Pinoy food culture can pose a great challenge to blood sugar control—in a country where three out of 100 are diabetic, according to the 2008 National Nutrition and Health Survey. Medical nutrition therapy (MNT), though, is a mainstay in the management of diabetes, along with education, exercise, blood glucose monitoring, and medications. The American Diabetes Association (ADA) points out evidence that MNT has caused about one percent decrease in HbA1c, a blood glucose parameter that clinicians use to monitor patients on treatment.
Masarap ang bawal
Filipino patients usually ask their doctors what they aren’t allowed to eat. This focus on prohibition makes them feel deprived or unsatisfied and goads them to cheat on their diets. Maria Bernadette Platon, R.N.D., who is also involved in diabetes education, says including the patient in nutritional decision-making is more important: “I review first the eating habit and usual food intake of my client before I give options and healthy food choices. The two of us will plan what the client can give up and emphasize food from present habits that can be highlighted.”
The easiest approach to dietary modification is the plate method—divide your plate by drawing imaginary lines. One half will be devoted to non-starchy vegetables such as carrots or broccoli. A quarter will be assigned to starchy food like potatoes, rice, corn; the last quarter, a matchbox-sized serving of lean meats. Don’t go for any seconds. Should you crave dessert, include half a cup of yogurt and a piece of fruit.
Knowing your limits
An alternative to the plate method is the calorie count. The required calorie intake per day varies for each individual and, for diabetic patients, there may be additional diet modifications required because of co-morbid conditions like kidney disease, lipid abnormalities and hypertension. Calorie requirements also depend on ideal weight for height. As such, diabetic patients are advised to see their dietitian for proper assessment. The usual range of healthful calorie intake is 1,600 to 2,200 kilocalories per day.
The ADA also recommends that saturated fats—including coconut and palm oil, often used in Filipino households for frying—comprise less than seven percent of total calories per day. Healthier alternatives would be corn, canola and olive oils, which are unsaturated.
Dietitians use the “exchange” to refer to a specified amount of a food group. Each exchange also has a pre-determined amount of calories. For example: a quarter-cup of cottage cheese has 55 calories, equivalent to an ounce of fresh ham or an ounce of canned tuna.
The beauty of an exchange list is being able to substitute one type of food for another. For instance, if you’re more of a bread person, you can substitute 1/3 cup of rice for two slices of bread for breakfast.
It’s also a lot easier to count calories. If you stick to the portions prescribed in the exchange list, you can easily add up the corresponding calories. Make sure you get from all food groups when planning meals, in amounts of this descending order: vegetables and fruits > meats, egg, nuts, low-fat dairy > fats, oils and sweets.
About artificial sweeteners
Beverages are also a common concern among diabetics. Platon opines: “Plain coffee and tea are considered “free foods”, meaning they have no significant calories. When creamer, milk and regular sugar are added, they have to be included in the meal plan, especially for those who drink more than a cup a day. Whole milk or full cream has 160 calories per cup, while low fat milk has only 100 calories.” As for zero-calorie soft drinks, Platon notes that these use artificial sweeteners and have fewer calories, but contain phosphoric acid which promotes calcium excretion from the body.
Some diabetics take the extreme measure of totally abolishing table sugar from their diet and choose other sweeteners. Platon elaborates, “Nutritive sweeteners like sorbitol and xylitol cause less glycemic fluctuations than regular glucose or sucrose and contain half as much calories as the regular carbohydrates [only two calories per gram]. Non-nutritive or artificial sweeteners include saccharin, sucralose, aspartame and acesulfame. There’s a set acceptable daily intake (ADI) for each, which is the maximum amount considered safe for daily consumption. ADIs are intended to be about 100 times less than the smallest amount that might cause health concerns.” For solid food like baked goods, sucralose is the sweetener of choice because it is stable under heat.
Being diagnosed with diabetes can be difficult, but it is not a sentence to a life of joyless eating. By having a good grasp of calorie counting, the food exchange list and plate method, diabetic Filipinos can achieve glycemic control while proving that eating really is more fun in the Philippines.