It is easy to say what a diabetic should not eat: sugars, simple carbohydrates, alcoholic beverages. Sometimes it seems like all tasty foods are off-limits: pizza, donuts, cakes, ice cream, brownies, etc.

Is a diabetic doomed to a diet of broccoli and grilled fish?

Not at all. For the most part, people can eat normal food, but sensibly.

The biggest problem diabetics have is consuming too many calories. Simply limiting caloric intake to 1,500-1,800 calories would stabilize blood sugar levels for many patients. Not only that, but body weight and serum cholesterol would also drop. If you are diabetic and only making one change to your diet, choose to eat less.

Problem foods for diabetics are those that rapidly raise blood glucose levels. Sugar yes, of course, but also simple carbohydrates and alcohol. It doesn’t mean you can’t eat even a bite of these foods, but rather that you should be discreet and limit your portion sizes to just 100-200 calories per day. Avoiding “white” foods is a good idea: white flour, white rice, white potatoes, white pasta. All of these are converted to glucose in the bloodstream almost as fast as sugar itself.

Beyond that, what should a diabetic eat? And because?

Some of the best foods for diabetics are fruits and vegetables, which are high in soluble fiber. These promote a feeling of fullness, help the intestines to eliminate properly, add potassium, vitamins, and antioxidants to the diet, and are generally low in calories. Aim for 5 servings of fruits and vegetables a day.

Among fruits, those that are less sweet are desirable, such as apples, berries and melon. Very sweet fruits like watermelon and pineapple can be eaten, but in limited quantities. A full cup of watermelon has about the same number of calories as a cup of 7-up and can spike your blood sugar just as much. A large slice of watermelon can have as many calories as a hot fudge sundae.

Vegetables tend to have more fiber and fewer calories. Lettuce, spinach, celery, cucumbers, cabbage, radishes, onions, leeks, kale, and other greens can be eaten as desired. Carrots have a higher glycemic index, but it’s hard to eat too many carrots. Green beans and pea pods are good because they include the low-calorie pod. Beans and peas are high in fiber, a good source of protein, but higher in calories than salad greens. Corn is actually a grain, not a vegetable, but it is preferable to a processed grain like white flour or cereal.

If it weren’t for the ingredients, a diabetic could eat an unlimited amount of salad. The dressing can add hundreds of calories, as can other dressings like eggs, croutons, seeds, and bacon bits. Flavorful low calorie dressings are an option, or use a small amount of regular dressing. Again, serving size is vital. A restaurant serving of regular dressing for a large salad is easily 500 calories, while a large serving of diet dressing can be under 100.

Most diabetics love carbs, but limiting them to whole grains is a good idea. And while oats have been touted as a health food, processed oats are metabolized almost as quickly as sugar-coated cereal. If you like oats, choose raw steel-cut oats (but keep in mind that they take much longer to cook).

Everyone needs dietary protein to keep muscles strong and healthy. While it is possible to get enough protein from a vegetarian diet, most people prefer to add animal products like fish, poultry, eggs, or meat. Many diabetics have high cholesterol levels and therefore need to avoid red meat and excess eggs. Lean meat such as chicken, fish or turkey is preferable, but be careful with salty meats, which can increase blood pressure.

Five daily servings of calcium foods (1500 mg) in the form of green leafy vegetables or dairy products should be included in the diet. Skim milk, low-fat cheese, and artificially sweetened yogurt are good choices.

Lastly, what about dessert? Today, many desserts are available in no-sugar-added varieties, including ice cream, cookies, and cakes. These are sweetened with sugar alcohols, which don’t raise blood glucose as fast as regular sugar, but are just as high in calories. A bowl of berries with some sugar free ice cream is a reasonable option.

Copyright 2010 Cynthia J. Koelker, MD