By Joyce Hendley
Even when presented with the results of her blood tests, Jan McManus couldn’t believe she had diabetes. “It was a term that didn’t exist in my vocabulary,” she remembers. At the age of 44, she seemed too young for such a serious-sounding diagnosis—and she didn’t feel particularly unwell, despite being overweight most of her adult life. Even though her father had died of heart disease years earlier, and her grandmother had had type 2 diabetes, it just didn’t seem possible. “I was scared and in denial,” she now admits.
Jan is hardly alone. Almost 4,000 Americans each day get a diagnosis of diabetes, adding up to more than 13 million cases nationally—and an estimated 5 million people have diabetes but don’t yet know it. The majority of the new people diagnosed are between the ages of 40 and 59, and up to 95 percent have type 2 diabetes, the form caused in large part by lifestyle habits. The direct and indirect costs are now running at over $130 billion a year, with a burgeoning human toll taken by diabetes-related problems including heart disease, stroke, high blood pressure, blindness and kidney and nervous system disease. In addition there are more than 80,000 lower-limb amputations for people with diabetes each year.
“The good news is that type 2 diabetes can be prevented or delayed,” says Marion Franz, a nationally recognized diabetes educator. “The new approaches to eating for people with diabetes—choosing the right carbohydrates, watching saturated-fat intake, making the right food choices—are the way we all should be eating.”
To learn how to change her diet and manage her disease, Jan McManus was advised to attend a diabetes education class at the Joslin Diabetes Center in Clearwater, Florida. She says that she did so “reluctantly.” The sessions, led by Certified Diabetes Educators Cindy Bray and Anne Schreiner, turned out to be a revelation.
“They told me that I’m 90 percent responsible for my own health, and that they could only help me with the remaining 10 percent,” she says. “It was the kick in the pants I needed to jump-start my life on the road to better health.”
Working with Schreiner, Jan developed a meal plan she could live with—one that “didn’t make anything forbidden.” Unlike the many weight-loss diets she’d tried unsuccessfully in the past, it gave her the flexibility to include the foods she loved, such as pasta and chocolate. Her health-care team at Joslin also focused on tackling one issue at a time, rather than overwhelming Jan with too many changes at once. “First, I worked on limiting the carbs I ate, then we worked on cutting down saturated fat.” And she acquired the habit of measuring all her portions, rather than “eyeballing” them.
Jan’s options for exercise were limited by injury; a former recreation therapist, she’d been sidelined by knee-replacement surgery, spinal fusion and a fused left foot. So she started from ground zero. “The first evening it was a matter of just putting on my sneakers and walking to the end of the driveway and back.” With her mother along for support, she increased her walking by small, realistic increments. “The next day, we walked to the end of the street and back; the day after, to the next telephone pole and back,” and so on, until she reached her goal of a 2.2-mile daily loop.
The pounds started melting off, gradually but persistently. A year and a half later, she had dropped 101 pounds and six dress sizes—and had greatly reduced her daily dose of diabetes medication. Now, within a few pounds of her weight-loss goal, Jan is a committed daily exerciser who aerobic water-walks in a swimming pool for an hour every day and does a cardio/strength workout three times a week (30 minutes on an exercise bike and 30 minutes on cardio and strength machines). Support from family and friends has been vital throughout her journey, and she’s especially grateful to her diabetes-education team. “I always know they’re just a phone call away.”
Today, Jan feels like a new person, “with more life and more energy”—and looks like one too. “When I run into people I haven’t seen in a few years, they don’t recognize me. Some of them figure I must have had gastric-bypass surgery!” she laughs.
As Jan McManus’s experience shows, eating to manage diabetes is, for the most part learning to eat with your eyes open—knowing what’s going into your body and when. That’s good advice for anyone to follow, diabetes or not. If you have diabetes, or are simply eating with prevention in mind, you’ll likely start by keeping track of your meals, using one of two methods: the Exchange System or counting Carbohydrate Servings.
Used in diabetes management for more than 50 years, this method groups together foods that have roughly the same amounts of calories, carbohydrate, fat and protein into “Exchange” groups, so that one may be exchanged for another. One exchange in the “Starch” group, for instance, could be a 6-inch corn tortilla or 1⁄2 cup of green peas or 1⁄3 cup of pasta; an exchange in the “Lean Meats” group could be 1 ounce of tuna or lean pork. Following the Exchange System starts with planning out a daily meal pattern: which exchanges to include in each meal and how many.
To manage diabetes through mindful eating, the newer method is to count Carbohydrate Servings. One Carbohydrate Serving, sometimes called a “Carbohydrate Choice,” is a portion of food that contains 15 grams of carbohydrate—about the amount in a small potato, a slice of bread or a medium apple. You aim for a predetermined amount of Carbohydrate Servings at each meal: typically, 3 to 5 Carbohydrate Servings at main meals and 1 to 2 Carbohydrate Servings for snacks. For most people with diabetes, the daily total number of Carbohydrate Servings will be about 12 (for a 1,500 calorie/day plan) or 16 (for a 2,000 calorie/day plan).
With either system, you’ll need to know the carbohydrate content of a food first. Food lists can help you get started. As you become more familiar with standard portions, you’ll be able to estimate the carbohydrate content of more complex foods, like pizza. Recipes with nutrition information, like those in EatingWell, are a good source of carbohydrate amounts. On packaged foods, check the food’s “Serving Size,” then look for the “Total Carbohydrate” value in grams. The “Dietary Fiber” listing is also important. The higher the better, as explained in the Carbohydrate-Servings Calculator box (below).
Because you are following a carbohydrate “budget” of sorts, it makes sense to opt for the best quality you can get. That means the bulk of your carbohydrates should come from so-called “good carbohydrates”: fiber-rich and whole-grain foods.
Use the ranges below to convert a food’s carbohydrate content to its equivalent in Carbohydrate Servings.
|Grams (g) Carbohydrate||Carbohydrate Servings|
THE FIBER BONUS: If a food contains 5 or more grams of dietary fiber per serving, subtract that number from the Total Carbohydrate grams. For example, a 38-gram carbohydrate portion with 5 grams of fiber would count as 38 – 5 = 33 grams.
This would make it equivalent to 2 Carbohydrate Servings instead of 2 1⁄2.