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Ask Dr. Gourmet

How can a pre-diabetic manage their condition without losing weight?

My husband is 5'10" and 150 lbs. and was diagnosed with pre-diabetes. We have been trying to find out how many carbs a day he should be eating or how many carbs per meal. He does not need to lose weight and trying to maintain his current weight without eating a lot of carbs is difficult. He is very active in his job and cannot afford to lose any weight.

It seems everything that I read is for people to lose weight to help control their condition. Please can you give me a guideline of how to control the pre-diabetes without losing any weight.

Dr. Gourmet Says...

sliced red apples topped with peanut butter

You are correct that most of our patients who have "pre-diabetes" are overweight. Those that are trim pose a little bit more of a challenge because often those who are overweight can work at losing weight and will have marked improvements in their blood sugar. The same principles apply, however, for your husband who is in the normal weight range.

The key is in the balance of his diet.

Looking at the research on Mediterranean style diet, carbohydrates consumed should be in the range of 50% of total calories. In an active job he likely needs to eat about 2,400 calories per day. 50% of that 2,400 calories is 1,200 calories and there are 4 calories in a gram of carbohydrate so the total number of carbs for him is around 300 grams per day.

The key to helping prevent diabetes and to controling blood sugar is to eat higher quality carbohydrates. This is one of the best examples of how to eat great food and eat healthy by choosing the best quality calories. In practical terms this boils down to simple sugars vs. more complex carbohydrates such as higher fiber foods.

For instance, a Milky Way Bar contains 240 calories. Of that there are 41 grams of carbohydrates, of which 35 grams are sugar. That works out to about 9 teaspoons of sugar (that's a whole lot). As with a many such low quality calorie foods, there's also a lot of fat. 10 grams of fat per bar (7 grams of saturated fat). Open the candy bar, eat in a few minutes, full of sugary carbs (and fat) and it's gone. A few minutes later your husband is not as satisfied as he should be.

Compare this to having a large apple. Less calories (190) and a bit fewer carbs (30) but without the fat. Full of fiber and really filling. There's good research that folks are just as satisfied eating the apple (but don't feel as guilty as when they have chocolate). The numbers are similar with the other low quality junk food – lots of high simple carbohydrate, low fiber foods (often jam packed with sugar and saturated fat).

Getting as many of our carbs from more natural whole foods and whole grain sources is the key to eating healthy and controlling blood sugar. In practical terms this means choosing foods that are low in sugars (simple carbohydrates) and higher in fiber (more complex carbs).

Here's more information about fiber choices.

The other key to great carbohydrate choices is choosing the correct portion sizes: here's a guide to choosing carbohydrates for diabetics (PDF).

The Mediterranean style diet has been shown to help in control of blood sugar because of the overall makeup of the foods. What is a Mediterranean style diet?

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet