New 2018 Diabetes Canada Guidelines - Nutrition Therapy
>> Monday, May 7, 2018
It's hard to know how to eat right - there is a lot of conflicting information out there, and unfortunately lots of claims that have no scientific backing nor evidence of long term success.
Eating well with diabetes is no exception.
Thankfully, we have the Diabetes Canada Clinical Practice Guidelines to give us evidence based recommendations on healthy eating with diabetes.
The updated Nutrition Therapy chapter in the 2018 Guidelines contains a lot of great information. I really encourage interested readers to snuggle up with a cuppa to read the whole chapter, but let's go through some of the key points here:
1. Nutrition therapy can reduce hemoglobin A1C (the diabetes report card) by 1-2% (that's as much as 1-2 diabetes medications!)
2. The proportion of carbs vs protein vs fat should be flexible within the recommended ranges, and will depend on individual treatment goals and preferences.
3. Eating low glycemic index foods instead of high glycemic index foods helps to improve diabetes control.
NEW: Aim for a fibre intake of 30-50g per day, with 10-20g coming from soluble fibre, to improve blood sugars and cardiovascular risk.
4. Added sugars should be MAXIMUM 10% of total daily caloric intake.
5. Intensive health behaviour interventions in people with type 2 diabetes can improve weight, fitness, diabetes control, and cardiovascular risk factors.
6. NEW: People with diabetes should be encouraged to choose the dietary patterns that best align with their values, preferences, and treatment goals. (check out the new sections on ethnocultural diversity in Canada, and on Ramadan, as well!)
Here are some of my favourite Key Messages For People With Diabetes:
1. Try to prepare more of your meals at home, using fresh and unprocessed ingredients.
2. Prepare meals together and eat as a family. This is a good way to model healthy food behaviours to kids and teens, which can help reduce their risk of developing overweight or diabetes.
3. The best strategy is one that you can maintain long term.
4. With prediabetes and newly diagnosed type 2 diabetes, weight loss is the most important and effective dietary strategy if you have overweight or obesity. A weight loss of 5-10% may help to normalize blood sugars.
5. Diabetes friendly eating habits can improve blood sugars and decrease the risk of cardiovascular disease, including:
- select whole foods instead of processed
- avoid sugar sweetened beverages
- pay attention to both carbohydrate quantity, and quality (low glycemic index instead of high)
- considering learning how to count carbs
- preferred dietary fats are unsaturated - maximum saturated fats has now been increased to 9% of total calorie intake (previously 7%) - and avoid trans fats completely
- choose lean animal protein, and eat more vegetable protein
The data for many different diets/patterns of eating is reviewed, with many different types of diets being suggested for an improvement in type 2 diabetes control, including Mediterranean, vegetarian, and DASH diets, as well as diets that include pulses (eg beans), vegetables, fruits, and nuts. The details of what is in these diets is provided in the chapter, and available data in type 1 diabetes is reviewed as well. At the end of the day, the key is to choose a healthy way of eating that is in keeping with individual preferences, as this gives the greatest likelihood of being able to follow it long term.
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