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We all know that healthy eating is a cornerstone of diabetes management, regardless of the type of diabetes we have or our stage of life. When you have a chronic condition such as diabetes that is profoundly affected by the foods and drinks you consume, there may be a tendency to focus more on the health aspects of nutrition and less on the psychosocial aspects of eating.

This is a shame because food is of course much more than a collection of nutrients: it is one of life’s greatest pleasures and is an important component of our culture, as well as an expression of our individuality. We enjoy certain foods and drinks to
celebrate all of the important events in our lives, from births to deaths and everything in between. Within our family and cultural circles, we have our own personal favourite foods and beverages that help define us as individuals.

Including diabetes in our relationship with food
Having diabetes does not suddenly put an end to these important functions of food. We must use our knowledge of how food and nutrition affect our diabetes to help tailor a healthy eating pattern that meets our diabetes management goals, but also allows us to continue to enjoy food.

To help put healthy eating into perspective, the American Diabetes Association has developed food and nutrition management goals that summarise the main points to consider:

1. Achieve and maintain blood glucose levels (BGLs) in the recommended range (4–8 mmol/L) or as close to as recommended is safely possible. Blood pressure levels in the recommended range (less than 130/80 mmHg) or as close to as is safely possible. A blood cholesterol (total cholesterol less than 4 mmol/L, HDL cholesterol more than 1 mmol/L) and triglyceride (less than 2 mmol/L) profile that reduces the risk of vascular (e.g. heart attack, stroke, retinopathy, kidney and peripheral vascular) diseases.

2. Prevent or at least slow the development of the chronic complications of diabetes
   by modifying your diet and lifestyle (e.g. exercise, sleep, tobacco, etc.).

3. Consider your individual nutrition needs, taking into account personal and cultural
   preferences and your willingness to make changes.

4. Maintain your pleasure of eating by only limiting food choices when indicated by scientific evidence.

The last of these points is often the goal that is most overlooked. Unfortunately, food and nutrition is plagued by fads – low fat, low carbohydrate, sugarfree, gluten-free, etc. – limited only by the various authors’ imaginations and the number of nutrients in foods. Indeed, approximately 2500 ‘diet’ books are published each year around the world. Sophisticated marketing and public relation plans are often used to sell these books and their associated products (foods, drinks and dietary supplements) to consumers.

Beware of fads
People with diabetes need to be wary of going along with the latest diet fad. The nutritional management of diabetes is complex due to the need to manage blood glucose, pressure and fat levels, usually for the rest of your life. So following the latest fad is not going to be a recipe for your long-term health and wellbeing. Also, most fads involve the complete avoidance of a particular nutrient, food group or food. This can create a range of social issues because food and drink is often enjoyed with others whether they are family or friends, and can lead to eating disorders, which are becoming increasingly common in Australia.

The simplest way to avoid fads is to follow the food and nutrition advice provided by reputable not-for-profit organisations such as ºÚÁÏÍø, and other members of the International Diabetes Federation. These organisations publish what are known as systematic literature reviews of the scientific evidence on a regular basis (usually
every five years). Teams of experts review all of the published scientific evidence, rate its quality and develop comprehensive recommendations based on only the highest-quality evidence available. The technical information is then provided to health
professionals so that they can provide you with the most comprehensive and up-to-date advice to help manage your particular condition and the advice is also translated into fact sheets and books like those found in your state or territory diabetes organisation.

When food becomes medicine
The rise in lifestyle-related health conditions such as bowel cancer, heart disease, stroke and type 2 diabetes has led towards what some regard as the medicalisation of the food supply. So-called functional foods that are low or high in the latest ‘bad’ or ‘good’ nutrient appear in increasingly large amounts in our local supermarkets. Many make claims about their potential health benefits. While it may be tempting to try these foods and measure their effect on BGLs or other indicators of diabetes
management, most the healthiest foods rarely make any claims at all – partly because some of them don’t come in packages or have labels.

Most unprocessed fruits and vegetables are packed full of vitamins, minerals and fibre, and do not contain excessive amounts of energy (kilojoules), fat or carbohydrate. Similarly, lean meat, fish, poultry and fresh grainy bread rarely come
packaged with nutrition or health claims. These core foods can be prepared in traditional ways to meet your personal and cultural needs.

Australia is a multicultural society with a high quality and diverse food supply. People enjoy a broad range of cuisines from Asia, India, the Mediterranean and Middle East and Europe, among other regions. You can develop a healthy eating plan and recipes that fit within these cultural eating patterns, ensuring continued enjoyment of food with minimum disruption to family and social life. Forget about the latest fad diet or health-promoting food in your local supermarket or health food store. Work with your local Accredited Practising Dietitian to develop a healthy eating plan based on the latest high-quality evidence to maintain your pleasure of eating, and save your social life.

Dr Alan Barclay, BSc, Grad Dip, PhD, APD, AN, is Head of Research, Australian Diabetes Council and Chief Scientific Officer, GI Foundation

This article was originally published in Conquest Magazine published by Health Publishing Australia