Читать книгу Diabetes Meal Planning Made Easy - Hope S. Warshaw - Страница 10
ОглавлениеHealthy Eating Guidelines for Diabetes
What You’ll Learn:
• the key principles of healthy eating with diabetes
• the goals of medical nutrition therapy (MNT), also known as nutrition counseling
• specific recommendations on the big and small nutrients
Over the last few decades, the American Diabetes Association (ADA) has revised its nutrition principles and recommendations for healthy eating numerous times. ADAs goal is to have these recommendations reflect the most current diabetes and nutrition research, as well as consensus among diabetes nutrition experts. Find and read the most current ADA nutrition recommendations at www.diabetes.org.
As you review these recommendations, you will see how similar they are to the Dietary Guidelines discussed in chapter 3. You’ll also note that the focus of diabetes care is much broader than just attending to blood glucose control. Today, diabetes care includes managing blood glucose, blood lipid, and blood pressure levels. Keeping these three factors in the target ranges (see ABC goals) will keep you healthy for years to come.
Healthy Eating with Diabetes
Here are four key principles to remember about healthy eating with diabetes:
1. There’s no such thing as a “diabetic diet.” These so-called diabetic diets shouldn’t be used. The healthy eating guidelines for everyone apply to people with diabetes as well. People with diabetes do not need to buy or eat any special foods.
2. Change your behaviors slowly but surely. Healthy eating and staying active are well-known and effective ways to stay healthy. They are essential if you are at high risk of type 2 diabetes, or have pre-diabetes or type 2 diabetes because you are more likely to have or be at high risk for heart and blood vessel diseases. When you learn that you have type 2 diabetes, your eating habits and food choices may need changing.
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Try not to think of your eating plan as a “diet.” Think of it as a way to slowly change your family’s eating habits for the better.
3. Individualization is important. Find a registered dietitian (RD) who specializes in diabetes medical nutrition therapy (MNT). Medical nutrition therapy is the formal name for nutrition counseling. It is the term some health plans, including Medicare, use to describe coverage of nutrition counseling. Your RD should work with you to develop a personalized healthy eating plan and goals for behavior change. This health care provider should consider all of your health, diabetes, and nutrition goals, as well as your food preferences: including what foods you like to eat; what time you like to eat; your cultural and religious food habits and customs; whether you like or need snacks at certain times; your daily and weekend schedule; and, most important, what you are willing, able, and ready to change. For instance, the eating plan and goals for a vegetarian who works the evening shift would be very different from those of someone who lives alone and eats most meals in restaurants.
4. Be flexible and realistic with yourself. In today’s fast-paced world, life doesn’t always go according to plan, and the healthiest foods are not always at your disposal. Your eating plan and behavior change goals need to be flexible enough to fit your lifestyle. They need to help you be able to delay a meal or snack, eat at a restaurant, or opt for convenience foods. Your eating plan needs to fit the days when your activity level is way up—perhaps for a weekend hike or day of skiing—and the days when you feel ill and have no appetite.
Recommendations for Big and Small Nutrients
Most people at high risk for or with type 2 diabetes need to shed some weight. To lose those 10 to 20 pounds, you need to know the right number of calories for you to eat, along with the proper foods that will provide the right mix of carbohydrate, protein, and fat. Research shows there is no single combination of nutrients that’s best for diabetes care and/or weight control.
The goals below give a calorie range to shoot for when it comes to each of the big nutrients.
Carbohydrate
Carbohydrate is the main nutrient that raises blood glucose levels. Both the amount and the type of carbohydrate you eat will affect your blood glucose, but the amount has a greater effect on your blood glucose. Once you learn the impact of carbohydrate on blood glucose, it’s rational to think that a low carbohydrate intake may be an answer to blood glucose control. Research doesn’t support this notion. Many studies have shown that a lower carbohydrate intake can help lower blood glucose initially; however, over time, it doesn’t improve weight loss, blood glucose control, and most other health parameters of interest. Lower carbohydrate diets (less than 45% of calories from carbohydrate) also don’t allot sufficient grams of carbohydrate to get the nutrients, fiber, vitamins, and minerals you need.
The ADA suggests that people with diabetes consult the general nutrition guidelines, which recommend that you get somewhere between 45 and 65% of your daily calories from carbohydrate. For example, suppose you eat about 1,400 calories a day and you decide to get half of those calories from carbohydrates. Because each gram of carbohydrate contains 4 calories, you would need to eat about 175 grams of carbohydrate to consume half of your total calories from carbohydrate. (In other words, half of 1,400 calories is 700, and 700 calories divided by 4 calories per gram is 175 grams.)
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It’s important to eat similar amounts of carbohydrate at each meal and to keep snacks, if you need them, consistent.
If you are not able to keep your blood glucose levels on target by eating a healthy and balanced amount of carbohydrate throughout the day, you may need one or more blood glucose-lowering medications. Decreasing the amount of carbohydrate you eat to unhealthy levels will not bring your blood glucose down sufficiently. If you are not reaching your blood glucose goals, talk with your health care provider about the steps you should take to hit your blood glucose targets.
Sugars and Sweets
Sugars and sweets are no longer off-limits for people with diabetes. You can choose to fit sugars and sweets into your eating plan in small quantities; however, don’t forget that they are concentrated sources of carbohydrate and calories and can elevate your blood glucose levels. Plus, sweets such as cheesecake and regular ice cream maybe high in total fats, especially the unhealthy saturated fats. Finally, because sweets usually offer little in the way of nutrition, everyone who wants to eat healthier should limit the amount of sugars and sweets they eat. Consider your weight, blood glucose and blood fat levels, and diabetes goals when fitting sweets into your eating plan.
Dietary Fiber
In general, you should try to increase the amount of fiber you eat to 14 grams of fiber for every 1,000 calories you eat. The recommended daily fiber intake levels can help you figure out specifically how much fiber you should include in your diet.
These goals are roughly double the amount of fiber that most Americans eat (11-17 grams/day). Good sources of fiber are whole grains, beans and peas, fruits, and vegetables. You can get about 5 grams of dietary fiber from a serving of a whole-grain cereal, a third of a cantaloupe, or 1/2 cup of cooked lentils. Learn more about how to increase your fiber intake in section 2.
Glycemic Index and Glycemic Load
The use of the glycemic index (GI) and glycemic load (GL) in diabetes meal planning has been an area of debate for several decades. The ADA suggests that GI and GL may be valuable concepts for people with diabetes if these measures are used in addition to and after careful monitoring of total carbohydrate intake; however, using GI or GL to choose foods may or may not help you make healthier food choices. For example, you might decide to eat lentils or barley instead of white rice because lentils and barley have a lower glycemic index. Conversely, choosing a high-fat food like ice cream because it had a low GI instead of a serving of fruit with a higher GI, a banana or fresh pineapple, doesn’t make sense. Think of GI and GL as another factor, rather than the main factor, to consider when you choose which foods to eat.
The GI measures the increase in blood glucose levels during the two hours after eating a particular kind of food. Some foods that contain carbohydrate create a quick and more dramatic rise in blood glucose, while others cause a slower and less dramatic rise. Glucose is the standard for the glycemic index and is assigned an arbitrary number of 100. Other foods are assigned GI numbers relative to the glucose standard of 100—either higher or lower. Today, there are several different glycemic indexes in use.
Keep in mind that GI numbers are available only for several hundred commonly eaten, non-mixed foods. In other words, foods like carrots, watermelon, and potatoes have GI numbers, but casseroles and vegetable soup do not. It’s also important to note that the type of carbohydrate (e.g., starch or sugar) does not consistently predict the GI. For example, some fruits have a low GI and others have a higher GI. The GI doesn’t consider typical food portions; however, GL does. The GL takes the glycemic index of a food and then factors in its common serving sizes to give a more practical indicator of the effect that food will have on blood glucose.
Raising Your Blood Glucose
Other factors that contribute to how foods raise your blood glucose are
• your blood glucose at the time you eat
• how much blood glucose-lowering medicine you take, when you take it, and when you eat
• your level of insulin resistance in general and at the time you eat the food(s)
• individual responses to foods and different responses on different days
• the amount of fiber and whole grains in a meal (these can slow the rise of blood glucose)
• how ripe a fruit or vegetable is when you eat it (the riper the food, the more quickly it can raise blood glucose)
• the form of the food (for example, fettuccine can affect blood glucose differently than macaroni)
• the variety of the food (for example, long-grain or short-grain rice, Yukon gold or red potatoes, and when and where a product was grown)
• whether you eat the food raw or cooked (the more a food is cooked, the more likely it is to raise blood glucose quickly)
• the other foods you eat along with the carbohydrate (a meal that is mainly carbohydrate with a small amount of fat will raise your blood glucose more quickly than a meal with more fat)
Many of the foods that have a low GI are healthy foods. Consider eating more whole-grain breads and cereals, legumes (beans), and fruits and vegetables. Include these foods in your eating plan, but don’t completely omit foods with a higher GI if they are healthy foods and you enjoy them.
You may find it helpful to create your own personal GI by recording the results of your after-meal blood glucose checks. Make notes about your experiences with certain foods and meals, and note what changes you might make when you eat that food or meal again, such as eating a smaller portion, avoiding them, or adjusting medicine (if you can).
Consider using the concepts of GI and GL in conjunction with other healthy eating strategies and priorities. First, look at your total carbohydrate count at meals, limit your intake of sweets and sugars, increase the amount of whole grains, fruits, and vegetables you eat, and then factor in the GI or GL of a food.
Protein
The ADA suggests that eating 15-20% of your calories as protein is fine as long as you don’t have diabetes-related kidney disease. This is not a lot of protein, as you can see in the model meals on pages 53-58. Eating 15-20% of your calories as protein certainly doesn’t allow for an 8-ounce piece of steak, fish, or chicken each night at dinner. Eating smaller (about 2-4 ounces), as well as leaner, portions of animal protein will also help reduce your intake of saturated and trans fat and will help you to reach your blood lipid targets. Read the information on fat, below, to learn more.
Protein can influence blood glucose, but to a much lesser degree than carbohydrate does. In people with type 2 who still make some insulin on their own, protein intake can cause an increase in the release of insulin from the pancreas; however, this doesn’t raise blood glucose. Because people with type 1 diabetes no longer make insulin, moderate amounts of protein have little effect on blood glucose. Keep in mind that a high-protein meal, which is often also high in fat, can cause a delayed rise in blood glucose.
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Most Americans eat more protein than their bodies need to be healthy— about 15-20% of your total calories. Portions need to be closer to 2-4 ounces cooked to achieve this goal.
Fat
As a person with diabetes or prediabetes, you may have abnormal blood lipid levels (unhealthy LDL, low HDL, and/or high triglycerides) and high blood pressure. Because these conditions put you at risk for heart and blood vessel problems, the most important advice for you is to limit the amount of saturated fat you eat to less than 7% of calories and to keep trans fat as low as possible. In years past, there was more emphasis on eating less total fat. Today, experts believe that anywhere from about 20-40% of your calories can come from fat. The key is to minimize the unhealthy fats and oils and to get the remainder of your calories from fat from the healthier monounsaturated and polyunsaturated fats. With our food choices today this is easier said than done. Try to keep your trans fat intake as close to zero as possible.
Fat affects blood glucose by slowing down the rise of blood glucose after you eat. In other words, a high-fat meal may cause a slower rise in blood glucose than a high-carbohydrate meal. This doesn’t mean you should eat a lot of fat, especially saturated fat, as a way to manage your blood glucose. Keep your total fat intake moderate and choose the healthiest fats. You’ll learn how to reach these goals in the pages ahead.
Sodium
Research showing the benefits of a lower sodium count on blood pressure is mounting. Control of blood pressure is an important topic because nearly three-quarters of people with diabetes have high blood pressure. A lower sodium intake can impact blood pressure even more in people with diabetes or high blood pressure, along with African Americans and adults who are middle-aged and older. Keep in mind that we now eat around 4,000-6,000 milligrams of sodium a day. More than half of this is from processed foods. Research shows you can further lower your blood pressure by eating sufficient fruits, vegetables, whole grains, and low-fat dairy foods that provide much needed potassium (among other essential nutrients). Learn more about how to reduce your sodium intake and raise your potassium count in chapter 8.
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Research shows that getting your sodium intake down to below 2,500 milligrams per day can help lower and control blood pressure.
Alcohol
The recommendation for alcohol is consistent with general dietary guidelines. Women should have no more than 1 drink a day, and men should have no more than 2 drinks a day. Research shows there are some benefits of various types of alcohol on the heart.
Vitamins and Minerals
If you eat at least 1,200 calories a day from a wide variety of healthy foods and your blood glucose levels are within the target ranges at this point, the ADA does not believe you need to take vitamin, mineral, or dietary supplements. People with diabetes have not been shown to have any greater need for various vitamins and minerals than anyone else.
You may be at risk for or have difficulty getting sufficient amounts of some critical vitamins and minerals. Studies show that many people are deficient in vitamins A, C, D, and E along with essential minerals like choline, folic acid, magnesium, and potassium. Your first step to ensure that you do get enough of these important nutrients is to eat a wide variety of foods. Choose nutrient-rich as well as minimally processed foods. Next, talk to your health care provider about a multivitamin and mineral supplement that offers you optimal amounts of missing vitamins and minerals as extra “insurance.” This is especially true if your daily calorie intake is at or below 1,200, or you know you don’t get enough of certain vitamins or minerals. (See chapter 7 for more information on vitamins, minerals, and supplements.)
Vegetarianism and Diabetes
Vegetarianism has exploded across the country in the last several years. There are more restaurants that cater to the vegetarian and vegan lifestyle. If you’re a vegetarian or thinking about becoming a vegetarian and you’re worried that it won’t mesh with your diabetes healthy eating lifestyle, think again. There is no reason a person with diabetes can’t adopt a vegetarian lifestyle.
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The nutrients vegetarians need to be concerned about are those provided by meats, poultry, and seafood as well as dairy products and eggs (if these are omitted). Consider your intake of calcium, iron, zinc, vitamin B-1 2, vitamin D, riboflavin, and omega-3 fats. Discuss the use of vitamin and mineral supplementation with your care providers.
Being a vegetarian represents a broad range of eating styles. Some vegetarians do not eat any meat products but will still consume milk and eggs, while vegans restrict all animal products from their diet. Others do not eat red meat, but will occasionally eat seafood or poultry. The Vegetarian Resource Group (www.vrg.org) defines four categories of vegetarianism.
Research shows that vegetarians tend to receive a multitude of health benefits because of their higher consumption of foods from healthier food groups, along with fiber and other nutrients; however, just because someone is a vegetarian doesn’t mean they automatically eat more healthfully. Vegetarians need to work just as hard (if not harder) to choose healthy foods and eat them in healthful ways. It will be important to choose and prepare your foods with limited fats and salt (as suggested for everyone) and to monitor your ABCs to make sure you are hitting your targets. If your blood glucose is difficult to control, you may be ready for blood glucose-lowering medication.
Health Benefits of Vegetarianism
Proven health benefits for those people who practice a vegetarian lifestyle are:
• Lower LDL cholesterol
• Lower blood pressure
• Lower rates of type 2 diabetes (over non-vegetarians)
• Lower body weight
