by Robin Fedie, RD, CD
“You have diabetes” is a life-altering phrase that has been heard by 18.8 million people in the United States. Another seven million people have diabetes but haven’t been diagnosed with it yet. As a registered dietitian with over 30 years of experience in nutrition counseling, I have observed the emotional and physical effects of the diagnosis of a chronic illness. Type 2 diabetes accounts for 90-95% of all cases of diabetes in the United States. It usually begins as insulin resistance, meaning the body isn’t allowing insulin to function as it is meant to. Diabetes is a progressive disease and eventually the pancreas doesn’t put out insulin as it should, so the disease becomes two pronged with the insulin not working properly and not enough insulin being produced.
One of the leading causes of type 2 diabetes is obesity. Type 2 diabetes was once called adult onset diabetes because it was seen only in adults. With the current obesity epidemic we are now seeing type 2 diabetes in children. Diabetes consequences are many. It is the most common cause of kidney failure, nontraumatic amputations of the lower limbs, and new cases of blindness in adults in the U.S. It is also a major cause of heart disease and stroke.
Prediabetes is a condition characterized by blood sugar values higher than normal but not high enough for a diagnosis of diabetes. People with prediabetes are at high risk for developing diabetes and at risk for heart disease and stroke. Fortunately, research has shown that lifestyle changes in the form of weight loss (the benefits are seen at about a 7% weight loss) and increased physical activity (150 minutes per week) can prevent or delay the onset of type 2 diabetes. The same recommendations for meal planning for type 2 diabetes apply to prediabetes too.
Meal planning goals include controlling blood sugar and blood fat levels, blood pressure, respecting the personal and cultural preferences of the individual and preserving the enjoyment of eating. A registered dietitian can help you determine your food needs to meet your goals. A number of meal planning methods can be used to meet these goals. Methods include carbohydrate counting, the plate method, exchange system, and the glycemic index. Many individuals find carbohydrate counting to be very effective and often meal plans will call for 45-60 grams of carbohydrate per meal depending on the individual. The plate method of meal planning is another option for some. Research also continues on the use of the glycemic index of foods as another tool.
The glycemic index (GI) of foods measures how a carbohydrate-containing food raises glucose levels as compared to a reference food (glucose or white bread). Higher GI foods increase blood glucose more than medium or low GI foods. Using the GI for meal planning involves choosing foods with low or medium GI foods. It may be possible to balance out the intake of a high GI food by choosing low or medium GI foods. Low GI foods include dried beans and peas, non-starchy vegetables, some starchy vegetables, most fruits, whole grain breads, and cereals including barley, whole wheat, and rye bread and all bran cereals. Of note, some foods with very little nutritional value have a low GI and some foods that are high in nutrients have a high GI value, so it is important to remember to emphasize the higher nutrient foods most of the time. Meats and fats don’t have a glycemic index because they don’t contain any carbohydrate.
The glycemic index of a food can be affected by a number of factors. Fat and fiber tend to lower the GI of food. The longer a food is cooked or processed the higher the GI value will usually be, but this is not always the case. In addition, the ripeness and storage of a food can affect the GI value.
The GI is a reflection of the type of carbohydrate but does not take into account the total amount of carbohydrate in a food, so it is still important to watch portion sizes to keep blood glucose values and weight in check. The GI combined with carbohydrate counting may have an added benefit over carbohydrate counting alone and may be the tool some people need to tweak their meal planning with for improved blood sugar control. To see some of the examples of the glycemic index of foods, visit www.diabetes.org and type in glycemic index in the search box.
Type 2 diabetes is on the rise but can be prevented. If you are at risk, take steps now to decrease that risk. Those living with diabetes can improve their health by following a healthy diet and including regular physical activity in their daily routines. We would be a much healthier nation if everyone (not just those with diabetes) would follow the recommendations for more whole foods in the diet including fruits, vegetables, and whole grains, with moderate amounts of lean proteins, healthy fats, and low fat dairy products.
Robin is a Registered Dietitian (RD), a food and nutrition expert with 35+ years of experience providing individual and group nutrition counseling. Robin’s goals include the promotion of wellness through healthy food choices and physical activity and providing nutrition therapy for existing conditions. Robinleerd@yahoo.com, Ph: 715 559-6948, Fax: 715 723-0870, http://robinfedienutrition.com/.
Delightful Diabetic Snacks
For those of us who crave the flavor and sweetness of tantalizing appetizers, but need to limit our sugar intake, the healthy hors d’oeuvres listed below do more than deliver. With a variety of salads, salsas, spreads and skewers that can be found in today’s dietary cookbooks, it has never been easier to substitute sugary cravings for healthier, yet just as tasty ones. Filling and flavorful, the following recipes are sure to satisfy.
Citrus & Cilantro Black Bean Salsa Zesty and super healthy, this salsa is fiber-rich, low-fat, and high in protein. Ingredients: 1 can (15 ounces) black beans, drained 3 medium tomatoes, diced 2 tablespoons frozen orange juice concentrate 1/2 cup chopped cilantro salt Directions: 1. In a medium bowl, mix the beans, tomatoes, orange juice, and cilantro. Add salt to taste. Let the mixture stand for 30 minutes to allow the flavors to combine. Recipe provided from: Eat Up Slim Down Annual Recipes 2006
Peppery Humus with Cilantro This healthy snack is full of flavor and fiber. Made with roasted red peppers and chickpeas, a 1/2 cup serving of this savory spread packs in seven grams of fiber. Ingredients: 2 red bell peppers 4 large cloves garlic, unpeeled 1 can (15 1/2 ounces) chickpeas, rinsed and drained 2 tablespoons tahini 2 tablespoons lemon juice 1 tablespoon mild cayenne pepper sauce 1/4 cup chopped fresh cilantro assorted vegetable sticks, for dipping Directions: 1. Preheat the broiler. Place the peppers on a foil-lined baking sheet. Wrap the garlic in foil and place on the sheet. Broil the peppers 6” from the heat for 15 to 20 minutes, turning until charred on all sides. Broil the garlic for 15 minutes. Place the peppers in a sealed bag and let stand for 10 minutes. 2. Meanwhile, when it’s cool enough to handle, peel the garlic and finely chop in a food processor. When the peppers are cool enough to handle, peel, core, and seed them. (You should have 1 cup of roasted peppers.) Add the peppers, chickpeas, tahini, lemon juice, and pepper sauce to the processor and blend until smooth. Add the cilantro and process just until combined. For best flavor, store refrigerated for at least 4 hours or up to 3 days. Serve with vegetable sticks or use as a spread for wraps or sandwiches. Recipe provided from: Prevention’s the Sugar Solution Cookbook