Individuals with diabetes and dyslipidemia may be able to modestly reduce total and LDL cholesterol by consuming 1.63 g/day of plant stanols or sterols typically found in enriched foods. The amount of dietary saturated fat, cholesterol, and trans fat recommended for people with diabetes is the same as that recommended for the general population. Nutrition therapy that includes the development of an eating pattern designed to lower glucose, blood pressure, and alter lipid profiles is important in the management of diabetes as well as lowering the risk of CVD, coronary heart disease, and stroke. (A), Modest weight loss may provide clinical benefits (improved glycemia, blood pressure, and/or lipids) in some individuals with diabetes, especially those early in the disease process. The American Diabetes Association say that people with diabetes should follow the 2020-2025 Dietary Guidelines for Americans. (B). Eating & Nutrition for Hemodialysis - NIDDK Wylie-Rosett J, Segal-Isaacson CJ, Segal-Isaacson A: Carbohydrates and increases in obesity: does the type of carbohydrate make a difference? What to Know About Vitamin D and Type 2 Diabetes Risk - Healthline : no conflicts of interest to report. The development of standardized definitions for high and lowglycemic index diets and implementation of these definitions in long-term studies to further evaluate their impact on glycemic control. Six published RCTs that included individuals with type 2 diabetes reported improved glycemic control and/or blood lipids when MUFA was substituted for carbohydrate and/or saturated fats (70,72,83,100,108,172). Yu-Poth S, Zhao G, Etherton T, Naglak M, Jonnalagadda S, Kris-Etherton PM: Effects of the National Cholesterol Education Programs Step I and Step II dietary intervention programs on cardiovascular disease risk factors: a meta-analysis. Diabetes Ireland is the only national charity in Ireland dedicated to helping people with diabetes. The basis for the beneficial effects of the Mediterranean-style eating pattern and approaches to translation of the Mediterranean-style eating pattern into diverse populations. 2013 by the American Diabetes Association. Fructose is a monosaccharide found naturally in fruits. Can dietary fructans lower serum glucose? A variety of eating patterns have been shown modestly effective in managing diabetes including Mediterranean-style, Dietary Approaches to Stop Hypertension (DASH) style, plant-based (vegan or vegetarian), lower-fat, and lower-carbohydrate patterns (36,46,72,92,93). Many individuals do regain a portion of their initial weight loss (77,85). : no conflicts of interest to report. Nutrition interventions should emphasize a variety of minimally processed nutrient-dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term. According to the EAL, 5% energy replacement of saturated fatty acid (SFA) with MUFA improves insulin responsiveness in insulin-resistant and type 2 diabetic subjects (173). The Dietary Guidelines for Americans, 2010 defines whole grains as foods containing the entire grain seed (kernel), bran, germ, and endosperm (105). In people with type 2 diabetes, a Mediterranean-style, monounsaturated fatty acid (MUFA)-rich eating pattern may benefit glycemic control and CVD risk factors and can, therefore, be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern. Thus, RCTs do not support recommending omega-3 supplements for primary or secondary prevention of CVD despite the strength of evidence from observational and preclinical studies. (B), For individuals with both diabetes and hypertension, further reduction in sodium intake should be individualized. American Diabetes Association: Diabetes nutrition recommendations for health care institutions (Position Statement). Vessby B, Unsitupa M, Hermansen K, Riccardi G, Rivellese AA, Tapsell LC, Nalsen C, Berglund L, Louheranta A, Rasmussen BM, Calvert GD, Maffetone A, Pedersen E, Gustafsson IB, Storlien LH: Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: the KANWU study. Alberti KG, Zimmet P, Shaw J: The metabolic syndrome: a new worldwide definition. The evidence suggests that several different macronutrient distributions/eating patterns may lead to improvements in glycemic and/or CVD risk factors (88). (A), In individuals with type 2 diabetes, ingested protein appears to increase insulin response without increasing plasma glucose concentrations. (A), Monitoring carbohydrate intake, whether by carbohydrate counting or experience-based estimation, remains a key strategy in achieving glycemic control. Kleefstra N, Houweling ST, Jansman FG, Groenier KH, Gans RO, Meyboom-de Jong B, Bakker SJ, Bilo HJ: Chromium treatment has no effect in patients with poorly controlled, insulin-treated type 2 diabetes in an obese Western population: a randomized, double-blind, placebo-controlled trial. Therefore, collaborative goals should be developed with the individual with diabetes. : no conflicts of interest to report. Successful approaches should also include regular physical activity and behavioral interventions to help sustain improved lifestyles (11). Type 2 Diabetes Mellitus is a multifactorial disease that is typically linked to energy metabolism, particularly carbohydrate and fat management in the organism, however, most micronutrients are also involved in some way either as part of the cause or effect of this chronic pathology. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. Studies designed to reduce excess body weight have used a variety of energy-restricted eating patterns with various macronutrient intakes and occasionally included a physical activity component and ongoing follow-up support. CKD patients need regular blood tests for iron overload; for zinc, RDA = 8 mg (women); DRI = 8 mg (women CKD); 10 mg (men CKD) 15 mg (dialysis); for vitamin A, RDA = 900 mg; DRI = 700-900 mg (CKD); for vitamin A precursor (retinol and carotene, not defined RDA or DRI); for vitamin E, RDA = 11 mg (women) 15 mg (men), DRI = more than . For a review of the studies focused on a low-carbohydrate eating pattern, see the carbohydrates section. (B), o A simple diabetes meal planning approach such as portion control or healthful food choices may be better suited to individuals with type 2 diabetes identified with health and numeracy literacy concerns. There currently exists insufficient evidence of benefit from vitamin or mineral supplementation in people with or without diabetes in the absence of an underlying deficiency (3,193,194). Factors affecting interpretation of this research include small sample sizes (148,151) and study durations of less than 6 months (148150). Find support, ask questions and share your experiences with 350,000+ members of the diabetes community. This may also be an effective meal planning strategy for older adults. Further, individualization of the macronutrient composition will depend on the metabolic status of the individual (e.g., lipid profile, renal function) and/or food preferences. Regular doses of vitamin D (VTD)about 2000 IU/dearly in life have been shown to reduce the risk of developing type 1 diabetes (up to an 80% reduction projected over the next 30 years). More research on vegan and vegetarian diets is needed to assess diet quality given studies often focus more on what is not consumed than what is consumed. Further, studies used varying definitions of low and high glycemic index (11,88,126), and glycemic response to a particular food varies among individuals and can also be affected by the overall mixture of foods consumed (11,126). Grains and starches - RDA 6 to 11 servings per day. In addition, achieving blood pressure and lipid goals can help reduce risk for CVD events (9,10). Mayer-Davis EJ, DAntonio AM, Smith SM, Kirkner G, Levin MS, Parra-Medina D, Schultz R: Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. More research on eating patterns, unrestricted and restricted energy diets, and diverse populations is needed to evaluate their long-term health benefits in individuals with diabetes. NHS approved education and behaviour change app for people with type 2 diabetes, prediabetes, obesity. In 1999, the Institute of Medicine (IOM) released a report concluding that evidence demonstrates that medical nutrition therapy (MNT) can improve clinical outcomes while possibly decreasing the cost to Medicare of managing diabetes (19). WHO Expert Consultation: Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. (C), o Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. Of note, however, those randomized to the intervention experienced statistically significant weight loss, requiring less medication for glycemic control and management of CVD risk factors, and experienced several additional health benefits (e.g., reduced sleep apnea, depression, and urinary incontinence and improved health-related quality of life) (7982). In the absence of clear scientific evidence for benefit in people with combined diabetes and hypertension (230,231), sodium intake goals that are significantly lower than 2,300 mg/day should be considered only on an individual basis. Fructans are an indigestible type of fiber that has been hypothesized to have a glucose-lowering effect. Norris SL, Zhang X, Avenell A, Gregg E, Schmid CH, Kim C, Lau J: Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: a meta-analysis. A healthful eating pattern, regular physical activity, and often pharmacotherapy are key components of diabetes management. Rabasa-Lhoret R, Bourque J, Ducros F, Chiasson JL: Guidelines for premeal insulin dose reduction for postprandial exercise of different intensities and durations in type 1 diabetic subjects treated intensively with a basal-bolus insulin regimen (ultralente-lispro). 1 Vitamin D treatment has also improved glycemic control and insulin sensitivity in people with type 1 diabetes, people with type 2 . In one study, patients with type 2 diabetes were randomized to atorvastatin or placebo and/or omega-3 supplements (2 g/day) or placebo. : no conflicts of interest to report. Chromium - Health Professional Fact Sheet - Office of Dietary Some studies did not show improvement with a lowerglycemic index eating pattern; however, several other studies using lowglycemic index eating patterns have demonstrated A1C decreases of 0.2 to 0.5%. Nutrition therapy for the prevention of type 2 diabetes and for the management of diabetes complications and gestational diabetes mellitus is not addressed in this review. Based on a review of the evidence, it is clear that gaps in the literature continue to exist and further research on nutrition and eating patterns is needed in individuals with type 1 and type 2 diabetes. A systematic review (212) evaluating the effects of cinnamon in people with diabetes concluded there is currently insufficient evidence to support its use, and there is a lack of compelling evidence for the use of other herbal products for the improvement of glycemic control in people with diabetes (213). A summary of key topics for nutrition education can be found in Table 4. Proven in 7 studies. Guerrero-Romero F, Rodriguez-Moran M: Complementary therapies for diabetes: the case for chromium, magnesium, and antioxidants. Two studies reported no beneficial effects of supplementation (183,184). : consultant/advisory board with Boehringer Ingelheim, Eli Lilly, Type Free Inc., NIH/National Institute of Diabetes and Digestive and Kidney Diseases Advisory Council. Currently, the EAL from the Academy of Nutrition and Dietetics recommends individuals with dyslipidemia incorporate 23 g of plant sterol and stanol esters per day as part of a cardioprotective diet through consumption of plant sterol and stanol esterenriched foods (187). For females, they recommend 3-4 servings of carbohydrates, at 15 grams . These recommendations include reducing SFAs to <10% of calories, aiming for <300 mg dietary cholesterol/day, and limiting trans fat as much as possible (105). However, because foods high in sucrose are generally high in calories, substitution should be made in the context of an overall healthful eating pattern with caution not to increase caloric intake. The ADA also recognizes the integral role of nutrition therapy in overall diabetes management and has historically recommended that each person with diabetes be actively engaged in self-management, education, and treatment planning with his or her health care provider, which includes the collaborative development of an individualized eating plan (1,2). West SG, Hecker KD, Mustad VA, Nicholson S, Schoemer SL, Wagner P, Hinderliter AL, Ulbrecht J, Ruey P, Kris-Etherton PM: Acute effects of monounsaturated fatty acids with and without omega-3 fatty acids on vascular reactivity in individuals with type 2 diabetes. Recommended Daily Allowances for Pregnancy / Lactating Mothers. Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM: Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. For many individuals with diabetes, the most challenging part of the treatment plan is determining what to eat. The emphases of education and counseling should be on the development of behaviors that support long-term weight loss or weight maintenance with less focus on the outcome of weight loss. (138) conducted a systemic review and meta-analysis of controlled feeding trials to study the impact of fructose on glycemic control compared with other sources of carbohydrates. Abdollahi M, Farshchi A, Nikfar S, Seyedifar M. Effect of chromium on glucose and lipid profiles in patients with type 2 diabetes; a meta-analysis review of randomized trials. It is also a component of added sugars found in sweetened beverages and processed snacks. The Role of Micronutrients in Managing Diabetes One factor affecting interpretation of these studies was that actual protein intake differed from goal protein intake. This position statement was written at the request of the ADA Executive Committee, which has approved the final document. Data from the Nurses Health Study examining whole grains and their components (cereal fiber, bran, and germ) in relation to all-cause and CVD-specific mortality among women with type 2 diabetes suggest a potential benefit of whole-grain intake in reducing mortality and CVD (128). 250 grams: The typical American diet is more than 250 grams of carb per day. Honey and Diabetes: The Importance of Natural Simple Sugars in Diet for There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes who do not have underlying deficiencies. Therefore, it is important that patients/clients with diabetes report the use of supplements and herbal products to their health care providers. (C). Because diabetes is a condition where blood sugar levels are too high, it's all too easy to think eating too much sugar is the cause. Diabetic Nephropathy Protein itself does not have much of an effect on blood sugar levels, though the food the protein is in may. Studies examining fibers effect on CVD risk factors are mixed; however, total fiber intake, especially from natural food sources (vs. supplements), seems to have a beneficial effect on serum cholesterol levels and other CVD risk factors such as blood pressure (11,88,134). Trichopoulou A, Orfanos P, Norat T, Bueno-de-Mesquita B, Ocke MC, Peeters PH, van der Schouw YT, Boeing H, Hoffmann K, Boffetta P, Nagel G, Masala G, Krogh V, Panico S, Tumino R, Vineis P, Bamia C, Naska A, Benetou V, Ferrari P, Slimani N, Pera G, Martinez-Garcia C, Navarro C, Rodriguez-Barranco M, Dorronsoro M, Spencer EA, Key TJ, Bingham S, Khaw KT, Kesse E, Clavel-Chapelon F, Boutron-Ruault MC, Berglund G, Wirfalt E, Hallmans G, Johansson I, Tjonneland A, Olsen A, Overvad K, Hundborg HH, Riboli E, Trichopoulos D: Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. Tapsell LC, Gillen LJ, Patch CS, Batterham M, Owen A, Bare M, Kennedy M: Including walnuts in a low-fat/modified-fat diet improves HDL cholesteroltototal cholesterol ratios in patients with type 2 diabetes. Despite the potential glycemic and cardiovascular benefits of moderate alcohol consumption, use may place people with diabetes at increased risk for delayed hypoglycemia. Many foods marketed to people with diabetes may contain large amounts of fructose (such as agave nectar); these foods should not be consumed in large amounts to avoid excess caloric intake and to avoid excessive fructose intake. Eating patterns have also evolved over time to include patterns of food intake among specific populations to eating patterns prescribed to improve health. You can reduce waste buildup by controlling what you eat and drink. An American Heart Association and ADA scientific statement on NNS consumption concludes that there is not enough evidence to determine whether NNS use actually leads to reduction in body weight or reduction in cardiometabolic risk factors (146). Four studies reported no difference in GFR and/or albumin excretion rate (152155), while one smaller study found some potentially beneficial renal effects with a low-protein diet (156). DIRA has the specific aim of promoting, supporting, and funding research related to the causes, prevention, and cure of diabetes. A wide range of diabetes meal planning approaches or eating patterns have been shown to be clinically effective, with many including a reduced energy intake component. Cefalu WT, Hu FB: Role of chromium in human health and in diabetes. Pittler MH, Stevinson C, Ernst E: Chromium picolinate for reducing body weight: meta-analysis of randomized trials. There are no published long-term studies in subjects with diabetes to prove benefit from the use of fructans (135). Several RCTs have examined the effect of higher protein intake (2840% of total energy) to usual protein intake (1519% total) on diabetes outcomes. Ryan GJ, Wanko NS, Redman AR, Cook CB: Chromium as adjunctive treatment for type 2 diabetes. Mooradian AD: Micronutrients in diabetes mellitus. Such studies are not available among individuals with diabetes; however, there is little reason to suspect that the diabetic state would mitigate the adverse effects of SSBs. Definition of RDA. Mayer-Davis EJ, Dhawan A, Liese AD, Teff K, Schulz M: Towards understanding of glycaemic index and glycaemic load in habitual diet: associations with measures of glycaemia in the Insulin Resistance Atherosclerosis Study. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K: Bariatric surgery: a systematic review and meta-analysis. Therefore, carbohydrate sources high in protein should not be used to treat or prevent hypoglycemia. Tariq SH, Karcic E, Thomas DR, Thomson K, Philpot C, Chapel DL, Morley JE: The use of a no-concentrated-sweets diet in the management of type 2 diabetes in nursing homes. The Mediterranean-style eating pattern reported the largest improvement of A1C at 1 year (1.2%) (72), and the Look AHEAD study intensive lifestyle intervention reported the next largest improvement (0.64%) (76). (A). In one small study in people with type 2 diabetes, the DASH eating plan, which included a sodium restriction of 2,300 mg/day, improved A1C, blood pressure, and other cardiovascular risk factors (46). Several RCTs comparing protein levels in individuals with diabetic kidney disease with either micro- or macroalbuminuria had adequately large sample sizes and durations for interpretation. In terms of glycemic control, Cozma et al. Carbohydrate Counting with Chronic Kidney Disease Individuals eat combinations of foods, not single nutrients, and thus it is important to study diet and disease relationships (95). The two face-to-face meetings and the travel of the writing group and teleconference calls were supported by the ADA. Beneficial effects on total, LDL cholesterol, and non-HDL cholesterol have been observed in four RCTs (188191). There is now abundant evidence from studies of individuals without diabetes that because of their high amounts of rapidly absorbable carbohydrates (such as sucrose or high-fructose corn syrup), large quantities of SSBs should be avoided to reduce the risk for weight gain and worsening of cardiometabolic risk factors (140142). However, two trials reported no improvement in CVD risk factors (149,151). If you have diabetes, it is important to learn about carbohydrates found in food. Effective nutrition therapy interventions may be a component of a comprehensive group diabetes education program or an individualized session (14,2938,4042,44,45). This recommendation, though not specific to people with diabetes, is based on a review of 20 clinical trials (187). Adults with diabetes choosing to consume alcohol should limit their intake to one serving or less per day for women and two servings or less per day for men (105). In terms of specific effects of fructose, concern has been raised regarding elevations in serum triglycerides (143,144). This may need to be adjusted over time based on changes in life circumstances, preferences, and disease course. Long-term reduction of adiposity is difficult for most people to achieve, and even harder for individuals with diabetes to achieve given the impact of some medications used to improve glycemic control (e.g., insulin, insulin secretagogues, and thiazolidinediones) (59,60). Reed RL, Mooradian AD: Management of diabetes mellitus in the nursing home. (B). Sjostrom L, Lindroos AK, Peltonen M, Torgerson J, Bouchard C, Carlsson B, Dahlgren S, Larsson B, Narbro K, Sjostrom CD, Sullivan M, Wedel H: Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. Wolf AM, Conaway MR, Crowther JQ, Hazen KY, Nadler L, Oneida B, Bovbjerg VE: Translating lifestyle intervention to practice in obese patients with type 2 diabetes: Improving Control with Activity and Nutrition (ICAN) study. Furthermore, the academy reviewed 28 studies that showed no adverse effects with plant stanol/sterol consumption (187). (C). The IOM recommended that individualized MNT, provided by an RD upon physician referral, be a covered Medicare benefit as part of the multidisciplinary approach to diabetes care (19). Magnesium - Health Professional Fact Sheet - Office of Dietary Therefore, it is important that all members of the health care team be knowledgeable about diabetes nutrition therapy and support its implementation. RDA | definition of RDA by Medical dictionary These studies used doses of 1.63 g of phytosterols or stanols per day, and interventions lasted 312 weeks. For patients with diabetes at risk for CVD, diets high in fruits, vegetables, whole grains, and nuts may reduce the risk. Nutrition therapy goals should be developed collaboratively with the individual with diabetes and be based on an assessment of the individuals current eating patterns, preferences, and metabolic goals. Use of nonnutritive sweeteners (NNSs) has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other food sources. However, a study comparing diets with a high proportion of omega-3 (fatty fish) versus omega-6 (lean fish and fat-containing linoleic acid) fatty acids reported both diets had no detrimental effect on glucose measures, and both diets improved insulin sensitivity and lipoprotein profiles (185). M.J.F. Not all weight loss interventions reviewed led to improvements in A1C at 1 year (35,68,70,71,74,75), although these studies tended to achieve less weight loss.
