Conquer Diabetes – Eat Healthy, Stay Happy!

Concepts of Nutrition

FOOD is fuel to our body and provides energy. A healthy diet and optimum nutrition play a central part in the management of diabetes. When you have diabetes, you have to know a lot about food because food affects your blood sugar, your body weight, and your overall health.

Understanding Nutrients

We obtain nutrition through the various foods we eat.

Foods supply the macro- and the micro-nutrients.

• Macro-nutrients – carbohydrates, proteins & fats
• Micro-nutrients – vitamins & minerals.

Components of Medical Nutrition Therapy

• Personalized dietary recommendations and structured meal plan
• Monitoring carbohydrate intake
• Maintaining ideal body weight, waist-hip ratio

Sample Menu

Generally, diet prescriptions are converted into a sample menu which is a defined meal plan that specifies the time and amount of food to be eaten at each meal and snack.

These sample menus are created after reviewing a person’s typical food intake habits.

They are best suited for people with a diabetic condition who:

• Have fairly routine eating habits
• Do not eat a wide variety of foods
• Need structured guidance on what to eat

Carbohydrates in Diabetes Management

Complex low–carbohydrate prescriptions have been found to improve A1C, serum triglycerides, VDL cholesterol, total cholesterol and HDL cholesterol levels.

Recommendations

• A diversified eating pattern is acceptable for managing diabetes.
• Focus on emphasizing non–starchy vegetables, encouraging whole foods over highly processed foods and minimizing added sugars and refined grains.
• Reducing overall carbohydrates intake may be applied in a variety of eating patterns that meet individual needs and preferences.

For T2DM adults, who are not meeting glycemic targets, or when reducing anti-glycemic medications is a priority, reducing overall carbohydrates intake with a low–carbohydrate eating pattern is a suitable approach.

Proteins in Diabetes Management

A high–quality protein diet with less fat and carbohydrate quantity may help glycemic control.

Recommendations

• Individualization of protein intake is necessary.
• The recommended dietary allowance of protein is 0.8 gm/kg IBW – 1 gm/kg IBW – 50% from protein of high biological value.
• Individuals with diabetes and non-dialysis–dependent diabetic kidney disease need not limit their protein intake below the recommended allowance.
• Carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia.

Examples of Good–Quality Protein Sources

• Meat, poultry and poultry products
• Fish
• Milk and milk products
• Legumes & nuts

Fats in Diabetes Management

• In people with T2DM, a balanced style, PUFA- and MUFA–rich eating pattern may benefit glycemic control and CVD risk factors.
• High–MUFA diets are associated with improved glycemic control and improved CVD risk.
• Long–chain omega–3 fatty acids (EPA and DHA) and ALA have beneficial effects on lipid levels, thus preventing heart disease.

Recommendations

• Saturated fat less than 10% as per dietary guidelines – ghee and coconut oil.
• Replace saturated fat with unsaturated fats, especially PUFA – e.g., cooking oil in moderation.
• Reduce intake of trans fats – e.g., fast food and bakery items.
• Increase the intake of plant stanols/sterols, omega-3 fatty acids and fiber – e.g., food sources like nuts (pistachios, walnuts and Brazil nuts) and super seeds.

Recommendations for Energy Balance in Overweight and/or Obese Individuals

• An eating plan, in combination with enhanced physical activity, that promotes energy deficit is recommended for individuals who are overweight and/or obese and have T1DM and T2DM.
• In patients with T2DM, moderate weight loss of up to 5% is of more clinical benefit.
• More intensive weight loss goals may be pursued if needed.
• For patients on low carbohydrate or very low carbohydrate eating plans, monitoring lipid profiles, renal function, protein intake and adjusting hypoglycemic therapy may be required.

Sugar and Salt Consumption

• When using sugar substitutes to reduce overall calorie and carbohydrate intake, avoid compensating with an intake of additional calories from other food sources – especially direct simple sugars.
• High intake of salt is linked to high blood pressure, an associated condition for diabetes.
• Follow DASH guidelines – dietary approach to stop hypertension. Recommendations of sodium are limited to 2500 mg/day (5 gm of salt/day).
• Nutrition label reading to be considered – be cautious about hidden salt.

Nutritional Interventions for T2DM and T1DM

Type 1 Diabetes

• An individual’s dietary pattern and physical activity should be combined with insulin therapy.
• For individuals using rapid–acting insulin injection or an insulin pump, the insulin doses should be adjusted according to the carbohydrate, protein and fat content of the meals and snacks.
• For individuals using fixed daily insulin doses, timely intake of carbohydrates should be consistent.
• Insulin doses can be adjusted for planned exercises, whereas extra carbohydrate intake may be required for unplanned exercises.

Type 2 Diabetes

• Individuals with T2DM are encouraged to incorporate lifestyle modifications that include increased physical activity, reduced intake of energy, saturated and trans-fatty acids, cholesterol and sodium.
• Plasma glucose monitoring can be used to determine whether modification in eating patterns will be sufficient to achieve the blood glucose goals or if medical support with nutrition therapy is required.

Nutritional Interventions for Pregnancy and Lactation

• Adequate energy intake for appropriate weight gain is recommended during pregnancy.
• Nutrition therapy for gestational diabetes management includes food choices for appropriate weight gain.
• Normal glycemic levels and absence of ketones.
• Evidence does not suggest that women with gestational diabetes have different caloric needs than women who are pregnant without GDM.
• Recommended dietary intake for all pregnant women is a minimum of 175 grams of carbohydrates, 70 grams of proteins and 28 grams of fiber/day.
• Lifestyle modifications such as weight reduction and an increase in physical activity are recommended after delivery to reduce the risk of developing T2DM in women with GDM.

Nutritional Interventions for Older Adults

Aging is linked to sarcopenia and this can reduce muscle strength and increase loss of muscle mass. Provide adequate protein combined with aerobic and resistance training.

• Dietary supplements may be useful if one cannot get enough nutrients through daily dietary intake.

Fibre Recommendations:

Fibre – 30-40 gm/day. All fruits and vegetables are the richest sources.

• Lowers the fasting blood sugars and post-meal blood sugars.
• Lowers the insulin dosage.
• Helps to decrease blood cholesterol levels in the blood.
• Helps in normal bowel movements.
• Helps in increased mineral absorption.
• Increases immune system strength.

Key Take Away

• Relationship between gut health and diabetes is very important. Eating pre and probiotic-rich foods is a good way to replenish the good bacteria in your digestive tract. Probiotics are foods or supplements that contain beneficial bacteria which maintain good gut health. Prebiotic are foods (typically high–fibre foods) that act as food for human gut microflora. Probiotics are foods such as yogurt. Prebiotics are whole unpolished grains, garlic, soybeans, etc.
• Nutrition, regular physical activity and medical treatment are integral parts of diabetes management.
• Individualized and personalized nutrition therapy is important for effective diabetes management.
• A variety of eating patterns are found to be effective in diabetes management.
• Programmed physical activity confers several benefits for diabetes control and its related complications.
• Millets, an ancient cereal loaded with good sources of all nutrients, have an average glycemic index score of 52.7 which is on the medium side. They are rich in antioxidants and fibre as well. Best way to consume millets is to soak, ferment and cook them with a good amount of water (three times more).
• Unpolished millets are excellent sources.
• Oral nutritional supplements prescribed by doctors/dieticians (in case patients don’t meet their calorie and protein requirements) can be considered.

EATING OUT IS BECOMING A CULTURE; A PERSON WITH DIABETES SHOULD LEARN TO MAKE SMART CHOICES.