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[ Food Exchanges ]
DIET
ADVISE
Diet should
be the mainstay of all diabetic management.
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Diabetic diet, is a diet for patients with diabetes
mellitus. | |
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The diet usually limits sugar or simple carbohydrates. | |
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It increases
proteins, complex carbohydrates, and unsaturated fats. | |
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Many persons with Type II
diabetes can control their disease by diet alone and need not take insulin. | |
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The
diet helps to keep the level of sugar in the blood stable. |
Guidelines.
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Diet should be the mainstay of all diabetic
management.
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The prescribed diet should be individualized.
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It must be realistic, flexible, and take into consideration
the patient's likes and dislikes, to as large an extent as
possible, and must suit the patient's life style.
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It is important to educate the patient about the
basic requirements of the diet and judge compliance at regular
intervals.
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Interestingly, our traditional Indian diets, with slight modification, are close to what is considered ideal diabetic diets.
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Patients do not have to make any major changes to their usual dietary habits, with the exception of avoiding simple sugars and adjusting the fat intake.
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This allows increasing compliance with the diet advise.
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Basic diet advise.
Avoid simple carbohydrates like sugar, sweets, jiggery, honey, etc., as they
tend to cause a sharp rise in the blood glucose levels.
Total calories.
Total calories allowed to an individual will depend on the
present weight and the targeted optimal weight.
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Underweight
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Normal Weight
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Overweight
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May have to increase food intake to optimize
weight
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Continue same amount of food intake May
need to increase food intake to make up for calories lost
through avoiding sugar.
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Gradual decrease in amount of food normally
eaten, if excessive, increase activity level.
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Usually, the prescribed diet should contain 30 calories/kg
optimal body weight. | |
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The total calories prescribed should also take into account
the activity levels of the patient, as well as special
circumstances like pregnancy and lactation, etc.
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Carbohydrates.
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Carbohydrates should
constitute around 60-70% of the total calories.
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The carbohydrates should be in the form of complex
polysaccharides (starch) and contain adequate amount of
fibers.
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The widespread misconception that carbohydrates (in any
form) should not be eaten by diabetics should be removed.
Carbohydrates in the form of simple sugars need restriction.
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It is important to emphasize that rice, potatoes and
fruits are not contraindicated in a diabetic diet.
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Most traditional Indian diets usually meet with this
requirement.
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There does not seem to be any need for additional fibers
supplement in the form of a pharmaceutical prescription.
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Proteins.
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Protein intake should
be approx. 0.8 grams/kg ideal body weight; this usually
comprises around 12-18% of the calorie intake.
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The requirements for proteins may be increased in
catabolic states, pregnancy, lactation and in some elderly
patients.
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Protein intake may need to be restricted in patients with
nephropathy.
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Fats.
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Fats should be
restricted to around 20-25% of the total calories.
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One should preferably take equal amounts of saturated,
mono-unsaturated and polyunsaturated fats.
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It is a misconception to feel that polyunsaturated fats
are safe and can be taken freely.
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Many foods contains fats; this "invisible fat"
should be taken into account when estimating the total fat
intake.
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It is advisable to restrict the total intake of cooking
fats to less than 6% of the total energy intake; in simple
terms, food should be cooked in the least amount of oil or
ghee; if feasible, food should be preferably be grilled,
steamed or broiled, micro waved, rather than fried.
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The total intake of cholesterol should be restricted to
around 300 mg per day.
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| The fat intake may need to be further modified if
associated dyslipidemia is present (Abnormal levels of
lipids)
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Essential fatty acids. (EFAs)
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Recent evidence
suggests that attention must be paid to the intake of
essential fatty acids (EFAs) such as omega-6 (w6) and omega-3
(w3) fatty acids.
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These EFAs make to be derived from food and cannot be
made in the body.
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Not only must they be eaten in adequate amounts, but the
relative ratio is around 4:1.
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Indian diets usually contain too much of w6 fatty acids
and little, if any, of w3 fatty acids. This is due to the
fact that most foods are rich in w6 fatty acids and poor in
w3 fatty acids which is mostly found in fish.
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Indian diets usually give a ratio of around 40:1.
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The disproportionate ratio is made worse by the use of
the so called "safe" cooking oils such as
safflower oil and sunflower oil, in which the ratio is
around 150:1!
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If this ratio is to be brought down to near optimal
levels, then it would be essential to do a RETHINK about the
advised mode of cooking media, and possibly revert to our
traditional cooking media, which although they may not
contain w3 fatty acids, also are poor in w6 fatty acids.
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Although these traditional cooking media like mustard
oil, coconut oil and ghee may be relatively high in their
saturated fat content, their poor content of w6 fatty acids
allows a more optimal w6/w3 intake, especially when
associated with increased w3 intake in the form of fish or
w3 supplements.
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The saturated fat content of these cooking media are
offset by the benefits of the more optimal w6/w3 intake,
especially if the total use of the cooking media is minimized.
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This change over to some of the more traditional cooking
media, accompanied by the use of as little as possible of
the cooking medium, allows a diet with a ratio of around 8:1
which is close to optimal.
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The Omega-6
and Omega-3 content of the commonly used edible oils is given
below:
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Omega - 6
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Omega - 3
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W6 / W3
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Safflower
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73
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0.5
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146
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Sunflower
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49
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0.3
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163
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Corn
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57
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0.8
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71
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Sesame
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40
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0.5
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80
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Palmolein
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9
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0.3
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30
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Groundnut
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28
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0.8
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35
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Coconut
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1.8
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--
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--
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Ghee Buffalo
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2
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0.9
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2.2
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Ghee (Cow)
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1.6
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0.5
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3.2
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Mustard / Rape
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13
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8.6
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1.5
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Salt intake.
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Salt restriction is
necessary in patients with associated hypertension, cardiac
failure and fluid overload. |
Fruits.
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These can be eaten by
diabetics in moderate amounts. Raw and partially ripe fruits
are preferable. |
Alcohol.
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If consumed, alcohol
should be used in moderation.
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It should be avoided in all diabetics who are overweight
and on
hypo caloric diets, on biguanides (anti diabetic
drugs), or in those who
have high Triglycerides levels. All other contraindications
to alcohol intake also apply to diabetics.
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In those diabetics, who are allowed alcohol, this should
be restricted to less than 5% of the total calories.
Generally, this is equivalent to about 45 ml of whisky or
related alcoholic drinks.
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Wine, sherry and beer are best avoided.
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Artificial sweeteners. (Sugar
Substitutes)
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Non
- Caloric Sweeteners
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Saccharin
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Aspartame
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Use by diabetes allowed
in moderation . (10 -12 tablets per day);
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Fear that its use may lead to cancer is misplaced, especially
if used in moderation;
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Each tablet contains 12mg approx.,
permissible doses unto 500mg per day in children and unto 1000
mg/day in adults; such high intake not advisable
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Non
caloric; may leave a bitter after taste,
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Avoid in pregnancy.
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Use by diabetics allowed in
moderation (10 - 12 tablets per day); |
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Fear that its use may
lead to cancer, mental retardation , menstrual
irregularities, etc., is misplaced if used in such small
doses; |
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Each tablet contains 18mg of aspartame approx., permissible
doses unto 50mg/kg/day; such high intake not advisable; |
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Technically does have calories, but so sweet that in amounts
used , can be considered non caloric, |
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Avoid in pregnancy and
in patients with phenylketonuria. |
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Diet
Supplements |
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An increasing number of dietary supplements specially
formulated for diabetes patients are available in the market.
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These should not be recommended for routine use by
diabetics.
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But such supplements may be of help in many special
circumstances.
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When prescribed, one must be aware of the precise contents,
as many food supplements called as diabetic foods are not calorie
free and mislead patients into thinking that such diabetic
foods can be taken in any quantity.
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What Is a Diabetic Diet?
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Good diabetes control means keeping your blood-sugar level as close to normal
as possible. | |
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You need to maintain a proper balance between the insulin you
produce or receive in a shot and the sugar your body makes out of the food you
eat. | |
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You should maintain a nutritious, healthy diet that would be good for
anyone. | |
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The main differences are that your diet contains limited or no added
sugar that could raise blood-sugar levels too high, specifies the amount of food
to be eaten, and sets specific times to eat for regulatory purposes. | |
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You should
also maintain a proper weight. |
What should I eat?
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Eat foods from the six main food groups--milk, meat, vegetables, breads,
fats, and fruits. | |
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Most diabetic meal plans list foods in terms of exchanges. | |
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Exchanges are units of measure that help you keep calories and types of foods
controlled but allow variety by letting you trade one exchange for another food
in the same group. Within each food group, serving sizes are adjusted to provide
about the same amount of calories, carbohydrates, protein, and fat. |
Isn't fat bad for you? Why can I eat fruits but not sugars?
Fat is a nutrient, and you need some fat in your diet. But too much fat can
be harmful for people with diabetes because it increases the risk of heart
disease and hardening of the arteries. Follow these tips:
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Avoid "hidden" fat (e.g., creamy pasta sauces, gravies), fried
foods, and high-fat salad dressings. | |
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Choose lean meats; eat more fish and skinned poultry. Eat liver or organ
meats only occasionally. | |
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Use diet margarine instead of butter. | |
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Drink
low fat or nonfat milk. | |
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Limit intake of eggs to 2 or 3 a week. | |
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People with diabetes should eat less sugar. | |
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Depending on your individualized
plan, some fruits may be encouraged because they provide fiber and carbohydrates
for energy. |
What foods should I stay away from?
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Besides monitoring your intake of fats and sugars, you may need to restrict
your intake of salt too. | |
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You should avoid other "ready sweets" like
candy, jam, jelly, syrup, most cakes, pies and pastries, regular soda, condensed milk, and sweet pickles. |
What about packaged foods?
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Learn to read and understand food labels. | |
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A dietetic label does not
necessarily mean that the product is intended for diabetics. Labels list food
ingredients in the order of relative quantity. Check food labels of all
products. | |
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Avoid those that contain hidden sugars such as sucrose, mannitol,
glucose, sorbitol, fructose, dextrose, corn syrup, invert sugar, and lactose. | |
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Consult your doctor or nutritional counselor before buying foods that are
labeled fat free. | |
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You can still enjoy eating out at restaurants. Choose restaurants that are
sensitive to the current public interest in fitness and nutrition. |
Here are a
few ideas to keep your blood sugar under control:
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Order fruits as either a dessert or an appetizer. | |
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Ask for your salad dressing "on the side" so that you can control
the portion. | |
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Make sure your meat or fish course is broiled, baked, roasted, or poached--never
fried! | |
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Avoid foods that may have unknown ingredients (e.g., foods with sauces). | |
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Ask how your food will be prepared. | |
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Some fast food restaurants can give you written information about their
ingredients and are written with diabetic concerns in mind. |
What about alcohol?
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Talk to your doctor before drinking alcohol. | |
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If your doctor says you may
drink some alcohol, you will most likely only be able to have one or two
alcoholic drinks, 1 or 2 times a week. | |
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The drink can be either a mixed drink
with 1 1/2 oz of alcohol, 4 oz of dry wine, or 12 oz of light beer. | |
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If you have
type I diabetes, eat before you drink any alcohol to avoid low blood sugar and
hypoglycemia. Alcohol interferes with glucose production in the liver, which is
the glucose used by the body during an episode of hypoglycemia. Even if you eat,
hypoglycemia can still occur several hours later, so follow your meal plan and
check your blood sugar. Alcohol does have calories. | |
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Do not add fruit juice or sweetened mixers to alcohol; use diet soft drinks,
club soda, seltzer, and water. Avoid drinks containing sugars or starches, such
as beer and sweet wines. | |
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Alcohol can also cause low blood sugar in some people with type II diabetes
who take oral medications. | |
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The combination of medication and alcohol may cause
flushed skin in some people. | |
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It is all right to cook with alcohol. When alcohol is heated, most of the
alcohol evaporates. This leaves few calories but adds flavor to the food in
which it is cooked. |
How will other medications affect my alcohol intake?
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You must check with your doctor about how alcohol may affect other medication
you are taking. | |
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Remember too that your judgment and control will be impaired
after a few drinks. You may forget an injection, forget to eat, or eat too much. |
To be safe, follow these tips:
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Before you start drinking, decide how much you will eat and drink. | |
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Put less alcohol in your mixed drinks. | |
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Drink slowly; make one drink last. | |
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Do not drink and drive. |
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