Dietary Management of Diabetes



Yesterday we treated most of the points under this article. Now we are just going to round up. Enjoy!

People with diabetes should limit or avoid intake of sugar-sweetened beverages (SSBs) (from any caloric sweetener including high-fructose corn syrup and sucrose) to reduce risk for weight gain and worsening of cardiometabolic risk profile.
Fructose is a monosaccharide found naturally in fruits. It is also a component of added sugars found in sweetened beverages and processed snacks. The term “free fructose” refers to fructose that is naturally occurring in foods such as fruit and does not include the fructose that is found in the form of the disaccharide sucrose, nor does it include the fructose in high-fructose corn syrup.
Non-nutritive Sweeteners and Hypocaloric Sweeteners:
Use of nonnutritive sweeteners (NNSs) has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources.
The U.S. Food and Drug Administration has reviewed several types of hypo-caloric sweeteners (e.g., NNSs and sugar alcohols) for safety and approved them for consumption by the general public, including people with diabetes. Research supports that NNSs do not produce a glycemic effect; however, foods containing NNSs may affect glycemia based on other ingredients in the product. An American Heart Association and ADA scientific statement on NNS consumption concludes that there is not enough evidence to determine whether NNS use actually leads to reduction in body weight or reduction in cardiometabolic risk factors. These conclusions are consistent with a systematic review of hypocaloric sweeteners (including sugar alcohols) that found little evidence that the use of NNSs lead to reductions in body weight. If NNSs are used to replace caloric sweeteners, without caloric compensation, then NNSs may be useful in reducing caloric and carbohydrate intake, although further research is needed to confirm these results.

For people with diabetes and no evidence of diabetic kidney disease, evidence is inconclusive to recommend an ideal amount of protein intake for optimizing glycemic control or improving one or more CVD risk measures; therefore, goals should be individualized.
For people with diabetes and diabetic kidney disease (either micro- or macroalbuminuria), reducing the amount of dietary protein below the usual intake is not recommended because it does not alter glycemic measures, cardiovascular risk measures, or the course of glomerular filtration rate (GFR) decline.
In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia.
Total Fat:

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes; therefore, goals should be individualized.Fat quality appears to be far more important than quantity.
Fatty acids are categorized as being saturated or unsaturated (monounsaturated or polyunsaturated).Transfatty acids may be unsaturated, but they are structurally different and have negative health effects. The type of fatty acids consumed is more important than total fat in the diet in terms of supporting metabolic goals and influencing the risk of CVD; thus more attention should be given to the type of fat intake when individualizing goals. Individuals with diabetes should be encouraged to moderate their fat intakes to be consistent with their goals to lose or maintain weight.
Recent studies of fat intake and diabetes incidence support the notion that eating the right kind of fats is beneficial to health. This goes against years of advocacy of a low-fat/high-carbohydrate diet. “When people started eating less fat, they compensated by eating more refined carbohydrates, which stimulate insulin secretion and increase fat deposition. A major problem with the American diet is too much refined grains and added sugar, which are associated with the rise in obesity and type 2 diabetes,” Dr. Hamdy says.

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Current evidence shows that some fats, such as those from red and processed meats, are associated with higher cardiovascular risk while other fats such as those from vegetable oils and nuts are associated with lower risk. The Joslin nutritional guidelines for diabetes recommend a diet with relatively high amounts of healthy fats and protein but moderately low amounts of carbohydrates.
Making the glycemic index easy
The glycemic index (GI) tells you how quickly a food turns into sugar in your system. Glycemic load, a newer term, looks at both the glycemic index and the amount of carbohydrate in a food, giving you a more accurate idea of how a food may affect your blood sugar level. High GI foods spike your blood sugar rapidly, while low GI foods have the least effect.
You can find glycemic index and glycemic load tables online, but you don’t have to rely on food charts in order to make smart choices. Australian chef Michael Moore has come up with an easier way to regulate the carbs you eat. He classifies foods into three broad categories: fire, water, and coal. The harder your body needs to work to break food down, the better.
A. Fire foods:
They have a high GI, and are low in fiber and protein. They include “white foods” (white rice, white pasta, white bread, potatoes, most baked goods), sweets, chips, and many processed foods. They should be limited in your diet.
B. Water foods:
These are free foods—meaning you can eat as many as you like. They include all vegetables and most types of fruit (fruit juice, dried fruit, and canned fruit packed in syrup spike blood sugar quickly and are not considered water foods).
C. Coal foods:
These have a low GI and are high in fiber and protein. They include nuts and seeds, lean meats, seafood, whole grains, and beans. They also include “white food” replacements such as brown rice, whole-wheat bread, and whole-wheat pasta.
Controlling weight with the glycemic index
Researchers believe that the key to weight control lies in reducing the amount of refined carbohydrates (“white” or “fire” foods) in your diet. Instead, focus on low GI or “coal” foods which keep you feeling fuller much longer. Low-glycemic foods take longer to digest so sugar is absorbed more slowly into the bloodstream. As a result you’re less likely to experience a spike in your blood sugar level, you’ll remain sated for longer, and are less likely to overeat.
Avoid processed foods like baked goods, sugary desserts, and packaged cereal and opt instead for steel cut oats, beans, fat-free low-sugar yogurt, dark green leafy vegetables, and whole grains.
Eat whole fresh fruit instead of fruit juice—squeezing fruit releases more sugar so a whole orange has a lower GI than a glass of juice.

Full adherence to the guidelines of this article should afford a diabetic a full, happy life. Stay Healthy Please!
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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

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