Chapter 20

Other Meal Planning Methods

IN THIS CHAPTER

check Exploring additional meal planning options

check Understanding glycemic index and load

The key to eating well with diabetes is finding a meal plan that meets your personal needs and sets you up to achieve your diabetes goals. There is not one specific “diabetes diet” or meal plan that is right for everyone with diabetes. The Plate Method (see Chapter 17), carbohydrate counting (see Chapter 18), and food choices/exchanges (see Chapter 19) are popular meal planning approaches for people with diabetes, but studies show many different eating patterns can be helpful in managing diabetes. These eating patterns include the Mediterranean-style eating plan, the DASH (Dietary Approaches to Stop Hypertension) eating plan, plant-based (vegetarian/vegan) eating patterns, and low-carbohydrate and low-fat eating patterns. In this chapter, we explore these eating patterns in detail to see if any of them may be right for you.

As you’re learning about all the different meal-planning options available, you may come across the terms glycemic index and glycemic load. We touch briefly on glycemic index and load in this chapter, because they may be useful tools to help you fine-tune your blood glucose management.

Eating Patterns and Meal Planning

An eating pattern is the foods or groups of foods that a person chooses to eat on a daily basis over time. According to the American Diabetes Association’s Standards of Medical Care in Diabetes, a variety of eating patterns are acceptable for the management of type 2 diabetes, including a Mediterranean-style eating pattern, the DASH eating plan, and plant-based eating patterns. These eating patterns place more focus on eating high-quality, nutrient-dense foods than they do on tracking specific nutrients. Low-carbohydrate and low-fat eating patterns may also be appropriate for some people with diabetes. The American Diabetes Association doesn’t recommend any one eating plan for people with diabetes; instead, consider these eating patterns as a few of the many healthy eating options for people with diabetes.

remember It’s important to work with a registered dietitian (RD) or registered dietitian nutritionist (RDN), a physician, or a certified diabetes educator (CDE) to find a meal plan or eating pattern that meets your individual needs. Ultimately, the meal-planning approach that you can follow and sustain in the long run will be the best option for you.

Eating Mediterranean style

The Mediterranean-style eating pattern or diet reflects the way of eating that is typical of people in the areas surrounding the Mediterranean Sea. Studies have shown that people in the Mediterranean region are some of the healthiest in the world. The Mediterranean-style eating pattern focuses mainly on fresh, seasonal, and locally grown plant foods (vegetables, fruits, whole grains, beans, and nuts) and supplements these foods with small amounts of dairy products, fish, and poultry. Fish that are rich in omega-3 fatty acids — such as salmon, albacore tuna, herring, mackerel, and rainbow trout — can be enjoyed a few times per week. Olive oil is the main source of fat used for cooking foods. It’s a good source of monounsaturated fat, which can help lower cholesterol when eaten instead of saturated fats (found in butter, margarine, and other solid fats).

People who follow a Mediterranean-style eating pattern are encouraged to limit their consumption of red meat and high-sugar foods. However, wine may be enjoyed in small amounts with a meal if desired. It is recommended that women have no more than one drink per day and men have no more than two drinks per day. One drink or one serving of wine is a 5-ounce glass.

This eating plan’s emphasis on plant foods and moderate amounts of dairy, fish, and poultry contrasts with the typical “American diet,” which is often full of refined carbohydrates, large portions of proteins (including red meat and processed meats), and lots of fat and sodium. The typical American diet, unlike the Mediterranean-style eating pattern, is lacking in fruits, vegetables, legumes, and whole grains.

The Mediterranean-style eating pattern has been shown to protect against heart disease, stroke, and some types of cancer. Studies have also suggested that this eating pattern may help with weight and blood glucose management, which means it can be considered a good meal-planning option for people with type 2 diabetes. With these potential benefits, it’s easy to see why so many people want to follow a Mediterranean lifestyle!

The Mediterranean way of eating is often referred to as the “Mediterranean diet.” Many people think of a “diet” as a temporary change in eating habits to bring on some desired result (often weight loss). But the Mediterranean-style eating pattern is more of a way of life than a short-term change to your eating habits. In addition to changing what you eat, this eating pattern may change how you think about food and mealtime. If you follow this eating pattern, you’ll want to make it a priority to include fresh, seasonal fruits and vegetables in your diet. This may mean planning trips to the farmer’s market to ensure you’re getting the freshest local ingredients. Another important part of the Mediterranean lifestyle is cooking, eating, and cleaning with family and friends. If you follow this eating pattern, try to make time in your schedule to sit down for a family meal and really enjoy your food and the process of cooking.

The DASH eating plan

Another eating pattern option for people with diabetes is called the DASH eating plan. DASH is an acronym for Dietary Approaches to Stop Hypertension. This diet was designed to help lower blood pressure in people with hypertension (or high blood pressure). People with diabetes are at an increased risk for cardiovascular complications, and keeping blood pressure under control may help prevent these complications, so this eating plan may be a good option for some people with diabetes.

The DASH eating plan, similar to the Mediterranean-style eating plan (see the preceding section), promotes eating more fruits and vegetables, whole grains, and legumes, as well as low-fat dairy, poultry, and fish. This eating pattern is relatively high in fiber and nutrients such as potassium, calcium, and magnesium, which may help lower blood pressure.

What kind of foods should you avoid when trying to reduce your blood pressure and protect your heart? The DASH eating plan limits red meat, high-sugar foods (such as sugar-sweetened drinks and sugary desserts), and saturated fat (found in butter, margarine, full-fat dairy products, and high-fat meats). It’s also important to limit your intake of foods that are high in sodium.

If you and your dietitian decide that the DASH diet is the right eating pattern for you, you may want to discuss setting a daily sodium intake goal that will help you meet your diabetes and heart-health goals.

Going vegetarian/vegan

Considering a vegetarian or vegan lifestyle? Plant-based eating patterns provide more carbohydrate than other eating patterns, but they can still be an option for people with diabetes. Vegetarian and vegan eating patterns are based on plant foods — such as fruits, vegetables, beans, nuts, seeds, and whole grains — with little to no animal products. The benefit to plant-based eating patterns is that they’re rich in fiber, vitamins, and minerals and low in cholesterol and saturated fat, which may reduce the risk of chronic diseases.

Although there hasn’t been much research that looks specifically at the effects of vegetarian or vegan diets in people with diabetes, research in the general population has linked following a plant-based eating pattern to a lower risk of obesity, heart disease, cancer, and diabetes.

There are a few different kinds of plant-based eating patterns that vary depending on the type and amount of animal products included. Check out these options to see if any will meet your needs:

  • Vegan: A vegan eating plan includes many plant foods, but no animal products at all. People following a vegan diet avoid all meats, poultry, eggs, fish and seafood, dairy, and (in many cases) even honey.
  • Lacto-vegetarian: A lacto-vegetarian eating plan includes plant foods and (unlike a vegan eating plan) dairy products such as milk, cheese, and yogurt. People who follow a lacto-vegetarian meal plan also avoid all meats, poultry, eggs, fish, and seafood.
  • Ovo-lacto vegetarian: An ovo-lacto vegetarian eating plan includes plant foods, as well as dairy products and eggs. People following this eating pattern still avoid all meats, poultry, fish, and seafood.

Some people choose to be a little more flexible and follow a semi-vegetarian eating pattern, which generally means that their eating pattern is primarily plant-based and they may include dairy, eggs, or even seafood on occasion, but they avoid poultry and red meat. You don’t need to follow a strict vegetarian eating pattern to include more fruits, vegetables, and whole grains in your meal plan. Eating vegetarian or vegan dishes for even just a few meals or days per week will help you increase your intake of nutritious plant foods.

Keep in mind that a vegan or vegetarian eating pattern isn’t automatically healthy. As with any meal plan or eating pattern, people following a plant-based eating pattern must make nutritious food choices and control their portion sizes. Aim to eat mostly fresh produce, whole grains (rather than refined grain products), beans, nuts, and seeds. Avoid eating a lot of highly processed products and foods that are high in sugar and/or sodium.

warning Meat substitutes, such as tofu, seitan, veggie burgers, and soy-based “meat” or “chicken” products, look like and may taste similar to meat and poultry. You can include these products in your plant-based diet if you choose, but pay attention to the information on the Nutrition Facts label (see Chapter 18). These products can be high in calories, carbohydrate, or sodium.

If you’re trying to remove animal products from your diet, or if you’re already living a vegan or vegetarian lifestyle and you’re wondering if it’s compatible with managing diabetes, rest assured. Plant-based diets are an option for people with diabetes as long as they choose nutritious plant foods and control their portions. Ask your dietitian or healthcare provider if a vegan or vegetarian diet is right for you.

A low-carbohydrate eating pattern

Many people believe that a low-carbohydrate diet is the “best” meal planning option for people with diabetes. Although this type of eating pattern may work for some people with diabetes, it’s certainly not the only option, and it isn’t the right eating pattern for everyone with diabetes.

A low-carbohydrate eating pattern focuses mainly on foods that are higher in protein and nonstarchy vegetables that are low in carbohydrate. People following this eating pattern will primarily eat nonstarchy vegetables — for example, carrots, onions, peppers, broccoli, cauliflower, green beans, and salad greens — and proteins and fats. Meats, poultry, fish and seafood, egg, and dairy can all be included in a low-carbohydrate diet. Highly processed sources of carbohydrate and grain foods, on the other hand, are usually avoided by people following this eating pattern. This generally includes rice, breads, pastas, and sugary foods and drinks.

There is no definition of how many grams of carbohydrate constitute a “low carbohydrate” diet. If you think that a low-carbohydrate eating pattern may be a good fit for you, talk to your dietitian or healthcare provider. He or she can help you find the best way to meet your nutritional needs and set daily carbohydrate goals. (For information on how to keep track of your carbohydrate intake, see Chapter 18.)

remember People following a low-carbohydrate eating pattern still benefit from making nutritious food choices. Frequently eating high-fat meats and full-fat dairy products, covering your nonstarchy vegetables in dressing and saturated fat (from butter and margarine), and adding lots of salt to your food isn’t good for you in the long run. Even if your blood glucose is well managed, eating a lot of saturated (and trans) fats and sodium can increase your risk of cardiovascular (heart and blood vessel) complications.

The skinny on low-fat diets

A low-fat eating pattern is another option for people with diabetes. This type of eating pattern includes vegetables, fruits, starches, lean proteins, and low-fat dairy products. The best protein options for a low-fat eating pattern are fish and poultry without skin. Limit your intake of excess fat, especially sources of saturated fat (such as butter, margarine, and other hard fats).

Following a low-fat eating pattern may improve heart health when overall calorie intake is also reduced and weight loss occurs. However, in studies, a low-fat diet didn’t always improve blood glucose levels or reduce heart disease risk factors. Talk to your dietitian or healthcare provider to determine if this eating pattern can help you achieve your diabetes goals.

technicalstuff According to the American Diabetes Association’s position statement “Nutrition Therapy Recommendations for the Management of Adults with Diabetes,” a low-fat eating pattern is defined as a total fat intake that is less than 30 percent of a person’s total calorie intake and a saturated fat intake that is less than 10 percent of total calorie intake. If you and your dietitian agree that a low-fat eating pattern is right for you, he or she can help you determine how many grams of fat to aim for each day and how to do that.

Glycemic Index and Load

The glycemic index (GI) measures how different carbohydrate-containing foods affect blood glucose. The carbohydrate-containing foods are ranked based on how each food’s effect on blood glucose compares to that of a standard reference food (pure glucose). A food with a high GI will raise blood glucose levels more than lower-GI foods.

Foods with a GI of 70 or above are considered high-GI foods, while anything with a GI of 55 or under is considered a low-GI food. Medium-GI foods have a GI between 56 and 69. Some examples of relatively low-GI foods include beans, peas, and lentils, many fruits and nonstarchy vegetables, and sweet potatoes, yams, and corn.

remember The glycemic index represents the type of carbohydrate in foods, not the amount. The serving sizes and how many grams of carbohydrate are in the foods you’re eating are still important. Watch your portions!

Glycemic load (GL) measures the impact that both the type and amount of carbohydrate in a certain food will have on blood glucose levels. It’s calculated by multiplying a food’s glycemic index by the amount of carbohydrate in the food/serving. As with the glycemic index, foods with a high GL have a greater impact on blood glucose than lower-GL foods do. Glycemic load may not be a practical tool for everyday meal planning; the glycemic index is more widely used and predictable than glycemic load. (For more information about GI and GL, check out Glycemic Index Diet For Dummies by Meri Reffetto [Wiley].)

Both the type and amount of carbohydrate in a food affect blood glucose levels, but studies show that the quantity of carbohydrate in a food generally has a stronger effect on blood glucose than the quality (the GI). This means that the first step toward blood glucose management for most people with diabetes, at least in terms of meal planning, will be some sort of carbohydrate counting/control rather than using the glycemic index. However, the glycemic index (and possibly glycemic load) may be useful tools when used in conjunction with carbohydrate control, for people who are looking to fine-tune their diabetes management efforts.

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