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Meal Replacements for Diabetes

What are meal replacements?
Meal replacements are food products, such as shakes, milk drinks, packaged entrées, cereals, soups, and bars, that are taken in place of meals and snacks. They contain a defined amount of calories, almost similar to the calories in a small meal. Since these products come in exact portions, dieters are able to control their calorie intake without having to worry about counting calories, and are able to stay within their prescribed low-calorie diets.

To give you a clearer idea, some popular meal replacement products that I may or may not have used on my patients in the past are: Slimfast, Optifast, Abbott Laboratories’ Meal Replacement Shakes (Ensure, Glucerna), Nutren Diabetes, Zone Perfect, Dr Siegal’s Cookie Diet, and Herbalife.

By law, meal replacement products must provide the recommended amount of nutrients for good health and the contents should conform with guidelines based on research (i.e., calorie content between 200and 400 calories, at least 25 percent protein, 23 vitamins and minerals, and about 5-6 grams of fiber). Ideal meal replacements are balanced and complete meals, follow the three A’s (Acceptable, Available, and Affordable), and contain the proper proportions of macronutrients to aid in glucose control and lipid management. If you are even thinking of replacing meals with a pint of your favorite ice cream, or a slice of decadent chocolate cake, or a glass of root beer float, sorry, think again they do not qualify as real meal replacements!

Meal replacement bars differ slightly from power bars, which contain more carbohydrates and are used for energy boosts especially during triathlons or marathons. Meal replacement shakes are also not synonymous with “protein diet shakes”, which contain less calories, have very high protein content, and are used as supplements to tide you over to the next meal.

How do you get started on meal replacements?
Simply choose a meal replacement product but read the instructions and label first. Avoid products that are high in sugar and fat, especially if you are diabetic, overweight, or obese. Use it in place of two meals, such as lunch and dinner, and then have a healthy light dinner. Alternatively, if you tend to overeat for dinner or have the habit of taking midnight snacks, then you can schedule your meal replacement at night. Use a blender and put a lot of ice to make milk drinks yummier and more filling. In between meals, you may have light snacks, around 100 calories each, twice a day. Remember to use these products as “replacements”, not as “meal supplements” (i.e., consuming them on top of regular meals), or else you’ll end up gaining more weight!

What are meal replacements used for?
These products may be used for weight loss and weight maintenance, diabetes management, as well as in sports nutrition. Using portion-controlled meal replacements is one of the most effective strategies for weight loss. Experts say that they are effective because they offer a structured planand are very convenient because they require little or no preparation or cooking. It’s a good option for those who like a simple approach to weight loss and don’t want to worry about planning individual meals. Meal replacements also take the pressure off when deciding what to eat for two meals a day, yet allow a variety of products and flavors to choose from. When meal replacements are incorporated in a calorie-restricted diet, such as 1,200 to 1400 calories per day, you can expect to lose around 1-2 pounds per week.

Aside from shedding off extra pounds, meal replacement products can also help maintain weight and prevent weight gain. A study conducted on 600 participants by Health Management Resources showed that those using meal replacements maintained their weight loss. Another study by Cheskin and colleagues showed that a diet using portion-controlled meal replacements yielded significantly greater initial weight loss and less regain after 1 year of maintenance compared to a standard, self-selected, food-based diet. They concluded that meal replacements may help obese patients with type 2 diabetes adhere to a weight control program, and diabetes educators may consider recommending meal replacements as part of their comprehensive approach to weight management.

The role of meal replacement drinks in diabetes management was extensively discussed by German researcher Ditschuneit in an article presented at the Nestle Nutrition Workshop Programme in 2006. He stated that the poor effectiveness of conventional dietary treatment for weight loss and maintenance in patients with type 2 diabetes may be improved by a meal replacement strategy thatprovides a strong structured meal plan. In obese subjects, diets with meal replacements have proven to be more efficient than conventional diets. In patients with type 2 diabetes, the group of patients on meal replacements achieved more weight loss after 6 and 12 months compared to the group without meal replacements. The conclusion was that meal replacements offer a promising strategy for treating obese patients with type 2 diabetes. Bodybuilders use whey protein powder drinks before and after exercise and in place of meals. Other athletes like runners use meal replacement products for postworkout recovery. The rationale behind this is that having adequate amount of protein in the diet allows for efficient growth and repair of muscle tissue.

Can diabetics use meal replacements?
Research studies have shown that meal replacements are safe and effective among overweight or obese type 2 diabetes patients. If you have diabetes, it would be prudent to consult your physician first before switching meals to shakes and other meal replacement products. Your doctor may need to adjust the dose of your diabetes medications and revise the schedule of blood glucose monitoring.

Bear in mind that meal replacements are just one of many treatment options for weight loss. For meal replacements to be successful in the long term, it is essential for nutritionists/dietitians and doctors to educate patients on a healthy, balanced diet especially when they are no longer using meal replacement products. They should counsel patients on how to change bad eating habits that caused the obesity in the first place. Adding an exercise prescription will complete the holistic approach to weight management.

What are the pros and cons of using meal replacements?
Aside from the effectiveness of meal replacements in losing weight and keeping the pounds off, they are also useful in controlling blood sugars. A study from the University of California, Los Angeles Medical Center showed that type 2 diabetes patients who used meal replacements in their low-calorie diet were able to lessen their dosage of diabetes medication compared to those patients only on low-calorie diets.

The main advantage of meal replacements is the convenience. No need to think about meal planning, food preparation, portion control, and calorie counting. Since everything is portion-controlled, you can’t overeat or starve. The first and main disadvantage is that you can’t stay on meal replacement products for life. After 6 weeks your body will start to look for “normal” food, so youhave to allot some time to learn how to eat properly once you are off the diet.
Unfortunately, meal replacement diets do little to educate people about their eating habits. Yes, they will definitely lose weight if they replace their high-calorie meals with shakes or bars. But once they stop using the meal replacement products and return to their poor eating habits, their weight will yo-yo as the pounds pile up again.

Another downside of using meal replacements is that it makes people complacent, thinking that the products are a “quick weight loss fix”. Once they stop using the products, they feel vulnerable and give in to food cravings once again. Meal replacements can become boring especially if you like a variety of flavors or if you love to cook. Having only vanilla or chocolate flavors day in and day out may eventually take its toll on your taste buds! Some meal replacement products contain lactose and may have side effects to those with lactose intolerance.

Although numerous studies have shown the effectiveness of meal replacements, we still don’t know if these results are applicable in real life. For one, the participants in the studies got their products for free for several months. Most meal replacement products are imported and are a bit pricey compared to regular food products. If you are on a tight budget, it might be difficult to stay on a meal replacement program for several months. Second, the participants in the studies were on supervised diets and had dietitians guiding them during their weight management program. The results may not be as effective when you do it on your own.

Considering all the pros and cons of meal replacement products, there is no reason why you shouldn’t give them a try. Go ahead—there is no harm in trying! I suggest you use them to jumpstart your weight loss program and when you’ve lost a few kilograms and are happy with the results, you can then shift to a long-term eating plan that allows you to enjoy good and healthy food.

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