Part two of the diabetes-themed blog from Mary Farmer, former NHS dietitian and Independent Living’s resident nutrition expert. In the first part, which you can read here, Mary explained a bit about the condition – what we understand about it, how it affects people, and what should be done to try and keep it under control. Here, she looks at diabetic diet advice.
Time to take diabetes really seriously
In spite of people not taking diabetes seriously and making silly jokes about it – parallels of which would be unheard of if the subject was cancer or heart disease – the last nutrition blog painted a grim picture of the effects of uncontrolled blood glucose levels. But there is hope, both in terms of prevention and of treatment.
For type 1 insulin-dependent diabetics, exciting new research promises the possibility of ending those pesky – but life-saving – injections by implanting insulin-producing cells. Further research is looking at improving the immune system to help these patients. It may be that the cells are just dormant. As type 1 diabetes is an autoimmune disease, both these approaches are enormous advances.
Weight control is the best treatment for type II diabetes
Avoiding being overweight or trying to lose weight sounds easy in theory but as many know in practice, it is far from it. If you have already been diagnosed with Type II diabetes, it is one of the best “treats” you can give yourself, and who knows? You may even be able to stop the prescribed medication, as your insulin levels get back to where they should be.
In short, the “diabetic diet” has undergone many changes, starting from the 1930s, when carbohydrate foods only were restricted (but not necessarily fat or protein). By the 1970s and 80s, it was advised that a greater proportion of the food intake should be of starchy foods, ideally of the “slow-release” variety, with a reduction of fat, as per the national “healthy eating” model.
People – including diabetics – got fatter, not least due to the “low fat” foods that tumbled into our supermarkets, claiming to be healthy, but which were usually laced with sugar, to make them more palatable. This was a bad plan. Now in the 2000s, it is realised that fats are not “all bad”, but carbohydrate is! What, you may ask, has been going on? Next time, we will attempt to unravel the story in more detail.
Avoid spikes in blood sugar levels
The basic premise is to try and avoid your blood sugar spiking by eating regularly and avoiding high sugar foods or drinks, especially on an empty stomach. These include fruit juices, drinks and smoothies.
More good habits:
• Have regular meals
• Try to cook from fresh ingredients – then you will know what is in your meals! Avoid processed foods.
• Limit your carbohydrate intake and choose those that release their energy slowly, such as porridge oats, brown rice, potatoes with skins, quinoa and wholemeal breads. Go to work on a bowl of (unsweetened!) porridge – or an egg!
• Have reasonable helpings of lean meat, dairy foods, eggs and fish. Try to have oily fish twice a week.
• Have a mixture of fats as spreads and in cooking – butter and olive oil, for example, unless advised otherwise
• Enjoy three to four pieces of fresh fruit and at least three servings of green leafy vegetables including pulses (peas, lentils and beans) a day.
• Limit your alcohol intake to two to three units a week. Be the one to drive home!
• Food treats or snacks for adults and children could be whole fresh fruit (including edible skin), nuts or unsweetened yoghurts. Start young children on a varied diet including vegetables and fruit.
• Don’t muddle up giving one’s family sweet treats with nurturing and love!
Is there any benefit to food supplements for diabetes management?
Some suggest that eating wild blueberries, strawberries and other fruits rich in polyphenols have significant overall health impacts, but so far, such experiments have been done only on laboratory rats. Others suggest that some herbal extracts and/or mineral supplements may help to control blood glucose, but Diabetes UK remains sceptical, suggesting that they have no clear benefits, unless there is an obvious deficiency.
Click the link here to read Diabetes UK statement on “Herbal and Food Supplements” (it will open in a new browser window)
Exercise has an important part to play
Exercise helps to normalise blood sugars. One of my patients monitored his blood glucose avidly. Seeing that it was higher than it should be, he went for a brisk walk. On his return, it had levelled out to normal.
Try to exercise at least 20 minutes each day. This does not mean having to run on a treadmill or sweating it out at the gym, but includes housework, running up and down stairs, cycling, walking – especially with a canine companion, jogging, horse-riding, swimming, dancing – whatever you enjoy, and can do regularly.
Start early in life! It is suggested that regular activity when young reduces the chance of developing type II diabetes. Being sedentary is not good! Mothers who develop diabetes during pregnancy (gestational diabetes) are more likely to have fatter children, due to metabolic changes in the unborn child. Further, Simon Stevens, CEO for the NHS, warns that many overweight parents do not spot that their children are following the same pattern as themselves. Misguided political correctness means that doctors and nurses are not pointing out this unwelcome home truth for fear of upsetting the family, but also because they are pushed for the necessary time for a suitable intervention.
Obesity is not taken seriously in Britain as in other European countries
After Hungary (no pun intended), Britain is the second fattest nation in Europe, with obesity being the cause of more hospital admissions than ever before.
Of more concern is the fact that, compared with the rest of Europe, we Brits don’t feel it is serious. Celebrating plus-size models doesn’t help. In Tonga, to be overweight is to be beautiful and also adds status. Type II diabetes on that island is rife. Up to 40% of the population is thought to have the disease, and life expectancy is falling.
NHS to become more engaged on weight management
I make no apologies for banging on about this: achieving and maintaining a healthy weight is the number one factor for both treatment and prevention. To help those who are “pre-diabetic”, the NHS is offering “motivational coaching” next year, which will include information on diet, weight loss and physical activity, both as groups and one-to-one sessions. As it has been shown that losing weight can actually reverse many cases of type II diabetes by returning insulin production to normal, this seems an eminently sensible idea. Even so, there appears to be an unfair “post-code lottery” in the UK, with unacceptable variations in diabetes care, not helped by patients themselves who miss their regular check-ups.
Overweight NHS staff are being offered Zumba classes to help them be better role models. Allied to this is a plea to hospitals to cut sales of unhealthy foods in their outlets and “practise what they preach”. New contracts are being negotiated.
Are we victims of our genes or bad habits?
Many overweight patients have always felt that there is a genetic connection, and recent research suggests that different genotypes do respond differently to foods – though not all experts are convinced.
The NHS is piloting a scheme in which patients’ DNA is tested and diet and exercise regimes are then tailor-made for the individual. Initial studies look promising, but it is the long-term results that will tell. Further research suggests that those who are overweight know which foods are healthy, but find it nigh impossible to choose them, due to the way in which their brains are hard-wired. But is this nature or nurture?
Maybe good gut bacteria help us control our weight
Other studies indicate that our “good” gut bacteria not only ensure gut health but may also “tell” us when we have eaten enough. But they need the right diet to flourish. One that is based on junk food won’t help! Indeed, it is thought that such a diet actually kills off more than a significant proportion of these jolly little microbes. Jamie Oliver is set to challenge those very food companies who sponsor the Olympics! Good chap!
Another study suggests that the increasing use of antibiotics may affect metabolism due to their indiscriminate bactericidal properties. Having said that, it is also possible that as-yet-undiagnosed diabetics may be getting more infections and thus, are prescribed more antibiotic medications. And what about the spores and bugs around us in the air, that we unwittingly breathe in? Could they also be challenging and upsetting the gut bacterial balance between good and evil? And could we, equally unwittingly, pass these on to family members? The Wellcome Trust Sanger Institute in Cambridge is looking at just this possibility and of ways to redress the balance.
Bariatric surgery can bring remission from diabetes for the most obese
For some seriously obese diabetics, a radical approach may be necessary: bariatric surgery could be offered to the one million of these who would benefit – and to the 100,000 a year who are likely to become suitable candidates. Drastic indeed! Research suggests that “long term remission” (from diabetes) can be achieved for many, at a cost of £6,000 per person – a mere drop in the NHS money-ocean compared with current expenditure for this condition.
Finally, these are the top tips to help reduce the risk of developing diabetes:
• Drinking three cups of coffee a day (without sugar!)
• Eating “live” yoghurt or other fermented products regularly – e.g. daily or alternate days
• Getting enough good quality sleep
• Eating hard cheese in moderation
• Eating a few walnuts two to three times a week
• Watching your weight – try to keep it within acceptable levels
• Stop watching food and cookery programmes on television!
• And … as everyone knows, an apple a day … Yes it DOES keep diabetes AND the doctor at bay!
Further reading and resources
You can read more of Mary Farmer’s nutrition blogs here
How to avoid diabetic amputations