Food Cures (31 page)

Early nerve damage may not cause any discomfort. Mild symptoms can include tingling or numbness, particularly in the feet. Over time, neuropathy progresses and may cause pain or large areas of numbness. Scientists estimate that about 26 percent of people with type 2 diabetes have painful neuropathy. If nerves die, muscles of the feet or hands can whither. As the nerve damage becomes more extensive, it can cause impotence, dizziness, gastrointestinal problems, and general weakness.

Because the feet are usually affected first, good foot care is critically important. You may overlook a blister, sore, or cut if that part of your foot is numb. If your foot becomes infected, it could eventually spread internally to the bone. In some cases, an infection can become so severe that it becomes necessary to amputate the limb.

The longer you have uncontrolled diabetes, the greater your risk of neuropathy, and the greater the potential damage. But, as with eye diseases and other complications, studies have shown that neuropathy can be delayed and yes, even prevented if you control blood glucose level strictly.

HOW FOOD AFFECTS DIABETES

Let’s talk about food on a grand scale for a minute. Regardless of whether you have prediabetes or diabetes, the best thing you can do for your health is to lose weight. I know, I know…that’s what your doctor said, right? But did she tell you that you don’t have to slim down to swimsuit shape to reap the benefits? Research has shown that losing even small amounts of weight—as little as 10 pounds over two years—can reduce the risk of developing diabetes by up to 30 percent. That’s a small amount of weight to lose for such a large return on the quality of your life! And if you add more lifestyle changes, you’ll reduce your risk even more. Among people with diabetes, weight loss improves insulin sensitivity and glycemic control, reduces triglycerides and LDL cholesterol, and lowers blood pressure. That is to say, losing a few pounds may very well save your life. (For more information on the basics of losing weight, see Weight Loss on Chapter 3.)

But healthy eating for diabetes prevention or control is about more than weight loss….

HIGH-QUALITY CARBOHYDRATES
VERSUS LOW-QUALITY CARBOHYDRATES

During digestion, carbohydrates break down to create glucose, which enters the blood stream, triggering a rise in insulin, which is necessary for the glucose to enter cells. In people with diabetes, this system is defective, so glucose stays in the blood. This is what you are checking when you test your blood sugar level.

You have no doubt heard about the concept of the
glycemic index
(GI). GI is a measure of how fast and how high a particular food will raise blood sugar. Foods with a high GI raise blood sugar faster and higher than foods with a low GI. It’s a controversial topic in nutrition because when it comes right down to it, GI values simply aren’t very user-friendly. One type of food can have many different GI values depending on ripeness (of a fruit or vegetable), method of preparation, and other factors. For example, a ripe banana has a higher GI than a green banana, and a baked potato has a different GI than a boiled potato. If you eat a high-GI food with a protein (and/or a food containing fat), the GI value goes down because protein and fat slow down the absorption of carbohydrate. Beyond that, a tomato grown in a North Carolina farm may have a different GI than a tomato grown in a Pennsylvania greenhouse. The myriad factors that influence GI values boggle the mind! There’s an easier way to achieve low-glycemic eating without feeling like every meal is an exercise in advanced mathematics.

If you’re looking for foods that raise blood sugar levels slowly and gently like rolling waves, choose high-quality carbohydrates (see list below) instead of low-quality carbs, and whenever possible, couple these carbs with protein and/or healthy fat. For example, eat brown rice and vegetables (high-quality carbs) together with grilled chicken or pork tenderloin (lean protein). High-quality carbs are full of vitamins, minerals, and fiber. They are found primarily in plant foods, including whole grain products, brown and wild rice, oats, vegetables, fruits and legumes. In addition, some of these high-quality carbs also contain soluble fiber, a component of plant cell walls. Soluble fiber slows the absorption of glucose from food in the stomach, which also helps keep blood sugar under control. Studies have shown that eating a diet rich in whole grains and high-fiber foods may reduce the risk of diabetes by between 35 and 42 percent.

Low-quality carbs, on the other hand, have much less nutritional value. They are made primarily of sugar, including sugar itself, candy, soft drinks, syrup, honey, jam and jelly, cakes, and most other foods we typically think of as sweets or desserts. Refined starches—the “white” carbs, such as white rice and white bread—are also low-quality carbohydrates because they act very much like sugars once you begin to digest them. You should also avoid drinking fruit juice—all fruit juice, even 100% pure fruit, fruit juice. Although these beverages certainly provide better nutrition than soft drinks, they’re concentrated in fruit sugar and raise blood sugars quickly. The same thing goes for dried fruit. Like fruit juice, dried fruit provides ample nutrition and fiber, but when the water content is removed from fresh fruit, the dried, dehydrated version becomes super concentrated in sugar and can cause a sharp rise in blood sugar. Clearly not worth the spike! Root vegetables—such as potatoes, carrots, beets, and turnips—have a higher glycemic index than other, non-root veggies, such as broccoli, peppers, and mushrooms. However, you can enjoy moderate amounts of root vegetables if you eat them with lean protein at meals (instead of eating them alone). For example, a balanced dinner might include grilled chicken, broccoli, and a small baked white or sweet potato topped with fat-free sour cream; lunch might include turkey breast in a whole wheat pita pocket with 1 cup crunchy baby carrots.

Your goal, then, is to choose high-quality carbohydrates whenever possible, and to limit or avoid most low-quality carbs.

MODERATE TOTAL CARBOHYDRATES, COUPLED WITH PROTEIN

If you stick with high-quality carbs, can you eat as much as you want? Unfortunately, NO. To best control your blood sugars, you have to
moderate
ALL carbs—even if they’re the best of the best carbohydrates. Your total carb intake should be limited to about 40 percent of your daily food intake. That’s why on my meal plan you’ll notice things like “half a baked white or sweet potato” or “reduced-calorie, whole wheat bread.” I’ve picked the best of the best carbs, but still had to limit the total amount.

To further slow or prevent a blood sugar rise, remember that, in general, carbs should be eaten together with high-quality protein. Some foods—such as lentils, beans, yogurts, milk, split peas, and soybeans—naturally contain both high-quality carbohydrate and lean protein. My food plan incorporates everything—moderate amounts of high-quality carbohydrate, coupled throughout the day with protein. If you like to have the plan laid out for you in detail, it’s all there; if you like to add your own flair to meals, use it as a reference guide.

HEALTHY FATS VERSUS SATURATED AND TRANS FATS

All fats are not created equal—some can decrease your risk of diabetes and complications, while others are downright dangerous. Let’s talk about the bad fats first.

Avoid Saturated Fats.
Saturated fats are found in animal-based foods, including meats, butter, whole-milk dairy products (including regular yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. Some studies have shown that eating a diet with lots of saturated fats can lead to insulin resistance, and may increase the risk of diabetes by up to 20 percent. In addition, many studies confirm that saturated fats increase the risk of heart disease. Because people with diabetes already have an increased risk of heart disease, eating these unhealthy fats will push your risk even higher. By making a few simple changes, you can dramatically reduce the amount of saturated fats in your diet:

• Avoid: butter, cream cheese, lard, sour cream, doughnuts, cake, cookies, chocolate bars, chocolate chips, ice cream, fried foods, pizza, cream- or cheese-based salad dressing, cheese sauce, cream sauce, animal shortening, high-fat meats (including hamburgers, bologna, pepperoni, sausage, bacon, salami, pastrami, spareribs, and hot dogs), high-fat cuts of beef and pork, whole-milk dairy products. If a food label lists palm oil, and the saturated fat content is more than 2 grams per serving, put the package back on the shelf.
  
• Choose: lean meat only (including skinless chicken and turkey, lean beef, lean pork), fish, reduced-fat or fat-free dairy products.
  
• Always remove skin from poultry.
  
• Prepare foods by baking, roasting, broiling, boiling, poaching, steaming, grilling, or stir-frying. No deep-fat frying.
  

Avoid Trans Fats.
Trans fats are worse than saturated fats for diabetes and its complications. Trans fats were developed in a laboratory to improve the shelf life of processed foods, and to turn oils solid. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, crackers, potato chips, snack foods, fried foods, and fast food that use or create
hydrogenated oils
. (Good news for consumers—all food labels must now list the amount of trans fats, right after the amount of saturated fats.) By substituting vegetable oil for trans fats, you may be able to reduce your risk of diabetes by about 40 percent, and you can reduce your risk of heart disease by 53 percent. Whether you already have diabetes or are working to prevent it, there is no amount of trans fats you can safely incorporate into your diet, so try to keep them as far from your plate as possible.

Choose Omega-3 and Monounsaturated Fatty Acids.
Polyunsaturated fatty acids (PUFAs) come in two varieties—omega-3 fatty acids and omega-6 fatty acids. Scientists believe that PUFAs have many beneficial effects, including improving insulin sensitivity by changing the composition of cell membranes and aiding in glucose metabolism. When it comes to food, omega-3 fats are the PUFAs you want to pay close attention to.

Studies have shown that omega-3s from fish oil may delay the development of glucose intolerance, but the effects are unclear when it comes people who already have diabetes. The studies are all over the place—some show worsening of glycemic control with increased intake of fish oil, others show improved insulin sensitivity, and yet others no benefit or harm at all. Because there is no clear consensus, if you have diabetes, I would not recommend taking fish oil supplements (unless instructed by your endocrinologist). However, food sources of omega-3s are a safe bet, especially if they replace other, more harmful fats in your diet. Omega-3s from food will definitely help reduce your risk of heart disease, so I highly recommended them for all my clients with diabetes.