Diet therapy - One of the most important methods of treating people with diabetes, the most important component in achieving stable compensation of carbohydrate metabolism, and in the preinsulin era - the only way to prolong the life of the patient with IDDM. Currently, it is 50% of successful treatment of diabetes mellitus (30% - insulin therapy is reserved and another 20% - adherence to day regimen, time and frequency of insulin injections and physical exertion), is one of the "three whales" to achieve compensation of carbohydrate metabolism. Constant overeating, especially when combined with impaired physiological composition of food ingredients, contributes to overloading, depleting the insular apparatus of the pancreas and realizing the genetic predisposition of diabetes.
Clinical practice has shown that taking carbohydrate foods under physiological conditions does not worsen the course of the disease — on the contrary, it leads to a more stable course of diabetes. M. Somogye in 1939 in young patients with severe labile diabetes who received high doses of insulin, increased the daily ration of carbohydrates from 100 to 300 grams (indicating the presence of frequent hypoglycemic conditions (against the background of the administration of excessive doses of insulin), accompanied by a compensatory release of contrinsulin hormones with the subsequent increase in a glycemia, increase in a glycosuria and an acetonuria). A sharp reduction in the diet of people with insulin-dependent diabetes mellitus carbohydrate with a normal daily caloric intake inevitably led to a proportional increase in the amount of other energy material - fat (long-term intake of large amounts of fatty foods contributes to impaired carbohydrate tolerance, which is associated with a decrease in insulin sensitivity Brumzell JD et al, 1974, increases the risk of atherosclerosis (coronary artery disease, lesion of cerebral vessels), leads to increased processes of ketogenesis and Niemi ketone bodies in urine and exhaled air).
The ratio of basic ingredients in food (proteins, fats and carbohydrates) is a very important element of the diet. The caloric content of the daily diet of healthy people is 50 ... 60% due to the presence of carbohydrates, 25 ... 30% - fat and 15 ... 20% of proteins.
Under physiological conditions, the energy value of food eaten by 50% is provided by the content of carbohydrates in it. The main source of carbohydrates is food of plant origin: cereals and leguminous crops, vegetables, fruits and berries. The value of these products is determined by the presence of “sugars” in them: mono-, di- and polysaccharides, which penetrate the body through the gastrointestinal tract and are actively involved in energy metabolism. Glucose in the human body provides not only energy needs, but also can accumulate in the form of glycogen polymer in the liver and muscles, and also takes an active part in the synthesis of fat - by activating the processes of lipogenesis, it has a pronounced antiketogenic property.
Mono- (glucose, fructose) and disaccharides (sucrose, maltose and lactose) are carbohydrates that are easily absorbed by the body. The main food easily digestible polysaccharide - starch - is absorbed much slower, since it must be broken down into simple sugars for absorption by villi. Polysaccharides (hemicellulose, cellulose, pectins, gums and dextrins are practically not absorbed by the human body (there are no enzymes, and in the intestine there is no microflora that can break them down into simple sugars).
Cellulose, hemicellulose, pectin and lignin (a non-carbohydrate aromatic polymer) form the basis of plant cell walls and are called cellulose. Pectin (found in large quantities in the skin of vegetables, fruits, and the skin of berries), connecting plant cells to each other, also belongs to indigestible carbohydrates. Dietitians call cellulose and pectin ballasts or dietary fibers. They are necessary for the normal functioning of the gastrointestinal tract and the prevention of obesity and diabetes mellitus - the mechanism of the protective effect of dietary fibers has not been finally clarified. It is known that dietary fiber is resistant to the digestive effect of enzymes of the stomach and intestines, which prevents their absorption. Long remaining in the lumen of the intestine, dietary fiber:
- actively retain water and cations, increase intestinal motility, promote its emptying,
- form insoluble and nonabsorbable complexes (gels) with other components of the food (monosaccharides, cholesterol), which prevents their absorption and promotes removal from the intestine,
- create normal conditions for the life of microflora and suppress putrefactive processes,
- stimulate the secretion of digestive glands and are actively involved in regulating the level of peptide (gastrointestinal) hormones,
- affect the level of intestinal glucagon (considered proven), having a mediated effect on the level of insulin in the blood,
- presumably stimulate the absorption of vitamins and minerals.
The positive effect of fruits and vegetables on glucose homeostasis is also due to the content of substances with hypoglycemic properties (guanidine derivatives) in them: vebulin is extracted from cabbage, and phenylamine from onions and grapefruit.
In persons with diabetes, refined carbohydrates are responsible for high glycemia and lipidemia. At the same time, the supply of non-absorbable carbohydrates in sufficient quantities with food contributes to the achievement of the best indicators of the level of glycemia and lipidemia. Bierman, E., L., Hamlin, J. T., 1961, Brumzell, J. D. et al., 1971.
Alimentary fiber normalize the function of the gastrointestinal tract, the level of peptide hormones, the response of the pancreas to the intake of carbohydrate foods, slow down the absorption, facilitating the removal of monosaccharides and cholesterol from the body. In healthy individuals, adequate dietary intake of dietary fiber improves carbohydrate tolerance and lipid metabolism, in patients with diabetes mellitus, it reduces glycemia and normalizes lipid metabolism. Korotkova VD et al., 1983, Miranda P., Horwitz DL, 1978, Riverllese A. et al., 1980; Bauer JH et al., 1982; Kinmonth AL, 1982.
The positive effect of dietary fiber on the course of diabetes mellitus is due to their effect on the process of carbohydrate absorption, that is, on the level of postprandial (after eating) glycemia. The level of postprandial glycemia (hyperglycemic effect, glycemic response, glycemic index) depends on the nature of taken carbohydrates (simple or complex), and on the presence of dietary fibers (their quantity and quality). The glycemic index of digestible carbohydrates (simple sugars) is higher than that of polysaccharides containing dietary fiber. If we take 100% glycemic glucose index (glycemia level 2 hours after its intake), then the glycemic index of vegetables (potatoes) is 70%, cereals and bread 60%, dry beans 31%, normal breakfast 65% (figures obtained during the examination of healthy young volunteers.
Based on the data obtained on the high glycemic index of refined (or “unprotected”) carbohydrates, most diabetologists now consider it necessary to completely exclude such carbohydrates from the diet of people with diabetes, preferring in the preparation of diets of plant foods with sufficient dietary fiber, that is, “ protected carbohydrates.
Additional introduction into the diet of people with diabetes mellitus products enriched with fibrous cellulose (bran, pectin, guar, dried beans, dietary fibrous fibers) in an amount of not less than 10 ... 15 g per reception gives a pronounced therapeutic effect (glycemia and lipidemia are reduced). However, in such quantities, these additives dramatically worsen the taste of food, the health of patients (cause bloating, pain and loose stools). In this regard, the question of the appropriateness of the use of such fillers in people with diabetes remains open Chedia Ye. S., 1983, Williams DR, et al., 1980, Florholmen J. et al., 1982. It is only certain that when preparing a diet for people with diabetes, the use of food products of plant origin, containing in sufficient quantities of natural dietary fiber, has a beneficial effect on the course of the disease and is well tolerated by patients.
An alternative to the use of food additives (fillers) containing coarse fiber is the use of pharmacological preparations (inhibitors of alpha-amylase and alpha-glucosidase enzymes) that interfere with the absorption of carbohydrates. Unfortunately, these drugs (acarbose, glucobay and others) also cause pronounced flatulence and discomfort. The question of the appropriateness of the widespread use of these drugs in the treatment of diabetes is under study Hadden D. R., 1982, Mehnert H., 1983, Dimitriadis G. et al., 1986, Henrichs J., Teller W. m., 1987.
In addition to the important role of carbohydrates in energy metabolism, carbohydrate food is an important source of vitamins (C, P and group B), carotene, alkaline mineral elements, potassium, iron in the form of organic compounds, easily digested in the presence of ascorbic acid. The value of plant foods (vegetables, fruits and berries) is also determined by the content of large amounts of organic acids (mainly malic and citric), which improve the activity of the gastrointestinal tract, change the composition of microflora, reduce putrefactive processes.
Proteins are involved in plastic metabolism, therefore, are necessary for the growing organism, that is, in childhood and adolescence. The need for protein in a child reaches 3-4 grams per kilogram of body weight per day (g / kg / day), and in a teenager it is 1-2 g / kg / day. Proteins - a source of amino acids (including essential) that contribute to the normal physical and mental development of the child, maintain a sufficient level of immune reactivity (immunity). Proteins of animal origin are the main source of high-grade protein, since they contain all the essential amino acids in the most favorable ratio:
- animal meat, poultry and fish,
- egg - contains lecithin, kefalin and essential amino acids,
- milk and dairy products (cottage cheese, hard cheese) - contain methionine in large quantities, which takes an active part in the synthesis of choline and lecithin. In addition to valuable protein, milk contains calcium in the most favorable ratio with phosphorus, salts of potassium and sodium, many trace elements, vitamins "A" and "B".
Both a healthy child and a patient with diabetes mellitus should cover the daily need for 15 to 20% of their daily intake of protein foods, and at least 50% should be animal protein.
Fats (a source of not only energy, but also lipids) participate in plastic metabolism - they are a component of a living cell, mainly membranes (structural fats) and participate in the processes occurring in cells. In addition, with food fats, the human body also receives biologically active substances: polyunsaturated fatty acids (linoleic, linolenic and arachidonic), phosphatides (leucine), fat-soluble vitamins (groups A or retinol, D or calciferols and E or tocopherols), sterols. Therefore, it is impossible to completely eliminate fats from the diet.
The question of the appropriate need for fat in the diet of healthy people and even more so in the diet of patients with diabetes is very complex. On the one hand, fats, especially in childhood, are an important source of energy. Lack of fat in the diet violates the activity of the central nervous system, weakens the immune system, reduces life expectancy. On the other hand, it has been proven that an increase in the level of cholesterol and lipids in the blood (as a result of excessive intake of food) speeds up the development of atherosclerosis. In the development of hypercholesterolemia and hyperlipidemia, it is not so much the amount of fat that matters as their composition (products containing cholesterol and saturated fatty acids in large quantities are definitely bad, and products containing unsaturated fatty acids, phosphatides, fat-soluble vitamins - definitely good - positively affect metabolism lipids, preventing the deposition of fat in fat depots and liver, promote the excretion of cholesterol from the body). Polyunsaturated fatty acids are actively involved in the regulation of fat metabolism, along with phospholipids and lipoproteins are part of the cell membrane and affect their permeability). The positive effect of polyunsaturated fatty acids and phosphatides on fat metabolism is potentiated (enhanced) when combined in food with complex carbohydrates, which contain sufficient quantities of dietary fiber.
According to most diabetologists, in patients with normal physical development indicators and type 1 diabetes mellitus in a state of compensation, the total amount of fat in the daily diet should not exceed 30% of the daily caloric need. Importantso that the daily amount of cholesterol does not exceed 300 mg, and the ratio in the diet of unsaturated and saturated fatty acids is 1: 1 or in favor of the predominance of unsaturated fatty acids.
In 1941, S. G. Genes and E. Ya. Reznitskaya substantiated the necessity of using a physiological, balanced in all respects parameters for patients with diabetes. Since that time, this principle of diet therapy has been officially recognized in our country and the vast majority of diabetologists are guided in practical work by the provisions developed by these researchers.
Based on the experience of previous years, experimental and epidemiological studies of diabetologists around the world came to a consensus on the appropriateness of use in patients with insulin-dependent diabetes mellitus (IDDM), especially in childhood (a growing body!), Completely balanced in all parameters of the physiological diet, fully capable of meet the energy needs of the body and maintain plastic exchange at the proper level. Therefore, the nutrition of a child with diabetes does not fundamentally differ from the nutrition of a healthy child of the same age and the same physical development data Martynov MI, 1980 (the nutrition recommended for children with diabetes is so rational that a similar diet can be recommended for all children ).
Vegetarian diet in treating and preventing diabetes Edit
In the 1999 experiment, results were obtained showing that a low-fat vegan diet may contribute to a greater weight loss and lower blood sugar than a non-vegetarian low-fat diet. A more extensive study of the same research group from 2004–2005 by the number of participants and duration revealed that a vegan diet consisting of whole vegetation and low in fat content is just as if not more effective in treating diabetes as recommended by the American Diabetes Association.A calorie-restricted vegetarian diet significantly increased insulin sensitivity compared to a normal diabetic diet. Vegan and vegetarian diets have been found to almost halve the risk of developing type 2 diabetes compared to a non-vegetarian diet. A vegetarian diet is associated with a significantly lower risk of metabolic syndrome, a combination of disorders leading to the development of diabetes and cardiovascular diseases.
Calorie Calorie Intake Calculation Edit
The patient's daily need for calories and basic food ingredients is determined by age, level of physical development, lifestyle (level of physical activity), individual, constitutionally determined features of metabolic processes, the clinical course of the disease, the presence of complications or associated diseases. When choosing the optimal diet option for a child with diabetes mellitus, a standard physiological diet is determined (daily calories, the composition of the main food ingredients), and then this average diet is individualized as much as possible (adapts to the needs, habits and lifestyle of a particular child).
The need for calories per 1 kg of body weight in children and adolescents, depending on age:
Menu for diabetics: recipes for every day, dietary features with regard to fat content and carbohydrate content
Surely every hostess is familiar with the situation when for dinner or breakfast something was bought from the assortment of sausages or the ready-made cooking department in the supermarket. However, if the family has a person with diabetes, especially a child.
Therefore, many housewives agree that the best option is to create an exemplary menu for diabetics for the week. Thus, it is possible to buy the necessary products in advance, for example, at the weekend, to prepare blanks.
Breakfast. Curd with carrots. Mix boiled grated carrots with low-fat cottage cheese (approximately in a ratio of 1: 4), add a little flour, an egg, you can sweeten with any sweetener. From the dough form small thin cheese cakes, lay them on baking paper and bake in the oven. Serve with low-fat sour cream.
Lunch. Boil beets, cut into cubes and mix with sliced sour apple. Salad can be filled with lemon juice.
Dinner. Chicken broth soup (for fillet take fillet or leg without skin). Green peas, broccoli, cauliflower, carrots, some celery roots or parsley root are added to vegetables. For taste add the whole onion which then pull out. Filled with greens.
On the "second" can be cooked veal stew. Cook meat until half cooked, chop cabbage and stew in milk. Beef disassembled into fibers, add to cabbage and stew, you can add a little vegetable oil. Buckwheat porridge will be suitable for a side dish.
High tea Pumpkin stewed in milk with fruit, you can add sweetener.
Dinner. Cod baked with vegetables. In the refractory dishes spread cut fish, on top - carrots, onions, greens. Pour water and cook in the oven.
Breakfast. Hercules porridge made from whole oats, 1 boiled hard boiled egg.
Lunch. Salad of shredded cabbage and chopped apples. Season with lemon juice.
Dinner. In a pan, lightly fry the onions, then add the chopped tomatoes. When the tomatoes are soft, add grated carrots and some rice (if the cereal is allowed to be eaten by the doctor). Pour meat broth and water and boil until cooked. Served with garlic passed through a press and chopped greens.
As a second dish, you can try stuffed zucchini. To do this, it is thoroughly washed, cleaned the core, filled with lightly stewed minced meat with carrots, poured sour cream and clean in the oven. A few minutes before being cooked, sprinkle with hard grated cheese.
High tea Low-fat yogurt or matsoni, you can add berries.
Dinner. Stuffed with carrots Bulgarian pepper stewed in a tomato.
Breakfast. Protein omelette cooked without butter in a double boiler. You can add spinach leaves or sprinkle with cheese.
Lunch. Self-made oatmeal cookies. To do this, oatmeal grind in a coffee grinder, ground with soft butter, sour cream and yolk. Bake on baking paper in the oven.
Dinner. Mushroom soup, which is prepared in the water, mushrooms, before adding to the pan, scalded with boiling water and cut into slices. One potato is allowed, chopped onions and carrots passaged in vegetable oil are used for refueling. Served with sour cream and herbs. On the second - porridge with seasonal stewed vegetables (eggplant, tomato, zucchini, bell pepper, onion, etc.).
High tea Low-fat cottage cheese with berries.
Dinner. Any allowable liver garnish. To this end, the by-product is fried in butter (until a slightly ruddy crust appears), salted at the end. Spread slices of apples, liver, and onions lightly stewed in butter on a baking sheet. Stew in the oven
Breakfast. Oatmeal or wheat pumpkin porridge.
Lunch. Pudding, for cooking through a meat grinder miss boiled beets, apples, cottage cheese. Add an egg, a spoon of semolina, a little sugar substitute. Bake in silicone tins in the oven.
Dinner. Fish soup cooked in broth from a low-fat variety of fish (preferably sea fish), if possible, add barley soaked in water. On the second one can offer boiled and sliced beef tongue with any side dish.
High tea Fruit salad of apple, orange or grapefruit, dressed with low-fat and savory yogurt.
Dinner. Steamed chicken cutlets (instead of bread, you can add cheese to the mince), vegetable salad from fresh blue or white cabbage with cucumber and tomato.
Breakfast. Low-fat cottage cheese with sliced apple, pear or berries.
Lunch. Salad with lots of greens and seafood, seasoned with olive oil and lemon juice.
Dinner. Buckwheat soup on beef broth, in addition to cereals, add browned onions, carrots, diced roots. Filled with greens. For the second, boiled meat stewed with vegetables (zucchini, carrots, onions, bell peppers, tomatoes) will do.
High tea Low-fat yogurt, you can - with fruit.
Dinner. Steamed fish (grass carp, carp, pike, pelengas) with lemon, garnish from cereals.
Breakfast. Through the meat grinder skim the cottage cheese and apples. Add the egg, sugar substitute, a little flour. Form cheesecakes and bake in the oven.
Lunch. Any permitted fruit, better citrus.
Dinner. Cold soup (perfect in summer or late spring). To do this, chop sorrel, spinach, eggs, green onions. Filled with water and sour cream. Add a little salt, citric acid. On the “second” - stuffed cabbage stewed in tomato sauce. You can cook without rice.
High tea Fresh vegetable salad, seasoned with linseed oil, herbs, and to taste - lemon juice.
Dinner. Baked in foil hake, boiled buckwheat porridge.
Breakfast. Oatmeal with carrots. Boiled solid oats until half cooked, add grated carrots and sweetener.
Lunch. Baked apples stuffed with cottage cheese. The fruit is taken out of the core, filled with cottage cheese mixed with a sugar substitute, baked in the oven.
Dinner. Lean borscht without potatoes. For the second, chicken breast is baked in the oven, for garnish - any permitted cereal.
High tea Low-fat yogurt or ryazhenka, you can replace the fruit salad.
Dinner. Vegetable stew with meat. For cooking better to take veal, eggplant, squash or zucchini, tomatoes and other seasonal vegetables.
The following menus and recipes are approximate. All dishes can be changed depending on the season, for example, white cabbage salad can be replaced with sauerkraut (with a limited amount of spices). The amount of food consumed should be adjusted according to body weight. If you are overweight, you need to follow a low-carb and low-calorie diet.
Compote from dried fruits, a variety of freshly squeezed fruit and vegetable juices, green, black, herbal tea are suitable as drinks. In the morning you can pamper yourself with a cup of coffee. Garnish grains are sometimes replaced with durum wheat pasta, and soups are served with bran bread.
The diet is able to restore the normal level of sugar in the initial stages of diabetes, it is especially necessary for the gestational type of the disease, which develops during pregnancy and threatens serious complications for both the mother and the baby.
Given the tendency of patients to diabetes to obesity, it is important to carefully monitor their weight. Not the last role in reducing and maintaining body weight at the proper level is played by the amount of fat in the diet. Approximately, the optimal weight is calculated by the formula: height in cm - 100 = the right amount of kg. If the patient is normal, the daily fat intake In obesity, this figure should be reduced. Therefore, in the preparation of the diet, you can use culinary tables indicating the fat content in 1 g of the finished product.
Food rich in carbohydrates should be an integral part of the diabetic diet. However, the "recruitment" daily rate should be due to the "useful" slowly digestible products. Therefore, it is better to keep such a table handy:
It must be remembered that the correct menu for diabetes is the key to successful therapy and a low risk of developing various complications. Exceptions are allowed only at the festive table, and then, within reasonable limits. For example, you can drink a glass of dry wine, but abandon the cake and high-calorie mayonnaise filled Olivier or sandwich.
Food for diabetics: principles of cooking, diet depending on the type of disease
The overwhelming majority of patients with diabetes mellitus constantly take glucose-lowering drugs or are forced to inject insulin.
The principle of action of these drugs is different, but the therapeutic effect is the same - reducing the level of glucose in the blood. In addition, often the mode of their use is closely related to meal times. Therefore, the main condition for proper nutrition in combination with drug therapy is a strict adherence to food intake. Otherwise, the probability of developing a life-threatening hypoglycemic state is high.
Currently available is a huge assortment of household appliances, intended for the preparation of healthy and tasty food. If possible, you should get a steamer and a slow cooker (by the way, steam cooking is also provided in this miracle saucepan, and in some, yogurt production).
Food for diabetics should be prepared using:
- quenching with minimal addition of butter or vegetable oil, for example, in a slow cooker, you can do without it,
- roasting in the oven, this method is suitable for meat, poultry, fish, but they are recommended to be wrapped tightly in foil or a special sleeve,
- steaming, so in a double boiler you can cook meat, fish dishes, omelets, puddings, casseroles, cook any cereal,
- boiling in plain water, meat or fish broth.
Frying in a pan is allowed only for cooking dressings from onions and vegetables for borscht, soups, cabbage soup. This method is best avoided when cooking meat, fish or poultry dishes.
The principles of how to eat in diabetes vary somewhat depending on the type of pathology. With the disease of the first form, when insulin production in the body is significantly reduced and the patient is on constant insulin therapy, adherence to the diet is of primary importance. With type 2 diabetes, which often occurs in retirees and people closer to the risk of obesity. In this case, the diet should be aimed at optimizing and maintaining the desired body weight.
Low-carb diets for diabetics
To lose weight, many people severely limit themselves to eating. Although doctors do not recommend this method, it can give at least a short-term effect and will not harm a healthy person. For diabetics in nutrition, there are quite a few important rules, some of them also concern how much you can restrict yourself in eating. If you have diabetes, you need to keep your blood sugar levels stable and hunger is contraindicated. For diabetics who want to lose weight, there are special diets.
Mayo Clinic Diet
The main thing in this diet: a healthy diet and low-glycemic carbohydrates. Adhering to this diet, you need to monitor the size of portions, snack several times during the day and, in addition, do physical exercises. It is important to avoid fluctuations in blood sugar. This diet includes fresh fruits and vegetables, lean meats and even some foods with refined sugars and simple carbohydrates, such as pasta. The latter, of course, should be eaten in very limited quantities.
The diet of the southern beach was invented by a cardiologist, its main goal is to control the level of sugar in the blood and, with it, the feeling of hunger. The diet consists of three stages, the task of the first two is to reduce weight. The third stage involves maintaining the results achieved throughout life. At the first stage - strict restrictions. You can eat mostly lean proteins and some vegetables. In the books and manuals on the diet of the southern beach there are recipes for all stages, including the first one. At the second stage complex carbohydrates, fruits, dairy products and lean meat are introduced into the diet. Among the permitted carbohydrates are sweet potatoes (yams) and brown rice instead of highly distinct simple potatoes and white rice. At the third stage, you consolidate the achieved result with a healthy diet, ideally it should be a permanent component of your lifestyle. The main thing here is to avoid simple carbohydrates and fats. It is recommended to adhere to the same rules for diabetics, therefore the diet of the southern beach is very popular among them.
This diet is particularly suitable for diabetics, because its main value is that the proposed diet helps to avoid sudden changes in blood sugar levels. The basis of the diet is a simple rule: 40% of all calories need to be obtained from raw foods containing complex carbohydrates. Therefore, adhering to such a diet, you need to replace the juice with fruit, white bread - whole grain and so on. Another 30% of calories you get from healthy fats. On your plate every day should be fish, chicken, lean pork, beef and avocado. And another 30% of calories are in dairy products - it is recommended to use fat-free.