Читать книгу 16 Myths of a Diabetic Diet - Karen Hanson Chalmers - Страница 8
ОглавлениеMEDICAL NUTRITION THERAPY VERSUS THE DIABETIC DIET
NATE: My family doesn’ understand that I can’ eat the same meals that they eat because I now have diabetes! There are so many foods that I need to avoid, and I feel restricted and limited with my food choices!
DIETITIAN: Why do you think you have to avoid many foods and only eat “special foods” when you have diabetes?
NATE: My cousin, who has had diabetes for 20 years, told me he can’ eat any foods with fat or sugar and that I should stay away from my family’s favorite staple foods such as pasta and bread. I tried some of those “diabetic foods” but they are so expensive and the flavor isn’t the same.
DIETITIAN: I’m happy that you came to see me today. I am confident that I can clear up a lot of the misconceptions that you and your family may have about diabetes and food. It’s not uncommon for many people to think of a diabetic diet as lists of foods labeled “good” and “bad,” while avoiding desserts and “sugar” foods. That is not how meal planning for people with diabetes works today. To put it simply, it is not about restriction! A person with diabetes can eat anything a person without diabetes eats, as long as he or she thinks about what they eat in terms of healthy eating and has accurate up-to-date education. The American Diabetes Association’s goals for healthy eating aim at reducing fat and calories, including healthy carbohydrate foods, increasing fiber, moderating your protein intake, limiting alcohol intake, and fitting in regular physical activity. This is what anyone should be striving for—not just people with diabetes.
NATE: Do you really mean that I can continue to eat the foods that my family and I enjoy with just a little bit of tweaking?
DIETITIAN: Of course! There are no foods that are off limits, although some food choices are healthier than others. My job is to teach you to eat normally, but healthfully, so you can maintain your energy and blood glucose levels and understand how foods affect your blood glucose and weight. At the same time, doing this will help lower your risks of heart disease, high blood pressure, and kidney disease.
NATE: When can we start? I can’t wait to begin eating like a “normal person” again.
WHAT’S NEXT?
There continues to be much confusion and debate about what foods to eat when you have diabetes. “What can I eat?” is the most often asked question, and Nate’s thinking about a rigid “diabetic diet” and “forbidden foods” is all too common. Nate soon discovered that the “diet” for healthy living is based on flexible meal planning. Because his family was also at an increased risk of developing diabetes, such a meal plan would be helpful for them, too. What Nate perceived as a major challenge is now nothing more than learning how to enjoy his favorite foods balanced with new foods and that all foods can be part of a balanced diet.
THE OLD AND THE NEW
You may recall family members and friends describing nutrition guidelines for people with diabetes as being inflexible and tedious. To control blood glucose levels, doctors and dietitians had to provide strict, standardized “diabetic diets” to all people with diabetes. This diabetic diet was rigid and limited and distributed calories from carbohydrate, protein, and fat based on scientific research available at that time, which is now out of date. The biggest restriction, however, was the strict avoidance of sugar endorsed by a diabetic diet. Foods with added sugar, such as dessert foods, were prohibited, and even the amount of fruit, vegetables, and milk, which contained natural sugar, was severely regulated. People with diabetes often lost their motivation to stick with these preplanned diets, and their interest in nutrition diminished. Furthermore, the primary goal for blood glucose management back then was to reach an ideal body weight based on height and frame size.
Current nutrition guidelines are flexible and offer a wide variety of food choices. What was once a rigidly controlled, semi-starvation diet in the early days is now the “all foods can fit” meal plan that is tailor made for each person’s food likes and dislikes, lifestyle, health risks, and diabetes medications. The “all foods can fit” motto balances food intake for people with diabetes and is now called medical nutrition therapy instead of a “diabetic diet.” Health experts are no longer convinced that achieving an ideal body weight is a primary goal for managing your diabetes. Instead, you may be encouraged to maintain a reasonable weight or strive for a weight that you and your health care provider feel is realistic and achievable. We now know that even a moderate weight loss of 10–20 pounds for those who are overweight can result in improved blood glucose and blood fat levels.
As you read over the American Diabetes Association’s medical nutrition therapy goals below, keep in mind that the 2005 U.S. Department of Agriculture (USDA) dietary guidelines for Americans and the American Heart Association recommendations are also very similar. Don’t forget that these are guidelines for all healthy Americans.
Summary of the 2006 American Diabetes Association’s Updated Medical Nutrition Therapy (MNT) Recommendations
People with diabetes should
• receive individualized nutrition education, preferably provided by a registered dietitian who is a diabetes educator
• make lifestyle changes, including weight loss, reduced fat intake, and regular physical activity
• increase their daily fiber intake
• minimize trans-fat and saturated fat intake
• monitor carbohydrate intake to regulate blood glucose levels
• limit daily alcohol intake
HERE ARE THE FACTS
The American diet clearly has too much fat, cholesterol, and sodium and too little fiber and healthy carbohydrates. Your overall health reflects many things, such as your environment, heredity, and regular health care. These are things that you do not always have complete control over. However, your food choices, which are controllable, can help you improve your health. Take a look at the following Dietary Guidelines for Americans:
Eat a variety of foods—diabetes still requires the same nutrients, vitamins, and minerals as for those without diabetes.
Maintain a healthy weight—excess body fat makes it more difficult to use insulin, which in turn can lead to high blood glucose levels.
Choose a diet low in total fat, trans-fat, saturated fat, and cholesterol—diabetes increases the risk for heart and blood vessel disorders.
Choose a diet with plenty of fresh vegetables, fruits, and whole-grain products—high fiber can help lower blood glucose and blood fat levels.
Use sugars only in moderation—with 16 calories per teaspoon, sugar is not particularly fattening, but many high-sugar foods contain less fiber and a lot of added fat that does contribute to weight gain.
Use salt and sodium in moderation—high blood pressure is common among people with diabetes, and too much salt may cause water retention.
If you drink alcoholic beverages, do so in moderation—alcohol can affect blood glucose and blood fat levels, as well as supply a lot of “empty calories.”
DESIGNING YOUR OWN EATING PLAN
You will be happy to learn that registered dietitians offer a positive message that emphasizes the importance of healthy eating and daily physical activity. With the help of a registered dietitian, you’ll be taught how to include foods you like to eat in your meal plan, identify what food groups these foods belong in, and make the best choices in quantity and quality for good health. You do not have to restrict foods that are high in fat, cholesterol, sugar, and sodium completely, but you do have to watch them. It is your overall intake of these foods over time that makes a difference, not a single food or meal. In the course of a day, it is important to know which foods are in each food group and the suggested food amounts from each food group.
The amount of food you should eat in a day depends on your age, gender, weight, and level of physical activity. Together with a registered dietitian, you will work to design an eating plan just for you that provides healthy calorie sources while still allowing you to eat many of your favorite foods. You will be assured of enough good sources of fiber and healthy carbohydrates and of how to cut down on the more unhealthy sources of fat, cholesterol, and sodium.
However, the most important point to remember is that actual “serving sizes” are usually smaller than what you are used to seeing on your plate. Instead of regularly eating smaller homemade meals, many Americans eat more restaurant meals and convenience foods, which provide larger portions than the standardized portion sizes found in Choose Your Foods: Exchange Lists for Diabetes. As these large portions become more familiar to us, portion sizes on our plates continue to grow bigger.
Let’s briefly review the actual serving sizes of some common foods. These portion sizes are standardized and apply to all Americans, not just those with diabetes.
WHAT COUNTS AS ONE SERVING?
Carbohydrate
Including bread, cereals, grains, dry beans, crackers, snacks, and desserts.
• 1 slice bread
• 1/2 cup potato
• 1/2 cup cooked cereal
• 1 cup regular cereal
• 1/2 cup corn or peas
• 1/2 cup lentils or beans
• 1/3 cup pasta or rice
• 1 low-fat granola bar
• 1/4 large bagel (1 oz)
• 3 cups air-popped popcorn
• 2 rice cakes
• 1/2 cup low-fat ice cream
Fruits and Vegetables
• 1 small fresh fruit
• 1/2 cup canned fruit or juice
• 1 cup berries
• 17 grapes
• 1/2 grapefruit
• 1/4 cup dried fruit
• 1 cup raw vegetables
• 1/2 cup cooked vegetables
• 1/2 cup vegetable juice
Milk and Yogurt
• 1 cup nonfat or low-fat milk
• 6 oz nonfat or low-fat yogurt
• 1 cup sugar-free cocoa
• 1 cup low-fat soy/rice milk
• 1/3 cup dry low-fat milk
Protein
Including meat and meat substitutes.
• 1 oz lean fish, meat, or poultry
• 1 oz low-fat cheese
• 1 egg
• 1/4 cup egg substitute
• 1/4 cup low-fat cottage cheese
• 2 oz tofu
• 2 Tbsp natural peanut butter
Fat
• 1 tsp butter/margarine
• 1 Tbsp lite margarine
• 1 Tbsp salad dressing
• 1 tsp oil
• 1 tsp mayonnaise
• 1 Tbsp light mayonnaise
• 6 almonds/cashews
• 1 Tbsp sunflower seeds
• 2 Tbsp light sour cream/cream cheese
Alcohol
• 1 1/2 oz liquor
• 12 oz lite beer
• 5 oz dry wine
Variables
Now that you have reviewed the appropriate serving sizes of some common foods, it is important to note that you may eat more than one serving. For example, a dinner portion of meat (protein) for a young, active male could be five to six servings (5–6 oz), whereas a dinner portion for a middle-aged, non-active woman may be two to three servings (2–3 oz). This is all determined by working together with a registered dietitian who can personalize a meal plan to meet your specific needs. If you have type 2 diabetes and control your diabetes by diet and exercise alone, or in combination with diabetes medications, you may be asked to eat consistent amounts of carbohydrate at meals as well as regulate the timing of your meals to coincide with the action of your diabetes medication(s). If you have type 1 or type 2 diabetes and are on insulin, you may be asked to eat a consistent amount of carbohydrate at meals or you may learn how to precisely match your insulin to the amount of carbohydrate you plan to eat for more flexibility. So, there are certain considerations that should be taken into account depending on the type of medication you are on for your diabetes as well as how your specific insulin dose is calculated at each meal.
HERE’S WHAT YOU CAN DO
1. You are a normal, healthy person who just happens to have diabetes. Don’t think of your diabetes as a disorder that takes all of the pleasure and taste out of eating. Remember, there are no foods that are off limits.
2. Get help. Sit down with a registered dietitian to find out where most of your calories are coming from. Are you eating too many fat-filled and animal foods and not enough whole grains, fruits, and vegetables? Have you eliminated carbohydrate foods from your diet? What do you need to eat more of? What do you need to eat less of?
3. Eat a variety of fresh fruits and vegetables every day.
4. Eat fewer animal products. Doing this will reduce your risk of heart disease.
5. Eat more fiber. Choose whole-grain breads and cereals. Eat the skins and peels of fresh fruits and vegetables. Add dried beans and lentils.
6. Eat less fat. Try to cut down on trans-fats and saturated fats, which are harmful to your arteries.
7. Cut down on your salt intake. Cut down on the salt you use when cooking and at the table.
8. Make a healthy grocery shopping list. Be sure to include more of the foods you have been missing and make an effort to include these foods on a regular basis.
9. Get help with weight loss. If you are trying to lose weight, let your registered dietitian help you tighten up your portion sizes and increase activity. Doing this will allow you to eat fewer calories and burn more calories.
10. Use teamwork. Work with your diabetes team and dietitian to coordinate your food intake with your activity level and diabetes medication(s).
11. Plan on eating meals that fill you up for longer periods. Such meals contain moderate amounts of protein and healthy fats and contain fiber-rich carbohydrate foods, such as whole-grain starches, fruits, and vegetables.
12. Educate your family and support system. Help your family members understand how to eat in a healthy way by bringing variety and balance from all of the food groups to your shared meals.
COMMONLY ASKED QUESTIONS
Will I still be able to keep good control of my blood glucose if I eat the same foods as the rest of the family?
If you work with your diabetes team and your registered dietitian to match your food intake with your diabetes medications and activity level, you won’t have to eat any differently than the rest of your family, assuming they are also eating a healthy, balanced diet.
How can I make wise food choices to lower my risk for heart disease and other problems caused by diabetes?
Keep your blood glucose in your target range and stick with your healthful eating plan, regular physical activity, and, if needed, diabetes medications.
Isn’t it more important for a person with diabetes to follow healthy eating guidelines than for the rest of the family?
Healthy eating guidelines are important for all Americans because we tend to eat too much fat, cholesterol, and sodium and not enough fiber and healthy carbohydrates. Because of excesses in our diets, all Americans are at a greater risk for heart disease, high blood pressure, stroke, diabetes, obesity or overweight, and some forms of cancer.
YOUR TURN
Now it’s your turn to recall some key points from this chapter. Let’s see how you do!
1. Instead of the term “diabetic diet,” we now call meal planning for those with diabetes ________________________ (3 words).
2. Achieving a “reasonable body weight” rather than “ideal body weight” is now one of the primary goals for diabetes self-management. True or false?
3. Please fill out what counts as one standardized serving size, for each of the following foods:
| Rice/pasta: | ________ |
| Cooked oatmeal: | ________ |
| Lentils/beans: | ________ |
| Berries: | ________ |
| Milk: | ________ |
| Light margarine/mayonnaise: | ________ |
| Olive oil: | ________ |
4. Currently, nutrition guidelines are flexible and offer a wide variety of food choices. True or false?
See APPENDIX A for the answers.
