohydrate although they kind of belong in the same family when we go from milk to cheese we lose the carbohydrate where you lose the lactose we go from milk to cottage cheese we lose the lactose and we identified both cheese and cottage cheese as protein foods cheese and cottage cheese are not really going to contribute to the blood sugar pool but an 8 ounce glass of milk would be one serving of carbohydrate or roughly 15 grams of carbohydrate something that is consistent with an 8 ounce glass of milk would basically be an individual serving of a light yogurt when we move forward in the presentation a little bit we'll talk about looking at labels and there's a whole whole spectrum of carbohydrate in yogurt some yogurt is very low in carbohydrate and some yogurt is very high in carbohydrate but these are two carbohydrate sources from the dairy group milk and yogurt provide carbohydrate that contribute to the blood sugar pool as we said earlier serving a carbohydrate is roughly 15 grams so be it a slice of bread a small apple and 8 ounce glass of milk each one of those servings is worth 15 grams of carbohydrate and we're looking at for most people that are maybe trying to lose a little bit of weight limiting the carbohydrate to about 45 to 60 grams or another way to say that would be 3 to 4 servings of carbohydrate that's per meal not per day but per meal moving forward to look at the food label the reason that we even mentioned grams of carbohydrate is the fact that the food label expresses the amount of carbohydrate in grams so everything we've looked at so far the slice of bread the Apple the glass of milk those are all worth 15 grams of carbohydrate when you look at a food label that has some carbohydrate for example I've got a bottle of regular Pepsi Cola here and the most important things to look at on a food label three things serving size servings per container and total carbohydrate in grams when when I work with people individually what I do the first thing I do on a food label is where it says percent daily value I put a big X through that all that information about daily value down at the bottom third of this food label has really nothing to do with carbohydrate counting so I put I put a big X through that what I'm very interested in on a food label is serving size servings per container and the total carbohydrate people that have had diabetes for a long time are very focused on sugars the sugars and if you look at this particular food label it tells us that there's 31 grams of carbohydrate and 5 grams of sugar that 5 grams of sugar is part of the total carbohydrate so that's why we have a red circle around the total carbohydrate we're not that concerned about the sugar content of things we're more interested in the total carbohydrate the other part of the food label it's really important is the serving size and servings per container all of the information the nutrition information on a food label applies to one serving unfortunately food many times is not divvied out in single servings for example I've got this bottle of regular Pepsi here the serving size is 8 fluid ounces and if I take a look at the total carb that's actually 28 grams of carbohydrate but that's only for 8 ounces that's only for a portion of this particular bottle of soda pop so if I look at the whole bottle of soda pop where it says servings for a container two and a half we're talking about two and a half servings times 28 grams per serving and we're at the very end of this if we do the math on that we're looking at 69 grams of carbohydrate for this bottle of Pepsi so again thinking back to how much carbohydrate is reasonable a reasonable amount of carbohydrate at a single serving for most women and men is about 45 to 60 grams we've blown all our carbohydrate on this regular this regular Pepsi on the other hand if I grab a Diet Pepsi the serving size is the same it's serving sizes 8 fluid ounces and there's two and a half servings per container and the total carbohydrate in this is zero grams so we're not worried about this this is basically flavored water with an artificial sweetener in it. 

it's carbonated like regular soda pop some people are okay with the flavor of diet colas some people don't like it we're okay with people with diabetes consuming diet cola or Diet anything really we're more focused on the the grams of carbohydrate that's not to say that diet soda pop or any kind of soda pop is particularly healthy but this is a much better deal for someone with diabetes 0 grams of carbohydrate versus 69 grams of carbohydrate for this bottle of regular Pepsi and by the way this these are both 20 ounce bottles of Pepsi okay diet and regular again if we talk about grams of carbohydrate we've just laid this out trying to keep women to about potentially three servings of carbohydrate per meal that would be 45 grams of carbohydrate per meal and for men 3 to 4 servings or 45 to 60 grams of carbohydrate per meal the other part of the equation that we talked about earlier is just balancing your meal with protein the protein is something that we need to build muscle and antibodies to fight infection so it's an important part of a healthy diet but again a reasonable amount of protein is about eight ounces of cooked meat and so when we say meat beef poultry fish in a day other things that count as protein beyond the meat fish and poultry this is a piece of cheese that I I mentioned earlier this would equate to a single serving of protein and then this is an egg the protein in an egg or a couple of egg whites is basically the same protein that we would find in an ounce of skinless turkey breast going back to our idea of keeping the protein to about six to eight ounces of meat a day these are other things that would count as protein in our in our discussion of protein in the diet again protein does not raise blood sugar it does contribute calories if you over consume protein you can gain weight and that's again not something that that is very desirable with with people with diabetes unless you're underweight so this slide just lays out again a few servings of protein for us in addition to what I showed on camera tofu half a cup of tofu equates to an ounce of protein a tablespoon of natural peanut butter is equivalent to an ounce of protein from a protein standpoint and then balancing out the meal will balance out the meal with a little bit of fat and we said earlier that fat contributes for the most part satiety to a diet when you consume fat in your diet that slows down the digestive process and the food literally hangs around in your stomach longer and it's gonna make you stay fuller longer which is a desirable thing pretty much for anybody that's eating food so we like fat in the diet we don't like a whole lot of fat in the diet and healthy fats would be for the most part vegetable fats oils avocado is a healthy fat we showed that earlier nuts and seeds are sources of healthy fat salad dressing but again we don't want you to consume too much fat because fat is very calorie dense we talked about earlier about trying to limit the fat to one to two servings per meal okay and then these are just examples of servings of fat there's some olive oil there a serving of fat in the form of olive oil or any oil would be one teaspoon a serving of fat in nuts be careful the nut six almonds counts as one serving of fat so it's not opening up a jar of or a bag of almonds and eaten almonds while you're watching TV because you will way over consume your fat but we like a little bit of fat in our meals just to make the the meal more satisfying and it's an important part of a balanced diet a lot of people ask about artificial sweeteners are they safe are they are they dangerous the Food and Drug Administration has looked at artificial sweeteners pretty pretty rigorously and and basically said that the artificial sweeteners that are on the market are safe to use again this is not an endorsement and saying that artificial sweeteners are health food but if we go back to our example with the diet Pepsi the diet Pepsi was zero grams of carbohydrate for a 20 ounce bottle and the regular Pepsi was 69 grams of carbohydrate for a 20 ounce bottle so using the artificial sweeteners will give you a perception on the tongue with no carbohydrate. 

No impact on blood sugar so we're ok with with folks having some artificial sweeteners in their diet in the form of Diet Coke or maybe a light yogurt something like that we don't really recommend consuming a couple liters of diet soda pop a day a couple of diet cokes maybe a couple of Lite yogurts that's that's very reasonable but not required a lot of people ask about alcohol here's a story with alcohol contrary to popular belief straight alcohol does not get converted into blood sugar so something like wine something like a shot of liquor has a very minimal effect on blood sugar it has a minimal effect of carton in terms of carbohydrate I'm the exception to the alcohol would be beer a 12 ounce beer like a Budweiser or whatever kind of beer a microbrew a 12 ounce microbrew has about 15 grams of carbohydrate so alcohol in the form of beer will contribute to the blood sugar pool alcohol in the form of wine and liquor really doesn't contribute to the blood sugar pool but be careful of the mixed drinks we don't want you to mix it up a drink with a shot of liquor with no out no carbohydrate mixing that shot of liquor into a big of juice and your blood sugar shoots up because of the juice another recommendation with alcohol is we want food to accompany alcohol this is somewhat counterintuitive but people who are for low-blood-sugar people that take diabetes medicine that aggressively lowers blood sugar like certain diabetes pills and all insulins should always always always make sure they consume some food with the alcohol because if you fall into a low blood sugar reaction with alcohol on board it's harder for people to come out of a low blood sugar reaction so we like the food with the alcohol hopefully prevent prevent the look the low blood sugar from ever occurring another thing to keep in mind with alcohol is that alcohol is very calorie dense if your goal is weight loss a couple of glasses of wine every night might not be helping that weight loss goal a whole lot bottom-line with alcohol discuss alcohol with your healthcare provider if he or she says that it's fair game it is fair game but be careful again with the calories make sure you have it with food so putting everything together this is a healthy plate of food with for someone that has diabetes what you see on this plate this is these are all plastic pieces of food so allegedly this is spinach carrots broccoli asparagus you don't have to have four different vegetables on your plate but we like that half plate of vegetables this is doing absolutely nothing to blood sugar it's providing vitamins minerals things that are very healthy for for really anybody and it's not having an impact on blood sugar we continue to balance this plate out by adding a little bit of protein again depending upon who you are a piece of meat about the size of the palm of your hand kind of does a nice job of balancing this plate out without providing too many extra calories okay but this is not a completely balanced plate we're missing the carbohydrate we need carbohydrate in the diet to provide blood glucose so that we can think so that we can move our body's blood glucose is needed by every cell in the body so we need something going to provide blood glucose in the diet and that's of course going to be carbohydrate so going back to our idea of three servings of carbohydrate per meal or 45 grams of carbohydrate I'm just going to kind of balance this plate out so I'll start with a little bit more than a cup of watermelon this would be 15 grams of carbohydrate I'm gonna balance this out real nicely by weaving in half a cup of these happen to be kid kidney beans but this could be pinto beans garbanzo beans that's another 15 grams of carbohydrate and then finally I think I'm gonna put a glass of milk on here which an 8 ounce glass of milk would basically be another 15 grams of carbohydrate so we've got our completely balanced plate here we've got 45 grams of carbohydrate a piece of meat the size of the palm of the hand and half this plate as vegetables so that's kind of I guess our parting words for you just because you have diabetes doesn't mean you have to eat low volume if you're strategic about the way you eat you can actually fill up a plate of food without adversely impacting your blood sugar you