diet plan recommendation questions

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Tanya posted on Thu, Jul 23 2009 7:02 PM

I am trying to get back on track again after some lapses in managing my diabetes and I have questions about diet plan and Joslin recommendations.  In particular, I would like to know how to put together/calculate/balance a diet plan with the 40% carb and slightly higher protein that I saw as currently recommended on the Joslin website. That seems different from what I see elsewhere.

I'm a 47 year old obese woman. I was diagnosed with Type II diabetes approximately 4 years ago. My PCP sent me to diabetes education (in Portland, Maine) which I completed. 

I was surprised at the time how many carbs were prescribed on the diet the dietition gave me, probably 55% and maybe 3 ounces of protein a day. Even during times that I am overeating, eating junk etc., though I clearly eat too many calories, too many bad fats and too many simple carbs,  I have never had a bowl of cereal and two pieces of toast for breakfast.  Maybe this is just subjective, but whenever I have been on that kind of ratio of carbs to protein with low fat I have felt  weak and hungry on and off throughout the day. I remember this particularly long before I was diagnosed with diabetes, back in the early 90's when my husband insisted that we go on the super low fat diet where dinner might be spaghetti with tomato sauce.

Of course I need to lose weight, and my other concern is that on the previous calorie restricted diet my dietition gave me, there was a relatively low proportion of the fruits, vegetable and milk that I read are important to health, as well as so little protein that it was hard to work enough oily fish in.

I am going to my new doctor in Austin next week and I am sure he will once again refer me to a diabetes educator (though I am not insured and cost will be an issue.) I am wondering if diabetes educators in general are now prescribing the formula recommended on the Joslin website, and if not, how to find one that does (as long as it is safe for me.) And, again, how to calculate for myself the proportions for a 40/30/30 diet of, say, 1,700 calories. 

Thanks for any info.

 

 

 

 

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whalen replied on Thu, Jul 23 2009 10:14 PM

Dear Tanya,

I think most of us have found out that with diabetes it's never one plan fits all.  This is the problem that I find with many CDE's and nutritionists.  I think the Joslin idea is good.  I try always to have some protein with my carbs and particularly not to have too many carbs at one time. 

For breakfast I have an egg (or two depending how hungry I am), a piece of toast and a small glass of V8.  For lunch a salad (with tuna or chicken on top) or half a sandwich.  For dinner, some lean protein and several vegetables.  I eat fruit for dessert and occasionally for snacks.

I am not recommending this to you since we are all different, just wanted to give you some idea as to mixing carbs and protein.  You need to test your blood sugar a lot at first to get an idea of how different foods and combinations affect  you.

It takes some time, but believe me, you will be able to do this faster than you ever thought.

Best,

Galemarie

Type 2, lantus and humalog 

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Ron AKA replied on Thu, Jul 23 2009 11:11 PM

I would suggest you do some research on the glycemic index of carbohydrates. There is a newer book than the one I have called the The New Glucose Revolution for Diabetics which may be helpful. Also lots of information on line if you Google glycemic index or glycemic load. In my view the secret is to find foods that have a low glycemic index, high fiber especially soluble, and low fat.

Ron

Not a med prof. Just diabetic type 2 on Prandin, Levemir, ramipril, bisoprolol, & Crestor. Diag. Feb/01.

"I have not failed. I have just found 10,000 ways that don't work." - Thomas Edison

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RobertIA replied on Fri, Jul 24 2009 12:09 AM

I am going to my new doctor in Austin next week and I am sure he will once again refer me to a diabetes educator (though I am not insured and cost will be an issue.) I am wondering if diabetes educators in general are now prescribing the formula recommended on the Joslin website, and if not, how to find one that does (as long as it is safe for me.) And, again, how to calculate for myself the proportions for a 40/30/30 diet of, say, 1,700 calories.

Tanya,  As much as I would like to think that there are dietitians and educators who will follow Joslin,  they will no longer be RD's or CDE's if they do not follow ADA's guidelines.  Their credentials could be lifted immediately if someone complains.  This is a weakness in our medical system and the extreme domination of our medical associations. 

Ron made an excellent suggestion and I would suggest doing a lot of self-education and having questions for your doctor.

Type 2 (10/2003)   Lantus and Novalog   Now added Metformin      Retired

 

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Madman replied on Fri, Jul 24 2009 10:39 AM

I would recommend reading The Zone diet books by Barry Sears.

These books even has sample meals and recipes.  It centers around a 40/30/30 diet ratio, but also shows how to manipulate those ratios somewhat to help find your ideal balance.

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I am shooting a wedding in Austin on 8-1..What is the weather like?

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Tanya replied on Fri, Jul 24 2009 11:28 PM

Record-breaking heatwave and drought for the last 8 weeks, between 102 and 106 degrees most days.   Next week is predicted to be 101-103 and the first real rain and thunderstorms in months. Good luck with the shoot.

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Tanya replied on Fri, Jul 24 2009 11:32 PM

Thanks for the good suggestions everybody.

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Dear All Who Wrote:

As the nutrition manager at Joslin I would like to clear up a few misconceptions.   Although the American Dietetic, American Diabetes and Joslin all have slightly different nutrition guidelines for diabetes, each organization stresses the need for individualization of meal plans based on the patient/client needs.  Specifically neither ADA defines a specific range for carbohydrate content.   Guidelines provide a framework for professionals to use their clinical judgement to evaluate best care practices for patients; they are not binding or prescriptive.  

Reseach has shown that a variety of nutrient distributions along with a calorie level that induces weight loss  in those who require it and is efffective in establishing glycemic control.  In addition to promoting weight loss and glycemic control, lowering carbohydrate intake moderatlely while increasing protein from unsaturated sources improves lipid parameters and perhaps reduce inflamatory states.

Whatever nutrient distribution is chosen the most important thing is to focus on  eating a healthy diet which includes plenty of fruits and vegetables, whole grains, low fat dairy and either lean meats or legumes/nuts/seeds.

Any qualified dietitian will work within the bounds of any diet structure a patient/cliient desires as long as  that  diet is not unheatlhy. To find a qualified dietitian one can go to the American Dietetic Association web site eatright.org and use the program to find someone in your area.  The CDE credential after the name will indicate if the person is a certified diabetes educator.   Another possibility if your health care provider is unable to provide a referral is to contact your local hospital.  Most hospitals have outpatient nutrition deoartments.  It is your right and your responsibility to interview the dietitian as you would a doctor to determine if the person is a good fit for you.

In answer to Tanya's question, calculating amounts of nutrients based on a 40/30/30 diet is the simple part. To calculate the amount of carbohydrate, protein and fat in a 1700 kcal diet using a 40, 40, 30 distribution one would multiply each macronutrient distribution by the calorie level and then divide by the calories per gram of the nutrient.  For example, 1700 x .4 = 680 /4 (kcals/gm for carbohydrate )=170gms of carbohydrate   Protein is 4 calories per gram and fat is 9 calories per gram.    It is often best to make an appointment with a dietitian to translate the nutrients into amounts of food that a client will enjoy and be able to eat on a long-term basis.  For many people this timeframe may be upwards of 40 years.

 

 

   

 

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jen1229 replied on Sat, Jul 25 2009 6:57 PM

Nora:

Thank you for the information.  It is always good to get the correct information from the people who know.

 

 

Jen  - LevemirConfused and Novalog Wink A1c 5.8

 

 

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THANKS...

sounds like PHX..

We had monsoon rains Fri and Sat and now..113.........

However...looking forward to the VEGAN cakes they plan and lunch at the Salt Lick????????

 

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Hi Tanya:

Have you seen this gent's food products?  http://medwell123.com/

Dr. Sears has developed some meal replacement carbs with just what is suggested.  Lower carb, higher proteins.  I'm trying them out to see if I think they work for my prediabetes.  BS fasting at 112; weight too much and I exercise every day, but don't control my food portions due to this never ending "hunger".  He suggests that it helps decrease the hunger.  Not really sure, but I'm giving it a try.

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Nelle replied on Thu, Nov 5 2009 2:17 PM

I know I'm late joining this discussion, but you might want to read Dr. Bernstein's books, "Diabetes Solution" and his cookbook.  A lot of great advice on what you should be eating.

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Ron AKA replied on Thu, Nov 5 2009 3:36 PM

Just remember that diabetics do not die of high blood sugar. They most often die of heart disease and stroke. Always eat heart health foods.

Ron

Not a med prof. Just diabetic type 2 on Prandin, Levemir, ramipril, bisoprolol, & Crestor. Diag. Feb/01.

"I have not failed. I have just found 10,000 ways that don't work." - Thomas Edison

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Nelle replied on Thu, Nov 5 2009 4:26 PM

They die of heart disease, strokes and kidney failure caused by high BG.  Read Gary Taubes What If It's All Been a Big Fat Lie and his book Good Calories, Bad Calories for some interesting stuff on what is good for the heart.

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