Advice - DIABETES: ARE YOU AT RISK ?
Over the past decade, an increasing number of my clients, when discussing their medical history, have told me that they have diabetes. As a nutritional therapist, I can't diagnose or treat diabetes -- however, if someone is under the care of a registered dietitian or specialist nurse practitioner, they may come to me for advice about a digestive complaint, or for motivational support if they're trying to lose weight.
Talking to the right health professional to manage diabetes, which includes making changes to your diet, is essential so that blood glucose levels are stabilised. If the condition is not identified and managed properly, it can lead to serious problems, including stroke and blindness. There are steps you can take to reduce your likelihood of getting type 2 diabetes, and managing your diet is certainly one of them.
Understanding the condition
This lifelong condition occurs when your body can't produce enough of the hormone insulin, or the insulin it does produce is not used properly. Insulin is needed for cells to take in glucose from the blood and convert it into energy.
When blood glucose levels rise consistently (known as high blood sugar levels), we may feel tired and lose weight unintentionally. This is because we can't access the glucose for energy, as the insulin is unable to deliver the glucose to our cells. High levels of glucose in the blood for long periods of time can damage blood vessels and nerves, which may lead to kidney disease, heart attack and even limb amputation.
So... is sugar the problem?
In the past few months, the debate about sugar has hit the headlines. Experts have warned about 'sugar addiction' and called for reductions in the amount of sugar added to processed foods. So is this why we're seeing a rise in cases of type 2 diabetes?
It's not as simple as that, but excess sugar in your diet is stored as fat, and being overweight may, over time, reduce your sensitivity to insulin and increase the risk of developing type 2 diabetes. This also makes you more at risk of heart disease. (Type 1 diabetes, on the other hand, is triggered when the body's immune system attacks the cells that produce insulin, and is thought to have no connection to the sugar you've eaten -- although you still must manage your insulin and blood sugar levels.)
Blood sugar refers to the amount of glucose in the blood -- as well as getting glucose from the foods we eat, it's also formed and stored inside the body. There are many factors influencing blood sugar -- what you eat, stress, amount of exercise, medications, etc. That's why it's too simplistic to blame sugar in food for type 2 diabetes.
High levels of blood sugar can be harmful even if you don't have diabetes.
Not only does it cause a rise in insulin and the stress hormone cortisol, it promotes oxidative stress and inflammation. These processes occur in the body anyway, but when repeatedly stimulated they can, over time, cause damage -- for example, hardening of the arteries, which can cause circulatory and cardiovascular problems.
So, although diabetics don't need to avoid sugar altogether, they -- like the rest of us -- should stick to a low-sugar diet. This means managing your intake of carbohydrate foods -- following a low-GI (Glycaemic Index) diet can help because it lets you maintain control of foods that are broken down into sugar by the body. This is of course a huge challenge, as so many foods contain high levels of sugar.
The less processed food you eat and the more you cook from scratch, the easier it is to control your diet. Not only will you keep your dentist happy, but you'll be reducing your risk of obesity, high blood pressure, some cancers, fatty liver disease, chronic fatigue, food cravings, depression and even mood swings. So what's to lose? Well, potentially, any extra pounds that have stubbornly refused to shift.
Spot the symptoms and cut your risk
Type 1 or Type 2 -- what's the difference?
* Accounts for about 10% of cases.
* Caused by the body not producing
insulin, because the immune system
attacks the cells that produce it.
* Not related to lifestyle or weight.
* Typically occurs in the under-40s and in childhood.
* Is a condition in its own right -- not simply a milder version of type 1.
* Accounts for the vast majority of cases.
* Is due to the body not producing enough insulin, or insulin not working properly.
* Key factors include diet and lifestyle, including being overweight and not taking enough exercise.
* Typically occurs later in life, but cases are now being diagnosed at a younger age.
Symptoms to look out for
* Frequent need to go to the loo -- especially at night.
* Increased thirst.
* Tiredness and poor energy levels.
* Blurred vision.
* Slow healing of cuts and wounds.
* Regular outbreaks of thrush.
* Frequent urinary or skin infections.
* Unexplained weight loss.
Risk factors for type 2 diabetes
* Are you over 40?
* Are you overweight? Waist
measurement is a factor: 311AaAaAeA AaAaAeAn2in/ 80cm for women and 37in/94cm men are the red flags.
* Do you have a close family member with the condition?
* What's your ethnic background?
Type 2 diabetes is more prevalent in South Asian, black African and African-Caribbean communities.
Still not sure where sugar lurks?
Sugar doesn't just refer to the white stuff you add to your tea or coffee (and if you do, it's time to cut back). When you buy packaged food (including savoury foods), check the 'Carbohydrates (of which sugars)' figure on the nutrition label. Your Reference Intake (RI) -- that's the maximum amount of sugar per day -- is 90g.
Here's a quick guide to help you spot those high-sugar products:
Over 22g of total sugars per 100g -- HIGH 5g or less of total sugars per 100g -- LOW
For more information, visit nhs.uk/livewell/goodfood/ pages/sugars.aspx
Steps to prevent type 2 diabetes
THE PRIORITY: LOSE WEIGHT... Shedding just 5-10% of your body weight will help lower blood glucose levels and reduce your risk of developing type 2 diabetes.
...AND CHOOSE A HEALTHIER LIFESTYLE Aim for 21AaAaAeA AaAaAeAn2 hours of acti each week -- walking is fine. Many of my clients find a pedometer is a great motivational tool. And if you smoke, there's no better advice than to stop.
ADAPT YOUR DIET Follow a low-GI (Glycaemic Index) diet to maintain blood sugar levels and keep fat, salt and sugar levels down. Low-GI foods include carbs that are slow to break down once you've eaten them, so the glucose they contain is released slowly and steadily into your bloodstream. Good choices include granary, wholemeal and rye bread; wholemeal pasta; beans; and pulses.
Avoid high-GI foods such as white refined products -- these include white pasta and bread, cornflakes and sugary drinks. They break down quickly, causing a rapid rise in blood sugar.
REDUCE YOUR INTAKE OF:
* Processed and red meats Not more than 70g per day.
* Fats Keep saturated fat down. Choose low-fat dairy and leaner meats.
* Fried foods Instead grill, bake, steam or poach food.
* Salty foods and products with added salt Choose low-salt options and don't add salt at the table.
* High GI-food and sugary drinks These cause blood sugar spikes.
Make healthier choices
* Eat at least three portions of whole grains, as studies suggest they have a protective effect. Opt for wholegrain and rye bread, oats, quinoa and brown rice.
* Aim for at least five portions of fruit and veg (and preferably more), and make one or more a serving of green leafy veg like spinach,
kale and cabbage.
* Eat three servings of low-fat dairy foods -- ideally look for unsweetened versions.
* Use oils that contain healthy unsaturated fats (such as nut oils) in dressings.
* Eat at least one portion of oily fish a week -- the healthy polyunsaturates improve insulin sensitivity and reduce cholesterol levels.
* Choose lean protein in the form of poultry, fish and plant sources like soya, beans and pulses.
* Instead of salt, add flavour with herbs, spices and citrus (try a squeeze of lemon or lime, or finely grate the zest).
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