Diabetes and Diet

Taking control now means fewer problems down the line.

Maryanne McDevitt, an active grandmother and weaver in Wayne, maintained her trim figure without dieting, worked out five times a week and had no family history of diabetes. So when she learned at age 63 that she had Type 2 diabetes, she was “flabbergasted.”

“I felt it was totally unfair,” she recalls. “Diabetes only strikes people who let their weight get out of control or who don’t exercise.”

Now McDevitt knows differently.

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Type 2—or adult onset—diabetes generally affects people over 50, interfering with the body’s ability to use insulin. Once food is digested, sugar enters the bloodstream but, due to insulin resistance or deficiency, isn’t absorbed by the cells. It stays in the blood and causes serious health problems, including infections, gum disease, wounds that won’t heal, miscarriages, birth defects, high blood pressure, nerve damage, vision problems, and kidney and heart disease.

McDevitt was lucky. Her diabetes was caught early during an annual screening. But an estimated 6.2 million Americans have the disease and don’t even know it.

Apparently, McDevitt’s lack of symptoms isn’t an exception—it’s the norm. “It usually takes eight to 10 years to be diagnosed because there are no warning signs,” says Lankenau Hospital endocrinologist Rita El-Hajj. “By that time, complications can set in.”

Symptoms may include frequent thirst and urination, blurred vision, fatigue, slow-healing sores, infections, dry skin, and tingling or numbness in the hands or feet. The American Diabetes Association (ADA) recommends an annual glucose blood test for anyone over 45. Testing should start at age 30 if you have a family history of diabetes, are overweight, gave birth to babies weighing more than 9 pounds or have experienced gestational diabetes. African Americans, Hispanics and Native Americans are especially at risk.

In treating Type 2 diabetes, data has shown that diet and exercise work better than medication. “A diabetic diet is a healthy diet,” El-Hajj says. “We set attainable goals for patients, encouraging them to stay away from trans fats and junk food, eat more fruits and vegetables, and get regular exercise.”

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Research shows that people with early-stage diabetes who exercise 30 minutes a day, five days a week, and follow a healthy diet can reduce their risk of developing full-blown diabetes by 58 percent—and without medication.

McDevitt balked when her doctor suggested medication. “I wanted to see if I could get my blood sugar under control on my own,” she says.

McDevitt recalled the advice of Dr. George Steele, her former physician at Penn Medicine at Radnor. He suggested the Mediterranean Hunter-Gatherer Diet in his book, The Best Way to Stay Healthy—one rich in healthy oils, green, leafy vegetables and protein, and low in fat and sugar. “He recommended the diet to me three years earlier, when I first began to have problems with high blood pressure,” she says. “But I wasn’t ready because it meant giving up all grains, as well as potatoes, rice, pasta, dairy products and certain fruits.”

But a diabetes diagnosis motivated McDevitt to give it a try. “I concentrated on the good stuff I could have—a steak with a green salad and a glass of wine, with fresh raspberries for dessert,” she says.

Still, McDevitt admits she has cravings for buttered bagels, chocolate chip cookies and ice cream. And the drastic change in her diet has been rough on her family. “My daughters can’t imagine life without pizza,” she says.

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Even so, McDevitt’s current physician is delighted with her progress. “I’ve had three fantastic checkups with my blood sugar levels well within normal range, and my cholesterol level is excellent,” she says.

Until recently, it was believed that the best way to lower the risk of heart disease for diabetics was to maintain “normal” blood sugar levels. But a new study of more than 10,000 middle-aged people with Type 2 diabetes shows that lowering their blood sugar actually increased the risk of death by heart disease.

Still, it’s important to note that the diabetics in the study were taking four or five insulin shots a day, using insulin pumps or taking oral medications. So they weren’t controlling their blood sugar by diet and exercise alone.

And when it comes to diet, Cathy Chinol, a nutritional educator with Lankenau Hospital’s diabetes management program, doesn’t advocate cutting out all carbohydrates. “The key is moderation,” she says. “I provide meal plans to diabetes patients on an individual basis, taking into consideration each person’s work schedule, family life and preferences. We establish a reasonable weight goal and work with patients to maintain healthy sugar and cholesterol levels.”

The program’s 10-hour course includes individual consultations with a diabetes nurse specialist or nutritionist, and ongoing support groups. “Because many patients have other health issues such as obesity, heart disease, high blood pressure or high cholesterol, there is no one-size-fits-all diet plan,” Chinol admits. “The goal is to formulate a diet and exercise plan that helps each individual attain optimum blood sugar, blood pressure, cholesterol and weight levels.”

According to the ADA, people with diabetes can and do eat sugar, but the rule is moderation. As for diet soda, it isn’t your friend. A recent study shows that drinking as little as one can per day increases the risk of diabetes and heart disease by 34 percent.

Although there have been no rigorous studies, certain dietary supplements are thought to have a positive effect on controlling blood sugar. These include alpha-lipoic acid (ALA), chromium, coenzyme Q10, magnesium, Omega-3 fatty acids and garlic.

ALA is found in all the things your mother always told you to eat—liver, spinach, broccoli, potatoes. Chromium is a trace mineral found in meats, fish, coffee, tea, and whole-wheat and rye bread. Coenzyme Q10 acts as an antioxidant and is found in meats and seafood. Green, leafy vegetables, nuts, seeds and some whole grains contain magnesium.

Load up on Omega-3 fatty acids by eating salmon, sardines, tuna, walnuts, wheat germ, and canola and soybean oils. Countries where lots of garlic is consumed claim the lowest incidence of many diseases—from diabetes to cancer—supposedly due to a chemical called allicin.

While the FDA hasn’t put its stamp of approval on any of the above as a “cure” for diabetes, a diet rich in these foods is highly recommended by the ADA.

To learn more, visit the ADA’s website at diabetes.org.

Diabetes Risk Factors
Family history. If you have a parent, brother or sister with Type 2 diabetes, you may have a greater risk of developing the disease.
Ethnic background. African Americans, Hispanic Americans, Native Americans and Asian Americans are at increased risk.
Obesity. Body fat—especially around the waist—increases insulin resistance and the risk of developing diabetes.
Lack of physical activity. The more you exercise, the better your cells use insulin.
Age. Risk increases as you get older.

Healthy Food Choices
Limiting the body’s intake of sugar and fat is good for everyone. So if you’re worried about how your diet will affect your family’s meals, just remember that it will make them healthier, too. The American Diabetes Association recommends the following:

• East plenty of non-starchy vegetables such as spinach, carrots, broccoli and green beans.
• Choose whole grains over processed, white-flour products (brown rice rather than white rice, whole-wheat pasta instead of regular).
• Include dried beans and lentils in your meals.
• Eat fish three times a week.
• Opt for lean meats, and remove the skin from chicken and turkey.
• Go for nonfat dairy products, and choose water over fruit juices, soda (diet or otherwise) and sweetened iced tea.
• Use liquid oils for cooking instead of butter or margarine, and avoid all trans fats and saturated fats.
• Watch portion size. Be especially careful of the amount you put on your plate at salad bars, buffets and parties.

Consult the ADA’s New Family Cookbook for People with Diabetes for recipes using recommended foods. To learn more, visit diabetes.org.

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