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In Focus |
DESIGNER MEALS
The diabetic diet, tailored to the individual's needs, can be both beneficial and fun
By Michelle Ciriacruz
"PEOPLE ARE EATING THEMSELVES INTO DIABETES," LAMENTS DR. LARS LINDHOLM (DEPARTMENT OF PUBLIC HEALTH, UMEÅ UNIVERSITY, SWEDEN) IN A RECENT VISIT TO THE COUNTRY.
Given the alarming incidence of diabetes worldwide-which is expected to double in the next 30 years-and studies linking this prevalence to high-fat and high-caloric diet, this statement cuts through the mountainous weight of evidence and into the heart of the matter.
Evidently, people's eating habits are responsible for much of the insulin deficiency or insensitivity besetting a rising number of children and adults alike. Not so evident, but which many people assume is true, is that for those who cannot take health for granted anymore, one price to pay is to suffer through dietary restrictions.
Certainly, diet is one the four cornerstones-exercise, medication, and education are the others-of diabetes management. But the idea of restrictions, in the sense it is commonly understood, does not apply if the diabetic diet is designed with the patient as a person in mind, as well as their nutritional requirements and improvement of symptoms.
Diet Truths
Contrary to popular opinion, a diabetic can eat whatever they want. Ideally, says nutritionist-dietician Joan Sumpio, a diabetic's diet should not be that different from that of a normal healthy person. "It shouldn't even be far from your usual diet once you are prescribed to follow a diabetic regimen," she explains.
The ideal diabetic diet is both simple and liberal, she relates. It is simple because it does not need to have too much restriction; liberal, because it can include all the food preferences of the patient.
These principles seem at odds with the commonly held belief about medical and nutritional therapy, which is "what tastes bad is good for you." Deeply rooted in folklore and probably inspired by the use of herbal remedies to treat sickness, this belief persists even as it hinders compliance of patients with the diet plan that will help them get better.
"[The diabetic diet] is something that is well quantified and well qualified, according to individual need," explains Sumpio.
The last two words of her statement are the key to the success of the diabetes nutrition care. "When the meal is not adapted to the lifestyle of the individual," the result is often discouraging, as patients are turned off by the conditions they have to meet to be able to follow the prescribed regimen.
More key words are individual taste. This specification gives the lie to the old adage, which ought to inspire compliance but often engenders only further distaste. Provided that it is well planned, the diabetic diet is appealing, Sumpio points out.
This appeal does not all interfere with the other goals of nutritional therapy, which is to keep blood glucose levels as close to normal as possible, ensure calorie intake is adequate for developmental needs and energy requirements, keep serum lipid levels optimal, and prevent or treat the complications from diabetes.
This appeal actually ensures the delivery of the health and nutritional benefits of the diet plan. Sumpio explains that without the cooperation of the diabetic patient and the patient's family, a painstakingly prepared nutritional assessment and diet plan might as well have been made in vain.
Since "there is no diabetic diet for the general population," points out Sumpio-for every diabetic, there is a diet unique to them-diet counseling is an effective way to identify what suits and what will work to take the patient towards treatment goals.
Diet counseling, however, involves not just the patient but also their family and household members. Sumpio stresses that the eating habits of the people around the diabetic will affect their attitude towards the diet plan. Which is why patients often have a relative or the family cook learn about preparing meals that are suitable to diabetics and nondiabetics.
This adjustment of the entire family to the diabetic diet is very important to prevent the newly diagnosed diabetic from getting worse.
Since palatability is rarely an issue with diabetic meals-nutritionists-dieticians have come up with recipes that make use of substitute ingredients if the usual ones are not desirable just as they have devised a system of quantifying and qualifying food ingredients-adjustment by the family is just a matter of temporarily abstaining from or indulging less in foods or condiments that will not help the diabetic family member gain control of his diabetic situation.
Sumpio explains that food variety previously enjoyed by the diabetic might hardly be affected, but the balance of nutrients would definitely have to be rearranged somewhat on account of a diabetic's blood sugar level problem and increased predisposition to lipid disorders.
It is in the balance of macronutrients-like the amount of carbohydrates, fats, and protein-that the difference in the diabetic diet is conspicuously different. However, "unless complications, such as complication of the kidney, have already set in, all requirements for micronutrients of a normal person should also be met by a diabetic person," she relates.
Since obese or overweight diabetics need to lose weight to improve glucose control, sensitivity to insulin, and blood pressure and cholesterol levels, they are advised to cut down on total caloric intake, eat less fat-and less salt, if hypertensive. A diabetic may still eat cake or ice cream (if it does not have too much icing or if sugar alternatives were used).
On the family's dining table, this may mean to the newly diagnosed diabetic being left out as nondiabetic housemates stuff themselves full while the patient is bound to be more restrained.
Essentially, the family's involvement in the diet planning ensures the patient's emotional well-being, which in turn ensures patient compliance. Sumpio explains that once the patient is categorized to be in control of his diabetic situation, family members could resume their usual eating habits.
Triple Q (Quantify, Qualify=Quality)
An individualized approach to meal planning can be a very personal undertaking. If only diabetics can always be home-served by their nutritionists-dieticians, Sumpio muses. That way, she explains, the patient's food intake can really be monitored and adherence to the treatment regimen maintained.
Barring this, the nutritionist-dietician should get a detailed dietary history, which includes the patient's cultural, psychosocial, and socioeconomic background. The patient's physician may have also prescribed a diet order, like the patient should consume 1800 kcal/day, which the nutritionist-dietician will work with.
When the nutritionist-dietician starts to formulate a meal plan, the patient's goals and readiness to learn should also be factored in.
Sumpio points out that local availability of food ingredients also has a big say on how the diet plan will turn out. She explains that local availability means that these food ingredients are readily available where the patient lives, works, or studies. So if the patient works in Makati City, then they should be able to refer to the diet plan what appropriate meals to order, say, at Greenbelt.
Taking just half servings of fast foods' serving size is a safe recommendation, says Sumpio.
What they ate, how they ate, and how much they ate might have brought the diabetic where they are. In the same token, what they eat, how they eat, and how much they eat-as long as, this time, these things are carefully considered-would be what will help the diabetic achieve and maintain optimal health. With a little discipline mixed in with eating habits, the diabetic can enjoy their meal-with the health hazards thrown out of the pot.
"[The diabetic diet] is something that is well quantified and well qualified, according to individual need...When the meal is not adapted to the lifestyle of the individual, [the result is often discouraging]."
-Ms. Sumpio
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BALANCING ACT
Every diabetic's diet is unique to the patient. One can have as much variety as they used to eat, but the more important consideration is to strike a balance between the amount of food intake and the nutrients the body needs. A carefully weighed meal is a function of 3-Q: Quantify, Qualify=Quality.