Stop Diabetes With Diet
Nancy Bennett, MS, RD, CDEThe number of Americans with diabetes, or with pre-diabetes, is staggering. There are currently 20.8 million persons with diabetes, 18.7 of which have Type 2 diabetes. The National Institute of Health estimates there are another 54 million Americans with pre-diabetes, defined by impaired fasting glucose (IFG) or impaired glucose tolerance (IGT). Some 20 to 34% of those with IFG will go on to develop Type 2 diabetes in 5 to 6 years; those with both IFG and IGT have a 38 to 65% chance of developing diabetes in the same time interval.
The above organization paints a dire picture for the health of future generations in this country. They predict that one third of all those born in the year 2000 will develop diabetes in their lifetime. As diabetes is the leading cause of blindness, amputations and kidney failure, it is imperative that health promoting interventions begin early and continue throughout their patient’s lifetime if untold levels of suffering are be averted.
As this threat to America’s public health is fueled by the obesity epidemic, these interventions need to be directed at stemming the tidal wave of obesity. Eighty percent of Type 2 diabetes is caused by obesity and, according to the National Health and Nutrition Survey 2003-2004, currently one third of Americans are obese and another one-third are overweight.
Though these facts are dire, there is a sliver of hope on the horizon. Researchers have shown that small losses in weight, coupled with activity, can reverse these escalating trends in diabetes and profoundly impact the future of America’s health.
The Diabetes Prevention Trial (DPP) published in 2001, demonstrated that a loss of 7 to 10 percent body weight, and an increase of 150 minutes of weekly activity, decrease the risk for developing diabetes by 58%. The Finnish Diabetes Prevention Program duplicated these results and found that the lifestyle intervention programs can produce lasting results. Those who received lifestyle intervention were shown to have maintained a 58% lower risk for developing diabetes four years after the study interval.
Researchers at the University of Colorado Health Sciences Center analyzed the DPP results and the relative contributions of changes in diet, physical activity and weight loss to the reduction in diabetes incidence. They found that weight loss was most strongly associated with lower diabetes incidence compared to diet and/or physical activity. On average, there was a 16% reduction in diabetes risk per kilogram weight loss (Hamman 2006).
Though this research is indeed promising in averting this looming epidemic, losing weight and maintaining that loss, is no easy matter. Simply eating fewer calories than one burn is easier said than done. Many a health professional has struggled right along side of their patients in this arena.
It might be helpful to focus interventions on those behaviors that lead to leanness. After all, the above studies focus on lifestyle interventions, not dietary restrictions; and, to this author’s knowledge, no one ever successfully “thought” their way to leanness, though their actions have lead them there.
Therefore, focusing interventions on those key, simple, action steps that lead to leanness is helpful in directing our patients’ efforts to lose weight and maintain a leaner weight.
One very realistic and practical approach to helping our patients lower their calorie intake and lose weight is to give them specific examples on how small substitutions in food choices can lead to large losses of weight over time. For example, sprinkling a tablespoon of toasted almonds on sautéed green beans instead of a one tablespoon of melted butter saves seventy calories a day. Not only does this daily action step translate into a seven pound weight loss per year, it lowers the patient’s saturated fat intake as well. As many of these clients are at a higher risk for heart disease, these small tips can help them translate the message "eat less saturated fat" into realistic, practical action steps they can do on a consistent basis. In other words, the behavior becomes a lifestyle change rather than a "diet". The side bar lists other practical substitutions for common food choices that help to lower calories, refined carbohydrate and saturated fat intake.
America is the land of plenty and our growing waistlines are the consequence of eating large portions of foods. Feeling satiated with smaller portions is a challenge for many. Fortunately, there are some food choices that have been proven to promote the feeling of fullness while lowering the caloric density of the meal.
Barbara Rolls, a professor of nutrition at Penn State University, has shown that those who begin meals with salads and/or broth based soups eat fewer calories per meal, and, more importantly, they do not compensate by eating more later on in the day. Suggesting soup is a well-received message for those who complain that they can not feel full with smaller portions of food.
Another action step that promotes satiety with smaller portions is to choose foods that require chewing, like fruits and vegetables. Though research tells us it takes twenty minutes for gastric hormones to signal satiety in the brain, most find eating slowly a difficult behavior to develop. Choosing foods that demand a lot of chewing aids in slowing down the speed in which people eat. Suggesting whole grain breads for sandwiches at lunch and apples for dessert (in lieu of softer foods like sandwich rolls and raisins), not only help boost satiety, but your patient’s soluble fiber intake as well. Soluble fiber from whole grains, fruits and vegetables slows gastric emptying which promotes satiety. Soluble fiber has also been shown to flatten post prandial glucose curves, lower insulin levels and decrease low density lipoproteins.
Another behavior that promotes satiety with meals is the inclusion of lean protein with every meal or snack. Protein and fat delay gastric emptying and gives meals or snacks “staying power”. One such food perfect for quick meals on the go are walnuts and dry-roasted edamame. These foods are also good sources of omega three fatty acids which have been shown to reduce chronic inflammation. However, though these foods are delicious and healthy choices, they can be a concentrated source of calories. Experience has shown that handing patients a ¼ cup container can help them limit their portions to a level that does not interfere with weight loss efforts.
Finally, encourage your patients to surround themselves with healthy foods. Those who are hungry will eat foods that are available. As we live in a sea of fast food chains and convenience markets filled with high fat, high-fructose containing foods; suggest they carry some healthy snacks with them to work or school. Set them up for success by suggesting a few of the snack and meal ideas in the sidebar.
Last, but not least, promote activity. Simply adding two thousand steps a day can lead to a ten pound weight loss in a year. A pedometer is an inexpensive tool in helping them monitor and increase their activity levels. Increased activity not only helps patients burn more calories, it also helps decrease the insulin resistance which is at the very core of this disease.
Health professionals have a pivotal role in shaping the health of future generations. We have an opportunity to share how simple, realistic action steps can help people lose weight and lower their risk of developing diabetes. If we share our perception of diabetes as preventable, we will begin to help our patients live in the solution and perhaps stem the tide of this wretched disease.
"Let history be the final judge of our deeds". J.F.K.
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