The Mayo Clinic Diabetes Diet

Mayo Clinic

Medical Editor

Donald D. Hensrud, M.D., M.P.H.

Associate Medical Editor

Manpreet S. Mundi, M.D.

editorial Director

Paula M. Marlow Limbeck

senior editor

Karen R. Wallevand

senior Product manager

Christopher C. Frye

Art Director

Stewart Jay Koski

Illustration, photography and production

Kent McDaniel, Matthew C. Meyer, Gunnar T. Soroos, Malgorzata (Gosha) B. Weivoda

Proofreading

Miranda M. Attlesey, Alison K. Baker, Julie M. Maas

Indexing

Steve Rath

contributors

Rachel A. Haring Bartony, Matthew M. Clark, Ph.D., L.P., Lisa M. Dierks, RDN, Ryan J. Eastman, Jason S. Ewoldt, RDN, Philip T. Hagen, M.D., Jessica R. Holst, RDN, Michael D. Jensen, M.D., Sara M. Link, Angela L. Murad, RDN, Deborah J. Rhodes, M.D., Kristine R. Schmitz, RDN, Warren G. Thompson, M.D., Kristin S. Vickers, Ph.D., L.P., Laura Hamilton Waxman, Jennifer A. Welper

Each of the habits in Lose It! has been the subject of scientific studies that support its role in weight management. In addition, Mayo Clinic conducted a two-week program to test the validity of the habit-based approach to weight loss. The 33 women who completed the program lost an average of 6.59 pounds, with individual results varying from 0.2 to 13.8 pounds lost. The 14 men who completed the program lost an average of 9.97 pounds, with individual results varying from 5.2 to 18.8 pounds lost. Consult your doctor before starting any diet program.

First electronic edition published 2018 by RosettaBooks LLC, New York.

All rights reserved. No part of this book may be reproduced or used in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system, without permission in writing from the publisher, except by a reviewer, who may quote brief passages in review.

© 2018 Mayo Foundation for Medical Education and Research (MFMER)

ISBN (epub): 978-0-7953-5199-0

Mayo Clinic Guide to Self-Care is designed to supplement the advice of your personal physician, whom you should consult regarding individual medical conditions.

MAYO, MAYO CLINIC and the Mayo triple-shield logo are marks of Mayo Foundation for Medical Education and Research.

Second Edition

Jacket design by Paul E. Krause

Contents

What is The Mayo Clinic Diabetes Diet?

Part 1: Lose It!

Chapter 1: Before you start

What you don’t feel can hurt you

Act now!

Yes, you can

Getting ready

What to watch for

On your mark

Chapter 2: Ready, set, go

Are you ready?

First things first

Finding your inner motivation

Readiness quiz

Your starting point

Some final thoughts

Chapter 3: Add 5 Habits

Eat a healthy breakfast

Eat vegetables and fruits

Eat whole grains

Eat healthy fats

Move!

From the Mayo Clinic Healthy Weight Pyramid to the Mayo Clinic Healthy Dining Table

Chapter 4: Break 5 Habits

No TV while eating

No sugar

No snacks

Limited meat & low-fat dairy

No eating at restaurants

Chapter 5: Adopt 5 Bonus Habits

Keep food records

Keep activity records

Move More!

Eat ‘real food’

Have a daily goal

Chapter 6: What have you learned?

Analyzing your results

Habit tracker

Part 2: Live It!

Chapter 7: The next phase

From short-term to lifelong

A new path

It’s your life

Live It! in real life

Chapter 8: Know your goals

Personal goals

Setting SMART goals

Chapter 9: Set your targets

Selecting your daily calorie target

Determining your daily servings targets

A portion vs. a serving

Serving sizes at a glance

Chapter 10: Create your eating plan

Speaking of time

Eating to the pyramid and dining table

Planning your meals

Making the process easier

Portions vs. servings

Estimating servings

Chapter 11: Expand your activity plan

Reduce the time you sit

Get more fit

Keep at it

Chapter 12: Track your progress

Why track?

How to track

Tracking tips

Start tracking

Assessing your progress

Transitioning from tracking to monitoring

Chapter 13: Seek support

Boosting your odds

Asking for help

Building your team

Getting your family on board

Other types of support

Be your No. 1 supporter

Part 3: All the Extra Stuff

Chapter 14: What’s your healthy weight?

What is a healthy weight?

Why am I overweight?

Chapter 15: Energy, calories and weight

Dietary sources of energy

Your energy account

Understanding energy density

Chapter 16: Diabetes and the pyramid

Energy density

Carbohydrates

Protein and Dairy

Fats

Vegetables and Fruits

Sweets

Physical activity

Chapter 17: Making meals easier

Grocery shopping

Time-saving strategies

Healthy ways to prepare your food

New ways to flavor food

Learning to mix and match

Rubbing in flavor

Chapter 18: Eating out

Plan ahead

Eating at fast-food restaurants

Uncovering clues

Dealing with all the extras

More helpful strategies

Your guide to healthy ethnic cuisine

Chapter 19: How to change behaviors

Strengthening your resolve

Preparing for change

Changing your behaviors

Chapter 20: Burning even more calories

Aerobic exercise

Resistance training

Stretching and flexibility

Chapter 21: I slipped up — what do I do?

Plateaus

Lapse and relapse

Behavior chains

Stress

Adjusting your attitude

Action guide to weight-loss barriers

Pyramid servings at a glance

Recipes for weight loss

Menu guide

What is The Mayo Clinic Diabetes Diet?

Donald D. Hensrud, M.D., M.P.H.

Preventive Medicine

Being overweight, a poor diet, inactivity, family history. These are the reasons millions of Americans have diabetes or are at risk. And while all of these factors are important and each deserves attention, one rises to the top. The single most important thing that you can do to improve your diabetes — or prevent yourself from ever getting it — is to lose weight.

Weight loss can reverse the physical process that causes diabetes. Within just a couple of days of losing weight, blood sugar (glucose) values generally improve, sometimes dramatically.

Certainly, losing weight isn’t easy. People often go on a diet to try and shed pounds, but they find the experience to be limiting and frustrating. So they eventually go off their diets and regain any weight they may have lost.

The Mayo Clinic Diabetes Diet is a different type of weight-loss program. It’s not an on again, off again fad diet. You’ve probably tried enough of those to know the results. Rather, it’s a lifestyle approach that’s focused on helping you to change your habits. Habits are important. Good lifestyle habits give you the best chance to treat your diabetes and prevent health complications.

The two main principles of The Mayo Clinic Diabetes Diet are to follow an eating plan that’s low in calories yet satisfying so that you’ll stick with it, and to burn more calories through physical activity.

You’ll jump right in and start losing weight in the first phase of the diet — the Lose It! phase — which lasts two weeks. In this phase, you can lose 6 to 10 pounds by making some sudden lifestyle changes. Initially, these changes may seem daunting. But as the weight starts to come off, people become empowered and realize they can actually do it (remember, it’s only two weeks!).

You’ll continue your weight loss journey in the second phase of the diet — the Live It! phase. Here, you create a personalized lifestyle program to help you lose about 1 to 2 pounds a week. The changes you make also will help you maintain your weight once you reach your weight-loss goal.

More than just a weight-loss plan, The Mayo Clinic Diabetes Diet is designed to help you feel good and have more energy. We want to help you get back that spring in your step and that sparkle in your eye.

As you’ll soon learn, this lifestyle approach is very practical and flexible. We provide you the knowledge and tools that you need to make important dietary and activity changes, but we don’t tell you what to do.

You know yourself best, so it’s up to you to actually create your own personalized program. We offer many suggestions, but you’re the one to decide how and when you’ll do it.

A popular feature of this lifestyle approach is that you don’t need to count calories or carbohydrates, and you don’t need to measure — no food scales or calculators are needed! Instead, we teach you how to estimate servings and how much food from each of the food groups you should eat.

We understand that change can be challenging, but losing weight doesn’t have to be difficult or boring. Many people find that the longer they follow The Mayo Clinic Diabetes Diet, the easier and more rewarding it becomes.

With the right attitude — and a bit of commitment and planning — you can have fun and feel great while adding years to your life!

Part 1: Lose It!

To lose weight and improve your blood sugar during this two-week period, you want to:

Chapter 1:

Before you start

Manpreet S. Mundi, M.D.

Endocrinology

Losing weight is critical to treating or preventing obesity-related type 2 diabetes. Within just a few days after making changes to your diet, you should begin to see a decrease in your blood sugar (glucose) levels. But it’s important that you know how to react to these short-term changes. In addition, understanding how long-term changes in diet and physical activity affect blood sugar levels will help you better manage your diabetes. This chapter provides important information on diabetes and weight loss and helps you get ready to lose weight safely and enjoy good health.

Perhaps you’ve recently been diagnosed with diabetes or you’ve been told by your doctor that you’re at risk of developing diabetes. Naturally, you’re worried. Diabetes is a serious disease that can lead to devastating complications. However, it’s a disease that you can control. So, take a deep breath, relax, and keep reading.

As the number of Americans who are overweight and obese has increased, so has the number of people with diabetes. Excess weight (obesity) is one of the biggest risk factors for the development of diabetes. To live a normal and healthy life and manage your diabetes — which you can! — it’s key that you control your weight.

The reason weight-related diseases such as diabetes are reaching epidemic proportions is because our lifestyles have changed. We eat more and move less. Meals are often purchased at restaurants and eaten on the run instead of prepared at home. These meals are often oversized, high in fat and calories, and low in vegetables and fruits. We’ve also become less physically active both at work and in our leisure time.

There is good news. A number of large studies have taught us a great deal about diabetes and how to control it. These studies have shown that by adopting a healthier lifestyle and losing weight, diabetes is a battle that you can win!

We understand that losing weight can be challenging, but you can succeed! This book will show you how.

The impact of weight on health is astounding. Being overweight increases your risk of a number of diseases and conditions. But, don’t forget, it’s often a two-way street! Just as weight gain increases your risk, weight loss decreases your risk. In other words, you’re in the driver’s seat! By managing your weight, you are controlling your future.

• • • • •

Q What is diabetes?

A Diabetes (diabetes mellitus) is a disease that affects the way your body uses blood glucose, commonly called blood sugar. Glucose is your body’s main source of energy.

When you eat, your body breaks down food and converts it into glucose. Insulin, a hormone made by the pancreas, helps move the glucose from the bloodstream into cells, where it’s burned for energy.

If you have type 1 diabetes, your body produces little or no insulin. Type 1 diabetes most often develops when you’re a child or teen, although adults can get type 1 diabetes, too.

If you have type 2 diabetes — the most common form — your cells become resistant to insulin, which means the hormone doesn’t work as well. As a result, too much sugar remains in your bloodstream. Increased body fat associated with excess weight is a key factor in the development of insulin resistance.

The Mayo Clinic Diabetes Diet is a weight-loss program designed to help you safely lose weight to improve and control your blood sugar.

Keep in mind, this diet isn’t for people with type 1 diabetes. Most people with type 1 diabetes don’t need to lose weight — they’re at or even below their ideal weight. This diet is for the millions of Americans with type 2 diabetes. And it’s for the even greater number of Americans who are at risk of diabetes — who have what’s called prediabetes.

What you don’t feel can hurt you

You may wonder, So what if I’m a little overweight and my blood sugar is a little high? I feel fine, and my diabetes doesn’t seem to be causing any problems. No harm in that. Right?

Wrong. Type 2 diabetes is easy to ignore because it typically causes few, if any, symptoms, especially early on. That’s also why people are often shocked to learn they have diabetes or they’re at risk.

But doing nothing only worsens the problem, and it may make your diabetes harder to manage later on.

• • • • •

What is prediabetes?

Prediabetes means that your blood sugar (glucose) is higher than normal but not high enough to be classified as type 2 diabetes. Prediabetes is serious because it’s the beginning of the process that leads to diabetes — in other words, the beginning of body changes that can result in heart and blood vessel damage.

You can prevent or delay prediabetes from becoming type 2 diabetes by making healthy lifestyle changes. This includes eating healthy, getting regular physical activity, and achieving and maintaining a healthy weight.

Act now!

Even though you may feel fine, there’s a lot going on inside your body that will eventually hurt you if you don’t take steps to stop it now. By losing weight you can:

Prevent yourself from ever getting diabetes.

Reduce your need for diabetes medication and possibly even eliminate medication use.

Prevent complications associated with diabetes, including heart attack, stroke, nerve damage, kidney disease and eye damage.

Yes, you can

If you have diabetes, you may wonder if it’s safe to go on a diet. The answer is a resounding yes! That is, provided you diet smart. Fad diets — those diets in which you eat very little, eat only a few foods, or eat specialized foods or formulas — aren’t what you want. These types of diets can, in many cases, cause problems.

Perhaps you’ve tried to diet before and it hasn’t gone very well. Don’t let the word diet paralyze you. As you’ll see, The Mayo Clinic Diabetes Diet not only offers dietary advice, but also is a step-by-step lifestyle change.

The best and safest way to lose weight if you have diabetes is to eat healthy foods, but in a manner that will both control your blood sugar and help you shed pounds.

The Mayo Clinic Diabetes Diet is rich in nutrients and low in calories, with an emphasis on vegetables, fruits, whole grains, lean sources of protein and healthy fats. The program also promotes a healthy lifestyle, including daily physical activity, to help encourage weight loss. It’s an eating plan all people can follow, regardless of whether they have diabetes.

• • • • •

A dangerous combination

Metabolic syndrome is a cluster of disorders — including prediabetes and diabetes — that make you more likely to develop heart disease and stroke. If you have three of more of these risk factors, you may have metabolic syndrome:

Abdominal obesity. Women, 35-inch waist or larger; men, 40-inch waist or larger*

High triglycerides. 150 milligrams per deciliter (mg/dL) or higher

Low high-density lipoprotein (HDL, or good) cholesterol. Women, under 50 mg/dL; men, under 40 mg/dL

High blood pressure. Top number (systolic), 130 millimeters of mercury (mm Hg) or higher; bottom number (diastolic), 85 mm Hg or higher

Elevated fasting blood glucose or diabetes. 100 mg/dL or higher

A healthy lifestyle can help combat metabolic syndrome and help prevent diabetes.

*Or 3 inches smaller with a family history of diabetes. For most Asian-Americans: women, 31-inch waist or larger; men, 35-inch waist or larger. For Japanese: women, 33-inch waist or larger; men, 35-inch waist or larger.

Sources: National Heart, Lung, and Blood Institute and American Heart Association.

Bottom line: You don’t have to make special meals for yourself. Your whole family can eat and enjoy healthy foods and activities with you.

• • • • •

Blood sugar testing

When and how often you need to test your blood sugar (glucose) depends on a variety of factors, including the severity of your disease and whether you take medication.

Blood sugar testing — also called blood sugar monitoring — is often done before meals and at bedtime. Your doctor may also advise you to check your blood sugar one or two hours after a meal. A change in your routine — including dieting to lose weight — makes blood sugar testing even more important. It can prevent episodes of low blood sugar (hypoglycemia).

Testing your blood sugar is a quick and easy process that generally takes less than two minutes. Your doctor or another member of your health care team can tell you what tools you’ll need and give you instructions on how to do it. Work with them to develop a testing schedule that’s best for you.

Getting ready

While you may be eager to get going, there are a couple of important things you need to do before you leave the starting block.

See your doctor. Your doctor can work with you to develop a plan for losing weight safely. He or she can give you important tips related to when and how often to eat (generally three meals a day), why you need to monitor your blood sugar, and expected changes in your blood sugar level.

This is especially important if you’re on medication to help control your blood sugar. As you lose weight, you may need follow-up appointments to adjust your medication.

Check your blood sugar regularly. Why? When you start a diet — even before you begin to lose weight — your glucose values will change. And they may be a bit erratic for a while. This is because when you’re dieting, you’re consuming fewer calories. In other words, you’re not supplying your body with as much energy to make blood sugar as it’s used to receiving — which is a good thing.

However, until your body adjusts to these changes in your energy supply, your blood sugar readings may be out of whack. They may drop at first but then level out or increase as your body becomes used to the change in calories. If you take diabetes medications and you don’t monitor your blood sugar, now is the time to do so.

What to watch for

Once you start your diet, monitor your blood sugar regularly. Record the results in The Mayo Clinic Diabetes Diet Journal (see it here). If you experience levels that are too high or too low, take appropriate steps. Your doctor will help you determine unhealthy levels and how you should respond.

It’s also important that you’re aware of symptoms that could signal a problem, such as sweating, shakiness, dizziness, weakness, rapid pulse, excessive thirst, dry mouth, nausea and confusion. You should know how to respond to these symptoms at all times — regardless of whether you’re dieting.

On your mark

Don’t let these precautions scare you, or keep you from doing something extremely important for your health. They’re just a few simple steps to ensure your dieting experience is a good one.

It’s now time to move on to the next chapter. Enjoy your journey to a slimmer you!

Chapter 2:

Ready, set, go

You want to lose weight, so let’s get going. Lose It! is designed to help you safely lose 6 to 10 pounds in two weeks and jump-start your journey to a healthier you. How much you lose is ultimately your call — the more closely you follow Lose It!, the more you’ll likely lose. This chapter provides some necessary preliminaries before you dive in.

How are you feeling? Hopeful? Cautiously optimistic? Wondering if this is the program that will finally help you get healthy?

As you know, losing weight and keeping it off isn’t easy. If it were, people wouldn’t be struggling as much as they are — more than two-thirds of adults in the United States are overweight or obese.

Because weight is such a challenging issue that affects so many people, there are many programs out there that promise quick, effortless weight loss. Sometimes these programs work for a short while, but most people who try them don’t make it for more than a few weeks.

The Mayo Clinic Diabetes Diet requires some planning and effort, and it involves opening yourself up to new ways of eating and being active — lifestyle changes. But these changes aren’t drudgery. And most importantly, for the time and effort you invest, the potential rewards you’ll experience to your health and quality of life are tremendous.

The goal is to help you achieve both a healthier weight and a healthier lifestyle. This is not only possible, but very achievable. By embracing these lifestyle changes, your health risks will decrease, your weight will improve, and you’ll feel much better — about your weight and about yourself.

Most of us know we need to change certain habits to live better, but we have trouble putting our thoughts into action — taking that step from knowing to doing.

The Mayo Clinic Diabetes Diet may be just what you need to finally make the changes that you’ve been thinking about for a long time. This weight-loss program is designed to help you live a healthier and more enjoyable life by making important lifestyle changes in two areas: diet and activity.

Will this be easy? No, but if it were everyone would be doing it. Will it work? Yes, if you’re willing to make the commitment.

We’ll be your partner in this journey. Good luck, and let’s hit the road!

Are you ready?

Time now to get down to business. You’re eager to get started and so are we! You can read more about the philosophy of the diet and why and how it works in later chapters.

First up, are you ready? There’s a good time to start losing weight, and there’s a bad time. You don’t