Free low carbohydrate diet plans
However, long-term weight loss is difficult for most people to accomplish. (B). Intrinsic variables that influence the effect of carbohydrate-containing foods on blood glucose response include the specific type of food ingested, type of starch (amylose versus amylopectin), style of preparation (cooking method and time, amount of heat or moisture used), ripeness, and degree of processing. NUTRITION RECOMMENDATIONS FOR THE MANAGEMENT OF DIABETES (SECONDARY PREVENTION) Carbohydrate in diabetes management Recommendations. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. S ( 26 ) strongly support the potential for moderate weight loss to reduce the risk for type 2 diabetes. Very-long-chain n-3 polyunsaturated fatty acid studies in individuals with diabetes have primarily used fish oil supplements. For unplanned exercise, intake of additional carbohydrate is usually needed. The 1-year follow-up data also indicate that the macronutrient composition of the treatment groups only differed with respect to carbohydrate intake (mean intake of 230 vs. Evening consumption of alcohol may increase the risk of nocturnal and fasting hypoglycemia, particularly in individuals with type 1 diabetes ( 70 ). It is recommended that a registered dietitian, knowledgeable and skilled in MNT, be the team member who plays the leading role in providing nutrition care. The importance of controlling body weight in reducing risks related to diabetes is of great importance. The long-term benefits and risks of bariatric surgery in individuals with pre-diabetes or diabetes continue to be studied. For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. Moreover, the variability in responses to specific carbohydrate-containing food is a concern ( 48 ). (A). No nutrition recommendation can be made for preventing type 1 diabetes. Adobe Flash Player is required to view this feature. However, meal replacement therapy must be continued indefinitely if weight loss is to be maintained. Goals of MNT that apply to individuals with diabetes. This is probably because the central nervous system plays an important role in regulating energy intake and expenditure. Adobe Flash Player is required to view this feature. (B). (A). The amount of carbohydrate ingested is usually the primary determinant of postprandial response, but the type of carbohydrate also affects this response. The use of glycemic index and load may provide a modest additional benefit over that observed when total carbohydrate is considered alone. Adobe Flash Player is required to view this feature. Adobe Flash Player is required to view this feature. Clinical trials of such interventions are ongoing in children. Individual variability in response to high-carbohydrate diets suggests that the plasma triglyceride response to dietary modification should be monitored carefully, particularly in the absence of weight loss. Similarly, a meta-analysis of randomized controlled trials failed to demonstrate any benefit of chromium picolinate supplementation in reducing body weight ( 81 ). (C). If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Adobe Flash Player is required to view this feature. This position statement provides evidence-based recommendations and interventions for diabetes MNT. In addition, available data do not support the use of antioxidant supplements for CVD risk reduction ( 74 ). Weight loss with behavioral therapy alone also has been modest, and behavioral approaches may be most useful as an adjunct to other weight loss strategies. In one study, those subjects with type 2 diabetes demonstrated a greater decrease in A1C with a low-carbohydrate diet than with a low-fat diet ( 20 ). However, carbohydrate coingested with alcohol may raise blood glucose. (B). In select groups such as the elderly, pregnant or lactating women, strict vegetarians, or those on calorie-restricted diets, a multivitamin supplement may be needed ( 1 ). Before being allowed on the market, all underwent rigorous scrutiny and were shown to be safe when consumed by the public, including people with diabetes and women during pregnancy. Chromium, other minerals, and herbs in diabetes management. Thus, weight loss is recommended for all such individuals who have or are at risk for diabetes. Two or more servings of fish per week (with the exception of commercially fried fish filets) ( 63, 64 ) can be recommended. For weight loss, either low-carbohydrate or low-fat calorie-restricted diets may be effective in the short term (up to 1 year). Use of sugar alcohols as sweeteners reduces the risk of dental caries. Low-carbohydrate diets might seem to be a logical approach to lowering postprandial glucose. Meal replacements (liquid or solid prepackaged) provide a defined amount of energy, often as a formula product. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Examples are meat, poultry, fish, eggs, milk, cheese, and soy. Since diabetes may be a state of increased oxidative stress, there has been interest in antioxidant therapy. Short-term studies have demonstrated that moderate weight loss (5% of body weight) in subjects with type 2 diabetes is associated with decreased insulin resistance, improved measures of glycemia and lipemia, and reduced blood pressure ( 13 ). However, the effects of high-protein diets on long-term regulation of energy intake, satiety, weight, and the ability of individuals to follow such diets long term have not been adequately studied. The few small clinical studies involving diabetes and functional foods thought to have high antioxidant potential (e. There is insufficient evidence to demonstrate efficacy of individual herbs and supplements in diabetes management ( 82 ). If you are using an operating system that does not support Flash, we are working to bring you alternative formats. However, there is no evidence that the amounts of sugar alcohols likely to be consumed will reduce glycemia, energy intake, or weight. Adobe Flash Player is required to view this feature. By testing pre- and postprandial glucose, many individuals use experience to evaluate and achieve postprandial glucose goals with a variety of foods. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Achieving nutrition-related goals requires a coordinated team effort that includes the person with diabetes and involves him or her in the decision-making process. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Potential methodological problems with the glycemic index have been noted ( 47 ). A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. However, given that population gene pools shift very slowly over time, the current epidemic of diabetes likely reflects changes in lifestyle leading to diabetes. S. This requires the use of the best available scientific evidence while taking into account treatment goals, strategies to attain such goals, and changes individuals with diabetes are willing and able to make. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. In metabolic studies in which energy intake and weight are held constant, diets low in saturated fatty acids and high in either carbohydrate or cis -monounsaturated fatty acids lowered plasma LDL cholesterol equivalently ( 1, 52 ). If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Because many individuals with type 2 diabetes are overweight and insulin resistant, MNT should emphasize lifestyle changes that result in reduced energy intake and increased energy expenditure through physical activity. The previous position statement with accompanying technical review was published in 2002 ( 1 ) and modified slightly in 2004 ( 2 ). Saturated and trans fatty acids are the principal dietary determinants of plasma LDL cholesterol. g. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. It must be clearly recognized that regardless of the macronutrient mix, total caloric intake must be appropriate to weight management goals. Plasma glucose monitoring can be used to determine whether adjustments in foods and meals will be sufficient to achieve blood glucose goals or if medication(s) needs to be combined with MNT. Foods with low glycemic indexes include oats, barley, bulgur, beans, lentils, legumes, pasta, pumpernickel (coarse rye) bread, apples, oranges, milk, yogurt, and ice cream. Intake of trans fat should be minimized. In overweight and obese insulin-resistant individuals, modest weight loss has been shown to improve insulin resistance. The best mix of carbohydrate, protein, and fat appears to vary depending on individual circumstances. For planned exercise, insulin doses can be adjusted. Third-party payers may not provide adequate benefits for sufficient MNT frequency and time to achieve weight loss goals ( 18 ). The importance of preventing type 2 diabetes is highlighted by the substantial worldwide increase in the prevalence of diabetes in recent years. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Individuals with diabetes should be aware of the importance of acquiring daily vitamin and mineral requirements from natural food sources and a balanced diet. Adobe Flash Player is required to view this feature. Exercise and physical activity, by themselves, have only a modest weight loss effect. However, heavy consumption of alcohol (greater than three drinks per day), may be associated with increased incidence of diabetes ( 42 ). Therefore, the use of added fructose as a sweetening agent in the diabetic diet is not recommended. Healthy lifestyle nutrition recommendations for the general public are also appropriate for individuals with type 2 diabetes. This statement updates previous position statements, focuses on key references published since the year 2000, and uses grading according to the level of evidence available based on the American Diabetes Association evidence-grading system. For planned exercise, reduction in insulin dosage is the preferred method to prevent hypoglycemia ( 86 ). (A). For those individuals seeking guidance as to macronutrient distribution in healthy adults, the Dietary Reference Intakes (DRIs) may be helpful ( 22 ). Both the quantity and the type or source of carbohydrates found in foods influence postprandial glucose levels. However, foods that contain carbohydrate are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability. The glycemic index of foods was developed to compare the postprandial responses to constant amounts of different carbohydrate-containing foods ( 46 ). Although low-fat diets have traditionally been promoted for weight loss, two randomized controlled trials found that subjects on low-carbohydrate diets lost more weight at 6 months than subjects on low-fat diets ( 19, 20 ). In individuals with diabetes, moderate alcohol consumption (when ingested alone) has no acute effect on glucose and insulin concentrations but carbohydrate coingested with alcohol (as in a mixed drink) may raise blood glucose. Thus, questions about the long-term effects on intake and metabolism, as well as safety, need further research. S. Studies of subjects with and without diabetes have shown that sugar alcohols produce a lower postprandial glucose response than sucrose or glucose and have lower available energy ( 1 ). Serum levels can readily detect the need for potassium or magnesium replacement, but detecting deficiency of zinc or chromium is more difficult ( 75 ). All cardiovascular risk factors except hypercholesterolemia improved in the surgical patients. (A). Several studies have demonstrated the potential for moderate, sustained weight loss to substantially reduce the risk for type 2 diabetes, regardless of whether weight loss was achieved by lifestyle changes alone or with adjunctive therapies such as medication or bariatricsurgery (see energy balance section) ( 1 ). The role of lifestyle modification in the management of weight and type 2 diabetes was recently reviewed ( 13 ). Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. A lipid and lipoprotein profile that reduces the risk for vascular disease. However, other well-designed studies have failed to demonstrate any significant benefit of chromium supplementation in individuals with impaired glucose intolerance or type 2 diabetes ( 79, 80 ). A 2004 ADA statement addressed the effects of the amount and type of carbohydrate in diabetes management ( 40 ). When calculating carbohydrate content of foods containing sugar alcohols, subtraction of half the sugar alcohol grams from total carbohydrate grams is appropriate. Therefore, it is important that health care providers be aware when patients with diabetes are using these products and look for unusual side effects and herb-drug or herb-herb interactions NUTRITION INTERVENTIONS FOR SPECIFIC POPULATIONS Nutrition interventions for type 1 diabetes Recommendations. Nutrition Recommendations and Interventions for Diabetes A position statement of the American Diabetes Association. Benefit from chromium supplementation in individuals with diabetes or obesity has not been clearly demonstrated and therefore can not be recommended. Blood glucose concentration following a meal is primarily determined by the rate of appearance of glucose in the blood stream (digestion and absorption) and its clearance from the circulation ( 40 ). Very-long-chain n-3 polyunsaturated fatty acid supplements have been shown to lower plasma triglyceride levels in individuals with type 2 diabetes who are hypertriglyceridemic. In addition, commercially available products are not standardized and vary in the content of active ingredients. Plant sterol and stanol esters block the intestinal absorption of dietary and biliary cholesterol. The primary goal with respect to dietary fat in individuals with diabetes is to limit saturated fatty acids, trans fatty acids, and cholesterol intakes so as to reduce risk for CVD. Abstention from alcohol should be advised for people with a history of alcohol abuse or dependence, women during pregnancy, and people with medical problems such as liver disease, pancreatitis, advanced neuropathy, or severe hypertriglyceridemia. Organization, delivery, and funding of lifestyle interventions are all issues that must be addressed. Since overweight and obesity are closely linked to diabetes, particular attention is paid to this area of MNT. A wide range of foods and beverages are now available that contain plant sterols. One alcohol containing beverage is defined as 12 oz beer, 5 oz wine, or 1. Individuals using rapid-acting insulin by injection or an insulin pump should adjust the meal and snack insulin doses based on the carbohydrate content of the meals and snacks. Two or more servings of fish per week (with the exception of commercially fried fish filets) provide n-3 polyunsaturated fatty acids and are recommended. A modified Mediterranean diet, in which polyunsaturated fatty acids were substituted for monounsaturated fatty acids, reduced overall mortality in elderly Europeans by 7% ( 59 ). Because of the effects of obesity on insulin resistance, weight loss is an important therapeutic objective for individuals with pre-diabetes or diabetes ( 12 ). In nondiabetic individuals, reducing saturated and trans fatty acids and cholesterol intakes decreases plasma total and LDL cholesterol. In individuals with diabetes, limit dietary cholesterol to. In other studies, when energy intake was reduced, the adverse effects of high-carbohydrate diets were not observed ( 53, 54 ). However, exercise and physical activity are to be encouraged because they improve insulin sensitivity independent of weight loss, acutely lower blood glucose, and are important in long-term maintenance of weight loss ( 1 ). No nutrition recommendations can be made for the prevention of type 1 diabetes at this time ( 1 ). Although the accompanying small rise in plasma LDL cholesterol is of concern, an increase in HDL cholesterol may offset this concern ( 60 ). Moderate amounts of alcohol, when ingested with food, have minimal acute effects on plasma glucose and serum insulin concentrations ( 42 ). (A). 120 g). Occasional use of alcoholic beverages should be considered an addition to the regular meal plan, and no food should be omitted. Monitoring carbohydrate, whether by carbohydrate counting, exchanges, or experienced-based estimation remains a key strategy in achieving glycemic control. Further research is needed to determine the long-term efficacy and safety of low-carbohydrate diets ( 13 ). Additionally, intake of other nutrients ingested with sucrose, such as fat, need to be taken into account, and care should be taken to avoid excess energy intake. Adobe Flash Player is required to view this feature. Although brain fuel needs can be met on lower-carbohydrate diets, long-term metabolic effects of very-low-carbohydrate diets are unclear, and such diets eliminate many foods that are important sources of energy, fiber, vitamins, and minerals and are important in dietary palatability ( 22 ). For individuals using insulin or insulin secretagogues, alcohol should be consumed with food to avoid hypoglycemia.
Dietary fat and cholesterol in diabetes management Recommendations. Sugar alcohols and nonnutritive sweeteners are safe when consumed within the daily intake levels established by the Food and Drug Administration (FDA). High-protein diets are not recommended as a method for weight loss at this time. For unplanned exercise, extra carbohydrate may be needed. Lifestyle changes characterized by increased energy intake and decreased physical activity appear to have together promoted overweight and obesity, which are strong risk factors for diabetes. Therefore, because of a lack of specific information, it is recommended that the dietary goals for individuals with diabetes be the same as for individuals with preexisting CVD, since the two groups appear to have equivalent cardiovascular risk. A number of studies in healthy individuals and in individuals with type 2 diabetes have demonstrated that glucose produced from ingested protein does not increase plasma glucose concentration but does produce increases in serum insulin responses ( 1, 66 ). Herbal preparations also have the potential to interact with other medications ( 83 ). For individuals using fixed daily insulin doses, carbohydrate intake on a day-to-day basis should be kept consistent with respect to time and amount. In diabetes management, it is important to match doses of insulin and insulin secretagogues to the carbohydrate content of meals. Individuals with type 2 diabetes are encouraged to implement lifestyle modifications that reduce intakes of energy, saturated and trans fatty acids, cholesterol, and sodium and to increase physical activity in an effort to improve glycemia, dyslipidemia, and blood pressure. The optimal macronutrient distribution of weight loss diets has not been established. Thus, saturated fatty acids trans fatty acids, and cholesterol intake. The DAFNE (Dose Adjustment for Normal Eating) study ( 85 ) demonstrated that patients can learn how to use glucose testing to better match insulin to carbohydrate intake. Although numerous studies have attempted to identify the optimal mix of macronutrients for the diabetic diet, it is unlikely that one such combination of macronutrients exists. Dietary protein and its relationships to hypoglycemia and nephropathy are addressed in later sections. NUTRITION RECOMMENDATIONS AND INTERVENTIONS FOR THE PREVENTION OF DIABETES (PRIMARY PREVENTION) Recommendations. Although structured lifestyle programs have been effective when delivered in well-funded clinical trials, it is not clear how the results should be translated into clinical practice. Adobe Flash Player is required to view this feature. Both the Finnish Diabetes Prevention study and the DPP focused on reduced intake of calories (using reduced dietary fat as a dietary intervention). (B). In individuals with type 2 diabetes, ingested protein can increase insulin response without increasing plasma glucose concentrations. A 2005 American Diabetes Association statement addresses diabetes MNT for children and adolescents with type 1 diabetes ( 88 ). Therefore, protein should not be used to treat acute or prevent nighttime hypoglycemia. Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. Health care providers should focus on nutrition counseling rather than micronutrient supplementation in order to reach metabolic control of their patients. Of note, reduced intake of fat, particularly saturated fat, may reduce risk for diabetes by producing an energy-independent improvement in insulin resistance ( 1, 33, 34 ), as well as by promoting weight loss. (E). Primary prevention interventions seek to delay or halt the development of diabetes. Use of meal replacements once or twice daily to replace a usual meal can result in significant weight loss. Chromium, potassium, magnesium, and possibly zinc deficiency may aggravate carbohydrate intolerance. To decrease the risk of diabetes and cardiovascular disease (CVD) by promoting healthy food choices and physical activity leading to moderate weight loss that is maintained. Increasing overweight and obesity in youth appears to be related to the increased prevalence of type 2 diabetes, particularly in minority adolescents. However, evidence is lacking to recommend a higher fiber intake for people with diabetes than for the population as a whole. , tea, cocoa, coffee) are inconclusive. Fiber, fructose, lactose, and fat are dietary constituents that tend to lower glycemic response. Although selected micronutrients may affect glucose and insulin metabolism, to date, there are no convincing data that document their role in the development of diabetes. To reduce risk of nocturnal hypoglycemia in individuals using insulin or insulin secretagogues, alcohol should be consumed with food. (B). Sucrose can be substituted for other carbohydrate sources in the meal plan or, if added to the meal plan, adequately covered with insulin or another glucose-lowering medication. Studies in individuals with diabetes demonstrating the effects of specific percentages of dietary saturated and trans fatty acids and specific amounts of dietary cholesterol on plasma lipids are not available. If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for women and two drinks per day or less for men). As for the general population, people with diabetes are encouraged to consume a variety of fiber-containing foods. Extrinsic variables that may influence glucose response include fasting or preprandial blood glucose level, macronutrient distribution of the meal in which the food is consumed, available insulin, and degree of insulin resistance. However, there are no published long-term studies in subjects with diabetes to prove benefit from the use of resistant starch. The type of alcohol-containing beverage consumed does not appear to make a difference. Secondary and tertiary prevention interventions include MNT for individuals with diabetes and seek to prevent (secondary) or control (tertiary) complications of diabetes. 5 oz distilled spirits. (E). Reduced calorie sweeteners approved by the FDA include sugar alcohols (polyols) such as erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol, xylitol, tagatose, and hydrogenated starch hydrolysates. A position statement of the American Diabetes Association. Adobe Flash Player is required to view this feature. The FDA has approved five nonnutritive sweeteners for use in the U. Although there are insufficient data at present to warrant any specific recommendations for prevention of type 2 diabetes in youth, it is reasonable to apply approaches demonstrated to be effective in adults, as long as nutritional needs for normal growth and development are maintained. However, at 1 year, the difference in weight loss between the low-carbohydrate and low-fat diets was not significant and weight loss was modest with both diets. Therefore, these foods are important components of the diet for individuals with diabetes. The goal of these recommendations is to make people with diabetes and health care providers aware of beneficial nutrition interventions. Prospective randomized clinical trials will be necessary to resolve this issue. (B). MNT, as illustrated in Table 1, plays a role in all three levels of diabetes-related prevention targeted by the U. Uncontrolled diabetes is often associated with micronutrient deficiencies ( 71 ). To date, research has not demonstrated that one method of assessing the relationship between carbohydrate intake and blood glucose response is better than other methods. (E). The glycemic loads of foods, meals, and diets are calculated by multiplying the glycemic index of the constituent foods by the amounts of carbohydrate in each food and then totaling the values for all foods. In addition to preventing diabetes, the DPP lifestyle intervention improved several CVD risk factors, including dsylipidemia, hypertension, and inflammatory markers ( 29, 30 ). In the Swedish Obese Subjects study, a 10-year follow-up of individuals undergoing bariatric surgery, 36% of subjects with diabetes had resolution of diabetes compared with 13% of matched control subjects ( 24 ). MNT is also an integral component of diabetes self-management education (or training). (A). Clinical trial data not only indicate the lack of benefit with respect to glycemic control and progression of complications but also provide evidence of the potential harm of vitamin E, carotene, and other antioxidant supplements ( 1, 72, 73 ). The risk of comorbidity associated with excess adipose tissue increases with BMIs in this range and above. Several methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation. (B). Soft gel capsules containing plant sterols are also available. The dietary intake of protein for individuals with diabetes is similar to that of the general public and usually does not exceed 20% of energy intake. These are acesulfame potassium, aspartame, neotame, saccharin, and sucralose. Reducing saturated fatty acids may also reduce HDL cholesterol. , lipid profile). If you are using an operating system that does not support Flash, we are working to bring you alternative formats. If individuals choose to use alcohol, intake should be limited to a moderate amount (less than one drink per day for adult women and less than two drinks per day for adult men). Insulin-to-carbohydrate ratios can be used to adjust mealtime insulin doses. (E). (E). Unfortunately, there are no studies examining the effects of dietary intervention on circulating levels of antioxidants and inflammatory biomarkers in diabetic volunteers. Clinical studies involving subjects without diabetes provide no indication that nonnutritive sweeteners in foods will cause weight loss or weight gain ( 51 ). (E). Care should be taken to avoid excess energy intake. Changes in serum triglyceride and HDL cholesterol were more favorable with the low-carbohydrate diets. Genetic susceptibility appears to play a powerful role in the occurrence of type 2 diabetes. A variety of methods can be used to estimate the nutrient content of meals, including carbohydrate counting, the exchange system, and experience-based estimation. (E). Blood glucose levels in the normal range or as close to normal as is safely possible. Adobe Flash Player is required to view this feature. The reduction in CVD does not appear to be due to an increase in plasma HDL cholesterol. Thus, very-low-calorie diets appear to have limited utility in the treatment of type 2 diabetes and should only be considered in conjunction with a structured weight loss program. Adobe Flash Player is required to view this feature. (A). When completed, this study should provide insight into the effects of long-term weight loss on important clinical outcomes. Although there are insufficient data at present to warrant any specific recommendations for the prevention of type 2 diabetes in youth, interventions similar to those shown to be effective for prevention of type 2 diabetes in adults (lifestyle changes including reduced energy intake and regular physical activity) are likely to be beneficial. Meta-analysis and expert committees also support a role for lifestyle modification in treating hypertension ( 7, 8 ). Because many individuals also have dyslipidemia and hypertension, reducing saturated and trans fatty acids, cholesterol, and sodium is often desirable. Department of Health and Human Services. (E). Therefore, these nutrition recommendations start by considering energy balance and weight loss strategies. Improvement in A1C without a significant increase in severe hypoglycemia was demonstrated, as were positive effects on quality of life, satisfaction with treatment, and psychological well-being, even though increases in the number of insulin injections and blood glucose tests were necessary. (E). However, it is important that all team members, including physicians and nurses, be knowledgeable about MNT and support its implementation. Further, individualization of the macronutrient composition will depend on the metabolic status of the patient (e. (E). Research including long-term trials is needed to assess the safety and potentially beneficial role of chromium, magnesium, and antioxidant supplements and other complementary therapies in the management of type 2 diabetes ( 71a, 71b ). The glycemic index of a food is the increase above fasting in the blood glucose area over 2 h after ingestion of a constant amount of that food (usually a 50-g carbohydrate portion) divided by the response to a reference food (usually glucose or white bread). Another study of overweight women randomized to one of four diets showed significantly more weight loss at 12 months with the Atkins low-carbohydrate diet than with higher-carbohydrate diets ( 20a ). A 2004 American Diabetes Association statement reviewed this issue in depth ( 40 ), and issues related to the role of glycemic index and glycemic load in diabetes management are addressed in more detail in the carbohydrate section of this document. Moreover, both moderate-intensity and vigorous exercise can improve insulin sensitivity, independent of weight loss, and reduce risk for type 2 diabetes ( 1 ). If alcohol is consumed, recommendations from the 2005 USDA Dietary Guidelines for Americans suggest no more than one drink per day for women and two drinks per day for men ( 45 ). A meta-analysis of studies of bariatric surgery reported that 77% of individuals with type 2 diabetes had complete resolution of diabetes (normalization of blood glucose levels in the absence of medications), and diabetes was resolved or improved in 86% ( 23 ). (E). Clinical trial data from both the Finnish Diabetes Prevention study ( 25 ) and the Diabetes Prevention Program (DPP) in the U. The first nutrition priority for individuals requiring insulin therapy is to integrate an insulin regimen into their lifestyle. Substantial evidence from clinical studies demonstrates that dietary sucrose does not increase glycemia more than isocaloric amounts of starch ( 1 ). GOALS OF MNT FOR PREVENTION AND TREATMENT OF DIABETES Goals of MNT that apply to individuals at risk for diabetes or with pre-diabetes. Importantly, the ratio of LDL cholesterol to HDL cholesterol is not adversely affected. Issues related to carbohydrate and glycemia have previously been extensively reviewed in American Diabetes Association reports and nutrition recommendations for the general public ( 1, 2, 22, 40, 45 ). g. For individuals receiving basal-bolus insulin therapy, the total carbohydrate content of meals and snacks is the major determinant of bolus insulin doses ( 84 ). (A). Palatability, limited food choices, and gastrointestinal side effects are potential barriers to achieving such high-fiber intakes. This involves public health measures to reduce the prevalence of obesity and includes MNT for individuals with pre-diabetes. Control of blood glucose in an effort to achieve normal or near-normal levels is a primary goal of diabetes management. Meal replacements are an important part of the Look AHEAD weight loss intervention ( 17 ). Although such diets may produce short-term weight loss and improved glycemia, it has not been established that these benefits are maintained long term, and long-term effects on kidney function for persons with diabetes are unknown. Blood pressure levels in the normal range or as close to normal as is safely possible. Fiber. Observational studies report that moderate alcohol intake may reduce the risk for diabetes, but the data do not support recommending alcohol consumption to individuals at risk of diabetes. If these products are used, they should displace, rather than be added to, the diet to avoid weight gain. There is, however, no reason to recommend that people with diabetes avoid naturally occurring fructose in fruits, vegetables, and other foods. Food and nutrition interventions that reduce postprandial blood glucose excursions are important in this regard, since dietary carbohydrate is the major determinant of postprandial glucose levels. When very-low-calorie diets are stopped and self-selected meals are reintroduced, weight regain is common. Thus, intake of sucrose and sucrose-containing foods by people with diabetes does not need to be restricted because of concern about aggravating hyperglycemia. The DPP analysis indicated that lifestyle intervention was cost-effective ( 31 ), but other analyses suggest that the expected costs needed to be reduced ( 32 ). (E). There is no clear evidence of benefit from vitamin or mineral supplementation in people with diabetes (compared with the general population) who do not have underlying deficiencies. 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. (B). It is, therefore, important at all levels of diabetes prevention (see Table 1 ). Nutrition counseling should be sensitive to the personal needs, willingness to change, and ability to make changes of the individual with pre-diabetes or diabetes. Glucose metabolism is not likely to be adversely affected. Insulin secretory response normally maintains blood glucose in a narrow range, but in individuals with diabetes, defects in insulin action, insulin secretion, or both impair regulation of postprandial glucose in response to dietary carbohydrate. If you are using an operating system that does not support Flash, we are working to bring you alternative formats. Excessive amounts of alcohol (three or more drinks per day), on a consistent basis, contributes to hyperglycemia ( 42 ). (A).
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