At just 27 years old, Edwin (last name withheld) was recently shocked to learn that he has a chronic disease: type 2 diabetes. But to his doctors, this news didn't come as much of a surprise. The 5-foot-8 Hispanic man weighed 334 pounds in February, when he was diagnosed. Obesity, as well as the genetic tendencies within certain ethnic groups, are major factors in diabetes.
Other than taking Metaformin, the pill he was prescribed, Edwin was at a loss for ways to deal with his illness when a registered dietitian at Lutheran Family Health Centers in Brooklyn invited him to participate in a “diabetes makeover,” a 12-week program designed to help patients manage the disease through several lifestyle changes.
The greatest of those lifestyle changes is diet. Edwin worked with Sheila Gittens, a registered dietitian and diabetes program coordinator at Lutheran, to learn how to eat differently - including eating fresh vegetables such as broccoli, frequently replacing red meat with lean chicken breast and fish, and spreading his daily caloric intake over several meals, rather than the huge one he used to consume, usually in the evening.
“Since I started the program, I've lost 30 pounds,” Edwin said. “I've already noticed I have fewer aches and pains. It feels really good.”
“Diet and exercise should always be the first line of medication for diabetes,” Gittens said. “It's certainly the cheapest approach to a fast-growing problem.”
Diabetes has reached epidemic proportions in recent years, affecting more than 20 million Americans, or 7 percent of the population, last year. According to the American Diabetes Association, 90 percent to 95 percent of all cases of diabetes fall into the category of type 2 - formerly known as non-insulin-dependent diabetes mellitus or “adult-onset diabetes.”
While there are genetic factors for both type 1 - formerly known as “insulin dependent” or “juvenile onset” - and type 2 diabetes, the latter is also strongly associated with overweight and obesity. And type 2 is believed to be not only manageable, but largely preventable through diet and exercise. (For more information, go to www.diabetes.org/uedocuments/nationaldiabetesfactsheetrev.pdf.)
Further complicating matters, people with diabetes are at a higher risk for other major illnesses, including kidney disease, hypertension, cardiovascular disease and blindness.
“The more alarming part of this is that type 2 diabetes is occurring in younger and younger people,” said Dr. Michael Rosenbaum, associate professor of clinical pediatrics and clinical medicine at Columbia University College of Physicians & Surgeons. “In the coming years, we are going to see an epidemic of people in their 30s and 40s going blind, on dialysis, with cardiovascular disease and amputations. And the economic cost of this will be astounding.”
The root of the problem, Rosenbaum says, is a poor diet, high in processed foods, rich in sugar and “bad” fats. “Weight gain and obesity increase resistance to insulin,” he said.
Diet can have a huge impact on diabetes. “They've shown in clinical studies that if you catch it quickly enough, start eating right and lose weight, you can actually reverse diabetes,” said Cathy Nonas, a dietitian and diabetes educator at North General Hospital in Manhattan, who is also a spokeswoman for the American Dietetic Association.
So what is the right diet for people with type 2 diabetes? Here's an answer some might find surprising: “A person with diabetes doesn't have to be on a special diet,” said Karmeen Kulkarni, a dietitian and diabetes educator who is part of the American Diabetes Association's Volunteer Leadership. “The focus is on healthy eating, portion control and healthy food choices - whole grains, fresh vegetables, fresh fruit, lean protein and heart-healthy fats.”
“It's a misconception that people with diabetes have to eat so differently from everybody else,” Nonas said. “There's really nothing that you can't eat, in moderation, if you're diabetic,” including fruit, once considered a diabetic no-no, although eating fiber-filled whole fruit is preferable to drinking fruit juice. “The diabetes food guidelines are very similar to the regular USDA guidelines you'll find on the food pyramid,” Nonas added.
For those who find such guidelines difficult to follow carefully, Nonas offered this simple short-cut: “Visualize a dinner plate. Imagine that half of the plate is filled with vegetables, while the other half is divided fairly evenly between high-fiber starch, like beans or whole grains, and lean protein, such as chicken, fish or pork.”
That's a very rough gauge, and Kulkarni says the right amount is different for everyone. “We tell most patients to make between 10 and 15 percent of their meals lean protein, and to divide the balance between carbohydrates and fat, based on their individual assessments,” she explained. “It's really encouraged that if you have diabetes, you find a dietitian who can help you figure out exactly what you need.”
It's important to pay careful attention not only to the proportions of certain types of foods you eat, but to the specific kinds of carbohydrates, proteins, vegetables and fats you take in as well.
åSkipping meals can add to problems
It's not just what you eat that affects diabetes, it's also
how you eat - like when and how often.
For example, many type 2 diabetics skip meals, and
typically eat just one huge meal a day. “One of the easiest ways to gain weight is to skip meals,” said Sheila Gittens,
a registered dietitian and program coordinator at Lutheran Family Health Centers in Brooklyn. “When you skip meals, you send a message to your brain that you haven't eaten. Later, you respond to that message by eating too much at once, and then you can't possibly burn all the sugar and calories you've taken in in one sitting.”
Gittens also recommends keeping your meals on schedule. “Eat at regular times,” she said. “You don't have to live
by the clock, but eat your meals within consistent time periods, around the same times each day, to keep your blood sugar stable.”
Many in the field recommend that patients have three small snacks each day, in addition to their three meals. Josephine Connolly-Schoonen, assistant professor of
family medicine at Stony Brook University Hospital, says be careful what you choose, to keep blood sugar from spiking. “If the snacks are foods containing healthy fats, let's say plain, all natural nuts, that would be OK if they
do not bump up the calorie level too high and the patient can still maintain a healthy weight,” she said. “Certain foods with lots of fiber, like beans, would not have much of an effect on most patients' blood sugars if eaten in moderate amounts. For example, beans mixed with olive oil, red onion and diced celery/bell pepper, should be OK in about a 1/3 cup serving.”
If you're dying for a “real” dessert, Gittens said, first go for an after-dinner walk. “If you want to indulge occasionally and say, have ice cream after dinner,” she said, “it's much better to do that after you've had a healthy walk to lower your blood sugar.”
- Special to Newsday
The greatest of those lifestyle changes is diet. Edwin worked with Sheila Gittens, a registered dietitian and diabetes program coordinator at Lutheran, to learn how to eat differently - including eating fresh vegetables such as broccoli, frequently replacing red meat with lean chicken breast and fish, and spreading his daily caloric intake over several meals, rather than the huge one he used to consume, usually in the evening.
“Since I started the program, I've lost 30 pounds,” Edwin said. “I've already noticed I have fewer aches and pains. It feels really good.”
“Diet and exercise should always be the first line of medication for diabetes,” Gittens said. “It's certainly the cheapest approach to a fast-growing problem.”
Diabetes has reached epidemic proportions in recent years, affecting more than 20 million Americans, or 7 percent of the population, last year. According to the American Diabetes Association, 90 percent to 95 percent of all cases of diabetes fall into the category of type 2 - formerly known as non-insulin-dependent diabetes mellitus or “adult-onset diabetes.”
While there are genetic factors for both type 1 - formerly known as “insulin dependent” or “juvenile onset” - and type 2 diabetes, the latter is also strongly associated with overweight and obesity. And type 2 is believed to be not only manageable, but largely preventable through diet and exercise. (For more information, go to www.diabetes.org/uedocuments/nationaldiabetesfactsheetrev.pdf.)
Further complicating matters, people with diabetes are at a higher risk for other major illnesses, including kidney disease, hypertension, cardiovascular disease and blindness.
“The more alarming part of this is that type 2 diabetes is occurring in younger and younger people,” said Dr. Michael Rosenbaum, associate professor of clinical pediatrics and clinical medicine at Columbia University College of Physicians & Surgeons. “In the coming years, we are going to see an epidemic of people in their 30s and 40s going blind, on dialysis, with cardiovascular disease and amputations. And the economic cost of this will be astounding.”
The root of the problem, Rosenbaum says, is a poor diet, high in processed foods, rich in sugar and “bad” fats. “Weight gain and obesity increase resistance to insulin,” he said.
Diet can have a huge impact on diabetes. “They've shown in clinical studies that if you catch it quickly enough, start eating right and lose weight, you can actually reverse diabetes,” said Cathy Nonas, a dietitian and diabetes educator at North General Hospital in Manhattan, who is also a spokeswoman for the American Dietetic Association.
So what is the right diet for people with type 2 diabetes? Here's an answer some might find surprising: “A person with diabetes doesn't have to be on a special diet,” said Karmeen Kulkarni, a dietitian and diabetes educator who is part of the American Diabetes Association's Volunteer Leadership. “The focus is on healthy eating, portion control and healthy food choices - whole grains, fresh vegetables, fresh fruit, lean protein and heart-healthy fats.”
“It's a misconception that people with diabetes have to eat so differently from everybody else,” Nonas said. “There's really nothing that you can't eat, in moderation, if you're diabetic,” including fruit, once considered a diabetic no-no, although eating fiber-filled whole fruit is preferable to drinking fruit juice. “The diabetes food guidelines are very similar to the regular USDA guidelines you'll find on the food pyramid,” Nonas added.
For those who find such guidelines difficult to follow carefully, Nonas offered this simple short-cut: “Visualize a dinner plate. Imagine that half of the plate is filled with vegetables, while the other half is divided fairly evenly between high-fiber starch, like beans or whole grains, and lean protein, such as chicken, fish or pork.”
That's a very rough gauge, and Kulkarni says the right amount is different for everyone. “We tell most patients to make between 10 and 15 percent of their meals lean protein, and to divide the balance between carbohydrates and fat, based on their individual assessments,” she explained. “It's really encouraged that if you have diabetes, you find a dietitian who can help you figure out exactly what you need.”
It's important to pay careful attention not only to the proportions of certain types of foods you eat, but to the specific kinds of carbohydrates, proteins, vegetables and fats you take in as well.
åSkipping meals can add to problems
It's not just what you eat that affects diabetes, it's also
how you eat - like when and how often.
For example, many type 2 diabetics skip meals, and
typically eat just one huge meal a day. “One of the easiest ways to gain weight is to skip meals,” said Sheila Gittens,
a registered dietitian and program coordinator at Lutheran Family Health Centers in Brooklyn. “When you skip meals, you send a message to your brain that you haven't eaten. Later, you respond to that message by eating too much at once, and then you can't possibly burn all the sugar and calories you've taken in in one sitting.”
Gittens also recommends keeping your meals on schedule. “Eat at regular times,” she said. “You don't have to live
by the clock, but eat your meals within consistent time periods, around the same times each day, to keep your blood sugar stable.”
Many in the field recommend that patients have three small snacks each day, in addition to their three meals. Josephine Connolly-Schoonen, assistant professor of
family medicine at Stony Brook University Hospital, says be careful what you choose, to keep blood sugar from spiking. “If the snacks are foods containing healthy fats, let's say plain, all natural nuts, that would be OK if they
do not bump up the calorie level too high and the patient can still maintain a healthy weight,” she said. “Certain foods with lots of fiber, like beans, would not have much of an effect on most patients' blood sugars if eaten in moderate amounts. For example, beans mixed with olive oil, red onion and diced celery/bell pepper, should be OK in about a 1/3 cup serving.”
If you're dying for a “real” dessert, Gittens said, first go for an after-dinner walk. “If you want to indulge occasionally and say, have ice cream after dinner,” she said, “it's much better to do that after you've had a healthy walk to lower your blood sugar.”
- Special to Newsday
