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    Introduction to Dietary Guidelines

    The Dietary Guidelines are a set of food and nutrition recommendations published by governments that suggest dietary targets for their public as a whole. The guidelines are based upon current, substantiated research that links common diseases to dietary patterns. The goal is to help citizens prevent nutrition-related diseases by making the recommended diet changes. Both the USA and Canadian governments have published Dietary Guidelines. Diets in both countries, and in other western societies, have a prevalence of diseases related to dietary excesses and imbalances. Science has suggested that these diseases could be reduced with some key changes in diet. The dietary guidelines summarize the suggested changes. While the dietary guidelines are not specific to people with diabetes, following them can lower the risk of developing diabetic complications, as well as improve overall health and well-being.

    Eat A Variety of Foods

    The Food Guide Pyramid is a tool designed to help people achieve balance by choosing from among a variety of food groups. Its message is to eat enough protein-rich foods, including fruit, vegetables, grains and calcium-rich dairy products. Yet, it is still possible to miss the optimal nutrition mark with one's diet if a variety of individual foods are not chosen from within each food group, as well.

    The point of this first Dietary Guideline is this:
    Apples do not contain the same vitamins as oranges; meats provide a different nutritional package than do dried beans and peas; broccoli and peppers have different phytochemical profiles, and oatmeal is a better source of soluble fiber than whole wheat toast. Each of these foods, and others, make important and unique contributions to one's diet. It is worth the effort to include many different foods in planning menus across a week to obtain as full a range of nutrients, phytochemicals, fibers and antioxidants as possible for your diet.


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    Healthy Weight Maintenance and Exercise

    Excessive weight gain is a health hazard, especially for people with diabetes. The strongest link to weight gain is known to be low levels of physical activity. It only makes sense, then, that the goals of regular exercise and maintaining or improving upon one's weight are combined.

    This Guideline does not define specific weight goals for individuals, but rather provides general references. Weight loss to an "ideal" standard equally applied to everyone is not the intention. Rather, reasonable, individual goals are suggested. For people with diabetes, a typical recommendation is to not gain weight if you are within a healthy range to start. It you are overweight, your diabetes will probably be easier to manage if you lose some of the excess weight you carry. To do this, it is usually suggested that you increase activity, and follow a balanced diet with moderately limited calories for a gradual weight loss. Medication adjustments may need to be made during and after weight loss, so always consult with your physician before starting.


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    Eat Plenty of Grains, Fruit and Vegetables

    Grains, fruit and vegetables are the basic plant foods of human diets. They are full of essential nutrients and fibers we have known about for years, and of other health enhancing plant compounds we are just beginning to discover. Most have very little fat, if any, and are a good calorie vs. nutrient bargain.

    People with diabetes are encouraged to eat a diet rich in grains, fruit and vegetables, but with a few important tips on how to best accommodate the carbohydrate contributions they make to the diet.

    First, whole grain, whole fresh fruit and fresh, raw vegetables are the best forms in which to take these foods. The less processed the food, the more digestive work your body must go through before sugars are ready for absorption into the blood. This effect results in less dramatic blood sugar rises after eating.

    Secondly, spread these foods out during the day, especially grains and fruit. While a good total amount of these foods is advised, each meal should contain some of the total so that no one meal is too heavily laden with fruit or grain.


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    Eat Foods Low in Fat, Saturated Fat and Cholesterol

    Portion for portion, foods that contain a lot of fat are higher in calories than similar foods with less fat. This doesn't mean all fats are undesirable, or that they should be excluded from a healthy diet. Fats adds satiety (sense of fullness) to meals and helps balance carbohydrate calories. But it is certainly easy to overshoot a calorie goal when fat intake is too high. Less than 30% calories from fat is the usual recommendation.

    The recommendation to limit saturated fat (harder fats) in one's diet is very important, however, because it contributes directly to the development of cardiovascular diseases. People with diabetes are particularly prone to these diseases.

    While not as strong a link to cardiovascular disease as saturated fat, dietary cholesterol should also be limited. Foods high in cholesterol are few (egg yolk, liver, other organ meats, shrimp and squid), but all meats contain some and a heavily meat-based diet is discouraged.


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    Choose a Diet Moderate in Sugar

    This Dietary Guideline obviously speaks to people with diabetes, but it still needs a bit more explanation.

    The intent of this Guideline was to advise limited use of added sugar sweeteners (table sugar, honey, syrups) and of foods which are concentrated with them (candy, desserts, soft drinks). These sweeteners intensify the calorie load of any food, and contribute to dental disease. They result in more sugar absorption after a meal, a specific concern for blood sugar control.

    For people with diabetes, sugar sweeteners can be eaten in moderation, but are better tolerated when eaten within the context of a whole, mixed meal. This means, a small portion of low fat frozen yogurt will not raise blood sugar as quickly or steeply when eaten with a tuna sandwich and 3-Bean Salad (meat, beans and mayonnaise all slow digestion) as it would if it were eaten alone.


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    Eat Salt and Sodium in Moderation

    Sodium is the main component of salt , which is of concern, so this Dietary Guideline encourages moderate sodium intake from all sources, including salt. But you should also scan food labels for the sodium content of packaged foods. This can often be quite high (i.e., above 400 mg/serving), as is most food from fast food restaurants.

    The reason for recommending caution with sodium to all Americans is that many people have high blood pressure and do not know it. For them, too much sodium can raise their blood pressure and further increase the risk of more serious health problems caused by this disease, such as kidney damage, heart attack or stroke.

    For people with diabetes, elevated blood pressure is of great concern for all the reasons stated above. High blood pressure often occurs in combination with diabetes, and, if left uncontrolled, will substantially increases the risk of developing kidney disease, eye problems, heart problems and of having a stroke. Take this guideline to heart.


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    Choose a Diet High in Fiber

    Most people know that fiber in foods is important to keep digestive systems healthy. But did you know that a high fiber diet could be especially helpful for people with diabetes?

    Dietary fiber comes in two forms, soluble and insoluble. Both forms provide health benefits, but soluble fiber can actually reduce blood sugar rises after a meal, and lower serum cholesterol.

    The term "soluble" refers to the fiber's properties in water. Pectin, gums and mucilage are the soluble fibers in food because they dissolve a bit when mixed with water. As they dissolve, they become sticky and bond to various compounds around them. One of the compounds they bind with in the intestines is sugar. Another is cholesterol. Because sugars and cholesterol molecules are trapped in the soluble fiber, they are less absorbable and fewer of them enter the blood.

    The best sources of soluble fiber are dried beans and peas (legumes), peas, oatmeal, whole oat products, and certain high pectin fruit like apples and pears.

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    If you Drink Alcoholic Beverages, Do So in Moderation

    Alcohol is not a nutrient. It is a drug. It has caloric value because our bodies can burn it as a fuel, but we do so at the expense of other nutrients (fats and carbohydrate) which would have been used as fuel if the alcohol had not been present.

    Alcohol directly alters metabolism (fuel utilization) and complicates blood sugar control. It also facilitates fat storage and excess weight gain. The most risky complication of alcohol for those who take insulin or oral diabetic medication is that it increases the likelihood of serious hypoglycemia. Precautions for alcohol consumption should always be followed. And, if you do not drink, there is no convincing health reason to start.

    One of the most difficult problems in drinking alcohol is determining what is truly "moderation." One "drink" is the amount of a beverage which contains 10 to 15 grams of alcohol (12 ounces of beer, 4 ounces of wine, 1-1/2 ounce of liquor). For women, moderation is defined as one drink. For men, moderation is up to 2 drinks. The difference in the recommendations for men vs. women is not just based on body size. Women have less enzyme activity than men for detoxifying alcohol, and are thus more easily hurt by alcohol excess.


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    If You Consume Caffeine, Do So in Moderation.

    If you consume caffeine, do so in moderation Caffeine, like alcohol, is a drug. It does not contain calories; it has no nutrient content. But for many people, it is an important part of their diet. Caffeine effects the central nervous system and, in moderation, can increase alertness and boost our energy level.

    But in excessive amounts, caffeine has a very negative effect on stress management. The ability to recover (calm down) after a stressful event is greatly impaired with caffeine. The more caffeine, the more pronounced the effect.

    For people with diabetes, stress management is an important health skill to master. Hormones of stress (glucagon, adrenalin) raise blood sugar. The longer one is under stress, the longer these counter regulatory hormones are active. This effect can make blood sugar more difficult to control.

    Individual tolerances to caffeine vary. Most people are advised to consume no more than 500 mg of caffeine daily. This would be the equivalent of 4 small cups (not mugs) of coffee. Less is best.

    When cutting down on caffeine, be aware that you may experience withdrawal symptoms of headache and fatigue. Cutting back gradually over 2 to 4 weeks can help to minimize this problem.


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