Diabetes Meal Planning Made Easy. Hope S. Warshaw

      *These guidelines are based on the Dietary Reference Intakes from the Institute of Medicine of the National Academy of Sciences. They are acceptable ranges for adults and children other than infants and younger children.

Chapter 4

       Healthy Eating Guidelines for Diabetes

       What You’ll Learn:

      • the key principles of healthy eating with diabetes

      • the goals of medical nutrition therapy (MNT), also known as nutrition counseling

      • specific recommendations on the big and small nutrients

      Over the last few decades, the American Diabetes Association (ADA) has revised its nutrition principles and recommendations for healthy eating numerous times. ADAs goal is to have these recommendations reflect the most current diabetes and nutrition research, as well as consensus among diabetes nutrition experts. Find and read the most current ADA nutrition recommendations at www.diabetes.org.

      As you review these recommendations, you will see how similar they are to the Dietary Guidelines discussed in chapter 3. You’ll also note that the focus of diabetes care is much broader than just attending to blood glucose control. Today, diabetes care includes managing blood glucose, blood lipid, and blood pressure levels. Keeping these three factors in the target ranges (see ABC goals) will keep you healthy for years to come.

       Healthy Eating with Diabetes

      Here are four key principles to remember about healthy eating with diabetes:

      1. There’s no such thing as a “diabetic diet.” These so-called diabetic diets shouldn’t be used. The healthy eating guidelines for everyone apply to people with diabetes as well. People with diabetes do not need to buy or eat any special foods.

      2. Change your behaviors slowly but surely. Healthy eating and staying active are well-known and effective ways to stay healthy. They are essential if you are at high risk of type 2 diabetes, or have pre-diabetes or type 2 diabetes because you are more likely to have or be at high risk for heart and blood vessel diseases. When you learn that you have type 2 diabetes, your eating habits and food choices may need changing.

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      Try not to think of your eating plan as a “diet.” Think of it as a way to slowly change your family’s eating habits for the better.

      3. Individualization is important. Find a registered dietitian (RD) who specializes in diabetes medical nutrition therapy (MNT). Medical nutrition therapy is the formal name for nutrition counseling. It is the term some health plans, including Medicare, use to describe coverage of nutrition counseling. Your RD should work with you to develop a personalized healthy eating plan and goals for behavior change. This health care provider should consider all of your health, diabetes, and nutrition goals, as well as your food preferences: including what foods you like to eat; what time you like to eat; your cultural and religious food habits and customs; whether you like or need snacks at certain times; your daily and weekend schedule; and, most important, what you are willing, able, and ready to change. For instance, the eating plan and goals for a vegetarian who works the evening shift would be very different from those of someone who lives alone and eats most meals in restaurants.

      4. Be flexible and realistic with yourself. In today’s fast-paced world, life doesn’t always go according to plan, and the healthiest foods are not always at your disposal. Your eating plan and behavior change goals need to be flexible enough to fit your lifestyle. They need to help you be able to delay a meal or snack, eat at a restaurant, or opt for convenience foods. Your eating plan needs to fit the days when your activity level is way up—perhaps for a weekend hike or day of skiing—and the days when you feel ill and have no appetite.

       Recommendations for Big and Small Nutrients

      Most people at high risk for or with type 2 diabetes need to shed some weight. To lose those 10 to 20 pounds, you need to know the right number of calories for you to eat, along with the proper foods that will provide the right mix of carbohydrate, protein, and fat. Research shows there is no single combination of nutrients that’s best for diabetes care and/or weight control.

      The goals below give a calorie range to shoot for when it comes to each of the big nutrients.

      Carbohydrate

      Carbohydrate is the main nutrient that raises blood glucose levels. Both the amount and the type of carbohydrate you eat will affect your blood glucose, but the amount has a greater effect on your blood glucose. Once you learn the impact of carbohydrate on blood glucose, it’s rational to think that a low carbohydrate intake may be an answer to blood glucose control. Research doesn’t support this notion. Many studies have shown that a lower carbohydrate intake can help lower blood glucose initially; however, over time, it doesn’t improve weight loss, blood glucose control, and most other health parameters of interest. Lower carbohydrate diets (less than 45% of calories from carbohydrate) also don’t allot sufficient grams of carbohydrate to get the nutrients, fiber, vitamins, and minerals you need.

      The ADA suggests that people with diabetes consult the general nutrition guidelines, which recommend that you get somewhere between 45 and 65% of your daily calories from carbohydrate. For example, suppose you eat about 1,400 calories a day and you decide to get half of those calories from carbohydrates. Because each gram of carbohydrate contains 4 calories, you would need to eat about 175 grams of carbohydrate to consume half of your total calories from carbohydrate. (In other words, half of 1,400 calories is 700, and 700 calories divided by 4 calories per gram is 175 grams.)

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      It’s important to eat similar amounts of carbohydrate