The Great Sugar Shake Up

Nutrition Guidelines

For Managing Diabetes

Sugar Shake Up

Babs Carlson, PhD, RD, CDE

Coordinator, DSMEP

Lifestyle Center

Chesapeake Regional Medical Center

Retired

Diabetes

24 million Americans have Diabetes – 8% of the population (1 in 12)

57 million Americans have pre-diabetes- 20% of the population

By 2020, 20% of the population will have Diabetes

34% of babies born after the year 2000 will develop Diabetes in their lifetime

Diabetes

Diabetes cost the nation $174 billion in 2008

1 in every 8 dollars spent on healthcare is attributed to Diabetes (12%)

Diabetes

50% of Black and Hispanic Americans over age 50 have Diabetes or Prediabetes

40% of white/ Caucasian Americans over age 50 have Diabetes or Prediabetes

Obesity

66% Americans are Overweight34% Americans are Obese: BMI>30

50 years ago, 20% of Americans were overweight. Some experts predict that by the year 2099, 99% of Americans will be overweight

Obesity

Why the Increase in Obesity?Why the increase in Visceral Obesity

ie Insulin Resistance ie Beta Cell Failure

Obesity

Consumption of calories as Fat has remained steady since 1980s

Consumption of calories as Sugar has increased from 129 pounds per person in 1980 to 148 pounds per person in 2005

Sugar consumption now as high fructose corn syrup contributes to Diabetes and triglycerides

Sugar Shake Up

Why Sugar? Sugar does not cause Diabetes.

ADA: “substituting sucrose containing foods for isocaloric amounts of other carbohydrates will have similar blood glucose effects”

Sugar Shake Up

Sugar does deliver excess calories with no satiety value

ADA: “People with diabetes should avoid intake of sugar-sweetened beverages to reduce the risk for weight gain and worsening cardiometabolic risk profile.”

Sugar Shake Up

Dietary Guidelines: Reduce added sugars intake to 4 – 10 teaspoons per daySedentary females: 4 teaspoonsActive males: 10 teaspoons

1 teaspoon = 4 grams of sugars

Sugar Beverages – 12 ounces

Apple juice – 7 teaspoonsEnergy Drink 10.5 teaspoonsOrange juice 7 teaspoonsPepsi 11 teaspoonsCoke 9 teaspoonsGingerale 9 teaspoonsVitamin Water 5 teaspoons

Sugar Beverages

7-11 Slurpee 6 teaspoons (ice) Big Gulp 12 teaspoons Sweet tea 6 teaspoons Latte 7 teaspoons Tazo Chai Frappuccino 14 teaspoons Tropical Smoothie 12 teaspoons Gatorade 6 teaspoons Powerade 8 teaspoons

Sugar Foods

Instant oatmeal 4 teaspoonsBlueberry muffin 5 teaspoonsChocolate chip cookies 2 teaspoonsGlazed donut 5.5 teaspoonsSherbet 5 teaspoonsFruit Yogurt 7 teaspoonsMars bar 7 teaspoons

Sugar Calorie Sources

Top calorie sources for AdultsGrain-based dessertsYeast breadsSoda/ energy drinksDairy desserts

Sugar Shake Up

If not Sugar, then WHAT?Follow the A, B, C’s

HbA1c = Average Blood Glucose: 6.5Blood Pressure: 130/80Cholesterol

Tchol <200mg/dlTrig < 150mg/dlHDL > 40 >50mg/dlLDL < 70mg/dl

Nutrition Guidelines

Eat Breakfast every dayBreakfast should be eaten within 60

minutes after getting out of bedBreakfast should be eaten before

exerciseBreakfast should include ProteinLast meal should be eaten prior to 2

hours before going to bed

Nutrition Guidelines

Carbohydrates – greatest impact on post prandial blood glucose

Protein – building block for insulin, provides satiety, necessary in each meal

Fat – delays gastric emptying, plant sources necessary daily

Salt as sodium – 1500 - 2300 mg daily

Nutrition Guidelines

Carbohydrates should provide 45-60% of calories per meal, per day1500 calories: 185 grams1800 calories: 225 grams2400 calories: 300 grams

Minimum daily recommendation is 135 grams distributed among 3 meals, snacks if necessary

Nutrition Guidelines

Carbohydrate sourcesVegetables: 4-5 servings dailyFruits: 2-3 servings unless triglycerides

elevated. Fruit not juiceWhole grains should provide 2-3 grams fiber

per servingCereals should provide 3 grams fiber per

servingFiber total: 25 grams daily

Nutrition Guidelines

Protein should provide 12-20% of calories per meal, per day1500 calories: 55 grams1800 calories: 70 grams2400 calories: 90 grams

Daily protein recommendation is 1 gram to 1.5 grams per kilo body weight

Nutrition Guidelines

Include low fat animal sources or plant protein sources in each meal. Include at least 10 grams protein in each meal

Portion size: 3 ounce portion, the “deck of cards” is 21 grams protein

Nutrition Guidelines

Fats should provide 27-27% of calories per meal, per day1500 calories: 55 grams fat1800 calories: 63 grams fat2400 calories: 90 grams fat

Nutrition Guidelines

Monounsaturated fats improve lipid profile, reduce cardiovascular risk. Choose olive oil, canola oil, peanut oil

Fish oils, Omega-3 oils, reduce cardiovascular risk, reduce inflammation. Choose fatty fish: salmon, mackeral, sardines; also walnuts.

Nutrition Guidelines

Pattern ManagementBreakfast should provide ¼ daily caloriesSecond meal: 4-5 hours after breakfastThird meal: 5-6 hours after second mealSnacks are optional, not requiredA “meal” must include carbohydrate, protein,

fat. Two “meals” should include vegetables.

Nutrition Guidelines

Supplements. There is no scientific evidence to support routine use of nutrient supplements.

Long term use of Metformin destroys Vitamin B12. Many persons with Diabetes are deficient in Vitamin D

Dinner

Resources

www.DietaryGuidelines.gov

• Policy Document

• Advisory Committee Report

• Public Comments Database

www.NutritionEvidenceLibrary.gov