By Jolie Wiener, September 19, 2017
Top Strategies for Diabetes Nutrition with Dr. Sarah Kaplan, PH.D in Clinical Epidemiology & a Member of CuraLife's Advisory Board
(Text version) "Hi good evening, my name is Dr. Sara Kaplan PhD, R.D and I am a member of CuraLife’s advisory board. This evening I would like to talk about a diabetic healthy diet. It is well known that the prevalence of diabetes mellitus (DM) is increasing around the world at a rate that appears dramatic as to have been characterized as an epidemic. Diabetes being a metabolic, endocrine disorder is directly connected to carbohydrate, lipid and protein metabolism. The resultant disease or metabolic disturbance leads to hyperglycemia and dyslipidemia in the short term, as well as long term complications such as retinopathy, neuropathy and nephropathy. Besides, people with diabetes are 2 to 4 times more likely to develop coronary artery disease or to suffer a stroke. Diet and physical activity are critically important in the management of the (A1C, Blood pressure, and Cholesterol level = (ABCs) of type 2 diabetes. Maintenance of near normal blood glucose level dramatically reduces the chronic complications associated with this disorder. In addition, reducing elevated blood lipid levels has been shown to lower the incidence of acute coronary events in other at-risk populations. I believe that diabetes cannot be completely cured, but it may be more easily regulated and controlled with the right diet. With strict nutritionist’s advice, understanding how to balance food intake and making healthy food choices every day diabetic patients may be able to significantly improve their quality of life.
WHY IS DIET IMPORTANT
A person with diabetes may affect the disease by controlling how much and what they eat, how frequently their blood sugar is monitored, physical activity levels, and accuracy and consistency of medication dosing. Even small changes can affect blood sugar control. The diet should be a balanced diet that is tailored to a person's medical needs, lifestyle, and personal preferences. Eating a diet with consistent amounts of food every day and taking medications as directed can greatly improve blood sugar control and decrease the risk of diabetes-related complications. For many of my diabetic patients, the most challenging part of the treatment plan is determining what to eat and following a food plan. As I mentioned before there is not a one-size-fits-all eating pattern for diabetics, and each patient should receive individualized medical nutrition therapy (MNT). Emphasis should be on healthful eating patterns containing nutrient-dense, high quality foods with less focus on specific nutrients. The Mediterranean, Dietary Approaches to Stop Hypertension (DASH) and plant-based diets are all examples of healthful eating patterns.
Let’s talk about the Goals of Nutrition Therapy for Adults with Diabetes
The first one is to promote and support healthful eating patterns, emphasizing a variety of nutrient -dense foods in appropriate portion sizes, in order to improve overall health and specifically to: ○ Achieve and maintain bodyweight goals ○ Attain individualized glycemic, blood pressure, and lipid goals such as cholesterol and Tg ○ Delay or prevent the complications of diabetes The second goal is to address individual nutrition needs based on a person's medical needs, lifestyle, and personal cultural preferences willingness and ability to make behavioral changes. The third one is to maintain the pleasure of eating. And finally to provide an individual with diabetes the practical tools for developing healthy eating patterns.
WHAT SHOULD I EAT?
There is no one single optimal diet or meal plan for people with diabetes. The proportion of carbohydrates, fat, and protein should be individualized based upon the metabolic status of the individual weight loss needs, lipid levels, and renal function, blood pressure and food preferences. While protein and fat do not affect blood glucose levels significantly, they do contribute to the number of calories consumed. Eating a consistent number of calories every day can help to maintain body weight.
Considering the need for Weight loss
Body weight management is important for overweight and obese people with type 1 and type 2 diabetes. Many people with type 2 diabetes are overweight, as Weight gain is a potential side effect some oral medications used for people with type 2 diabetes. Therefor lifestyle intervention programs for the above should be intensive and have frequent follow-up to achieve significant reductions in excess body weight and improve clinical indicators. Losing even a small amount of weight -5 to 10 percent of total body weight can improve one's parameter of diabetes. In fact, eating fewer calories can reduce blood sugar levels even before the first kilogram is lost. A diabetic patient has to reduce body weight by eating fewer calories and exercising regularly (as can be seen in CuraLife's Blog). Also, increased physical activity can lead to improved glycaemia, decreasing insulin resistance, and reduced cardiovascular risk factors
What about carbohydrate consumption?
The fraction of total calories to be obtained from carbohydrates is generally in the range of 20% to 45%. The diet should be low in sugar and refined carbohydrates, while relatively high in dietary fiber, especially soluble fiber. A diet that is high in fiber (25 to 30 grams per day) may help control blood glucose levels and glycated hemoglobin (A1C). Likewise, people with diabetes may be encouraged to reduce their intake of carbohydrates that have a high glycemic index (GI) IN CONCLUSION: The diet should include carbohydrates from fruits, vegetables, whole grains, legumes, and of course low-fat dairy, lean meats, nuts, and seeds.
Let’s talk about fat consumption
Fat quality is more important than fat quantity. Saturated fat and Trans fat are found in solid fats like cheese, red meats, and margarine contribute to coronary heart disease (CHD), while monounsaturated and polyunsaturated fats like in fish, olive oil and nuts are relatively protective. Saturated fats can be replaced with monounsaturated and polyunsaturated fatty acids. Trans fatty acid consumption should be kept as low as possible. People with diabetes are at increased risk for heart disease and stroke, and eating a diet low in saturated and Trans fats and cholesterol can help reduce cholesterol levels and decrease these risks. In addition, Eating foods rich in long-chain OMEGA v-3 fatty acids, such as fatty fish (EPA and DHA) nuts and seeds (ALA) is recommended to prevent or treat CVD, however, evidence does not support a beneficial role for OMEGA v-3 dietary supplements.
The usual intake of dietary protein should be approximately 10 to 25 percent of total caloric intake. Patients should be encouraged to substitute lean meats, fish, eggs, beans, peas, soy products, and nuts and seeds for red meat. In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia.
As For Sodium
Just like the general population, people with diabetes should limit sodium consumption to (twenty three hundred), 2,300 mg/day, although further restriction may be indicated for those with both diabetes and hypertension. For people with diabetes and heart failure, further reduction in sodium may be necessary to reduce symptoms. Concerning nonnutritive sweeteners Artificial sweeteners do not affect blood glucose levels and may be consumed in moderation. Artificial sweeteners are generally safe to use within the defined acceptable daily intake levels The use of artificial sweeteners has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners and without compensation by intake of additional calories from other food sources.
As for - alcohol
Adults with diabetes who drink alcohol should do so in moderation no more than one drink per day for adult women and no more than two drinks per day for adult men.
In addition - Exercise
Increased physical activity can lead to improved glycaemia, decreased insulin resistance, and reduced cardiovascular risk factors. Exercising regularly can help lose weight and keep it off. The recommended amount of exercise is 30 minutes per day most days of the week.
Last but not least, Meal timing
Consistently eating at the same times every day is important. Good eating habits can help to control the disease and may be able to improve the quality of life. Before ending our lecture, I received many questions from you (Thank you!) and I have chosen a few that I think are relevant to everyone to answer: 1. Jeff Smart - Most diabetic diets are meant to reduce your blood sugars, how do I make sure that my blood sugar levels don't go too low? Dear Jeff- the purpose of a balanced diet, which is tailored for you, is to reduce your blood sugar and maintain of near normal blood glucose level. You should test your glucose level daily if you can, or at least one's a week. 2. Phil Williams - What fruits are safe to eat if any, because of the fructose? Dear Phil, you can have all kinds of fruits. However, you should pay attention to the quantities consumed in accordance to your overall diet, which, I hope, was prescribed by your dietitian. 3. Scott Edgar - Just found out blood sugar levels are high and wondering about a good diet to start with? Dear Scott, first I hope that after my talk you feel more informed, at least as of the basics of a blanched diet. My best advice to you, is to go to a registered dietician, and get a tailored made plan specifically for you. 4. Tara Dolan - What can I eat for balanced diet in regards to type 2 diabetes? Dear Tara, I love your question because the answer lies in the body of it. A balanced diet, done right for your specific needs, should include all kinds of foods and should help in keeping glucose levels in check.