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Christopher Saudek, M.D. and Emily Loghmani, MS, RD, LDN, CDE
05-13-2010
Trinidad and Tobago Information Author: June Holdip, R.D. and Alison White, BSc,RdN
- The Caribbean Six Food Groups are the basic daily guide for meal planning. These groups are:
- 1. Staples: Cereals -rice, flour (all types used as bread, bake, roti, dumplings etc.) pasta, oats, corn and its byproducts e.g cornmeal. "Provisions" irish/white potatoes, yam, green bananas, dasheen, eddoes, breadfruit, cassava, plantain etc.
- 2. Legumes and Nuts - dried pigeon peas, lentils, red beans, peanuts, cashew nuts, channa/chick peas, red beans, split peas etc.
- 3. Vegetables - patchoi, bodi, dasheen bush, bhaghi, ochroes, melongene, pumpkin etc.
- 4. Fruits (including juices) - bananas, mangoes, guava, pommerac, pawpaw, water melon, west Indian cherries, sapodilla, citrus fruits etc.
- 5. Food from Animals - meats, poultry, fish - fresh and processed; dairy products and eggs
- 6. Fats and Oils - margarine, butter, vegetable oils, bacon, mayonnaise, avocado, coconut milk /cream
- Follow Specific Nutrition Recommendations PLUS
- Better carbohydrate choices: provisions, whole grain and whole wheat products, legumes, fruits, vegetables. Other carbohydrate choices: rice, low fat milk and yoghurt.
- Increase fibre intake using foods such as dried peas and beans, fruits, vegetables, whole grains and provisions.
- May use approved and available sugar substitutes
- Products labelled - "unsweetened" - or "for persons with diabetes" should not be used freely (as a "free" food). These should be considered as part of the days intake.
- Use fats and/or oils sparingly (very little or none if possible) during or after cooking, including in sandwiches, snacks, hors-d'oeuvres and such-like.
- Eat regular meals. Skipping meals can contribute to poor glycemic control, hypoglycemia, and subsequent overeating.
- For specific portions and macronutrient intake, see Carbohydrate Counting.
- An individualized meal plan integrated with oral diabetes medications or insulin, is the basis of all therapy for diabetes.
- Experts avoid the term "diet", which carries negative connotations and prefer to promote a healthy meal plan and regular physical activity.
- A well-developed meal plan is not a single one-size-fits-all handout.
- The meal plan will help promote a healthy weight,reach HbA1c goals while avoiding hypoglycemia, improve lipid levels, promote healthy blood pressure and provide a good quality of life.
- The meal plan is developed by the process of medical nutrition therapy (MNT). This includes assessment of eating habits and diabetes knowledge, identification and negotiation of nutrition goals, nutrition education and intervention, ongoing monitoring and evaluation of outcomes.
- Individualize the nutrition meal plan based on age, type of diabetes, co-morbidities, cardiovascular risk factors, patient preferences, cultural and personal circumstances (Franz).
- Consider energy requirements, macronutrients (carbohydrates, fats, proteins), vitamins and minerals.
- Refer to a registered dietitian familiar with diabetes whenever possible, preferably for more than one visit.
- Choose a meal planning method that matches patient's needs and ability: healthy food choices, portion control, carbohydrate awareness, carbohydrate counting or exchanges.
- Achieve target blood glucose levels while minimizing episodes of hypoglycemia and hyperglycemia.
- Promote lipid and blood pressure levels that reduce the risk of cardiovascular disease.
- Promote normal growth and development in children and adolescents and a healthy weight in adults.
- Prevent, delay or reduce chronic complications of diabetes.
- Adjust nutrition guidelines to match the patient's needs, preferences and lifestyle.
- Choose carbohydrates from whole grains, fruit, vegetables and low fat milk and yogurt.
- Track total carbohydrate, but be aware that source and type may also effect postprandial blood glucose levels.
- Reduce total fat, saturated fat and cholesterol and avoid trans fats. Use more mono- and polysaturated fats.
- Choose lean meats, poultry, fish and other lower fat proteins.
- Increase fiber intake with whole grains, dried peas and beans and more fruit and vegetables.
- Eat foods that are lower in sodium if patient has high blood pressure.
- May use sugar substitutes approved by the FDA.
- If overweight, promote lifestyle intervention with increased physical activity (150 minutes/week) and 5%-10% weight loss (DPP).
- Refer to a structured, individualized weight management program that promotes reduced calorie intake, increased physical activity and frequent follow-up visits.
- Reduce excessive carbohydrate intake.
- Refer to module on prediabetes
- Adjust energy and carbohydrate intake to achieve appropriate weight gain, target blood glucose levels and absence of maternal ketosis.
- Provide nutrients necessary for maternal and fetal health.
- Monitor blood glucose levels at fasting and 1-2 hours after eating.
- Add exogenous insulin if target blood glucoses are not achieved by diet alone.
- Encourage physical activity to improve glucose tolerance.
- Encourage breastfeeding.
- Promote lifestyle changes to prevent progression to type 2 diabetes.
- Refer to module on gestational diabetes
- Initial: Includes nutrition assessment, basic nutrition education with meal planning guidelines and, if relevant, education about prevention/treatment of hypoglycemia.
- Follow-up: Frequency and length of visits depends on the complexity of the case and the success of treatment.
- The central importance of good nutrition as an integral part of diabetes management cannot be over emphasized.
- Individualization is the key, based on the above factors and specifics mentioned elsewhere (see Nutrition for Type 1 Diabetes and Nutrition for Type 2 Diabetes modules).
- In general, the goals of treating type 2 diabetes include weight control (Klein) whereas the goals of treating type 1 diabetes include careful carbohydrate awareness to match insulin doses and activity (Am Diabetes Association 2010).
- Sustainability of a meal plan is key: the extreme, restrictive diet will never be as successful as the more moderate, healthy and sustainable meal plan.
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