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Maintaining a healthy diet is important for everyone, but it is especially important for people with diabetes. Following the right meal plan can make all the difference to a person struggling to keep their blood sugar under control. But, what is the right meal plan? How much of which food group should you eat?

Along with a visit to a dietician, this guide should help answer questions you may have.

Understanding Carbohydrates and Fiber

Carbohydrates are one of the major food categories (the others include proteins and fats). They provide fuel for the body in the form of glucose. Glucose is a sugar that is the primary means of energy for all of the body's cells.

There are two ways to classify carbohydrates -- simple and complex. Simple carbohydrates are sugars -- like glucose, sucrose, lactose and fructose. They are found in refined sugar and in fruits. Complex carbohydrates are the starches, which are the simple sugars bonded together chemically -- they are found in beans, nuts, vegetables and whole grains. Complex carbohydrates are considered healthier mostly because they are digested by the body slowly, providing a steady source of energy. They also contain valuable amounts of fiber.

Carbohydrates, rather than fats or proteins, have the most immediate effect on your blood glucose since carbohydrates are broken down directly into sugar early during digestion. It is important to eat the suggested amount of carbohydrate at each meal, along with some protein and fat.

Carbohydrates are mainly found in the following food groups:

• Fruit
• Milk and yogurt
• Bread, cereal, rice, pasta
• Starchy vegetables

What Is Carbohydrate Counting?

Carbohydrate counting is a method of meal planning that is a simple way to keep track of the amount of total carbohydrate you eat each day. It helps allow you to eat what you want. Counting grams of carbohydrate and evenly distributing them at meals will help you control your blood glucose.

Instead of following an exchange list, with carbohydrate counting you monitor how much carbohydrate (sugar and starch) you eat daily. One carbohydrate serving is equal to 15 grams of carbohydrate.

With carbohydrate counting, you plan your carbohydrate intake based on what your pre-meal sugar is and your intake or insulin dose can be adjusted. Carbohydrate counting can be used by anyone and not just by people with diabetes that are taking insulin. If you eat more carbohydrates than your insulin supply can handle, your blood glucose level goes up. If you eat too little, your blood glucose level may fall too low. These fluctuations can be managed by knowing how to count your carbohydrate intake.

A registered dietitian will help you figure out a carbohydrate counting plan that meets your specific needs. For adults, a typical plan generally includes three to four carbohydrates at each meal, and one to two carbohydrate servings as snacks.

With carbohydrate counting, you can pick almost any food product off the shelf, read the label, and use the information about grams of carbohydrates to fit the food into your meal plan.

Carbohydrate counting is most useful for people who take multiple daily injections of insulin, use the insulin pump or who want more flexibility and variety in their food choices. However, it may not be for everyone, and the traditional method of following food exchange lists may be used instead.

How Much Fiber Should I Eat?

Fiber is the indigestible part of plant foods. It plays an important role in the digestive process as it helps move foods along the digestive tract, adding bulk to stool to help it pass through the bowel. In addition, diets high in fiber are associated with lower risks of obesity, hypertension, heart disease and strokes.

Fiber also:

• Delays sugar absorption, helping to better control blood glucose levels.
• Binds with cholesterol and may reduce the level of 'bad' LDL cholesterol in the blood.
• Is a good source of vitamins and minerals.
• Helps prevent constipation and reduces the risk of certain intestinal disorders.
• Promotes weight loss by helping to decrease caloric intake. (It adds bulk to the food we eat, making you feel fuller.)

The goal for all Americans is to consume 25 to 35 grams of fiber per day. The best way to increase your fiber intake is to eat more of these fiber-rich foods:

• Fresh fruits and vegetables
• Cooked dried beans and peas
• Whole grain breads, cereals, and crackers
• Brown rice
• Bran products

Understanding Fat

Since diabetes increases your risk of developing heart disease, eating foods lower in fat -- especially saturated fat -- is particularly important to keep that risk as low as possible. In addition, limiting calories from fat can help you lose any extra weight, especially when combined with an exercise program.

The major contributors of saturated fats in our diet come from cheese, beef, milk and baked items. Trans fats also contribute to the increase risk of heart disease. These fats are vegetables oils that are harder; we recognize these as solid oils. Many of these are used in baking and frying.

Here are some general guidelines for selecting and preparing low-fat foods:

• Select lean meats including poultry, fish, and lean red meats. When preparing these foods, don't fry them. Instead, you can bake, broil, grill, roast or boil.
• Select low-fat dairy products such as low-fat cheese, skim milk and products made from skim milk such as nonfat yogurt, nonfat frozen yogurt, evaporated skim milk, and buttermilk. Remember to include dairy products in your daily carbohydrate count.
• Use low-fat vegetable cooking spray when preparing foods or consider using cholesterol lowering margarine containing stanols or sterols. Examples include "Take Control" and "Benecol."
• Use liquid vegetable oils that contain poly- or monounsaturated fats which can help lower your 'bad' LDL cholesterol.
• Select lower fat margarines, gravies and salad dressings and remember to watch the carbohydrate count on condiments and dressings.
• All fruits and vegetables are good low-fat choices. Remember to include fruit and starchy vegetables in your daily carbohydrate count.

A registered dietitian can provide more information on how to prepare and select low-fat foods.

Understanding Salt

Diabetes increases your risk for high blood pressure. High levels of sodium (salt) in your diet can further increase that risk. Your health care provider or dietitian may ask you to limit or avoid these high-sodium foods:

• Salt and seasoned salt (or salt seasonings)
• Boxed mixes of potatoes, rice or pasta
• Canned meats
• Canned soups and vegetables (with sodium)
• Cured or processed foods
• Ketchup, mustard, salad dressings, other spreads and canned sauces
• Packaged soups, gravies or sauces
• Pickled foods
• Processed meats: lunch meat, sausage, bacon and ham
• Olives
• Salty snack foods
• Monosodium glutamate or MSG (often added to Chinese food)
• Soy and steak sauces

Low-Sodium Cooking Tips

• Use fresh ingredients and/or foods with no salt added.
• For favorite recipes, you may need to use other ingredients and eliminate or decrease the salt you would normally add.
• Try orange or pineapple juice as a base for meat marinades.
• Avoid convenience foods such as canned soups, entres and vegetables; pasta and rice mixes; frozen dinners; instant cereal; and pudding, gravy and sauce mixes.
• Select frozen entres that contain 600 milligrams or less of sodium. However, limit yourself to one of these frozen entres per day. Check the Nutrition Facts label on the package for sodium content.
• Use fresh, frozen, no-added-salt canned vegetables or canned vegetables that have been rinsed before they are prepared.
• Low-sodium canned soups may be used.
• Avoid mixed seasonings and spice blends that include salt, such as garlic salt.

What Seasonings Can Replace Salt?

Herbs and spices are the answer to improving the natural flavors in food without using salt. Below are some mixtures to use for meats, poultry, fish, vegetables, soups, and salads.

Spicy Blend
2 tablespoons dried savory, crumbled
1/4 teaspoon freshly ground white pepper
1 tablespoon dry mustard
1/4 teaspoon ground cumin
2 1/2 teaspoons onion powder
1/2 teaspoon garlic powder
1/4 teaspoon curry powder

Saltless Surprise
2 teaspoons garlic powder
1 teaspoon basil
1 teaspoon oregano
1 teaspoon powdered lemon rind or dehydrated lemon juice

Herb Seasoning
2 tablespoons dried dill weed or basil leaves, crumbled
1 teaspoon celery seed
2 tablespoons onion powder
1/4 teaspoon dried oregano leaves, crumbled
A pinch of freshly ground pepper

Spicy Seasoning
1 teaspoon cloves
1 teaspoon pepper
2 teaspoons paprika
1 teaspoon coriander seed (crushed)
1 tablespoon rosemary

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.

Edited by John Seibel, MD, WebMD, December 2006.