On the surface, it may seem as if the lifestyle choices needed to manage diabetes are simple. However, having access to healthy foods and eating a well-balanced diet is a significant challenge for millions of people with diabetes and their families. Here are some tips on how to eat a balanced diet even with limited access to healthy foods.
One of the first steps in managing diabetes is to make a conscious effort to change your lifestyle as a way to maintain stable blood glucose levels. Some of these lifestyle patterns include eating a balanced diet, regular exercise, reducing stress, and getting adequate sleep/rest. One of the biggest challenges for many people diagnosed with diabetes is eating a balanced diet, especially on a budget.
However, for many, finding a grocery store that sells fresh produce is a challenge. In many cities across the nation, there are places known as food deserts, which are areas with limited access to healthy and affordable foods, especially fresh fruits and vegetables. In addition, even if stores selling fresh produce are nearby, they are often more expensive.
These environments provide several obstacles for individuals pursuing not only a healthy diet, but maintaining a consistent diet at all. When a person lives in a food desert or has limited access to food due to financial constraints, the situation is referred to as “food insecurity.”
How does food insecurity impact diabetes management?
“For some, food security is a major issue,” said Kim Rose, a dietician and nutritionist in Florida whose inclusive approach revolves around making nutrition easy and attainable. “In clinical settings, some people have to choose between paying for their medications or buying foods from a fully stocked grocery store. This is tragic when you consider the price of food is steadily increasing.”
In a food desert, not only are prices a concern, but getting to a grocery store is another hindrance. For those relying on public transportation, this means extra time required to get to the store, shop, and get home. Rising gas prices also impact those with limited means even if they have a vehicle.
Those living in food deserts still have to work, care for their families, get adequate rest, exercise, and try to reduce their stress levels. According to Rose, these factors inhibit people from making the journey to the grocery stores. As a result, they end up going to less healthy, limited choice stores for food. These locations, while effective, often do not have many healthy options. And for many of these individuals, moving is not an option due to both personal and financial reasons.
The cost of healthier food options is typically higher than that of processed foods, requiring longer meal prep times as well. For instance, whole grains are more expensive than refined grains. Whole grains are essential in increasing fiber intake which helps with reducing glucose levels, lowering cholesterol and promoting cardiovascular (heart) health. Unfortunately, when comparing the cost of a loaf of white bread versus whole grain bread, there is often a $1-$2 difference!
While these considerations are important for all people, the consequences can be more dire for people with diabetes.
Effects of a History of Food Insecurity on Diabetes Management
Dr. Kera Nyemb-Diop, a nutrition expert and creator of the popular Instagram page @black.nutritionist, mentioned that many of her clients struggle with overeating or binging because of a history of food insecurity. She explained that while many of them are doing well now financially and live in areas where they have access to grocery stores with healthy options, some still struggle with overeating because of how they grew up.
Children that grow up in food insecurity may have poor eating habits that have been ingrained since birth. The concept of “finishing everything on your plate,” for example, is a survival tactic based on not wasting food because it was hard to obtain. This kind of experience results in children who may become desensitized to their body’s signals for satiety – a word for fullness. As a result, these children may grow into adults who are at a higher risk for overeating, obesity, and type 2 diabetes.
Inconsistent eating is also a bad habit that could come from a history of food insecurity. If there is not enough food in a child’s home to eat consistently (breakfast, lunch, dinner, and snacks), these children grow into adults that learn to eat whatever is available. Then when they do eat, they do so in excess.
Physiologically, this level of binging can result in numerous and/or extreme spikes in the blood glucose levels which can contribute to type 2 diabetes. Mentally, this can lead to a mindset of shame regarding the amount and types of foods eaten, and potentially disordered eating.
Food insecurity is most commonly seen in impoverished communities with marginalized individuals, which is why experts cautioned that paying attention to cultural differences is crucial. For instance, financial constraints combined with a wellness community that presents certain cultural foods as “unhealthy” can create an enormous amount of pressure. It is no surprise that these communities struggle with chronic illnesses such as diabetes, high blood pressure, and heart disease.
Nyemb-Diop and Rose talk extensively about not discarding cultural foods as a part of the diet. Many of these foods are healthy and provide balanced nutrition. Both nutritionists spoke about how people often struggle because their healthcare provider doesn’t understand their culture, traditional foods, and the context of their living situation before making recommendations. Sometimes, this makes it nearly impossible to follow the recommendations. In other cases, this can create feelings of shame around eating and lifestyle choices. Many people find that they are more open with providers that share the same ethnic and cultural background. If possible, seek out those individuals.
Managing Diabetes in Spite of Food Insecurity
“The best food starts within your own freezer,” said Nyemb-Diop. “Many recommendations appear to tell people to dispose of the food they already have and repurchase all new food. This isn’t practical, at all. It’s a waste of food, money, and time, all of which a person in food insecurity has limited amounts of.”
Rose recommends taking advantage of any local food markets that supply locally sourced produce in your area. These are normally small businesses, so a bit of searching may be required. However, for people that rely on public transportation, farmers markets and local produce stores could be closer to home, convenient, and a great source of healthy foods.
Both Rose and Nyemb-Diop recommended incorporating canned foods. Canned and frozen fruits and vegetables are often cheaper while providing similar, or the exact same, nutritional value as fresh produce. Usually, the only difference when it comes to canned food items is taste, but certain seasonings can help with that.
However, when it comes to canned food items, choose vegetables listed as low-sodium. For canned fruit, pick those with water or lower sugar fruit juice as opposed to those with syrup. Also, if possible, look for fruit with no added sugar.
Ignoring brand loyalty can also help save money. Most grocery stores have their own brands, which tend to be significantly cheaper. And in many cases, they are processed and packaged in the same plants as the name-brand items!
Some grocery stores also have deals on produce and fresh meat. A very popular deal is to find the sections where vegetables and meats are marked down for a quick sale. Personally, I like to buy them, portion the meat and chop the vegetables, and freeze them.
The biggest piece of advice is to get as much help as you can. At the end of the day, both nutritionists suggested that everyone do the best they can with what they have. Be open and honest with your healthcare providers to make sure they are considering your needs and lifestyle when making recommendations.
For more about managing diabetes and food insecurity, check out these resources:
Food Insecurity and Diabetes, A Dangerous Combination
Largest Expansion of SNAP in 60 Years is Approved: What this Means for Millions with Diabetes