Encourage lean diet for patients with diabetes, metabolic syndrome

Issue: May 2008

Endocrinology in the News Conference

PHILADELPHIA — With the many diet options for patients with diabetes or metabolic syndrome or for those who are obese, it is important to encourage patients to eat a high-colored, easily balanced diet, according to Diana Cullum-Dugan, RD, LD, who presented at the Endocrinology in the News Conference last weekend.

According to Cullum-Dugan, our brain and central nervous system need 130 grams of carbohydrates per day and additional carbohydrates can be added depending upon energy level. “It’s almost an individualistic approach. Encouraging more fruits and vegetables to reach 40% carbohydrates per day would be best,” said Cullum-Dugan, nutrition program director for the Nutrition and Weight Management Center at Boston Medical Center.

She addressed the difficulty of changing the mental thought processes to a new dietary paradigm that encourages a patient’s plate to be half vegetables, one-fourth protein and one-fourth starch. This, she says, “will provide a good entryway into overall healthy eating. It is really simple and patients do not have to think about calories or fat grams; it is about inviting a colorful plate.”

While many diet options are available, available data favor each type and often show a similar outcome between each, Cullum-Dugan said. For example, one study published by Michael L. Dansinger, MD, compared the Atkins, Ornish, Weight Watchers and Zone diets and found that all diets had a similar effect, with a sustained weight loss beyond one year in 20% to 25% of participants (JAMA. 2005;293:43-53.). Considering the facts, Cullum-Dugan stressed the importance of a lean diet and a personal approach to a patient’s eating habits.

“No matter what we believe deep down, our patients do have choices and they do have rights. With that said, when talking to people about protein and their choice of protein, it is going to be a really personal issue, but hopefully we can encourage them into a more lean diet,” she said.

Cullum-Dugan also stressed portion control, structure and consistency and a diet that will allow patients to disregard calorie counting. – by Stacey L. Adams

This is a commonsense approach to try to eat the most colorful foods because they are high in antioxidants. Center it around visually what a plate should look like — more colored vegetables than huge portions of potatoes, rice and noodles that are white. In my estimation, whatever works easiest for the patient is what you need to go with. If you tell patients to buy a smaller dinner plate, they consume less. There is evidence to show that people will eat to the capacity of the plate or drink as much as the glass will hold, so sometimes it is something as simple as looking at the utensils or the dinnerware they are using. They should not be eating off of a platter.

It is interesting, if you step back and think about it, when managing diabetes there are medications that, over time, all need to be changed — either switched or the dose should be raised. So medication is one method of managing. But when it comes to food, I think people get 'fatigued' with eating the same things and managing their diet in the same ways, and sometimes they need to shake it up a little bit. Some patients will have a meal replacement bar for a while so they do not have to think too much about it and that is fine if it works for them. Then they might come back and say that since the weather is nice and it is hot they will do a salad kick. So, just like medications, food should be changed up occasionally for people too. As long as you keep the basics, like good healthy fruits, vegetables, unprocessed types of foods and whole grains, switch it up a little bit. To assume that someone is going to eat the same way all of the time is not very realistic. Food is for a lifetime and you have got to find what works, as long as whatever works incorporates eating a little bit healthier.

– Mary Austin, MA, RD, CDE

Endocrine Today Editorial Board member

For more information:

Cullum-Dugan D. Nutritional approach to obesity: High vs. low-carb diet? Presented at: Endocrinology in the News; April 12-13, 2008; Philadelphia.