Transcript Eating Strategies to Prevent and Control Diabetes

EATING STRATEGIES TO PREVENT
AND CONTROL DIABETES
Mireille Moreau RD, MSc Human Nutrition
[email protected]
DIABETES MELLITUS

A disease characterized by elevated blood
glucose levels and inadequate or ineffective
insulin
Type 1
Type 2
Prediabetes
5 -10% of cases
90-95% of cases
~5.4 million ppl
Autoimmune disorder
- little to no insulin
secretion
Lose sensitivity to
insulin
Impaired fasting
glucose, impaired
glucose tolerance
FPG ≥ 7.0mmol/L
2HPG ≥ 11.1mmol/L
FPG ≥ 7.0mmol/L
2HPG ≥ 11.1mmol/L
FPG ≥ 6.1-6.9mmol/L
2HPG 7.8-11mmol/L
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Definition, Classification and
Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome.
PREVALENCE OF DIABETES
THROUGHOUT THE WORLD
Age-standardized prevalence and number of cases of
diagnosed diabetes among individuals aged ≥ 1 year,
1998/99 to 2008/09 in Canada
Public Health Agency of Canada. Diabetes in Canada: Facts and figures from a public health perspective. Ottawa, 2011.
RISK FACTORS
Age ≥ 40 years
 Having a close relative who has type 2 diabetes;
 Member of a high-risk population (Aboriginal,
Hispanic, Asian, South Asian or African descent);
 History of prediabetes/ gestational diabetes;
 Heart disease;
 High blood pressure;
 High cholesterol or other fats in blood;
 Being overweight

Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes
Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes.
COMPLICATIONS OF DIABETES
Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes
Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes.
DIABETES: A SILENT DISEASE

Signs and symptoms can include
Unusual thirst
 Frequent urination
 Weight change
 Extreme fatigue or lack of energy

BUT

Early stages often present few or no warning signs
• Everyone over 40 years old OR younger people
with risk factors should be tested regularly
• Lifestyle modifications
Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes
Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes.
LIFESTYLE MODIFICATIONS
Thomas Ransom, Ronald Goldenberg, Amanda Mikalachki, Ally RH Prebtani Zubin Punthakoo. Canadian Diabetes
Association 2013 Clinical Practice Guidelines. Reducing the Risk of Developing Diabetes.
DIABETES AND OBESITY
EverGreenHealthTips (2014), Preventing type 2 diabetes. http://evergreenhealthtips.co.uk/diabetes/preventing-type-2-diabetes
DIET THERAPY FOR DIABETES
NUTRIENTS IN FOOD

Carbohydrate
Breaks down into glucose (sugar) in blood
 Glucose is our main source of energy
 Insulin is needed to use that energy
 3 types of carbohydrate

Sugars
 Starches
 Fibres

SOURCES OF CARBOHYDRATE

Starches
Bread
Rice
Potatoes
Legumes

Cereal & grains
Pasta
Corn
Flour
Sugars
Fruits
Milk
Vegetables
Yogurt
Sugars: table sugar, syrup,
honey, molasses

Fibres
Vegetables & fruits
Whole grains
Legumes
Nuts and seeds
FIBRE UP!
Plant material that is not digested
 No effect on blood glucose level
 Control of blood glucose concentrations
 Promotion of normal blood cholesterol
 Control of blood pressure
 Maintenance of a healthy bowel function
 Promotion of a healthy body weight
 We should eat 25-50g/d



Enjoy fruits and vegetables, beans and legumes and
whole grain products more often
Choose foods with at least 3-4g of fibre/serving
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Diet Therapy. Canadian Diabetes
Association.
NUTRIENTS IN FOOD

Protein
Building block for your body
 Helps slow down absorption of carbohydrates
 Helps to control appetite
 Main sources – Meat & alternatives, Milk & alternatives


Fat
Storage of energy
 Adds taste and texture to foods
 Main sources – Oils, butter, meat, milk products, nuts & seeds
 Different types of fats



Heart healthy fats – Polyunsaturated and monounsaturated
Fats to limit – Saturated and trans fats
EFFECT OF NUTRIENTS ON BLOOD SUGAR

Carbohydrate





Changes into glucose (sugar) in the blood
Sugars – 5 minutes to exit the stomach
Starches – 30 minutes to exit the stomach
Fibres – not digested = no effect on blood sugar
Protein
Can change into glucose if too much is eaten
 50% of protein breaks down into glucose after 6-8 hours


Fat

Minimal effect on blood glucose
To help control blood sugars, meals should include a
balance of carbohydrate, protein and fat
TRUE OR FALSE?
If I have prediabetes or diabetes, I should avoid
sugar and sugar-containing foods
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Diet Therapy. Canadian Diabetes
Association.
PLATE METHOD
(Canadian Diabetes Association, 2008)
PORTION SIZES
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Portion Guide. Canadian
Diabetes Association.
REGULAR MEALS

Eat 3 meals per day at regular times
Space meals no more than 6 hours apart
 Spread carbohydrate evenly throughout the day


Include 3-4 food groups at meals
Eat balanced meals
 Complex carbohydrate and lean protein


Include snacks between meals


Include 1-2 food groups
Quench your thirst with water
CARBOHYDRATE DISTRIBUTION IS IMPORTANT
TO CONTROL YOUR BLOOD SUGARS.
D
BLOOAR
SUG
20
TIME
DIET THERAPY FOR PEOPLE WITH DIABETES
 Controlled
in total carbohydrates
 Low in saturated and trans fats

≤ 7% of kcal from sat fats
 Adequate

in protein
15-20% of total energy intake or 0.8-1.5g/kg/d
 Adequate
in nutrients from foods
 Adequate in fibre
 Moderate in added sugars
 Limited salt intake

1500-2300mg/d
 Moderate
alcohol intake
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Diet Therapy. Canadian Diabetes
Association.
WHERE DO WE START?
Copyright © 2012 by Nelson
Education Ltd.
EATING WELL WITH CANADA’S FOOD
GUIDE
Copyright © 2012 by Nelson Education
Ltd.
23
FRUITS AND VEGETABLES
High in Fibre
High in vitamins, minerals and antioxidants

Eat at least one dark green and one orange
vegetable each day

Eat your fruits and vegetables with the peel

Eat vegetables raw, steamed, or boiled in a small
amount of water

Eat the fruit/vegetable, don’t drink it!
CFG recommends:

Eating a minimum of 5-10 servings/d
WHOLE GRAINS AND CEREALS
High in Fibre
High in B vitamins
CFG recommends:
 Making at least half of your grain products whole
grain each day.
• Eat a variety of whole grains such as barley, brown
rice, oats, quinoa and wild rice.
• Enjoy whole grain breads, oatmeal or whole wheat
pasta.
MEATS AND ALTERNATIVES
Main source of protein
CFG recommends:
 Having meat alternatives (plant-based protein)
often such as soy, beans, legumes, nuts and
seeds
 Having
 Choose
at least 2 servings of fish each week
meats and alternatives prepared with
little or no added fat, sugar, or salt
MEATS AND ALTERNATIVES

Animal protein
High in saturated fats
 High in cholesterol


Plant protein
Low in saturated fats
 No cholesterol
 High in phytosterols


Increase your risk of
heart disease
Fatty fish

Major source of omega-3 FA
Decrease your risk
of heart disease
Decrease your risk
of heart disease
FATS

Limit consumption of “bad” saturated fats


Animal fats and the tropical oils of coconut and palm
contain mostly saturated fatty acids
Choose “healthy” mono- and polyunsaturated fats
Some vegetable oils such as olive and canola oils are
rich in monounsaturated fats
 Many vegetable oils are rich in polyunsaturated fats

Safflower oil
 Sunflower oil
 Corn oil
 Soybean oil
 Cottonseed oil

MILK AND ALTERNATIVES
 Major source of calcium and vitamin D for healthy
bones
 Source of protein
CFG recommends:
 Choosing 2-3 servings of milk and alternatives each
day


Calcium requirements


Choose low-fat (skim, 1%) more often
Adults age 19-50: 1000mg/day
Vitamin D requirements

Adults age 19-70: 600IU/day
READ NUTRITION LABELS
(Health Canada, 2010)
READ NUTRITION LABELS
(Health Canada, 2010)
GLYCEMIC INDEX
GLYCEMIC INDEX (GI)
 Scale
that ranks how
much carbohydrate-rich
food raises blood sugar
 Limitations

of GI
Resist notion of “good” or
“bad” foods
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Glycemic Index. Canadian
Diabetes Association.
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Glycemic index. Canadian
Diabetes Association.
WHICH FOOD HAS THE LOWEST GI?
WHICH FOOD HAS THE LOWEST GI?
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Glycemic index. Canadian
Diabetes Association.
NONNUTRITIVE SWEETENERS
SUGAR ALCOHOLS
Neither sugars nor alcohols
 Naturally found in fruits and vegetables


Erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol,
xylitol
Used to sweeten foods labelled “sugar free” or “no
added sugar”
 Provide fewer calories and a lower glycemic
response compared with sugar
 Safer for teeth than sugar
 Over 10g/day may cause: gas, abdominal
discomfort, and diarrhea

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Nutrition Therapy. Canadian
Diabetes Association.
ARTIFICIAL SWEETENERS
 Sugar




substitute
Aspartame
Acesulfame-potassium
Saccharin (Sweet’ n Low)
Sucralose (Splenda)
 Sweeten
foods with negligible, if any
calories
 Concerns about their use in large amounts
 Appetite stimulants
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Nutrition Therapy. Canadian
Diabetes Association.
ALCOHOL
ALCOHOL
 Alcohol


can:
Provide empty calories
Increase blood pressure and triglycerides
 Recommendations

•
•
Limit to 1-2 drinks/d
Drink slowly
Always eat
carbohydrate-rich
foods when
drinking alcohol
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Alcohol. Canadian Diabetes
Association.
PHYSICAL ACTIVITY
PHYSICAL ACTIVITY
 Regular
physical activity will help you
achieve/maintain a healthy body weight and
will improve your blood glucose control
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Physical Activity and Exercise.
Canadian Diabetes Association.
PHYSICAL ACTIVITY GUIDELINES

The Canadian Diabetes Association Clinical
Practice Guidelines recommend


150 minutes of aerobic exercise at moderate intensity
Moderate intensity
Vigorous intensity
Brisk walking
Jogging
Bike riding
Cross-country skiing
Continuous swimming
aerobics
3 sessions of resistance exercise per week

Progress to 3 sets of 8 repetitions at heavier weight
Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. 2013. Physical Activity and Exercise.
Canadian Diabetes Association.
FOR MORE INFORMATION

Canadian Diabetes Association Website

http://www.diabetes.ca/
THANK YOU!