Nutrition Recommendation

s for Diabetes Mellitus

Northeastern University

Table of Contents

Objectives

Medical Nutrition Therapy

Nutrient Distribution

Carbohydrates

Meal Planning

Healthy Eating Plate

References

Objectives

Inform health care providers of effective nutrition recommendations for diabetic patients

Provide guidelines for serving sizes and meal content

Present sources of quality carbohydrates, fats, and proteins

Use knowledge to create a basic nutrition outline for patients

Medical Nutrition Therapy (MNT)

Goals

Translate data and pertinent evidence into nutrition care

Develop healthy eating habits and lifestyle changes

Achieve normal levels of:Blood glucose

Blood pressure

Lipids and lipoproteins

Prevent development of chronic complications

Meet individual nutritional requirementsMaintain pleasure of eating

Do not limit food choices

Medical Nutrition Therapy (MNT)

Effectiveness

Reduction of HbA1c by 1-2%

Fasting plasma glucose level decreased by 50-100 mg/dL

Average weight loss of 5 kg after 3 months

Most effective when implemented early in the disease course

Still beneficial at any point during treatment

Greater impact on weight loss and metabolic control compared to other interventions

Nutrient Distribution

Caloric intake: 50% carbohydrates, 30% fat, 20% protein

Percentages can be adjusted based on comorbiditiesPatients with nephropathy should consume at most .8 g/kg in protein

Monitor lipid profiles of patients at risk for CVD and adjust accordingly

No evidence to show long term effectiveness of low-carb diets in diabetics

Very low-carb diets pose risk of ketosis

Micronutrient supplements are only advised for patients with a diagnosed deficiency

Carbohydrates

Minimum of 130 g/dayProvides sufficient fuel for central nervous system

Total carbohydrates in meals more important than source

Added sugars should be less than 25% of total calories consumed

High soluble fiber diets beneficial (>25 g/day)

Reduces postprandial glycemia

Lowers LDL cholesterol

Carbohydrates1 Serving (15 g)

1 slice of bread or 1 tortilla

1/2 cup of oatmeal

1/3 cup of pasta or rice

1/2 cup of beans, corn, potato

1/4 large baked potato

1 cup of soup

4-6 crackers

1 small fruit (apple)

1/2 cup of canned or frozen fruit

1 cup of skim or 1% milk

2/3 cup of plain fat-free yogurt

1/4 serving of medium french fries

3/4 cup of unsweetened cereal

1/2 cup casserole

3 cups of popcorn

6 chicken nuggets

3/4 oz. of chips

1/2 cup of ice cream

2 inch square brownie or cake

2 small cookies

1 Tbsp. syrup, jelly, jam, honey

Meal PlanningDaily caloric intake deduced from patient height, weight, and activity level

Usually around 1800-2000 kcal

Three meals per day with two snacksFour servings of carbs per meal (60 g)

One serving of carbs per snack (15 g)

Consistent mealtimes

Each macronutrient should be represented in every meal

Smaller portions to prevent weight gain

Cholesterol intake < 200 mg/day

Sodium intake < 2300 mg/ day

Meal Planning

Healthy Eating PlateSuggested foods

Whole grains rather than enriched, white grains

Oats, whole wheat bread or pasta, popcorn

Quinoa, brown rice, whole grain cereal or crackers

Non-starchy vegetables

Negligible amount of carbs (~5 g per 2 servings)

Asparagus, green beans, broccoli, carrots, cauliflower

Spinach, lettuce, squash, tomatoes, mushrooms

High fiber foods

Fruits (with skin), whole wheat grains, vegetables

Legumes, nuts, seeds

Healthy Eating PlateFat/ Healthy Oils

Saturated fat intake should be <7% of total calories

All trans fatty acids should be eliminatedTrans fats shown to raise LDL and lower HDL levels

Foods high in Ω-3 polyunsaturated fatty acids encouragedFish, walnuts, soy, leafy greens

Foods prepared with unsaturated fatty acids rather than butter

Olive, sesame, peanut, canola oils

Foods with plant sterols should replace normal choices when possible

LDL lowering effects

Fortified spreads, yogurt, milk, dressings

Healthy Eating Plate

Healthy Protein

Poultry, lean pork, and fishNegligible carbs and low in fat

Low amounts of red and preserved meats

High in saturated fat and sodium

Plant sourcesSoy, quinoa, legumes, nuts

Still counts toward carb total

Beverages

1% milk rather than skimGastric emptying delayed

Smaller spikes in blood sugar

3 L of water intake per day Needed for high fiber diet

Moderate consumption of coffee and tea okay

Non-sugar sweeteners

Alcohol use discouragedMaximum one drink for female, two for male

Always consume with food

ReferencesPastors J.G., Warshaw H., Daly A., Franz M., & Kulkarni K. (March 2002). The evidence for the effectiveness of medical nutrition therapy in diabetes management. Diabetes Care, 25, 608–613. doi: 10.2337/diacare. 25.3.608

Franz M.J., Bantle J.P., Beebe C.A., Brunzell J.D., Chiasson J.L., Garg A., ... Wheeler M. (Janurary 2002). Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care, 25, 148–198. doi: 10.2337/diacare.25.1.148

American Diabetes Association. (2014). Carbohydrate Counting. Retrieved February 13, 2014, from http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/

carbohydrate-counting.html

Food Insight. (2007, July 1). Functional Foods Fact Sheet: Plant Stanols and Sterols. Retrieved February 21, 2014, from http://www.foodinsight.org/Resources/Detail.aspx?

topic=Functional_Foods_Fact_Sheet_Plant_Stanols_and_Sterols

Diabetes Care. (2008, January). Nutrition Recommendations and Interventions for Diabetes. Retrieved February 14, 2014, from http://care.diabetesjournals.org/content/31/Supplement_1/S61.full#ref-1

National Kidney Foundation, Inc. (2007). KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Retrieved February 14, 2014, from http://www.kidney.org/professionals/kdoqi/guideline_diabetes/guide5. htm

[Healthy Eating Plate photograph]. (2014). The Nutrition Source. Retrieved February 15, 2014, from http:// www.hsph.harvard.edu/nutritionsource/

References[Untitled photograph of a glucose molecule]. (n.d.). Retrieved February 13, 2014, from http:// lifefermented.wordpress.com/2013/06/11/diy-belgian-candy-syrup-1-sugar-science/

[Untitled photograph of a pancreas, stomach, and artery]. (n.d.). Retrieved February 13, 2014, from http://healingisessential.com/tag/diabetes/

[Untitiled photograph of a triglyceride molecule]. (2006). Retrieved February 13, 2014, from http://en.wikipedia.org/wiki/File:Trimyristin-3D-vdW.png

[Untitled photograph of body with healthy food]. (n.d.). Retrieved February 15, 2014, from http://wanabfitnow.wordpress.com/2011/08/

[Untitled photograph of carbohydrate sources]. (n.d.). Retrieved February 13, 2014, from http:// www.macronutrients.net/carbohydrates/

[Untitled photograph of protein sources]. (n.d). Retrieved February 21, 2014, from http:// www.functionalfitmag.com/blog/2012/07/30/protein-foods-protein-powder-2/

[Untitled photograph of the DHRS7B protein]. (2012). Retrieved February 13, 2014, from http://en.wikipedia.org/wiki/File:DHRS7B_homology_model.png

Reflective LetterThe audience I designed this document for is practicing physicians,

mainly those who treat patients with diabetes. The idea for this power point presentation came during a lecture in my nutrition course. I assumed that all physicians knew the physiological mechanisms through which diabetes occurs, but I wondered if they knew enough about nutrition to advise their patients on the maintenance of the disease. Physicians will provide more balanced care if they were also able to give nutritional advice.

This presentation provides physicians with guidelines for healthy foods, serving sizes, and meal components. I know that most physicians do not have a lot of time to spend with each patient. That is why I tried to make the presentation straightforward and concise, in order to relay the most important facts quickly. I focused on listing foods in each category so anyone referencing this presentation can also provide details regarding the makeup of a healthy diet. The information will hopefully be easily internalized and transferred to patients. I hope this knowledge will be used to facilitate healthier eating habits in diabetic patients.

This presentation may be encountered on a website which covers diabetes or nutritional information, like the American Diabetes Association. I think it works well as a crash course in nutrition; well rounded but not too complex. Since it is not a large file it is possible to download it or send it in an email for future reference. Going along that idea, if one physician finds the presentation useful then he can easily spread it to his peers. Individual slides might be printed off for reference within a clinic like the serving size list.

Overall I think this presentation will go well in my professional portfolio. It shows range in my ability to work with different genres and audiences.