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Nutrition Basics for Diabetes Presented to you by your Diabetes Care Team: Virginia Center for Diabetes Prevention & Education UVA Diabetes Education & Management Program P O Box 800873 Charlottesville, Virginia 22908 Office Number: (434) 243-4620 FAX Number: (434) 243-4619 revised 03.2017 Class Objectives: Participants will learn how to make healthy food choices Participants will gain an understanding of how different nutrients effect their blood glucose levels and overall health Participants will learn the plate method and basic carbohydrate counting for meal planning Choosing What, When, & How Much to Eat? 1.) What to Eat All foods can fit into a healthy diabetes eating plan Eat a variety of foods that includes vegetables, whole grains, fruit, low-fat or non-fat dairy or dairy alternatives, healthy fats, lean or plant-based proteins Eat balanced meals to get the nutrients your body needs and best glycemic control Choose lower-fat and lower-sodium containing foods for heart health Choose water and calorie-free drinks instead of sweet drinks 2.) When to Eat Do not skip meals Eat within 1-2 hours of waking up Space your meals evenly throughout the day; eat every 4-5 hours Eat meals and snacks at consistent times each day Work snacks into your meal plan, if you enjoy having snacks between meals 3.) How Much to Eat Try not to eat too much at one time Eat a consistent amount of food at meals; particularly carbohydrates Become aware of of serving sizes so that you can better control your portion sizes Measure out foods and learn to read labels What are Carbohydrates? Carbohydrates (carbs) are the body's main energy source and also provide important vitamins, minerals and fiber that your body needs. Carbohydrates are not bad but some choices are better than others. Selecting better carbohydrate choices in right-size portions is a key to healthy diabetes meal planning. Types of Carbohydrates: 1.) Sugars o Natural Sugars Fruit and Fruit Juice (fructose or fruit sugar) Milk and Yogurt (lactose or milk sugar) o Added Sugars Table sugar (sucrose), honey, molasses, nectars, sweet drinks, desserts 2.) Starches (also known as complex carbohydrates) o Breads, cereals and grains, pasta, starchy vegetables, crackers, beans, peas, lentils o Complex Carbohydrates are a major source of dietary fiber 3.) Fiber – the indigestible part of plant foods that aides in overall good health 1 Choose Healthy Carbohydrates, such as: Whole grains - Foods that list a whole grain as the first ingredient: o Whole wheat flour, stone-ground whole wheat, whole oats/oatmeal, brown rice, wild rice, rye, barley, whole wheat pasta, whole grain corn, popcorn, millet, quinoa Beans (legumes) and lentils, like black beans, kidney beans, pinto beans. Beans are also a great plant-based protein source. Sweet potatoes instead of white potatoes, more often, when potatoes are eaten Limit refined starches, which are processed white-flour based products. White foods are not as nutritious and can raise blood glucose levels higher. How Much Carbohydrate Should You Eat? Below is the general recommendation that can be individualized to meet your needs. 1 carbohydrate serving (or choice) = 15 grams of carbohydrate AT EACH MEAL 3-4 servings of carbohydrate OR 45-60 grams of total carbohydrate SNACKS 1 serving or 15 grams of total carbohydrate What to look for on Nutrition Fact Labels for carbohydrate information What is the serving size? __________ What is the total amount of carbohydrate per serving? ___________ If you eat 2 servings of this food, how many grams of carbohydrate will you consume? __________ 2 CARBOHYDRATE FOOD LISTS Starches/Breads 1 serving or 15 grams of carbohydrate. At least half your grains should be whole grains. Starches ½ cup Dried Beans (pinto, navy, lentil, garbanzo, great northern) ½ cup cooked cereal (oatmeal, cream of wheat, grits, etc.) ¾ cup dry, unsweetened Cereal (check labels) 1/3 cup Pasta; cooked (all kinds) 1/3 cup Rice; cooked (all kinds) Breads 1 slice Bread (whole wheat, rye, white) ½ English muffin or small bagel ½ Pita pocket bread (6”-8” across) 1 small Dinner Roll 1/2 Sandwich bun or roll 1 Tortilla (6” corn or 8” flour) Starchy Vegetables ½ cup Corn or Peas 6" ear Corn on the cob 1 small (3 oz.) Potato; baked, boiled, steamed ½ cup Yam or sweet potato 1/2 cup 1 cup Squash (winter, acorn) or Pumpkin 1/3 cup Plantain (green, mature) Crackers/Snacks 4-6 Crackers 3 Graham crackers squares ¾ oz. Pretzels (hard) 3 cups Popcorn (popped) 3 Gingersnaps 2 Rice Cakes 15-20 Chips Fruits 1 serving or 15 grams of carbohydrate. Choose fresh, frozen, or canned without added sugar. 1 medium Apple ½ cup Applesauce or canned fruit; no sugar added Banana (medium) 1/2 ¾ - 1 cup Berries 1 cup Cantaloupe or honeydew melon 12 Cherries ½ Grapefruit 17 Grapes (small) ¾ cup Mandarin oranges ½ Mango 1 medium Orange 1 cup Papaya 1 small-medium Peach or pear ¾ cup Pineapple; fresh 2 Plums 2 Tbsp. Raisins or craisins ¼ cup Dried Fruit 2 Tangerines (cuties, halos) 1 ¼ cup Watermelon 1 Tbsp. Fruit spreads, jam, or jelly Fruit Juices ½ cup Apple, orange, or grapefruit 1/3 cup Cranberry, grape, or prune 1 bar (3 oz.) Fruit juice bars, frozen, 100% juice 3 Milk and Milk Products 1 serving or 12 grams of carbohydrate. Choose low-fat, non-fat, or dairy alternatives. 1 cup Milk (skim, 1%, 2%, whole) 2 cup regular Plant-based milk (soy, almond, cashew, coconut) 6-8 oz. Yogurt (non-fat, lite, or plain); read the label 1/3 cup dry milk powder Non-starchy Vegetables Enjoy these in any amount because the small amount of carbohydrate (mainly fiber) in them do not raise your blood glucose levels. This is not an all-inclusive list. Artichokes Asparagus Bean sprouts Beans (green, waxed, Italian, snap) Beets Broccoli Cabbage Carrots Eggplant Greens Mushrooms Okra Pea pods or snow peas Peppers Sauerkraut Spinach Squash (summer and zucchini) Tomato Tomato or vegetable juice Other lists * Others Carbohydrates (15 g of carbohydrate): It is best to look at the label! 2 small cookies 2 inch brownie square or cake with no icing ½ cup Ice cream (regular, light, or fat free) 1/3 cup frozen yogurt ½ cup sugar-free Pudding ¼ cup Sherbet Free Foods have less than 5 g of carbohydrate per serving. Large portions of some of these foods can raise blood glucose. Examples include: Sugar-free gelatin 1 piece of hard, sugar-free candy 1 Tbsp catsup or pickle relish Coffee, tea, diet soft drinks Sugar substitutes Spices, herbs, mustard, cooking sprays 4 Protein Recommendations: Meals should be balanced with adequate protein and fat. Most adults need only 6 ounces of protein a day. o Large portions of protein may adversely affect your blood sugar. o Meals without protein may cause your blood sugar to rise faster than desired. Eating too much protein and fat may cause weight gain and other diabetes-related complications such as heart disease and kidney disease. Meat and Meat Substitutes cooked lean chicken, beef, pork, fish, turkey, venison low-fat cheeses (1 slice is 1-oz protein) ¼ cup cottage cheese 1 egg (1-oz protein) 1 Tbsp nut butter (1-oz protein) 1/2 cup tofu (1-oz protein) 3-oz meat portion Fat Recommendations: Include small amounts of healthy fats in your meals. A high fat meal will delay the rise of your blood sugar. See page 8 for details on fat sources and blood cholesterol levels. Fats are high in calories, too much can contribute to weight gain, so serving sizes should be small. Fats and Serving Sizes (small amounts): 2 Tbsp – Avocado or reduced fat salad dressing 1 oz nuts (examples – 10 peanuts, 6 almonds) 1 tsp of oil, butter, stick or tub margarine 2 tsp. regular mayonnaise 1 Tbsp – low-fat margarine spread, reduced fat mayonnaise, regular salad dressing 2 Tbsp half and half, sour cream A Note about Alcohol: If you choose to drink alcohol, do so in moderation. The American Diabetes Association recommended limits: women – no more than 1 drink per day men – no more than 2 drinks per day. 5 Remember, a healthy meal plan should include: complex carbohydrates, fiber, lean protein, lots of vegetables, and a limited amount of heart healthy fat. Meal Planning Approaches: The Plate Method The Plate Method is a meal planning approach that promotes consistent carbohydrate meals. Below are the guidelines for following the plate method. The Plate Method works best when using a 9-inch plate. As illustrated, the plate can be used to plan breakfast, as well as lunch and dinner. Carbohydrates. Your meals should include approximately 3 or 4 Plate Method at Breakfast carbohydrate choices, which is equivalent to 45 to 60 grams of carbohydrates. (1 carbohydrate choice equals 15 grams of carbohydrates) Carbohydrates are grains, legumes, fruits, starchy vegetables, and dairy. Choose whole grains over processed, refined grains. Vegetables. Fill half your plate with 1 cup or more of non-starchy Fruit 1/2 banana 1/2 cup juice 1 cup berries 2 Tbsp raisins Protein 1 egg 1 oz cheese 2 Tbsp peanut butter Milk or yogurt 1 cup vegetables such as lettuce, cabbage, cucumbers, peppers, mushrooms, onions, garlic, beets, green beans, broccoli, celery, carrots, cauliflower and tomatoes. An easy way to meet this requirement is to eat a small salad along with your side vegetable. Lean Protein. The protein section should provide 3 ounces of meat Starch/grain/bread 2 slices whole wheat bread 1 cup oatmeal 2 oz dry cereal 1 Eng. muffin or sm. bagel or meat substitute, the same dimensions as a deck of cards. Examples are: poultry, fish, and lean steak. Examples of vegetarian sources of protein are: beans, tofu, cheese, eggs, and peanut butter. 5 Non-Starchy Vegetables Cucumbers Carrots Cabbage Cauliflower Green beans Leafy greens Lettuce Tomatoes Celery Peppers Eggplant Broccoli Asparagus Spinach Mushrooms Serving = 1 cup raw or ½ cup cooked Lean Protein MEAT Fish Chicken Turkey Pork loin Lean beef Seafood NON-MEAT Beans* ½ cup* Eggs 1 egg Peanut Butter 1 Tbsp Tofu ½ cup Low-fat Cheese 1 slice *count as one carbohydrate serving Sources of Carbohydrate Starch, Fruit, &/or Milk CHOOSE 3-4serv. Non-Starchy Vegetables UNLIMITED Lean Protein CHOOSE 2-3 oz. Oozoz 1 serving of carbohydrate = 15 grams of carbohydrate Starches Potatoes Corn Dry beans ½ cup Peas Macaroni Pasta 1/3 cup Rice Breads Crackers Pretzels read Muffins label Waffles Pancakes Fruits Orange Pear Apple 1 fruit Kiwi Peach Banana Mango ½ fruit Grapefruit Berries Grapes 1 cup Pineapple Cantaloupe Watermelon Milk Skim milk Low fat milk 1 cup Lite yogurt 6 Meal Planning Approaches: Carbohydrate Counting Carbohydrate Counting emphasizes the total amount of carbohydrate, not necessarily the source. This approach can be used to assure a consistent, controlled amount of carbohydrate. Keys to remember: One carbohydrate serving = 15 grams of carbohydrate Goal for most people = 3-4 carbohydrate servings/meal, which is 45 – 60 grams/meal 7 Sources and Types of Fats: Food contains three types of fats, and some are better for you than others, depending on how they affect your cholesterol: Unsaturated Fat Preferred fat sources, in small amounts Monounsaturated Oil (olive, canola, peanut) Olives Avocados Peanut butter Nuts (peanuts, cashews, almonds) ↓ LDL cholesterol Polyunsaturated Oil (Corn, Safflower, Soybean) Margarine Mayonnaise Walnuts Sesame Seeds Omega fatty acids in fish ↓ LDL cholesterol Saturated Fat Limit these fat sources Meat Cheese Egg yolk Whole milk 2% milk Ice cream Butter Bacon Sour cream Fatback Coconut oil Shortening Hydrogenated vegetable oil Poultry skin Trans Fat Avoid these fat sources Partially hydrogenated vegetable oil (may be found in vegetable shortening, some margarines, crackers, cookies, snack foods) ↑ LDL cholesterol ↓ HDL cholesterol ↑ LDL cholesterol Sodium Recommendations: Reducing dietary sodium may help reduce blood pressure, as well as long-term complications associated with cardiovascular disease and kidney disease Goal is <1,500 mg sodium per day Strategies for Reducing Sodium: Decrease salt in cooking; Remove the salt shaker from the table Try seasonings and spices that can add flavor without adding sodium Look for lightly salted, lower sodium, or no salt added products Drain and rinse canned foods Avoid/limit - fast foods, processed meats, rice/noodle mixes and boxed meals, canned foods, salty snacks Choose pre-packaged foods that are: o Less than 300 mg per serving for snacks and side dishes o Less than 600 mg per serving for entrée items 8 CHO0SING SNACKS Aim for no more than 15-20 grams of carbohydrate for snacks. Choose one from each circle for a healthy, satisfying snack. Tip: CHOOSE RAW VEGGIES ANYTIME CARBOHYDRATES Grains 1 mini bagel ½ English muffin 20 pretzels sticks 2 4-in. rice cakes 6 crackers 12-15 veggie chips ½ whole wheat pita ¼ cup low-fat granola 2 slices reduced calorie bread 1 whole wheat tortilla (6 in.) 3 graham cracker squares 3 cups light popcorn Fruits 1 ¼ cup whole strawberries ¾ cup blackberries or blueberries 1 cup cantaloupe or honeydew 1 ¼ cup watermelon 1 small apple or pear ½ cup cherries 1 medium peach 2 tbsp. raisins 17 grapes Dairy 8 oz. low fat or fat-free milk ~6-8 oz. lite yogurt ½ cup ice cream ½ cup sf pudding PROTEIN Meats 1-2 oz. white meat, skinless, chicken, turkey 1 hard boiled egg ½ cup egg whites 1-2 oz. deli meat 1-2 oz. turkey/tuna/egg salad made with light or fat-free mayo 1-2 oz. salmon Cheese 1 oz. part-skim block cheese, soy cheese or string cheese ¼ cup part-skim grated cheese ¼ cup low fat or fat -free cottage cheese 2 tbsp fat-free cream cheese Beans & Dip 1/4 cup hummus ½ cup tofu 1/3 cup bean dip ¼ - ½ cup edamame 1 oz soynuts ¼ cup Nuts & Seeds 1 oz. sunflower, pumpkin, or sesame seeds 1 oz. pecans, walnuts, almonds, cashews, or peanuts 1 oz. peanut, almond, or cashew butter 9 NOTES: _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Thank you for attending “Nutrition Basics for Diabetes” Additional nutrition class offered: “Eat Smart, Change Your Lifestyle” 10