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Simeon Margolis, M.D.
08-23-2010
Trinidad and Tobago Information Author: Alison White BSc, RdN and June Holdip MS, RD
- Based on a short verbal questionnaire given to community people in Trinidad and Tobago with diabetes, they know about but do not use internationally "popular" diets. Persons with diabetes do not look to the internationally 'popular' diets.
- Patients do, however, associate diabetes with a 'diet', and often ask for a 'diet sheet'. Persons should be dissuaded from simply using a diet sheet. Rather, they should focus on healthy meal planning based on their own individual situation.
- However, there are some ingrained 'myths', misconceptions or practices which people associate with diabetes. Some common myths are as follows:
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Myth 1 - Should avoid rice but can eat green bananas.
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Myth 2 - Must avoid all starchy foods.
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Myth 3 - Should not eat bread but can eat crackers.
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Myth 4 - Need to strain rice to reduce the starch content.
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Myth 5 - Should toast bread, especially white bread, to reduce starch content and calories. In fact, all these foods are choices from the Staples food group,and can be used in specific amounts. Moreover, foods such as provisions contain complex carbohydrate, the preferred option.
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Myth 6 - Persons with diabetes should not eat certain fruits such as mangoes, bananas especially those with specks on the skin, or oranges because of their sugar content, though grapefruit can be used freely. Persons with diabetes should be taught how to include fruits in their diet regardless of the type.
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Myth 7 - Olive oil is healthy and therefore any amount can be used. Persons with diabetes should be taught to control the amount of olive oil or any other vegetable oil that is used.
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Myth 8 - Food for persons living with diabetes should be boiled/bland and seasoning-free. There is no reason to discourage the use of seasonings. However, it is prudent to discuss controlling the amount of salt and other high sodium seasonings. Encourage the use of a variety of fresh or dried herbs, spices and other flavourings. Tasty food is always enjoyable.
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Myth 9 - Using bitter tasting food e.g. carilli and drink e.g. mauby can get the "sugar" under control. Persons should continue to be taught that the taste of a food has nothing to do with controlling blood sugar.
- Many weight loss diets have been promoted over the years and are usually popular for only a short time.
- Some diets specifically restrict calories, but most are aimed at reducing caloric intake indirectly by placing restrictions on the percentages of fat, protein, and carbohydrates in the diet.
- Other popular diets aim to control blood glucose and/or reduce cardiovascular risk, usually in conjunction with pharmacotherapy.
- New weight loss diets pop up constantly; many reach best seller lists
- Most recent fad diets do not restrict calories per se, but restrict a given foodstuff
- Atkins: 20% carbohydrates (C), 50% fat (F), 30% protein (P)
- South Beach and Zone: 40% C, 30% F, 30% P
- Weight Watchers: 40% C, 40% F, 20% P and calorie restriction
- American Diabetes Association (ADA) diet aims to achieve and maintain: 1) blood glucose as close to normal as safely possible; 2.) a lipid and lipoprotein profile to reduce CVD; 3) blood pressure normal or as close to normal as possible (American Diabetes Association).
- ADA nutritional recommendations: 1) restrict calories if needed to approach normal weight; 2) balanced diet of 50% C, 30% F, 20% P (<7% saturated fat, < 200 mg cholesterol per day) (American Diabetes Association).
- The Pritikin Weight Loss Breakthrough: about 10% of calories from fat Very low fat diets raise triglycerides and lower HDL cholesterol (Lichtenstein).
- Ornish diet: 70% C, 10% F, 20% P and other lifestyle measures for regression of coronary atherosclerosis
- Mediterranean diet: includes a high consumption of fruits, vegetables, bread, wheat and other cereals, potatoes, beans, nuts, seeds, and olive oil, with limited intake of red meats and eggs; yields a higher intake of monounsaturated fatty acids (Martinez).
- DASH diet: emphasizes fruits, vegetables, and low-fat dairy products. The diet includes whole grains, poultry, fish, and nuts; contains only small amounts of red meat, sweets, and sugar-containing beverages; and has decreased amounts of saturated fat and cholesterol (Appel; Liese).
- National Cholesterol Education Program (NCEP) and American Heart Association (AHA) diets similar to ADA diet
- AHA and ADA recommend eating fish at least twice a week or possibly taking fish oil supplements (Wang).
- Low glycemic index (GI) and low glycemic load diets: GI of a food is the increase in the blood glucose area over 2 hours after ingestion of a constant amount of that food (usually a 50-g carbohydrate portion) divided by the response to a reference food (usually glucose or white bread). For example, low GI=kidney beans, high GI=mashed potatoes. Glycemic load calculated by multiplying the glycemic index of the constituent foods by the amounts of carbohydrate in each food (Brand-Miller).
- Low protein diet for kidney disease (Robertson)
- Long-term weight loss the same with Atkins, South Beach, Zone, Ornish as with more conventional diets; about 6 kg at 6 months, 3.3 kg at 2 years (Sacks).
- Very low fat diets do not lower cholesterol any more than a diet containing about 25% of calories as fat; but they also decrease HDL cholesterol and raise triglycerides.
- DASH diet lowers blood pressure (Appel) and may prevent development of type 2 diabetes.
- Mediterranean diet improves lipid pattern and may prevent type 2 diabetes (Martinez).
- NCEP diet improves LDL cholesterol
- Low glycemic index diet improves postprandial glucose; longer term benefits uncertain (Brand-Miller).
- Low protein diet may prevent progression of kidney disease (Robertson).
- Even relatively small amounts of weight loss, for example 7% of body weight, can significantly improve glycemic control.
- Calories do count. Diets that restrict a major food stuff (e.g. Atkins restricts carbohydrate) achieve weight loss because total caloric intake is also decreased.
- Different diets affect the speed of short-term weight loss, but weight loss outcomes are similar regardless of the diet; in the end, no single diet has been proven especially advantageous (Sacks).
- Unbalanced diets or severe calorie restricted diets can be difficult to maintain.
- Over time, most people regain weight lost on weight-loss diets.
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Expert's choice: follow the ADA dietary recommendations with additional sodium restriction (i.e. no added salt [3 - 4 gm/day]).
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