Your grandma told you to eat your vegetables and clean your plate. Your diabetes educator told you to count your carbohydrates. Your coworker told you to avoid dairy products. The spokesperson on the late-night TV infomercial told you to drink a special protein shake three times a day.
From friends and family to members of your health-care team to complete strangers, it may seem like everyone is giving you nutrition advice. Some of these people may know you have diabetes; others likely do not. With so many different and often conflicting recommendations, how can you know which claims have a basis in science and which are pure hokum?
One of your most reliable sources of guidance through the maze of nutrition advice is Dietary Guidelines for Americans, 2010. Released jointly by the US Department of Agriculture and the Department of Health and Human Services, Dietary Guidelines for Americans has long been a cornerstone of national nutrition policy and education. First published in 1980, these guidelines are carefully reviewed by a panel of experts and updated every five years as needed, based on the current science of nutrition. The 2010 edition of Dietary Guidelines for Americans, released in early 2011, emphasizes that making healthy food choices is now crucially important as the United States is experiencing rising rates of chronic disease, disability, and death related to poor diet and lack of physical activity.
The Report of the Dietary Guidelines Advisory Committee — which outlines the scientific basis for the government’s dietary recommendations — has been transformed into a user-friendly booklet filled with helpful nutrition advice. (You can download a copy from www.choosemyplate.gov.) Each recommendation is supported by specific tips and ideas for putting it into practice. Many of the nutrition recommendations have special relevance to people with diabetes or prediabetes (blood glucose levels that are higher than normal but not high enough for a diagnosis of diabetes). This article summarizes Dietary Guidelines for Americans, 2010 and describes how you can turn its recommendations into diabetes-friendly food choices that taste great and are good for you, too.
Inside the guidelines
While researching the current science of nutrition in preparation for Dietary Guidelines for Americans, 2010, the Dietary Guidelines Advisory Committee found that diet-related chronic diseases are taking a heavy toll on the health of Americans. In addition to having high rates of cancer and osteoporosis, 37% of Americans have cardiovascular disease, 34% have high blood pressure, 11% have diabetes, and 35% have prediabetes. These numbers lend an urgency to the report’s special emphasis on two themes, both of which apply especially to people with diabetes or prediabetes: maintaining calorie balance over time to achieve and sustain a healthy weight, and focusing on consuming nutrient-dense foods and beverages.
Maintaining calorie balance. Overweight and obesity are linked to the development of Type 2 diabetes, so successfully curbing the obesity epidemic in the United States would be expected to also have a positive effect on the diabetes epidemic. Dietary Guidelines for Americans, 2010 defines the term calorie balance as “the balance between calories consumed in foods and beverages and calories expended through physical activity and metabolic processes.” In other words, calories in must equal calories out to remain in calorie balance. Calorie balance over time is the key to weight management. If you are overweight or obese, your calorie balance has been skewed; you’ve been consuming more calories than you’ve expended. To lose weight, you must either consume fewer calories or increase your physical activity — or, for the greatest effect, both.
Research has found that reaching one’s “ideal” body weight is not necessary to prevent Type 2 diabetes or to improve control of existing diabetes. Participants in the landmark Diabetes Prevention Program with a high risk of developing Type 2 diabetes were found to be 58% less likely to actually develop it if they lost 7% of their body weight and were physically active for 150 minutes a week. For a 250-pound person with prediabetes, this translates into losing 18 pounds and performing 20 minutes of exercise every day — goals that are realistic and achievable.
Focusing on nutrient-dense foods and beverages. Nutrient-dense foods and beverages are those that pack vitamins, minerals, and other healthful substances into relatively few calories. Vegetables, fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-fat dairy products, and lean meats and poultry are nutrient-dense foods—when prepared without added solid fats or sugars.
Some nutrient-dense foods are also sources of carbohydrate. Although you might not be able to eat unlimited amounts of carbohydrate-containing foods such as fruits, vegetables, beans and peas, and whole grains, you can make every bite count by choosing foods that are nutrient-dense rather than those that are high in sodium or that get a high percentage of calories from solid fats, added sugars, or refined grains.
Putting policy into practice
Dietary Guidelines for Americans, 2010 contains recommendations that fit into four categories: balancing calories to manage weight, foods and nutrients to increase in the diet, foods and substances to reduce in the diet, and taking action in the community. The report’s recommendations are based on research data and principles of nutrition science, as well as practical considerations that take into account the way people live and the challenges they face. The report also addresses overall eating patterns to follow, offering a framework that connects all of the individual recommendations regarding calorie balance and healthful food choices. (Click here for a basic overview of the Dietary Guidelines for Americans, 2010.)
Balancing calories to manage weight
Focusing on calorie balance is important at every stage of life, and it has become particularly so in childhood, as weight-related diseases and conditions that were once diagnosed primarily in adults are now being seen increasingly in children and adolescents with excess body fat. Tips for maintaining calorie balance or encouraging weight loss, if needed, include the following:
• Know your (and your children’s) calorie needs. Dietary Guidelines for Americans, 2010 outlines estimated daily calorie needs based on age, sex, and physical activity level. Estimated needs for adults range from 1,600–2,400 calories per day for women to 2,000–3,000 calories per day for men. Estimated needs for young children range from 1,000 to 2,000 calories per day, and the range for older children and adolescents varies substantially from 1,400 to 3,200 calories per day, with boys generally having higher calorie needs than girls.
• Plan ahead to make better food choices. Overly hungry people often make poor food choices and eat oversize portions. By planning ahead to have healthy meals and snacks available at home and on the go, it’s more likely that you’ll consume nutrient-dense foods rather than highly refined, easy-to-grab items.
• Track food and calorie intake. As a person with diabetes, you may already be familiar with logging blood glucose results. Tracking food and beverage intake can make you more aware of what you’re consuming so that you can evaluate your choices and make changes as needed. One online food planner you may find useful can be found at www.choosemyplate.gov; click on “Interactive Tools.” (To see the new “MyPlate” icon that has replaced the food pyramid, click here.)
• Reduce portion sizes, especially of high-calorie foods. Everyone loves a special treat once in a while, but to achieve calorie balance on a daily basis, you may need to employ such tricks as using smaller plates, portioning out smaller amounts of high-calorie foods, or replacing large servings of high-calorie foods with lower-calorie choices such as fresh fruits.
• Physical activity is an important part of the calorie balance equation. People with diabetes are advised to perform 150 minutes per week of moderate-intensity aerobic activity (such as brisk walking, dancing, or biking), and people with Type 2 diabetes are additionally encouraged to engage in resistance training three times a week. Dietary Guidelines for Americans, 2010 recommends a similar amount of exercise for all adults and also advises that children and adolescents get at least 60 minutes of physical activity each day. The report encourages adults who are capable of vigorous aerobic activity (such as aerobic dance, running, or jumping rope) to include it in their workouts.
Always check with your doctor to evaluate any health risks before embarking on a new physical activity program. If you are just beginning to be more active, start slowly, with short bouts of activity. And remember that every bit counts!
Foods and nutrients to increase
Including more nutrient-dense foods in your meal plan means increasing your intake of vegetables, fruits, whole grains, fat-free and low-fat dairy products, seafood, lean meats and poultry, eggs, beans and peas, and nuts and seeds.
Why vegetables and fruits? When prepared without added fat or sugar, vegetables and fruits are relatively low in calories. They also contain a variety of health-promoting nutrients and are associated with a reduced risk of chronic conditions such as high blood pressure, cardiovascular disease, and diabetes. Try to include vegetables and fruits in as many meals and snacks as possible. Make it easy to eat more by picking produce that requires little peeling or chopping, and keep it visible and accessible in your refrigerator or freezer or on your countertop.
Increase your intake of whole grains by replacing refined products with whole-grain choices such as 100% whole-grain breads, whole-grain cereals such as oatmeal, whole-grain crackers and pasta, and brown rice. Read labels carefully; foods labeled as “multigrain,” “stone-ground,” “100% wheat,” or “bran” may not be 100% whole-grain products and in some cases may not contain any whole grains at all.
Drink fat-free (skim) or low-fat (1%) milk rather than reduced-fat (2%) or whole milk. Top fruit salads with fat-free or low-fat yogurt. Choose low-fat or reduced-fat cheeses. When a recipe calls for sour cream, consider substituting fat-free or low-fat plain yogurt (or similar versions of sour cream).
Protein is often associated with red meat, but this food group includes a much wider variety of choices. Try to eat seafood in place of meat or poultry twice a week. If you do choose meat or poultry, select the leanest varieties, and drain the fat from ground meat after cooking it. Beans and peas are also excellent protein sources (see “The Benefits of Beans.”)
Foods and substances to reduce
Americans — including those with diabetes — consume too much sodium, solid fats, added sugars, and refined grains, all of which may increase the risk of chronic diseases. Excessive alcohol intake is also an important health concern. Reducing your intake of these substances and boosting your intake of nutrient-dense foods will help you better meet your nutrition needs and stay in calorie balance.
The current recommendation regarding sodium for most people is to consume less than 2300 milligrams daily; however, people ages 51 and above and those of any age who are African-American or have high blood pressure, diabetes, or chronic kidney disease are advised to consume no more than 1500 milligrams daily. The estimated average intake of sodium for Americans ages 2 and above is 3400 mg per day, with most of it coming from salt added during food processing. (For more information on reducing sodium intake, see “Shaking the Salt Habit.”)
The report advises getting less than 10% of total dietary calories from saturated fat, consuming less than 300 mg per day of dietary cholesterol, and keeping trans fat consumption as low as possible. In practical terms, this means choosing soft margarines with zero grams of trans fat rather than stick margarine or butter; using vegetable oils such as olive, canola, corn, safflower, and sunflower oil rather than solid fats when cooking; and using only small amounts of fat and oil in cooking.
Dietary Guidelines for Americans, 2010 introduced a new term to the nutrition world: SoFAS, an acronym for solid fats and added sugars. These substances are consumed excessively by Americans, amounting to almost 35% of caloric intake or nearly 800 calories per day. By reducing your consumption of SoFAS, you’ll have more room in your diet for nutrient-dense foods — and it will be easier to stay in calorie balance. The report recommends that no more than 5% to 15% of total dietary calories come from SoFAS. Solid fats are most often found in cakes, cookies, pastries, ice cream, cheeses, and processed and fatty meats. Added sugars are commonly found in regular soft drinks, energy drinks, sports drinks, desserts, sugar-sweetened fruit drinks, and candy.
You can cut back on SoFAS with low-fat cooking methods such as steaming and broiling; selecting lean meats and poultry; choosing fat-free or low-fat dairy products; and drinking water, 100% fruit juice, or unsweetened tea or coffee in place of sugar-sweetened drinks.
Refined grains have undergone processing that removes vitamins, minerals, and dietary fiber. Grains that are less refined and closer to their original form not only contain these nutrients but are also broken down in the body and digested more slowly, helping to prevent spikes in blood glucose after meals. Eating fewer refined grain products and replacing them with whole-grain foods is a good way to improve your overall nutrition.
Alcohol can have either positive or negative health effects, depending on the amount consumed and the age and characteristics of the person consuming it. Moderate drinking (no more than one drink per day for women and two drinks per day for men) is associated with a lower risk of cardiovascular disease and may have other health benefits. However, these potential benefits are not compelling enough to recommend that someone begin to drink, particularly in light of the risks associated with alcohol consumption. If you do drink alcohol, beware of the caloric and carbohydrate content of drinks — especially those made with mixers — and of the potential for hypoglycemia after drinking, especially if you take insulin or a drug that increases insulin production (such as glyburide, glipizide, or glimepiride).
Building healthy eating patterns
To address the challenge of putting all of the report’s recommendations together into a healthy eating pattern, Dietary Guidelines for Americans, 2010 endorses three established eating patterns: the DASH (Dietary Approaches to Stop Hypertension) diet, the Mediterranean diet, and a vegetarian diet, all of which are reviewed in detail. They’re based on common elements such as generous amounts of vegetables and fruits, an emphasis on whole grains, moderate amounts of protein, and limited amounts of solid fats and added sugars.
Unfortunately, as the report states, “the average American eating pattern currently bears little resemblance to these dietary recommendations.” To see sample menus that show how the report’s recommendations can be put into practice in a meal plan, visit www.choosemyplate.gov and click on “Print Materials.” Don’t forget that a healthy eating pattern also means following food safety recommendations to avoid food-borne illnesses.
The final section of Dietary Guidelines for Americans, 2010 is a call to action for all Americans to take part in the movement to create a healthy country. For many Americans, the environment we inhabit makes it difficult to choose healthy foods and engage in physical activity. This environment won’t change unless individuals, community organizations, health professionals, small and large businesses, educators and academics, and policymakers work together to change it.
What can you do? Start by preparing healthy meals and snacks for yourself and your family. Support access to healthy foods in your community by shopping at a local farmer’s market or joining a community-supported agriculture buying group (also known as a CSA). Support programs in schools, or elsewhere in your community, that stress good nutrition and physical activity beginning in childhood. Have a look at the Web sites www.letsmove.gov and www.physicalactivityplan.org to see how to get involved in these national efforts promoting healthier living. And share Dietary Guidelines for Americans, 2010 with others as you use it to help you achieve your diabetes and lifestyle goals.