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Lecture at the Guam Diabetes Association last 8 November 2009 for patients with diabetes
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Practical Dietary Prescriptions in Type 2 DiabetesIris Thiele Isip Tan MD, FPCP, FPSEMClinical Associate Professor, University of the Philippines College of MedicineSection of Endocrinology, Diabetes & MetabolismDepartment of Medicine, Philippine General Hospital
What is a
healthy diet?
What is portion control?
What is on the food
label?
Outline
What is a
healthy diet?
What is portion control?
What is on the food
label?
Outline
What is a “healthy diet?”
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
grain products >6 servings/day
fish
2-3 servings/
week
Limited servings of lean meat or poultryMinimal or healthy fat
choices
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
How much carbohydrate is needed?
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
grain products >6 servings/day
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
fish
2-3 servings/
week
Limited servings of lean meat or poultryMinimal or healthy fat
choices
How much carbohydrate is needed?
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
grain products >6 servings/day
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
fish
2-3 servings/
week
Limited servings of lean meat or poultryMinimal or healthy fat
choices
It is wrong to avoid plant-based foods as “they will turn into sugar.”
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Consume more fiber(at least 20-35 g/day)
Top yogurt with dried fruit or nuts
Add dried fruit to cereal
Cook dried fruit in hot cereal and sprinkle
wheat germ or flax seed
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Consume more fiber(at least 20-35 g/day)
Choose whole grain alternative
whenever possibleUse cooked beans, peas and
lentils in soups, salads etc.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Fish contain omega-3 fatty acids
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
fish
2-3 servings/
week
grain products >6 servings/day
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
Limited servings of lean meat or poultryMinimal or healthy fat
choices
Fish contain omega-3 fatty acids
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
fish
2-3 servings/
week
grain products >6 servings/day
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
Limited servings of lean meat or poultryMinimal or healthy fat
choices
Eat 2-3 servings of fish/weekor other foods that contain omega-3 fatty acids
Nonpredator, fatty, dark meat fish i.e. salmon, sardines, mackerel, herring
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Eat 2-3 servings of fish/weekor other foods that contain omega-3 fatty acids
Plant sources i.e. flaxseed, soybeans and walnuts
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Limit saturated fat
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Limited servings of lean meat or poultryMinimal or healthy fat
choices
low-fat dairy 2 servings/day
grain products >6 servings/day
fruits & vegetables >5 servings/day
fish
2-3 servings/
week
Limit saturated fat
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Limited servings of lean meat or poultryMinimal or healthy fat
choices
low-fat dairy 2 servings/day
grain products >6 servings/day
fruits & vegetables >5 servings/day
fish
2-3 servings/
week
Lower intake of saturated fat
Smaller and fewer meat servings i.e. ~6 oz/day
(after cooking); 4-5 oz for women
Leaner cuts of meat i.e. beef/pork tenderloin, fish or
poultry (without skin)
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Lower intake of saturated fat
Limit high-fat meat servings to 2-3 times/week i.e. luncheon meat, frankfurters, sausage,
bacon and prime cuts of meat
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Lower intake of saturated fat
Drink fat-free or 1% milk
Use plain nonfat yogurt as in salad dressings or dips
2 tbsps yogurt < 20 calories
2 tbsps sour cream 50 calories
2 tbsps mayonnaise200 caloriesUse low fat
cheese
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Lower intake of saturated fat
Use soft margarine rather than butter
Should list a liquid oil as a first ingredient i.e. corn, safflower or soybean oil
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Lower intake of saturated fat
Broil, bake or roast
When frying or sauteing, use nonfat cooking spray or a small amount of vegetable oil
Use canola or olive oil
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Decrease trans fats
Decrease total fat intakeDecrease saturated fat intake
Trans fats from hydrogenation that solidifies
liquid oils
vegetable shortening, margarine, potato chips, crackers, cakes,
pies, doughnuts,
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Alcohol is allowed<2 drinks/day for men
<1 drink/day for women
If you don’t drink, don’t start!
Add to regular meal plan.
Do not omit food. Regular beer is counted
as 1 carbohydrate serving.
1 drink = 15 g alcohol12 oz beer 5 oz wine1.5 oz distilled spirits
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Limit sodium intake
Sodium <2,000 mg/day
Sodium <2,400 mg/day
Sodium 2,4000-3,000
mg/day
Diabetic and
hypertensive
Diabetic without
hypertension
Severe hypertension,
edema or kidney disease
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Try herbs, spices, lemon juice, garlic and
onion to flavor food
Remove the salt shaker
from the table
Cook with less salt
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Limit high-sodium foods i.e. dill pickles, sauerkraut, potato/corn chips, processed meats, canned soups and sauces (ketchup, soy sauce and steak sauce)
Limit fast food which tend to be higher in sodium than food at
sit-down restaurants
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Eat unprocessed food prepared at home more often than processed and restaurant food
When eating out, choose plain foods (e.g. grilled chicken and baked potato) rather than combination foods (e.g. chicken potpie)
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Use fresh or frozen instead of canned
vegetables
Choose fresh meat (eg. pork loin) instead of
cured meat (ham)
Include fruit.Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
What is portion control?
What is a
healthy diet?
What is on the food
label?
Outline
What is portion control?
What is a
healthy diet?
What is on the food
label?
Outline
Eat 25% less than your current intake
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Tight fist = 1/2 cup Handful = 1 cup
Palm = 3 oz
Thumb = 2 tbsp or 1 oz
Thumb tip = 1 tspHand guides
for portion control
What are servings?
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
grain products >6 servings/day
fish
2-3 servings/
week
Limited servings of lean meat or poultryMinimal or healthy fat
choices
fruits & vegetables >5 servings/day
low-fat dairy 2 servings/day
Diabetic Exchanges (“Servings”)
Starch Meat/meat substitutes
Vegetables
FatsFruit Milk
Free Food
Less than 20 calories and 5 grams of carbohydrate
diet softdrinks sugar-free gelatin dessert
sugar-free ice popssugarless gum
sugar-free syrup
= =
1/2 cup rice1 cup
corn flakes1 cup pasta
crackers 8 pcs5 x 4 x 1/2 cm
=
corn 1 pc12 x 4 cm
=
wheat bread 2 pcs
11 1/2 x 8 x 1 cm
ONE Starch Serving
= =
Chicken leg13 1/2 cm x 3 cm
1 chicken egg Shrimps 5 pcs 12 cm each
Fish 1 slice
=
Cheddar cheese 1 slice6 x 3 x 2 cm
=
Lean pork1 slice
6 1/2 x 3 x 1 1/2 cm
ONE Meat Serving
= =
Cabbage1 cup raw or
1/2 cup cooked
Peas1 tbsp
Carrot 1/2 cup raw or cooked
= =
Mushroom1/3 cup
ONE Vegetable Serving
Tomato 1 cup raw or
1/2 cup cooked Squash
1/2 cup raw or cooked
= =
Grapes10 pcs (2 cm) or
4 pcs (3 cm )
Mango ripe1 slice 12 x 7 cm
or 1/2 cup
Watermelon 1 cup or
1 slice (12 x 6 x 3 cm)
= =
Strawberry1 1/4 cup
ONE Fruit Serving
Banana 1 pc 9 x 3 cm
Apple 1/2 of 8 cm diameter
=
ONE Fat Serving
=
Olive oil 1 tsp Butter 1 tbspAvocado 1/2 of 12 x 7 cm
Mayonnaise 1 tbsp
= =
Margarine1 tbsp
Bacon 1 strip10 x 3 cm
ONE Milk ServingWhole milkMilk, evaporatedMilk, freshMilk, powdered
1/2 cup undiluted1cup4 level tbsp
Low fat milkPowderedLight low fat milk
1/4 cup or 4 level tbsp1 tetra brick
Skimmed (nonfat)buttermilk
LiquidPowdered
2/3 cup1/4 cup or 4 level tbsp
Longlife skimmedMilk
Yogurt1 cup1/2 cup
Milk or
or yogurt
Brown et al Diabetes Spectrum 2001
Idaho Plate Method
Idaho Plate Method
Lunch/Dinner9-inch plate
Brown et al Diabetes Spectrum 2001
provides 1200-1500 calories
TIP #1When purchasing produce (fruits, vegetables, starches), buy the smallest ones.
Look for small apples,
bananas and potatoes.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #2Use smaller plates, such as a lunch-size plate.
Large dinner plates
promote overfilling.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #3Do not prepare too much food.If you plan on leftovers, put the extra food away before serving.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #4Do not place bowls, pots or casserole pans on the table within easy reach. Make people get up if
they want seconds.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #5Do not order large servings unless you plan to split them.
giantgrandesupremeextra largejumbo
doubletripledouble-deckerking-sizesuper
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #6Order small menu items. Do not upsize!
juniorsinglequeen
regularpetitekiddie
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #7Be creative with menus.
Don’t automatically order a main course.
soup and salad salad and appetizer appetizer and soup
Order a half portion
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
TIP #8Use portion estimating abilities.
If the portion served will be too large, ask for a take home container.
Put away the extras before starting the meal.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
What is portion control?
What is a
healthy diet?
What is on the food
label?
Outline
What is portion control?
What is a
healthy diet?
What is on the food
label?
Outline
“Sugar free” does not necessarily mean calorie-free or carbohydrate-free
Sugar free<0.5 g/serving
No fructose or lactose
Reduced sugar<25% of
regular version
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Is it safe?
Polyols or sugar alcoholsSorbitolLactitolMannitolPolydextrose
No calorie sweetenersSaccharin Neotame Acesulfame K Sucralose Aspartame
“GRAS”
Laxative effect with excess consumption
Gum, sugar-free candy, cookies and ice cream
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
No-calorie sweetener2 calories per sweetness equivalent of a teaspoon of sucrose (16 calories)
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Regular Diet
12 oz
140 calories35 g carbohydrate~ 9 tsp sugar
Zero calories0 g carbohydrate
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Pay attention to serving sizes!Some foods sweetened with no-calorie sweeteners have practically no calories.
Others contain calories from
other ingredients.
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Fat free<0.5 g fat/serving
Low fat<3 g of total fat
Reduced saturated fat <25% of regular version
Fat replacersModified food starchGuar gumXanthinMaltodextrins
May have low impact on calorie saving (low fat but higher carb content)
Taste may be less than desirable.
Low Fat
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Free Low ReducedCalorie <5 cal/serving <40 cal/serving
Fat<0.5 g fat or saturated fat/
serving
3 g or less of total fat
Saturated fat <0.5 g saturated fat or trans fat
1 g or less at least 25% less than regular version
Sugar <0.5 g/serving at least 25% less than regular version
Salt <5 mg Na/serving140 mg Na or less, very low 35 mg or less
at least 25% less than regular version
Cholesterol <2 mg/serving 20 mg or less at least 25% less than regular version
Nutrient Claims and % Daily Value
High Fiber
Excellent source of fiber > 5 g/serving
Good source of fiber 2.5-4.9 g/serving
Whole grain bread 3 g fiber/serving
Whole grain cereal 3 g fiber/serving Consider cereal mixture with >7 g fiber/serving
Whole grain crackers >2 g fiber/serving
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
Read the
label!
macaroni & cheese
The nutrients in the Nutrition Facts are provided by one serving of the food
Estimate the amount of carbohydrate in the portion you will actually eat
Eat just the serving size of the food given in the food label
Food label serving sizes are not necessarily the same as diabetes (exchange/choice) servings
Food Diabetes Serving Food Label Serving
Milk 1 cup / 8 oz 1 cup / 8 oz
Bread 1 slice / 1 oz 1 slice / 1 oz
Fruit juice 1/2 cup / 4 oz 1 cup / 8 oz
Margarine 1 tsp regular stick 1 tbsp regular stick
Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003
The number of servings you consume determines the number of calories you actually eat
If you ate the whole package, that would be 500 calories and 220 calories from fat!
General Guide
Low 40 calories
Moderate 100 calories
High >400 calories
1 serving
2 servings
You can use the % DV to make
dietary trade-offs
“I look upon the diabetic as a charioteer, and his chariot is drawn by three steeds named Diet, Insulin and Exercise. It takes will to drive one horse, intelligence to manage a team of two, but a man must be a very good teamster who can get all three to pull together.”
Elliott P. Joslin, MD1869-1962
Thank Youwww.endocrine-witch.info
One, Two ... Count my food.Three, Four ... Exercise more.Five, Six ... Small meals I fix.Seven, Eight ... Now how’s my weight?Nine, Ten ... Start again.
Brown et al Diabetes Spectrum 2001