The Diabetes Plate Method for Cultural Diets
By Toby Amidor, MS, RD, CDN, FAND
Vol. 25 No. 2 P. 26
Clients can eat the foods they know and love for better diabetes management.
Many clients who receive a diabetes diagnosis often become overwhelmed if they have to take insulin or other medications and make adjustments to their eating habits to help manage blood sugar. When it comes to diet, following the diabetes plate method can make their lives easier.
The American Diabetes Association developed the diabetes plate method to aid people with diabetes to eat a balanced meal and manage blood sugar.1 This method enables people to portion meals that include a healthful balance of vegetables, protein, and carbohydrates. They don’t have to count calories or grams of carbohydrates or do any weighing or measuring. The method uses the plate to balance food groups, and it’s easy for people with lower education levels to understand and follow. Another advantage of the diabetes plate method is that people who enjoy foods from diverse cultural foodways can use it.
In this article, Today’s Dietitian will discuss how clients and patients from a variety of global cultures can use the diabetes plate method with the foods they know and love for optimal nutrition and diabetes management.
Designing the Plate
The diabetes plate method includes five steps.2 Clients should start with a dinner plate that’s about 9 inches in diameter. If they need more calories than average, suggest they use a larger plate, such as an 11- or 12-inch dinner plate. Those with lower calorie needs can use an 8-inch dinner plate. Ask clients to imagine the plate divided into three parts: one-half and two-quarters.
• Step 1. Fill one-half the plate with nonstarchy vegetables, such as cauliflower, broccoli, spinach, or kale.
• Step 2. Fill one-quarter of the plate with a lean protein food, such as meat, fish, eggs, or a plant-based protein like soy. Choose lean proteins when possible, as they’re lower in fat and saturated fat and, thereby, a more healthful choice. In addition, remind clients that some plant-based proteins, such as beans and legumes, also are high in carbohydrates.
• Step 3. Fill the other quarter of the plate with carbohydrate foods, such as grains, starchy vegetables, fruit, milk, or yogurt. These foods are higher in carbohydrates and have the greatest effect on blood sugar. Limiting portions to one-quarter of the plate can prevent high blood sugar spikes after meals.
• Step 4. To complete the meal, water is the best choice, since it contains no calories or carbohydrates and has no effect on blood sugar. Additional zero- or low-calorie beverages include unsweetened hot or iced tea, unsweetened hot or iced coffee, club soda, flavored water or sparkling water without added sugars, diet soda, and other diet drinks.
• Step 5. Choose healthful fats, such as avocado or olive oil, in small amounts.
In some cases, meals consist of a combination of foods or a combination of different food types. Such is the case with casseroles, soups, sandwiches, and pasta dishes.1 The plate method still can be used when preparing and portioning combination foods. Identify the different foods in the dish and where they’d fit on the plate. For example, one slice of pizza topped with mushrooms: The crust is the carbohydrate, the cheese is the protein, and the tomato sauce and mushrooms are the nonstarchy vegetables. Clients should eat combination dishes in the same proportions as the plate. In this case, the pizza should have a thin crust with mushrooms (and other nonstarchy vegetables, if desired). If clients want more food, they can add a side salad that consists of nonstarchy vegetables with one to two tablespoons of vinaigrette dressing, which is a healthful fat.
Below is a discussion on a variety of cultures RDs may encounter in practice, along with examples of the most common foods and dishes they traditionally eat, including a sample plate.
In 2019, 40.6 million people in the United States were Black/African American, representing 12.8% of the total population.3 This group includes direct descendants of African slaves, along with voluntary immigrants from Africa, the Caribbean, and Central and South America.4 In the United States, the prevalence of diabetes and diabetes-related mortality and morbidity are disproportionately high in African Americans and other populations of color. Food is an important aspect of African and African American lifestyles, even though many foods and recipes are prepared differently, depending on the country or region of influence. Four foods appear to be common in the African American diet: rice, beans (black-eyed peas or red beans), chicken, and greens.4
Foods Traditionally Used in African American Cuisine4
• Grains and cereal. Cornmeal, grits, hominy, oatmeal, pasta, rice, and wheat flour
• Starchy vegetables and beans. Black-eyed peas, carrots, corn, dried beans, squash, sweet potatoes, and white potatoes
• Nonstarchy vegetables. Beets, cabbage, cucumbers, green beans, greens (eg, collards, mustard, turnip), kale, okra, onions, spinach, and tomatoes
• Fruits. Apples, bananas, blackberries, cantaloupe, grapefruit, grapes, honeydew melon, oranges, peaches, pears, strawberries, and watermelon
• Milk and milk products. Buttermilk, cheese (eg, American, cheddar), cottage cheese, ice cream, milk, and yogurt
• Meats and meat substitutes. Beef, eggs, fish, lamb, pork, and poultry
• Fats and oils. Bacon, butter, chitterlings/chitlins, fatback, hog/pork jowl, lard, pig feet, pork neck bones, and salt pork
Traditional African American dishes include baked beans, baked sweet potatoes, barbecue ribs, cabbage cooked with smoked meat, coleslaw, crab cakes, glazed ham, grits, gumbo, hamburgers, mashed potatoes, meatloaf, pork chops, potato salad, red beans and rice, and spaghetti and meat sauce.
An example of a dinner plate following the diabetes plate method includes 4 oz baked pork chop, one-half of a small sweet potato with skin with 1 tsp trans fat–free margarine, and 11/2 cups collard greens and yellow squash sautéed in olive oil with one slice turkey bacon.
Approximately 37 million people live in South America among the French province of French Guiana, the British Falkland Islands, Argentina, Bolivia, Brazil, Chile, Columbia, Ecuador, Guyana, Paraguay, Peru, Suriname, Uruguay, and Venezuela. Spanish is spoken in all countries except Brazil, where the people speak Portuguese.4 French, Quechua, Ayamara, Guarani, Italian, English, German, Dutch, and Japanese also are spoken throughout this region.
The US Latino population is defined as an ethnic group that includes any person of Cuban, Mexican, Puerto Rican, South or Central American descent, or those from another Spanish culture or origin, regardless of race.5 This group represents 18.9% of the US population, which is the second largest racial or ethnic group after non-Hispanic whites.5 Diabetes tends to occur in Hispanics between the ages of 35 and 64, which is younger compared with non-Hispanic whites.4 There’s no single South American diet. Typical dishes and cuisines vary from country to country. In addition, traditional foods vary depending on the region. Furthermore, climate, geography, religion, and culture influence the foods that are cultivated and served. The cuisines of natives and colonizers also have mingled, contributing to different regional dishes.
Foods Traditionally Used in South American Cuisine4
• Grains and cereal. Amaranth, breadcrumbs, pasta, quinoa, rice, and tortillas
• Starchy vegetables. Arracacia (Andean root vegetable), beans, chickpeas, corn (maize), jicama, peas, potatoes, sweet potatoes, tapioca (cassava, manioc, yuca), taro, water yam (root vegetable)
• Nonstarchy vegetables. Broccoli, cabbage, carrot, cauliflower, garlic, heart of palm, kale, lettuce, mushroom, okra, onion, pepper, spinach, and tomato
• Fruits. Acai, acerola (Barbados cherry), avocado, banana, breadfruit, cashew, cherimoya (sugar apple), citrus juices, coconut, grapes, guava, jaboticaba, jackfruit, kiwi fruit, lemon, mango, orange, papaya, passionfruit, peach, pear, persimmon, pineapple, plum pomegranate, prune, quince, soursop (guanabana), starfruit, Surinam cherry (pitanga), and watermelon
• Milk and milk products. Cottage cheese, cream cheese (cheese curd), creamy cheese, farmer’s cheese, ricotta, sour cream, and yogurt
• Meats and meat substitutes. Beef jerky, beef steak, blood sausage (chorizo), chicken (hen), codfish, eggs, guinea pig, llama, lobster, mutton (sheep), oyster, pork, salami, salmon, shredded beef, shrimp, squid (calamari)
• Spices and seasonings. Chili, basil, cilantro, cinnamon, oregano, parsley, rosemary, salt, and vanilla
Several traditional South American dishes include ajiaco colombiano (Columbian chicken and vegetable stew), arepes (Spanish flat cornmeal cakes or fritters), asado (Spanish grilled beef, pork, or lamb), bolinho de bacalhau (Portuguese small deep fried codfish cake), ceviche, feijoada complete (Portuguese black beans with pork meat served with white rice, kale, and oranges), and panquecas (Portuguese savory crepes filled with ground beef, creamed spinach, or cheese and ham).
An example of a dinner plate following the diabetes plate method includes 4 oz grilled top sirloin steak, beans and rice, and steamed broccoli, kale, and snap peas.
The area of Mexico spans from the Gulf of Mexico and Caribbean to the Pacific Ocean. There’s a vast array of regional cuisine, which influences the Mexican American population. Some internationally known foods from this area include corn tortillas, mole sauce, and ceviche. Mexican cuisine has become popular in the United States due to the large immigrant population. Mexican Americans fall under Hispanic Americans and represent 18.9% of the total US population.5 Prevalence of diabetes among Hispanic Americans is 1.7 times greater compared with non-Hispanic whites. NHANES data estimate that diabetes among Hispanic adults will be greater than 20% by 2031.4 Specifically, the prevalence of diabetes in Mexican Americans is two to three times higher than in non-Hispanic Americans, according to NHANES data.
Foods Traditionally Used in Mexican American Cuisine4
• Breads. Tortillas
• Starchy vegetables. Beans, corn/masa
• Nonstarchy vegetables. Chilies, nopales, tomatoes, tomatillos
• Milk. Crema (cream)
• Meats. Carne asada (thinly sliced grilled beef), chorizo, tripe
• Fish. Grouper, marlin, red snapper, mackerel
• Fats. Lard
Several traditional Mexican American dishes include arroz con pollo (rice with chicken), salsa, enchiladas, tacos, tamales, sopa de arroz (rice soup), sopa de fideos (vermicelli cooked and served with a tomato-based sauce), horchata (drink made with ground rice blended with water or juice and melon seeds), arroz con leche (rice cooked in milk, sweetened with sugar, and spiced with cinnamon), and flan.
Two tacos made with two corn tortillas, 4 oz grilled or baked red snapper, 1/2 cup tomato salsa, one-quarter of a sliced avocado, and 1 cup steamed broccoli.
South Asian Indian
India and Pakistan are in South Asia and were established as independent nations in 1947.4 The cuisine of South Asia varies, partially due to the variety of religions practiced in this area. More than 80% of India’s population is Hindu; however, religious minorities include Muslims, Christians, Sikhs, Buddhists, Parsis, and Jews. South Asian Indians are one of the fastest growing populations in the United States. They represent 15% of the US Asian population and are the third largest group of the Asian American population (after Chinese and Filipino Americans). Asian Indians have a lower rate of diabetes in the United States compared with white Americans.
Foods Traditionally Used in South Asian Indian Cuisine4
• Grains and cereal. Rice, wheat
• Legumes. Black-eyed peas, chickpeas, lentils, pink beans
• Starchy vegetables. Corn, peas, plantains, potatoes, pumpkin, squash (green, yellow, acorn, butternut), sweet potatoes, yams
• Nonstarchy vegetables. Bean sprouts, beets, bitter melon, bottle gourd, Brussels sprouts, cabbage, carrots, cauliflower, celery, cluster beans, cucumber, drumsticks, eggplant, green beans, green papaya, greens (eg, collard, kale, mustard, turnips), okra, onions, peppers and chiles, radishes, ridge gourds, spinach, and tomatoes
• Fruits. Apples, apricots, bananas, figs, grapes, guava, jambu (jamun), lychee, loquat, mangoes, oranges, papayas, passionfruit, raisins, and sweet limes
• Milk and milk products. Condensed milk, dahi (homemade yogurt or curd), lassi (buttermilk), and plain yogurt
• Meats and meat substitutes. Chicken, eggs, fish, shellfish, goat, lamb, and lentils
• Fats and oils. Butter, canola oil, ghee, and nuts (eg, almonds, cashews)
• Herbs and spices. Aniseed, mustard, nutmeg, onion seeds, parsley, poppy seeds, saffron, sesame seeds, tamarind, turmeric, dill, fennel, fenugreek, cumin, coconut, coriander, bay leaf, amchur, and more
Several traditional South Asian Indian dishes include aviyal (vegetables in gravy with coconut and butter), channa (chickpeas cooked in a tomato gravy with onions and spices), dal (lentil dish), idli (South Indian steamed dish made from fermented rice and lentil batter), and raita (yogurt dish that usually includes a vegetable like cucumber).
1 cup of lamb and chickpea curry and 1/2 cup cucumber salad.
Chinese Americans are the largest Asian American ethnic group in the United States. In 2020, the US Census showed that 19.9 million people identified as Asian alone, and 4.1 million identified as Asian combined with another race.6 This group varies widely in lifestyle, socioeconomic status, education level, and practices regarding diet, health, and health care. They also may speak several Chinese dialects, including Mandarin, Cantonese, and Toisanese. The prevalence of diabetes in this population is between 10% and 20%.4
Foods Traditionally Used in Chinese American Cuisine4
• Starches. Vermicelli, sticky rice, rice, and rice noodles
• Starchy vegetables. Corn, ginkgo seeds, lotus root, pumpkin, sweet potatoes, tapioca, taro, and water chestnuts
• Soyfoods, beans, and peas. Broad beans, mung beans, red beans, soybeans, soymilk, and tofu
• Nonstarchy vegetables. Bamboo shoots, bitter melon, black and white woodear, brown mushrooms, Chinese spinach, Chinese cabbage, chives, eggplant, garlic, Napa cabbage, scallions, string beans, watercress, and winter melon
• Fruits. Banana, star fruit, dragon fruit, grapes, guava, lychee, longan, mango, oranges, papaya, passion fruit, pineapple, pomelo, and tangerines
• Meats. Beef, chicken, Chinese sausage, eggs, fish, seafood, oxtail, ox tongue, pork, pig blood pudding, pork intestine, and beef tripe
• Seasonings and spices. Bouillon cubes, Chinese chili pepper, coriander, fermented tofu, five-spice powder, ginger, MSG, mustard seeds, oyster sauce, sesame seeds, soy sauce, star anise, and Szechuan peppercorn
Several traditional Chinese American dishes include beef chow-fen (stir-fried flat rice noodles with soy sauce, beef slices, and scallion), lo mein, rice congee (rice pudding), roast duck, dim sum, and har gao (shrimp dumpling).
Approximately 11/4 cups of a stir-fry made with 1/2 cup cubed tofu with Chinese cabbage, 1/2 cup rice (preferably brown) with scallions, and two tangerines.
Recommendations for RDs
The beauty of practicing dietetics in the United States is the diversity of our clients from various cultures. It’s important for RDs first to identify the cultural populations they see regularly and become familiar with their risk factors for type 2 diabetes as well as their traditional foods and dishes, customary health beliefs, and food practices. The Academy of Nutrition and Dietetics published “Cultural Food Practices,” which is a helpful tool for practitioners to educate themselves on the global populations they serve.4 In addition, dietetics professionals should become familiar with local supermarkets, restaurants, and other foodservice establishments their clients from various cultures visit. RDs can create shopping lists and approve menu items for clients to choose from when they frequent their favorite establishments.
Proper communication also is imperative with clients from diverse cultures. It isn’t only about what RDs say but also the manner in which they say it and how clients perceive it. Clients may not comply with recommendations if they perceive any bias, insecurity, or prejudicial statements from dietitians. In addition, RDs must know that some cultures may not be comfortable working with health professionals from a culture or ethnic group different from their own and, therefore, should find ways to build a rapport with clients to make them feel as comfortable as possible. Once a rapport has been built, RDs can work with clients to make small strides toward change and improve blood sugar and diabetes management.
— Toby Amidor, MS, RD, CDN, FAND, is founder of Toby Amidor Nutrition (tobyamidornutrition.com) and a Wall Street Journal bestselling author. She’s written nine cookbooks, including Diabetes Create Your Plate Meal Prep Cookbook: 100 Delicious Plate Method Recipes and The Family Immunity Cookbook: 101 Easy Recipes to Boost Health. She’s also a nutrition expert for FoodNetwork.com and a contributor to U.S. News Eat + Run and other national outlets.
1. What is the diabetes plate method? American Diabetes Association website. https://www.diabetesfoodhub.org/articles/what-is-the-diabetes-plate-method.html. Published February 2020.
2. Amidor T. The Create Your Plate Diabetes Cookbook: A Plate Method Approach to Simple, Complete Meals. American Diabetes Association; 2020.
3. Profile: Black/African Americans. US Department of Health and Human Services: Office of Minority Health website. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=61. Updated October 12, 2021.
4. Goody CM, Drago L, eds. Cultural Food Practices: Diabetes Care and Education Dietetic Practice Group. American Dietetic Association; 2010.
5. Profile: Hispanic/Latino Americans. US Department of Health and Human Services: Office of Minority Health website. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64#:~:text=Overview%20(Demographics)%3A%20This%20ethnic,living%20in%20the%20United%20States. Updated September 26, 2022.
6. Monte LM, Shin HB. Broad diversity of Asian, Native Hawaiian, Pacific Islander population. US Census Bureau website. https://www.census.gov/library/stories/2022/05/aanhpi-population-diverse-geographically-dispersed.html. Published May 25, 2020.