I attended the recent 70th Scientific Sessions of the American Diabetes Association in Orlando, Florida. While I mainly attended symposia involving medication treatment updates (I didn’t attend any nutrition symposia), it was still sobering to see that the incidence of diabetes is still on the rise. For instance more than 4300 new cases of diabetes are diagnosed each day (3 new cases every minute, 24:7) and that 18,000 diabetes patients lose their vision every year. Or that 200 diabetes patients die every day due to the complications of diabetes. And while diabetes previously was thought of as a disease of inactivity and excess (supersizing meals and waistlines), some of the populations on the rise come from countries where people aren’t that large… like Asia. And though the National Cholesterol Education Program (NCEP) defines a metabolic waist as 35 inches or larger for women and 40 inches or larger for men, Asian diabetes patients often aren’t anywhere near that size range. In fact there are studies that show Asians tend to hide truncal obesity within smaller waistlines. In other words, we may not look fat on the outside but we are fat on the inside.
What is Diabetes?
Diabetes is usually divided into two main forms; Type 1 and Type 2. In Type 1, an autoimmune reaction destroys the beta cells in the pancreas so that no insulin is produced and the patient needs to inject insulin to maintain life. It usually occurs very early in life so it was previously termed Juvenile Diabetes. However this autoimmune reaction can also occur later in life (ie Mary Tyler Moore) so Type 1 also occurs in adults. In Type 2 diabetes, a combination of declining insulin production and insulin resistance eventually leads to the frank diagnosis of diabetes.
Nutrition
If you do have diabetes or are living with someone who has diabetes, it would be a great idea to see a nutritionist or dietician to learn about portion sizes and which foods should be limited. There are only three macronutrients; carbohydrate, fat and protein and severely restricting intake of one would invariably lead to over consuming another. And the rationale is not to starve yourself but rather portion control foods that might spike your blood sugar.
Carbohydrates
These are the starches or fillers in our diets. The rice, noodles, potatoes, breads and cereals. However they also come in the form of sugars and sweets including fruits and other starchy vegetables like corn, peas and beans. The general recommendation is limiting your starches to 3 servings per meal or 10 to 12 servings per day. One serving is a 15gm portion. For rice and pastas, this is roughly 1/3 of a cup. Therefore a cup of ramen noodles or a cup of rice would be your limit for that one meal. You also want to get as much of your carbohydrates as whole grain if possible; whole wheat bread instead of white bread, brown rice instead of white rice, whole grain pasta instead of processed semolina. And even if it’s whole grain, you still need to adhere to the allotted portion controls. Why whole grain if I can’t eat more? Well, whole grain also includes carbohydrates that we don’t absorb, ie the fiber. This fiber takes additional time to digest so that it doesn’t spike our blood sugar upon digestion so it’s easier for our natural insulin to help clear those glucose molecules released into our blood stream (try avoiding car that starts rolling down a hill versus a car coming at you at 90 mph).
Protein
Trying to avoid all carbohydrates and consuming all protein and fat isn’t a good idea either. For starters, patients with diabetes are at an increased risk for nephropathy or a decline in kidney function. Any excess protein that’s not incorporated into muscle tissue is transformed into energy. However before this occurs, the nitrogen on all amino acids must be removed and excreted by the kidney. This makes the kidney work a little harder, a kidney already under some stress due to the diabetes. The general recommendation is to limit protein to 3 to 4 ounces per serving (roughly the size of a deck of cards) and to look for leaner proteins if possible. Like poultry breasts with visible fat removed or leaner cuts of beef or pork with the visible fats removed. Or vegetable proteins like beans or soy protein.
Fat
Since patients with diabetes are at a higher risk for developing heart disease (even if their blood sugars are well controlled), limiting saturated fat takes on a greater urgency. Look for fat free dairy products (or reduced fat diary products at the very least) in place of regular dairy products. Limit animal fats to a minimal though fatty fish 3 times per week is fine and remove any visible fat from beef, pork and poultry whenever possible. Substitute vegetable oils and nuts as the main fat source in place of animal fats. Just remember that good fats don’t mean they’re all-you-can-eat fats. A Mercedes may be a safer vehicle than a Jeep but driving a Mercedes recklessly at 90 mph can still kill you. And since fat is twice as concentrated in calories as carbohydrates and protein, unrestricted consumption of even good fats will add inches to your waistline… which unfortunately reduces your sensitivity to insulin.
Lifestyle Measures
Even if you adhere to a healthy diet, you still need to adopt other lifestyle measures to optimize control of your diabetes. Like getting regular exercise and loosing a little weight. Both will help to improve your insulin sensitivity and reduce your chances for developing diabetes. In fact the Diabetes Prevention Program showed that subjects with pre-diabetes who exercised for 150 minutes each week and lost 7% of their body were 58% less likely to develop diabetes each year (subjects who were 60 years and older were 71% less likely to develop diabetes). Whatever glucose that circulates in your bloodstream needs assistance to enter the cells. This assistance comes in the form on insulin. Think of insulin as the key that unlocks the cell door. A new key can unlock the cell door with ease. With diabetes, it’s like carrying an old key that must be jiggled in the lock to unlock that door. That’s what happens when you lose insulin sensitivity… it doesn’t unlock those cell doors as readily and since blood sugar can’t enter the cells, it starts to increase. Getting regular exercise and loosing weight is like getting a new set of keys.
Not Just for Diabetes
Though I prefaced this article as guidelines for patients with diabetes, they can (and should) be applied to everyone regardless of your current medical history. We should all try to partake in a healthier diet that’s higher in whole grains, leaner proteins and healthier fats. Remember my motto that Cholesterol & Calories Don’t Count on Holidays, Vacations and your Birthday. Well, on other days they do count and even for a fully vested worker, those “free” days only account for about 5 or 6 weeks which means moderation for those other 46 or 47 weeks. And holidays and vacations only apply to those still working, there are no vacations or holidays for the retired, just your birthday.
Diabetes is usually divided into two main forms; Type 1 and Type 2. In Type 1, an autoimmune reaction destroys the beta cells in the pancreas so that no insulin is produced and the patient needs to inject insulin to maintain life. It usually occurs very early in life so it was previously termed Juvenile Diabetes. However this autoimmune reaction can also occur later in life (ie Mary Tyler Moore) so Type 1 also occurs in adults. In Type 2 diabetes, a combination of declining insulin production and insulin resistance eventually leads to the frank diagnosis of diabetes.
Nutrition
If you do have diabetes or are living with someone who has diabetes, it would be a great idea to see a nutritionist or dietician to learn about portion sizes and which foods should be limited. There are only three macronutrients; carbohydrate, fat and protein and severely restricting intake of one would invariably lead to over consuming another. And the rationale is not to starve yourself but rather portion control foods that might spike your blood sugar.
Carbohydrates
These are the starches or fillers in our diets. The rice, noodles, potatoes, breads and cereals. However they also come in the form of sugars and sweets including fruits and other starchy vegetables like corn, peas and beans. The general recommendation is limiting your starches to 3 servings per meal or 10 to 12 servings per day. One serving is a 15gm portion. For rice and pastas, this is roughly 1/3 of a cup. Therefore a cup of ramen noodles or a cup of rice would be your limit for that one meal. You also want to get as much of your carbohydrates as whole grain if possible; whole wheat bread instead of white bread, brown rice instead of white rice, whole grain pasta instead of processed semolina. And even if it’s whole grain, you still need to adhere to the allotted portion controls. Why whole grain if I can’t eat more? Well, whole grain also includes carbohydrates that we don’t absorb, ie the fiber. This fiber takes additional time to digest so that it doesn’t spike our blood sugar upon digestion so it’s easier for our natural insulin to help clear those glucose molecules released into our blood stream (try avoiding car that starts rolling down a hill versus a car coming at you at 90 mph).
Protein
Trying to avoid all carbohydrates and consuming all protein and fat isn’t a good idea either. For starters, patients with diabetes are at an increased risk for nephropathy or a decline in kidney function. Any excess protein that’s not incorporated into muscle tissue is transformed into energy. However before this occurs, the nitrogen on all amino acids must be removed and excreted by the kidney. This makes the kidney work a little harder, a kidney already under some stress due to the diabetes. The general recommendation is to limit protein to 3 to 4 ounces per serving (roughly the size of a deck of cards) and to look for leaner proteins if possible. Like poultry breasts with visible fat removed or leaner cuts of beef or pork with the visible fats removed. Or vegetable proteins like beans or soy protein.
Fat
Since patients with diabetes are at a higher risk for developing heart disease (even if their blood sugars are well controlled), limiting saturated fat takes on a greater urgency. Look for fat free dairy products (or reduced fat diary products at the very least) in place of regular dairy products. Limit animal fats to a minimal though fatty fish 3 times per week is fine and remove any visible fat from beef, pork and poultry whenever possible. Substitute vegetable oils and nuts as the main fat source in place of animal fats. Just remember that good fats don’t mean they’re all-you-can-eat fats. A Mercedes may be a safer vehicle than a Jeep but driving a Mercedes recklessly at 90 mph can still kill you. And since fat is twice as concentrated in calories as carbohydrates and protein, unrestricted consumption of even good fats will add inches to your waistline… which unfortunately reduces your sensitivity to insulin.
Lifestyle Measures
Even if you adhere to a healthy diet, you still need to adopt other lifestyle measures to optimize control of your diabetes. Like getting regular exercise and loosing a little weight. Both will help to improve your insulin sensitivity and reduce your chances for developing diabetes. In fact the Diabetes Prevention Program showed that subjects with pre-diabetes who exercised for 150 minutes each week and lost 7% of their body were 58% less likely to develop diabetes each year (subjects who were 60 years and older were 71% less likely to develop diabetes). Whatever glucose that circulates in your bloodstream needs assistance to enter the cells. This assistance comes in the form on insulin. Think of insulin as the key that unlocks the cell door. A new key can unlock the cell door with ease. With diabetes, it’s like carrying an old key that must be jiggled in the lock to unlock that door. That’s what happens when you lose insulin sensitivity… it doesn’t unlock those cell doors as readily and since blood sugar can’t enter the cells, it starts to increase. Getting regular exercise and loosing weight is like getting a new set of keys.
Not Just for Diabetes
Though I prefaced this article as guidelines for patients with diabetes, they can (and should) be applied to everyone regardless of your current medical history. We should all try to partake in a healthier diet that’s higher in whole grains, leaner proteins and healthier fats. Remember my motto that Cholesterol & Calories Don’t Count on Holidays, Vacations and your Birthday. Well, on other days they do count and even for a fully vested worker, those “free” days only account for about 5 or 6 weeks which means moderation for those other 46 or 47 weeks. And holidays and vacations only apply to those still working, there are no vacations or holidays for the retired, just your birthday.
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