Cooking up a balance

New approaches help diabetics make tasty food

Last year, in the middle of a teenage whirl of high school, friends, and sports, Emma Lowenstein’s life changed. The Chevy Chase, Md., teenager, now 15, was diagnosed with type 1, or juvenile, diabetes. Now, she needs to be cooking up a balance.

Her mother says she never saw it coming. Emma had symptoms, she says, including weight loss and constant thirst, but diabetes “was so off my radar screen.” No one in the family had the disease. The Juvenile Diabetes Research Foundation says that’s common in about 90% of cases.

“I knew one kid my daughter’s age with diabetes, but I knew nothing about it,” says Emma’s mother, Shelley Lowenstein. “We were so ignorant.”

Not anymore. The diagnosis has meant changes, not only for Emma — who has learned to test her blood several times a day, inject insulin and balance diet and exercise — but also for her family.

“We didn’t know if Emma could ever eat cookies again,” her mother says. She and Emma pored over nutrition labels in the grocery store, combed through cookbooks and went online looking for information. “We were always a family that loved to cook,” she says. “My husband clips recipes. We eat out all the time.”

Now the family’s dining choices are influenced by Emma’s need to eat a balanced diet on a daily schedule. As a diabetic, “you learn to live by the clock, which we’ve never done,” Lowenstein says. “That means you have to get up at a certain time, eat at a certain time, have a mid-morning snack at a certain time . . . “

People with diabetes need to eat frequently, generally three meals and at least a couple of snacks, to keep blood sugars on an even keel. That means keeping portion sizes small and eating a variety of foods in moderation, says Carol Guber, whose book, Type 2 Diabetes Life Plan (Broadway Books, $25) is being published this week.

While most dieters obsess over fats and calories, diabetics need to limit carbohydrates, which greatly affect blood sugar. Guber says most adults can consume 45-75 grams of carbohydrates per meal, depending on age, weight and activity level. (There are around 15 grams of carbohydrates in a slice of bread or half a banana, and about 41 per cup of pasta. A 2-ounce package of strawberry Twizzlers has 54 grams.)

Carbohydrates are nutrients that are released into the bloodstream in the form of glucose, a simple sugar that fuels cells. Insulin is a hormone that allows cells to use this sugar fuel, but in juvenile diabetes, the body’s insulin-producing mechanism is destroyed. Patients have to take insulin shots every day.

In type 2 diabetes, insulin is produced, but it’s not used efficiently by the body, resulting in high blood sugars. Type 2 diabetes often can be managed with drugs and diet. In either form of the disease, diet plays a crucial role in balancing blood sugars.

Food and family eating habits have as much to do with culture and social interaction as with nutrition, Guber says. When she was diagnosed with diabetes nearly five years ago at age 50, she says, “I thought it was going to separate me from everyone.”

Food was “part of the community I lived in,” says Guber, who taught nutrition and food preparation at New York University for many years. She feared the need to watch every morsel would separate her from her peers.

It hasn’t, she says. In fact, she says she’s able to incorporate new dining habits seamlessly into everyday life — whether eating at home or in restaurants — by corralling her cravings, losing weight and developing eating patterns that would be good for all Americans.

“Everybody should be eating as if they have diabetes,” Guber says. “It’s a healthy way of eating.”

When Emma Lowenstein was diagnosed with diabetes, her mother set out to find recipes that would be good for Emma and that the whole family would enjoy. That soon proved frustrating, she says, because newspapers, magazines, cooking shows and even cookbooks often fail to provide complete nutritional information.

Lowenstein set out to change that, launching an advocacy group called Per Serving ( to try to persuade newspaper food editors, through a letter-writing campaign, to include per-serving food facts for all recipes. The effort has won the support of the American Association of Diabetes Educators, the American Cancer Society, the American Heart Association and other groups.

“I’m a very practical person, and I want to do anything I can to make her day-to-day life easier,” Lowenstein says.

“When reputable newspapers run headlines all the time about diabetes, obesity, heart disease and cancer and don’t give us this information on their food pages, they’re only giving us half the story”

So far, she says, the reaction from editors has been mixed. Many big-city papers, including The Washington Post, The Philadelphia Inquirer, Chicago Tribune and San Francisco Chronicle do print complete nutrition information with recipes, but “there is still a lot of resistance,” she says. One editor wrote to say her paper provides information on calories and fat in recipes; anything more is important only to “people with special needs, and she can’t cater to them,” Lowenstein says. “She said those people should get special cookbooks.”

There are plenty of “special cookbooks” for diabetics, including dozens published by the American Diabetes Association (ADA), ( “People with diabetes are starving for information,” says Chris Smith, author of Cooking with the Diabetic Chef ($19.95), one of the ADA’s publications.

A Culinary Institute of America-trained chef and a type 1 diabetic, Smith has developed cooking methods that he demonstrates across the country for audiences made up of diabetics, heart patients, and others interested in healthy eating. At a recent event at the East Texas Medical Center in Tyler, where about 70 audience members were expected, a crowd of 800 showed up, most of them non-diabetic, he says.

Smith will attend the upcoming ADA annual meeting, starting Friday in San Francisco. While most of the hundreds of presentations will focus on the latest medical advances in diabetes, Smith will hold cooking seminars on such topics as summer salads, vegetarian cuisine, and grilling.

There’s nothing magic about a diabetes-friendly diet, he says.

“What I teach is actually cooking lessons, from pan searing to roasting to wok cooking to poaching,” he says. “People are compromised nutritionally. I’m fighting a tidal wave. I want to teach people to eat healthy.”

By exercising portion control and making simple changes in cooking methods — roasting instead of deep-fat frying, for instance, or using marinades and spices to flavor foods instead of heavy sauces — people with diabetes or other health problems can eat just about anything, he says.





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