Diabetics Can Have Cake and Eat It, Too

Feb. 12, 2002 -- For years, diabetics were told to stay away from sweets and keep fat consumption to a minimum, but it now appears that restricting certain types of foods is not necessary to keep blood sugar levels under control.

Guidelines recently released by the American Diabetes Association (ADA) lift restrictions on products made from sucrose, or table sugar, and allow a diet high in monounsaturated fats like olive, canola, and peanut oils. The guidelines give diabetics more dietary options, but patients still must be vigilant about how they eat, experts say.

"We often say that a good diabetic diet is really just a good diet," ADA spokesman Nathaniel Clark, MD, tells WebMD. "We have tried to get away from the concept that there is a special diet that people must follow when they have diabetes. Somebody with diabetes can eat anything that anyone else can eat. They just need to be far more careful about how they eat."

The key to keeping diabetes under control is not avoiding particular foods, but keeping blood sugar at acceptable levels. The guidelines stress that regular exercise is key to achieving this goal for most diabetics. Moderate exercise not only lowers blood sugar levels, it is an important part of permanent weight control.

High blood sugar levels increase the chance of problems from diabetes such as heart attack, stroke, leg amputations, and blindness. Fifteen million Americans have type 2 diabetes. Being overweight or obese is the most significant risk factor for the disease, which is reaching epidemic numbers among adults and being seen for the first time in large numbers of children.

Clark says clinical experience and scientific research have highlighted the flaws in the one-diet-fits-all approach to controlling diabetes. An individualized approach to eating is important, he adds, because different diabetics have different needs.

Research conducted for the past 15 years has shown that there is no significant difference in blood sugar response to foods high in sugar or starch, as long as the total amount of carbohydrates is similar. The guidelines note that many things, including how a food is processed and whether it is cooked, can influence a food's effect on blood sugar.

"When I counsel patients, the first thing I do is find out how they like to eat," says Clark, who is the ADA's national vice president for clinical affairs. "With proper planning, a person with diabetes should be able to eat what others would eat."

The ADA once recommended a low-fat diet for diabetics, but that is no longer the case. While saturated fats, such as butter or other animal fats, should still be limited, studies have shown that diabetics can thrive on diets rich in monounsaturated fats. In the mid 1990s, Abhimanyu Garg, MD, and colleagues from the University of Texas Southwestern Medical Center in Dallas found that such a diet improved diabetes control, reduced cholesterol levels, and lowered triglycerides.