Healthier Choices: Adapting for diabetics

What do you do when people you care about develop high blood sugar or diabetes? Invite them over for a meal of macaroni cheese, pierogies, and lima beans? Give them a gift basket full of your famous home-baked Christmas cookies and your home town's best artisan chocolates? Yes, I did serve them that high-carb meal, followed by cake and ice cream. It was my child's birthday dinner. I still feel guilty about it. At Christmas, though, I skipped the cookies and made them a nice basket of their favorite cheeses.

What should I serve the next time they are over? Surely, most of the things I've been eating for the last couple of years are pretty good. The DASH diet is pretty well balanced, not too high in blood-sugar boosting refined sugars and carbohydrates, right?

I asked some questions at the Diabetes discussion group at bigoven.com. What do you know? The very first recipe I posted here, a delicious, hearty, one-pot, balanced, healthy meal is not really so well balanced for diabetics. I was told the recipe was high in "net carbs" (total carbohydrates - fiber), because it has so many potatoes, and the serving size really represents an awful lot of food for one meal.

So I used an EXCEL spreadsheet to help me figure how many servings of what food groups I would get by fiddling with ingredients and quantities, and used to figure the nutritional information. I used the EXCEL spreadsheet to help me replace half of the potatoes with rutabaga, and then reduce the number of vegetable servings from 4 to 3 while leaving the meat unchanged. This took a little bit of fiddling and weighing of rutabagas. I used BigOven's nutritional links to help me get to and save information about how many cups of diced rutabaga I can get from half a large rutabaga.

After I was done fiddling with the quantities in the recipe, I updated my recipe in Bigoven to reflect the decisions I had made. Then I used Bigoven's nutritional calculator to tell me how I had done. Success! The original recipe had 367 calories in an enormous, 2-cup serving, and included 55g of carbs with 9g of fiber for a 46g of net carbs. The revised recipe has has 257 calories in a 1 1/2 to 1 3/4 cup serving, features 3 half-cup servings of vegetables, 33g of carbs and 7g of fiber for 26g of net carbs. The group told me I was now on the right track.

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Of pyramids and potatoes

For the past few years, I have been following the recommendations of the DASH diet developers, which are similar to the USDA recommendations. But I am always interested in other food pyramids. A British dietician, Melanie Thomassian, in her Dietriffic blog, presented the British food pyramid, which turns out to be more of a pie. Considering the popularity of savory pies in the UK, this seems appropriate. The UKFSA food pie groups fruits and vegetables together. The USDA and DASH food pyramids separate them, because they have different nutrient profiles. The UKFSA pie groups the potato with grains, presumably because they are similarly starchy. The USDA groups the potato with vegetables because, well, it is a vegetable, and (starchiness aside) is nutritionally most similar to other vegetables.

By putting the potato with grains, the UK food pie recognizes the potato's role as a staple food. The last time I visited (several years ago now), the potato was a part of "meat and three veg", a standard choice for the evening meal, highly desirable in a breakfast "fry-up", and often eaten at noon. In vast territories of the US, however, the potato fell out of favor during the low-carb craze. Grains are coming back into fashion, but the potato, excellent source of calcium though it is, is presented by the USDA as one of a "vary your veggies" menu. And, because it is not featured in the "eat more dark greens, orange, and dry beans and peas" advice, it is now pretty low in the vegetable rotation. Somewhere down there with kohlrabi and tomatoes, I suppose. But I suspect the potato is more popular than the USDA is letting on. Many restaurants still offer a choice of "potato, pasta, or rice" with the main course. McDonald's still sells a lot of fries. And Waffle House still offers hundreds of variations on the hash brown.

When I was growing up, there were only four food groups in the US. A potato was equivalent to a grain. These days, though, I am much more likely to have a grain (pasta, rice, biscuits, or bread) than a potato with the evening meal. Occasionally, I'll serve a grain AND a potato. It feels a little strange to me, but I do it any way. The DASH diet advises choosing tomatoes and dark green leafy vegetables for half of the weekly vegetable servings, and choosing a variety for the other half. I could still work a potato in there fairly often. Especially if it is a cold potato, which has "better carbs".

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