Diabetes Nutrition Guidelines

In October of 2013, the American Diabetes Association made recommendations as the diabetes nutritional guidelines to be practiced by type 1 and type 2 diabetics.  According to the ADA, nutrition therapy should be a part of the management of every patient with diabetes.  There is no set eating pattern that is successful in all diabetics but the nutrition guidelines should be the goal of diabetic patients, regardless of the other treatments they receive for their diabetes.

The basis of the nutritional guidelines includes eating many different types of nutrient-packed foods in portion sizes that are not excessive.  The eating plan should vary according to the religious beliefs, traditions, culture, and individual preferences of each diabetic patient.  The new guidelines also focused on eating patterns in diabetic patients.

In selecting a meal plan that is good for diabetics, individuals should look at their metabolic goals, such as their blood sugar levels, lipid levels, and blood pressure.  This means choosing foods that are healthy for you, low in sugar, have a low glycemic index, low fat, and low in salt.

According to the guidelines, there is no set amount of carbohydrates a diabetic patient should have.  The trick is to get carbohydrates in the form of whole grains, vegetables, legumes, dairy products, and fruits and to avoid taking in too much sugar, fat, or sodium.

They also indicate that there is no set amount of fat a diabetic should eat per day but that the fat should be mostly of the monounsaturated or polyunsaturated type instead of trans fats and saturated fats.  For those diabetics who are trying to lose weight, fats should still be a part of the diet but should be used in moderation.

According to the new nutritional guidelines:

• Diabetic patients should avoid or limit the amount of sugar-sweetened beverages they eat, including those that are sweetened with high fructose corn syrup. Drinking these beverages can cause weight gain and can increase the chances of having a cardiovascular event.
• People with diabetes should also eat less than 2300 milligrams of sodium per day. This amount should be even less among patients with high blood pressure along with their diabetes.
• People with diabetes don’t receive any benefit from taking in omega 3 fatty acid supplements, according the guidelines. The recommendations say that you should eat at least 2 servings of fatty fish per week in order to get benefits of omega 3 fatty acids in the diet rather than through a supplement.
• The guidelines also indicated that there was no evidence that mineral or vitamin supplementation is helpful in diabetics who have no nutritional deficiencies. Only those diabetics that have a known vitamin or mineral deficiency should consider taking a supplement such as a multi-vitamin.  Herbal supplements were also not recommended by the guidelines.

According to the guidelines, the key features of diabetic management should involve eating healthy foods, exercising on a regular basis, and taking medications if needed to control the blood pressure.  Part of the most challenging aspect of being a diabetic is selecting which foods are healthy to eat. With so many food choices out there, which foods should the diabetic have as part of their regular daily diet and which foods should be avoided?

The goals of nutrition guidelines for diabetic patients include the following:

• To prevent or at least delay the complications of diabetes through healthy nutrition
• To get to a normal weight and remain there
• To have low LDL cholesterol levels, low triglyceride levels, and high HDL cholesterol levels
• To have a blood pressure of less than 140/90
• To have a Hemoglobin A1c that is less than 7 percent
• To have good blood pressure control
• To have good lipid goals
• To have good control over blood sugars
• To support healthy eating patterns for diabetics that includes nutrient-packed foods in normal portion sizes
• To give the diabetic some practical tools for everyday meal planning rather than placing the focus on a certain number of macronutrients or micronutrients
• To have eating be pleasurable by having positive goals about food choices, limiting only those foods that have been scientifically shown to be detrimental to diabetics
• To focus on individual needs for nutrients that is based on cultural and personal preferences, access to healthy food choices, barriers to change, and the ability to make behavioral changes in the diabetic’s eating pattern

Nutrition Therapy for Diabetics

Under ideal circumstances, every diabetic patient should be seen by a registered dietician when they receive the diagnosis of diabetes.  The purpose of the meeting is to receive advice about what foods to eat and what foods to avoid.  Follow up visits should be undertaken in order to reinforce the recommendations of the dietician and to see whether the food choices the diabetic selects are detrimental or helpful to diabetic control.

Unfortunately, many diabetics do not receive any type of structured education on diabetes or the nutritional management of diabetes.  According to nationally-acquired data, only about half of diabetic patients get any type of diabetic education and even fewer than that see a registered dietitian.  In one study of more than 18,000 diabetics, only 9 percent had at least one visit with a dietitian within the previous nine years.  Many diabetics (and their doctors) did not know that this kind of education was available and that it is recommended by the American Diabetes Association.

Nutrition therapy involves using food as part of the treatment of a disease or condition, such as diabetes.  The nutrition therapy usually is provided by a registered dietitian but it can be given by a nurse, a doctor, or other healthcare professional who understands the nutrition goals of diabetics.

Nutrition therapy should involve an assessment of the client’s current nutritional state, a nutrition diagnosis, nutrition interventions (including counseling and education), and nutrition monitoring through follow up visits that are supportive of the diabetic making long term healthy food choices, exercising regularly, and taking the proper medical care for their diabetes.

Diabetes Self-care and Management

In addition to nutrition therapy by a registered dietician, it is important for diabetics to learn self-care and management tips as part of their nutrition guidelines.  These things are considered necessary to improve diabetic outcomes and reduce complications of diabetes.

Energy Balance

Type 2 diabetics who are overweight or obese should reduce their caloric intake while still eating a healthy diet that also promotes weight loss.  Moderate weight loss has a great effect on blood sugar levels, lipid levels, and blood pressure.  In order to get this type of weight loss, the diabetic needs to have intensive lifestyle changes through nutrition therapy and counseling, physical exercise, and changes in behavior.

More than 75 percent of diabetics are overweight and almost half of diabetics are obese.  Because weight and insulin resistance are related, weight loss is a good way to improve insulin resistance and diabetic outcomes in type 2 diabetics.

According to many research studies, people who lost the most weight and had the best control over their diabetes were those who followed the Mediterranean diet.  People who chose this diet had a weight loss of 8.4 kg over 12 months.  Diabetics with high blood pressure have followed the DASH diet, which addresses the sodium intake of the diabetic with hypertension as well as blood sugar difficulties.

References:

• American Diabetes Association Releases New Nutrition Guidelines. http://www.diabetes.org/newsroom/press-releases/2013/american-diabetes-association-releases-nutritional-guidelines.html
• Dyson PA, et.al. Diabetes UK Evidence-based nutrition guidelines for the prevention and management of diabetes. Diabetic Medicine. 2011 Jun.
• Evert AB, et. al. Nutrition Therapy Recommendations for the Management of Adults with Diabetes. Diabetes Care. 2013 Nov; 36(11): 3821-3842.