Today’s post comes from Amy Campbell, MS, RD, LDN, CDE. Campbell is a registered dietitian and certified diabetes educator at Joslin Diabetes Center. She is actively involved in education initiatives, both at Joslin and with the American Association of Diabetes Educators, the American Diabetes Association and the Academy of Nutrition and Dietetics. She has authored several books published by the American Diabetes Association and recently received the 2012 Will Solimene Award for Excellence in Medical Communication. Campbell is also a member of the Egg Nutrition Center’s Health Professional Advisor panel.
I recently had the pleasure recently of speaking at the Food & Nutrition Conference and Expo (FNCE) in Philadelphia along with Osama Hamdy, MD, Medical Director of Joslin Diabetes Center’s Obesity Clinical Program. Our presentation was titled Myths and Mysteries: Dietary Intake and Diabetes.
Dr. Hamdy spoke first, laying the groundwork and scientific framework for current nutrition recommendations for people with type 2 diabetes. Almost 26 million people in the United States have diabetes and most of them have type 2 diabetes. In addition, many, although certainly not all, of people with type 2 diabetes are overweight or obese. Dr. Hamdy’s research has led to the development of Joslin’s Clinical Nutrition Guideline for Overweight and Obese Adults with Type 2 Diabetes or Pre-Diabetes, and these guidelines are the basis for Joslin’s premier weight management program entitled Why WAIT. One of the myths that Dr. Hamdy helped to dispel is that more, not less, dietary protein is beneficial in the diabetes meal plan. Higher-protein intakes can actually improve glycemic control, improve cardiovascular outcomes and lower urine albumin excretion levels.
Here are the key “take home” messages from Dr. Hamdy’s presentation:
• Dietary protein can be increased (generally, 1.2 to 1.5 grams per kilogram adjusted body weight, or approximately 20 to 30% of total calories) in patients with type 2 diabetes who have normal kidney function. A higher protein intake can improve glycemic and cardiovascular outcomes, preserve lean body mass, and increase satiety.
• Dietary carbohydrate should be capped at 40 to 45% of total calories to improve glucose and lipid levels and reduce visceral (belly) fat.
• Dietary cholesterol has only a modest effect on blood cholesterol levels and is primarily affected by the amount of saturated fat one eats. Saturated fat is a type of unhealthy fat found in butter, stick margarine, shortening, red meat, cheese, whole milk and ice cream, for example.
- I presented during the second half of Myths and Mysteries. As a dietitian and diabetes educator, I know first-hand how confusing and often frustrating it is for both clinicians and patients alike to translate research into realistic recommendations that are sustainable. Dietitians know that there is no “one size fits all” when it comes to helping people manage a chronic health condition like diabetes. No two people are alike. But there continue to be certain “myths” about diabetes that prevail. Here’s a synopsis of the five common myths and suggestions for dispelling them, hopefully for good:
• Based on Diabetes Self-Management Education standards, a qualified healthcare professional can provide medical nutrition therapy (MNT). The reality is that only a registered dietitian can provide and be reimbursed for MNT. However, all members of the healthcare team should be able to provide general nutrition messages to people with diabetes until he or she is able to meet with a dietitian. By the way, MNT is reimbursable by Medicare. All you need is a doctor’s referral to see a dietitian.
• There is a standard diabetic diet. We know this isn’t true. In fact, there is no “diabetic diet.” Instead, a “diet” for diabetes is an eating plan that is individualized and tailored to a person’s lifestyle, food preferences and health goals.
• People with diabetes should only eat low glycemic index foods. In theory, this would seem to be correct, but we know that the glycemic index (GI) is a ranking of all carbohydrate foods regardless of their nutritional quality. So, healthy foods, like watermelon and potatoes have a high GI, whereas not-so-healthy foods like peanut M&M’s have a low GI. In addition, the GI of a food is affected by so many factors, such as variety, ripeness and cooking time. The point here is to choose fewer refined and processed foods, to control carbohydrate intake of all foods, and to use blood glucose results as a guide for making better food choices.
• Always include protein at a snack to prevent low blood glucose. Despite the long-standing belief that a diabetes snack should include “one bread and one meat,” there’s little scientific evidence to support this. Studies show that including protein, particularly at a bedtime snack, does not prevent hypoglycemia. However, there’s nothing wrong with having a protein source, like a boiled egg or a slice of turkey breast, as part of a snack. In fact, doing so may help curb your appetite so that you end up eating less later on.
• Fat doesn’t affect blood glucose levels. Fat is a slowly digested nutrient, and a small amount at a meal can not only help make you feel full, it can help slow the rise in blood glucose after a meal by slowing down digestion. However, while some fat is good, too much isn’t so good. Too much fat at a meal can increase insulin resistance and lead to blood glucose spikes hours after the meal. Aiming for less than 35% of calories from fat is a general goal to aim for.
My final take-home message: Nutrition for diabetes need not be a mystery. Recognize that what may work for one person may not work for another. If you have diabetes, ask your doctor for a referral to a dietitian who specializes in diabetes, or attend a diabetes education program.