Diabetic Diet

Nearly 21 million Americans have diabetes and one-third of these people don't even know it. What's more, an additional 54 million people in the U.S. have blood-glucose levels that fall into a risky "prediabetes" range.

Basically, diabetes is a health condition characterized by high levels of glucose-a form of sugar that fuels our body's cells-in the blood. Our bodies break down the foods we eat into glucose-but the sugar can't get into cells without an escort. Insulin, a hormone produced by the pancreas, ushers the sugar in. But in people who have diabetes, the beta cells of the pancreas don't make enough insulin, or the body's cells don't respond effectively to the hormone. The result: glucose stays in the blood, where it accumulates. Over time, this high concentration of blood glucose-a condition called hyperglycemia-weakens blood vessels and then can damage the eyes, kidneys and nerves. Diabetes can also cause heart disease and stroke.

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The root cause for the diabetes "epidemic" still eludes medical researchers but most experts agree that poor diet and sedentary living are significant contributing factors. The upside of this is that eating well and moving more helps prevent the condition-even if your blood glucose level is already in what's considered to be a "pre-diabetes" range. (And if you have diabetes already, a healthy diet helps keep glucose levels in check.) The nutrition experts at EatingWell recommend the following steps to help control blood glucose and prevent diabetes.

Lose weight.
Extra fat can make your body resistant to the action of insulin. Losing weight improves insulin's activity, which reduces blood-glucose levels. Research suggests that people at high risk for diabetes who lose as little as 5 percent of their body weight (i.e., about 10 pounds, if they weigh 200 pounds) can prevent or delay onset of the condition. The most effective approach, say experts, is a structured weight-loss program, such as The EatingWell Diet, that emphasizes lifestyle changes.

Exercise regularly.
Studies show that physical activity improves the body's response to insulin and helps lower blood-glucose levels. Aim to fit in 30 minutes of moderate activity-such as brisk walking-nearly every day.

Choose whole grains.
Selecting whole grains, such as whole-wheat breads and pastas, barley, corn and oats, over refined ones can help improve insulin sensitivity. Whole grains will help you meet your recommended daily intake for fiber (25 grams); they also provide more vitamins, minerals and other health-promoting nutrients than refined grains.

Don't skip meals. 
Research suggests that eating breakfast increases insulin effectiveness in lowering blood-glucose levels, and eating regularly spaced meals also has a beneficial effect on insulin response.

Use good fats.
Season dishes with moderate amounts of olive oil and the other "good fats" that make food tastier and more satisfying. At the same time, keep a watchful eye on saturated fat and trans fats. Limit saturated fats to less than 7 percent and trans fats to less than 1 percent of total calories; restrict cholesterol intake to less than 200 mg/day. Do this by limiting fatty meat and full-fat dairy products (which supply saturated fats and cholesterol) and processed foods (which tend to be packed with partially hydrogenated oils, a.k.a. trans fats).

Choose foods low on the glycemic index.
The glycemic index (GI) is a system of ranking foods that contain equal amounts of carbohydrates according to how much they raise blood-glucose levels. (The lower the GI number, the less the food boosts your blood sugar and the more diabetic-diet-friendly it is.) The GI is somewhat confusing and even a little controversial. But, in general, it does lead you to healthy foods. For example, vegetables, whole grains, beans and high-fiber foods tend to fall lower on the glycemic scale, while processed and refined foods and sweets are higher up.

Type 1 diabetes
People with type 1 diabetes are unable to produce their own insulin and must take insulin daily-via injections or through a pump-to survive. Insulin doses are timed to correspond with food intake. This category used to be called "juvenile" diabetes because it's most often diagnosed before age 30; however, it can occur at any age, even in the elderly.

Type 2 diabetes
Type 2 diabetes-by far the more common kind, accounting for nine out of ten American cases-usually begins as a person's cells become "insulin resistant," or less able to process insulin's signals. As long as the body can make enough insulin to overcome the resistance, blood-glucose levels remain normal. Eventually, however, the pancreas can't produce enough insulin to overcome this resistance, and the problem becomes a deficiency in insulin. Even though insulin levels may still be higher than normal, the amount just isn't enough to keep blood-glucose levels within a normal range. The longer a person has diabetes, the more likely it is that insufficient insulin is the cause of high blood-glucose levels. When type 2 diabetes is first diagnosed, many people can control their glucose by making and maintaining changes in their eating and physical activity. But diabetes is a progressive disease; over time, lifestyle changes need to be combined with medications, such as diabetes pills-and, eventually for many, insulin. When some people with diabetes reach this point, they may blame themselves, or feel as if they've "failed." In fact, diabetes progression isn't anyone's fault, but rather the result of inheriting beta cells that fail over time. To keep the beta cells working longer, it's important to keep blood-glucose levels as normal as possible by whatever means necessary. Eating a healthy diet helps.

Recipes

Mushroom, Sausage & Spinach Lasagna
An Italian classic made healthier.

Makes 10 servings

ACTIVE TIME: 30 minutes
TOTAL TIME: 2 hours
EASE OF PREPARATION: Easy

8 ounces lasagna noodles, preferably whole-wheat (see Ingredient note)
1 pound lean spicy Italian turkey sausage, casings removed (see Variation)
4 cups sliced mushrooms (10 ounces)
1/4 cup water
1 pound frozen spinach, thawed
1 28-ounce can crushed tomatoes, preferably chunky
1/4 cup chopped fresh basil
Salt & freshly ground pepper to taste
1 pound part-skim ricotta cheese (2 cups)
8 ounces part-skim mozzarella cheese, shredded (about 2 cups), divided

1. Preheat oven to 350°F. Coat a 9-by-13-inch glass baking dish with cooking spray. Put a large pot of water on to boil.
2. Cook noodles in the boiling water until not quite al dente, about 2 minutes less than the package directions. Drain; return the noodles to the pot, cover with cool water and set aside.
3. Coat a large nonstick skillet with cooking spray and heat over medium-high heat. Add sausage and cook, crumbling with a wooden spoon, until browned, about 4 minutes. Add mushrooms and water; cook, stirring occasionally and crumbling the sausage more, until the sausage is cooked through, the water has evaporated and the mushrooms are tender, 8 to 10 minutes. Squeeze spinach to remove excess water, then stir into the pan; remove from heat.
4. Mix tomatoes with basil, salt and pepper in a medium bowl.
5. To assemble lasagna: Spread 1/2 cup of the tomatoes in the prepared baking dish. Arrange a layer of noodles on top, trimming to fit if necessary. Evenly dollop half the ricotta over the noodles. Top with half the sausage mixture, one-third of the remaining tomatoes and one-third of the mozzarella. Continue with another layer of noodles, the remaining ricotta, the remaining sausage, half the remaining tomatoes and half the remaining mozzarella. Top with a third layer of noodles and the remaining tomatoes.
6. Cover the lasagna with foil and bake until bubbling and heated through, 1 hour to 1 hour 10 minutes. Remove the foil and sprinkle the remaining mozzarella on the lasagna. Return to the oven and bake until the cheese is just melted but not browned, 8 to 10 minutes. Let rest for 10 minutes before serving.

NUTRITION INFORMATION: Per serving: 316 calories; 13 g fat (6 g sat, 2 g mono); 59 mg cholesterol; 28 g carbohydrate; 26 g protein; 6 g fiber; 681 mg sodium. Nutrition bonus: Vitamin A (90% daily value), Calcium (35% dv), Folate (15% dv). 1 1/2 Carbohydrate Servings. Exchanges: 1 starch, 1 1/2 vegetable, 1 lean meat, 2 medium-fat meat

Ingredient Note: Whole-wheat lasagna noodles are higher in fiber than white noodles. They can be found in health-food stores and some large supermarkets.

Variation: For vegetarians, use a sausage-style soy product, such as Gimme Lean, or simply omit the sausage altogether.

MAKE AHEAD TIP: Prepare through Step 5 up to 1 day ahead.

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Asian Tofu Salad
The best thing about tofu - besides its nutritional value - is the way it carries other flavors, such as the tanginess of this sesame dressing. Serve this warm salad with crunchy breadsticks and a tall glass of iced jasmine tea.

Makes 4 servings

ACTIVE TIME: 25 minutes
TOTAL TIME: 25 minutes
EASE OF PREPARATION: Easy

3 tablespoons canola oil
2 tablespoons rice vinegar
1 tablespoon honey
2 teaspoons reduced-sodium soy sauce
1 teaspoon toasted sesame oil
1 teaspoon minced fresh ginger
1/2 teaspoon salt
1 14-ounce package extra-firm, water-packed tofu, rinsed, patted dry and cut into 1-inch cubes
8 cups mixed salad greens
2 medium carrots, peeled, halved lengthwise and sliced
1 large cucumber, chopped

1. Whisk canola oil, vinegar, honey, soy sauce, sesame oil, ginger and salt in a bowl.
2. Place tofu and 2 tablespoons of the dressing in a large nonstick skillet. Cook over medium-high heat, turning every 2 to 3 minutes, until golden brown, 12 to 15 minutes total. Remove from the heat, add 1 tablespoon of the dressing to the pan and stir to coat.
3. Toss greens, carrots and cucumber with the remaining dressing. Serve immediately, topped with the warm tofu.

NUTRITION INFORMATION: Per serving: 237 calories; 16 g fat (2 g sat, 8 g mono); 0 mg cholesterol; 16 g carbohydrate; 11 g protein; 5 g fiber; 454 mg sodium.

Nutrition bonus: Vitamin A (180% daily value), Folate (41% dv), Vitamin C (38% dv), Calcium (29% dv). 1 1/2 Carbohydrate Servings. Exchanges: 3 vegetable, 1 medium-fat meat, 2 fat.

MAKE AHEAD TIP: The dressing (Step 1) will keep, covered, in the refrigerator for up to 2 days. Whisk just before using.

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Minted Peas & Rice with Feta
The flavors of fresh mint and feta enliven this dish. Toss any leftovers with some cooked shrimp for a satisfying, easy lunch.

Makes 4 servings, 3/4 cup each

ACTIVE TIME: 10 minutes
TOTAL TIME: 25 minutes
EASE OF PREPARATION: Easy

1 1/4 cups reduced-sodium chicken broth
3/4 cup instant brown rice
1 1/2 cups frozen peas (6 ounces)
3/4 cup sliced scallions
1/4 cup finely crumbled feta cheese
1/4 cup sliced fresh mint
Freshly ground pepper to taste

Bring broth to a boil in a large saucepan over high heat. Add rice and bring to a simmer; cover, reduce heat to medium-low and cook for 4 minutes. Stir in peas and return to a simmer over high heat. Cover, reduce heat to medium-low and continue to cook until the peas are hot and the rice has absorbed most of the liquid, about 6 minutes. Remove from heat and stir in scallions, feta, mint and pepper. Cover and let stand until the liquid is absorbed, 3 to 5 minutes.

NUTRITION INFORMATION: Per serving: 134 calories; 3 g fat (1 g sat, 0 g mono); 8 mg cholesterol; 22 g carbohydrate; 7 g protein; 4 g fiber; 321 mg sodium. Nutrition bonus: Vitamin A (30% daily value), Iron (15% dv), Vitamin C (15% dv). 1 1/2 Carbohydrate Servings. Exchanges: 1 1/2 starch, 1/2 lean meat.

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From www.eatingwell.com with permission.  © 2008 Eating Well Inc.