Authors: Karen Halderson, MPH, RD, CDE Extension Diabetes Coordinator; and Martha Archuleta, PhD, RD Extension Food and Nutrition Specialist.

Table of Contents

Circular 631A: Choosing Foods at Meals and Snacks
Circular 631B: How to Read a Nutrition Facts Label
Circular 631C: What About Sweets?
Circular 631D: Keeping Heart Healthy
Circular 631E: Diabetes Food Guide Pyramid

Circular 631A: Choosing Foods at Meals and Snacks

• People with diabetes must balance foods high in carbohydrates and foods low in carbohydrates.
  
  
• Low-carbohydrate foods include vegetables, meats and nuts, and fats.
  
  
• High-carbohydrate foods include grains, fruits, milk, and sweets. These foods raise blood glucose.
  
  
• In the 50/50 method, half of each meal is taken from the low-carbohydrate groups and half from the high-carbohydrate groups.
  
  
• It helps to divide up high- and low-carbohydrate foods visually, keeping each on its own side of the plate or the table.
  
  
• Eating extra vegetables can help you feel fuller and more satisfied after meals without raising your glucose levels.

The Diabetes Food Guide Pyramid is very helpful as a guide for food choices during the course of a day. However, you want to balance these food choices during the day so that foods high in carbohydrate are not eaten all at once. For example, two to four servings of fruit and two to three servings of milk every day are recommended. But you would not want to consume all your fruit and milk servings at breakfast because this could be too much carbohydrate for your body to handle at one time.

50/50 Method

The purpose of the 50/50 method is to make meal planning and food selection easy for people with diabetes. The 50/50 method balances foods high in carbohydrate with foods low in carbohydrate. It works particularly well for lunch and dinner meals.

For most people, a good balance is to have about 50% (half) of servings from foods high in carbohydrate and about 50% (half) of servings from foods low in carbohydrate.

The food groups that contain significant amounts of carbohydrate are the grains, beans and starchy vegetables group; the fruits group; the milk group; and sweets. These foods raise blood glucose.

The food groups low in carbohydrate are the vegetables group; the meat and meat substitutes group; and fats. These foods do not cause blood glucose to go up.

It can help to think of placing foods high in carbohydrate on one side at a meal and foods low in carbohydrate on the other side.

How does this actually look when you sit down to eat? With some foods, you could actually place them on different sides of your plate and look to see if your plate is “balanced.” Often, though, not everything we eat at lunch or dinner is on our plate. So we need to remember those foods—like salads, milk, a piece of fruit or dessert—that often aren’t served on the plate. These foods also need to fit into the overall balance of a meal.

Here is another thing to remember: many dishes, such as enchiladas or pizza, are made up of foods from different food groups. For these dishes, you’ll need to estimate how much is from each of the foods that make up the dish (see enchiladas, Example 6).

Vegetables can help you feel fuller and more satisfied after meals. An easy way to be sure to eat enough low-carbohydrate foods is to serve up double portions of vegetables. For example, a serving of cooked green beans on the Diabetes Food Guide Pyramid is 1/2 cup. If you take 1 cup of green beans, you’ve already got two servings on the low-carb side of your plate! Green salads are another case where it’s easy to eat two servings. A serving of salad on the Diabetes Food Guide Pyramid is 1 cup. Fill a good-sized salad bowl, and you’ve likely dished up two cups. So again, you’ve got two servings of low-carbohydrate foods and are well on your way to getting the recommended servings of vegetables for the day. It’s fine to have an extra low-carb serving from vegetables (see carne adobada, Example 8).

Here are nine examples of meals that you might commonly have for lunch or dinner. Each of these examples has two to three servings of foods that are high in carbohydrate and at least three servings of foods that are low in carbohydrate. Two to three high-carbohydrate foods are used as examples. The diet plan from your dietitian or diabetes educator may differ in the number of high-carbohydrate foods recommended for your meals. You should follow the recommendation from your dietitian or diabetes educator.

Even so, the 50/50 plan can be used for different levels of carbohydrate serving recommendations. For example, if four servings of carbohydrate foods are recommended for lunch for an active person, then four servings of low-carbohydrate foods provide a good balance.

The 50/50 method doesn’t work as well for breakfast because a lot of breakfast foods are high in carbohydrate. Try to include some protein at breakfast. Protein doesn’t affect blood sugar, but it does increase satiety (feeling full). Most people can have 3 eggs per week. Add nuts to dry or cooked cereal. Have toast with peanut butter or a slice of cheese. Put peanut butter on pancakes or french toast. Control the overall amount of high carbohydrate foods eaten at breakfast. Follow the recommendations of your dietitian or diabetes educator. Table 1 gives examples of breakfasts that have 3 servings of high carbohydrate foods.

Table 1. What about breakfast?

Example 1. 50/50 Method	Example 2. Steak Dinner
Example 3. Chicken Dinner	Example 4. Stir Fry
Example 5. Spaghetti Dinner	Example 6. Enchiladas
Example 7. Bean Burrito	Example 8. Carne Adovada
Example 9. Navajo Taco	Example 10. Mutton Stew

Circular 631A (Printed and electronically distributed September 2007, Las Cruces, NM.)

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Circular 631B: How to Read a Nutrition Facts Label

• Remember that 15 grams of carbohydrate is a serving.
• Look at Total Carbohydrate, not just at Sugars, to see if a food will raise blood sugar.
• Always compare serving sizes on nutrition labels to those listed with the Diabetes Food Guide Pyramid.
• Look carefully at the number of servings per container. The amount of calories and nutrients listed on the label applies to one serving, not necessarily to the full quantity of food in the container.
• Calories are a measure of the amount of energy in food. You can compare the amount of calories in similar products if the serving sizes are the same.
• Look at both the amount of calories and the amount of total fat when comparing the regular and low fat versions of a food. Low fat doesn’t necessarily mean low calorie.
• Look for foods with less saturated and trans fats. Choose the leanest cuts of meat.
• Cholesterol intake should be 300 mg or less per day.
• Look for foods that contain 400 mg of sodium or less per serving.

The Nutrition Facts label on food (Figure 1) contains information that can be helpful to people with diabetes.

Figure 1. Nutrition Facts label, french fries

Serving Size

Compare this to the serving size listed with the Diabetes Food Guide Pyramid. For example, the serving size listed on a bottle of orange juice is 8 oz, but the serving size listed with the Diabetes Food Guide is 1/2 cup, which is 4 oz. You may need to make adjustments so that you are comparing similar serving sizes.

Servings Per Container

Look carefully at the number of servings per container. A container that appears to be one serving may contain more than one serving.

Amount Per Serving

The amount of calories and nutrients listed on the label applies to one serving, not necessarily to the full quantity of food in the container.

Calories

Calories are a measure of the amount of energy in food. You can compare the amount of calories in similar products if the serving sizes are the same.

Total Fat

Look at both the amount of calories and the amount of total fat when comparing the regular and low fat versions of a food. Low fat doesn’t necessarily mean low calorie.

Saturated Fat

Saturated fat comes mainly from animal-based foods. Saturated fat raises total cholesterol and LDL cholesterol levels in the blood. Look for foods with less saturated fat.

Trans Fat

Trans fat is found mainly in processed foods. Trans fat also raises total cholesterol and LDL cholesterol levels in the blood. Trans fat is now listed on the label. Look for foods with little or no trans fat.

Cholesterol

Cholesterol is found in animal-based foods. Cholesterol intake should be 300 mg or less per day.

Sodium

In general, sodium intake should be less than 2,400 mg per day. Look for foods that contain 400 mg of sodium or less per serving. For a frozen convenience dinner or entrée, look for one that contains 800 mg of sodium or less. People with kidney disease may need to have a lower daily sodium intake.

Total Carbohydrate

This is probably the most important information for a person with diabetes. Remember that 15 grams of carbohydrate is a serving. By looking at the grams of total carbohydrate in a food, you can figure out how many servings of carbohydrate it has. Most foods don’t have exactly 15 grams of carbohydrate. Table 1 can be helpful in estimating carbohydrate servings.

Table 1. Estimating carbohydrate servings

Dietary Fiber

A food that contains 5 grams of fiber or more per serving is considered high fiber. A food that contains 2.5 to 4.9 grams of fiber per serving is considered a good source of fiber.

Sugars

A food product that states “no added sugar” or “sugar-free” can still contain other carbohydrates. Look at Total Carbohydrate, not just at Sugars, to see if a food will raise blood sugar.

Protein

Meats contain saturated fat and cholesterol as well as protein. Choose the leanest cuts of meat. Choose low-fat cooking methods for meat, poultry and fish. People with kidney disease may need to restrict the amount of protein they eat each day.

Circular 631B (Printed and electronically distributed October 2007, Las Cruces, NM.)

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Circular 631C: What About Sweets?

• Sugar and sweetened foods have the same effect on blood sugar as other high-carbohydrate foods.
• Sugar and sweets can be part of a healthy diet if you take care not to let them replace nutrient-rich carbohydrate foods like whole grains, fruits, beans and milk.
• Many delicious desserts can be made using fresh fruits and other nutritious ingredients.
• Artificial sweeteners can add sweet-ness to desserts while adding few or no calories or grams of carbohydrate.
• Remember that fruit desserts—as well as those made with artificial sweeteners—may still contain high levels of carbohydrate. This is because they contain other high-carbohydrate ingredients, such as flour and milk.
• Reading a nutrition label helps in deciding how much of a sweet food to eat. Remember that 15 grams of carbohydrates equal one serving of a carbohydrate food.
• Go ahead and enjoy an occasional sweet. Moderation and balance are the keys to fitting the foods you love into your overall diet.

In times past, people with diabetes were told that they couldn’t eat sugar or sweet foods. But what about fruit or milk, foods that contain naturally occurring sugars? If it had been true that people with diabetes simply couldn’t eat sugar, they also would have had to forgo fruit and milk.

Now we understand that sugar and sweetened foods have the same effect on blood sugar levels as other high-carbohydrate foods (such as starches, milk and fruit), when we compare equivalent amounts of these foods in terms of the carbohydrates they contain. The key is to control the total carbohydrate intake. Many delicious desserts can be made using fresh fruits and other nutritious ingredients. Artificial sweeteners can be used to add sweetness to desserts while adding few or no calories.

Many sweet foods (such as cakes, cookies and candies) do not contain nutrients that the body needs. Even if you balance your carbohydrate intake using the 50/50 Method (see Circular 631A, Choosing Foods at Meals and Snacks, in the Control Your Diabetes for Life series) it’s not a good idea to eat large amounts of these foods. If you do, it’s likely that you’ll end up eating fewer portions of grains, fruits and milk on a daily basis. Sugar and sweets can fit into a healthy diet occasionally. However, they should not replace nutrient-rich carbohydrate foods like whole grains, fruits, beans and milk.

One solution is to eat fruit for dessert, either alone or incorporated into recipes. While fruit is high in carbohydrate, it also contains vitamins, minerals and fiber. If you choose canned fruit, look for the kind packed in light syrup or fruit juice. These types have less sugar than fruits packed in heavy syrup. If canned fruit in heavy syrup is the only type available, drain off the syrup and rinse the fruit before eating it.

A second strategy is using sugar substitutes, which lend a sweet taste to foods without adding many calories or grams of carbohydrate. Remember that sugar is more than a sweetener. In addition to sweetening a recipe, sugar makes baked products tender and moist. It gives a golden brown color to baked desserts and breads. It also gives volume to cakes and cookies. To avoid disappointing results, start by replacing only part of the sugar with artificial sweeteners. Keep in mind that most sugar substitutes are much sweeter than sugar; be careful to find out a product’s sugar equivalency by reading the food label. Recipes that usually do well with sugar substitutes are beverages, frozen desserts, pie fillings, sauces, gelatins and puddings. You can look for artificial sweetener recipes on product containers, request them from the company or search for them online.

There are four categories of sugar substitutes, which are also called non-nutritive sweeteners:

Saccharin
Saccharin sweeteners are very stable for baking, but leave a bad aftertaste when used in large amounts. Sweet n’ Low, Sweet Twin and Sugar Twin are saccharin-based sweeteners. Women are advised not to consume saccharin during pregnancy.

Aspartame
Aspartame has very little aftertaste, but it loses its sweet taste when heated. Equal, Nutrasweet and Natrataste are aspartame-based sweeteners.

Acesulfame Potassium
Acesulfame potassium is more stable when heated than aspartame and has less aftertaste than saccharin. Sweet One, Swiss Sweet and DiabetiSweet are acesulfame potassium-based sweeteners.

Sucralose
Sucralose is an artificial sweetener that is made from sugar that has undergone certain chemical changes. It has the same volume and taste as sugar and it is stable when heated to high temperatures. Splenda and Altern are sucralose-based sweeteners.

These four substances were tested for years before manufacturers were permitted to add them to foods. They have been determined by the Food and Drug Administration to be safe for human consumption. One exception is people who are born with a very rare condition called phenylketonuria. These people cannot metabolize foods that contain large amounts of phenylalanine, one of the ingredients in aspartame. They need to avoid aspartame as well as many other foods.

Look for information about food safety from reliable sources, such as the American Dietetics Association (www.eatright.org), the American Diabetes Association (www.diabetes.org), and the American Association of Diabetes Educators (www.aadenet.org).

If you choose to use artificial sweeteners the following Web sites have recipes and other information.

www.sweetnlow.com
www.nutrasweet.com
www.natrataste.com
www.sweetone.com
www.splenda.com
www.equal.com
www.diabeticproducts.com/diabetic-dish

Reading a nutrition label helps with decisions about how much of a sweet food to eat. Remember that 15 grams of carbohydrates is considered 1 serving of a carbohydrate food. If a serving of dessert contains 45 grams of carbohydrates, it counts as 3 carbohydrate servings. Depending on how many servings of carbohydrates you are allotted at a meal, dessert could use up your total carbohydrate “allowance.” In this case, you might want to eat less than a serving. Remember that many fruit desserts, as well as those made with artificial sweeteners, still contain high levels of carbohydrate. This is because they also contain other high-carbohydrate ingredients, such as flour and milk.

Go ahead and enjoy an occasional sweet. As with all high-carbohydrate foods, moderation and balance are the keys to fitting the foods you love into your overall diet.

Circular 631C (Printed and electronically distributed January 2008, Las Cruces, NM.)

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Circular 631D: Keeping Heart Healthy

• People with diabetes are much more likely to suffer from heart disease than those without diabetes.
• Heart healthy eating refers to choosing foods that are low in saturated fat and sodium and high in fiber. In terms of fat, it is important to focus on limiting cholesterol and solid fats.
• Saturated fats are solid fats found in fatty animal products and in some vegetable oils, such as coconut and palm oils.
• Liquid vegetable oils can also be converted into solid fats by hydrogenation, which produces trans-fatty acids (trans fats). Trans fats are similar to saturated fats and should be eaten only in small amounts.
• Good sources of heart healthy monounsaturated fats include olive oil, canola oil, and peanut oil. In most recipes, these oils can replace solid fats such as lard or butter.
• Many people with diabetes also have high blood pressure. If you have high blood pressure, you should be careful about the amount of sodium in your diet.

People with diabetes are at increased risk for heart disease. Eating a diet high in saturated fat—and having high blood glucose and high blood pressure—may contribute to this. A diet high in saturated fat can also contribute to other vascular problems associated with diabetes, such as stroke, bad circulation to the legs and feet, and male impotence.

People with diabetes should keep their blood glucose and blood pressure under control and choose heart healthy foods every day. Heart healthy eating means choosing foods that are low in fat and sodium and high in fiber. In terms of fat, it is important to focus on limiting cholesterol and solid fats.

Cholesterol

All animals, including humans, make cholesterol. Some people’s bodies make too much of it. Cholesterol is also found in fatty animal products such as eggs, some meats, and high-fat dairy products (like many cheeses).

Solid Fats

Solid fats refers to fats that are solid at room temperature. One type of solid fat, saturated fat, is found in fatty animal products and in some vegetable oils, such as coconut and palm oils—these are often used in processed foods.

Liquid vegetable oils can also be converted into solid fats by hydrogenation, which produces trans-fatty acids (or trans fat). These substances can be as harmful to the body as saturated fat. For this reason, trans fat now appears on Nutrition Facts labels.

Products with high amounts of trans fat include solid vegetable shortening and regular margarines. Trans fat is commonly used in crackers, cookies, snack foods and baked goods. Look for ways to substitute healthier oils for fats and oils that contain high amounts of cholesterol, saturated fatty acids or trans fat. Lard, bacon fat and butter add flavor to foods, but are high in cholesterol and saturated fat. These fats should be used only occasionally and in small amounts. All fats and oils are high in fat and calories, so it is important to eat them only in moderation.

It is also important to choose solid vegetable fats carefully. Even though vegetable shortening and margarine do not contain cholesterol, they do have high amounts of saturated and trans fats and therefore should be used only once in a while.

Healthy Oils

In contrast, there are liquid oils that should be your “fats of choice” because they are good sources of heart healthy monounsaturated fats. These include olive oil, canola oil, and peanut oil. In most recipes, these oils can replace solid fats like lard or butter. Oils with strong flavors (olive, sesame or walnut) add flavor to foods even when used in small amounts. Most nuts contain high amounts of monounsaturated fats; try almonds, walnuts or pecans.

Food Preparation

Prepare food with less fat. Vegetables can be steamed, stir-fried, cooked in a microwave oven, roasted or grilled. Potatoes, sweet potatoes and winter squash can be baked. Oven bake french fries instead of frying them. Use lower fat salad dressings or less regular salad dressing. Use vinaigrette or lowfat yogurt with seasonings to dress coleslaw. Season foods with Canadian bacon or lean ham instead of fattier meats.

Meats

Choose lean cuts of meat. Marbled fat is the main source of saturated fat for many people. Trim visible fat before cooking. Remove the skin of poultry. Broil, grill, roast, braise or stew meats instead of frying them. Remove the fat from soups and stews. If you refrigerate the liquid, the fat will harden and be easier to remove. After ground beef has been thoroughly cooked, it can be placed in a colander and rinsed with hot (but not boiling) water.

Dairy Fats

The fat in dairy products is quite saturated and contains cholesterol. Choose skim milk or 1% milk instead of 2% or whole milk. Evaporated skim milk can be used in place of high-fat cream in sauces and desserts. Use a small amount of a strongly flavored high-fat cheese such as Parmesan or sharp cheddar to add flavor without adding a lot of fat. Also, try lowfat cheeses. These are better quality today than when lowfat cheeses were first marketed. Buy lowfat or nonfat yogurt that has been sweetened with a sugar substitute, or choose plain nonfat yogurt and add fruit or a sugar substitute to taste. Plain yogurt can be substituted for sour cream or mayonnaise in many recipes.

Sodium and Salt Substitutes

Many people with diabetes also have high blood pressure. If you have high blood pressure you should be careful about the amount of sodium in your diet. Your doctor can tell you how much sodium is healthy for you.

Sodium is measured in milligrams (mg). Dietary Guidelines for Americans, 2005, recommends consuming less than 2,300 mg of sodium a day, less than 1 teaspoon. Certain population groups—those with high blood pressure, African Americans, and those middle aged and above—are recommended to consume no more than 1,500 mg of sodium a day. To reduce sodium, use less salt in cooking and at the table.

According to the American Diabetes Association, “hidden salt” may be the biggest source of sodium in our diets. Hidden salt is found in processed foods, including fast food, restaurant food, canned food and frozen and boxed dinners. Read Nutrition Facts labels to find how much hidden salt foods contain.

When using canned vegetables in a recipe, don’t add extra salt, since salt is contained in the canning liquid. You can also rinse canned vegetables before adding them to recipes. Or, select canned vegetables that are lower in sodium.

Read labels carefully when you buy seasoning blends. Garlic salt is made of salt and just a little garlic powder. Using garlic powder is better. Mixes like Mrs. Dash™ are very tasty and do not contain salt. Start by using a small amount and increase it gradually until you obtain the flavor you like. Salt substitutes can also be prepared at home. Recipes for three salt substitutes are given in Table 1. Be careful when choosing salt substitutes, because some of them are made with potassium chloride. This compound is not healthy for all people to consume. Ask your doctor before using a substitute that contains potassium chloride.

Table 1. Salt Substitutes

Circular 631D (Printed and electronically distributed January 2008, Las Cruces, NM.)

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Circular 631E: Diabetes Food Guide Pyramid

• Choosing foods from the Diabetes Food Guide Pyramid can help you get the nutrients you need while keeping your blood glucose under control.
• The Diabetes Food Guide Pyramid places starchy vegetables at the bottom of the pyramid, with grains. These foods are similar in carbohydrate content to grains.
• The Diabetes Food Guide Pyramid puts cheese is in the Meat and Others group instead of the Milk group because cheese has little carbohydrate and is similar in protein and fat content to meat.
• Knowing the serving size of high-carbohydrate foods, and choosing the right number of servings per meal, can help you manage your blood glucose.
• One slice of bread or one starchy vegetable serving fits in the palm of a woman’s hand.
• One fruit serving is about the size of a tennis ball or small fist.
• One milk serving is 8 ounces, about the size of a small coffee cup.

Diabetes Food Guide Pyramid. Reprinted with permission from the American Diabetes Association from Diabetes Meal Planning Made Easy by Hope S. Warshaw ©2000.

The Diabetes Food Guide Pyramid is a tool that shows how much you should eat each day from each food group for a healthy diet. The Diabetes Food Guide Pyramid differs from the old USDA Food Guide Pyramid and from USDA’s new MyPyramid. Until MyPyramid is modified for use by people with diabetes, the Diabetes Food Guide Pyramid is the best food guide for people with diabetes. The Diabetes Food Guide Pyramid places starchy vegetables such as peas, corn, potatoes, sweet potatoes, winter squash, and beans at the bottom of the pyramid, with grains. These foods are similar in carbohydrate content to grains. Cheese is in the Meat and Others group instead of the Milk group because cheese has little carbohydrate content and is similar in protein and fat content to meat.

Choosing foods from the Diabetes Food Guide Pyramid can help you get the nutrients you need while keeping your blood glucose under control. You need foods from all the food groups to have a healthy diet. Refer to Circular 631A, Choosing Foods at Meals and Snacks, in the Control your Diabetes for Life Nutrition Series, for information on getting the right balance of low- and higher carbohydrate foods at meals and snacks.

Foods that are high in carbohydrates increase blood glucose levels and are in the Grains, Beans, and Starchy Vegetables group, the Fruits group, and the Milk group. Other foods that raise blood glucose are Sweets, found in the top of the Pyramid. Starchy foods, sweet foods, fruits and milk are high in carbohydrate. Foods low in carbohydrates are found in the Vegetables group, Meat and Others group and Fats. These foods do not raise blood glucose. Table 1 shows examples of foods high in carbohydrates and their serving sizes. Table 2 shows examples of foods low in carbohydrates and their serving sizes.

Table 1. Foods High in Carbohydrates.

Table 2. Foods Low in Carbohydrates.

What is a Carbohydrate Serving Size?

Knowing the serving size of high-carbohydrate foods, and choosing the right number of servings per meal, can help you manage your blood glucose. Table 3 can help you estimate carbohydrate servings.

Remember

—One slice of bread or 1 starchy vegetable serving fits in the palm of a woman’s hand.

—One fruit serving is about the size of a tennis ball or small fist.

—One milk serving is 8 ounces, about the size of a small coffee cup.

Table 3. Carbohydrate Servings.

Circular 631E (Printed and electronically distributed March 2008, Las Cruces, NM.)

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Where to Go for More Information

• Your health care provider
• American Diabetes Association: 1-800-DIABETES www.diabetes.org
• National Diabetes Education Program: 1-800-438-5383 or visit the World Wide Web at ndep.nih.gov or www.cdc.gov
• New Mexico Diabetes Prevention and Control Program www.diabetesnm.org
• Your county Extension office

This publication was made possible by grants from New Mexico State University’s Cooperative Extension Service and the New Mexico Department of Health Diabetes Prevention and Control Program.

New Mexico State University is an equal opportunity/affirmative action employer and educator. NMSU and the U.S. Department of Agriculture cooperating.