Eating to Manage Diabetes Health Article

The Right Fats

Nutrition experts recommend that most of the fat you eat come from the following sources:

Monounsaturated fats are favored by cardiologists and nutritionists alike. "Mono" fats are found in plant-based oils like olive, canola and high-oleic varieties of safflower and sunflower oil, as well as in nuts and avocados. They tend to raise heart-healthy HDL cholesterol, while lowering "bad" LDL cholesterol—an undeniable win-win combination, especially for people with diabetes who are at increased risk of heart problems. Mono fats play an important role in the cuisines of countries around the Mediterranean Sea, one of the world's healthiest eating patterns.

Polyunsaturated fats also come from plant sources, including corn oil, soybean oil and other salad oils. These "poly" fats also tend to lower LDLs, but can lower heart-protective HDLs at the same time. The negatives on HDL seem to be modest, though, and mostly outweighed by the heart-healthy positives. In the huge Nurses' Health Study at Boston's Harvard School of Public Health, for example, women who used the most salad dressings (including poly-fat-rich mayonnaise-based types) had half the risk of fatal heart disease as those who rarely used dressings.

Aim for 25 to 35 percent of your daily calories to come from fat, staying on the lower end of the range if you need to lose weight. If your eating plan averages 2,000 calories per day, that's 56 to 78 grams of fat. If your plan averages 1,500 calories per day, that's 42 to 58 grams of fat.

Fats to Limit

The following fats fall squarely into the "eat less" category, whether or not you have diabetes.

Saturated fats are easy to spot because they're solid at room temperature—like the marbling in a steak, or a pat of butter. Saturated fats come mostly from animal sources, like meats, poultry skin and dairy products, such as cheese, butter and whole milk, as well as from palm and coconut oils. Saturated fats hinder LDLs, or "bad" cholesterol particles, from getting into cells where they belong. As a result, cholesterol stays in the blood longer, and can become a part of the blood-vessel plaques that build up and cause heart disease. So decreasing saturated fat intake is the most important dietary step you can take to lower your blood cholesterol. Because of an increased heart-disease risk, people with diabetes need to be vigilant about limiting saturated fats. Limit saturated fat to 7 to 10 percent of your daily calories, staying on the low end of that range or below if you have high blood cholesterol. If you get about 2,000 calories per day, that means no more than 15 to 22 grams of saturated fat daily—about the amount in two to three (3 1/2-ounce) hamburgers. If you eat about 1,500 calories per day, that means no more than 12 to 17 grams of saturated fat daily. That's two to three (1-inch) Cheddar cheese cubes.

Trans fatty acids are a product of modern technology that, like Frankenstein, haven't quite turned out as hoped. Trans fats are formed by a chemical process called hydrogenation that enables unsaturated fats (usually vegetable oils) to resemble saturated ones, giving them a solid texture and a longer shelf life. From your heart's point of view, trans fats are even worse than saturated fats. Not only do they raise harmful LDLs, they reduce heart-protective HDLs.

Solid vegetable shortenings and margarines are our main sources of trans fats, especially the crackers, chips, cookies, cake mixes, bakery goods and other foods made with them. Federal regulations were recently updated to require food manufacturers to list trans fats on their nutrition labels. To detect trans fats on older labels, look for the words "partially hydrogenated" or "hydrogenated." There is currently no "safe" daily amount of trans fats, so avoid them as much as possible. Thankfully trans fats are becoming scarcer as many manufacturers are reformulating their products to be "trans-fat-free." Seek out those choices.

Cholesterol is a fatlike substance that's an essential component in the walls of all our cells; we also need it to make hormones and bile acids. Technically, there's no need to get any cholesterol in the foods we eat, because our bodies manufacture all the cholesterol we need. But we take in cholesterol every time we eat foods from other animals that make their own cholesterol too: meat and poultry, eggs and full-fat dairy products.

Compared with saturated fat and trans fat, dietary cholesterol isn't as powerful an influence on our blood-cholesterol levels. Usually, our bodies compensate for the cholesterol we eat by manufacturing less. But it's still important to limit—possibly more so with diabetes. Keep your intake of cholesterol to 300 milligrams (mg) per day—under 200 mg if you have an LDL cholesterol reading of over 100. For comparison, a large egg yolk contains 218 mg cholesterol. Compared with the general public, people with diabetes appear to be more sensitive to dietary cholesterol. Not to mention the fact that the foods that supply cholesterol frequently deliver a hefty dose of saturated fat too.

What About Sodium?

Since many people with diabetes have high blood pressure, chances are you've been asked by your health-care team to limit your sodium (the main ingredient in table salt). Studies show that, on average, as sodium intake rises, so does the incidence of high blood pressure—and, when people make a conscious effort to reduce their salt intake, their blood pressure tends to drop.

The Institute of Medicine of the National Academies (IOM) recently revised its guidelines for sodium, recommending that adults get no more than 2,300 milligrams (mg) of sodium daily—and that people with diabetes try to stay under that amount. That's slightly less than the amount in a teaspoon of salt (2,400 mg). Since most Americans regularly take in much more sodium than current recommendations, you'll probably have to make a concerted effort to cut salt intake if that's your goal.