By Megrette Fletcher M.Ed, RD, CDE and Michelle May, M.D.
Authors of Eat What You Love, Love What You Eat with Diabetes
In our last post, "Is Butter Bad? Is Margarine Better?", we introduced three important questions to ask when deciding what to eat:
What do I want?
What do I need?
What do I have?
We also explored a “liking scale” to help you consider how much your preference for a particular food will affect your decision. Of course, it’s not enough to just think about what you like; you also want to consider what you need.
What Do I Need?
While awareness of your preferences is important, don’t stop there! Next think about what your body needs by considering questions like: What are my health issues? What is my family history? What are my goals? What else am I going to eat now? What else have I eaten today? What else am I likely to eat today? How will my choices affect my blood glucose level?
With prediabetes and diabetes, health considerations are particularly important because having diabetes is a significant risk factor for atherosclerosis. When you have diabetes, you are two to four times more likely to suffer from heart disease and stroke than someone without diabetes. In fact, two out of three people with diabetes will die from these causes. While these are frightening statistics, awareness and knowledge empower you to minimize your personal risk.
What Can You Do?
Of course, keeping your blood glucose in the target range is important. In addition, you’ll want to manage your other risk factors—don’t smoke, manage your weight, and control your blood pressure and cholesterol levels. We promised to look at the butter vs. margarine debate so we’ll focus on cholesterol levels.
Know Your Numbers
As we explained in chapter 14 of Eat What You Love, Love What You Eat with Diabetes, not all cholesterol is created equal. Therefore, you need to know your blood cholesterol numbers. Remember:
LDL is lousy cholesterol = the lower the lower
HDL is healthy cholesterol = the higher the better
Find out what your LDL, HDL, and triglyceride levels are and compare them to the following goals.
Blood Cholesterol Goals
LDL (lousy) cholesterol
Less than 100 mg/dL
Less than 70 mg/dL if you have heart disease
HDL (healthy) cholesterol
Men: Above 40 mg/dL
Women: Above 50 mg/dL
Under 150 mg/dL
If your tests are above these goals, you may need to change your diet, increase your exercise, start medications, or try some combination of these tactics. Did you know that improving your cholesterol—LDL, HDL, and triglycerides—can reduce cardiovascular disease and associated complications by 20 to 50 percent?1
Cholesterol levels are determined by three main factors: hereditary, activity, and dietary. Knowing your family history of high cholesterol, heart disease, and stroke is useful information. Further, understanding how eating and physical activity affect cholesterol levels is also helpful. Without going into too much detail, here’s what you need to know:
- Exercise increases HDL—in other words, it’s beneficial. But then you knew that already!
- Replacing saturated fats (typically solid at room temperature) with unsaturated fats (typically liquid at room temperature) lowers LDL cholesterol and improves the ratio of total cholesterol to HDL cholesterol, lowering the risk of heart disease.
This is where your decision about butter or margarine comes in.
Butter’s Bad Rap
Butter is a saturated fat. (Remember: Saturated fat is solid at room temperature so it sits in your arteries). The American Diabetes Association and the American Heart Association recommend that you limit the amount of saturated fat in your diet to 7 percent of total calories. We’re not big on counting calories (watch for a future blog post explaining why) but it can be helpful to know what your “fat gram limit” is when you’re looking at nutrition information. Since it is based on your total number of calories which will vary each day and knowing that there are 9 calories per gram of fat, that would require some math (now you see one reason why we aren’t big on calorie counting!). Instead, just estimate your average daily calorie intake and keep the following number in mind:
1600 calories = 12 grams of saturated fat
1800 calories = 14 grams of saturated fat
2000 calories = 16 grams of saturate fat
Clearly, since the recommendation isn’t “zero,” there’s room in your diet for butter if you love it! It’s not a “bad” food—but it is a matter of balance, variety, and moderation. This is what we mean when we say “all foods can fit.”
Margarine’s Muddy Past
Margarine was originally made from unsaturated liquid oils that were chemically altered (hydrogenated) to make them solid. Later it was discovered that hydrogenated and partially hydrogenated oils, now know as trans fats, no longer had the healthful properties of the liquid oils they were made from. Further, trans fats actually increase risk. The American Heart Association recommends limiting your intake of trans fats to 1 percent of your total daily calories (less than 2 grams per day).
Nowadays, many margarines no longer contain trans fats (hint, the softer or more liquid it is, the better). Some even have other healthful ingredients (more on that in the next blog post). It’s easy to see why this can all be so confusing!
In our next post, we’ll explore various options in the butter vs. margarine debate to answer the question, “What do I have?”
1 Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. pg 10.