The Great Sugar Shake Up
Nutrition Guidelines
For Managing Diabetes
Sugar Shake Up
Babs Carlson, PhD, RD, CDE
Coordinator, DSMEP
Lifestyle Center
Chesapeake Regional Medical Center
Retired
Diabetes
24 million Americans have Diabetes – 8% of the population (1 in 12)
57 million Americans have pre-diabetes- 20% of the population
By 2020, 20% of the population will have Diabetes
34% of babies born after the year 2000 will develop Diabetes in their lifetime
Diabetes
Diabetes cost the nation $174 billion in 2008
1 in every 8 dollars spent on healthcare is attributed to Diabetes (12%)
Diabetes
50% of Black and Hispanic Americans over age 50 have Diabetes or Prediabetes
40% of white/ Caucasian Americans over age 50 have Diabetes or Prediabetes
Obesity
66% Americans are Overweight34% Americans are Obese: BMI>30
50 years ago, 20% of Americans were overweight. Some experts predict that by the year 2099, 99% of Americans will be overweight
Obesity
Why the Increase in Obesity?Why the increase in Visceral Obesity
ie Insulin Resistance ie Beta Cell Failure
Obesity
Consumption of calories as Fat has remained steady since 1980s
Consumption of calories as Sugar has increased from 129 pounds per person in 1980 to 148 pounds per person in 2005
Sugar consumption now as high fructose corn syrup contributes to Diabetes and triglycerides
Sugar Shake Up
Why Sugar? Sugar does not cause Diabetes.
ADA: “substituting sucrose containing foods for isocaloric amounts of other carbohydrates will have similar blood glucose effects”
Sugar Shake Up
Sugar does deliver excess calories with no satiety value
ADA: “People with diabetes should avoid intake of sugar-sweetened beverages to reduce the risk for weight gain and worsening cardiometabolic risk profile.”
Sugar Shake Up
Dietary Guidelines: Reduce added sugars intake to 4 – 10 teaspoons per daySedentary females: 4 teaspoonsActive males: 10 teaspoons
1 teaspoon = 4 grams of sugars
Sugar Beverages – 12 ounces
Apple juice – 7 teaspoonsEnergy Drink 10.5 teaspoonsOrange juice 7 teaspoonsPepsi 11 teaspoonsCoke 9 teaspoonsGingerale 9 teaspoonsVitamin Water 5 teaspoons
Sugar Beverages
7-11 Slurpee 6 teaspoons (ice) Big Gulp 12 teaspoons Sweet tea 6 teaspoons Latte 7 teaspoons Tazo Chai Frappuccino 14 teaspoons Tropical Smoothie 12 teaspoons Gatorade 6 teaspoons Powerade 8 teaspoons
Sugar Foods
Instant oatmeal 4 teaspoonsBlueberry muffin 5 teaspoonsChocolate chip cookies 2 teaspoonsGlazed donut 5.5 teaspoonsSherbet 5 teaspoonsFruit Yogurt 7 teaspoonsMars bar 7 teaspoons
Sugar Calorie Sources
Top calorie sources for AdultsGrain-based dessertsYeast breadsSoda/ energy drinksDairy desserts
Sugar Shake Up
If not Sugar, then WHAT?Follow the A, B, C’s
HbA1c = Average Blood Glucose: 6.5Blood Pressure: 130/80Cholesterol
Tchol <200mg/dlTrig < 150mg/dlHDL > 40 >50mg/dlLDL < 70mg/dl
Nutrition Guidelines
Eat Breakfast every dayBreakfast should be eaten within 60
minutes after getting out of bedBreakfast should be eaten before
exerciseBreakfast should include ProteinLast meal should be eaten prior to 2
hours before going to bed
Nutrition Guidelines
Carbohydrates – greatest impact on post prandial blood glucose
Protein – building block for insulin, provides satiety, necessary in each meal
Fat – delays gastric emptying, plant sources necessary daily
Salt as sodium – 1500 - 2300 mg daily
Nutrition Guidelines
Carbohydrates should provide 45-60% of calories per meal, per day1500 calories: 185 grams1800 calories: 225 grams2400 calories: 300 grams
Minimum daily recommendation is 135 grams distributed among 3 meals, snacks if necessary
Nutrition Guidelines
Carbohydrate sourcesVegetables: 4-5 servings dailyFruits: 2-3 servings unless triglycerides
elevated. Fruit not juiceWhole grains should provide 2-3 grams fiber
per servingCereals should provide 3 grams fiber per
servingFiber total: 25 grams daily
Nutrition Guidelines
Protein should provide 12-20% of calories per meal, per day1500 calories: 55 grams1800 calories: 70 grams2400 calories: 90 grams
Daily protein recommendation is 1 gram to 1.5 grams per kilo body weight
Nutrition Guidelines
Include low fat animal sources or plant protein sources in each meal. Include at least 10 grams protein in each meal
Portion size: 3 ounce portion, the “deck of cards” is 21 grams protein
Nutrition Guidelines
Fats should provide 27-27% of calories per meal, per day1500 calories: 55 grams fat1800 calories: 63 grams fat2400 calories: 90 grams fat
Nutrition Guidelines
Monounsaturated fats improve lipid profile, reduce cardiovascular risk. Choose olive oil, canola oil, peanut oil
Fish oils, Omega-3 oils, reduce cardiovascular risk, reduce inflammation. Choose fatty fish: salmon, mackeral, sardines; also walnuts.
Nutrition Guidelines
Pattern ManagementBreakfast should provide ¼ daily caloriesSecond meal: 4-5 hours after breakfastThird meal: 5-6 hours after second mealSnacks are optional, not requiredA “meal” must include carbohydrate, protein,
fat. Two “meals” should include vegetables.
Nutrition Guidelines
Supplements. There is no scientific evidence to support routine use of nutrient supplements.
Long term use of Metformin destroys Vitamin B12. Many persons with Diabetes are deficient in Vitamin D
Dinner
Resources
www.DietaryGuidelines.gov
• Policy Document
• Advisory Committee Report
• Public Comments Database
www.NutritionEvidenceLibrary.gov