Healthy eating for people with diabetes
Wednesday, May 16, 2018
Q Is there anything new about healthy eating for people with diabetes? — G.H., Greenville
A Every January since 1989, the American Diabetes Association (ADA) has published an update to the Standards of Care for people with diabetes based on the results of new studies. Sometimes the changes in recommendations are big. Sometimes they are just tweaks. We recommend that all people with diabetes have an annual checkup with their registered dietitian nutritionist (RDN) to see if there are new strategies to help you manage your diabetes. Dan Olson, a Brody medical student, reviews the changes for you here.
Fortunately, this year brings very few changes to the diet and nutrition guidelines in the Standards of Care. The ADA continues to recommend a well-balanced diet from nutrient-rich sources, individualized to each person’s unique circumstances. If you’re looking for specific diet recommendations like DASH, Atkins, keto or vegan, you won’t find it here.
The big focus is on macronutrients (fats, carbs and protein) and getting a good balance of each, in ratios like what you normally eat. What does this mean? Say, for example, you’re the kind of person who likes to eat meat. A vegetarian or low-fat diet would probably not work for you because after a while you’d eventually want to go back to eating meat. Instead, what the ADA recommends is to continue eating meat if that’s what you like, but to switch to a healthier meat like a chicken breast. By healthier meats, we mean those that are low in saturated fats.
Everyone, not just people with diabetes, should limit saturated fat intake to less than 6 percent of total caloric intake. If you eat only one or two 3-ounce portions of meat in a day, you would meet that goal. In addition, you should make sure your carbohydrates are coming from healthy sources as well: fruits, vegetables, legumes, nuts, seeds, whole grains and low-fat dairy.
If this answer is still unsatisfactory to you, and you absolutely must know what type of diet to choose, the ADA states the Mediterranean and DASH diets come the closest to providing the right amounts of carbs, fats and proteins from the healthiest sources, though it emphasizes the fact that it does not officially endorse any particular diet plan.
Did you know reducing your total body weight by 5 percent or more may reduce your hemoglobin A1C levels by 2 percent? Weight loss is another recommendation from the ADA for any overweight person with type 2 diabetes. For a 200-pound person, a 5 percent weight loss would be 10 pounds. The ADA’s recommendation for achieving this goal is to eat 500-750 fewer calories every day. For the average woman, this would mean taking in about 1,200 to 1,500 calories per day, and for the average man it equates to 1,500 to 1,800 calories per day. The ADA emphasizes that the actual amounts differ from person to person based on factors like physical activity and the amount of lean body mass a person has.
For all other aspects of nutrition, the ADA suggests you follow the same guidelines that people without diabetes follow. For alcohol, people should limit themselves to one drink per day for women or two standard drinks per day for men. A standard drink in this case is 12 ounces of beer, 5 ounces of wine or one shot of liquor. For sodium, this means limiting total daily intake to 2,300 mg or less. There is still no evidence that vitamin, mineral or herbal supplements are beneficial for anyone who does not have a dietary deficit. Therefore, taking dietary supplements is not recommended in the ADA guidelines. On the flipside, despite the negative press they often receive, the ADA does say that non-nutritive sweeteners such as saccharin and aspartame can be helpful in getting people to decrease the amount of sugar-sweetened beverages they consume.
To sum up the ADA’s stance on nutrition: eat a well-balanced diet that consists of healthy, nutrient-dense foods with macronutrient ratios roughly equal to what you eat normally; lose weight if you’re an overweight person with type 2 diabetes by eating 500 to 750 fewer calories every day; and for all other areas of nutrition, follow the guidelines set out for the general population. Most importantly, all dietary changes should be made with the cooperation and guidance of an RDN or expert in nutrition to ensure you meet your nutrient needs, avoid weight gain and manage your blood sugar.
Professor emeritus Kathy Kolasa, a registered dietitian nutritionist and Ph.D., is an Affiliate Professor in the Brody School of Medicine at ECU. Contact her at firstname.lastname@example.org.