Nutrition and Oral Medicine (Nutrition and Health)

Chapter 11 / Diabetes Mellitus 199als with diabetes in the absence of a deficiency. The exceptions to this include folatefor the prevention of neural tubular birth defects and calcium for prevention of bonedisease, both recommendations for all individuals independent of diabetes. In addition,the B-level evidence also indicates that routine supplementation of antioxidants is notadvised as there are no data regarding the long-term efficacy or safety of supplementaldoses. B-level evidence regarding alcohol indicates that intake should be limited to onedrink per day for women and two for men.The reader is encouraged to consult the references for more detailed discussion onmanagement of T1DM and T2DM and special situations. Other recommended clinicalresources include the American Diabetes Association (Website: www.diabetescare.org)and the American Dietetic Association (Website: www.eatright.org).6.4. The Diabetic DietIndividuals with diabetes should be seen by an RD for MNT on diagnosis in orderto determine the appropriate diabetic diet and establish individualized goals and mealplans. In addition to the traditional diabetes exchange system diet, there is also carbohydratecounting, the diabetes food guide pyramid, and the glycemic index.The diabetes food guide pyramid (83) is similar to the US Food Guide Pyramid butis composed of six food groups. The largest group, grains and starchy vegetables, formsthe base of the pyramid, and fats, sweets, and alcohol are the smallest group is at thetip, indicating that one should consume the least amount of servings from each group.The remaining groups—vegetables, fruits, dairy, and protein foods—form the middleof the pyramid. An individualized diabetes diet care plan will include a specific numberof servings from each group depending on the individual’s goals and energy andnutrient needs. It is important to distribute food groups at each meal and snack.The diabetes exchange lists are published by the American Dietetic Association andAmerican Diabetes Association (84) and are another guide often used for individualizedmeal planning. Exchange systems are also available for several nationalities tofacilitate keeping to one’s ethnic food preferences. The exchange system is based ondistribution of foods on the basis of their nutrient composition and includes a carbohydrategroup that contains starch, fruit, milk, and other carbohydrates; and vegetablelists; a meat and meat substitutes group that includes categories based on the fat content;a fat group; and lists for vegetarian alternatives, fast foods, and other carbohydrates,including cakes, pies, puddings, and cookies.Carbohydrate counting is another tool for individuals with diabetes to use in makingfood choices and planning meals (85). It is based on the principle that total carbohydrateintake influences blood glucose the most. Using this method, individuals withdiabetes calculate the grams of carbohydrate they eat at meals and snacks. Individualsmust learn to use carbohydrate counting along with the principles of balanced nutritionand the food guide pyramid in planning their meals.The glycemic index (GI) of a carbohydrate is the rise in plasma glucose (abovebaseline) relative to that induced by a standard, usually 50 g, glucose or “white breadchallenge” (86). GI values are based on digestion and absorption postprandially.Clearly, dietary fiber content and other factors influence the GI of individual foods.There is no consensus as to its usefulness and practicality as means of dietary managementof DM.