Pasta and Diabetes: 5 Healthy Ways to Eat Pasta

Written by Marina Chaparro, RD, CDE, MPH

Pasta! Mangia bene pasta! For me—and countless others—there's nothing like eating freshly-made fettuccine with a sprinkle of olive oil, parmesan cheese and a nice glass of wine.

Yet, for many people with diabetes, pasta is on the top 10 list of worst foods to eat. For years, the health message given to people with diabetes was to avoid pasta at all cost. Reasons included causing blood glucose spikes, weight gain, spiking excessive insulin and simply being a white food with too many carbs.

Yes, pasta can be problematic for some people with diabetes. But, the problem with pasta is not the grain itself, but rather the quantities Americans are accustomed to eating.

The appropriate serving size is not what you get at Olive Garden (equivalent to 3 cups of pasta), but rather the size of your fist or about 1 cup. Contrary to what most people think, pasta is a low glycemic food. One cup of fettuccine, which yields 45 grams of carbohydrates, has a glycemic index of 32 and a glycemic load of 15. Compare that to the same portion of Jasmine rice and the glycemic index more than triples,111 glycemic index and 45 glycemic load.

Does pasta make you gain weight? Not according to the research. A recent Italian study published in the Journal Nutrition & Diabetes surveyed over 14,000Italians and found that those who ate more pasta had, in fact, a lower body mass index and smaller waist circumference, But Italians don’t just eat pasta.They eat olive oil, lots of nuts and seeds, whole grains, fruit, and veggies- all trademark of a Mediterranean diet, which is linked to longer lifespan, better heart health, and lower obesity rates. Pasta is never the main entree in Italy, but instead a side dish. First comes the salad, then the pasta then the protein. The point is, pasta is not the cause of all evils.

I confess I eat pasta once or twice per week, and I have been living with type 1 diabetes for over 18 years with very tight control. I was even crazy enough to travel to Italy while I was six months pregnant and having to manage my diabetes.

But, diabetes is not about restricting all carbohydrates or limiting yourself to favorite foods. By doing so, you are less likely to commit to a balanced and healthy diet long-term. Diabetes is an individualized approach. If you are a pasta lover like me and decide to eat pasta the “Italian way,” consider the following strategies to help keep your blood sugars in check:

#1. Measure the pasta and go easy on the portions.

Practice by either using measuring cups or a scale for more precise carb amounts.  Aim for 1/2 cup or ¾ cup females and about 1 cup males. Not entirely a set rule but a good recommendation to follow.    The bigger portion size, the stronger carbohydrate impact on your blood sugars.

A word about sauce. If you can't eat pasta without tomato sauce be sure to read the label carefully. Some are heavy in sugar and sodium. Select the sauce that has the fewest number of ingredients and add your own seasoning. Or make your own sauce using tomato purée, garlic, oregano, basil, etc. 

#2. Chose whole grain.

Thankfully there are many types of pasta in the supermarket aisle.  Look for options with three grams or more of dietary fiber per serving, such as whole wheat penne, farro, and whole wheat fettuccine. Or consider new alternative pasta made of brown rice, soy germ, quinoa, and higher protein versions which can be a good option for people with diabetes because they will be lower in carbs and higher in protein.

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#3. Pair it with protein.

As mentioned, pasta should not cover the entire plate.  Aim for ¼ of the plate.  The other quarter should consist of a lean protein such as fish, chicken, tofu, or egg.  Protein will help lower the glycemic response to the meal and will result in steady blood sugars after the meal. An excellent way to avoid spikes.

#4.  Start off with a salad.

This strategy can apply to all meals, not just pasta nights. Adding veggies will increase satiety, give a sense of fullness, and prevent you from overeating. Additionally, the order of food in a meal can influence blood sugars. Studies show if you start a meal with veggies or protein first, followed by carbohydrates (pasta), blood sugars are more likely to be on target.

#5. Cook it al dente.

Overcooked pasta has a slightly higher glycemic index.  Al dente pasta which translates “firm to the touch or to the tooth” just means firmer pasta. Al dente pasta will have a lower Glycemic index than overcooked pasta and can help slow down the absorption of carbohydrates. 

For me, pasta is emotionally satisfying. The idea of eating pasta as a family is comforting. It reminds me that even though I have diabetes, I don’t need to feel deprived to enjoy the food I love.

Pasta may have a bad reputation in the world of diabetes, but we should not demonize it. The message should be to understand the different types of pasta and choose appropriate portion sizes. By allowing yourself to experience foods you enjoy in moderation, you instantly eliminate guilt or the concept of “cheating.” So, go ahead, and enjoy your pasta, just keep the portion size in check.

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