Protein and diabetes – do you get the balance right?

Guest Post Sally Marchini, Dietitian

With diabetes it’s important that we consider all the nutrients that contain energy (macronutrients) and understand what their roles are and how to ensure that we have enough of them for our Wellbeing. Protein is one of the four macronutrients that also include carbohydrates, fats and alcohol.  Also, as protein is one of the 5 food groups that feature in our Australian Dietary Guidelines (hereafter referred to as’ the guidelines’), I thought it would be a good topic to take a closer look at with a focus on our diabetes. It is a huge topic, so we’ll start here and maybe revisit at a later date.

We’ll start today by looking at which foods contain protein and why it’s important to include protein in our diet from a healthy eating point of view for all Australians. We’ll look at what the guidelines tell us about the six categories within this fascinating group. We’ll also look at protein as a form of energy, and will cover what the evidence from scientific research tells us is the right amounts to include in our diet to maintain our muscle mass and healthy weight. And we’ll finish off with a question I’m often asked by people with diabetes who enjoy regular physical exercise on whether they need to increase their protein intake.  Take a deep breath and hold on tight – it’s a biggie!!

As we know carbohydrates break down to glucose that is our body’s preferred fuel and one that we keep a close eye on with our diabetes.  If we look at proteins in the same light, they break down to amino acids that allow our bodies to carry out repairs and other important cellular functions.

Also relating to our knowledge of carbs, you know that carbohydrates with low glycemic index will help us to feel satisfied for longer (read more about the glycemic index of carbohydrates here)… Well, that’s a role that proteins also play in our diets and is a good reason that it’s important to include both low-GI carbohydrates and a serve of protein foods (as well as a great variety of vegetables) in our main meals.

At this point it would be a good thing to have a quick review of one of my previous blogs,  ‘Energy In/Energy Out – understanding how much you need and where you get it’  which reminds us that  “energy is obtained by oxidation of fuels which include carbohydrates, fats, proteins and alcohol”.

In terms of micronutrients in protein foods, the guidelines tell us:  “This food group provides a wide variety of other nutrients such as: iodine, iron, zinc, vitamins, especially B12, and essential fatty acids.

“Lean red meats are a particularly good source of iron, zinc and B12 and are easily absorbed. Iron is especially important during infancy and for adolescent girls, pregnant women, menstruating women and endurance athletes.

“The iron and zinc in animal foods is more easily absorbed by the body than in plant foods such as nuts, seeds and legumes/beans. However, the vitamin C found in fruit and vegetables will help the absorption of iron from these non-animal foods.

“Legumes provide many of the same nutrients as lean meats, poultry, fish and eggs and because of this they have been placed in this food group as well as the vegetable food group. They are essential in vegetarian and vegan eating patterns to get enough of the key nutrients found in this food group.”

Health Benefits of Protein foods

Again this is best explained by the guidelines: “Lean red meat provides a very good source of nutrients, however consumption of greater than 100/120g per day of red meat, which is more than double the recommended amount, is associated with an increased risk of colorectal cancer and renal cancer.  So remember to also eat other foods from this food group. Non meat options such as legumes provide many of the same nutrients as meats, poultry, fish and eggs. In fact, nuts and seeds may help reduce the risk of heart disease and are not associated with weight gain if total energy intake (kilojoules) is controlled.

“There are also many benefits in eating fish.  Consumption of fish more than once a week is associated with a reduced risk of developing dementia in older adults.  Consuming fish at least twice a week has even further benefits with reduced risk of cardiovascular disease, stroke, and age-related macular degeneration in the eyes. Aim for about 2 serves of fish a week, preferable oily fish.”

How much should we eat?

 

The guidelines clearly explain how much is in a serve, and how many serves we need (adult serves are shown in the image above).

• 65g cooked lean red meats such as beef, lamb, veal, pork, goat or kangaroo (about 90-100g raw)
• 80g cooked lean poultry such as chicken or turkey (100g raw)
• 100g cooked fish fillet (about 115g raw) or one small can of fish
• 2 large (120g) eggs
• 1 cup (150g) cooked or canned legumes/beans such as lentils, chick peas or split peas (preferably with no added salt)
• 170g tofu
• 30g nuts, seeds, peanut or almond butter or tahini or other nut or seed paste (no added salt)*

*Only to be used occasionally as a substitute for other foods in the group (note: this amount for nuts and seeds gives approximately the same amount of energy as the other foods in this group but will provide less protein, iron or zinc).

The guidelines continue: “To ensure adequate iron and zinc, about half the serves from this food group should be lean meat (for example beef, veal, lamb, pork, kangaroo).  For those who do not eat animal foods, nuts, seeds, legumes (including tofu) can provide some iron and zinc, plus a good mix of plant-based protein. Non meat diets that include milk products, eggs, nuts/seeds and legumes can provide all the essential nutrients required for health. Vitamin B12 is only found in animal products and a supplement may be desirable if eating a non-animal diet.

“Beware that smoked, salted and preserved foods from this food group, such as ham, bacon and salami, are usually higher in saturated fat, salt, and contain chemical properties that may be responsible for increased health risks.  Because of this, most of these food choices are placed in the discretionary food group, and consumption of these foods should be limited.” Especially for us with diabetes!!

I tell my clients that a good guideline for balanced eating is to include one protein serve with each main meal with their several serves of low GI carb to help ensure that you don’t get hungry before your next meal or snack.  As we can add 2.5 serves of ‘discretionary’ choices to our daily food intake, the protein section is a good area to add one or two extra serves from, as from a diabetes point of view protein doesn’t have much effect on our blood glucose levels and will save us from getting hungry and potentially damaging our wellbeing plan. Remember to beware of the processed ones!

Including them across your day can be as simple as:

Nuts on your cereal, eggs or baked beans on toast – work well at breakfast time.

Legumes such as 4 bean mix or others in salads, soups or casseroles, tinned fish, cheese, eggs or cold meats in sandwiches or salads – work well at lunch time.

Beef, chicken, fish or vegetarian alternatives work well for our evening meal served with low-GI carbs and a variety of vegetables. Our featured image today is a Salad Nicoise which includes 2 types of protein – eggs and salmon – with the wonderful salad greens.

 

You may even work your day differently, but hopefully you get the idea about including your serves evenly spread across the day to help you stick with your healthy eating plan.

Do we need extra protein if we’re exercising?

This is a question I’m often asked as a dietitian, and often clients come to me for weight management who are doing lots of great exercise and wonder why they’re not losing weight. Turns out more often than not they’ve been advised by someone who isn’t trained as a dietitian that they ‘need’ protein powder in addition to their usual diet to help them build muscle. This just simply isn’t true if you’re meeting your daily protein requirements with quality protein foods, and choosing protein as your discretionary ‘extras’ if you feel you need a bit more.

If however, you’re trying to gain weight and you have diabetes, quality lean proteins can be an excellent way to help you achieve this. More and more evidence is coming to light that indicates we don’t need to minimise protein intake due to diabetes. Please take note though, if you have medical issues such as kidney disorders, you should seek medical advice first.

Phew! That *was* a huge topic! As usual please let me know if you have any questions, or feel that there points that weren’t covered in enough detail. As mentioned at the top, we may revisit this topic down the track. Just a reminder that if you’d like personalised advice from our e-dietitians, just register here.

Wishing you happy and healthy eating, Sally 🙂

Sally Marchini is owner of her private practice (Marchini Nutrition), has had type 1 diabetes for close to 40 years and coeliac disease for many years too.