Practical Dietary Prescriptions in Type 2 Diabetes

Practical Dietary Prescriptions in Type 2 Diabetes Iris Thiele Isip Tan MD, FPCP, FPSEM Clinical Associate Professor, University of the Philippines College of Medicine Section of Endocrinology, Diabetes & Metabolism Department of Medicine, Philippine General Hospital

Outline What What is What is is a portion on the healthy control? food diet? label?

What is a “healthy diet?” grain ﬁsh fruits & >6 se products 2- 3 servings/ vegetables rving s/day week >5 servings/day Limit servi ed ngs o low-fat lean meat f Minimal or dairy poult ry or healthy fat 2 servings/ choices day Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

How much carbohydrate is needed? grain ﬁsh fruits & >6 se products 2- 3 servings/ vegetables rving s/day week >5 servings/day Limit servi ed ngs o low-fat lean meat f Minimal or dairy poult ry or healthy fat 2 servings/ choices day Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

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

Add dried Cook dried fruit in hot fruit to cereal and sprinkle Top yogurt with cereal wheat germ or ﬂax seed dried fruit or nuts Consume more ﬁber (at least 20-35 g/day) Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Choose whole Use cooked beans, peas and grain alternative lentils in soups, salads etc. whenever possible Consume more ﬁber (at least 20-35 g/day) Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Fish contain omega-3 fatty acids grain ﬁsh fruits & >6 se products 2- 3 servings/ vegetables rving s/day week >5 servings/day Limit servi ed ngs o low-fat lean meat f Minimal or dairy poult ry or healthy fat 2 servings/ choices day Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Nonpredator, fatty, dark meat ﬁsh i.e. salmon, sardines, mackerel, herring Eat 2-3 servings of ﬁsh/week or other foods that contain omega-3 fatty acids Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Plant sources i.e. ﬂaxseed, soybeans and walnuts Eat 2-3 servings of ﬁsh/week or other foods that contain omega-3 fatty acids Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Limit saturated fat grain ﬁsh fruits & >6 se products 2- 3 servings/ vegetables rving s/day week >5 servings/day Limit servi ed ngs o low-fat lean meat f Minimal or dairy poult ry or healthy fat 2 servings/ choices day Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Smaller and fewer meat Leaner cuts of meat i.e. servings i.e. ~6 oz/day beef/pork tenderloin, ﬁsh or (after cooking); poultry (without skin) 4-5 oz for women Lower intake of saturated fat Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Limit high-fat meat servings to 2-3 times/week i.e. luncheon meat, frankfurters, sausage, bacon and prime cuts of meat Lower intake of saturated fat Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Use plain nonfat Drink fat-free yogurt as in salad or 1% milk dressings or dips 2 tbsps yogurt < 20 calories 2 tbsps sour cream 50 calories 2 tbsps mayonnaise Use low fat 200 calories cheese Lower intake of saturated fat Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Use soft margarine rather than butter Should list a liquid oil as a ﬁrst ingredient i.e. corn, safﬂower or soybean oil Lower intake of saturated fat Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Use canola or olive oil Broil, bake or roast When frying or sauteing, use nonfat cooking spray or a small amount of vegetable oil Lower intake of saturated fat Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Decrease total fat intake Decrease saturated fat intake vegetable shortening, margarine, Trans fats from potato chips, crackers, cakes, hydrogenation pies, doughnuts, that solidiﬁes liquid oils Decrease trans fats Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Alcohol is allowed <2 drinks/day for men <1 drink/day for women 1 drink = 15 g alcohol 12 oz beer 5 oz wine 1.5 oz distilled spirits Add to regular meal plan. If you Do not omit food. don’t drink, Regular beer is counted as 1 carbohydrate serving. don’t start! Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Severe hypertension, Diabetic Diabetic edema or and without kidney disease hypertensive hypertension Sodium Sodium Sodium <2,000 mg/day <2,400 mg/day 2,4000-3,000 mg/day Limit sodium intake Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Remove the Try herbs, spices, salt shaker lemon juice, garlic and from the table onion to ﬂavor food 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

Eat 25% less than your current intake Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Palm = 3 oz Tight ﬁst = 1/2 cup Handful = 1 cup Thumb = Thumb tip 2 tbsp = 1 tsp Hand guides or 1 oz for portion control

What are servings? grain ﬁsh fruits & >6 se products 2- 3 servings/ vegetables rving s/day week >5 servings/day Limit servi ed ngs o low-fat lean meat f Minimal or dairy poult ry or healthy fat 2 servings/ choices day Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Diabetic Exchanges (“Servings”) Starch Meat/meat Vegetables substitutes Fruit Milk Fats

Free Food Less than 20 calories and 5 grams of carbohydrate diet softdrinks sugar-free gelatin dessert sugar-free ice pops sugarless gum sugar-free syrup

1 cup 1 cup pasta 1/2 cup rice corn ﬂakes = = crackers 8 pcs corn 1 pc wheat bread 5 x 4 x 1/2 cm 12 x 4 cm 2 pcs 11 1/2 x 8 x 1 cm = = ONE Starch Serving

Shrimps 5 pcs Chicken leg 12 cm each 13 1/2 cm x 3 cm 1 chicken egg = = Cheddar Lean pork Fish 1 slice cheese 1 slice 1 slice 6 x 3 x 2 cm 6 1/2 x 3 x 1 1/2 cm = = ONE Meat Serving

Carrot Cabbage Peas 1/2 cup raw or cooked 1 cup raw or 1/2 cup cooked 1 tbsp = = Tomato 1 cup raw or Squash 1/2 cup cooked 1/2 cup raw or cooked Mushroom 1/3 cup = = ONE Vegetable Serving

Watermelon Grapes Mango ripe 1 cup or 10 pcs (2 cm) or 1 slice 12 x 7 cm 1 slice (12 x 6 x 3 cm) 4 pcs (3 cm ) or 1/2 cup = = Banana Apple Strawberry 1 pc 9 x 3 cm 1/2 of 8 cm diameter 1 1/4 cup = = ONE Fruit Serving

Avocado Olive oil 1 tsp Butter 1 tbsp 1/2 of 12 x 7 cm = = Mayonnaise 1 tbsp Bacon 1 strip Margarine 10 x 3 cm 1 tbsp = = ONE Fat Serving

ONE Milk Serving Whole milk Milk, evaporated 1/2 cup undiluted Milk, fresh 1cup Milk, powdered 4 level tbsp Low fat milk Powdered 1/4 cup or 4 level tbsp Light low fat milk 1 tetra brick Skimmed (nonfat) buttermilk Liquid 2/3 cup Powdered 1/4 cup or 4 level tbsp Longlife skimmed Milk 1 cup Yogurt 1/2 cup

Idaho Plate Method Milk or or yogurt Brown et al Diabetes Spectrum 2001

Idaho Plate Method 9-inch plate Lunch/Dinner provides 1200-1500 calories Brown et al Diabetes Spectrum 2001

TIP #1 When purchasing produce (fruits, vegetables, starches), buy the smallest ones. for smal l apples, Look tatoes. banana s and po Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

TIP #2 Use smaller plates, such as a lunch-size plate. r plates rge dinne lling. La promo te overﬁ Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

TIP #3 Do 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 #4 Do not place bowls, pots or casserole pans on the table people get up if within easy reach. Make conds. they want se Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

giant double grande triple supreme double- extra large decker jumbo king-size super TIP #5 Do not order large servings unless you plan to split them. Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

junior regular single petite queen kiddie TIP #6 Order small menu items. Do not upsize! Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

TIP #7 Be creative with menus. Don’t automatically order a main course. soup and salad salad and appetizer appetizer and soup lf portion Order a ha Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

TIP #8 Use 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

Sugar free <0.5 g/serving “Sugar free” does not necessarily mean calorie- No fructose free or carbohydrate-free or lactose Reduced sugar <25% of regular version Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Gum, sugar-free candy, cookies and ice cream Polyols or sugar alcohols No calorie sweeteners Sorbitol Saccharin Neotame Lactitol Acesulfame K Sucralose Mannitol Aspartame Polydextrose Laxative effect with excess consumption Is it safe? “GRAS” Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

No-calorie sweetener 2 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 calories Zero calories 35 g carbohydrate 0 g carbohydrate ~ 9 tsp sugar 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

May have low impact on Low Fat calorie saving (low fat but higher carb content) Taste may be less than desirable. Fat free <0.5 g fat/serving Fat replacers Low fat Modiﬁed food starch <3 g of total fat Guar gum Xanthin Reduced saturated fat Maltodextrins <25% of regular version Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

Nutrient Claims and % Daily Value Free Low Reduced Calorie <5 cal/serving <40 cal/serving <0.5 g fat or 3 g or less of Fat saturated fat/ total fat serving <0.5 g saturated at least 25% less Saturated fat fat or trans fat 1 g or less than regular version at least 25% less Sugar <0.5 g/serving than regular version 140 mg Na or at least 25% less Salt <5 mg Na/serving less, very low than regular version 35 mg or less at least 25% less Cholesterol <2 mg/serving 20 mg or less than regular version

High Fiber 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 Excellent source of fiber > 5 g/serving Good source of fiber 2.5-4.9 g/serving Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

macaroni & cheese Read the label!

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 General Guide consume determines the number of calories you actually eat Low 40 calories Moderate 100 calories High >400 calories If you ate the whole package, that would be 500 calories and 220 calories from fat!

You can use the % DV to make dietary trade-offs 1 serving 2 servings

“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, MD 1869-1962

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 Thank You www.endocrine-witch.info

Practical Dietary Prescriptions in Type 2 Diabetes

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