Joslin Diabetes Center Announces New Nutrition
Guidelines
BOSTON—As Americans' waistlines continue to expand, contributing
to a burgeoning epidemic of type 2 diabetes, the scientific
jury is in and the verdict is clear: weight loss and increased
physical activity is directly related to improved diabetes
control. To help Americans fight the dramatic increase in
type 2 diabetes, Joslin Diabetes Center has crafted new nutrition
and physical activity guidelines for overweight and obese
individuals with type 2 diabetes and those at risk for developing
diabetes (pre-diabetes).
"Since obesity doesn't seem to be
slowing down and the complications of diabetes are so serious,
we were especially alarmed about the health of the American
public. We felt the best way to impact the largest number
of people was to strengthen our nutrition guidelines," said
James L. Rosenzweig, M.D, head of Joslin's clinical guidelines
committee. The team of physicians, dietitians, exercise physiologists
and educators spent months reviewing the scientific literature
to draw up new guidelines. "The search was on for guidelines
that would improve insulin sensitivity, cardiovascular health
and reduce body fat. And most importantly, we wanted to deliver
a plan that makes clear what people need to do to achieve
their goals," said Dr. Rosenzweig, who also is Director
of Joslin's Disease Management Program and Assistant Professor
of Medicine at Harvard Medical School.
The new guidelines recommend approximately 40 percent of
a person's daily calories come from carbohydrates; 20 to
30 percent from protein (unless the person has kidney disease);
30-35 percent come from fat, (mostly mono- and polyunsaturated
fats); and at least 20-35 grams of fiber. To initiate and
continue weight reduction, a modest goal of one pound every
one to two weeks is advised by reducing daily caloric intake
by 250 to 500 calories. Total daily calories should not be
less than 1,000 to 1,200 for women and 1,200 to 1,600 for
men. A target of 60 to 90 minutes of modest intensity physical
activity most days of the week with a minimum of 150-175
minutes/week is encouraged and should include cardiovascular,
stretching and resistance activities to maintain or increase
lean body mass.
Two out of three people in the U.S. are overweight or obese,
resulting in a skyrocketing rate of type 2 diabetes that
now affects at least 18.2 million Americans, including an
increasing number of young people. An estimated 41 million
Americans have pre-diabetes and are at risk of developing
full-blown type 2 diabetes unless they lose weight and increase
physical activity. Diabetes is a leading cause of heart disease,
stroke, blindness, kidney disease, amputations and other
complications.
"Setting the standards for diabetes
treatment for more than 100 years, Joslin Diabetes Center's
approach to diabetes management has always been to focus
on the individual and not dictate a 'one size fits all' strategy.
While these guidelines are very straightforward, Americans
should meet with their healthcare team so they can adapt
the guidelines to meet their personal needs," said
Osama Hamdy, M.D., Ph.D., Clinical Director of Joslin's
Obesity Program and an obesity researcher, who co-chaired
the committee that developed the new guidelines.
"Eating smaller portions, modest carbohydrates and
slightly more protein with careful selection of fat, protein
and carbohydrate sources is the way to go if you are overweight
or obese and have diabetes or pre-diabetes and normal kidney
function. These recommendations can help people lose weight,
have better diabetes control and prevent serious cardiovascular
complications," Dr. Hamdy added.
Catherine Carver, M.S., A.N.P., C.D.E., Director, Educational
Services and New Clinic Program Development, also co-chaired
the workgroup that wrote the guidelines. Amy P. Campbell,
M.S., R.D., C.D.E., Education Program Manager of Joslin's
Affiliates Programs/Disease Management Program, also was
integral to developing the guidelines.
Among the highlights of the new Joslin
guidelines are the following recommendations:
Carbohydrate: Approximately 40 percent of a person's daily
calories should come from carbohydrate; the total should
not be less than 130 grams daily. This is a significant change
from Joslin's previous recommendations that promoted a higher
carbohydrate intake. Scientific data show that reducing one's
carbohydrate intake while simultaneously increasing healthier
protein and fat choices may be a better approach to weight
control. It may also help decrease cardiovascular disease
in overweight people with type 2 diabetes. The best sources
are fresh vegetables, fruits and beans. Whole grain
foods are preferable to eating pasta, white bread, white
potatoes and low fiber cereal. Fiber intake should be approximately
50 grams daily if that amount can be tolerated; a minimum
of 20-35 grams per day is recommended and an external supplement
may be needed. High-fiber foods include fruits, vegetables,
whole grain cereals, breads, nuts and seeds.
Fat: Approximately 30 to
35 percent of a person's daily calories should come
from fat. Most should come from mono- and polyunsaturated
fats, such as olive oil, canola oil, nuts, seeds and fish
(especially those high in omega-3 fatty acids, such as
salmon, mackerel, lake trout, herring and sardines). Foods
that are high in saturated fat, such as beef, pork, lamb
and high-fat dairy products (cream cheese, whole milk)
should be eaten in small amounts. Foods that are high in
trans fats such as fast foods, commercially baked goods,
crackers, cookies and some margarines should be avoided.
Cholesterol intake should be less than 300 mg daily; or
less than 200 mg in people with an LDL ("bad")
cholesterol that is more than 100 mg/dL.
Protein: While anyone with signs of kidney disease should
consult their provider before increasing the daily amount
of protein, approximately 20 to 30 percent of a person's
total calories should come from protein.
This is a higher percentage than Joslin recommended in the
past.
Scientific data reveal that eating
more protein helps people feel "full" and
thus causes people to eat less calories overall. Protein
also helps to maintain lean body mass during weight
loss. Examples of protein include fish, skinless chicken
or turkey, nonfat or lowfat dairy products and legumes such as kidney
beans, black beans, chick peas and lentils.
Weight Loss Guidelines: A modest weight loss of one pound
every one to two weeks is advised. Reducing daily calories
should be by 250 to 500 calories; total daily calories should
not be less than 1,000 to 1,200 for women and 1,200 to 1,600
for men. Weight loss is different for each person and should
be continued until a person reaches a target body mass index,
or BMI (ask your provider about how to obtain this measurement.)
Meal replacements, such as shakes, bars and ready-to-mix
powders that match these guidelines can be helpful for some
people. Blood glucose patterns often change with these types
of replacements and thus people should monitor their blood
glucose.
Physical Activity
Guidelines: Physical activity is extremely
important to a weight loss plan. A minimum of 150 to 175
minutes of moderate intensity physical activity is recommended.
Examples of this include walking, biking, swimming and dancing.
A target of 60 to 90 minutes most days of the week is encouraged.
Physical activity should be a mix of cardiovascular, stretching
and resistance activities to maintain or increase lean body
mass.
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