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Nutritional Guidelines - The Basics
Prepared by Lynn Maarouf, M.S., R.D., L.D. -
Stark Diabetes Center
Edited: 06/24/2003
What can I eat?
The first thought many people have
when they learn they have diabetes
is: "I have to give up everything I like to eat." The truth is you can eat
anything. You just have to measure it. Are desserts still a possibility ?
What about eating out? And will you have to have a "special diet" that is
different from everyone else?
That Word Diet!!!
What do we think of when we hear the
word diet? Most of us think of restrictions and limitations and walking
around feeling hungry all of the time. A "diet" for people with diabetes
is planned around their present eating habits. For this reason, the phrase
"meal plan" is now used instead of "diet." Calorie restriction is not
necessary unless weight reduction is a goal to improve blood sugar or
cholesterol levels.
A healthy "lifestyle" including regular activity and nutritious food is
recommended for everyone including people with diabetes. What is this meal
plan all about? For convenience, dietitians assign foods to groups based
on similar nutritive value. For instance, foods in the "Starch List"
contain the same amount of carbohydrate, similar vitamins, minerals, and
calories per serving. The same is true for the 5 other Food Groups: fruit,
milk, meat, fat and vegetables.
Carbohydrates, protein, and fat are 3 nutrients found in foods that
contribute to their caloric value. These 3 nutrients affect blood glucose,
but to different degrees. About 98% of dietary carbohydrate is found in 3
food groups: starch, fruit, and milk. These foods have the greatest impact
on blood sugar levels. Carbohydrates which are in liquid form, like soda,
juices and milk, will increase the blood sugar more quickly. Diet Sodas
which are sugar-free do not affect blood sugar levels.
What you need to know...
In order to maintain normal blood
sugar levels, people with type 2 diabetes should consume about the same
amount of carbohydrate at meals and snacks, maintain a steady activity
level, and eat meals at regular times. The physician can then prescribe
and adjust medications to meet individual needs. Being consistent with
activity, carbohydrate intake and eating regular meals is very important
in the management of type 2 diabetes.
These are factors which can increase blood sugar levels:
- Drinking regular sodas and large
servings of juices
- Skipping meals and then eating larger
meals later in the day
- Over-eating, eating high-carbohydrate
snacks, or consistently
exceeding your recommended intake of carbohydrate
How much carbohydrate should I eat per day?
This depends on the number of calories
you need and varies based on your age, gender, height, weight and activity
level. Current recommendations for the diabetic diet are that about 50% of
the total calorie intake come from carbohydrate sources. Eating adequate
carbohydrate helps prevent us from filling up on high fat foods which will
cause more weight gain and heart disease over the long run. Whole grain
carbohydrates like whole wheat bread, pasta and tortillas are recommended
over refined carbohydrates like white bread. Eating more fiber helps keep
blood sugars more stable and promotes a feeling of "fullness" which
assists in appetite control. Few Americans meet the recommended levels of
25 grams of fiber per day for women and 38 grams of fiber per day for men.
What about cholesterol?
The incidence of heart disease in
diabetes is 2-4 times higher than the average population. High blood
pressure is also often present. It is best to follow a low fat, low
cholesterol, moderately low sodium diet as a preventative measure. Though
most people do not think of fat reduction as a necessity in diabetes,
reducing fat intake can promote weight loss and help prevent heart disease
and high cholesterol levels. The American Heart Association guidelines for
reducing fat and cholesterol are used in diabetes.
How do I reduce cholesterol and fat?
- Limit portions of meat to about 6
ounces total per day. ( A
3-ounce portion of meat is about the size of a deck of cards.)
- Use well-trimmed lean meats and chicken
without the skin.
Hamburger should be < 10% fat and lunch meats should be 95%-99% fat
free.
- Replace shortening and oil with cooking
oil spray. Olive oil is
the best overall choice for cooking oil and also comes in spray form.
- Limit egg yolks to 3 per week and limit
consumption of organ
meats.
- Change to diet margarine, and "light"
or "fat-free" salad
dressings and mayonnaise.
- It is currently advised that people
with diabetes consume fish
twice a week to maintain a good intake of natural Omega-3 fatty acids.
The Omega 3 fatty acids are felt to play a role in heart disease
prevention and should help raise HDL (good) cholesterol.
Remember every teaspoon of oil, shortening
or margarine is 45 calories (a teaspoon is 1 pat of margarine at a
restaurant). Fried foods may have triple the calories of the same food
cooked with cooking oil spray.
Watch out for trans fatty acids!
"Trans fat" is a new word we are
beginning to see especially on margarine labels. "Trans fat" (also called
trans fatty acids) is a type of fat that is a little different from other
fats. It is found in many foods and is formed by the hydrogenation of
vegetable oils. Look for margarine with "no trans fat" on the label.
Recent research suggests that trans fatty acids, commonly found in
deep-fried foods may play more of a role in high cholesterol levels and
heart disease than saturated fats. Convenience foods such as potato chips,
cookies and candy bars usually contain partially hydrogenated vegetable
oils which increases their trans fat content.
What about exercise?
You don't have to join the local
health club just because you have diabetes, but it IS a nice, cool place
to get a good work-out. Due to our increasing rate of overweight and Type
2 diabetes in this country the current government recommendation for
exercise is one hour per person per day. This may sound like a lot of
exercise to some, but we all need to consider that changes in our
lifestyle which include automobiles, television and computers have made us
all far more sedentary than our parents or grandparents would ever have
dreamed of being.
Always check with your doctor before changing your activity
level--especially when you have other health conditions.
If you have diabetes and are over 35, it is recommended that you check
with your physician before beginning any vigorous exercise program.
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Frequent thirst