Happened across some very novel, comprehensive and beautiful materials on Diabetic Dietary Recommendations focusing on care and management and I simply couldn’t wait to share! In other to avoid lethargy, I divided it into two parts, the second of which would be published on this blog tomorrow.. without further ado let’s delve in!!!

Energy Balance:

For overweight or obese adults with type 2 diabetes, reducing energy intake while maintaining a healthful eating pattern is recommended to promote weight loss. Modest weight loss may provide clinical benefits (improved glycemia, blood pressure, and/or lipids) in some individuals with diabetes, especially those early in the disease process. To achieve modest weight loss, intensive lifestyle interventions (counseling about nutrition therapy, physical activity, and behavior change) with ongoing support are recommended
More than three out of every four adults with diabetes are at least overweight, and nearly half of individuals with diabetes are obese. Because of the relationship between body weight (i.e., adiposity) and insulin resistance, weight loss has long been a recommended strategy for overweight or obese adults with diabetes. Prevention of weight gain is equally important. Long-term reduction of adiposity is difficult for most people to achieve, and even harder for individuals with diabetes to achieve given the impact of some medications used to improve glycemic control (e.g., insulin, insulin secretagogues, and thiazolidinediones). A number of factors may be responsible for increasing adiposity in people with diabetes, including a reduction in glycosuria and thus retention of calories otherwise lost as an effect of therapeutic intervention, changes in food intake, or changes in energy expenditure. If adiposity is a concern, medications that are weight neutral or weight reducing (e.g., metformin, incretin-based therapies, sodium glucose co-transporter 2 [SGLT-2] inhibitors) could be considered. Several intensive DSME and nutrition intervention studies show that glycemic control can be achieved while maintaining weight or even reducing weight when appropriate lifestyle counseling is provided.
Studies designed to reduce excess body weight have used a variety of energy-restricted eating patterns with various macronutrient intakes and occasionally included a physical activity component and ongoing follow-up support. Studies achieving the greatest weight losses, 6.2 kg and 8.4 kg, respectively, included the Mediterranean-style eating patternand a study testing a comprehensive weight loss program that involved diet (including meal replacements) and physical activity
Optimal Mix of Macronutrients:

Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.
Although numerous studies have attempted to identify the optimal mix of macronutrients for the meal plans of people with diabetes, a systematic reviewfound that there is no ideal mix that applies broadly and that macronutrient proportions should be individualized. On average, it has been observed that people with diabetes eat about 45% of their calories from carbohydrate, ∼36–40% of calories from fat, and the remainder (∼16–18%) from protein.
Regardless of the macronutrient mix, total energy intake should be appropriate to weight management goals. Further, individualization of the macronutrient composition will depend on the metabolic status of the individual (e.g., lipid profile, renal function) and/or food preferences. A variety of eating patterns have been shown modestly effective in managing diabetes including Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH) style, plant-based (vegan or vegetarian), lower-fat, and lower-carbohydrate patterns
Dietary Fiber and Whole Grains:

People with diabetes should consume at least the amount of fiber and whole grains recommended for the general public.
Intake of dietary fiber is associated with lower all-cause mortality in people with diabetes. Two systematic reviews found little evidence that fiber significantly improves glycemic control. Studies published since these reviews have shown modest lowering of preprandial glucose and A1C (−0.2 to −0.3%) with intakes of >50 g of fiber/day. Most studies on fiber in people with diabetes are of short duration, have a small sample size, and evaluate the combination of high-fiber and low-glycemic index foods, and in some cases weight loss, making it difficult to isolate fiber as the sole determinant of glycemic improvement. Fiber intakes to improve glycemic control, based on existing research, are also unrealistic, requiring fiber intakes of >50 g/day.
Studies examining fiber’s effect on CVD risk factors are mixed; however, total fiber intake, especially from natural food sources (vs. supplements), seems to have a beneficial effect on serum cholesterol levels and other CVD risk factors such as blood pressure. Because of the general health benefits of fiber, recommendations for the general public to increase intake to 14 g fiber/1,000 kcals daily or about 25 g/day for adult women and 38 g/day for adult men are encouraged for individuals with diabetes.

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Research has also compared the benefits of whole grains to fiber. TheDietary Guidelines for Americans, 2010 defines whole grains as foods containing the entire grain seed (kernel), bran, germ, and endosperm. A systematic review concluded that the consumption of whole grains was not associated with improvements in glycemic control in individuals with type 2 diabetes; however, it may have other benefits, such as reductions in systemic inflammation. Data from the Nurses’ Health Study examining whole grains and their components (cereal fiber, bran, and germ) in relation to all-cause and CVD-specific mortality among women with type 2 diabetes suggest a potential benefit of whole-grain intake in reducing mortality and CVD. As with the general population, individuals with diabetes should consume at least half of all grains as whole grains.
Foods such as oat cereal, yogurt and dairy products, green leafy vegetables, grapes, apples, blueberries and walnuts were associated with reduced diabetes risk. Drinking coffee and even decaffeinated coffee were also associated with lower type 2 diabetes risk.
Participants who followed a Mediterranean eating plan — without restricting calories — showed a greater improvement in glycemic control and insulin sensitivity than participants who ate other popular diets. In addition, overweight patients with newly diagnosed type 2 diabetes who followed the Mediterranean diet had less need for antihyperglycemic medications compared with participants on a low-fat diet.
Overall, a variety of eating plans, including the Mediterranean, low-carbohydrate/low glycemic index and high-protein diets, improved glycemic control and cardiovascular disease risk factors in patients with diabetes compared with control diets. This offers patients a range of options for diabetes management.
Foods associated with a higher risk of diabetes include red and processed meat, sugar-sweetened beverages, alcohol in excess quantities and refined grains, such as white flour.
Starch and Fructans:
Resistant starch is defined as starch physically enclosed within intact cell structures as in some legumes, starch granules as in raw potato, and retrograde amylose from plants modified by plant breeding to increase amylose content. It has been proposed that foods containing resistant starch or high amylose foods such as specially formulated cornstarch may modify postprandial glycemic response, prevent hypoglycemia, and reduce hyperglycemia. However, there are no published long-term studies in subjects with diabetes to prove benefit from the use of resistant starch.
Fructans are an indigestible type of fiber that has been hypothesized to have a glucose-lowering effect. Inulin is a fructan commonly added to many processed food products in the form of chicory root. Limited research in people with diabetes is available. One systematic review that included three short-term studies in people with diabetes showed mixed results of fructan intake on glycemia. There are no published long-term studies in subjects with diabetes to prove benefit from the use of fructans

Tags : Dietary Management of DiabetesLatest Research on Diabetes

The author Prince

Hi, I’m Prince.. a registered Dietitian, an avid reader and a passionate writer. I hope you enjoy my articles as much as I enjoy writing them

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