Nutritional Management of Type 2 Diabetes and Lipids

1. Eating too much sugar causes diabetes
2. Avoiding sweet foods manages T2DM
3. Avoiding all carbs manages T2DM
3. There is a diabetes diet
4. Ppl with diabetes must eat 3 meals + 2 snacks a day
5. Everyone with T2DM is overweight
6. Ppl with diabetes must eat sugar substitutes

1. Avoiding all fat manages cholesterol
2. Dietary cholesterol is what causes blood cholesterol
3. Eggs cause high cholesterol
4. Everyone with high lipids is overweight
5. Avoiding red meat is sufficient for managing elevated lipids
6. Elevated lipids are caused completely by genetics

1. Food models
2. Standard measuring tools
3. Patient quantification
4. Zimbabwe hand jive: 1 fist= 1 cup of starch/fruit, 1 palm = 3 ounces of protein, tip of thumb = 1 teaspoon fat

1. Eat less: quantity of carbs
2. Eat better: quality of carbs
3. Move more: excercise
4. Combination

1. Amount: reduce amt per meal so less insulin demand, distribute better so more small meals per day
2. Type: low GI foods decrease insulin demand and promote satiety
3. Absorption: soluble fibre will slow bulk of nutrients to the gut which will decrease insulin demand. Diabetics should be eating 25-50g of fibre per day.

1. Acids: slow movement of carbs through GI tract thus decreasing insulin demand
2. Physical Activity: increases sensitivity to insulin, reduces post-prandial rise in lipids, is good for cardiovascular complications

1. Increase: Low GI/Whole Grains, plant sterols, nuts, soluble fiber
2. Decrease: saturated fatty acids, cholesterol, Trans-fatty acids, refined carbs

1. Fats: change from bad fats (saturated/trans) to good fats (unsaturated)
2. Fibre: add soluble and insoluble fibres (oats, barley, psylium)
3. Plant Sterols: add plan sterols to a max does of 2g/d, they inhibit cholesterol absorption in gut, bigger effect in elderly, lower LDL-C by 9-13%
3.

1. Diet: avoid trans fat, add omega 3 fats, add 1 glass of alchol
2. Lifestyle: lose weight, exercise, stop smoking

1. Lifestyle: lose weight, control elevated blood sugar
2. Diet: reduce sweets, reduce alcohol

1. Increase: low GI/whole grains, antioxidants, Omega 3
2. Decrease: saturated FA, trans-fats, refined carbs

1. History: fat-containing foods, fibre containing foods, foods eaten out
2. Recommendations: improve quality of fats, increase fibre, Mediterranean diet (high fats but low SFA and low cholesterol), portfolio diet (soy/soluble fibre/plant sterols/almonds/soy to decrease LDL + reduced SFA/TFA)
3. Outcomes: portfolio diet decreases LDL-C by 30%, Mediterranean diet decreases LDL-C by 35% and increases HDL by 12%

1. New diagnosis of T2DM
2. New diagnosis of high lipids
3. Wt loss counselling
4. Meal-planning
5. If patient prefers lifestyle changes over medications
6. For more education/support than you can offer