Diabetes Diet?

The Sweet Truth about Diabetes?

What Kind of Diabetes Do You Have?

 Diabetes Diet

Anyone who has diabetes needs some diet plan. One 18-month study of people with type 2 diabetes found no difference between a high-carbohydrate/high-fiber diet, a low-fat diet, and a weight management diet; all groups, however, experienced lower glycolated hemoglobin levels and lower LDL cholesterol levels. There were no changes in HDL cholesterol or triglycerides. The researchers concluded that the positive benefits of the diets derived not from the specific regimens, but because the people in the study were attentive and focused. In other words, any diet works if patients work at it. Choosing a healthy diet and then making the effort are the primary requirements for successful control of blood glucose levels.

Several dietary methods are available for controlling blood sugar levels. The simplest method is to follow the Food Guide Pyramid, recommended by the government for everyone. Some experts believe this may be sufficient for many people with diabetes. More intricate dietary methods are available for control of blood sugar. They can be effective, but they are also complex and many patients become discouraged using them. The most common method for controlling blood sugar is the use of The Diabetic Exchange Lists, designed by the American Diabetic and American Dietetic Associations. More sophisticated methods include counting carbohydrate grams and adjusting them according to blood glucose levels and tabulating the total available glucose (TAG) derived from foods that are eaten. Counting calories is usually the basis for weight loss. If one of these methods 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. 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.

Weight control is an especially important part of the management of type 2 diabetes. Health benefits are highest with the first pounds lost, and losing only 10% of body weight can control progression of diabetes type 2. Weight loss can be gradual -- about one pound per week. The first step is to calculate the daily caloric need for maintaining a healthy weight. This is typically 12 to 15 calories for each pound of ideal body weight, but it varies depending on gender, age, and whether a person is active or sedentary. 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. Naturally, the more severe the daily calorie restriction, the faster the weight loss. Many dietitians recommend avoiding the scale during dieting; weighing oneself daily is self-defeating and even looking at the scale once a week may be discouraging.

Some studies suggest that replacing foods high in fats and sugars with low-fat complex carbohydrates (fruits, vegetables, and whole grains) may be more effective for weight control than calorie counting. In a one-year study, those on low-fat diets lost three times as much weight as those on a standard low-calorie diets. Very low-fat diets however (15% or less of daily calories) may increase triglycerides and reduce HDL cholesterol levels -- risk factors for heart disease. Many people who reduce their fat intake may also not consume enough of the basic nutrients, including vitamins A and E, folic acid, calcium, iron and zinc, and they often increase their intake of carbohydrates. People on low fat diets should consume a high variety of foods and take a multivitamin if appropriate. Simply switching to low-fat or skimmed milk may help people achieve the recommended dietary goal of 30% or fewer calories from fat and also help provide calcium. Some dietary fat is essential; such fats should be derived from non-tropical plant oils and fish. All healthy diets should also be high in fiber, which studies are reporting to be an important weight loss-factor.

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 extra food is needed too often to offset low blood sugar levels.

Up to one third of young women with type 1 diabetes have eating disorders that prompt them to underdose insulin to lose weighta very hazardous practice. Healthy eating habits along with good insulin control are essential in managing this complex disease.

The food guide pyramid contains the U.S. Department of Agriculture's general nutritional guidelines, but it has some problems. Some nutritional experts have recommended modifying it to adapt to the so-called Mediterranean diet. A recent study of heart attack patients found that those on the Mediterranean diet had a 76% lower risk of for major adverse cardiovascular events, including subsequent heart attacks, unstable angina, and stroke compared to those on a normal diet. Although the study does not constitute proof for the superiority of the Mediterranean diet, it does lend additional support to that possibility. Research indicates that it is not a single food but the spectrum of foods in this diet that has the benefits. The table below indicates the differences. Of some concern with the Mediterranean diet are added calories from the high intake of olive oil, reduced iron levels, and possible lack of calcium from fewer dairy products. Experts recommend that those who choose the Mediterranean diet should use only olive oil (no margarine or butter even on bread) to avoid excess fat. They should cook in iron pans and eat foods that contain iron and those rich in vitamin C, which boosts iron intake. They might need a calcium supplement. The recommendation of wine may be problematic for some people with diabetes and for anyone who is pregnant or abuses alcohol. In addition, all people with diabetes who have indications of kidney damage should restrict protein below the intake of the general population.

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. 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 the American Diabetes Association.

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. 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. The exchange lists should then be used to set up menus for each day that fulfill these requirements. 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 (e.g., 3 starch choices equal 1 1/2 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. 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 1/2 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. 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 (3 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.

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. 

Of the nutrients, carbohydrates have the greatest impact on blood sugar; fats and protein play only minor roles. If all other dietary methods fail, carbohydrate counting may be beneficial, but it is very complex and requires the collaboration of the physician. This technique relies on knowing the number of carbohydrate grams needed during the day, how to calculate them from food, and how rapidly different foods increase blood sugar levels. Multiple blood sugar readings are taken over a few days to determine the daily insulin requirements that will keep blood sugar balanced. A special calculation is then made for the number of carbohydrate grams that are covered by that daily insulin dose. The next step is to find the number of carbohydrates in foods, so that the right amount can be eaten to balance insulin. Commercial foods are labeled with carbohydrate amounts and for other foods, a number of books are available that provide the percentage of carbohydrates to the total nutrients.

In general, one gram of carbohydrate 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. Patients must choose not only the appropriate amount of carbohydrates needed to raise glucose levels, however, but they must also know which carbohydrate-containing foods will raise blood sugar within a desired time frame. For instance, foods with fast carbohydrates may be needed for sudden blood sugar drops shortly before a meal. Foods with slow carbohydrates may be useful for long periods of exercise

To determine fast and slow carbohydrates, a glycemic index of foods has been developed. The glycemic index is an indicator of how quickly specific foods affect blood sugar (see Table below). The index is based on a scale of 1 to 100. (For example, a glucose tablet equals 100 and has the most rapid effect; when taken for hypoglycemia can bring relief in 10 to 15 minutes.) Some studies have shown that diets high in foods that have a low glycemic index improve blood sugar, cholesterol, and triglyceride levels and may even reduce the risk for kidney disease. It should be noted that numbers attributed to each food are not additive. In other words, adding All Bran cereal with a glycemic index number of 49 to a banana with an index of 61 does not equal 110. Combinations with fats or protein, however, do change the impact on blood sugar. For instance, a baked potato has a very high index of 87, but when a fat such as butter is added to, the impact slows down and the glycemic index of the combined foods is considerably less than the potato alone.

No one should use the glycemic index as a complete dietary guide, since it does not provide nutritional guidelines for all foods. The Food Pyramid, Mediterranean Diet, or Exchange Lists should still serve as the basis for planning meals; the index is simply an indication of how the metabolism will respond to carbohydrates eaten. Low glycemic index numbers, however, are often associated with whole grains and other beneficial complex carbohydrates. One study tracked the glycemic indices for the traditional foods (corn, lima beans, white and yellow teparies, mesquite, and acorns) of the Pima Native American. The foods had a very low index and experts believe they had protected this genetically susceptible population from the high incidence of type 2 diabetes the Pimas are experiencing now, most likely from the Western diet.