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Chapter 1 DIABETES NUTRITION GUIDELINES HEALTHY, WEALTHY, AND WISE

Do you think the right foods for your diabetes are too costly for your family’s food budget? Maybe you mistakenly believe some of these common diabetes money myths:

“I can’t afford to follow a diabetes meal plan. It’s too expensive.”

“I’ll have to spend too much on special foods that the rest of my family won’t eat.”

“I can’t pay for all the fresh fruits and vegetables and high-priced cuts of meat a diabetes meal plan requires.”

This book was created to dispel these myths and prove that good food does not have to break your budget. Eating foods that are healthy for diabetes should cost you only a bit more than you’re already spending in time, effort, and dollars.

GOOD FOOD FOR THE ENTIRE FAMILY

If you are concerned that your diabetes nutrition needs will stretch the family’s food budget, don’t worry. The latest diabetes nutrition recommendations parallel the most recent dietary guidelines, which emphasize making smart choices from every food group, finding a balance between food and physical activity and getting the most nutrition out of your calories.

Adequate Nutrients Within Calorie Needs

Consuming a variety of nutrient-dense foods and beverages within the basic food groups is the best way to ensure you will meet all of your nutrient needs. It is also important to limit your intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol.

Weight Management

In order to maintain your weight in a healthy range, balance calories from foods and beverages with calories expended. To prevent gradual weight gain over time, make small decreases in food calories and increase physical activity.

Physical Activity

Engaging in regular physical activity and reducing sedentary activities promotes health, psychological well-being, and a healthy body weight. The best way to achieve physical fitness is by incorporating cardiovascular conditioning, with stretching exercises for flexibility and resistance exercises or calisthenics for muscle strength and endurance into your workout.

To reduce the risk of chronic disease in adulthood, engage in at least 30 minutes of moderate-intensity physical activity on most days of the week. Greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration.

To help manage body weight and prevent weight gain, engage in 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements.

To sustain weight loss in adulthood, participate in at least 60-90 minutes of daily moderate-intensity physical activity, while not exceeding caloric intake requirements. You may need to consult a health care provider before participating in this level of activity

CHECKLIST FOR HEALTHY EATING

Consume a sufficient amount of fruits and vegetables while staying within energy needs. Two cups of fruit and 2 1/2 cups of vegetables per day are recommended for a 2,000-calorie intake, with higher or lower amounts depending on the calorie level.

Choose a variety of fruits and vegetables each day. In particular, select from all five vegetable groups (dark green, orange, legumes, starchy vegetables, and other vegetables) several times a week.

Consume 3 or more 1-oz servings of whole-grain products per day, with the rest of the recommended grains coming from enriched or whole-grain products. At least half the grains should come from whole grains.

Consume 3 cups per day of fat-free or low-fat milk or milk products.

Food Groups to Encourage

Fats

Consume less than 7% of calories from saturated fatty acids and less than 200 mg/day of cholesterol. Try to keep trans fatty acid consumption as low as possible.

Keep total fat intake between 20 and 35% of calories, with most fats coming from sources of polyunsaturated and monounsaturated fatty acids-such as fish, nuts, and vegetable oils.

When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat free.

Limit intake of foods that contain fats and oils high in saturated and/or trans fatty acids.

Carbohydrates

Include fiber-rich fruits, vegetables, and whole grains as part of your everyday diet.

Choose and prepare foods and beverages with little added sugars or caloric sweeteners. Use the U.S. Department of Agriculture (USDA) Food Guide and the DASH Eating Plan for reference.

Reduce the incidence of dental caries by practicing good oral hygiene and consuming less sugar and starch containing foods and beverages.

Sodium and potassium

Consume less than 2,300 mg-approximately 1 tsp-of sodium per day.

Choose and prepare foods with little salt. At the same time, consume potassium-rich foods like fruits and vegetables.

Alcoholic beverages

Those who choose to drink alcoholic beverages should do so sensibly and in moderation-defined as the consumption of one drink per day for women and up to two drinks per day for men. Make sure to check your blood glucose after consumming alcohol because alcohol can raise certain blood fats and may cause low blood glucose.

ALCOHOL AWARENESS

Alcoholic beverages should never be consumed by certain individuals, including:

those who cannot restrict their alcohol intake

women of childbearing age who may become pregnant

pregnant and lactating women

children and adolescents

individuals taking medications that can interact with alcohol

those with specific medical conditions

individuals engaging in activities that require attention, skill, or coordination, such as driving or operating machinery

Food Safety

To avoid microbial foodborne illness:

Clean hands, food contact surfaces, and fruits and vegetables.

Separate raw, cooked, and ready-to-eat foods while shopping, preparing, or storing foods.

Cook foods to a safe temperature to kill microorganisms.

Chill (refrigerate) perishable food promptly and defrost foods properly.

Avoid raw (unpasteurized) milk and any products that may contain unpasteurized milk. Foods containing raw eggs, undercooked meat, unpasteurized juices, and raw sprouts should also be avoided.

DIABETES FOOD GOALS FOR YOU

The first diabetes diet recommendations were made in Egypt in 1550 B.C., and consisted of wheat grains, fresh grits, grapes, honey, and sweet beer. Today, the American Diabetes Association nutrition recommendations stress an overall healthy eating plan, with an emphasis on several vital nutrients.

If you’d like to learn more about specific nutrient needs and food recommendations for your family members based on gender, age, and activity level, access the website of the USDAs new interactive food model, MyPyramid, at www.mypyramid.gov.

Calories

The days of preprinted, calorie-level diet sheets are over. Although we know that most adults require between 1,800 and 2,500 calories per day, what you need to maintain a reasonable body weight may be different. To lose weight, between 1,000 and 1,600 calories per day may be your goal. Individualized meal plans, designed with the help of a registered dietitian (RD), are the best for watching your weight.

Protein

Your intake of protein foods (meats, poultry, seafood, dairy foods, beans, peas, nuts, and seeds) should be at the same level as that of the general public. These foods should make up between 15 and 20% of the calories you eat, which translates into two 3-oz servings each day (3 oz is the size of a deck of cards or the palm of a woman’s hand).

Although a high intake of protein may be a risk factor for the development of diabetic kidney disease, there is evidence that vegetable protein- which comes from beans, grains, and vegetables-may slow the rate of kidney disease in people with diabetes. Eating less protein from animal sources-meat, milk, eggs, and cheese-also means less fat, saturated fat, and cholesterol in your diet.

Fat

A lower fat intake also lowers your risk for cardiovascular (heart) disease, a common complication of diabetes. Lower fat intake means lower calorie intake, which helps you maintain a reasonable body weight. Mono- and polyunsaturated fats can help to lower your blood cholesterol and protect your heart. Saturated and trans fats can raise your blood cholesterol and increase your risk of heart disease.

The cholesterol in food may also increase your blood cholesterol. Limiting your intake of animal proteins and whole-milk dairy foods will help you to consume less fat and cholesterol in your diet. Your cholesterol intake should be less than 200 milligrams per day. Intake of trans fat and saturated fat should be minimized. The exact amount and type of fat you should eat will depend on your weight, your blood lipid levels, and your overall health.

Carbohydrates

Carbohydrates from fruits, vegetables, whole grains, legumes, and low-fat milk are great for your health. Sweets can be substituted for other carbohydrates in your meal plan or covered with insulin or other glucose-lowering medications.

Both the amount (grams) of carbohydrates as well as the type of carbohydrates in a food influence your blood glucose levels. Monitoring your total grams of carbohydrates-whether by using the exchanges/choices system or carbohydrate counting-is a great strategy to help improve your blood glucose control.

There is no need for you to spend money on special diabetic foods unless you enjoy their taste or the variety they provide. Sweeteners such as corn syrup, fruit juice, and sorbitol may offer no advantage over regular sugar. Enjoy sweet treats in moderation. Substitute sweets for other carbohydrates in your diet, and check your blood glucose after eating to see how they affect you.

Fiber

You should be eating the same amount of fiber as the other members of your family-approximately 20-35 grams per day, or 14 g for every 1,000 calories you eat. Unfortunately, most Americans eat only 10-13 grams daily, so they don’t reap all of fiber’s benefits, like better digestive health. To ensure you are getting the most out of fiber in your diet, choose wholewheat grains and plenty of fresh fruits and vegetables every day. Oats and dried beans are great sources of soluble fiber, which has a positive effect on blood lipid levels.

Sodium

Sodium intake recommendations for people with diabetes are similar to those for the general population-less than 2,300 milligrams per day. If you have high blood pressure, it may be helpful to eat less, shake the salt habit, and carefully read food labels to track the amount of sodium in your diet.

Sweeteners

FDA-approved reduced-calorie sweeteners include sugar alcohols, such as sorbitol, xylitol, and hydrogenated starch hydrolysates. Keep in mind that reduced-calorie sweeteners contain both calories and carbohydrates.

The FDA has approved five nonnutritive (zero calorie) sweeteners for use in the U.S. They are:

acesulfame potassium

aspartame

neotame

saccharin

sucralose

Vitamins and Minerals

You may be a good candidate for vitamin and mineral supplements if you are in poor diabetes control; if you are on a very restricted weight-loss diet; if you are elderly, pregnant, or breast-feeding; or if you are a strict vegetarian.

Eating a well-balanced diet should provide everyone with the essential vitamins and minerals they require. At this time the American Diabetes Association does not recommend any special supplements to benefit individuals with diabetes, however, you should ask your health care team to discuss your individualized vitamin and mineral needs.

SMART CHOICES

The ever-changing information about diabetes nutrition may have left you more confused than ever. A session with an RD and certified diabetes educator (CDE) is money and time well invested. An RD can evaluate your individual case and suggest the meal planning approach that is best for you, whether it is the MyPyramid, carbohydrate counting, or something in between.

Making smart food choices is the key to taking care of your diabetes. Poor choices will cost you time, money, and your health. Eating well helps you avoid the expensive damage to your eyes, heart, and kidneys that occurs when blood glucose levels are high day after day. You can eat healthfully on a lean budget by using the diabetes nutrition guidelines to make smart food choices.

ADDITIONAL RESOURCES IN YOUR AREA

To find an RD near you, call The American Dietetic Association at 1-800-877-1600 or visit the website www.eatright.org. Ask for a specialist in diabetes nutrition.

To find a CDE in your area, call the American Association of Diabetes Educators at 1-800-338-3633 or visit the website www.aadenet.org.

To find a diabetes education program in your area, call 1-800-342-2383 or log onto the American Diabetes Association’s website at www.diabetes.org.

MOTHER NATURE KNOWS BEST

Sticking to the most basic, natural, and nutritious foods is far better for both your health and pocketbook than ready-to-eat, highly processed, and expensive refined foods.

Keep this example in mind: Five pounds of naturally fat-free baking potatoes costs $2.79. In contrast, you’ll pay $16.50 for 5 pounds of high-fat potato chips. It’s easy to see which choice is better for your budget-and your health!

Money $aving Tip

Regular physical activity works to promote good health, helping to lower the cost of medical bills in the future.