practical dietary prescriptions in type 2 diabetes

Practical Dietary Prescriptions in Type 2 DiabetesIris Thiele Isip Tan MD, FPCP, FPSEMClinical Associate Professor, University of the Philippines College of MedicineSection of Endocrinology, Diabetes & MetabolismDepartment of Medicine, Philippine General Hospital

What is a

healthy diet?

What is portion control?

What is on the food

label?

Outline

What is a

healthy diet?

What is on the food

label?

Outline

What is a “healthy diet?”

Pastors et al. Diabetes Nutrition Q&A for Health Professionals, 2003

grain products >6 servings/day

2-3 servings/

Limited servings of lean meat or poultryMinimal or healthy fat

choices

fruits & vegetables >5 servings/day

low-fat dairy 2 servings/day

How much carbohydrate is needed?

2-3 servings/

choices

How much carbohydrate is needed?

2-3 servings/

choices

It is wrong to avoid plant-based foods as “they will turn into sugar.”

Consume more fiber(at least 20-35 g/day)

Top yogurt with dried fruit or nuts

Add dried fruit to cereal

Cook dried fruit in hot cereal and sprinkle

wheat germ or flax seed

Consume more fiber(at least 20-35 g/day)

Choose whole grain alternative

whenever possibleUse cooked beans, peas and

lentils in soups, salads etc.

Fish contain omega-3 fatty acids

2-3 servings/

choices

Fish contain omega-3 fatty acids

2-3 servings/

choices

Eat 2-3 servings of fish/weekor other foods that contain omega-3 fatty acids

Nonpredator, fatty, dark meat fish i.e. salmon, sardines, mackerel, herring

Eat 2-3 servings of fish/weekor other foods that contain omega-3 fatty acids

Plant sources i.e. flaxseed, soybeans and walnuts

Limit saturated fat

choices

2-3 servings/

Limit saturated fat

choices

2-3 servings/

Lower intake of saturated fat

Smaller and fewer meat servings i.e. ~6 oz/day

(after cooking); 4-5 oz for women

Leaner cuts of meat i.e. beef/pork tenderloin, fish or

poultry (without skin)

Limit high-fat meat servings to 2-3 times/week i.e. luncheon meat, frankfurters, sausage,

bacon and prime cuts of meat

Drink fat-free or 1% milk

Use plain nonfat yogurt as in salad dressings or dips

2 tbsps yogurt < 20 calories

2 tbsps sour cream 50 calories

2 tbsps mayonnaise200 caloriesUse low fat

cheese

Use soft margarine rather than butter

Should list a liquid oil as a first ingredient i.e. corn, safflower or soybean oil

Broil, bake or roast

When frying or sauteing, use nonfat cooking spray or a small amount of vegetable oil

Use canola or olive oil

Decrease trans fats

Decrease total fat intakeDecrease saturated fat intake

Trans fats from hydrogenation that solidifies

liquid oils

vegetable shortening, margarine, potato chips, crackers, cakes,

pies, doughnuts,

Alcohol is allowed<2 drinks/day for men

<1 drink/day for women

If you don’t drink, don’t start!

Add to regular meal plan.

Do not omit food. Regular beer is counted

as 1 carbohydrate serving.

1 drink = 15 g alcohol12 oz beer 5 oz wine1.5 oz distilled spirits

Limit sodium intake

Sodium <2,000 mg/day

Sodium <2,400 mg/day

Sodium 2,4000-3,000

mg/day

Diabetic and

hypertensive

Diabetic without

hypertension

Severe hypertension,

edema or kidney disease

Try herbs, spices, lemon juice, garlic and

onion to flavor food

Remove the salt shaker

from the table

Cook with less salt

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

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)

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

What is a

healthy diet?

What is on the food

label?

Outline

What is a

healthy diet?

What is on the food

label?

Outline

Eat 25% less than your current intake

Tight fist = 1/2 cup Handful = 1 cup

Palm = 3 oz

Thumb = 2 tbsp or 1 oz

Thumb tip = 1 tspHand guides

for portion control

What are servings?

2-3 servings/

choices

Diabetic Exchanges (“Servings”)

Starch Meat/meat substitutes

Vegetables

FatsFruit Milk

Free Food

Less than 20 calories and 5 grams of carbohydrate

diet softdrinks sugar-free gelatin dessert

sugar-free ice popssugarless gum

sugar-free syrup

1/2 cup rice1 cup

corn flakes1 cup pasta

crackers 8 pcs5 x 4 x 1/2 cm

corn 1 pc12 x 4 cm

wheat bread 2 pcs

11 1/2 x 8 x 1 cm

ONE Starch Serving

Chicken leg13 1/2 cm x 3 cm

1 chicken egg Shrimps 5 pcs 12 cm each

Fish 1 slice

Cheddar cheese 1 slice6 x 3 x 2 cm

Lean pork1 slice

6 1/2 x 3 x 1 1/2 cm

ONE Meat Serving

Cabbage1 cup raw or

1/2 cup cooked

Peas1 tbsp

Carrot 1/2 cup raw or cooked

Mushroom1/3 cup

ONE Vegetable Serving

Tomato 1 cup raw or

1/2 cup cooked Squash

1/2 cup raw or cooked

Grapes10 pcs (2 cm) or

4 pcs (3 cm )

Mango ripe1 slice 12 x 7 cm

or 1/2 cup

Watermelon 1 cup or

1 slice (12 x 6 x 3 cm)

Strawberry1 1/4 cup

ONE Fruit Serving

Banana 1 pc 9 x 3 cm

Apple 1/2 of 8 cm diameter

ONE Fat Serving

Olive oil 1 tsp Butter 1 tbspAvocado 1/2 of 12 x 7 cm

Mayonnaise 1 tbsp

Margarine1 tbsp

Bacon 1 strip10 x 3 cm

ONE Milk ServingWhole milkMilk, evaporatedMilk, freshMilk, powdered

1/2 cup undiluted1cup4 level tbsp

Low fat milkPowderedLight low fat milk

1/4 cup or 4 level tbsp1 tetra brick

Skimmed (nonfat)buttermilk

LiquidPowdered

2/3 cup1/4 cup or 4 level tbsp

Longlife skimmedMilk

Yogurt1 cup1/2 cup

Milk or

or yogurt

Brown et al Diabetes Spectrum 2001

Idaho Plate Method

Lunch/Dinner9-inch plate

provides 1200-1500 calories

TIP #1When purchasing produce (fruits, vegetables, starches), buy the smallest ones.

Look for small apples,

bananas and potatoes.

TIP #2Use smaller plates, such as a lunch-size plate.

Large dinner plates

promote overfilling.

TIP #3Do not prepare too much food.If you plan on leftovers, put the extra food away before serving.

TIP #4Do not place bowls, pots or casserole pans on the table within easy reach. Make people get up if

they want seconds.

TIP #5Do not order large servings unless you plan to split them.

giantgrandesupremeextra largejumbo

doubletripledouble-deckerking-sizesuper

TIP #6Order small menu items. Do not upsize!

juniorsinglequeen

regularpetitekiddie

TIP #7Be creative with menus.

Don’t automatically order a main course.

soup and salad salad and appetizer appetizer and soup

Order a half portion

TIP #8Use 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.

What is a

healthy diet?

What is on the food

label?

Outline

What is a

healthy diet?

What is on the food

label?

Outline

“Sugar free” does not necessarily mean calorie-free or carbohydrate-free

Sugar free<0.5 g/serving

No fructose or lactose

Reduced sugar<25% of

regular version

Is it safe?

Polyols or sugar alcoholsSorbitolLactitolMannitolPolydextrose

No calorie sweetenersSaccharin Neotame Acesulfame K Sucralose Aspartame

“GRAS”

Laxative effect with excess consumption

Gum, sugar-free candy, cookies and ice cream

No-calorie sweetener2 calories per sweetness equivalent of a teaspoon of sucrose (16 calories)

Regular Diet

140 calories35 g carbohydrate~ 9 tsp sugar

Zero calories0 g carbohydrate

Pay attention to serving sizes!Some foods sweetened with no-calorie sweeteners have practically no calories.

Others contain calories from

other ingredients.

Fat free<0.5 g fat/serving

Low fat<3 g of total fat

Reduced saturated fat <25% of regular version

Fat replacersModified food starchGuar gumXanthinMaltodextrins

May have low impact on calorie saving (low fat but higher carb content)

Taste may be less than desirable.

Low Fat

Free Low ReducedCalorie <5 cal/serving <40 cal/serving

Fat<0.5 g fat or saturated fat/

serving

3 g or less of total fat

Saturated fat <0.5 g saturated fat or trans fat

1 g or less at least 25% less than regular version

Sugar <0.5 g/serving at least 25% less than regular version

Salt <5 mg Na/serving140 mg Na or less, very low 35 mg or less

at least 25% less than regular version

Cholesterol <2 mg/serving 20 mg or less at least 25% less than regular version

Nutrient Claims and % Daily Value

High Fiber

Excellent source of fiber > 5 g/serving

Good source of fiber 2.5-4.9 g/serving

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

Read the

label!

macaroni & cheese

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

The number of servings you consume determines the number of calories you actually eat

If you ate the whole package, that would be 500 calories and 220 calories from fat!

General Guide

Low 40 calories

Moderate 100 calories

High >400 calories

1 serving

2 servings

You can use the % DV to make

dietary trade-offs

“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, MD1869-1962

Thank Youwww.endocrine-witch.info

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.

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