Читать книгу 101 Tips on Nutrition for People with Diabetes - Patti B. Geil - Страница 2
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©2006 by the American Diabetes Association, Inc. All Rights Reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including duplication, recording, or any information storage and retrieval system, without the prior written permission of the American Diabetes Association.
Printed in the United States of America
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The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.
The paper in this publication meets the requirements of the ANSI Standard Z39.48-1992 (permanence of paper).
ADA titles may be purchased for business or promotional use or for special sales. To purchase this book in large quantities, or for custom editions of this book with your logo, contact Lee Romano Sequeira, Special Sales & Promotions, at the address below, or at LRomano@diabetes. org or 703-299-2046.
American Diabetes Association
1701 North Beauregard Street
Alexandria, Virginia 22311
Library of Congress Cataloging-in-Publication Data
Geil, Patti Bazel.
101 tips on nutrition for people with diabetes / Patti B. Geil, Lea Ann Holzmeister.—2nd. ed.
p. cm.
Includes bibliographical references and index.
ISBN 1-58040-254-2 (alk. paper)
eISBN 978-1-58040-404-4
1. Diabetes—Diet therapy—Miscellanea. 2. Diabetics—Nutrition—Miscellanea. I. Holzmeister, Lea Ann. II. Title. III. Title: One hundred one tips on nutrition for people with diabetes.
RC662. G448 2006
616.4’620654—dc22
2006009890
To our families
Jeff, Erin, Adam, and Emily Holzmeister
Jack,Kristen, and Rachel Geil
101 thank-yous for your love and support!
—Lea Ann and Patti
Contents
Chapter 1 Nutrition: The Big Picture
Chapter 3 Challenges of Children
Chapter 11 Nutrition Potpourri
TYPE 1 & TYPE 2
How do I know when I should see a registered dietitian?
See a registered dietitian (RD) when your diabetes is first diagnosed, when a new doctor changes your treatment plan, or twice a year for a routine review of your meal plan and goals. See the RD more often if
You want to improve your diabetes management.
Your have a lifestyle or schedule change, such as a new job, marriage, or pregnancy.
Your nutritional needs keep changing (children).
You’ve begun an exercise program or had a change in diabetes medication.
You feel bored, frustrated, or unmotivated to use your meal plan.
You have unexplained high and low blood glucose levels.
You’re concerned about your weight or blood fat levels.
You develop nutrition-related complications, such as high blood pressure or kidney disease.
You may have an RD on your diabetes team. Ask your doctor or hospital for a referral. You can also call the American Diabetes Association (800-342-2383), the American Dietetic Association (800-877-1600), or the American Association of Diabetes Educators (800-338-3633) for referrals. Many RDs are certified diabetes educators (CDEs) and have additional training in diabetes care.
TYPE 1 & TYPE 2
What should I eat until I can meet with the registered dietitian?
Eat the foods that are healthy for everyone—grains, beans, vegetables, fruits, low-fat milk, and meat. Cut down on foods and drinks with a lot of added sugar (soda, desserts, candy) and fat (fried foods, lunch meats, gravy, salad dressings). You do not need special or diet foods.
It is important to eat about the same amount of food at the same time each day. Don’t eat one or two large meals. Try to eat at least three small meals each day, especially if you are taking diabetes medication. You may need a snack between meals and before you go to bed. Avoid drinking alcohol until you learn how it fits into your diabetes treatment plan. Remember, you can make a big difference in your diabetes management through what you choose to eat. Before you see the RD, keep a record of everything you eat and drink for 3–5 days and bring this record to your appointment. This will help the RD personalize the meal plan for you.
TYPE 1 & TYPE 2
How often do I need to eat to keep my blood glucose levels near normal?
This depends on the type of diabetes you have, your medications, the amount of physical activity you get, and where your blood glucose level is at the moment. An RD can help you decide.
For people with type 1 or people with type 2 who use insulin: Have food in your system when your insulin is peaking. You may need three meals and an evening snack. If you take two injections of short-and intermediate-acting insulin, you may need three meals and three snacks. If you use rapid-acting insulin, eat within 15 minutes of taking your insulin. You may need a snack for physical activity (see Do I need a snack when I exercise?). A common mistake is not waiting a half hour to eat after taking regular insulin. If you start eating before insulin activity is peaking, you may have higher blood glucose levels after meals.
For people with type 2: Eat a small meal every 2–3 hours. When you eat smaller amounts of food, your blood glucose levels are lower after eating. Mini-meals spread throughout the day may help control your hunger and calorie intake, leading to near-normal blood glucose levels and weight loss. Your blood cholesterol levels will also be lower.
TYPE 1 & TYPE 2
What can I eat for snacks?
Choose from the same healthy foods that you eat at meals. Often, snacks are based on foods with 15 grams of carbohydrate per serving. Choose foods from the grain group, such as air-popped popcorn, baked tortilla chips and salsa, graham crackers, whole grain crackers, pretzels, bagels, or cereal. Fresh fruits and vegetables make excellent snacks, and they’re also portable! To make a snack more substantial, add a source of low-fat protein, such as low-fat or skim milk, reduced-fat peanut butter on a slice of whole wheat bread or a bagel, low-fat cheese on whole wheat crackers, or a slice of turkey breast on whole-wheat bread. Keep in mind, however, that although adding protein to your snack may ward off hunger, it does not increase blood glucose to prevent hypoglycemia, and it may add unwanted calories.
Be prepared! Always carry a snack with you in case of a delayed meal or unexpected change in your schedule. Snacks can be stashed in your desk, briefcase, backpack, or glove compartment. Having good food on hand will save you from hypoglycemia and from having to settle for less nutritious fast foods.
TYPE 1 & TYPE 2
How can keeping a food diary help my diabetes?
The food you eat raises your blood glucose. Until you write it down, you probably are not aware of how much or what you are eating. A food diary helps you make important decisions about your medication, meal plan, and exercise plan.
Record information you need. If you want to lose weight, measure your serving sizes and write down how many calories or fat grams you’re getting for several days. Looking up the nutrient values of foods helps you learn what nutrients each food gives you.
Keep records that are easy to use—a notebook, calendar, or form created on your computer. Write it down when you eat it; don’t wait until later.
Use the information. Bring your record to the next appointment with your RD. Look for patterns in your eating behaviors and blood glucose levels. For example, your records may show that high-fat snacks in late afternoon result in high blood glucose at dinner. Or you may notice that when your lunch is much smaller than other meals you are too hungry before dinner. You may want to adjust the size of lunch and decrease your afternoon eating.
Research shows that individuals who keep food and activity records are more successful in following their meal plan.
TYPE 1 & TYPE 2
Why are serving sizes important? Is there an easy way to remember them?
No matter what meal plan you follow—carbohydrate counting, exchanges, or the food guide pyramid—serving size is the key. An extra ounce of meat or a tablespoon of margarine doesn’t sound like much, but it can quickly add up to higher blood glucose levels and weight gain.
Begin by using standard kitchen measuring cups, spoons, and food scales until you train your eyes to see correct serving sizes. Once you’ve weighed, measured, and looked at 1/2 cup of green beans or 5 oz of chicken, you’ll have a mental picture no matter where you dine. Every few months, measure some servings again to keep your eyes sharp and your servings the right size.
Mental pictures can help you eat correct serving sizes.
| Food | Looks like |
| 1 cup pasta or rice | a clenched fist |
| 1/2 cup vegetables | half a tennis ball |
| 1 cup broccoli | a light bulb |
| 3 oz meat, chicken, or fish | a deck of cards or the palm of a woman’s hand |
| 1 oz cheese | two saltine crackers or a 1-inch-square cube |
TYPE 1 & TYPE 2
What should I be looking for on food labels—carbohydrate or fat?
Most people with diabetes should be looking at both carbohydrate and fat on the Nutrition Facts panel on food labels. Carbohydrate is what raises your blood glucose the most, so it’s important to you. Fat carries the most calories per gram, so it affects your weight. Also, diabetes puts you more at risk for developing heart disease. Eating foods lower in fat (especially saturated fat and trans fat) may help you lose weight and lower your risk for heart disease.
The total amount of carbohydrate and the type of carbohydrate you eat can affect your blood glucose. The carbohydrate listed in the Nutrition Facts can be from beans, vegetables, pasta, grains, and sugars (added or naturally present in foods such as milk and fruit). The food label will tell you exactly how many grams of carbohydrate and fat are in a serving of food.
TYPE 1 & TYPE 2
How do I deal with comments such as, “Are you allowed to eat that?”
Your family and friends mean well. Here are some strategies for you to use when others seem to be overly concerned with what you’re eating and drinking:
Recognize your own feelings. Part of adjusting to diabetes is recognizing the difficult emotions that come with it. How do you feel about the lifestyle changes and pressures of self-care?
Recognize the feelings of family and friends. Your family and friends are also adjusting to your diabetes and the ways it affects them. They may feel anxious, intimidated, guilty, or overwhelmed.
Use positive reframing. Change the way you see the situation. If you feel angry at someone’s comment, take a moment to acknowledge your own feeling and then the other person’s feeling. Then look at the situation in a positive way. For example, you may say, “Thanks for reminding me. I know you want to help. I’ve already planned to adjust my insulin (or exercise) to handle the additional calories and carbohydrate in this food.”
Develop an interaction plan. Changing years of old thinking and communication patterns takes time. In a calm moment, discuss a new way to talk about food and diabetes issues.
TYPE 1 & TYPE 2
Now that sugar is no longer forbidden for people with diabetes, can I eat all the sweets I want?
It’s true that the carbohydrate in table sugar can have the same effect on your blood glucose as any other carbohydrate, such as that in bread, potatoes, or fruit. Different carbohydrates do raise blood glucose in different ways; however, for blood glucose management, it’s more important to focus on the total amount of carbohydrate you eat, rather than on where it comes from. You substitute sweets into your meal plan for other carbohydrates—don’t add them on top.
No, don’t have sweets at every meal. Sugary foods don’t have the nutrients, vitamins, and minerals that your body needs to be healthy. That’s why we call these calories “empty” and list these foods as extras in the food pyramid. If you include sweets in a meal, eat a small serving and check your blood glucose before and 1–2 hours after you eat to see how it affects you. Keep an eye on your weight and blood glucose levels over time. Hold back on the sweets if you see your numbers creeping up.
TYPE 1 & TYPE 2
I went to lunch with three friends who also have diabetes. We all follow different types of meal plans. What happened to the “diabetic” diet?
Just as there is no one medication that works for all people with diabetes, there is no single meal-planning approach. The standard 1,800-calorie preprinted diet sheet is gone. Individualization is the key to effective diabetes management.
The best meal plans are designed by you and an RD and are based on your health, other medications, activity level, and treatment goals. Your friend with type 1 diabetes may be taking multiple insulin injections and using the carbohydrate counting approach with frequent blood glucose monitoring. Her food choices would be quite different from those of your friend with type 2 diabetes who has high blood fat levels and needs to lose weight. She may be trying to lower her carbohydrate intake and increase the monounsaturated fats in her diet by eating more nuts, olives, or canola oil. And the friend who works a swing shift is probably using an entirely different approach to the timing and food choices in her meals and snacks. The important thing is to use a meal plan that works for you.
TYPE 1 & TYPE 2
I’ve heard that a low-carbohydrate, high-protein, high-fat diet will help me lose weight without cutting calories. Should I change from the high-carbohydrate, low-fat diet I’ve always followed?
Probably not. A low-carbohydrate diet is very difficult to follow for a long period of time. On this diet, you eat meat, eggs, and cheese but very few carbohydrate foods, such as pasta, breads, fruits, and vegetables. You eat too few fruits and vegetables to get all the vitamins and minerals you need.
The rapid weight loss on a low-carbohydrate diet comes from an unhealthy loss of water and muscle tissue. Side effects include dehydration, low blood pressure, and increased work for the kidneys. The high-fat foods certainly aren’t good for heart health. Other side effects include constipation, fatigue, and nausea. And as with all very restricted diets, once you go back to a normal way of eating, your weight is going to come back.
Until there’s more evidence, it’s probably best to continue with a balanced carbohydrate meal plan. If you have insulin resistance, you may do better substituting some monounsaturated fats for carbohydrates (see monounsaturated fats). Get your health care team’s help to decide on a nutrition approach for you.
TYPE 1 & TYPE 2
Will fiber help my diabetes management?
Fiber can keep your blood glucose from going high after a meal because it slows down the speed at which the food is digested. Foods that are high in fiber are good sources of vitamins, minerals, and other substances important for good health. A high-fiber, low-fat way of eating can also reduce your risk for cancer, cardiovascular disease, high blood pressure, and obesity. Fiber has a favorable effect on blood cholesterol, too.
Fiber in food is made up of two types: insoluble fiber, such as that in vegetables and whole-grain products, and soluble fiber, found in fruits, oats, barley, and beans. Insoluble fiber improves gastrointestinal function, while soluble fiber can affect blood glucose and cholesterol. Unfortunately, most Americans eat only 8–10 grams of fiber daily, not the recommended 20–35 grams a day from a variety of foods. You can increase fiber by eating foods such as the ones in this chart.
| Food | Serving Size | Total Fiber (g) | Soluble Fiber (g) |
| Beans | 1/2 cup cooked | 6.9 | 2.8 |
| Oat bran | 1/3 cup dry | 4.0 | 2.0 |
| Barley | 1/4 cup dry | 3.0 | 0.9 |
| Orange, fresh | 1 small | 0.9 | 1.8 |
| Oatmeal | 1/3 cup dry | 2.7 | 1.4 |
TYPE 1 & TYPE 2
Is it true that beans can improve diabetes management?
Yes. Beans are very high in carbohydrates and need to be eaten in the proper portions, but beans digest slowly, resulting in only a small rise in blood glucose and insulin levels. Several research studies have shown that eating 1 1/2–2 1/2 cups of cooked beans daily has a beneficial effect on diabetes management. Beans also reduce the risk of cardiovascular disease, a common complication for people with diabetes. Eating 1–3 cups of cooked beans a day will lower total cholesterol by 5–19%. Beans are also an excellent source of folate, which may help reduce the risk of cardiovascular disease.
Packed with protein, fiber, vitamins, and minerals, beans are also low in fat, cholesterol, and sodium. They can be included in all types of diabetes meal plans. Beans can be used in salads, soups, or entrées. Canned beans require less preparation time and have the same beneficial effects as dried beans, but they are higher in sodium than beans “cooked from scratch.”
Soak dried beans overnight and rinse well before cooking. Introduce beans gradually into your diet, chew them thoroughly, and drink plenty of liquids to aid digestion. Enzyme products such as “Beano” can also help you avoid gastrointestinal distress.
TYPE 1 & TYPE 2
I keep hearing about carbohydrate counting. Is it still okay to use exchanges?
Yes. The exchange system is a valuable way for people with diabetes to plan meals. It can also help if you want to count carbohydrates. The Exchange Lists for Meal Planning group foods with similar carbohydrate content, so the “carb” counting is already done for you. For example, all the foods on the starch list (1 slice of bread, 3/4 cup dry cereal, etc.) contain 15 grams of carbohydrate.
To use exchanges, you need an individualized meal plan that tells you how many exchanges from each list to eat daily for meals and snacks. You can choose a variety of foods from the exchange lists to fit into your meal plan. An RD can help you design a meal plan and teach you how to use this system. In 2003, the Exchange Lists were updated. The food groupings were changed and more foods were included. A pocket-sized guide is now available.
Many people prefer to use exchanges because it helps keep their food choices balanced and healthy. If this system works for you, there is no reason to switch to another.
TYPE 1 & TYPE 2
What is carbohydrate counting?
Carbohydrate counting is a precise method of meal planning for people with diabetes. Foods containing carbohydrate (grains, vegetables, fruit, milk, and sugar) have the largest effect on blood glucose levels. A small amount of carbohydrate (1 apple) raises blood glucose some; a larger amount of carbohydrate (3 apples) raises blood glucose more. You track how the carbohydrate affects you by monitoring your blood glucose. You’ll have to invest some time in monitoring blood glucose, record keeping, measuring food servings, and learning about nutrients in foods.
Carbohydrate counting has two levels: basic and advanced. Basic carbohydrate counting is generally used by people with type 2 diabetes and consists mostly of counting and eating consistent amounts of carbohydrate. Advanced carbohydrate counting is often used by people taking insulin and is based on recognizing and managing patterns in blood glucose, food, medication, and exercise for intensive management of blood glucose. You may only need to learn about basic carbohydrate counting. The amount of work may seem overwhelming at first, but most people find that the improvements in their blood glucose levels are worth it! An RD can help you learn about carbohydrate counting.
TYPE 1 & TYPE 2
Do I need special vitamins and minerals because I have diabetes?
You don’t need special vitamins because of diabetes. You do need vitamins and minerals for a well-functioning body, whether you have diabetes or not. If you are eating a variety of foods, you don’t need a special vitamin or mineral supplement. There is currently no scientific evidence to show that certain vitamins or minerals can improve your blood glucose management, except in rare cases of deficiencies of the minerals chromium, copper, magnesium, manganese, selenium, or zinc (see Should I take chromium supplements or can I get enough from foods?).
Discuss your diet with your physician or RD. You may need a vitamin and mineral supplement if you are
on a diet of fewer than 1,200 calories a day
following a strict vegetarian diet
at risk for bone disease
over age 65
pregnant or breastfeeding
taking diuretics
having trouble keeping your blood glucose levels on target
TYPE 1 & TYPE 2
I really don’t feel like eating in the morning. Do I have to eat breakfast?
Yes. Breakfast is crucial for people with diabetes. Your body has been without food for 8–12 hours. If you have type 1 diabetes, you need food to balance your injected insulin. If you have type 2 diabetes, you may skip breakfast to cut calories and lose weight, but it can lead to overeating later. In fact, research shows that breakfast skippers have higher blood cholesterol levels and extra pounds!
The best breakfast has carbohydrate, protein, and fiber. Save high-fat foods like bacon, sausage, and eggs for special occasions. You can choose whole-grain cereal or an English muffin, low-fat milk or yogurt, and fruit, but there’s no rule that says breakfast can’t be whole-wheat pasta tossed with low-fat ricotta cheese or a leftover chicken breast with a piece of fruit.
Once you experience the dividends that breakfast pays in mood, performance, and diabetes management, you’ll never skip your morning meal again!
Hint: People who eat a smaller evening meal (and spread their calories out over the day) are more likely to wake up hungry for breakfast.
TYPE 1 & TYPE 2
I’ve heard I’m supposed to eat five fruits and vegetables a day. Why?
Increasing the fruit and vegetables in your diet may lead to better health, particularly in the prevention of cancer and heart disease. Fruits and vegetables are low in fat and are rich sources of vitamin A, vitamin C, and fiber. The average American eats only one serving of fruit and two servings of vegetables a day. You can find ways to put five or more servings in your salads, soups, sandwiches, main dishes, and snacks.
Fruits and vegetables affect diabetes in different ways. Fruit has 15 grams of carbohydrate per serving and affects your blood glucose within 2 hours. The amount your blood glucose rises depends on whether you eat the fruit on an empty stomach, the form of the fruit (cooked or raw, whole or juice), and your blood glucose level when you eat. Check your blood glucose level after eating fruit to see what it does to you. Nonstarchy vegetables contain only 5 grams of carbohydrate per serving, few calories, and lots of vitamins and minerals. Moderate portions of vegetables have little effect on blood glucose but major effects on your health. Eat up!
TYPE 1 & TYPE 2
Why does it seem that I need less food—and enjoy it less—now that I’m older?
If you are not as active as you were when you were younger, you probably don’t need to eat as many calories. However, it may be that your appetite and enjoyment are being affected by changes in one of the following:
Taste buds—affecting taste and interest in food
Smell—affecting interest in food and the amount you eat
Vision—making it difficult to read labels or recipes
Hearing—affecting your ability to enjoy the social events around eating
Touch—making it difficult to prepare food
Teeth or poorly fitting dentures—making it painful to eat anything but soft, easy-to-chew foods
For reasons such as these, you may skip meals or eat fewer calories than you need, which affects your diabetes management. Limitations on movement can keep you from exercising, leading to loss of energy and appetite. Poor nutrition itself can bring on fatigue and a general sense of not feeling well. Work with your RD to overcome any challenges to following your meal plan.
TYPE 1 & TYPE 2
Are plant sources of protein better for me than animal protein?
Maybe. Plant proteins have benefits for people with diabetes. Plant foods are low in fat, especially saturated fat, and high in fiber. Animal protein adds cholesterol and saturated fat to our diets. People with diabetes have a greater risk of heart disease earlier in life; therefore, it is important to decrease your intake of saturated fat and cholesterol. For people with diabetic kidney disease, changing the source of protein in the diet is being studied as a treatment. Whether plant protein (beans, nuts, vegetables, tofu) is preferred over animal protein (meat, poultry, fish, milk, eggs) has not been decided. Discuss the latest research with your diabetes care professionals. We do know that people in other countries who eat less meat and more soy protein and rice have lower rates of cancer and heart disease than Americans, who eat lots of animal protein.
Animal protein contains all eight essential amino acids that you need to build cells in the body. Because your body can’t make them, your food choices must supply them. However, eating a variety of plant proteins each day can also provide all the amino acids that you need (see Should I eat less protein to keep my kidneys healthy?).
TYPE 1 & TYPE 2
Is there a benefit to including more soy foods in my diet?
Yes. Soy foods are low in saturated fat, have no cholesterol, and contain high-quality protein. Scientists are learning about compounds in soybeans that may reduce your risk of certain chronic diseases, such as heart disease, osteoporosis, and cancer. Eating soy foods may lower blood cholesterol levels and decrease your risk for heart disease. Soy protein contains a group of phytochemicals called iso-flavones that may directly lower blood cholesterol levels. In certain stages of kidney disease, vegetable protein may be easier on the kidneys than animal protein.
Soybeans are included in a variety of foods, from ice cream to burgers, and they can be eaten whole or used in your recipes.
TYPE 1 & TYPE 2
Should I eat less protein to keep my kidneys healthy?
Not necessarily. The American Diabetes Association recommends that you eat the same amount of protein as the general public. The Recommended Daily Allowance suggests that healthy adults eat 15–20% of their daily calories as protein or about 0.8 grams of protein per kilogram of weight. For a 132-pound person, this would be about 50 grams of protein per day. Some plant and animal protein choices are listed below. Individuals whose blood glucose levels are not on target may benefit from more protein than the RDA recommended amount. However, most Americans eat more than enough protein. If you already have kidney disease, you may want to eat less protein. Your doctor will consider the stage of kidney disease and your overall nutrition before prescribing a low-protein diet.
TYPE 1 & TYPE 2
How can I use the USDA’s My Pyramid system to eat healthfully for diabetes?
The United States Department of Agriculture has replaced the Food Guide Pyramid with MyPyramid, a system based on the 2005 Dietary Guidelines. This system emphasizes an individual approach to healthy food choices and physical activity and has a new pyramid-shaped graphic or symbol to illustrate its key concepts. The MyPyramid system recommends foods high in vitamins, minerals, dietary fiber, and other essential nutrients while limiting foods high in saturated fat, trans fat, and cholesterol. This system also promotes balancing calorie intake with energy needs to achieve a healthy weight. You can use the online MyPyramid system at www.MyPyramid.gov
