I was recently asked to present the “latest and greatest” nutrition information to a group of lay people interested in prevention and/or treatment of diabetes. I truly enjoy these requests, as it encourages me to return to the literature and most recent standards of care to assure that I am giving my patients the best education possible.
Recently, Diabetes Care published “Nutrition Therapy Recommendations for the Management of Adults with Diabetes.” I am always delighted to see Marion Franz’s name as a co-author, as I trust her knowledge and common sense approach to nutrition and diabetes. In addition, the Canadian Journal of Diabetes published a recent review of food and dietary pattern-based recommendations.
As we learn more about food planning for diabetes, it is clear that there is not a perfect pattern for diabetes management. Each person is unique and their needs and desires vary. Using dictated percentages of fat, protein and carbohydrates are not evidence-based, and often burdensome to the patient. Although carbohydrate counting remains an important aspect of treatment, the quality of those carbohydrates may have more impact on overall health. In addition, the amount tolerated by each person may vary and should be assessed by using pre- and post-meal blood glucose monitoring.
Incorporation of fish (not fish oil supplements), inclusion of fiber rich foods (similar to that recommended for patient without diabetes) and dietary pulses (legumes) along with recommendations to consume lean meats, low fat dairy products, fresh fruit and vegetables remain the cornerstone of dietary recommendations. Consumption of sugar-laden beverages (e.g., juice, sports drinks, sodas) are discouraged.
The focus on dietary patterns such as the Mediterranean and DASH diets are being suggested as a way to communicate healthy eating as a whole, rather than just focusing on quantities of carbohydrates. This helps to minimize food plans rich in fatty meats and cheese, which are often the default when patients are encouraged to reduce carbohydrate intake (or horrifyingly, to eliminate them!) I always joke with my patients that when carbohydrate counting, all the carbohydrates should not come from ice cream sundaes from the local drive-thru.
Recognizing that one food plan does not fit all patients is important to our message delivery. With our increased understanding of “nutrition meets genetics,” we can begin to listen once again to the patient, adjust their food plan to meet their needs, coach them through eating real food, and work with them in minimizing the intake of foods that lack nutrient density. As we have all known for a long time, there is no tear off sheet for nutrition and diabetes. It is our job to help the patient find a way to incorporate nutrient rich foods into their daily lives, help to minimize blood glucose excursions and promote overall health.