Here we are again, talking about diabetes, the so-called plague of the century. Diabetes is serious, as it results in an accumulation of glucose in the blood, which, if left untreated, can damage almost every major organ in your body. And it can be fatal.
“What Aids was in the last 20 years of the 20th century, diabetes is going to be in the first 20 years of this century,” said Paul Zimmet, foundation director of the International Diabetes Institute. If action is not taken now to stop the rise in diabetes among the population, there is a significant risk that governments and social security systems may fail to ensure the appropriate care to the millions who will be affected by diabetes in 2025.
A cure for diabetes has not yet been found, but the good news is that eating the right foods, maintaining a healthy weight and getting plenty of exercise can help prevent the disease.
For the individual, diabetes control is a difficult equilibrium of willpower and knowledge; a complex piece of music, orchestrated by a team of technicians, including the family doctor, the practice nurse and the dietician.
Sticking to a healthy, balanced food programme is fundamental in the treatment of everyone with diabetes, whether oral or insulin medication is taken or not. Dividing nutritional requirements equally and adjusting the individual’s metabolism will contribute towards a better control in the level of glucose (glycaemia), fats and cholesterol in the bloodstream and blood pressure.
It is good to control these parameters, as this will contribute in diminishing the risk of complications from diabetes, for example cardiovascular disease. The individual with diabetes should be subject to healthy food regulations that do not differ much from the individual that wishes to remain healthy. Like any other individual, in the diet of a diabetic the largest part of energy requirement should be provided by carbohydrates at 50–55 per cent, with fats contributing to 25–30 per cent and proteins providing the remaining 15 per cent.
Being overweight is common in individuals that suffer from Diabetes Type II. In these cases, weight loss (even if it is only five or six kilos) is one of the main objectives of diet education, as this contributes to improving the levels of glycaemia, generally accompanied by a reduction in the levels of fats in the blood and reduction of blood pressure. The diet plan, which is adapted to this situation, should also be balanced and based on healthy choices, although with fewer calories.
In an average daily regime of 2,000 Kcal (for active adults who do not need to lose weight), 50–55 per cent of carbohydrates provide around 1,060Kcal. This works out at 4Kcal/g, which means that, in this case, the average intake is 270g of carbohydrate per day.
For a better control of the glycaemia levels, it is fundamental that small portions should be eaten at one time and distributed throughout the day in six or seven meals.
The majority of carbohydrates should be provided by amides (starch) and not sugars (glucose, sucrose and fructose).
Of the amides, the most preferred are those that are absorbed slowly, as they cause a slower elevation in glycaemia levels. These include wholegrain pastas (spaghetti, fusilli and so on) and pulses, such as beans, chickpeas, peas, broad beans and lentils that can also be used in soups (whole or purée).
Other amides cause a more rapid rise in glycaemia levels and should be taken in moderation: potatoes, white rice and white bread. This last one should be avoided.
The addition of fibres in carbohydrates, especially in the last foods mentioned, contribute, among other things, in avoiding a more rapid glycaemic elevation, which makes it vital that salads and vegetables should be introduced as a starter, or included in lunch or dinner. In this context, brown bread is preferable. Other sources of carbohydrates, such as milk, yoghurts and fruit, should also be a part of the daily diet.
For better control of diabetes, we recommend:
• A correct distribution of carbohydrates over six or seven meals throughout the day.
• That every day the same quantity of carbohydrates is eaten at each meal.
In other words, do not greatly vary the quantities from day to day. When changing some foods for others maintain the same quantity of carbohydrates.
Fats should represent 25–30 per cent of total calories and, in relation to a total daily calorific requirement of 2,000Kcal, with fats producing 9Kcal/g, intake should only be around 60g/day and no more.
Included in this should be that which is used to marinade and cook with, as well as the food products used.
The type of fats eaten is a determining factor in risk of cardiovascular disease. In this context, it is advisable to reduce intake of saturated fats, which are predominantly in foods from animals, such as red meat, milk, fat cheese, butter and cream. Unsaturated fats are preferred and they are predominantly found in foods with a vegetable base, or fish.
Between the added fats, it is always preferable to use only olive oil to marinade and cook with, in moderate quantities.
Olive oil should be the fat of choice, due to the type of fat it contains (monounsaturated fat) and for the presence of Vitamin E and other substances, such as anti-oxidants and anti-inflammatories. Consuming olive oil has been proven to contribute towards the prevention of cardiovascular diseases and inflammation. A soup spoon of olive oil contains 10g of fat.
On the other hand, the monounsaturated fat present in olive oil is the type of fat which is very resistant to oxidation, even at high temperatures. Other vegetable oils (sunflower, corn and soya), which contain polyunsaturated fats (more sensitive to heat), should only be used in ambient temperatures.
Animal fat (lard)
This is extremely resistant to air and high temperatures, so it does not oxidise easily. As such, although it is not recommended to fry food when this happens, olive oil, animal fat or even peanut oil should be used.
The fact that butter is rich in saturated fats, contributing to an increase in cholesterol levels, justifies the recommendation of a reduction of intake to one small packet of 15g per day (containing 12g of fat). But, for the majority of people, principally when the blood levels of fats and cholesterol are raised or there is a necessity to lose weight, it is better to opt for a low fat butter (low fat or light). Through this, calories and saturated fats can be reduced. Those who prefer can use low fat butter as long as the words hydrogenated fat do not appear on the label or if the label mentions “virtually free of trans fatty acids”.
Milk: This is an indispensable protein and is only contra-indicated in dairy intolerance. For adults, two or three glasses of milk (skimmed or semi-skimmed) is an excellent recommendation. This can be substituted for low fat yoghurt, without sugar (check the label as it could be low fat but with the addition of sugar). Yoghurt also contains a wide variety of nutrients of excellent tolerance and absorption and, due to this, can make a great contribution to a healthy diet.
Eggs: Eggs are a food that should not be ignored. What is not always recommended is the fat that they are fried in. It is preferable to boil or poach them.
An average of two eggs a week is recommended, and should substitute the meat or fish in that meal (or at least the portions should be halved) so as not to have an excess of protein, which could be a danger to the nutritional balance. For example, a poached egg with pea stew is an excellent combination.
Fish and meat
They are excellent food sources with such good protein quality that just a small quantity is sufficient.
Meat: It is not necessary, or desirable, to eat large quantities. The idea that eating meat is very healthy and gives us great strength is wrong, which is shown in the population of richer countries, who are paying dearly in terms of early onset illnesses and death.
Red meat (from ruminating animals), due to the bad quality of fat they contain (rich in saturated fats that help increase cholesterol levels) and the high amounts consumed, is a risk factor in health. Poultry (cleaned of skin and visible fat), rabbit and lean pork are preferable to lamb, beef or goat.
Fish: When it is possible, it is always preferable to choose fish over meat; fresh or frozen, all types even the fatty ones (sardines, salmon, mackerel, carapau, tuna or eel).
Fish is a particular source of the polyunsaturated fat, Omega 3, which has important functions in the control of fat in the blood and in the prevention of inflammatory or cardiovascular diseases.
Small quantities, and preferably little fat (less than 45 per cent) or low fat, such as low fat fresh cheese (always pasteurised). Other soft or hard fat cheeses are such a high source of salt and saturated fats they should only be eaten at parties two or three times a year.
Protein sources of vegetable origin are vegetables, fruit, water, salt, yoghurts, and more … to be continued on the next Luzdoc sponsored page.
Wishing you a healthy diet!
The Diabetes Team at Luzdoc