Joslin Diabetes Center’s New Nutrition Guideline For People with Type 2 Diabetes or Pre-Diabetes Who Are Overweight or Obese

The scientific jury is in and the verdict is clear: weight loss is directly related to improved diabetes control. What is also clear is that two out of three people in the U.S. are overweight or obese, resulting in a skyrocketing rate of diabetes.

Joslin Diabetes Center’s approach to nutrition and physical activity has always been to focus on the individual and not dictate a “one size fits all” strategy. This approach has not changed with the creation of Joslin’s new clinical nutrition guideline. Indeed the “Joslin Diabetes Center Clinical Nutrition Guideline for Overweight and Obese People with Type 2 Diabetes, Prediabetes or at High Risk for Developing Type 2 Diabetes” is consistent with Joslin’s care strategy, which emphasizes a personalized approach to diabetes management.

What has changed, however, is an explicit goal of weight loss resulting from increased physical activity and a decrease in the number of calories and carbohydrates a person eats each day. With this goal met, outcomes will include improved insulin sensitivity, better cardiovascular health and a reduction in body fat. The scientific data support this plan. And it is a plan that can be followed because it makes clear what people need to do to achieve their goals.

The best way for people to approach the plan is to work with a registered dietitian (R.D.) for an assessment, review of treatment goals, and an individualized meal plan tailored to meet their needs.

This Joslin guideline, which evolved from a review of the scientific literature, details the following for the major nutrients that provide calories:

Carbohydrate:

• Approximately 40 percent of a person’s daily calories should come from carbohydrate; the total should not be less than 130 gm daily. This is a significant change from 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.
  • In terms of carbohydrate intake, eating fresh vegetables, fruits, beans, and whole grain foods is 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. High-fiber foods include fruits, vegetables, whole grain cereals, breads, nuts and seeds.

For Fat:

• Approximately 30 to 35 percent of a person’s daily calories should come from fat.
  • 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:

• Approximately 20 to 30 percent of a person’s total calories should come from protein. This is a higher percentage than 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.
  • Anyone with signs of kidney disease should consult their provider before increasing the daily amount of protein.

Guidelines for Weight Loss:

• 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.

Guidelines for Physical Activity:

• 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.

Click here to read the complete guideline.