Diabetes patients present with very different management problems and unraveling the specific factors which are contributing to the individual’s difficulty controlling weight and cholesterol and insulin level, and which of these factors it is feasible for the patient to modify, is an important aspect of the assessment process. In recent years, special attention is given to the individualization of dietary patterns and unique approaches to every patient and his disease history. This approach is based on cultural and regional differences, personal preferences, and style of life (Shaw, 2006).
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Current dietary patterns suggest that cholesterol levels in food should be less than 300 mg/day. Fat appears to exert its greatest influence on energy balance through its effects on appetite. In studies where people have been allowed to eat as much as they like, the same quantity of food is generally eaten with high fat as with high carbohydrate meals, but because fat gram for gram contains more than twice the number of calories as carbohydrate, considerably more calories are consumed. Patients should reduce intake of trans fatty acids. It is highly recommended to use current fat replacers. also, patients with type II diabetes should consume saccharin, acesulfame potassium (K), aspartame, and sucralose instead of sugar (Clark, 2004). For instance, in their research, Shaw et al (2006) single out a specific diet and general diet for patients with diabetes. These researchers claim that a specific diet is based on self-care management aimed to help patients deal with dietary changes themselves. This diet involves fruits and vegetables, high-fat foods such as red meat, or full-fat dairy products. Doctors admit that an increasing amount of fruits and vegetables help patients to deal with diabetes and maintain a healthy way of life.
Fruits and vegetables are naturally low in fat, high in fiber, and are rich sources of vitamins and minerals, particularly antioxidant nutrients such as vitamin C, beta-carotene, selenium, and others such as lycopene. Epidemiological studies suggest the antioxidant and fiber content of fruit and vegetables protects against disease, particularly cardiovascular disease and cancer. The mechanism behind this protective effect is believed to be the capacity of antioxidants to scavenge free radicals, preventing DNA damage and subsequent mutation and decreasing atherosclerosis. The model divides food into five food groups and the size of the plate divisions represents the balance of foods needed to make up a healthy diet. It emphasizes the large contribution of fruit and vegetables, the need to increase starchy foods, and the importance of limiting, although not removing completely, foods high in sugars and fat. Regular eating is the main tool for diabetes treatment (Shaw, 2006). Researchers suggest eating 4-5 times a day instead of 3 times. Patients may skip meals as a means of controlling weight, turning to ‘grazing’ patterns of eating. To many, it may seem logical that one less meal a day would result in quicker weight loss. However, evidence suggests the reverse; meal skipping leads to increased eating and overcompensation later in the day and commonly to increased snacking on high fat, energy-dense foods. Patients who present with an irregular pattern of eating must initially focus on establishing regular meals and planned snacks.
Clark admits that traditional carbohydrate counting is also used in the treatment of diabetes, but it is based on individualized approaches and counting methods. Carbohydrate is known to have a greater satiating effect than fat and its intake is quite closely regulated by the body. Furthermore, high carbohydrate meals appear to keep hunger suppressed for longer than meals high in fat. Whether the type of carbohydrate influences energy balance has been subject to some debate. The energy density (calories per unit weight) of carbohydrates varies depending on the type of carbohydrate, for example, bread has a lower energy density than sugar. Evidence is beginning to emerge which supports the theory that low energy density carbohydrates tend to result in lower energy intakes than high energy density carbohydrates, so supporting the increased consumption of high fiber starchy carbohydrates rather than simple sugars to replace fats (Clark, 2004).
Clark, M. 2004, Understanding Diabetes. Wiley.
Shaw, B.A., 2006, Assessing Sources of Support for Diabetes Self-Care in Urban and Rural Underserved Communities. Journal of Community Health, 31 (5), 393.