Susan Neuman can still recount a saying her grandmother brought “from the old country — “What a man eats, a man is.”
The saying has had an even greater impact since Neuman was diagnosed with diabetes in 2013.
“My mother and father both had diabetes,” said Neuman, owner of a Miami public relations firm. “Family history is a major factor. But I did manage to delay the onset eight or 10 years later than my parents did.”
Neuman has learned to change her way of eating.
“I grew up eating meat and potatoes,” she said. “I’ve learned to rebalance my plate. Meat used to be the star. I’m making the meat portion smaller and smaller. When I go to a restaurant, I take home a doggie bag.”
She sometimes craves mashed potatoes but blends the spuds with cauliflower to lower her carbs. She keeps chopped fresh vegetables in the fridge. And this professed “chocoholic,” savors a square of dark chocolate instead of a lavish dessert.
“I’m not 100 percent vegetarian, but the vegetable side of my plate has outgrown the meat side,” said Neuman, who is now off insulin.
Diet, exercise are key
These kinds of dietary changes are crucial in the battle against type 2 diabetes, which accounts for 90 to 95 percent of the more than 34 million U.S. diabetes cases. In patients with type 2, the body doesn’t use insulin properly.
And while family history, race, ethnicity and age are risk factors, among the biggest triggers for type 2 diabetics are obesity and a sedentary lifestyle. This can lead to higher levels of visceral fat around the belly, causing further problems linked to diabetes — heart attacks, heart disease and kidney issues.
“Generally speaking, diet and proper lifestyle are extremely important in preventing and treating diabetes,” said Dr. Gianluca Iacobellis, a research scientist in the Diabetes Research Institute at the University of Miami Health System.
Candace O’Neill, a registered dietitian with Cleveland Clinic Florida in Weston, is even more blunt: “Diet and lifestyle can reduce the risk of type 2 by 58 percent,” said O’Neill. “We know that eating a whole foods, plant-based diet decreases the risk of developing diabetes and prediabetes.”
Beneficial foods include legumes, whole grains, fruits, vegetables and nuts, with limited or no refined foods and animal products.
But there are caveats, said Natacha Borrajo, a registered dietitian with Baptist Health South Florida.
“Potatoes are plants,” she said, noting that not all plant-based foods have equal value. “You need to be able to balance your carbs. It’s not about avoiding carbs, it’s about how to eat them.
“Some patients come in and they’re ready to make lifestyle changes and they’re gung-ho,” she said. “But if a patient is not ready to be a vegan, we encourage them to eat as many plant-based foods as possible on their plate.”
Iacobellis, an endocrinologist, said that patients can eat a healthy diet without going exclusively vegan or vegetarian.
Mediterranean, plant-based diets work
“A plant-based diet is one of the options but it’s not the only option,” he said. “Those diets are very strict and it can be difficult for patients to stick to them.”
A Mediterranean-style diet can be effective for many patients, said Iacobellis. It’s typically high in vegetables, fruits, whole grains, beans and seeds, with a limited amount of red meat, chicken and dairy products. A Mediterranean-style diet also has healthy fats like olive oil, nuts and fatty fish.
“You can make small changes instead of removing a food group altogether,” said O’Neill. “You want something that you can do every day rather than twice a week. We can always improve our diet but we don’t have to do it all in one day.”
Portion control is a good place to begin. Neuman said she’s learned to reduce serving size and eat more slowly so she gets fuller faster.
To keep track, she keeps a food log of what she eats and also checks blood glucose readings several times a day. “You can see what foods cause a spike,” said Neuman. “Each of our bodies is slightly different.”
Iacobellis said he sees patients make huge strides in managing the disease.
Overcoming diabetes, he said, “can be a reality, not a fantasy.”
Diet tips to help prevent or treat diabetes
▪ Learn about carbohydrates: Carbs are the sugars, starches and fibers found in fruits, grains, vegetables and milk products.Your body breaks carbs down into glucose (a type of sugar). “Carbs are our gasoline,” said Baptist Health’s Borrajo.
▪ Manage carbs: You don’t need to eliminate carbs, but choose ones that are rich in fiber, vitamins and minerals and low in added sugars, sodium and unhealthy fats. Even if you eat a plant-based diet, “it’s still important to manage the amount of carbs on your plate for glycemic control,” said Cleveland Clinic’s O’Neill. High-fiber foods “help to ensure your blood sugar is balanced throughout the day and that you feel fuller longer.”
▪ Make smart carb choices: Whole unprocessed, non-starchy choices include lettuce, cucumbers, broccoli, tomatoes and green beans and should make up half of your plate. Also good, but in smaller portions (a quarter of your plate): apples, blueberries, strawberries and cantaloupe, whole grains (brown rice, whole wheat bread, oatmeal, whole grain pasta), beans and lentils. You can also substitute spaghetti squash or spiralized vegetables instead of pasta.
▪ Eliminate sugary drinks: This includes soda, juices or other sweet drinks. Eating whole fruits adds more fiber and you’re not getting added sugar.
▪ Eat healthy fats: Plant oils, such as extra-virgin olive oil and canola oil, carry less risk. Stock up on omega-3 fats, found in walnuts, flax seeds and fatty fish (like salmon, sardines, tuna).
▪ Look for alternate dairy products: If you’re cutting back or eliminating dairy, try nut milks instead of cow’s milk. Nutritional yeast is a cheese alternative that has a cheddar-like flavor, said O’Neill. Vitamin D is important for building bones and for its immunity-promoting properties, so if limiting dairy products, make sure you’re getting the vitamin.
▪ Avoid ultra-processed foods: No foods, not even doughnuts, have to be completely banned, but they should be eaten rarely. Also watch out for chips, packaged pastries, candy and fast food.
“We want to think about foods that are as close as possible to their natural state,” O’Neill said.