Читать книгу Diabetes Meal Planning Made Easy - Hope S. Warshaw - Страница 13
ОглавлениеVitamins, Minerals, and Dietary Supplements
What You’ll Learn:
• the definitions for vitamins, minerals, and dietary supplements
• ADA recommendations on vitamins, minerals, and dietary supplements
• how to take a “foods first” approach to eat enough vitamins and minerals
• the intake recommendations (daily value) for vitamins and minerals
• top 10 food sources of key vitamins and minerals
• facts about dietary supplements of interest to people with diabetes
• factors to consider before you buy and try dietary supplements
Vitamins, Minerals, and Dietary Supplements Defined
Vitamins are essential substances contained in foods that help your body use the food you eat for proper functioning. Each vitamin performs unique tasks. Vitamins often partner with enzymes in your body to carry out specific tasks.
Minerals, like vitamins, are essential substances found in foods that help your body use the food you eat to make your body work properly. Each mineral serves a particular role. For example, calcium strengthens your bones, and potassium helps regulate the circulatory system and helps control blood pressure. Minerals often partner with enzymes in your body to accomplish certain tasks.
Dietary supplements include vitamins, minerals, herbs, botanicals, and other substances that perform, or claim to perform, actions in your body to achieve good health and/or prevent or control health problems. They are not food or drugs, but they contain one or more ingredients that are usually found in foods. They are intended to be used in addition to food, not as a replacement for a healthy eating plan. In the United States, the FDA regulates dietary supplements, but doesn’t regulate the approval or marketing of supplements in the same manner as prescribed medicines. The FDA does not approve dietary supplements before they are allowed on the market, but it can take dietary supplements off the market if problems occur. The FDA now requires all supplement containers to be labeled “dietary supplement” and to have a Supplement Facts label that is similar in look, but not content, to the Nutrition Facts label on foods and beverages.
ADA Recommendations
If you eat a wide variety of nutrient-packed healthy foods, eat at least 1,200 calories a day, and generally keep your blood glucose within target goals, the ADA does not believe that you need to take vitamins, minerals, and/or dietary supplements to achieve optimal nutrient intake.
Many American adults and children don’t get adequate amounts of several key nutrients for two main reasons: 1) inadequate intake of the foods packed with vitamins and minerals: fruits, vegetables, whole grains, low-fat dairy foods, and 2) inadequate availability of some nutrients in the common food supply.
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Current research on vitamins, minerals, and dietary supplements (although there have not been many large studies) does not show that people with diabetes have any greater need for various vitamins and minerals than anyone else.
If you think you may not be getting adequate supplies of vitamins and minerals, your first step is to eat a wider variety of foods and to choose more nutrient-packed foods. If you still feel you have some “nutrition gaps,” you may want to take a multivitamin and mineral supplement that offers a good supply of the vitamins and minerals you need; however, it is difficult to get sufficient amounts of some vitamins and minerals from a combination of foods and multivitamin supplements. For these nutrients, such as calcium and Vitamin D, you may need to take an individual supplement. (See the section on daily values below for more information.)
Vitamin and Supplement Needs
The ADA does note that a person with diabetes may need a specific vitamin or mineral supplement if you
• are a strict vegetarian (meaning you eliminate a number of food groups)
• are following a weight-reducing meal plan of 1,200 calories or less per day
• are pregnant or breastfeeding
• are elderly
• have certain additional short- or long-term illnesses
If any of these factors apply to you, consider your current food intake and whether you are meeting your blood glucose goals.
The Missing Vitamins and Minerals
Nutrition intake surveys conducted by the U.S. government on a regular basis point out that while people are eating more calories per day than ever, about 2,150, we’re falling short on certain key vitamins and minerals. A big reason for the shortfall: adults are not eating enough whole grains, fruits, and vegetables and are eating too much added sugars and fats. Adults are not consuming enough of vitamins A, C, D, E, and the minerals: calcium, choline, folate, potassium, and magnesium. Except for vitamins A (as carotenoids) and C, children are lacking in this same list. While it’s not a vitamin or a mineral, one nutrient that’s lacking in most people’s diet is dietary fiber.
To have the best chance of getting the vitamins, minerals, and dietary fiber you need, eat a wide variety of nutrient-dense (packed with vitamins and minerals) foods, such as fruits, vegetables, whole grains, and low-fat dairy foods, lean meats, nuts, seeds, beans, and healthy liquid oils. The guidelines also recommend lightening up on foods that are low in nutrients and are contributing excessive calories. These are drinks with added sugars, sweets, candy, fried foods, high-fat meats, and whole-milk dairy foods.
Take a Foods First Approach
Plan your meals and snacks to eat a wide variety of nutrient-dense foods and get the vast majority of your vitamins and minerals from the tfoods you eat. Experts in nutrition believe that foods contain vitamins and minerals as well as many naturally occurring substances (some not yet even known) that may protect against chronic health problems.
If you are keeping your calorie level low (1,500 calories and below) to meet your diabetes and nutrition goals, you’ll have towork even harder to eat all the nutrients you need. If you need to eat less than 1,500 calories a day or you cannot eat a particular category of food, ask your health care provider whether you should take a multivitamin and mineral supplement or a supplement that contains the nutrients you are lacking. For example, many people need to take a supplement to get enough calcium and vitamin D. Luckily, these nutrients are often paired in one supplement.
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Keep nutrition-packed fruits, such as berries, bananas, oranges, apples, grapefruit, and mangos in your refrigerator and rotate your fruit choices.
Vitamin and Mineral Needs: Who Sets the Targets?
Vitamin and mineral deficiencies, which can result in diseases, were much more common several hundred years ago. Today, people don’t often get scurvy from having insufficient vitamin C, beriberi from a deficiency of thiamin, or rickets from not getting enough vitamin D. For the past few decades, government agencies and government-appointed experts have worked to establish which vitamins and minerals are necessary for health and how much of these vitamins and minerals people need at various ages and stages of life.
The recommendations for many vitamins and minerals are based on the Dietary Reference Intakes (DRIs), which are developed through the Institute of Medicine at the National Academy of Sciences. Over time, the DRIs are reviewed and revised based on the evolving nutrition science.
Daily Values on the Nutrition Facts Label
The Nutrition Facts label uses the single term Daily Value (DV) to provide nutrient levels, which will cover the needs of most people. The Daily Values provide food manufacturers with guidelines to follow for food labeling and nutrition claims. Keep in mind that Daily Values are based on a calorie intake of 2,000 calories a day.
The table on page 65 lists current Daily Values and the amount of the vitamin or mineral that a food must have per serving to use an “excellent source of” or “good source of” nutrition claim.
• The terms “excellent source of,” “rich in,” and “high” mean that a serving (noted on the food label) of the food provides 20% or more of the Daily Value.
• The terms “good source of,” “contains,” and “provides” mean that a serving of the food must provide 10-19% of the Daily Value.
Learn more about food labeling and use of the Nutrition Facts label in chapter 22.
Getting Enough Vitamins and Minerals
While the vitamin and mineral needs of people with diabetes are no different from those of other Americans, research shows that many adults don’t get enough of the essential vitamins and minerals. These tips can help you:
• Eat more fruits and vegetables and eat a wide variety of them. Go for the high-color ones because they often provide more vitamins and minerals—orange, dark green, blue, and red.
• Eat more fruits and vegetables raw, unprocessed or minimally processed.
• Make many of your starch choices whole-wheat or whole grains—cereals and breads, brown rice, whole-wheat pasta, bulgur, and barley.
• Use legumes (beans, peas, and lentils) frequently. Make soups or bean salads or sprinkle beans or peas on tossed salad. These foods are packed with vitamins and minerals.
• Eat or drink 2 to 3 servings a day of low-fat milk, yogurt, or cheese. Many children and young adults don’t get enough calcium and vitamin D. Dairy foods naturally contain calcium and are nearly always fortified with vitamin D.
See the individual chapters in section 2 for more tips on how to eat your vitamins and minerals.
Top 10 for 10 Vitamins and Minerals
Each of the 10 tables on the following pages provides a list of the top 10 food sources (based on one serving of food) of the nutrients you are most likely to be lacking. At the top of each table, you’ll find the daily value for each nutrient and the amount needed for a food to be considered an “excellent source” or a “good source” of the nutrient. Use these tables to see how the foods you eat stack up and to find new nutrition-packed foods to add to your eating plan. Nutrient data was obtained from the USDA nutrient database. This is a searchable database which is an excellent resource for nutrition information on about 8,000 foods at: www.ars.usda.gov/ba/bhnrc/ndl.
Dietary Supplements and Diabetes
Research shows that people with diabetes are more likely to take dietary supplements than the general public. Good quality research, however, is still very limited on dietary supplements and whether some people with diabetes would benefit from certain vitamins, minerals, and nutrients.
According to the Diabetes Supplement Health and Education Act (DSHEA), dietary supplements don’t require FDA approval prior to marketing. This lack of approval leads to the marketing of many ineffective products and many unfounded product claims. A number of dietary supplements are marketed to people with diabetes. If you choose to use dietary supplements, make sure you have good scientific reason to use them and make sure you buy high-quality supplements. Read Before You Buy (below).
Below are a few of the dietary supplements that show some promise for people with diabetes in animal and human studies. Keep in mind that most of these still require more research to verify those claims. At this time, the ADA does not recommend the use of dietary supplements for most people.
Antioxidants
Nutrition experts used to believe that people with diabetes might need more antioxidants—that is, vitamins E, C, and A (as beta carotene) and other carotenoids and selenium—because diabetes is a state of oxidative stress. Oxidative stress is known to create free-radicals that may damage various tissues in the body. Some large research trials have demonstrated that the use of antioxidants didn’t show a benefit. In fact, there was concern that high doses, particularly of vitamin E, might cause health problems. ’
This doesn’t mean that you shouldn’t get the amount of these nutrients suggested by the Dietary References Intakes for your age and gender. It does mean that taking these in greater volume was not found to be beneficial.
Alpha-Lipoic Acid (ALA)
ALA, an antioxidant normally made in the liver, circulates in the body in small amounts. Foods also contain only small amounts of ALA. Some studies have shown that, in people with type 2 diabetes, ALA may help the muscles use glucose more efficiently and may make tissues more sensitive to the insulin made by the body. Some studies have also found ALA to lessen the pain of diabetes nerve disease (neuropathy).
Chromium
Chromium is an essential trace mineral that the body needs to maintain normal blood glucose levels. Chromium is found in small amounts in foods like egg yolks, whole grains, and green vegetables. Chromium, in the form of chromium picolinate, may help lower blood glucose levels and improve blood lipids in people with type 2 diabetes who may be chromium-deficient; however, the research remains mixed. Chromium supplements are generally not recommended for people with diabetes at this time.
Cinnamon (the spice)
The active ingredient in cinnamon, hydroxychalcone, is thought to enhance the effectiveness of insulin and lower blood glucose. Several small studies have shown that significant amounts of cinnamon consumed per day can lower blood glucose levels; however, other research has shown no benefit. A 2008 report that analyzed a number of the studies together (meta-analysis) showed no significant benefits of cinnamon on glucose or lipid levels.
Fenugreek
Fenugreek is a legume (bean) found in India, North America, and the Mediterranean. It is used in Indian cooking and has been used for centuries as a remedy for high blood glucose levels. Like other legumes, it’s high in fiber and may lower blood glucose levels by slowing the rate at which foods with carbohydrate are broken down. It may also help the body make better use of glucose. Studies with fenugreek have been done in people with type 1 and type 2 diabetes but have not generally proven its effectiveness.
Garlic
Garlic, a member of the lily family, is a common ingredient in cooking. As a dietary supplement it has been studied for several benefits, including antioxidant effects, lowering blood glucose by increasing the release of insulin, lowering blood pressure, and improving blood lipids. So far, the research on garlic’s benefits for people with diabetes is inconclusive.
American Ginseng
American ginseng is one of several species of ginseng plants, and most of the positive diabetes-related research about ginseng is with the American variety. The main benefit found in animal and human studies is that ginseng lowers blood glucose, possibly by slowing the breakdown of carbohydrate.
