Fat doesn't have a direct immediate effect on the blood glucose level. Consumed to excess, it causes weight gain, and increased weight results in resistance to insulin. In fact, as I mention earlier, fat in a meal may lower blood glucose by slowing the absorption of the glucose.
Children need a lot of fat in their diet up until the age of 5. Breast milk is 50 percent fat, for example. After the age of 5, children should begin eating a diet of less fat, with the emphasis on types of fat that decrease the development of arteriosclerosis rather than increase it. The fats to avoid are saturated fats and trans fats.
When a child is a little older (over age 5), the recommended daily intake of fat is 30 percent of kilocalories and no more than 300 mg of cholesterol (which is one type of fat) in the diet. That much cholesterol is found in an egg yolk. An ounce of hard cheese like cheddar has 28 mg of cholesterol, and a glass of whole milk has 35 mg of cholesterol. Switch your child to skim milk and you drop to just 5 mg of cholesterol.
In addition to cholesterol, fat comes as several forms of triglyceride.
1 Saturated fat raises a person's cholesterol level and worsens arteriosclerosis. It's the main fat in meat, but it's also present in certain vegetable oils, especially coconut oil, palm oil, and palm kernel oil. If your child must have that occasional steak, encourage him to cut off all visible fat.
1 Trans fatty acid, though present in nature, is mostly added to foods by food manufacturers looking to replace butter. The trouble is that trans fatty acids not only raise LDL (bad) cholesterol, but they lower HDL (good) cholesterol at the same time, so they are even worse than butter! (See Chapter 7 for an introduction to good and bad types of cholesterol.)
1 Unsaturated fat is a much better choice than saturated fat and trans fatty acids because it doesn't raise bad cholesterol. It can be either of the following:
• Monounsaturated fat, which is in avocado, olive oil, canola oil, and nuts like almonds and peanuts.
• Polyunsaturated fat, which is in soft fats and oils such as corn oil, mayonnaise, and margarine. Polyunsaturated fat lowers good cholesterol, however.
Fat should make up 30 percent of your child's daily caloric intake, and most of that 30 percent should be from the unsaturated fat group.
What do you feed your child with T1DM to improve his cholesterol level without damaging his blood glucose? Here are some suggestions:
1 Oatmeal lowers the bad cholesterol but also contains soluble fiber, so it slows the absorption of glucose. Apples and pears make good snacks because they also provide soluble fiber (which I discuss earlier in this chapter).
1 A handful of walnuts or almonds is a great snack that reduces bad cholesterol. But don't overdo the nuts — the "good" fat in them is still fat and has 9 kilocalories per gram.
1 Delicious salmon provides the omega-3 fatty acids described in the previous section on protein to lower triglycerides. Walnuts, canola oil, and soybean oil have omega-3s that do the same.
Soy protein, once thought to have cholesterol-lowering power, has now been shown to have little effect on the cholesterol.
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