I Have Diabetes: What Can I Eat?

A Journey Through the History of the “Diabetic Diet”

By Alison Evert, MS, RD, CDE

Before insulin was discovered in 1922 and the first oral diabetes medicine was available in 1955, the only treatment for diabetes was called “nutrition therapy.” Through the years, diabetes nutrition guidelines have varied greatly.

As far back as 1500 BC, Egyptians were first described treatment for excessive urination. The Egyptians treated this problem with a diet of grains, fruits, honey, and beer. Hindu doctors between 100 BCE to 700 CE observed that diabetes could be inherited. They also thought that diabetes was a result of too much food and alcohol and being sedentary. In 150 AD, the Greek physician Arateus described what we now call diabetes as “the melting down of flesh and limbs into urine.” From then on, doctors began to understand diabetes better, but treatment was still unclear.

By the seventeenth century, doctors noted that people with diabetes had sweet-tasting urine. Soon two different types of nutrition therapy emerged. Some doctors believed that restricting carbohydrates (carbs) was necessary to reduce the sugar in the urine. Other doctors felt that replacing sugar lost in the urine was the best treatment. A typical carb-restricted breakfast could include milk, a slice of bread with butter, and lime water. The midday meal might be a serving of plain pudding (either blood or suet pudding). A serving of rotten old meat or game was a common evening meal. However, a high-carb “cure” might include several servings of diluted milk boiled with white bread and barley or rice, oatmeal, potato, legumes, or porridge.

Around the early 1900s doctors prescribed diets low in total calories for people with diabetes. The most popular low-calorie diet for diabetes in the United States was the Allen Starvation diet, with a book available for home use. In 1921 Dr. Allen opened the first clinic in the world for people with diabetes. People on the Allen Starvation diet had to fast for several days until no trace of sugar appeared in their urine. Then the patient was started on a very strict, low-carb diet. The diet consisted of vegetables boiled 3 times, and very small amounts of protein and fat. The diet also recommended an occasional 1½ ounces of whisky for additional calories. The alcohol also helped to make the patient feel more comfortable as he/she were starving.

A noted doctor who supported this dietary approach stated, “It is not particularly important for a diabetic to know a great deal concerning the theory of the disease, but it is vital for him to be able to plan his diet intelligently, and to cooperate with his physician.” Needless to say, the person with diabetes did not have much say in what they could eat.

All of this changed after insulin was discovered. Dr. Elliot Joslin from Boston was the first to teach patients to care for their own diabetes. This approach is now referred to as diabetes self-management education. With Dr. Joslin’s process, the patient would spend several weeks in the hospital after being diagnosed with diabetes. Then, a traveling nurse trained by Dr. Joslin would go to the patient’s home and teach them how to manage their diabetes. Education included learning how to weigh, measure, and record every bite of food. Diets were carefully planned to match the insulin that had been prescribed. The diets were still very strict, but at least now people could eat some fruit, vegetables, and starchy foods. However, sugar and desserts were still not allowed. When the patient returned to the clinic for follow-up care, Dr. Joslin would spend up to half of the appointment talking about what his patient had been eating.

In the early 1950s the American Diabetes Association, the American Dietetic Association, and the United States Public Health Service joined forces to create national diabetes dietary recommendations. This dietary approach was called the Exchange Lists Meal Planning and became the Carbohydrate Counting meal planning. Now, the diabetes diet is tailored to the individual.

Thank goodness times have changed! However, “what can I eat” is still very commonly asked by people with diabetes.

So, what is recommended in 2011?

  • Try to eat at regular times. Don’t eat all of your food at one time. Instead, eat smaller amounts at each meal.
  • Use a plate to see how much you are eating, instead out of the bag or box.
  • Eat whole foods and whole grains more often – they are good sources of fiber.
  • Drink water when you are thirsty instead of soda or juice.
  • Eat five or more servings of vegetables and fruits. Try picking from the rainbow of colors that are available. Fresh and frozen vegetables are usually lower in salt than canned and are a good value.
  • Choose non-starchy vegetables more often, such as spinach, carrots, broccoli or green beans.
  • Choose lean protein foods, such as chicken and turkey without skin, and cuts of beef and pork that end in “loin.”
  • Choose low-fat and non-fat dairy foods.
  • Try to eat fish two or three times per week.
  • Try to eat meatless meals once a week or more using kidney or pinto beans or lentils.
  • Sweets and desserts are okay for people with diabetes, but should be eaten in small amounts. Sweets are foods to eat “once in a while.” People without diabetes should follow the same advice!

If you are still struggling to figure out what to eat, ask for a referral to a registered dietitian [dye-uh-TISH-un] or certified diabetes educator to help you create an individualized meal plan.

Letters from Readers

Question:My doctor says I need to lose weight, but it’s very hard. What’s the best way to quickly lose weight?

Answer: You are right, losing weight can be very difficult. But the important thing is not to lose weight quickly, it’s to lose it permanently. There are thousands of “lose weight quick” programs, but the only way to make a lasting difference is to change your lifestyle. Start small by doing just a little more physical activity, or making healthier food choices for at least one meal a day. Once you can sustain that change for a while, you’ll feel and see the difference! And you’ll be motivated to make another small change. Add up enough small changes, and you’ll have real and sustained weight loss.

Question: What’s the perfect diabetes diet?

Answer: There is no such thing as a perfect diabetes diet. But the most important thing to remember is all things in moderation. There are no foods that are off limits to you, but too much of anything can be a problem. For tips on eating healthy with diabetes and a number of other conditions, check out The Complete Guide to Lifelong Nutrition on Amazon.com

Question: I saw a copy of your magazine in my doctor’s office, and didn’t pick it up. Is there any way I can get a copy?

Answer: In fact, there are many ways. You can go to www.powerofprevention.com to access online copies of every issue of the magazine. You can also send an e-mail to feedback@powerofprevention.com

Question: I saw your article about Olympic athlete Gail Devers’ struggle with thyroid disease. I’d like to tell her what an inspiration she is.

Answer: Gail’s story is truly inspiring and yet, not unlike the struggle that millions go through every day. We’ve shared your comments with Gail, and we’re sure she appreciates them. Anyone who would like to comment on an article in this magazine can send your thoughts to feedback@powerofprevention.com and we will make sure that the appropriate person receives your message.

Alison Evert is a Diabetes Nutrition Educator and the Coordinator of Diabetes Education Programs at the University of Washington Medical Center, Diabetes Care Center in Seattle, WA. She is part of the Diabetes Care Centerʼs multi-disciplinary diabetes team. In this role, she works to translate evidenced-based diabetes and nutrition research into practical information that can be used by her patients with diabetes. She writes and presents frequently about the role of nutrition therapy in diabetes.