DIABETES-Diet - 1 October 2010
TYPE I
PREVENTION
Cows milk too early- lose immunoprotective effect of breast milk leaving the b-cells more prone to attack via chemicals or possibly viruses
Such chemicals include nitrosamines which are used as an antibacterial agent in bacon and cured meats
TREATMENT
Aside from applying the concepts of adequacy, balance, variety, moderation, calorie control, nutrient density and correct insulin dosing (amount and timing of insulin) there is very little else one can do
So emphasis will be on type II diabetes where diet plays a much more significant role in the prevention and management of type II diabetes
TYPE 2
CALORIC INTAKE
CARBOHYDRATE
FIBRE
SWEETENERS
PROTEIN
FAT
ALCOHOL
SODIUM
VITAMINS AND MINERALS
CALORIC INTAKE
Weight loss is the primary consideration here- exercise is also critical not just a hypocaloric diet
As body fat drops –insulin sensitivity increases
CARBOHYDRATE
Restricting simple carbohydrates is not necessary
Substituting simple carbohydrates for complex carbohydrates has no impact on blood glucose levels
Starches have higher glycemic index than fruits milk or fructose
Fructose has a lower glycemic index than sucrose
Total carbohydrates is the issue in blood sugar control with an emphasis on lower glycemic index foods
FIBRE
Soluble fibre (eg oats) inhibit glucose absorption believed to be clinically insignificant
But more fibre tends to crowd out higher fat foods in diet
Impact on HDLc, VLDL, chylomicrons, total triglycerides and small dense LDL
SWEETENERS
Watch out for total sweetener load calories- if too many of these calories do get body fat increases
Other alternatives like sugar alcohols (eg sorbitol, mannitol and xylitol) cannot be dissolved in water- they must be dissolved in fat- what are the implications for this dissolution in fat?
PROTEIN
In uncontrolled type II diabetes there is increased gluconeogenesis- protein to glucose conversion
However there is no evidence to suggest that there be any alteration in the Canadian recommendation of 0.8 grams of protein/kg body weight/day
FAT
Fat to fat conversion-relatively efficient- therefore risk of obesity from this nutrient is higher than with same intakes of other nutrients
Keep saturated fats to less than 10 % of total calories
Saturated fats tend to exacerbate the dyslipidemia of type II diabetes
Increased PUFAs gives increased flexibility of insulin receptor
-increased HDLc
-decreased triglycerides and hence increased LDL size
-decreased post-prandial lipemia
ALCOHOL
Can get elevation of triglycerides- which leads to ?
Get more body fat with excess consumption
SODIUM
Lowering of sodium intake in sodium sensitive persons
Sodium elevates blood pressure in such persons
Blood pressure is elevated in type II diabetes in part due to obesity
VITAMINS AND MINERALS
Beta-carotene, C, and E tend to be lower in plasma of type II diabetics
-type II patients may benefit-how?
Chromium believed to increase insulin sensitivity but type II diabetics are associated with chromium deficiencies
Magnesium replacement may be required for patients with poor glycemic control or those receiving diuretics- magnesium deficiency has been associated with plasma insensitivity which may improve with oral supplementation.