maturityonset diabetes. type 1 and type 2 diabetes share one central feature: elevated blood Dietary control in type 1 diabetes is very important and …
Diabetes Diet
Diabetes Diet
Introduction
The two major forms of diabetes are type 1, previously called insulin-dependent diabetes mellitus IDDM or juvenile-onset diabetes, and type 2, previously called non-insulin-dependent diabetes mellitus NIDDM or maturity-onset diabetes [For more details, seeWell-Connected Report 9 Diabetes Type 1and Report 60 Diabetes Type 2]
Insulin
Both type 1 and type 2 diabetes share one central feature: elevated blood sugar glucose levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas Insulin is a key regulator of the bodys metabolism It normally works in the following way:
During and immediately after a meal the process of digestion breaks carbohydrates down into sugar molecules of which glucose is one and proteins into amino acids Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply Glucose levels after a meal are called postprandial levels The rise in blood glucose levels signals important cells in the pancreas, called beta cells, to secrete insulin, which pours into the bloodstream Within ten minutes after a meal insulin rises
to its peak level Insulin then enables glucose and amino acids to enter cells in the body, particularly muscle and liver cells Here, insulin and other hormones direct whether these nutrients will be burned for energy or stored for future use It should be noted that the brain and nervous system are not dependent on insulin; they regulate their glucose needs through other mechanisms When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again As blood glucose levels reach their peak, the pancreas reduces the production of insulin About two to four hours after a meal both blood glucose and insulin are at low levels, with insulin being slightly higher The blood glucose levels are then referred to as fasting blood glucose concentrations
Type 1 Diabetes
In type 1 diabetes, the disease process is more severe than with type 2, and onset is usually in childhood: Beta cells in the pancreas that produce insulin are gradually destroyed Eventually insulin deficiency is absolute Without insulin to move glucose into cells, blood glucose levels become excessively high, a condition known as hyperglycemia Because the body cannot
utilize the sugar, it spills over into the urine and is lost Weakness, weight loss, and excessive hunger and thirst are among the consequences of this starvation in the midst of plenty Patients become dependent on administered insulin for survival Dietary control in type 1 diabetes is very important and must focus on balancing food intake with insulin intake and energy expenditure from physical exertion [SeeWell-Connected Report 9 Diabetes: Type 1]
Type 2 Diabetes
Type 2 diabetes is the most common form of diabetes, accounting for 90 of cases An estimated 16 million Americans have type 2 diabetes, and half are unaware they have it The disease mechanisms in type 2 diabetes are not wholly known, but some experts suggest that it may involve the following three stages in most patients: The first stage in type 2 diabetes is the condition called insulin resistance Although insulin can attach normally to receptors on liver and muscle cells, certain mechanisms prevent insulin from moving glucose blood sugar into these cells where it can be used Most type 2 diabetics produce variable, even normal or high, amounts of insulin, and in the beginning this amount is usually sufficient to
overcome such resistance Over time, the pancreas becomes unable to produce enough insulin to overcome resistance In type 2 diabetes the initial effect of this stage is usually an abnormal rise in blood sugar right after a meal called postprandial hyperglycemia This effect is now believed to be particularly damaging to the body
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Diabetes Diet
Eventually, the cycle of elevated glucose further impairs and possibly destroys beta cells, thereby stopping insulin production completely and causing full-blown diabetes This is made evident by fasting hyperglycemia, in which elevated glucose levels are present most of the time Obesity is common in type 2 diabetics and this condition appears to be related to insulin resistance The primary dietary goal for overweight type 2 patients is weight loss and maintenance Studies indicate that when people with type 2 diabetes can maintain intensive exercise and diet modification programs, many can minimize or even avoid medications [SeeWell-Connected Report 60 Diabetes: Type 2]
General Dietary Guidelines
The treatment goals for a diabetes diet are the following: To achieve near normal blood glucose levels People with type 1 diabetes and people
with type 2 diabetes who are taking insulin or oral medication must coordinate calorie intake with medication or insulin administration, exercise, and other variables to control blood glucose levels New forms of insulin are now allowing more flexibility in timing meals To protect the heart and aim for healthy lipid cholesterol and triglyceride levels and control of blood pressure To achieve reasonable weight Overweight type 2 diabetics who are not taking medication should aim for a diet that controls both weight and glucose A reasonable weight is usually defined as what is achievable and sustainable, rather than one that is culturally defined as desirable or ideal Children, pregnant women, and people recovering from illness should be sure to maintain adequate calories for health To manage or prevent complications of diabetes People with diabetes, whether type 1 or 2, are at risk for a number of medical complications, including heart and kidney disease Dietary requirements for diabetes must take these disorders into consideration To promote overall health Overall Guidelines There is no longer a single diabetes diet that will suit everyone The overall approach is based on the US
Dietary Guidelines for healthy eating for all Americans, and includes the following: Overall, experts recommend that foods containing carbohydrate from whole grains, nuts, fruits, vegetables, and low- or non-fat milk should be included in any healthy diet Carbohydrates and monounsaturated fat should provide 60 to 70 of calories, but the mix should depend on calorie intake needed for weight loss or maintenance Avoid saturated fats found in animal products and trans fatty acids hard margarines, commercial products, fast foods In selecting fats or oils, prefer monounsaturated fats virgin olive oil, canola oil, although also include polyunsaturated oils as well sunflower, rapeseed Different studies have reported an association between type 2 diabetes and both saturated fats and trans fatty acids Limit protein Protein should provide 15 to 20 total calories less in people with nephropathy In selecting proteins, eat in moderation and prefer fish or soy protein to poultry or meat Avoid, in any case, high-fat meats When choosing foods with sugar, choose fresh fruits, but do so in moderation
Some Dietary Approaches for Type 1 or Type 2 Diabetes
Patients should meet with a professional
dietitian to plan an individualized diet within the general guidelines that takes into consideration their own health needs There is no single diet that meets all the needs of everyone with diabetes For instance, a type 2 diabetic who is overweight and insulin-resistant may need to have a different carbohydrate-protein balance than a thin type 1 diabetic in danger of kidney disease If one of these approaches works in controlling glucose levels, there is no reason to choose another Each of them can be effective, but because regulating diabetes is an individual situation, everyone with this condition should get help from a dietary professional in selecting the best method Healthy eating habits along with good control of blood glucose are the basic goals in managing this complex disease, and several good dietary methods are available to meet them: General Dietary Guidelines for Type 2 Diabetes A simple heart-healthy diet with weight control may be sufficient for people with type 2 diabetes One study of people with type 2 diabetes compared several diet plans: A high-carbohydrate/high-fiber diet A low-fat diet A weight management diet After 18 months all groups experienced similar
and improved glycolated hemoglobin and cholesterol levels The researchers concluded that the positive benefits of the diets were derived not from the specific regimens, but because the people in the study were attentive and focused In other words, any healthy diet works if patients work at it
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Diabetes Diet
On the other hand, the so-called Western diet higher consumption of red meat, processed meat, French fries, high-fat dairy products, refined grains, and sweets and desserts poses a high risk for type 2 diabetes Of note: in a 2003 study, people with type 2 diabetes who used sucralose a sugar substitute and a fat replacer derived from oats as part of a low-calorie diet achieved better weight and glucose control than those on a standard diabetic diet General Dietary Guidelines for Type 1 and Insulin-Dependent Type 2 Diabetes Intricate dietary methods are available for control of blood sugar in type 1 and insulin-dependent type 2 diabetes The most common method for controlling blood sugar is the use of The Diabetic Exchange Lists More sophisticated methods include counting carbohydrate grams and using the so-called glycemic index to determine the impact of carbohydrates on
blood sugar
Monitoring
Tests for Glucose Levels Both hypoglycemia and hyperglycemia are of concern for patients who are receiving insulin It is important, therefore, to monitor blood glucose levels carefully Patients should aim for the following measurements: Pre-meal glucose levels of between 80 and 120 mg/dL Bedtime levels of between 100 and 140 mg/dL In general, patients who are tightly controlling glucose levels need to take readings four or more times a day Blood glucose levels are generally more stable in type 2 diabetes than in type 1, so experts usually recommend measuring blood levels only once or twice a day Different goals may be required for specific individuals, including pregnant women, very old and very young people, and those with accompanying serious medical conditions
Tests for Glycosylated Hemoglobin Another test examines blood levels glycosylated hemoglobin, also known as hemoglobin A1c HbA1c Measuring glycosylated hemoglobin is not currently used for an initial diagnosis, but it may be useful for determining the severity of diabetes The test is not affected by food intake so it can be taken at any time A home test has been developed that might make it
easier to measure HbA1c In general, measurements suggest the following: Normal HbA1c levels should be below 7 Levels of 11 to 12 glycolated hemoglobin indicate poor control of carbohydrates High levels are also markers for kidney trouble Other Tests Other tests are needed periodically to determine potential complications of diabetes, such as high blood pressure, unhealthy cholesterol levels, and kidney problems Such tests may also indicate whether current diet plans are helping the patient and whether changes should be made Annual urine tests showing even microscopic traces of a protein known as albumin can also indicate a future risk for serious kidney disease
Preventing Hypoglycemia Insulin Shock
For prevention of long-term complications of diabetes, experts are now recommending that both type 1 and type 2 patients should aim at keeping blood levels as close to normal as possible Such intensive insulin treatment increases the risk of hypoglycemia, which occurs when blood sugar is extremely low below 60 mg/dL The following tips may help avoid hypoglycemia or prepare for attacks Patients are at highest risk for hypoglycemia at night Bedtime snacks may be helpful Patients who
intensively control their blood sugar should monitor blood levels as often as possible, four times or more per day This is particularly important for patients with hypoglycemia unawareness In adults, it is also particularly critical to monitor blood glucose levels before driving, when hypoglycemia can be very hazardous Diabetic patients on therapies that put them at risk for hypoglycemia should always carry hard candy, juice, sugar packets, or commercially available glucose substitutes designed for diabetic individuals
Other Factors Influencing Diet Maintenance
Food Labels Every year thousands of new foods are introduced, many of them advertised as nutritionally beneficial It is important for everyone, most especially people with diabetes, to be able to differentiate advertised claims from truth The current food labels show the number of calories from fat, the amount of nutrients that are potentially dangerous fat, cholesterol, sodium, sugars as well as useful nutrients fiber, carbohydrates, protein, vitamins Labels also show daily values, the percentage of a daily diet that each of the important nutrients offers in a single serving Unfortunately, the daily value is based on
2,000 calories, generally much higher than most diabetics should
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Diabetes Diet
have, and the serving sizes may not be equivalent to those on the Exchange Lists Most people will need to recalculate the grams and calories listed on food labels to fit their own serving sizes and calorie needs Weighing and Measuring Weighing and measuring food is extremely important in order to get the correct number of daily calories Along with measuring cups and spoons, choose a food scale that measures grams A gram is very small, about 1/28th of an ounce Food should be weighed and measured after cooking After measuring all foods for a week or so, most people can make fairly accurate estimates by eye or by holding food without having to measure everything every time they eat Timing Meals should not be skipped, particularly for those who are on insulin Skipping meals can upset the balance between food intake and insulin and also can lead to weight gain if the patient eats extra food too often to offset low blood sugar levels The timing of meals is particularly important for people taking insulin: Patients should coordinate insulin administration with calorie intake In general, they should eat
three meals each day at regular intervals Snacks are often required They should try to take an insulin injection 30 minutes before they eat, although this timing could vary, depending on the form Some experts recommend a fast acting insulin insulin lispro at each meal and a longer basal insulin at night
Major Food Components Carbohydrates
Compared to fats and protein, carbohydrates have the greatest impact on blood sugar Evidence now suggests that it is the total amount of carbohydrates rather than the specific type that most directly affects blood glucose Carbohydrate types are either complex as in starches or simple as in fruits and sugars One gram of carbohydrates equals four calories The current general recommendation is that carbohydrates should provide between 50 and 60 of the daily caloric intake Complex Carbohydrates In all cases, complex carbohydrates found in whole grains and vegetables are preferred over those found in starch-heavy foods, such as pastas, white-flour products, and potatoes Most of these are high in fiber, which is important for health Whole-grains specifically are extremely important for people with diabetes or at risk for it [For specific benefits, see
Box Whole Grains, Nuts, and Fiber-Rich Foods and see Table Some Examples of Healthy Foods] Simple Carbohydrates Sugar Sugars are generally one of two types: Sucrose table sugar Sucrose has also been associated with higher triglycerides and harmful cholesterol levels And a 2002 study suggested that a high level of sugar consumption may reduce levels of HDL cholesterol, the so-called good cholesterol Fructose sugar molecule found in fruits Fructose may produce a slower increase in blood sugar than sucrose, which may have some advantages for people with diabetes Dark-colored fruits are rich in important vitamins and other nutrients, and studies continue to report their benefits for the heart and health in general Other fruits, such as apples and grapes also have important food chemicals As with any sugar, however, excess use of fructose is associated with triglycerides and harmful cholesterol levels Sugar itself, either as sucrose or fructose, adds calories, increases blood glucose levels quickly, and provides no other nutrients High level of sugar consumption–whether fructose or sucrose–has been associated with higher triglycerides and lower levels of HDL cholesterol, the
so-called good cholesterol And the high consumption of sugar is most likely one of the factor in the current obesity epidemic Soda, other sweetened beverages, and fruit juice in fact may be singled out as major contributors to childhood obesity People with diabetes should continue to avoid products listing more than 5 grams of sugar per serving, and even fruit intake should be moderate If specific amounts are not listed, patients should avoid products with either sucrose or fructose listed as one of the first four ingredients on the label [See Box Fat Substitutes and Artificial Sweeteners] Of increasing interest to researchers in the study of possible harm from sugar are advanced glycation end-products called AGEs, which are end-products of the chemical reaction between sugar and protein This reaction occurs most intensively when cooking at high temperatures–particularly animal fats Steaming or cooking food in water does not produce these chemicals Low, slow cooking also produces fewer AGEs AGEs can also be formed by chemical reactions in the body itself They are now believed to promote factors in the inflammatory response that cause a number
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Diabetes Diet
of diseases or their
complications, including diabetes and other serious conditions eg, Alzheimers, atherosclerosis, cataracts, and osteoporosis
Whole Grains, Nuts, and Fiber-Rich Foods
Fiber is an important component of many complex carbohydrates It is almost always found only in plants, particularly vegetables, fruits, whole grains, nuts, and legumes dried beans, peanuts, and peas One exception is chitosan, a dietary fiber made from shellfish skeletons Fiber cannot be digested but passes through the intestines, drawing water with it and is eliminated as part of feces content The following are specific advantages from high-fiber diets up to 55 grams a day: Insoluble fiber found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels may help achieve weight loss Consuming whole grains on a regular basis appears to provide many important benefits, and especially to people with type 2 diabetes They are associated with insulin sensitivity, a lower risk for heart disease, and possibly even weight loss They may even lower the risk for type 2 diabetes in the first placeOf special note, nuts, such as almonds, macadamia, and walnuts may be highly heart protective, independent of
their fiber content One study reported that high consumption of nuts or peanut butter was also associated with a lower risk for type 2 diabetes Peanuts are not technically nuts but are legumes Soluble fiber found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes has important benefits for the heart, particularly for achieving healthy cholesterol levels and possibly reducing blood pressure as well Evidence on the heart benefits of beans continues to grow For example, a 2001 study indicated that eating beans four or more times a week reduced the risk for heart disease by 22 Soluble fiber supplements, such as those that contain psyllium or glucomannan, may be beneficial Psyllium is taken from the husk of a seed grown in India It is found in laxatives eg, Metamucil, breakfast cereals Bran Buds, and other products In one 2002 study, for example, patients with type 2 diabetes who consumed psyllium Plantaben for breakfast for 11 weeks experienced lower total and LDL cholesterol There was no difference in glucose of HbA1c levels Of note, although there were no changes in mineral and vitamin levels, there was an increase in sodium after consuming psyllium People who
increase their levels of soluble fiber should also increase water and fluid intake Some human and animal studies suggest, however, that psyllium increases triglyceride levels in postmenopausal women
Fat Substitutes and Artificial Sweeteners
Replacing fats and sugars with substitutes may help many people who have trouble maintaining weight In fact, in one 2003 study, people with type 2 diabetes used the artificial sweetener sucralose and a beta-glucan fat replacer derived from oats as part of a low-calorie diet At the end of the four weeks, they achieved better weight, glucose control, and HDL levels than those on a standard diabetic diet Fat Substitutes Fat substitutes added to commercial foods or used in baking, deliver some of the desirable qualities of fat, but do not add as many calories It should be stressed that eliminating all fats from ones diet can be harmful to general health Some include the following: Stanols Stanols are plant compounds used in margarines Benecol, Take Control Benecol is derived from pine bark and Take Control from soybeans Two servings a day of either brand as part of a low-fat diet can lower LDL and total cholesterol by impairing its absorption in
the intestinal tract Some studies have reported that their use can allow lower doses of statins–cholesterol lowering agents These products do not appear to block absorption of fat-soluble nutrients or vitamins, as olestra does [see below] They can be hydrogenated, however, and can contain some trans-fatty acids Olestra Olean passes through the body without leaving behind any calories from fat Studies suggest that it improves cholesterol levels and helps people lose weight when it is used to replace a third of normal dietary fats Simply adding snacks containing olestra do not appear to have any effect on cholesterol or weight loss Early reports of cramps and diarrhea after eating food containing olestra have not proven to be significant Of greater concern is the fact that even small amounts of olestra depletes the body of certain vitamins and nutrients that may help protect against serious diseases, including cancer The FDA requires that the missing vitamins be added back to olestra products, but not other nutrients The adverse health effects, if any, are unknown Beta-glucan is a soluble fiber found in oats and barley Products using this substance eg, Nu-Trim may reduce
cholesterol and have additional health benefits
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Diabetes Diet
A number of other fat-replacers are also available Although studies to date are not showing any significant adverse health effects, their effect on weight control is uncertain, since many of the products containing them may be high in sugar Artificial Sweeteners Many artificial or low-calories sweeteners are available A 2002 study confirmed that people who consumed artificial sweeteners in beverages and foods and reduced their sugar intake weighed less over time than those who ate similar types and amounts of drinks and food containing sugar It should be noted that using these artificial sweeteners should not give dieters a license to increase their fat intake Studies indicate that consuming some sugar is not a significant contributor to weight gain as long as the total caloric intake is under control There is some public concern about chemicals used to produce many of these sweeteners and adverse effects in studies using rats Natural low-calories sweeteners are available that may be more acceptable to many people
TM
Saccharin Sugar Twin, Sweet n Low , Sucaryl, and Featherweight Saccharin has been used for years
but is not used as commonly now Some studies found that large amounts of saccharin cause bladder cancer in rats Although the rats were fed huge amounts that do not apply to human diets, some evidence suggests that people who have six or more servings of saccharin per day may have an increased risk Aspartame Nutra-Sweet, Equal, NutraTase Aspartame has come under scrutiny because of rare reports of neurologic disorders, including headaches or dizziness, associated with its use People with phenylketonuria PKU, a rare genetic condition, should not use it Studies have not reported any serious health dangers, but some people may be sensitive to it Sucralose Splenda Sucralose has no better aftertaste and works well in baking, unlike other artificial sweeteners It is made from real sugar by replacing hydroxyl atoms with chlorine atoms Some people are concerned because chlorinated molecules used in major industrial chemicals have been associated with cancer and birth defects Over 100 studies have been conducted on sucralose over a 20-year period with no reports of such risks Acesulfame-potassium Sweet One, SwissSweet, Sunette It has been used in the US since 1988 with no reported adverse
effects Neotame Neotame Neotame is a synthetic variation of aspartame but was developed to avoid its side effects The association with aspartame has raised some concerns Studies to date have reported no effects that would cause alarm and it appears to be safe for general consumption D-tagatose Tagatose This reduced calorie sweetener is a novel low-calorie sweetener derived from lactose, which is found in dairy products and other foods It may be specifically beneficial for people with type 2 diabetes and have additional benefits that aid the intestinal tract Alitame Aclame is formed from amino acids It has the potential to be used in all products that contain sugar, including baked goods Stevioside Stevia This is a natural sweetener derived from a South American plant It is available in health food stores People with diabetes should avoid alcohol-based forms It has not been rigorously tested Others being investigated include, glycyrrhizin derived from licorice, and dihycrochalcones derived from citrus fruits The Carbohydrate Counting System Some people plan their carbohydrate intake using a system called carbohydrate counting It is based on two premises: All carbohydrates
either from sugar or starch will raise blood sugar to a similar degree In general, one gram of carbohydrates raises blood sugar by 3 points in people who weigh 200 pounds, 4 points for weights of 150 pounds, and 5 points for 100 pounds Carbohydrates have the greatest impact on blood sugar; fats and protein play only minor roles In other words, the amount of carbohydrates eaten rather than fats or proteins will determine how high blood sugar levels will rise There are two options for counting carbohydrates: advanced and simple Both rely on the collaboration with a physician, dietitian, or both Once the patient learns how to count carbohydrates and adjust insulin doses to their meals, many find it more flexible, more accurate in predicting blood sugar increases, and easier to plan meals than other systems The basic goal is to balance insulin with the amount of carbohydrates eaten in order to control blood glucose levels after a meal The steps to the plan are as follows: The patient must first carefully record a number of factors that are used to determine the specific requirements for a meal plan based on carbohydrate grams: Multiple blood glucose readings taken several times a day
The time of meals Amount in grams of all the carbohydrates eaten Time, type, and duration of exercise
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Diabetes Diet
The time, type, and dose of insulin or oral medications Other relevant factors, such as menstruation, illness, and stress The patient works with the dietitian for two or three 45 to 90 minute sessions to plan how many grams of carbohydrates are needed There are three carbohydrate groups: Bread/starch Fruit Milk One serving from each group should contain between 12 and 15 carbohydrate grams Patients can find the amount of carbohydrates in foods from labels on commercial foods and from a number of books and web sites The dietitian creates a meal plan that accommodates the patients weight and needs, as determined by the patients record, and makes a special calculation called the carbohydrate to insulin ratio This ratio determines the number of carbohydrate grams that a patient needs to cover the daily pre-meal insulin needs Eventually, patients can learn to precisely adjust their insulin doses to their meals It should be noted that patients who choose this approach must still be aware of protein and fat content in foods They may add excessive calories and
saturated fats Patients must still follow basic healthy dietary principles The Glycemic Index The glycemic index has been developed to determine which carbohydrate-containing food raise blood glucose levels more or less quickly after a meal The index uses a scale of numbers for specific foods that reflect greatest to least delay in producing an increase in blood sugar after a meal The lower the index number, the better the impact on glucose levels Some evidence suggests that the benefit of foods with a low glycemic index is due to their ability to increase insulin levels quickly and so remove blood sugar rather than their ability to slow the release of blood sugar itself There are currently two indexes in use One uses a scale of 1 to 100 with 100 representing a glucose tablet, which has the most rapid effect on blood sugar [SeeTable The Glycemic Index of Some Foods] The other common index uses a scale with 100 representing white bread so some foods will be above 100 A major 2003 analysis suggested that choosing foods with a low glycemic index scores may have a small but significant effect on controlling the surge in blood sugar after meals Many of these food are also high in fiber
and so have heart benefits as well Substituting low- for high-glycemic index foods may even help prevent weight gain One easy way to improve ones glycemic index is simply to replace starches and sugars with whole grains and legumes eg, dried peas, beans, and lentils However, there are many factors that affect the glycemic index of foods, and maintaining a diet with low glycemic load is not straightforward The following are some considerations: The numbers attributed to each carbohydrate-rich food are not additive In other words, adding All Bran cereal index of 49 to a banana index of 61 does not equal 110 Adding certain fats to a food, for example butter to potato, can slow down the potatos impact on blood sugar One study reported that when patients ate fatty foods first, their blood glucose levels were significantly lower an hour after the meal than when carbohydrates were eaten first Adding foods with organic acids eg, pickles, yogurt to meals may reduce the impact of foods with high glycemic scores on blood sugar It should be noted that yogurt alone, however, has the same high glycemic index as regular milk No one should use the glycemic index as a complete dietary guide,
since it does not provide nutritional guidelines for all foods It is simply an indication of how the metabolism will respond to certain carbohydrates Some experts believe it is too complicated to be practical and that simply tracking carbohydrates, eating healthily, and maintaining a healthy weight is sufficient Nevertheless, a study on children with type 1 diabetes suggested that it offered as many choices as the exchange diet and they did not report feeling any greater limitations
The Glycemic Index of Some Foods
Based on 100 a Glucose Tablet BREADS pumpernickel sour dough rye white 49 54 64 69
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Diabetes Diet
whole wheat 72 GRAINS barley 22 sweet corn 58 brown rice 66 white rice 72 BEANS soy 14 red lentils 27 kidney dried and boiled, not 29 canned chickpeas 36 baked 43 DAIRY PRODUCTS milk 30 ice cream 60 CEREALS oatmeal 53 All Bran 54 Swiss Muesli 60 Shredded Wheat 70 Corn Flakes 83 Puffed Rice 90 PASTA spaghetti-protein enriched 28 spaghetti boiled 5 minutes 33 spaghetti boiled 15 minutes 44 FRUIT strawberries 32 apple 38 orange 43 orange juice 49 banana 61 POTATOES sweet 50 yams 54 new 58 mashed 72 instant mashed 86 white 87 SNACKS potato chips 56 oatmeal cookies 57 corn
chips 72 SUGARS fructose 22 refined sugar 64 honey 91 Note These numbers are general values, but may vary widely depending on other factors, including if and how they are cooked and foods they are combined with
Protein
In general, experts recommend that proteins should provide 12 to 20 of calories This daily amount of poses no risk to the kidney in people without signs of nephropathy Protein is important for strong muscles and bones Protein intake in diabetes is complicated, however:
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Some evidence also suggests that a high-protein diet lowers post-meal blood sugar more effectively than standard diets This might be specifically help for patients with type 2 diabetes On the other hand, protein restriction may be important for insulin-dependent diabetic patients with kidney disease Evidence now strongly indicates that even moderate restriction of proteins may help slow the progression of nephropathy A 1999 study indicated that a strict-low protein diet may even delay the need for dialysis in patients with kidney failure All major studies on restricting protein have used insulin-dependent patients as subjects It is not yet known if lowering protein would have the
same benefits for diabetics with nephropathy who are not insulin-dependent Note: Diets that are severely low in both protein and salt and coupled with high fluid intake increases the risk for hyponatremia, a rare condition that can cause fatigue, confusion, and, in extreme cases, can be life-threatening One gram of protein contains four calories Protein is commonly recommended as part of a bedtime snack to maintain normal blood sugar levels during the night, although studies are mixed over whether it adds any protective benefits against nighttime hypoglycemia If it does, only small amounts 14 grams may be needed to stabilize blood glucose levels Fish Fish is probably the best source of protein Evidence suggests that eating moderate amounts of fish twice a week may improve triglyceride and help lower the risks for death from heart disease, dangerous heart rhythms, blood pressure, a tendency for blood clots, and the risk for stroke It should be noted that a French study reported a higher incidence of heart attack in men who ate fish daily Such findings may be due to mercury toxicity, which has harmful effects on the heart High mercury content has been observed in swordfish and shark
and, to a medium extent, in tuna, trout, pike, tilapia tile fish and bassMore research is needed to further define the risks and benefits of fish, but at this time most evidence for eating fish two or three times a week is highly positive for most people [See Beneficial Fats and Oils under Fats and Oils, below] Soy Soy is an excellent food It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all essential proteins Not all studies are consistent, but the majority has shown an improvement in at least one of the cholesterol components in people who consumed at least 25 grams of soy protein Soy may also reduce other heart risk factors, including blood pressure, at least in certain populationsIn one 2002 study, soy was associated with better control of blood sugar and lower LDL levels in postmenopausal women with type 2 diabetes The best sources are soy products tofu, soy milk or whole soy protein Adding soy to lean ground beef may still provide heart benefits and be more acceptable for people who object to soys taste or its veggie image Note: Tablets of individual isoflavones–chemicals, such as genistein or daidzein, found in soy–do not appear to offer
any advantages Soy sauce is also not a good source It contains only a trace amount of soy and is very high in sodium More research is important to determine if soy has long-term complications Of possible concern, a high intake of soy during pregnancy may have some adverse effect on the fetus, although only animal studies have suggested this Meat and Poultry For heart protection, one 1999 study suggested that it didnt matter if you chose fish, poultry, beef, or pork as long as the meat was lean Saturated fat in meat is the primary danger to the heart The fat content of meat varies depending on the type and cut It is best to eat skinless chicken or turkey However, the leanest cuts of pork loin and tenderloin, veal, and beef are nearly comparable to chicken in calories and fat and their effect on LDL and HDL levels It should be noted, however, that even chicken and lean meat do not improve cholesterol levels, and, in terms of cardiac health, fish is a more desirable choice Dairy Products A 2002 study reported a lower incidence of factors related to type 2 diabetes and heart disease insulin resistance, high blood pressure, obesity, and unhealthy cholesterol with a high intake of dairy
products, including those with a high-fat content Some researchers suggest the calcium in dairy products may be partially responsible for these benefits The effects of extra calcium on blood pressure, however, are mixed with some even showing higher pressure Because many dairy products are high in saturated fats, which are related to heart disease, this study requires confirmatory evidence
Fats and Oils
Some fat is critical in everyones diet, but certain fats have good or harmful effects on health, depending on their chemistry All fats, good or bad, are high in calories compared to proteins and carbohydrates In order to calculate daily fat intake, multiply the number of fat grams eaten by nine one fat gram is equal to 9 calories, whether its oil or fat and divide by the number of total daily calories desired One teaspoon of oil, butter, or other fats equals about five grams of fat All fats, no matter what the source, add the same calories People should strive to replace saturated animal fats and transfatty acids commercial fats with unsaturated fats from plant and fish oils The American Heart Association and other experts now recommend that the source of most of these unsaturated
fats should come from omega-3 fatty acids, which are found in fish and plant sources The Chemistry of Fats and Cholesterol Most of the cholesterol in the body does not come from food but is produced by the liver–stimulated by saturated fats The dietary key to managing cholesterol, then, lies in understanding some of the major compounds in fats and oils that are becoming important in health:
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Fatty Acids All fats and oils found in foods are made up of chains of molecules called fatty acids There are three major chains: saturated fatty acid found mostly in animal products and two unsaturated fatty acids–monounsaturated and polyunsaturated fatty acids found in plant products The oils and fats that people and animals eat are nearly always mixtures of these three chains, but one type of fatty acid usually predominates in specific oils or fats Essential Fatty Acids In addition, there are three chemical subgroups of polyunsaturated fatty acids called essential fatty acids: omega-3 and omega-6 polyunsaturated fatty acids, and omega-9 monounsaturated fatty acids Transfatty Acids To complicate matters, there are also trans-fatty acids, which are not natural but are
manufactured by adding hydrogen atoms to polyunsaturated fatty acids called hydrogenation Harmful Fats Reducing consumption of saturated fats and trans-fatty acids is the first essential step in managing cholesterol levels through diet Saturated Fats Saturated fats are found predominantly in animal products, including meat and dairy products They are strongly associated with higher cholesterol level and have been associated with a higher risk for type 2 diabetes They may be even more dangerous in women than in men Avoiding fats during the evening meal may be especially helpful High-fat meals are associated with sudden surges in triglyceride levels and other lipids along with impaired blood flow in the arteries to the heart The so-called tropical oils, palm, coconut, and cocoa butter, are also high in saturated fats Evidence is lacking, however, about their effects on the heart The countries with the highest palm-oil intake, Costa Rica and Malaysia, also have much lower heart disease rates and cholesterol levels than Western nations Trans-fatty Acids Trans-fatty acids are manufactured fats created during a process called hydrogenation, which is aimed at stabilizing polyunsaturated
oils to prevent them from becoming rancid and to keep them solid at room temperature Studies report that high consumption of these fats reduces HDL cholesterol levels, has harmful effects on the linings of the arteries, and may increase the risk for diabetes type 2 In one study, women whose diets were high in trans-fatty acids had a 53 increased risk for heart attack compared to those who consumed the least of those fats Some experts believe that these partially hydrogenated fats are even worse for the heart than saturated fats They may also pose a risk for certain cancers Hydrogenated fats are used in stick margarine and in many fast foods and baked goods, including most commercially produced white breads Liquid margarine is not hydrogenated and is recommended The FDA has now required that food labels include information on trans-fatty acids Beneficial Fats and Oils It should be noted that some fat is essential for health, and fat is essential for healthy development in children Public attention has mainly focused on the possible benefits or hazards of monounsaturated MUFA and polyunsaturated PUFA fats Polyunsaturated fats are found in safflower, sunflower, corn, and cottonseed
oils and fish Monounsaturated fats are mostly present in olive, canola, and peanut oils and in most nuts Canola is the most unsaturated of all the fats Some studies have reported that replacing carbohydrates with monounsaturated fats improves glucose control after meals and reduces triglycerides in people with type 2 diabetesA study on type 1 patients also reported improved cholesterol levels Diabetic patients who are overweight, however, should be conscious of the calories in any oils Researchers are most interested in the smaller fatty-acid building blocks contained in both oils, which may have more specific effects on lipids Three important fatty acids are the essential fatty acids omega-3, omega-6, and omega-9 Omega-3 fatty acids are found in fish oil docosahexaenoic and eicosapentaneoic acids and plants alpha-linolenic acid Docosahexaenoic DHA and Eicosapentaneoic EPA Acids DHA and EPA are found in fish oils, and evidence suggests that they have significant benefits for the heart, including reducing sudden death from heart disease, dangerous heart rhythms, inflammation, blood clotting factors, blood pressure, and improving triglyceride levels Fish oil has little effect on
LDL or HDL levels Its effects on blood glucose levels in people with type 2 diabetes are unclear These fatty acids may also reduce risks for other disorders, including stroke, rheumatoid arthritis, asthma, ulcerative colitis, some cancers, and mental decline Three capsules of DHA-EPA supplements are about equivalent to eating one serving of fishThe richest sources of omega-3 fatty acids are oily fish, such as salmon, mackerel, or sardines [For more information, see Fish under Protein] Alpha-linolenic Acid Alpha-linolenic acid is a plant precursor of DHA, which means the body can convert it to DHA Sources include canola oil, soybeans, flaxseed, and certain nuts and seeds walnut, flax, chia and sometimes pumpkin seed Some, but not all, studies suggest that oils or foods containing these oils may also be heart-protective Supplements or foods containing these oils may also protect the heart For example studies have reported heart protection from flaxseed supplements and also from nuts, such as almonds, macadamia, and walnuts Nuts are high in calories, although studies in 2002 reported that replacing usual snacks with almonds did not affect the daily diet and significantly reduced
cholesterol and other heart disease risk factors Still, people must be aware of that nuts are not low-calorie snacks
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Diabetes Diet
Omega-6 polyunsaturated fatty acids are found in corn, safflower, soybean, and sunflower oil PUFA oils containing omega-6 fatty acids constitute most of the oils consumed in the US Some omega-6 fatty acids are important for health However, high intake of these fats was associated in one study with weight gain in the abdomen the so-called apple shape, a risk factor for heart diseaseHigh consumption is also associated with a higher risk for certain cancer and some chronic diseases Omega-9 monounsaturated fatty acids are contained in canola and olive oil Both oils have been associated with health protection Research suggests that a healthy balance of all these fats may be important and that our current Western diet contains an unhealthy ratio of omega-6 to omega-3 fatty acids 10 to 1 Omega-9 fatty acids may also contain chemicals that block harmful factors found in omega-6 fatty acids Researchers are finding then that the most benefits may be found in mixture of all three fatty acids found in both poly- and monounsaturated oils, but in modest amounts
that do not add too many calories Fat Substitutes Fat substitutes added to commercial foods or used in baking, deliver some of the desirable qualities of fat, but do not add as many calories [See Box Fat Substitutes and Artificial Sweeteners]
Dietary Cholesterol
The story on cholesterol found in the diet is not entirely straightforward Cholesterol is found only in animal tissues, with high amounts occurring in meat, dairy products, egg yolks, and shellfish The American Heart Association recommends no more than 300 mg of cholesterol per day One study estimated, however, that reducing dietary cholesterol intake by 100 mg/day would only produce a 1 decrease in cholesterol levels Of note, however, are studies indicating that although dietary cholesterol itself does not appear to increase the risk for heart disease in most individuals, people with diabetes, especially type 2, may be an exception Until more research is done, they should consider avoiding eating eggs or other high-cholesterol foods such as shrimp more often than once a week
Some Examples of Healthy Foods
Foods Vitamins and other Benefits valuable food components Apples May have activity against certain cancers lung Also
may help maintain healthy cholesterol May protect against asthma Beans Flavonoids Folate, iron, potassium, and Some experts believe beans zinc are the perfect food Berries, all kinds of dark Ellegic Acid Vitamin C, minerals May protect the aging brain colored In one study blueberries were most effective Broccoli also kale, Brussels Flavonoids, isothiocyanates, Vitamin C, folate, fiber, and Anticancer properties sprouts, cauliflower lutein, beta and alpha selenium Protective against heart carotene Note: Young disease and stroke sprouts of broccoli and cauliflower contain much higher levels of isothiocyanates than their mature forms Carrots and other bright Lutein, beta carotene and Vitamin A converted from Protects eyes, lungs yellow vegetables other provitamin A carotenoids, Vitamin C Cooking carrots may carotenoids increase the potency of food nutrients Chocolate, dark Note: Milk Flavonoids Heart protective may chocolate does not have improve lipids and help benefits prevent blood clotting May have protective properties against lung cancer not other cancers Eggs Lutein Many B vitamins, Vitamin Although egg yolks are high A, Vitamin D in cholesterol, very little of it has a
negative effect on people with normal levels And the health benefits of
11
Phytochemicals and Carotenoids Flavonoids
Diabetes Diet
Fish, oily mackerel, salmon, sardines Garlic
Allium organosulfurs
Ginger Grains whole Grapes, including purple grape juice, and red wine Nuts such as almonds, macadamia, and walnuts
Zingiberaceae Lignans phytoestrogens Flavonoids, resveratrol, quercetin and catechin
Nuts Onions Oranges Potatoes Sweet Soy The best products are Isoflavones tofu, soy milk, or whole soy phytoestrogens, protein flavonoids, phytosterol, phytate, saponins Flavonoids, allium organosulfurs Monoterpenes
Spinach and other dark green leafy vegetables
Zeaxanthin, beta carotene
Tea Both black and green Flavonoids primarily tea are beneficial Best catechins results associated with green tea
eggs are now known to be very high People with diabetes or those with high cholesterol should restrict eggs, however Vitamin B3, B12 Essential Heart and brain protective fatty acids, selenium Possibly protective against certain cancers, heart diseases, and infection Heating garlic can reduce benefits Allowing crushed fresh garlic to stand 10 minutes before heating, however, may preserve
beneficial chemicals while cooking Cancer fighting properties Vitamin B, selenium May help reduce the ability important antioxidant of cancer cells to invade mineral, fiber, folate health tissue Fight heart disease and cancer May help lower the risk for asthma May benefit people with diabetes Vitamin E, Vitamin B1, May lower cholesterol essential fatty acids, folate, levels, reduce sudden death fiber rates from heart disease, and help prevent stroke and type 2 diabetes Vitamin E, Vitamin B1, Protects the heart and may essential fatty acids, folate help prevent stroke May have activity against certain cancers lung Vitamin C, folate, Many health benefits potassium Increases HDL levels Vitamin C, Vitamin E, Many health benefits Vitamin A May have effects similar to estrogen, including maintaining bone and benefiting the heart in women May also be protective against prostate cancer and possibly other cancers More studies are needed Effects on breast cancer are uncertain Note: Soy may have different effects in men than in women Of some concern is one study reporting more mental decline in men who consume greater amounts of tofu Vitamin C, folate, Vitamin Protects lungs and brain A
converted from carotenoids Cancer fighting properties, particularly in green tea, which may be especially beneficial for smokers Both black and green tea may protect against heart disease and stroke, although
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Diabetes Diet
studies are mixed Tea drinking also may help with weight control and help prevent osteoporosis Tomatoes Lycopene, Flavonoids Vitamin C, biotin, minerals Studies link to reductions in prostate and other cancers Infection fighters Note on Organic versus Inorganic Products There is some evidence that organic produce has higher levels of antioxidants and that some agricultural chemicals may destroy flavonoids Nevertheless, organic produce is expensive, and fruits and vegetables, no matter how they are grown are still filled with healthful nutrients
Vitamins and Supplements
The value of specific vitamins on health in general and for individual diseases is unclear Nevertheless, of interest was a 2003 study reporting a significantly lower rate of infections 17 in people with type 2 diabetes who took a multivitamin and mineral supplement compared to those who took a placebo 93 Antioxidant Vitamins E, C, and A Deficiencies in Vitamins E and beta carotene have been
linked to heart disease and also to higher blood glucose levels These nutrients as well as vitamins C and A have antioxidant effects and other properties that should benefit the heart However, a number of studies have found no reductions in heart disease in people who have taken antioxidant vitamins In 2003, the US Preventive Service Task Force concluded that, to date, evidence is insufficient to confirm or refute the benefits of supplements of any of these vitamins in protecting against heart disease It is important to note, in addition, that each of these supplements may even be harmful to the heart in high doses [See Box Antioxidants: Pros and Cons] Folate and B12 Vitamins Deficiencies in the B vitamins folate known also as folic acid and B12 have been associated with a higher risk for heart disease in some but not all studies Such deficiencies produce elevated blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure Some studies in 2002, suggest that any risk posed by homocysteine or benefits from folic acid for heart disease are at most modest One study, however, reported lower failure rates after
angioplasty in patients who took folic acid and vitamins B12 and B6 And a major 2002 suggested that lowering homocysteine levels with folic acid would reduce the risk for heart disease by 16 and stroke by 24 More evidence is needed to determine whether homocysteine plays a causal role in cardiovascular disease and whether the B vitamins are protective Folate improves blood flow through the arteries, which may be important for the heart, regardless of its effect on homocysteine Niacin Niacin vitamin B3 is used for lowering unhealthy cholesterol levels Although vitamin B3 is available over the counter, it can have significant side effects A physician should prescribe niacin in order to ensure its safety and effectiveness [For more information, see Well-Connected Report 39 Vitamins, Carotenoids, and Phytochemicals]
Antioxidants: Pros and Cons
Description of Oxygen-Free Radicals Oxidants Currently, the most important benefit claimed for vitamins A, C, E, and many of the carotenoids and phytochemicals is their role as antioxidants, which are scavengers of particles known as oxygen-free radicals also sometimes called oxidants These chemically active particles are by-products of many of
the bodys normal chemical processes Their numbers are increased by environmental assaults, such as smoking, chemicals, toxins, and stress In higher levels, oxidants can be very harmful in the following way: They can damage cell membranes and interact with genetic material, possibly contributing to the development of a number of disorders including cancer, heart disease, cataracts, and even the aging process itself Oxygen-free radicals can also enhance the dangerous properties of low-density lipoprotein LDL cholesterol, a major player in the development of atherosclerosis Description of Antioxidants and Warnings on High-Dose Supplements Antioxidant vitamins A, C, and E, carotenoids, and many phytochemicals can neutralize free radicals Unfortunately, although it is clear that vitamins are required to prevent deficiency diseases, to date, there is no strong evidence that antioxidant supplements offer any real protection Everyone should try to obtain these nutrients from dark colored fresh fruits and vegetables, which contain balanced teams of antioxidant vitamins and
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Diabetes Diet
nutrients In fact, there is some increasing evidence that high doses of vitamin C, vitamin E, and
beta carotene supplements may have pro-oxidant effects, which can be harmful in certain cases The strongest evidence on negative effects to date are studies reporting an increase in lung cancer and overall mortality rates among smokers who took beta carotene supplements In determining reasons for this disturbing effect, one animal study suggested that beta carotene increased enzymes in the lungs that actually promote cancerous changes A 2000 study also reported a higher risk for cancer in male smokers who took multivitamins plus A, C, or E And, even more worrisome, in people with existing cancer, high doses of antioxidant vitamins, such as vitamin C or beta carotene, may actually protect cancer cells just as they do healthy cells For example, a 2003 study reported a higher risk in melanoma in people with vitamin-C rich diets Some evidence also exists that high doses of vitamin C may speed up atherosclerosis In a 2003 study, women with heart disease who took antioxidant vitamins had a higher risk for heart attack or death than those who didnt take one A 2002 study, also reported a higher incidence and greater severity of respiratory infections in older adults who took 200 mg of
vitamin E daily Some researchers speculate that certain immune factors generate oxidants to fight bacteria These antioxidant vitamins then may block that action
Salt and Sodium
Most experts recommend salt restriction in people who are hypertensive Some people, however, are much more sensitive to harmful effects from salt than others: People at Risk for Salt-Sensitivity African Americans, Diabetics, the Elderly About half of people with hypertension have blood pressure that reacts significantly to salt Such people are known to be salt-sensitive High-salt diets in anyone who is salt-sensitive may harm the heart, kidney, and brain and increase the risk for death, regardless of their blood pressure Even people with normal blood pressure can be salt-sensitive Among those at highest risk for salt sensitivity are African Americans, people with diabetes, and elderly people A 2001 study, for example, reported that reducing sodium intake in older people, including African Americans, was very effective in controlling their hypertension Still because testing for salt-sensitivity is not easy, experts recommend that everyone proactively restrict their daily salt-intake Overweight People
Overweight individuals may absorb and retain sodium differently from people with normal weights In fact, one 1999 study reported that high sodium intake was associated with an increased risk of heart disease and all cause mortality in overweight, but not in normal weight, people Unfortunately, because overweight people generally consume more calories, they are also likely take in more sodium Simply eliminating table and cooking salt can be beneficial It should be noted, however, that about 75 of the salt in the typical American diet comes from processed or commercial foods, not from food cooked at home, so the benefits of table-salt substitutes are likely to be very modest Some sodium is essential to protect the heart, but most experts agree that the amount is significantly less than that found in the average American diet If people cannot significantly reduce the amount of salt in their diets, adding potassium-rich foods might help to restore a healthy balance
Other Minerals
Calcium Calcium supplements may be important in older patients with diabetes to help reduce the risk for osteoporosis, particularly if their diets are low in dairy products Potassium Evidence now strongly
indicates that a potassium-rich diet can help achieve healthy blood pressure levels, and that potassium supplements can lower systolic blood pressure by 18 m Hg and diastolic blood pressure by 1 mm Hg In fact, there is some evidence that a potassium-rich diet can reduce the risk of stroke by 22 to 40 Current expert guidelines now support the use of potassium supplements or enough dietary potassium to achieve 3,500 mg per day for people with normal or high blood pressure who have no risk factors for excess potassium levels This goal is particularly important in people who have high sodium intake The best source of potassium is from the fruits and vegetables that contain them Some potassium-rich foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados Of note, in this regard, certain kidney problems can cause potassium overload Medications commonly used in diabetes, such as ACE inhibitors or potassium-sparing diuretics, also limit the kidneys ability to excrete potassium No one should take potassium supplements without consulting a physician The best source of potassium is from the fruits and vegetables that contain
them
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Diabetes Diet
Magnesium Magnesium deficiency may have some role in insulin resistance and high blood pressure One study reported that low magnesium levels as measured in blood tests were associated with a higher risk for type 2 diabetes in whites but not in African Americans Dietary intake of magnesium, however, did not appear to play any role in increasing or reducing risk for either population group It is more likely that diabetes may cause magnesium loss A major 2001 study on diet found no effect on blood pressure from magnesium intake from foods No supplements are recommended at this time for patients with adequate levels of magnesium The recommended daily allowance is 320 mg Persons who live in soft water areas, who use diuretics, or who have other risk factors for magnesium loss or ectopic beats may require more dietary magnesium than would others Chromium Some studies have reported an association between deficiencies in the mineral chromium and a higher risk for type 2 diabetes Studies on fat rats that were given chromium reported improvement in insulin sensitivity and glucose metabolism Most studies on type 2 patients, however, reported little or no effect on
glucose metabolism and some even reported adverse side effects Zinc Many type 2 diabetics are also deficient in zinc; more studies are needed to establish the benefits or risks of taking supplements Zinc has some toxic side effects, and some studies have associated high zinc intake with prostate cancer
Fluids: Water, Caffeine, and Alcohol
Water Many heart risk factors, especially those associated with blood clotting, are elevated with dehydration In an interesting 2002 study, drinking five or more glasses of water a day was significantly associated with a lower risk for fatal heart events than drinking two or fewer glasses a day More research is warranted on this simple way of protecting health Other fluids, including caffeinated and sugared drinks, were not protective Alcohol A number of studies have found protection from heart disease and type 2 diabetes with light to moderate intake of any type of alcohol Some research suggests that alcohol has anti-inflammatory properties that protect arteries from injury Red wine in particular may have specific benefits for people with type 2 diabetes It has strong anti-oxidant effects that benefit the heart Some evidence also suggests that
red wine may improve insulin sensitivity and reduce blood glucose levels and may even protect against type 2 diabetes Note: In those taking insulin or sulfonylureas, however, alcohol may cause a hypoglycemic reaction, of which the drinker may not be aware Women who are pregnant or at risk for breast cancer and anyone at risk for alcohol abuse should not drink alcohol Tea Although it contains caffeine, tea, both black and green, is often cited for its health benefits Green tea is especially is rich in chemicals that offer protection against damaging forms of LDL In one study, for example, higher intake, particularly by women, was associated with a lower risk for severe coronary artery disease Black tea has also been associated with heart health In one study oolong tea, a partially fermented tea, was specifically associated with lower blood sugar levels in type 2 diabetics Coffee Coffee, like red wine, contains phenol, which helps prevent oxidation of LDL cholesterol Studies are finding no association between coffee consumption and fatal or nonfatal heart disease even after 10 years In fact, in one study the highest rates of fatal heart disease were in non-coffee drinkers, and women
who increased their coffee intake reduced their mortality rates On the downside, unfiltered coffee Turkish coffee, Scandinavian boiled or French pressed coffee, and espresso contains an alcohol called cafestol, which may raise cholesterol and triglyceride levels Filtered coffee does not contain this residue Coffee drinking is associated with small increases in blood pressure, but the risk it poses is very small in people with normal blood pressure People with existing hypertension should avoid caffeine altogether Of note, caffeine has specific effects on insulin and glucose that may have an effect on people with diabetes, but the consequences are not clear Some studies suggest that drinking large amounts of coffee may protect against diabetes On the other hand, other research indicates that caffeine may increase the risk for insulin resistance Some studies have reported a spike in insulin after drinking caffeinated beverages, which can be dramatic in people who are overweight Research is needed to clarify the effects of caffeine on diabetes In any case, caffeine intake can affect a persons awareness of hypoglycemia, since it reduces blood flow in the brain even in the presence of
sufficient blood sugar People with diabetes who drink even two or three cups of coffee may even believe they are hypoglycemic when their blood glucose levels are normal On the positive side, coffee intake may increase awareness of hypoglycemia in some people who have difficulty recognizing its symptoms
Weight Control for Type 2 Diabetes
Even modest weight loss can reduce the risk factors for heart disease and diabetes There are many approaches to dieting and many claims for great success with various fad diets They include calories restriction, low-fat/high-fiber, or high protein and fat/low carbohydrates Some evidence suggests that people may respond differently to specific diets depending on whether their weight is overly distributed around the abdomen or not According to a 2003 report comparing four major diets Atkins, the Zone, Ornish, and Weight Watchers, any healthful diet that achieves weight loss helps the heart To date, although many diets achieve effective immediate weight loss, none has emerged as an effective tool for maintaining healthy weight [For more detailed information,see Well-Connected Report 53 Weight and Diet]
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Diabetes Diet
The following are some basic
approaches to dieting depending on the severity of the weight problem: The simplest but still difficult approach to weight loss is reducing calories and exercising at least 150 minutes a week, assuming there are no health problems to preclude it Behavioral and mental changes in eating habits and attitudes about food and weight are also essential to weight management For people who are very overweight and cannot lose weight using lifestyle measures, a number of effective weight-loss medications are available And for those with severe obesity, surgical procedures are proving to be very beneficial Some Tips for Losing Weight The following offer some general suggestions for dieters: Start with realistic goals Diet failure is extremely common and the odds of significant weight loss are low, particularly in people with the highest weights People who are able to restrict calories, engage in an exercise program, and obtain help in making behavioral changes can expect to lose between 5 and 10 of their current body weight–which is generally all that is needed to achieve meaningful health changes Certainly, the unwholesome and distorted image of a super-thin female shape should not be
anyones goal Anorexia, obesitys alter ego, is far less common but is the other side of this dysfunctional aspect of our culture Maintain a regular exercise program, assuming no precluding health problems Choose one that is enjoyable Check with a physician about any health considerations [For more information, see Well-Connected Report 29 Exercise] Do not use hunger pangs as cues to eat A stomach that has been stretched by large meals will continue to signal hunger for large amounts of food until its size reduces over time with smaller meals Be honest about how much you eat and start by recording all calories in writing Studies suggest that when many people report their own calories intake they significantly underestimate their consumption of high-calorie and over-estimate the low-calorie foods People who do not carefully note everything they eat tend to take in excessive calories when they believe they are dieting Observe weekend eating People tend to eat more on the weekends If it is difficult to monitor all meals during the week, it be may be useful to at least track eating habits during these days Once the pound are lost, strive to maintain the healthier weight Make daily,
even hourly, conscious decisions about eating and exercising activities Such thinking, in many cases, can become automatic and not painful Dont give up, even after repeated weight loss failure Most studies indicate that yo-yo dieting or weight cycling has no adverse psychological or physical effects Repeated dieting also does not impair the bodys ability to burn calories efficiently Weight loss, in any case, should not be the only or even the primary goal for people concerned about their health The success of weight reduction efforts should be evaluated according to improvements in chronic disease risk factors or symptoms and by the adoption of healthy lifestyle habits, not by just the number of pounds lost
Calorie Restriction
Calorie restriction has been the cornerstone of obesity treatment Restricting calories in such cases also appears to have beneficial effects on cholesterol levels, including reducing LDL and triglycerides and increasing HDL levels In fact, in a study of an African community, inhabitants had very-low-calorie diets and favorable cholesterol levels in spite of a relatively high intake of saturated fats The standard dietary recommendations for losing weight
are the following: As a rough rule of thumb, one pound of fat equals about 3,500 calories, so one could lose a pound a week by reducing daily caloric intake by about 500 calories a day Naturally, the more severe the daily calorie restriction, the faster the weight loss Very-low calorie diets have also been associated with better success, but extreme diets can have some serious health consequences [See Box Warning on Extreme Diets] To determine the daily calories requirements for specific individuals, multiply the number of pounds of ideal weight by 12 to 15 calories The number of calories per pound depends on gender, age, and activity levels For instance a 50-year old moderately active woman who wants to maintain a weight of 135 pounds and is mildly active might require only 12 calories per pound 1,620 calories a day A 25-year old female athlete who wants to maintain the same weight might require 25 calories per pound 2,025 calories a day Fat intake should be no more than 30 of total calories Most fats should be in the form of monounsaturated fats such as olive oil Saturated fats found in animal products should be avoided
Heart-Healthy Diets
Diet plays an important role in the
health of the heart There is no single diet that suits everyone, but at this time the Mediterranean diet appears to have the most favorable findings Of note, weight control, quitting smoking, and exercise are essential companions of any diet program [For detailed information, see Well-Connected Report 43 Heart Healthy Diet]
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Diabetes Diet
Mediterranean Diet
The Mediterranean diet is rich in heart-healthy fiber and nutrients, including omega-3 fatty acids and antioxidants Evidence now strongly indicates that this dietary approach may be the most important for protecting the heart and extending survival The diet recommends the following: A relatively high fat intake about 35 to 45 of daily calories, mostly in monounsaturated and polyunsaturated fats The Mediterranean diet is known for its use of olive oil, but the greatest benefits found in a major study of this diet appeared to be derived from the use of canola oil, which is rich in omega-3 fatty acids Olive oil, in fact, does not contain omega-3 fatty acids On the other hand, olive oil may have beneficial effects independent from those on lipids, such as improving insulin and blood glucose levels and reducing blood pressure
Daily glass or two of wine The same protein intake as the AHA, although fish is the primary source It avoids high-fat dairy and meat products In fact, one 2001 study suggested that fish-consumption, not wine, is the heart-protective ingredient in this diet Lower carbohydrate intake than AHA Emphasizes not only fresh fruits and vegetables, but also higher amounts of nuts, legumes, beans, and whole grains Foods seasoned with garlic, onions, and herbs
Therapeutic Lifestyle Changes TLC from the National Cholesterol Education Program
Guidelines in 2001 from the National Cholesterol Education Program include the following for preventing and managing high cholesterol levels in adults: Choose five or more servings of fresh fruits and vegetables and six or more servings of whole grains, legumes Soluble fiber is preferred from cereal grains, beans, peas, legumes, and many fruits and vegetables Fats can be up to 35 of daily calories, but no more than 7 should be from saturated fat People with high triglycerides or low HDL or both may need a higher fat intake Choose fats containing unsaturated fatty acids from vegetables, fish, legumes, and nuts Choose margarines containing sterols or
stanols eg, Benecol, Take Control Avoid trans fatty acids found in commercial products as much as possible Proteins choices should be limited in general to fat-free and low-fat milk products, fish, legumes, skinless poultry, and lean means Limit cholesterol intake to less than 200 mg per day Maintain healthy body weight and a healthy level of physical fitness
The Ornish Program and Severely Fat-Restricted Diets
The Ornish program limits saturated fats as much as possible, reduces total fat to 10, and increases carbohydrates to 75 of calories It is a very effective but demanding regimen: It excludes all oils and animal products except nonfat yogurt, nonfat milk, and egg whites Foods stressed are whole grains, legumes, and fresh fruits and vegetables People in the program exercise 90 minutes at least three times a week Stress reduction techniques are employed People do not smoke nor do they drink more than two ounces of alcohol per day Everyone on low fat diets should consume a wide variety of foods and take a multivitamin if appropriate
High-Protein Diets
High-protein diets, such as the Atkins and South Beach diets, are proving to be very effective in producing short-term
weight loss Because of their emphasis on fats and proteins, many experts are concerned about long-term health problems Still, significant studies are reporting benefits on cholesterol and blood sugar levels Centers that promote this approach argue that heart problems from obesity are due to insulin disturbances from sugar imbalances Therefore, they believe that restricting carbohydrates is the best approach for obesity–and especially for overweight people with diabetes More research is needed, however, to determine the long-term impact on health
The DASH Diet
The DASH diet Dietary Approaches to Stop Hypertension is proving to help lower blood pressure after eight weeks Restricting sodium improves results The diet appears to have antioxidant effects and may even prove to be a good diet for lowering LDL cholesterol levels–although the beneficial HDL levels also decline This diet is not only rich in important nutrients and fiber but also includes foods that contain far more electrolytes, potassium, calcium, and magnesium, than are found in the average American diet The dietary recommendations are as
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Diabetes Diet
follows: Avoid saturated fat although include calcium-rich
dairy products that are no- or low-fat When choosing fats, select monounsaturated oils, such as olive or canola oils One study reported a reduced need for anti-hypertension medication in people with a high intake of virgin olive oil, but not sunflower oil, a polyunsaturated fat Choose whole grains over white flour or pasta products Choose fresh fruits and vegetables every day In one 2002 study, people who increased their intake of fruits and vegetables experienced a drop in blood pressure after six months Many of these foods are rich in potassium, fiber, or both which may help lower blood pressure Include nuts, seeds, or legumes dried beans or peas daily Choose modest amounts of protein preferably fish, poultry, or soy products Soy in combination with fiber-rich foods or supplements may have specific benefits Oily fish may also be particularly beneficial They contain omega-3 fatty acids, which have been associated with heart and nerve protection [For more information, seeWell-Connected Report 14 High Blood Pressure]
Diabetic Exchange Lists
The objective of the exchange lists is to maintain the proper balance of carbohydrates, proteins, and fats throughout the day The exchange
lists can be obtained by calling or writing to the American Diabetes Association [See Resources] In developing a menu, patients must first establish with a doctor or dietitian their individual dietary requirements, particularly the optimal number of daily calories and the proportion of carbohydrates, fats, and protein The exchange lists should then be used to set up menus for each day that fulfill these requirements The following are some general rules: The diabetic exchanges are six different lists of foods grouped according to similar calorie, carbohydrate, protein, and fat content; these are starch/bread, meat, vegetables, fruit, milk, and fat A person is allowed a certain number of exchange choices from each food list per day The amount and type of these exchanges are based on a number of factors, including the daily exercise program, timing of insulin injections, and whether or not an individual needs to lose weight or reduce cholesterol or blood pressure levels Foods can be substituted for each other within an exchange list but not between lists even if they have the same calorie count In all lists except in the fruit list choices can be doubled or tripled to supply a
serving of certain foods For example 3 starch choices equal 15 cups of hot cereal or 3 meat choices equal a 3-ounce hamburger On the exchange lists, some foods are free These contain less than 20 calories per serving and can be eaten in any amount spread throughout the day unless a serving size is specified
Exchange List Categories
The following are the categories given on the exchange lists: Starches and Bread Each exchange under starches and bread contains about 15 grams of carbohydrates, 3 grams of protein, and a trace of fat for a total of 80 calories A general rule is that a half-cup of cooked cereal, grain, or pasta equals one exchange and one ounce of a bread product is one serving Meat and Cheese The exchange groups for meat and cheese are categorized by lean meat and low fat substitutes, medium-fat meat and substitutes, and high-fat meat and substitutes High fat exchanges should be used at a maximum of 3 times a week Fat should be removed before cooking Exchange sizes on the meat list are generally one ounce and based on cooked meats three oz of cooked meat equals 4 oz of raw meat Vegetables Exchanges for vegetables are 1/2 cup cooked, 1 cup raw, and 1/2 cup juice Each
group contains 5 grams of carbohydrates, 2 grams of protein, and between 2 to 3 grams of fiber Vegetables can be fresh or frozen; canned vegetables are less desirable because they are often high in sodium They should be steamed or microwaved without added fat Fruits and Sugar Sugars are now included within the total carbohydrate count in the exchange lists Sugars still should not be more than 10 of daily carbohydrates Each exchange contains about 15 grams of carbohydrates for a total of 60 calories Milk and Substitutes The milk and substitutes list is categorized by fat content similar to the meat list A milk exchange is usually one cup or 8 oz For those who are on weight-loss or low-cholesterol diets, the skim and very low-fat milk lists should be followed, and the whole milk group avoided Others should use the whole milk list very sparingly All people with diabetes should avoid artificially sweetened milks
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Diabetes Diet
Fats A fat exchange is usually 1 teaspoon but it may vary People, of course, should avoid saturated and trans fatty acids and choose polyunsaturated or monounsaturated fats instead
Number of Exchanges per Day for Various Calories Levels
Calories Starch/Bread
Meat Vegetable Fruit Milk Fat 1,200 5 4 2 3 2 3 1,500 8 5 3 3 2 3 1,800 10 7 3 3 2 3 2,000 11 8 4 3 2 4 2,200 13 8 4 3 2 5
Exercise
Sedentary habits, especially TV watching, are associated with significantly higher risks for obesity and type 2- diabetes Regular exercise, even of moderate intensity such as brisk walking, improves insulin sensitivity and may play a significant role in preventing type 2 diabetes–regardless of weight loss An important study reported a 58 lower risk for type 2 diabetes in adults who performed moderate exercise for as little as 25 hours a week In 2002, a well-conducted study on overweight adults confirmed previous research that reported beneficial changes in cholesterol and lipid levels, including lower LDL levels the so-called bad cholesterol, even when people performed low amounts of moderate or high intensity exercise eg, walking or jogging 12 miles a week However, more intense exercise is required to significantly change cholesterol levels, notably increasing HDL the so-called good cholesterol An example of such a program would be jogging about 20 miles a week Such benefits in the study occurred even with very modest weight loss, suggesting that
overweight people who have trouble losing pounds can still achieve considerable heart benefits by exercising Aerobic Exercises Aerobic exercise is proving to have significant and particular benefits for people with both type 1 and type 2 diabetes Regular aerobic exercise, even of moderate intensity, improves insulin sensitivity People with diabetes are at particular risk for heart disease, so the heart protective effects of aerobic exercise are very important for this patient population Moderate exercise, in fact, protects the heart in people with type 2 diabetes, even if they have no risk factors for heart disease other than diabetes itself In general, when exercising people with diabetes, should aim for a heart rate target of 55 to 75 of their maximum heart rate Strength Training Strength training, which increases muscle and reduces fat, may be particularly helpful for people with diabetes, but evidence is needed to confirm this Yoga One study reported that yoga helped patients with type 2 diabetes reduce their need for oral medicationsStudies have indicated that yoga and Tai Chi an ancient Chinese exercise involving slow relaxing movements may lower blood pressure almost as well
as moderate-intensity aerobic exercises Some Precautions for People with Diabetes Who Exercise The following are precautions for all people with diabetes, whether type 1 or 2: Because people with diabetes are at higher than average risk for heart disease, they should always check with their physicians before undertaking vigorous exercise For best and fastest results, frequent high-intensity not high-impact exercises are best for people who are cleared by their physicians For people who have been sedentary or have other medical problems, lower-intensity exercises are recommended using regimens designed with physicians Strenuous strength training or high-impact exercise is not recommended for people with uncontrolled diabetes Such exercises can strain weakened blood vessels in the eyes of patients with retinopathy High-impact exercise may also injure blood vessels in the feet Patients who are taking medications that lower blood glucose, particularly insulin, should take special precautions before embarking on a workout program Glucose levels swing dramatically during exercise; people with diabetes should monitor their levels carefully before, during, and after workouts Patients
should probably avoid exercise if glucose levels are above 300 mg/dl or under 100 mg/dl To avoid hypoglycemia, diabetics should inject insulin in sites away from the muscles they use the most during exercise They should also drink plenty of fluids Before exercising, they should also avoid alcohol, which increases the risk of hypoglycemia Insulin-dependent athletes may need to decrease insulin doses or take in more carbohydrates prior to exercise but may need to take an extra dose of insulin after exercise Stress hormones released during exercise may increase blood glucose levels; in non-diabetics insulin is released to control this The diabetic, therefore, needs
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Diabetes Diet
to test their blood sugar and take an extra dose as instructed by their diabetes healthcare provider Anyone with existing hypertension should discuss an exercise program with their physician Before starting to exercise, people with moderate to severe hypertension should lower their pressure and be able to control it with medications They should avoid caffeinated beverages, which increase heart rate, the workload of the heart, and blood pressure during physical activity Everyone, and especially people
with high blood pressure, should breath as normally as possible through each exercise Holding the breath increases blood pressure Good, protective footwear is essential to help avoid injuries and wounds in the feet [For more detailed information,see Well-Connected Report 29 Exercise]
Stress Reduction
Chronic stress has been associated with the development of insulin-resistance, a condition in which the body is unable to use insulin effectively to regulate glucose blood sugar Insulin-resistance is a primary factor in diabetes Stress can also exacerbate existing diabetes by impairing the patients ability to manage the disease effectively [For recommendations on stress reduction, seeWell-Connected Report 31 Stress]
Resources
wwwdiabetesorg — American Diabetes Association 800-232-3472 wwwniddknihgov — National Institute of Diabetes, Digestive, Kidney Diseases wwwjdfcurecom — Juvenile Diabetes Foundation 800-JDF-CURE wwwneinihgov — National Eye Health Education Program 800-869-2020 wwweatrightorg — American Dietetic Association wwwfdagov — US Food and Drug Administration 888-INFO-FDA wwwhealthviewdiabetescom — Software for managing diet and glucose control
wwwdiabetesincontrolcom — Informational site for professionals wwwchildrenwithdiabetescom — Children with Diabetes dietary page wwwsoyfoodscom — Soy website wwwmendosacom/gilistshtm — Glycemic index of a number of foods, including commercial cereals wwwslrhcorg/healthinfo/dietaryfiber — Lists of fiber-rich foods wwwgourmetconnectioncom/diabetic — Diabetic Gourmet Magazine Review Date: 12/31/2003 Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions Call 911 for all medical emergencies Links to other sites are provided for information only — they do not constitute endorsements of those other sites Copyright 2003 ADAM, Inc Any duplication or distribution of the information contained herein is strictly prohibited
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Source:healthandage.com
