In the spring of 2005, the Joslin Diabetes Center in Boston, well respected for its role in the treatment of diabetes for over a century, finally took the lead and came out with its own version of diet and exercise guidelines for overweight people with either type 2 diabetes or pre-diabetes. The results of their scientific perusal of the most current research, Joslin’s clinical guidelines (available at http://www.joslin.org/Files/Nutrition_ClinGuide.pdf), are intended to provide clear and easy-to-follow recommendations to improve insulin sensitivity and cardiovascular health while reducing body fat.
In brief, these guidelines recommend that less than 40 percent of daily calories come from carbohydrates (with a minimum of 130 grams of carbohydrate daily), 20 to 30 percent from protein (except in the presence of kidney problems), and 30 to 35 percent from fat (mostly mono- and polyunsaturated fats), along with a minimum of 20 to 35 grams of fiber (with a goal of 50 grams, if tolerated). They also advocate reducing daily caloric intake by 250 to 500 calories a day to allow most individuals to gradually lose no more than one pound every one to two weeks, but stress that minimum total daily calories should be 1,000 to 1,200 for women and 1,200 to 1,600 for men. Finally, they recommend a target of 60 to 90 minutes of moderate-intensity physical activity, including cardiovascular, stretching, and resistance activities, most days of the week, with a minimum of 150 to 175 minutes weekly.
As a whole, these guidelines are probably the most health-promoting ones that have ever been endorsed for prevention and control of type 2 diabetes. Although no foods are considered completely taboo in their plan, they do advocate that you consume fewer carbohydrates with higher glycemic effect, thus limiting your intake of refined carbohydrates or processed grains and starchy foods–especially pasta, white bread, low-fiber cereal, and white potatoes. Although they don’t specifically say so, their endorsement of a 40 percent carbohydrate diet very likely stems from the fact that, as a whole, Americans are not likely to remove enough refined carbohydrates from their diet to effectively moderate the glycemic effect of eating more than 40 percent of their calories as carbohydrates.
The bottom line of Joslin’s guidelines is that if you emphasize healthier sources, you will not need to cut all carbohydrates out of your diet (I certainly don’t), and the same applies to fats and proteins, as long as you choose better types of fats and healthier sources of protein. Balanced meal plans, rather than extreme ones, are undeniably the best ones to follow–whether you have diabetes or not.