BaseLine Meal Planning

Meal plans are meant to help you rather than to be an obstacle.They should be individualized to meet your particular needs, wants, and lifestyle and organized within the bounds of your particular health problem(s). The plan must meet the caloric level of your daily activity unless you are overweight, in which case you need to decrease your caloric intake in relation to the calories you burn in daily activity (with a weight-loss goal of from one-half to two pounds per week).

The three most important things to keep in mind are these:

1. Be sure that you are getting the nutrition you need to meet your energy demands.

2. The food should be distributed throughout the day so that the body is not overwhelmed at anyone time.

3. The food pattern and amounts eaten should be consistent, unless a greater or lesser energy use requires a greater or lesser amount of food intake.

The purpose of a meal plan is to help you achieve these important goals. A meal plan may be developed using a variety of methods. To figure out the ideal body weight for a female, take the height (for example, 5'4") and give 100 pounds for the first five feet and 5 pounds for each inch above five feet. That would be 100 + (4 x 5), for an ideal body weight of 120 pounds for a medium-boned female, plus or minus 10 percent to allow for differences in bone structure (that is, large boned or small boned). For males, 106 pounds are given for the first five feet of height, and 6 pounds for each inch above five feet. For a male who is 5' 11" tall, the calculations would be 106 + (11 x 6) = 172 pounds, plus or minus 10 percent to account for bone structure.

The average recommended dietary intake is 10-15 calories per pound (20-30 calories per kilogram), depending on whether you are male or female and active or inactive. A pregnant woman requires up to 17 calories per pound (39 calories/kg), especially during the last trimester; nursing mothers also require this amount. An infant needs roughly 55 calories per pound, and a school-age child needs 30 or more calories per pound.

These calories need to be distributed throughout the day in a pattern of three meals and one to three between-meal snacks. Children, especially, thrive on three meals and three snacks. Because their stomachs are too small to hold larger quantities at mealtimes and their ability to store glucose is limited because of their size, some food intake every 2 or 3 hours is most appropriate. As they grow, children need an increase in caloric intake to meet their needs. This can be figured scientificlly with a chart or mathematic calculation. It can also be done by noting when the child is consistently eating more than the baseline meal plan that was calculated in the office or hospital, and then increasing the total meal plan by that extra number of calories (usually in increments of 100 or 200 calories).

The goal of any meal plan is to meet caloric and nutritional requirements with high-fiber, low-fat foods, with little or no concentrated sweets. The meal plan should be altered for changes in growth, activity level, and lifestyle.

The major approaches to meal planning are carbohydrate counting. Carbohydrate counting means that a person is requested to eat so many servings of carbohydrate foods to equal a certain number of grams of carbohydrate. Little restriction is placed on fat and protein other than following the recommended dietary intake of 12 to 15 percent protein, 30 percent or less fat, and the rest in carbohydrates.

The food-points system was first planned for a non-English-speaking population so it was very simple and easy to learn. It can be used to plan for a certain amount of carbohydrates, protein, fat, major vitamins and minerals, cholesterol, sodium, and calories. We use the calorie system (75 calories = 1 point). The food is distributed throughout the day in serving sizes.

The newest method of dietary control of diabetes is carbohydrate counting. This system of diet control was devised by the DCCT study to better provide diet for persons undergoing intensive diabetes management. The standard Exchange List did not work well in this study for intensive management. Carbohydrate counting is a system of calculating the carbohydrate composition of foods for each meal and then calculating the insulin dose based on so much insulin for a set amount of carbohydrate. The usual formula is 1 unit of insulin for each 15 grams of carbohydrate, or 60 calories. The system has much to recommend it in precision and a mathematical method for determining insulin doses. There are several problems to the system, however, that limit its usefulness. The problems are as follows:

1. The system is complex since the patient has to be able to determine the number of carbohydrate points in each piece of food. This can be very difficult, especially for mixed foods such as a casserole or a soup. At our diabetic camp, several children up to 16 years of age have come insisting on carbohydrate counting and claiming the know how. When tested by having the dietician cross check their calculations on the food line, we found that the majority of the kids didn't have a clue.

2. Foods other than carbohydrate are counted as free in the sense that the person can have as much as they want. This can have two important consequences: (a) the extra food can result in too much to eat and obesity and (b)there can be an underestimation of the insulin need. Protein also requires insulin for its metabolism, and 60 percent of it is converted to carbohydrate. This carbohydrate requires insulin but does not enter into the insulindose calculation. Thus the person may be underinsulinized and in poor diabetic control. Hemaglobin A1c values on the children at camp using carbohydrate counting were on average 2 points higher than the children using the point system (9.4 versus 7.4).

Carbohydrate counting is really a variation of the Point System in which only carbohydrates are counted, while in the Point. System all calories are used to calculate insulin so that more accuracy is achieved. It is also easier to calculate total points or calories than to try to sort out only the carbohydrate. The point calculation is simple and based on everyday food usage for example, 1 slice of bread is 1 point, 1 glass of skim milk is 1 point, 1 ounce of meat or cheese is 1 point, et cetera. The point system is so simple and it works well. We use it daily in hundreds of patients with good results.