| Medical nutrition therapy (Therapeutic nutrition) has been reported as being an important and integral aspect in the management of Diabetes. This becomes a crucial modulator in the self-management of Diabetes considering the prevalence of obesity and overweight as complicating aspects of Diabetes. Effective use of principles of nutrition in Diabetes can contribute significantly toward the prevention of or minimizing the potentially permanent and damaging complications arising from Diabetes. |
|
Goals of nutrition in individuals with diabetes
The basic goals of nutrition in individuals with Diabetes include: |
- The most important nutritional goal of Diabetes is the control of body weight and composition so as to improve Insulin resistance.
- Achieving and maintaining blood glucose levels in the normal range with a lipid level that helps maintenance of blood pressure levels in the normal range and reduces the risk for Cardiovascular disease.
- Prevention or delay of the development of the chronic complications of Diabetes by modification of nutrient and Phytochemical intake and lifestyle.
- To address individual nutrition need while also taking into account cultural and personal preferences while only limiting those food choices when it is indicated by scientific evidence.
- There are special populations, such as pregnant and lactating women, older adults, and children and youths with diabetes, who need to have their nutritional requirements met based on alterations in life phases and events.
|  |
Weight loss in Diabetes
Moderate (up to 5%) and sustained weight loss has been shown to improve the action of Insulin in diabetics as well as a contributing to a reduction in the levels of lipids in the blood while also aiding better control of blood pressure. Thus weight loss is recommended for all individuals with or at risk of Diabetes. |  |
It is important to keep in mind that a weight-loss diet should be a low-carbohydrate, low-fat, calorie-restricted diet for it to be effective in the short-term. Protein intake is recommended up to 40% of the diet in individuals with normal kidney and liver functions. In individuals suffering from complications of the kidney as sequelae of diabetes, it is best to consult with the treating doctor before undertaking any drastic changes in diet. It is advisable that all weight-loss and weight-management diets be accompanied by suitable modifications in physical activity and behavior such that they are helpful in the maintenance of weight loss.
Weight loss medications and surgery should be considered a last resort in diabetics as they can contribute to about 10–15% of weight loss when combined with suitable physical activity. Such treatment is only indicated in those who repeatedly fail in diet control and weight reduction. However, the long-term benefits of these measures are yet to be definitively understood.
Standard weight loss diets aim at reducing between 500 and 100 calories from that required for weight maintenance. This can initially result in weight loss of between 0.5 and 1 kg per week but may not be sustained without physical activity or behavioral therapy and such individuals usually end up regaining all the weight they had lost.
Another important aspect of weight loss in diabetics is resorting to meal replacements. These include liquid or solid prepackaged foods that are limited in the amount and quantity of nutrients that they supply while also aiming at providing the basic essentials of a meal. These replacements are usually formula products that can cause significant weight loss if used once or twice-daily as they provide a definite amount of energy with every recommended serving. It is very important to ensure adequate breakfast and whole-grain products intake. The role of soluble fiber and low glycemic foods in weight management is well demonstrated.
The dietary guidelines of the WHO (2003) for prevention and control of Coronary vascular disease (CVD) are widely popular. (Fat <30%, saturated fat 0%, trans-fat less than 10%, n3/n6 fatty acid ratio 2–10, sugar <10%, fiber 30 g/day. Recently, a National workshop gave recommendations on the diet in diabetics and in metabolic syndromes (available with Dr. Anoop Misra, New Delhi).
|
Nutrients in diabetic diet
The daily requirements of nutrients based on their type have been defined to aid better adherence and understanding of dietary needs.
|
Carbohydrate - The daily minimum requirement for carbohydrates is 130 g. It is recommended that this minimum requirement be derived from a variety of fruits, vegetables, whole grains, legumes and low-fat milk.
- High-glycemic index foods should be avoided while choosing carbohydrates. Foods with high glycemic index are those that cause a sharp rise in blood sugar within an hour of their being consumed.
- These are bad for the body as they cause steep demands on Insulin and can apply undue load on the body’s already burdened blood sugar regulation.
|  |
Food rich in fiber should be consumed in major portion and sugaralcohols such as brandy, whisky and rum are safe when consumed withinthe daily intake levels.
|
|
Fat and cholesterol - Saturated fats should only constitute 7% of the total calories.
- Intake of trans fats, such as that from chips or deep-fried foods, will need to be curtailed.
- Dietary cholesterol should be kept below 200 mg/day.
- Fish or foods rich in omega-3 fatty acids are advisable as at least two servings per week.
|
Protein - It is recommended that protein should constitute between 10% and 35% of energy intake per day, with an average around 15%.
- Good-quality protein sources include meat, poultry, fish, eggs, milk, cheese and soy.
- While planning a meal, it should be kept in mind to include 0.8 g of protein per kg per day.
- Protein in diet contributes to long-term regulation of energy intake, reduces appetite, increases satiety and ensures compliance.
Micronutrients
Micronutrients should be derived to meet the daily recommended allowances as these are essential for the proper maintenance of the eyes and nerves as well as delay in the onset of complications of Diabetes. However, it would be best to consult with the treating physician before going on any additional or preformulated supplements. |