Nutrition Therapy and You

Nutrition therapy and you

If you have type 1 or type 2 diabetes – or pre-diabetes – you should have access to up-to-the-minute dietary advice and support from your GP or a dietitian. Helen Gibbs looks at exactly what care you should be getting.

Many people with a new diagnosis of type 1 or type 2 are uncertain how they should be eating, and even more confused when they start googling all the competing views, theories and research papers. That’s why we recommend you have access to professional Medical Nutrition Therapy (MNT).

In April 2019, The American Diabetes Association released an important report: Nutrition Therapy for Adults with Diabetes or Pre-diabetes: a consensus report. In it they reviewed recent research (up to the end of February 2018), and distilled it into key messages.

Any MNT needs to aim to achieve or maintain good blood glucose control, while also managing or improving heart-disease risk factors, such as cholesterol or high blood pressure. However, MNT should be individualised to fit the patient’s culture, lifestyle and values.

MNT FOR DIABETES

Nutrition Therapy for Adults with Diabetes or Pre-diabetes: a consensus report has reached consensus on these things:

Consistent, individualised care

According to the report, adults living with type 1 or type 2 diabetes should receive “individualized, diabetes-focused MNT at diagnosis and as needed throughout the life span and during times of changing health status to achieve treatment goals.”

What this means is: if you live with diabetes, you should, from the start, be seeing the dietitian regularly, and when you need them.

For those with Type 1, carbohydrate counting and insulin adjustment training should be offered as part of education in ways you can engage with.

Education

Adults with type 1 and type 2 diabetes should be referred to “comprehensive diabetes self-management education and support (DSMES) services”.

This means that within a year of your diagnosis, you should have received education either in groups or 1:1 that will help you manage your own condition.

Qualified specialists

The report stressed that diabetes-focused MNT should be provided by “a registered dietitian, preferably one who has comprehensive knowledge and experience in diabetes care.”

Intervention for pre-diabetes

The report found that people with pre-diabetes or a high risk of diabetes should be referred to “an intensive lifestyle intervention program that includes individualized goal-setting components, such as the Diabetes Prevention Program (DPP) and/or to individualized MNT.”

This means that if you are pre-diabetic or at risk of diabetes, you should have access to services that will help you to be more active and improve the quality of your diet.

Groups are an efficient way to see people who want to make lifestyle changes, but they need to have an element of individual care, i.e. they should encourage individual goal setting.

WHAT IS MEDICAL NUTRITION THERAPY (MNT)?

This is a term that’s now used to describe the treatment of a condition through specialised advice on diet or eating, usually from a doctor or registered dietitian. It can involve support, counselling, advice, diet planning and ongoing monitoring.

DIETARY RECOMMENDATIONS TO EXPECT

Research shows that no one diet will meet everyone’s needs. Some people do best following a plant based diet, others may do better on a healthy omnivorous diet, and others on a reduced or low carb diet. Your optimum diet should be worked out based on your response to it: changes in HbA1c values, blood pressure and cholesterol values. The diet should also be appropriate to your lifestyle and culture.

If you have either type of diabetes there are some specific areas that you should receive advice on:

Dietary fibre

Every adult should aim to have at least 25g of fibre per day, preferably from food (vegetables, legumes, fruit and wholegrains), or else through fibre supplements. This improves blood glucose control. If there are reasons to limit fibre, this should be under the supervision of the same dietitian providing your diabetes care.

Types of fat

Although the direct roles of saturated and unsaturated fats in diabetes are uncertain, there is clear evidence that replacing saturated fat in the diet with unsaturated fat lessens cardiovascular risk. Reducing saturated fat remains one of the goals of nutrition therapy, but the impact of this intervention should be assessed through a regular review of the patient’s cardiovascular risk.

Sweeteners

The report stressed that sugar substitutes don’t turn an unhealthy choice into a healthy one; they simply make the choice less unhealthy. This supports the position of Diabetes NZ that sweeteners should be used as transitional products to reduce sugar intake.

Advice to individuals needs to encourage reduction of added (free) sugars to 10% or less of total energy (kJ/kcal).

Alcohol

Drinking alcohol alters liver function and increases the risk of low blood glucose during the hours after alcohol is consumed (delayed hypoglycaemia). Moderation and consumption of food with alcohol is important for people with diabetes. The advice to stick to safer alcohol limits and have at least two alcohol free days each week applies to everyone.

Salt

Almost everyone in New Zealand should be aiming to reduce their salt consumption. Most New Zealanders consume well over the recommended daily intake.

The maximum amount of salt recommended for an adult New Zealander is 5–6 grams (around one teaspoon) from all food sources. This translates as 2,300 mg sodium. Less is better, especially for those with high blood pressure.

We used to rely on iodised salt to get enough iodine. Nowadays, if you eat bread produced by commercial bakers here, you’ll receive enough iodine from this source. If you don’t eat commercial bread, just 1g of iodised salt per day should meet your intake need for iodine.

Supplements and herbal medications

No herbal studies have been of sufficient scientific standard to recommend any herbal preparation specifically for diabetes. And for people with either type of diabetes, as with the general population, there is no evidence that vitamin and mineral supplements offer any benefit when there is no deficiency.

However, people with type 2 diabetes who are on metformin for long periods are at greater risk of B12 deficiency. Screening for this should be considered after five years on metformin or if there is any indication of low Vitamin B12 levels.

Weight loss

In those who are overweight, even relatively small weight losses (5%) help with blood glucose control, cholesterol levels and blood pressure management.

In addition, type 2 diabetes can be either delayed or, in some cases, reversed with a weight loss of around 15kg.

However, medical professionals need to recognise that there is a substantial level of disordered eating in the population who struggles with their weight. Therefore, disordered eating patterns must be screened for and managed appropriately, before and during any weight loss attempt.

TELL US YOUR EXPERIENCES

Do you feel you have access to the dietary advice and MNT you need? We’d like to hear your great experiences as well as those where you felt your care was inadequate. How is New Zealand doing on the MNT front? Email us at editor@diabetes.org.nz

HELEN GIBBS, REGISTERED DIETITIAN

Helen Gibbs is a New Zealand registered dietitian and accredited DESMOND educator working for WellSouth PHN. She also runs her own private practice seeing clients, writing about nutrition and advising the food industry while maintaining a social media presence focused on food and nutrition.