By Linda Melone
If you have diabetes, watching what you eat is one of the most important things you can do to stay healthy.
"The basic goal of nutrition for people with diabetes is to avoid blood sugar spikes," said Dr. Gerald Bernstein, director of the diabetes management program at Friedman Diabetes Institute, Beth Israel Medical Center in New York.
Candy and soda can be dangerous for diabetics because the body absorbs these simple sugars almost instantly. But all types of carbs need to be watched, and foods high in fat—particularly unhealthy fats—are problematic as well because people with diabetes are at very high risk of heart disease, said Sandy Andrews, RD, director of education for the William Sansum Diabetes Center in Santa Barbara, Calif.
Worst: White rice
The more white rice you eat, the greater your risk of type 2 diabetes, according to a 2012 review. In a study of more than 350,000 people, those who ate the most white rice were at greatest risk for type 2 diabetes, and the risk increased 11 percent for each additional daily serving of rice.
"Basically anything highly processed, fried, and made with white flour should be avoided," Andrews said.
White rice and pasta can cause blood sugar spikes similar to that of sugar.
Have this instead: Brown rice or wild rice. These whole grains don't cause the same blood sugar spikes thanks to fiber, which helps slow the rush of glucose into the bloodstream, Andrews said. What's more, a Harvard School of Public Health study found that two or more weekly servings of brown rice was linked to a lower diabetes risk.
Worst: Blended coffees
Blended coffees that are laced with syrup, sugar, whipped cream, and other toppings can have as many calories and fat grams as a milkshake, making them a poor choice for those with diabetes. A 16-ounce Frappuccino at Starbucks, for instance, can contain 500 calories, 98 grams of carbs, and 9 grams of fat. You may consider a treat such as this "just coffee," but the blended versions can send blood glucose soaring.
Have this instead: Ask for the smaller, 12-oz light or non-fat versions, which range from 60 to 200 calories, making it a much lower-calorie, lower-sugar substitute, said Andrews.
"The lighter version won't drive blood sugars sky high, especially if you take a walk afterward," she added. Ideally, black coffee is best.
Worst: Bananas and melons
All fresh fruit is packed with vitamins and fiber, making them a healthy part of any diet. However, some fruits contain more sugar.
"Bananas, melons, and stone fruits like peaches and nectarines are on the high-sugar side," said Dr. Cathy Doria-Medina, a Los Angeles endocrinologist.
These may cause blood sugar spikes more than other fruit, although this may not be true for everyone.
Have this instead: Granny Smith apples, blueberries, and other berries are lower in sugar.
"But what works for one diabetic may not work for another, so you need to find which fruits work best for you," said Doria-Medina. "Combining the fruit with peanut butter or low-fat cheese (making sure to reduce the fruit portion by half) is also a good way to cut down the fruit portion."
Test your blood sugar two hours after eating to find out how you react.
Worst: Chinese food
High-calorie, high fat, high-sodium, and high-carb Chinese food dishes can spike blood sugar dramatically and keep it high for a while, said Andrews. The biggest offenders include fried entrees such as orange chicken and sweet and sour dishes, which contain breading and are served swimming in a sugary sauce.
Have this instead: If you enjoy Chinese food, prepare a modified recipe at home using steamed veggies and low-sodium, low-fat condiments and flavorings. Reducing sodium can help lower blood pressure and decrease the risk of heart attacks. Skip the white rice and noodles; have brown rice or wild rice instead.
Worst: Breakfast pastries
Avoid doughnuts, toaster pastries, and other bakery sweets if you want to keep your blood sugar under control, said Andrews.
"They're made from processed white flour and are high in fat, carbs, and sodium."
Cinnamon rolls may be the worst, clocking in at over 800 calories and up to 120 grams of carbs.
Have this instead: Try half of a whole-grain English muffin or a brown rice cake topped with peanut butter and a little low-sugar jam, suggested Andrews.
"They're less processed and lower in fat, carbohydrates, and sodium."
Worst: Fruit smoothies
A fruit smoothie sounds like healthy refreshment, but can be a sugary disaster if you have diabetes. A large (28-ounce) smoothie from Jamba Juice contains as much as 510 calories and 92 grams of carbohydrates
"They're full of sugar," said Doria-Medina, a diabetes expert with Healthcare Partners Medical Group in Los Angeles. "A large Jamba Juice smoothie is like drinking three cans of soda."
Have this instead: Make your own smoothie so you can control exactly what goes in it. Include vegetables like kale or spinach and use low-sugar fruits such as green apples and berries, said Dr. Doria-Medina.
Worst: Trail mix
Store-bought trail mix is a blend of nuts, dried fruit, and milk chocolate. Only the nuts are a safe bet for diabetics (and in moderation; they can be high in calories)¬. The dehydration process causes fruits’ natural sugars to become super concentrated.
"Plus, the portion sizes are big, especially when you consider a single dried apricot represents a whole apricot," said Doria-Medina. "It’s easy to eat too much."
Have this instead: Make your own low-carb mix with sunflower seeds, walnuts, soy nuts, roasted peanuts, and almonds with small amounts of unsweetened coconut. Eating nuts in moderation (one ounce per serving) may reduce the rise in blood glucose when consumed along with carbohydrates such as bread, and they are also linked to a lower risk of heart disease.
Worst: Refined cereal
Sweetened breakfast cereals can cause a spike in blood sugar, but the response can vary.
"Blood sugar reactions to cereal vary greatly from person to person," said Doria-Medina.
Even oatmeal—which is recommended as a good choice by the ADA—can be a problem if it's the sweetened, instant type.
Have this instead: Swap breakfast cereal for a high-protein meal instead, suggested Dr. Doria-Medina. Try an egg white omelet with vegetables and turkey or Canadian bacon with a small slice of low-carb (7 grams) bread. Cholesterol in the yolk may contribute to a higher risk of heart disease and diabetes, which makes egg whites a healthier option. Steel cut and traditional oatmeal, cooked slowly, is a better choice than other types of oatmeal as it is less likely to spike blood sugar, says Andrews. Small portions and adding protein can help.
Worst: Fruit juice
Pair a glass of orange juice with your breakfast, and you may as well have sipped a can of soda—fruit juices are just as high in sugar and calories, said Dr. Joel Zonszein, director of the clinical diabetes center at the University Hospital of the Albert Einstein College of Medicine in the Bronx, NY.
"This includes all juices, including those from your juicer as well as those labeled 'no sugar added.' "
Have this instead: Eat a piece of (low-sugar) fruit and skip the juice, said Zonszein. The sugar in whole fruits is less concentrated than in juice form.
"This creates less of a surge of blood sugar (along with more vitamins), which makes the sugar absorb more slowly and keeps blood sugar steadier."
Worst: Energy bars
Sports bars aren't totally off limits, but you need to read labels, said Andrews.
"They may seem like a healthful snack choice, but many snack bars contain high levels of sugar and carbs, up to 450 calories and 60 grams of carbohydrates."
Look for a balance of protein and carbs with a little fat (about 3 grams) and wholesome ingredients, said Andrews, who suggests talking to a registered dietitian to determine those that best suit your needs.
Have this instead: In addition to taking your dietitian's advice, satisfy your snack fix with lower carb treats. Try a cup of light popcorn, 10 goldfish crackers, a piece of string cheese, 15 almonds, or a frozen, sugar-free popsicle, all of which contain fewer than five grams of carbs, according to the American Diabetes Association.
Worst: Pasta Alfredo
Alfredo sauce is made from heavy cream, Parmesan cheese, and lots of butter. Pour it on top of a bed of white fettuccine noodles and your meal can easily top 1,000 calories, 75 grams of fat, and nearly 100 grams of carbohydrates.
"White flour pasta in a high-fat, high-sodium sauce can elevate blood sugars over a long period of time due to the high fat content of the sauce," said Andrews.
Have this instead: Have whole-wheat pasta with a tomato based sauce instead, says Andrews. A half-cup serving of Alfredo sauce contains approximately 280 calories and 24 grams of fat compared to half a cup of marinara sauce at 70 calories and only three grams of fat
"Both sauces have a similar amount of carbs (8 to 10 grams), but it's the pasta that adds up, at 15 grams per one-third cup portion, clearly less than the typical serving size."
The exact portion size of pasta depends on the number of carbs in the rest of your meal. A cup of pasta contains 45 grams of carbohydrates, which may be all the carbs for your entire dinner, for example.
Worst: French fries
Andrews describes french fries as "little carbohydrate sponges soaked in fat." At 25 grams of fat, 500 calories, and over 63 grams of carbohydrates, a large serving of French fries can wreak havoc on blood sugar. The American Diabetes Association notes that starchy foods like potatoes, corn, and peas are "great sources of vitamins, minerals, and fiber," but recommends skipping those with added fat or sodium. You can test your blood sugar two hours after eating to find out what effect any particular food has on your blood sugar.
Have this instead: Fries are usually the default option when ordering a burger or sandwich, but most restaurants will swap in fresh fruit or a side salad if you ask.
Worst: Fatty meats
People with diabetes are at high risk of heart disease. Although meat is rich in protein and doesn't contain carbohydrates (which raise blood sugar), some proteins sources are better than others. Try to avoid meat that's particularly high in saturated fat (like red meat), breaded, fried, or loaded with sodium (like processed meats).
Have this instead: Aim to eat more plant-based proteins like beans, peas, lentils, and soy (keeping in mind that some vegetarian protein sources do contain carbs). Opt for fish, seafood, and chicken, which tend to be lower in saturated fat and contain more heart healthy fats. Avoid food that's covered in high-calorie sauces, breading, or high-fat skin (in the case of chicken).