Description
Diabetes occurs at approximately the same rate in people experiencing homelessness as in the general population. However, the diagnosis and management of diabetes in people experiencing homelessness remains challenging. A diabetes diet is a healthy-eating plan that's naturally rich in nutrients and low in fat and calories. Key elements are fruits, vegetables and whole grains. In fact, a diabetes diet is the best eating plan for most everyone. For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat and following a meal plan. There is not a one-size-fits-all eating pattern for individuals with diabetes, and meal planning should be individualized. As an essential and integral role in overall diabetes management, individualized or group MNT should be offered by an RDN or Certified Diabetes Educator knowledgeable and skilled in providing diabetes-specific Medical Nutritional Therapy
Summary Listen
- The ADA's nutrition therapy goals for individuals with diabetes have evolved to be more flexible and patient-centric, focusing on promoting healthful eating patterns, nutrient-dense foods, appropriate portion sizes, and achieving weight goals to improve overall health and prevent complications. These goals emphasize individualized nutrition plans based on personal preferences, cultural backgrounds, health literacy, and the ability to make behavioral changes.
- Ideal macronutrient proportions for diabetic individuals involve 40-55% of calories from carbohydrates, 20-30% from proteins, and 20-30% from fats, with around 20g of fiber per 1000 calories daily. In India, carbohydrate intake often ranges from 61-67%, while fat ranges from 19-26% and protein from 14-16%. Limiting refined carbs and added sugars, with a focus on complex carbs from vegetables, legumes, fruits, and whole grains, is advised.
- Glycemic index (GI) ranks carb-containing foods on their potential to raise blood glucose. Studies show low-GI diets can reduce HbA1c levels. Glycemic load (GL) considers both GI and portion size, where a high GL is above 20, and a low GL is below 10. GI and GL should be considered when making food choices for individuals with diabetes.
- Resistant starches, found in unripe bananas and legumes, resist digestion in the small intestine, acting like fiber. It is suggested that resistant starch intake leads to a smaller postprandial glucose increase. Processing methods like drying, popping, and fermentation can decrease resistance starch and increase the glycemic index.
- ICMR-INDIAB study indicated that reducing carbs slightly can reverse diabetes. The aim was to achieve remission for newly diagnosed diabetes and pre-diabetes, with HbA1c levels below 6.5% and 5.6%, respectively. Fiber intake, around 20g per 1000 calories, can increase tissue sensitivity, satiety, and insulin receptor numbers.
- Protein flattens the glycemic response of food and has a high satiety index. Recommendations include lean protein sources at each meal, such as lean meat, eggs, pulses, legumes, or soy. Fat intake should be determined based on glucose, lipid, and weight goals.
- Diabetes food plates should consist of half the plate with non-starchy vegetables, a quarter with lean protein, and a quarter with complex carbohydrates. Choose locally and seasonally available foods.
- Low-carbohydrate and Mediterranean diets are the most studied eating patterns, often improving HbA1c levels. Very low carbohydrate diets led to less insulin use and glycemic variability. A Mediterranean style diet with less than 50% of total daily calories coming from carbs or a lowfat diet may have a better outcome than other diets.
- Eating order can also impact postprandial glucose and insulin excursions, with consuming protein and vegetables before carbohydrates showing lower glucose and insulin levels. Medical Nutrition Therapy (MNT), individualized education, and understanding personal preferences are key to effective and sustainable diabetes management.
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About the Speakers
Ms. Varsha Koppikar
Format Head - Nutrition Wellness at cure.fit (cult.fit) Clinical Nutritionist
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