Diet and Diabetes

© Janet Zand L.Ac., O.M.D.

What is Diabetes?
Diabetes is a general term for an endocrine disease that is characterized by excessive urination and thirst. Many Americans suffer from this disease, as well as the limitations to one's lifestyle that accompany it. The two most commonly known forms are diabetes mellitus and diabetes insipidus.

Diabetes mellitus is a pancreatic disease primarily affecting carbohydrate metabolism. In this condition, the pancreas is unable to secrete sufficient insulin to maintain a normal blood glucose level. This results in abnormally high levels of blood sugar, causing the symptoms of thirst, hunger, emaciation, and weakness. The imperfect combustion of fats may ensue, resulting in ketosis-- high levels of ketones in the body. Difficult breathing, heart problems, and even coma may occur in the complicated stages of diabetes.

Diabetes insipidus is a condition associated with the kidney's inability to conserve water. It is caused by the failure of the hypothalamus to release anti-diuretic hormone, resulting in the passage of large amounts of urine. This is often accompanied by a voracious appetite, loss of strength, and emaciation.

Who is Diabetic?
Diabetes mellitus is far more prevalent than diabetes insipidus. It affects more than 10 million people in the United States and causes over 30,000 deaths each year; it contributes to an additional 100,000 deaths annually. Diabetes is costly for Americans-- over 18 billion dollars are spent every year to treat the disease. Its prevalence increases with age from affecting approximately .1% of the population under 17 years of age to reaching approximately 8% of persons over age 65.

The non-insulin, dependent type of diabetes usually occurs in obese people who are age 40 or older. They have higher than normal amounts of insulin in their blood but are resistant to the action of this blood sugar regulating hormone.

How is Diabetes Diagnosed?
A variety of methods, including Glucose Tolerance Tests, have been used to diagnose diabetes mellitus. The most reliable of these methods detects a blood glucose concentration greater than 140 milligrams per deciliter (normal is considered to be between 70-100 mg/dl) after an overnight fast.

How is Diabetes Treated?
After the isolation of insulin by Frederick Banting and Charles Best in 1921, incidence of death from ketoacidosis and diabetic coma decreased dramatically. The prolonged life span, however, revealed long-term complications such as kidney failure, eye disease, blindness, heart disease, gastrointestinal and nervous system disorders. Elevated blood glucose levels are believed to be at the root of these disorders. Thus, the objective of treatment for the diabetic is to restore blood glucose to normal levels.

In obese, non-insulin dependent individuals with diabetes, the treatment of choice is weight loss. If this plan is not successful, oral, blood sugar-reducing medicines are required. These hypoglycemic agents act primarily by stimulating the patient's pancreas to secrete additional insulin.

Is There a "Diabetic Diet"?
It is apparent that there are as many "diabetic diets" as there are persons with diabetes. Any dietary program is complicated by the fact that the same food may be eaten by different people and produce different responses in blood sugar levels. On-going research which investigates a food's ability to raise glucose levels (also known as glycemic index) indicates that the response is dependent upon the proportions of carbohydrate, protein and fat. For example, some individuals will spike a high blood glucose level when juice is ingested alone. However, the same juice may be better tolerated if taken with a meal which includes more protein and fat.


Generally, a diabetic meal plan discourages the daily intake of fatty meats, high fat dairy products, fatty desserts, highly salted foods, and excess calories that may lead to obesity.

How to Begin?
So, what can the individual with diabetes do to create an individualized diet? Perhaps two of the most useful tools are blood glucose self-monitoring and a detailed diet diary. Glucose meter readings indicate the body's response to meals, snacks, exercise, stress, illness and general habits. Upon careful examination of multiple meter readings and diary notations, you and/or your physician can devise a diet suited to your lifestyle. For example, your physician or a board-certified diabetes educator may advise you to avoid large caloric intake during the evening meal. This can be especially true if the diary note for the same night was, "Sat and watched television until bedtime." Whereas a diary note such as, "I took a brisk walk for 20 minutes after dinner" may necessitate no changes in the evening meal because exercise lowers blood glucose levels.

What is a "Diabetic Diet?"
Simply "cutting out sugar" and "watching your diet" are not diet plans. In fact, a successful plan generally includes all types of foods. Most meal plans begin by estimating the amount of calories an individual needs to manage a realistic weight. Then, 55-65% of the total daily calories are allotted to complex carbohydrates; 20% to protein rich food; and, 15-30% to fatty foods.

After these proportions have been estimated, the size, time and number of meals may be determined. For example, it is possible that six small meals are going to be easier to digest and assimilate than three larger ones. For some people, it is easier to dispose of smaller amounts of glucose because less insulin is needed. Oftentimes, merely eating meals and snacks at consistent times will improve glucose levels.

What is an Exchange List?
Many individuals with diabetes are introduced to the "exchange list" system of food choices when they are given a diet plan. Foods are placed on one of six lists based upon their predominant nutrient content. Portion sizes are also indicated to keep caloric value very close for all foods on the list. These six lists are: starch/bread, meat/substitutes, vegetables, fruit, milk, and fats. A meal plan will most likely indicate how many choices may be taken from a list for a meal or a snack. Such an arrangement should afford a well- balanced diet while still regulating blood glucose levels.

What is Carbohydrate Counting?
Carbohydrate counting is a method of achieving a diet plan which is responsive to effective glucose control as well as offering a tremendous variety of food choices. Plans are drawn up which indicate a suggested amount of carbohydrates and calories for a meal or snack. Today most packaged foods have a nutrient label indicating the carbohydrate and calorie count in a serving. Once choices are made to attain the optimal carbohydrate amount, the remainder of the calories are allotted for protein and fat. Many vegetarians prefer to use carbohydrate counting because animal products which appear on the meat and milk exchange lists are usually omitted.

What about Fats?
Fat restriction is very important for the person with diabetes. Cooked fats are perhaps the most offensive to the body. High fat diets are not only linked with diabetes, but also with other degenerative conditions such as cardiovascular disease, breast cancer and colon cancer.

How do you reduce your fat consumption? Here is a simple list of do's and don'ts.

1. Don't fry food. Rather: bake, broil, steam or poach.
2. Use low fat or skim milk dairy products.
3. When buying canned products make certain they are packed in water and not oil.
4. Do eat lean meats. Try to emphasize white poultry meat with the skin removed.
5. Consider fish as a replacement for meats. You should avoid smoked fish and the dark fatty sections of some fish.

How do I Reduce my Salt Intake?
Reducing salt intake of particular importance. Salt is frequently a culprit in cases of high blood pressure. Individuals with diabetes tend to develop hypertension which can threaten the health of the kidneys and the circulatory system.

1. Limit the use of prepared sauces such as mustard, ketchup, salad dressings and packaged foods high in "sodium."
2. Persons with hypertension are recommended not to exceed 2000 milligrams of sodium a day. A teaspoon of salt has 2300 milligrams of sodium.

How do I Increase Fiber Intake?
There are numerous benefits in replacing animal protein-saturated foods with plant foods which are richer in fiber. Improved digestion and elimination, lowered blood cholesterol, lowered blood pressure, weight loss and an increased sensitivity to insulin are some of the possible benefits of increased fiber in the diet.

1. Choose whole grain cereals, brown rice, barley, millet, oats, etc..
2. Eat plenty of whole, raw, fresh vegetables and fruit. String beans, cucumbers, celery, Jerusalem artichokes, garlic, and onions are particularly good for the diabetic. Garlic, in fact, has been shown to reduce blood sugar in those suffering from diabetes.

Are There Any Herbs to Help the Individual with Diabetes?
Several herbal remedies have been used successfully by persons with diabetes. It is a good idea to experiment with one herb or herbal formula at a time, making sure that its effect on your blood sugar is beneficial. Typically, these herbs are used as a tea or an herbal extract. Make a strong decoction of the herb in hot water, and drink the tea one to three times a day. If you prefer the liquid extract, take the recommended dose in warm water two or three times daily. It is also acceptable to use the capsule or tablet form.

Siberian ginseng is a great place to start for the diabetic, as it can aid in the regulation of blood sugar. As an "adaptogenic" herb, it helps the body adapt to stress, including the metabolic stress of blood sugar fluctuations. It often has a harmonizing effect on blood glucose, making it the ideal remedy for the diabetic to consider. In addition, rarely does one find an unfavorable reaction to Siberian ginseng.

Other botanicals include dandelion root and goldenseal*. These two herbs assist digestion, and are best taken with a meal to reap optimal benefits. The herbs blueberry leaf, nettle leaf, red raspberry leaf, and string bean pod are better when taken one hour before a meal as they may ultimately help reduce the quantity of insulin needed. Horsetail and alfalfa, both high in silica and other trace minerals, are best taken at the beginning of a meal. Juniper berries, which are cleansing to the kidneys, may be taken between meals. Keep records on how each one affects your blood sugar levels. Ideally, you will find a few that you can rely on to help stabilize your condition.

Are there any Nutritional Supplements to Help the Diabetic?
Many nutritional supplements have been demonstrated as effective in helping to correct and improving the diabetic condition. The following are nutritional supplements to consider in a program:

1. B Complex
2. Chromium
3. Trace mineral complexes including calcium, magnesium, zinc, and manganese
4. Vitamin C
5. Vitamin E
6. Beta Carotene (Vitamin A) and Vitamin D

What About Exercise?
Both types of diabetes can be fought using a regular, moderate exercise program. There is a clearly demonstrated effect of aerobic activities, including brisk walking, running, cycling, and swimming, on blood sugar levels. Improved glucose uptake by the exercising muscles occurs and lasts for up to 72 hours. Many diabetics who exercise regularly are able to decrease their medication. Exercise programs also have been shown to improve the blood lipid profile and help control blood pressure. However, you are urged to carefully monitor your blood sugar during this time to avoid overdoses of insulin.

General Guidelines for the Person with Diabetes?

1. Avoid overeating.
2. Emphasis should be on whole foods.
3. Avoid excessive emotional stress.
4. Avoid soft water. Diabetes is higher in soft water areas. Diabetics should drink natural, non-carbonated mineral or spring water which contains naturally occurring trace minerals. Clinical studies have shown that a good supply of trace minerals are important for effective glucose tolerance and utilization.
5. Get lots of exercise! Aside from dietary restrictions, exercise and strong physical labor will help to diminish the need for insulin.

* NOTE: Goldenseal should not be taken by itself for more than seven consecutive days.

Janet Zand, OMD, L. Ac., is a respected naturopathic physician who lives and practices in the Los Angeles area. She has developed a unique and effective method of combining herbal medicine with nutrition, homeopathy and acupuncture. Her credentials include a Doctor of Naturopathy, Doctor of Oriental Medicine, and Certified Acupuncturist. Dr. Zand has over fifteen years of clinical experience treating with natural medicine, as well as formulating her own line of herbal supplements.