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Diet and Diabetes: A Personalized Approach

By Osama Hamdy, M.D., Ph.D., Director, Joslin Obesity Clinical Program;
Amy Campbell, M.S., R.D., C.D.E., Joslin Education Program Manager

Despite the new fad diets published and diet aids marketed each year, Americans’ waistlines and the epidemic of obesity and diabetes continue to expand. With current scientific knowledge and clinical experience, however, health care providers and industry influencers can make a difference.

In 2005 for the first time in 13 years, the United States Department of Agriculture (USDA) updated the Food Guide Pyramid. The USDA touts the latest version as no longer a “one size fits all” approach, but rather an “individualized approach to improving diet and lifestyle.” Though this long-awaited update to the nation’s only federal nutrition guidelines offers healthier food choices for healthy Americans, for the 17 million Americans with type 2 diabetes and the 41 million more who are at high risk for developing the disease, these guidelines are not enough.

One Size Fits Some

Joslin’s approach to diabetes management has always been to focus on the individual, and not dictate a “one size fits all” strategy. At a time when the diet advice waters are muddied with thousands claiming the answer to the battle of the bulge, Joslin offers evidence-based clinical nutrition guidelines for overweight and obese people with type 2 diabetes, prediabetes or at high risk for developing type 2 diabetes. The ultimate goal is to help these populations improve cardiovascular health, reduce body fat and increase sensitivity to insulin. This decreases their risk for devastating diabetes complications, including kidney disease, heart disease and amputations.

The Basics

The biggest difference between the USDA’s guidelines and Joslin’s is the recommendation of fewer carbohydrates and more protein in the diet, as recent studies have shown that this helps people eat less and lose weight.

The following are Joslin’s guideline essentials (shown as approximate percents of daily calories):

Carbohydrate: 40 percent from carbohydrates, including at least 20-35 grams of fiber. Best carbohydrate/high-fiber sources: fresh vegetables, fruits, beans and whole-grain foods. Eat less of these carbs: pasta, white bread, white potatoes and sugary cereals.

Protein: 20-30 percent from protein (unless you have kidney disease). Best protein sources: fish, skinless chicken or turkey, nonfat or low-fat dairy products, tofu and legumes (beans and peas).

Fat: 30-35 percent from fat (mostly mono- and polyunsaturated fats). Best fat sources: olive oil, canola oil, nuts, seeds and fatty fish like salmon.

Lifestyle Change

With 80 percent of people with type 2 diabetes overweight, and weight loss directly related to improved diabetes control, these guidelines are meant to help people with diabetes or at risk for the disease lose weight and keep it off. To initiate and maintain weight loss, Joslin recommends losing just one pound every one to two weeks by reducing daily calories by 250 to 500 calories.

An essential component of any healthy lifestyle is physical activity.Joslin encourages a target of 60–90 minutes of modest-intensity physical activity (including cardiovascular, stretching and strength training) most days of the week, with a minimum of 150–175 minutes per week.

Joslin’s bottom line: There is no fad diet that will help people with type 2 diabetes lose weight and reduce their risk for serious complications—just a lifestyle change.

This article appeared in the Special Diabetes Insert of the November 21, 2005 issue of TIME Magazine.

To learn more about how food affects blood glucose and about meal planning, Staying Healthy with Diabetes -- Nutrition & Meal Planning is available from Joslin.

Page last updated: August 29, 2014