Diabetes Type 2 Nutrition Management and Prevention

Your diet should contain plenty of fiber and little fat. You should derive about 60% of calories from complex carbohydrates; preferably high fiber and complex (unrefined) carbs such as whole grains, fruits, vegetables and beans. You should also get about 30% of calories from fat (preferably monounsaturated olive oil or canola oil) and 15% of your calories from protein.

High fat, high calorie diets increase your risk for obesity - the number one risk factor for Type 2 diabetes. Refined carbohydrates that are rapidly absorbed, such as white bread, white rice, pasta, fruit juices and soda cause you blood sugar to shoot up, putting excessive stress on you pancreas to produce more insulin. If you are overweight and eating a poor diet, eventually your cells may become less sensitive to the effects of insulin (which helps them to use energy) and your pancreas will work less efficiently. Complex carbohydrates high in fiber, by contrast, are absorbed into your system more slowly, causing a gradual rise in blood sugar and a decreased need for insulin.

Fiber

You need at least 30-35 grams per day. Start your day with fruit, whole grain cereals and breads, skim milk dairy or soy food. Lunch on legume based soups and salads, whole grain breads with lean meat or fish, low fat cheese or crunchy veggies, fruits and vegetables. Dine on whole grain pastas, brown rice, beans, white meat poultry or fish. Insoluble fiber (whole grain bread, brown rice, bran cereal, crunchy fruits and vegetables) slow the breakdown of carbohydrate to glucose. Soluble fiber (oats, barley, apples and beans) lower blood sugar and bind with bile thus preventing cholesterol from being absorbed into your blood stream during digestion.

Glycemic Index

The glycemic index ranks foods on how they affect your blood sugar by measuring how much your blood sugar increases 2-3 hours after eating. Carbohydrates increase your blood sugar. The more refined the carbs, the higher the index. Recent studies show that diabetics who keep their blood sugar under tight control avoid the complications of the disease. The recommendation is a high fiber diet that is low in saturated fat. (For more on foods and the glycemic index, see The Glycemic Index Diet on this website.)

Soy Protein

Soy Protein may be especially helpful for diabetics in the prevention of nephropathy (kidney disease), a major contributor to death in this population. The reasons: 1)Amino acid composition, 2)Phytochemical content, 3)Lipid lowering and 4)Antioxidant effect. Try tofu, tempeh, soymilk, textured vegetable protein, etc.(See Protein on this website).

How you eat is as important as what you eat. To slow the glucose rush, eat fruits or refined carbohydrates as part of your meal. Don't wolf your food and never skip a meal! These habits throw your blood sugar out of whack and worsen hypoglycemia (low blood sugar), often a precursor to diabetes.

Heart Disease And Small Vessel Disease

Diabetics are at high risk for heart disease for many reasons - One is that cells do not respond to normal amounts of the hormone insulin so the body compensates by cranking out more, damaging heart vessels.

Excess sugar damages blood vessels that carry oxygen and nutrient to the nerves. Nerve damage and decreased nutrient flow cause tissue damage in extremities - e.g. feet and legs.

Blood Pressure

If you have high blood pressure, management is a MUST. High blood pressure inflames and injures arteries and veins. It constricts blood flow and creates an environment that lets plaque build up. This increases your risk for heart disease and cerebral hemorrhage. Low sodium foods, skim milk (calcium), fruits and vegetables (high potassium foods) seem to work in concert to lower blood pressure.

Micronutrients

Stabilized rice bran (SRB) - phytochemical that reduces harmful cholesterol levels and raises HDLs (good cholesterol). Stabilizes blood sugars.

Alpha Lipoic Acid- helps unlock energy from food and directs calories away from fat production while stabilizing blood sugar. Alpha lipoic acid recycles the breakdown products of vitamins C and E to restore them to their full antioxidant power. Used for many years to improve nerve health, balance the sugar in blood and to stop retinal degeneration.

Chromium- this mineral helps to make your cells more receptive to insulin. Chromium rich foods are peas, prunes, Brewer's yeast, chicken breast, peanut butter, shredded wheat, and potatoes. Make sure you are getting 120-200mcg from your daily diet and MVI/mineral supplement.

Magnesium- Harvard researchers have found that the more magnesium in your diet the less likely you are to get diabetes. Good sources are whole grain cereals, spinach, black-eyed peas and beans. Your need 350mcg from your diet and daily supplement. If your diet is low in this mineral you may be resistant to insulin.

Beta-carotene (pumpkin, sweet potatoes, spinach, melon, etc.) and Lycopene (tomatoes, watermelon, red grapefruit) may be helpful in management. Research shows low blood levels of these nutrients are found in NIDDM. Get your beta-carotene from food, not supplements.

Metamucil

Soluble fiber known as psyllium found in Metamucil can lower cholesterol and lower blood sugar. Mixing 1 tsp. of psyllium in 1 cup of water before each meal can drop blood sugar levels from 210 to 140mg/dl. Enough to eliminate the need for medication in some people with Type 2 diabetes.

Metamucil helps if: 1)Your diabetes is newly diagnosed, 2) You have mildly elevated blood sugar <240mg/dl> and 3) You do not get 35g/fiber from food every day.

Don'T Exceed 40g/Day, Drink Lots Of Fluids

CAUTION: The use of psyllium in insulin dependent diabetes is contraindication as it decreases the absorption of insulin. There have also been reports of allergic reaction. Before embarking on any new OTC remedy always consult with you private healthcare provider.

Source: Journal of Diabetes and Its Complications Sept-Oct 1998

Some Fats Are Better Than Others

Monounsaturated fats are the healthiest for your body. Nuts such asalmonds, cashews, hazelnuts, and peanuts contain this type of fat, asdoes avocado. Choose olive, canola or peanut oil for cooking. Avoidsaturated fats like butter, lard and meat fat, bacon, and shortening.There are lower-fat versions of saturated fats like sour cream, yogurtand cream cheese. A healthy diet includes less than 30% of caloriesfrom fat, with less than 10% of these from saturated fat. Remember allfats are 9 calories per gram. If you are Type 2, weight management isthe number one treatment for blood sugar control.

Omega 3 fatty acids in fish and flaxseed oil help to improve kidneyfunction in diabetics. They are also being evaluated for their abilityto lower blood glucose in diabetics. GLA (gamma linolenic acid) mayalso be of benefit. Most think you can take both of these supplementstogether safely. They work almost like a natural prednisone.

Cutting Fat

Stir-fry foods that have been marinated in tinyamounts of oil and lots of seasonings. Choose nonfat or low-fatselections, but stick to the correct portion size. Avoid fried foods -bake, broil, or roast vegetables and meat instead. (See Trimmingthe Fat on this website).

Artificial Sweeteners

Artificial sweeteners are safe for everyone except pregnant or breastfeeding women (who should not use saccharin). People with phenylketonuria should not use aspartame. Calorie-free sweeteners like aspartame (Equal), saccharin (Sweet & Low), and acesulfame-K (Sweet One) won't increase your blood glucose level. The sugar alcohols (xylitol, mannitol, and sorbitol) have some calories and do slightly increase blood glucose level. Eating too much of any of these can cause gas and diarrhea. Look for Stevia on the market (available in health food stores) and Splenda coming out soon. Both can be used in place of sugar for baking, cup for cup and will maintain sweetness. see more about Sugar Substitutes

Exercise

People who exercise and eat well are less likely to get diabetes. Those that have the disease and exercise regularly have an easier time managing their diabetes while living longer. A Harvard study shows that brisk walking for one hour a day and/or any other type of leisure activity of moderate intensity reduces the risk of Type 2 diabetes by 46%, compared to those who exercised the least. Physical activity improves insulin sensitivity, in addition to helping reduce body weight. EXCESS WEIGHT is the trigger that causes a sugar imbalance to show itself. If you are 20% over your desirable body weight, you become at risk for adult onset DM.

The Bottom Line

If you are overweight, lose it! The number one cause of Type 2 diabetes is obesity. Weight loss can reverse it!

Limit fat, avoid saturated and trans fat. Use monounsaturated fat and omega 3 exclusively.

Avoid sugar and refined carbohydrates, concentrate on whole grains. Foods like whole wheat bread and brown rice can actually slow down the absorption of sugars in food and help you manage your diabetes. You need 25-35 grams of fiber (found in whole foods like these) every day.

Eat a variety of colored vegetables and fruits on a daily basis.

Exercise, Exercise, Exercise!!!

Donna Tinnerello MS, RD, CD/N
Updated June 2000

Donna Tinnerello MS, RD, CD/N is registered dietitian with more than 10 years experience in HIV and nutrition. She works in lower Manhattan at Cabrini Medical Center, the community and in private practice.. Her subspecialties are cardiovascular, renal, gastrointestinal disease, diabetes and weight loss. Donna is available for private consultation by referral only.