Guidelines for People w. Diabetes or Pre-Diabetes who are Overweight or Obese
- From: Enrico C <use_replyto_address@xxxxxxxxxxxxx>
- Date: Sat, 4 Jun 2005 20:40:08 +0200
http://joslin.org/news/nutritionarticle.shtml
Joslin Diabetes Center Announces New Nutrition Guidelines for People with
Type 2 Diabetes or Pre-Diabetes who are Overweight or Obese
April 6, 2005 - BOSTON - As Americans' waistlines continue to expand,
contributing to a burgeoning epidemic of type 2 diabetes, the scientific
jury is in and the verdict is clear: weight loss and increased physical
activity is directly related to improved diabetes control. To help
Americans fight the dramatic increase in type 2 diabetes, Joslin Diabetes
Center has crafted new nutrition and physical activity guidelines for
overweight and obese individuals with type 2 diabetes and those at risk for
developing diabetes (pre-diabetes).
"Since obesity doesn't seem to be slowing down and the complications of
diabetes are so serious, we were especially alarmed about the health of the
American public. We felt the best way to impact the largest number of
people was to strengthen our nutrition guidelines," said James L.
Rosenzweig, M.D, head of Joslin's clinical guidelines committee. The team
of physicians, dietitians, exercise physiologists and educators spent
months reviewing the scientific literature to draw up new guidelines. "The
search was on for guidelines that would improve insulin sensitivity,
cardiovascular health and reduce body fat. And most importantly, we wanted
to deliver a plan that makes clear what people need to do to achieve their
goals," said Dr. Rosenzweig, who also is Director of Joslin's Disease
Management Program and Assistant Professor of Medicine at Harvard Medical
School.
The new guidelines recommend approximately 40 percent of a person's daily
calories come from carbohydrates; 20 to 30 percent from protein (unless the
person has kidney disease); 30-35 percent come from fat (mostly mono- and
polyunsaturated fats); and at least 20-35 grams of fiber. To initiate and
continue weight reduction, a modest goal of one pound every one to two
weeks is advised by reducing daily caloric intake by 250 to 500 calories.
Total daily calories should not be less than 1,000 to 1,200 for women and
1,200 to 1,600 for men. A target of 60 to 90 minutes of modest intensity
physical activity most days of the week with a minimum of 150-175
minutes/week is encouraged and should include cardiovascular, stretching
and resistance activities to maintain or increase lean body mass. Two out
of three people in the U.S. are overweight or obese, resulting in a
skyrocketing rate of type 2 diabetes that now affects at least 18.2 million
Americans, including an increasing number of young people. An estimated 41
million Americans have pre-diabetes and are at risk of developing
full-blown type 2 diabetes unless they lose weight and increase physical
activity. Diabetes is a leading cause of heart disease, stroke, blindness,
kidney disease, amputations and other complications. "Setting the standards
for diabetes treatment for more than 100 years, Joslin Diabetes Center's
approach to diabetes management has always been to focus on the individual
and not dictate a 'one size fits all' strategy. While these guidelines are
very straightforward, Americans should meet with their healthcare team so
they can adapt the guidelines to meet their personal needs," said Osama
Hamdy, M.D., Ph.D., Clinical Director of Joslin's Obesity Program and an
obesity researcher, who co-chaired the committee that developed the new
guidelines.
"Eating smaller portions, modest carbohydrates and slightly more protein
with careful selection of fat, protein and carbohydrate sources is the way
to go if you are overweight or obese and have diabetes or pre-diabetes and
normal kidney function. These recommendations can help people lose weight,
have better diabetes control and prevent serious cardiovascular
complications," Dr. Hamdy added.
Catherine Carver, M.S., A.N.P., C.D.E., Director, Educational Services and
New Clinic Program Development, also co-chaired the workgroup that wrote
the guidelines. Amy P. Campbell, M.S., R.D., C.D.E., Education Program
Manager of Joslin's Affiliates Programs/Disease Management Program, also
was integral to developing the guidelines.
Among the highlights of the new Joslin guidelines are the following
recommendations:
Carbohydrate: Approximately 40 percent of a person's daily calories should
come from carbohydrate; the total should not be less than 130 grams daily.
This is a significant change from Joslin's previous recommendations that
promoted a higher carbohydrate intake. Scientific data show that reducing
one's carbohydrate intake while simultaneously increasing healthier protein
and fat choices may be a better approach to weight control. It may also
help decrease cardiovascular disease in overweight people with type 2
diabetes. The best sources are fresh vegetables, fruits and beans. Whole
grain foods are preferable to eating pasta, white bread, white potatoes and
low fiber cereal. Fiber intake should be approximately 50 grams daily if
that amount can be tolerated; a minimum of 20-35 grams per day is
recommended and an external supplement may be needed. High-fiber foods
include fruits, vegetables, whole grain cereals, breads, nuts and seeds.
Fat: Approximately 30 to 35 percent of a person's daily calories should
come from fat. Most should come from mono- and polyunsaturated fats, such
as olive oil, canola oil, nuts, seeds and fish (especially those high in
omega-3 fatty acids, such as salmon, mackerel, lake trout, herring and
sardines). Foods that are high in saturated fat, such as beef, pork, lamb
and high-fat dairy products (cream cheese, whole milk) should be eaten in
small amounts. Foods that are high in trans fats such as fast foods,
commercially baked goods, crackers, cookies and some margarines should be
avoided. Cholesterol intake should be less than 300 mg daily; or less than
200 mg in people with an LDL ("bad") cholesterol that is more than 100
mg/dL.
Protein: While anyone with signs of kidney disease should consult their
provider before increasing the daily amount of protein, approximately 20 to
30 percent of a person's total calories should come from protein. This is a
higher percentage than Joslin recommended in the past. Scientific data
reveal that eating more protein helps people feel "full" and thus causes
people to eat less calories overall. Protein also helps to maintain lean
body mass during weight loss. Examples of protein include fish, skinless
chicken or turkey, nonfat or lowfat dairy products and legumes such as
kidney beans, black beans, chick peas and lentils.
Weight Loss Guidelines: A modest weight loss of one pound every one to two
weeks is advised. Reducing daily calories should be by 250 to 500 calories;
total daily calories should not be less than 1,000 to 1,200 for women and
1,200 to 1,600 for men. Weight loss is different for each person and should
be continued until a person reaches a target body mass index, or BMI (ask
your provider about how to obtain this measurement.) Meal replacements,
such as shakes, bars and ready-to-mix powders that match these guidelines
can be helpful for some people. Blood glucose patterns often change with
these types of replacements and thus people should monitor their blood
glucose.
Physical Activity Guidelines: Physical activity is extremely important to a
weight loss plan. A minimum of 150 to 175 minutes of moderate intensity
physical activity is recommended. Examples of this include walking, biking,
swimming and dancing. A target of 60 to 90 minutes most days of the week is
encouraged. Physical activity should be a mix of cardiovascular, stretching
and resistance activities to maintain or increase lean body mass.
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