Tami Ross, RDN, LD, CDCES, MLDE, FADCES is a nationally recognized registered dietitian nutritionist, diabetes care and education specialist, spokesperson and consultant with more than 25 years of experience in diabetes care and education. Tami has been named Diabetes Educator of the Year by the Academy of Nutrition and Dietetics’ Diabetes Care and Education group, and was the president of the Association of Diabetes Care and Education Specialists (formerly AADE) in 2013. She has written for professional and consumer publications and has co-authored 10 books.
Q: What inspired you to write What Do I Eat Now?
A: Given that one in 10 Americans have diabetes, and one in three have prediabetes, most people know someone who’s trying to eat well to manage blood glucose (also called blood sugar). As a registered dietitian nutritionist specialized in diabetes care and education, the biggest and most common question I hear among people with diabetes or prediabetes is, “What do I eat now?” Figuring out what, when, and how much to eat can undoubtedly seem challenging! I want people to know that healthy eating with diabetes or prediabetes should be pleasurable, and that most foods can fit (maybe just in different portions than you’re used to). It’s important to know that there’s no “one size fits all diet!” A variety of eating patterns and approaches can help manage blood glucose. It’s good to have options, because everyone is different. The end goal for each person is finding what works to keep blood glucose in range, and then doing more of that.
Q: What are type 2 diabetes and prediabetes and how are they related?
A: Diabetes, in general, is a chronic condition where blood glucose (also known as blood sugar) builds up in the blood, leading to levels higher than normal, which can cause problems if not managed. Type 2 diabetes is the most common form of diabetes. While once called “adult onset diabetes,” type 2 diabetes can actually occur at any age. With type 2 diabetes, the body does not use the hormone insulin properly, which is called “insulin resistance.” It’s helpful to know that insulin’s job is to help keep the right amount of glucose (sugar) in the blood as fuel for the body. Thus, with insulin resistance, blood glucose rises too high.
Prediabetes, as the name implies, comes before type 2 diabetes. Prediabetes is when blood glucose levels are slightly higher than normal, but not high enough to fall into the diabetes range. Having prediabetes is basically the first step toward type 2 diabetes. Many with prediabetes go on to develop type 2 diabetes within 10 years. Current estimates from the Centers for Disease Control and Prevention (CDC) are that one in three American adults have prediabetes. Most aren’t aware. Think about prediabetes this way—it is like a yellow caution light. It’s a warning that type 2 diabetes may be ahead. There are often no symptoms with prediabetes. However, prediabetes can still cause problems, and lead to increased risk for heart disease and stroke. The really positive news is that prediabetes responds well to healthy eating habits, weight loss and exercise—what may also be known as “lifestyle change.”
Q: What is a SMART Goal and how is it beneficial for people with diabetes?
A: When it comes to embracing lifestyle changes to help manage diabetes or prediabetes, SMART goal setting gives a framework for “getting it done.” It helps you reach your health goals, manage your time and track your progress. SMART is an acronym for Specific, Measurable, Attainable, Relevant and Timely. These are the five characteristics or qualities your goal should have.
Specific: A specific goal has a greater chance of being achieved. What exactly do you want to accomplish? Answer who, what, when, where, how and why.
Measurable: Measuring progress keeps you on track. How can you track your progress? How will you know when you’ve reached your goal?
Attainable: An attainable goal is tied to small, easily accomplished steps. Is meeting this goal attainable or possible for you? If not, how will you get what you need to make it happen?
Relevant: A relevant goal is one you are willing and able to work toward. Why do you want to reach this goal? Is it important to you? Is it something you can do?
Timely: A deadline gives a sense of urgency and helps you to identify progress. When will you complete the goal? Set a time or deadline you can meet if you try. Set a halfway measurement or milestone at which to check your progress.
Here’s an illustration of how to transform a general goal into a SMART goal:
• Initial goal: I will eat more fruits and vegetables.
• SMART goal: I will have a small piece of fresh fruit at lunch three days this week. I will fill half of my plate at dinner with non-starchy vegetables five days this week.
You get the idea. It’s important to emphasize to be realistic. Sometimes “life happens” and you may not accomplish every goal you set, that’s ok. Do the best that you can do. Having goals helps maintain focus and keeps you moving onward and upward.
Q: Please explain the Diabetes Plate Method.
A: With diabetes and prediabetes, what you eat has a big impact on blood glucose, weight and overall health. Making healthy food choices can help. That begins with how you portion your plate, which is known as the Diabetes Plate Method. It is an easy way to plan meals and manage portions. It doesn’t require any counting or too much thinking. You can use this method at home, at work, and when you go out to eat. Some people may be able to achieve their blood glucose, weight and other health goals with the Diabetes Plate Method alone.
Here’s how it works:
A 9-inch plate is about the right size. While many think first about the meat or protein, vegetables (the non-starchy kind) become the focus with the Diabetes Plate Method. They’re low in calories and don’t have much effect on blood glucose. Imagine a line down the middle of the plate. Then on one side, cut it again so you will have three sections on your plate.
Step 1: Fill half of your plate with non-starchy vegetables. These include things like salad greens, broccoli, green beans, carrots and tomatoes.
Step 2: Fill one-quarter of your plate with protein. Protein foods include fish, chicken, turkey, lean beef or tofu.
Step 3: Fill one-quarter of your plate with carbohydrate foods such as grains, starchy vegetables, fruit or milk/yogurt. If your eating plan allows, you may add a glass of milk or serving of another carbohydrate food, such as fruit, outside the plate itself.
Step 4: Choose water or other zero calorie drink such as unsweetened tea, sparkling water, or an occasional diet lemonade or diet soda.
Step 5: Choose healthy fats. These are largely plant-based fats, such as olive oil, canola oil or avocado.
You see that sweet treats are not part of the Diabetes Plate Method. Sweets are not off limits. But fewer added sugars are best for anyone, diabetes or not. One of the questions I’ve gotten frequently over the years is “How high can you pile your plate?” A great question! The answer is no higher than a deck of cards is thick. That will help keep portions in check.
Q: In addition to altering their diet, what other lifestyle changes do you recommend?
A: We hear that term “lifestyle change” used frequently. Lifestyle is a core influencer on diabetes care. It’s a process that begins with small steps, small swaps and small changes in what you eat, how you manage weight, how you move and how you manage stress. Small changes add up and make a difference. What Do I Eat Now? focuses primarily on the “what to eat” piece of lifestyle to help you live your best life, but keep in mind that healthy eating does not stand alone. To elaborate a little on each of the other impactful lifestyle changes…
Weight management: Basically, the thing to know is that weight loss helps, and generally, the greater the weight loss, the greater the benefits. Small changes can yield big results. The vast majority of individuals with type 2 diabetes are overweight and have insulin resistance. Many also have high blood pressure and high blood lipids. Weight loss is an important part of therapy for improving all aspects of type 2 diabetes. Maintaining a 7 to 10 percent weight loss (if overweight) can help delay/prevent type 2 diabetes. Weight management is not only critical for preventing type 2 diabetes, but also for managing type 2 diabetes. Losing at least 5 percent helps lower not only blood glucose, but also blood pressure and lipids. If you have a lot of weight to lose, losing 15 percent or more when feasible and can be safely accomplished, is associated with even better outcomes.
Physical activity: Regular physical activity is a good thing! It has many benefits—it lowers blood glucose, can help with both weight loss and prevention of weight regain, it helps keep the heart healthy, and is a great stress reliever. The goal is to move more, sit less.
Stress management: Living with diabetes can be stressful. And stress can have a big impact on diabetes management. Stress causes your body to make hormones that raise blood glucose. When you are stressed, it’s common to spend a lot of time thinking about the past and worrying about the future. It may also be harder to eat healthy, be physically active, take your medication or check your blood glucose frequently enough. Managing stress is an important part of staying healthy with diabetes. Managing stress means either reducing stressors in your life or reducing your response to stress. While on the topic of stress management, I want to encourage you if you use tobacco or nicotine in any form to take steps to stop because it is a harmful combination with diabetes. It can not only worsen blood glucose, but increase the risk of heart disease, other health complications, and result in premature death. Many don’t realize that tobacco and smoking may actually increase the risk for developing type 2 diabetes as well.
Get your Zzzs: Sleep loss actually can make it harder to manage blood glucose. And when sleep deprived, you may let your guard down and find yourself craving high fat, high carbohydrate food. Aim to get at least seven to eight hours each night.
Q: Do you recommend dietary supplements? If so, which ones?
A: Many wonder if by having diabetes there are any special needs they need to cover. Here are the current evidence-based recommendations based on the American Diabetes Associations Standards of Medical Care in Diabetes 2020:
• Routine use: Routine use of multivitamin or mineral supplements (such as chromium or vitamin D) is not generally recommended without an underlying deficiency.
• Metformin and B12: If you take the diabetes medication metformin, you should get your vitamin B12 level checked at least annually. If the level is low, B12 supplementation is an option then.
• Magnesium and prevention: In terms of diabetes prevention, there is some emerging evidence that suggests magnesium supplementation may positively effect blood glucose in people with prediabetes.
• Herbal supplements: There’s no evidence of blood glucose benefit from routine use of herbal supplements (such as cinnamon or aloe vera).
• Multivitamin: Talk with your health care team about whether you could benefit from a multivitamin based on your health status.
Q: Is there anything else you would like to add?
A: What Do I Eat Now? is designed to provide core basic foundation and guide you in deciding what you can and are willing to do. For readers that may be focused on managing diabetes or prediabetes in their own life, I encourage you to partner with your diabetes health care team to focus together on how to optimize lifestyle for you. The best place to find the individualized and personalized advice you need to ensure healthy eating success is by working with a registered dietitian nutritionist (RDN) and/or certified diabetes care and education specialist (CDCES, formerly CDE). Managing diabetes or prediabetes is a journey not a sprint. Small changes add up!