Diabetes and nutrition - not a one-size-fits-all approach

March is National Nutrition Month and Lovelace Medical Group dietitian Teresa Anderson, RDN, LDN, CDE explains why this is an important time to take stock of your dietary needs, especially when living with diabetes. “Nutrition plays a vital role in helping or hurting your diabetes management,” explains Anderson. “First, it is vital we consume ‘high-value’ foods – foods that are loaded with nutrients. We all have genetic risks and lifestyle risks for certain health problems or diseases ranging from cancers, dementia and heart disease to age-related macular degeneration. Having diabetes adds risks especially for heart disease, hypertension, vision problems, nerve damage and kidney disease. We need the protection from a nutrient-dense diet to help our body be defensive. Second, a personalized meal plan will guide the placement and portioning of those foods to optimize blood glucose (BG) outcomes throughout the day.”
 

You may be thinking to yourself, “It seems the news is always touting a new diet for diabetes, but what does that mean for me?” For the best blood sugar control, should you follow a Mediterranean diet? What about becoming a vegetarian? Teresa explains how nutrition guidelines from the American Diabetes Association (ADA), along with the personalized advice from your health care provider can help decipher this diet dilemma for you: “To determine the best dietary approach, or design, for someone’s meal plan I start by evaluating my clients’ whole lifestyle,” she adds. “I assess their current status and their short and long-term goals including, for example, their activity, exercise, weight, other health risks and even their likes and dislikes. Then I determine an appropriate calorie level and range of suited macronutrients by percent of carbohydrate, protein and fat. Then we personalize the timing and frequency of eating. Personalization is key.”
 

Personalized Eating Patterns
 

The ADA reviewed numerous scientific studies to develop its updated recommendations on nutrition. One major conclusion: No diet - or more appropriately, eating pattern - works best for all people with diabetes. In fact, research shows several eating patterns can effectively control the disease. These include:
 

“I think one of the key ideas here is ‘eating patterns’ over time versus the idea of a strict ‘good food – bad food’ diet for a few weeks or months in hopes to correct problems and reach goals,” Anderson says. “That approach would unlikely achieve the long term consistent health benefits supported by research. Most of my clients require some weight loss too so we can never ignore total calories.”
 

So what do these eating patterns really mean on day-to-day basis? “Plant-based diets,” Anderson says, “emphasize fruits, vegetables, legumes and whole grains, with modest amounts of fish, lean meat and low-fat dairy. Plant based could also be taken to mean eating vegetarian, vegan and even ‘raw’. Most of us do not include enough fruits or vegetables in our diets, or whole grains. So if I suggest to be more ‘plant-based’ could be interpreted as decreasing animal protein portion sizes and increasing choices of fruits, veggies and whole grains.”

Those following a Mediterranean diet need to be aware of choosing too many high-fat  and high-calorie food sources, Anderson says. One tip she advises is to watch your portions carefully.
 

“Low-fat” Or “low-carb” eating patterns refer to adjusting what may already be a high-carb or high-fat way of eating that is out of proportion to what it should be, and thus that is the source of excess calories, Anderson says. “So to get their eating pattern aligned and at an appropriate calorie level, the suggestion is to lower the fat or the carb; never to eliminate,” she says. “‘Low’ has no specific number of grams for either diet and is widely interpreted.
 

Work with your health care provider to determine the best eating pattern for you based on your needs. It may be one of the above or another strategy. Choose one that melds with your preferences, including your culture and beliefs. It should also support your specific health goals. For instance, if you have high blood pressure, you may want to try the DASH diet pattern.
 

Nutrition Therapy and More
 

The ADA also recommends people with diabetes have medical nutrition therapy (MNT) as a Standard of Care. During MNT, a registered dietitian nutritionist reviews your eating habits and nutritional health and develops nutrition goals and a personalized meal plan for you. “Unfortunately fewer than 90 percent of folks with pre-diabetes or diabetes ever even get referred for MNT,” Anderson states. “These folks are left trying to reach their BG goals with lack of professional evidence-based information, with incorrect information, and with ‘sound bites’ from radio or TV shows and other sources.”
 

This is especially important for those newly diagnosed with the disease. The ADA reviewed 18 clinical studies that looked at the use of MNT in managing Type 1 or Type 2 diabetes. In trials that were randomized, the group found that MNT did help significantly to manage diabetes. Teresa adds that with comprehensive education her clients consistently report a stronger feeling of confidence and of being self-empowered. “You don’t know what you don’t know,” she adds.
 

Many insurance companies cover several sessions of MNT with a registered dietitian nutritionist [RDN]. The initial one-on-one visit typically lasts 45 to 60 minutes. At the Diabetes and Metabolism Care Clinic, Anderson sees patients in an educational path. Based on the patient’s diagnosis, she will advise a few classes and one-on-one sessions with her. The education program she coordinates is a Nationally Accredited Program, and, Medicare is accepted. If you have a primary care provider with Lovelace you can receive MNT.

Along with MNT, the  ADA's guidelines include direction on key nutrition basics. Here are a few:
 

It's not only what you eat, but how you prepare food that matters, also. Anderson suggests these great sources for healthy recipes and cooking tips. 

The Academy of Nutrition and Dietetics at  www.eatright.org/resources/food/

American Diabetes Association Food Advisor    www.diabetes.org/mfa-recipes/recipes/

USDA for general healthy food tips for all ages www.choosemyplate.gov/