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Friday, February 11, 2011

What Diabetes Can Do to Your Body


Healthy food can help prevent diabetes complications.

If you have diabetes, a healthy diet does more than keep your blood sugar under better control. A good diabetes dietcan also help prevent or delay the onset of complications such as nerve pain or heart disease.

Although some people talk about a "diabetes diet," there's really no such thing, experts say. The same healthy diet recommended for those without diabetes will help you if you have diabetes, too. You may need to then tailor the meal plan to your specific needs, such as lowering your cholesterol. But the general concepts of healthy eating are the same for you as for someone without diabetes.

Here, what you need to know about eating to feel better now -- and for years to come.

The Diabetes Diet Myth

"The diet that used to be termed a diabetes diet is now considered just a healthy diet for all Americans based on the healthy guidelines from the Department of Agriculture," says Ruth S. Pupo, RD, a registered dietitian and certified diabetes educator at the East Los Angeles Center for Diabetes at White Memorial Medical Center.

One slight difference when she counsels those with diabetes: "We might encourage them to be more cautious with concentrated sugars like juices, candy, cake," she says.

Diet plans for people with type 2 diabetes are also more individualized than in the past. Such diet plans follow goodnutrition, but also take into account the individual's specific dietary needs, says Angela Ginn-Meadow, RD, a registered dietitian and certified diabetes educator at the Joslin Diabetes Center, in Baltimore.

One person with diabetes may need to lower cholesterol. Another may need to lower high blood pressure.

"One diet [plan] is not going to work for everyone," she says.

Yet, all are based on the same general concepts proven effective for improving blood sugars and controlling diabetes. Eat a diet that is:

  • Lower in calories
  • Higher in complex carbohydrates found in vegetables, fruits, beans, and whole grain cereals
  • Lower in saturated fats like butter, cheese, and fatty meat
  • Higher in mono and polyunsaturated fat like olive oil or canola oil

Although experts disagree somewhat on the "ideal" meal plan details, they agree that spreading your carbohydrates over the day, or counting them carefully, are good ways to maintain blood glucose control.

Diet Plan Specifics for People With Diabetes

How much should you have of each type of food? The American Diabetes Association (ADA) suggests that people with diabetes eat mostly high-fiber complex carbs, limit protein to 20% of the total daily calories, and limit saturated fat to less than 7% of calories.

Experts from the Joslin Diabetes Center issued guidelines directed at those with type 2 diabetes who areoverweight or obese -- about 80% of those with type 2 diabetes. Those guidelines suggest fewer carbohydrates and a slight boost in protein.

  • About 40% of calories from carbohydrates
  • About 30% from protein
  • About 30% from fat

Fewer carbohydrates and slightly more protein helps people with type 2 diabetes drop unhealthy weight and control their diabetes, says Osama Hamdy, MD, PhD, medical director of the Obesity Clinic and Program, Joslin Diabetes Center, Boston.

"Any diet for a type 2 diabetic who is overweight should be a weight reduction diet," Hamdy says. Modest losses of a pound every one or two weeks, achieved by reducing daily calories by 250 to 500, is recommended for those who are overweight, he says.

Managing Your Carbohydrates

One goal of healthy eating is to stabilize blood sugar, and that's done by a "consistent carbohydrate" eating plan, says Pupo.

People with diabetes should take in about the same amount of carbohydrates with every meal. Total carbohydrates in your diet should be based on advice from your doctor.

Try to avoid having blood sugars spike up too high or down too low, she says. This happens with diets high in refined carbs or sugary drinks. Having consistent meals throughout the day is one way to manage blood sugar levels.

There are several ways to manage carbohydrates.

Carbohydrate Counting

Write down how many carbs you eat. The ADA suggests you start with 45 to 60 grams of carbs per meal. The consult with your doctor, and adjust your carbohydrates per meal based on blood sugar levels and your doctor’s advice.

To learn carb counting, you can read food labels or get a list from your doctor.

The Plate Method for Carbohydrates

The plate method is a simpler way to count carbs and control portion sizes. You visualize a line dividing your plate in half. Then divide one half into two quarters.

  • Fill the largest section -- half your plate -- with non-starchy vegetables such as spinach, carrots, or green beans.
  • Fill one of the two smaller sections -- a quarter of your plate -- with starchy foods such as whole grain breads, potato, or cooked cereal such as cream of wheat.
  • Fill the second smaller section - a quarter of your plate -- with meat or meat substitutes.

The Link Between Healthful Eating and Fewer Complications

Eating healthfully can help you control blood sugars and reduce the risks of complications of diabetes such as nerve pain (diabetic peripheral neuropathy),heart disease, and foot problems.

Does a Better Diet Really Make a Difference With Diabetes?

Weight loss, plus exercise, can make a difference in helping people with type 2 diabetes get their hemoglobin A1C -- the measure of average blood sugar levels -- to the goal of less than 7%, Hamdy has found.

He reported on results of a program at Joslin Diabetes Center called Why WAIT (Weight Achievement and Intensive Treatment), in which those with type 2 diabetes are encouraged to lose weight by following the Joslin guidelines for overweight patients.

In a report on 85 WAIT participants, he found that they reduced their initial weight by an average of 24 pounds after 12 weeks. About 82% of the participants reached the target A1C of less than 7%.

Their cholesterol levels improved significantly, too. And participants needed less diabetes medicine once they lost weight.


What is Stevia


Stevia rebaudiana is a shrub native to South America. Its leaves have been used there for centuries to sweeten beverages. It is also an approved food additive in other countries, including Japan, Brazil, and China.

In the U.S., stevia products were long sold as dietary supplements -- but not as a food additives or ingredients -- because of safety concerns. In 2008, the FDA stated that the use of a refined stevia preparation called Rebiana is "generally recognized as safe," and can be used as a food ingredient. Products include, Good & Sweet, PureVia, Reb A, SweetLeaf Stevia Sweetener, Sun Crystals (which combines stevia and sugar), and Truvia.



Fresh stevia leaves can be found at many farmers markets. The FDA now also allows certain refined stevia preparations to be used in food and drinks.

What does it taste like?

Stevia-based sweeteners have zero calories, yet are as much as 200 times sweeter than sucrose (table sugar). Some products may have a bitter taste.

Are stevia sweeteners artificial?

"I think that the FDA didn’t require good-enough testing," Michael F. Jacobson, PhD, executive director of the nonprofit Center for Science in the Public Interest (CSPI), says in an email to WebMD. "That said, [Rebiana] is probably safe.”

In April 2010, the European Food Safety Authority (EFSA) announced that studies showed no risk of toxicity from highly purified stevia sweeteners. The CSPI still argues that more testing of these products is warranted.

Can stevia sweeteners be used in baking?

Yes, they can. Many product web sites have conversion charts to help.

How does stevia compare with other sugar substitutes?

Here is an overview of various sugar substitutes, including stevia.

Aspartame

  • What is it: Two amino acids, aspartic acid and phenylalanine; and methanol. Brand names are Equal and NutraSweet.
  • How it's used: Equal tabletop sweetener, diet soft drinks such as Diet Coke and Diet Pepsi, some sugar-free desserts, including gelatin desserts, yogurt, and puddings.
  • Advantages: Tastes similar to sugar. Enhances sweet flavors, especially fruit flavors.
  • Drawbacks: Should not be consumed by people with phenylketonuria (PKU). Controversy continues about whether aspartame is linked to increased cancer rates. Government agencies say it is safe. A recent study from an Italian cancer institute found more lymphomas and leukemia in rats fed very large amounts of aspartame. The CSPI recommends avoiding it.

Saccharin

  • What is it: Benzoic sulfinide.
  • How it's used: Sweet'N Low tabletop sweetener, Tab diet cola, salad dressings, baked goods, canned fruit.
  • Advantages: Less expensive than other artificial sweeteners. Stable at high temperatures, so can be used for baking. Passes through the body unaltered.
  • Drawbacks: After studies in the early 1970s linked saccharin consumption to bladder cancer in rats, all food containing saccharin was required to carry a warning label. But studies in humans showed no consistent evidence that saccharin causes bladder cancer, according to the National Cancer Institute. The warning label is no longer required. The CSPI advises avoiding saccharin because of studies that link it to cancer in rodents.
  • cesulfame-K, or Ace-K

    • What is it? Acetoacetic acid and the mineral potassium.
    • How it's used: Usually in gums, confections, cough drops, and carbonated and alcoholic beverages, often in combination with another sweetener. Also sold as Sunett or Sweet One.
    • Advantages: Extends shelf life of diet drinks. Can be used for cooking and baking. Not metabolized or absorbed by the body.
    • Drawbacks: Government health agencies say it is safe. The CSPI advises avoiding it and has asked the FDA to require more tests. Can taste bitter on its own; better tasting when blended with other sweeteners.

    Sucralose

    • What is it? A sugar molecule chemically altered by replacing three hydroxyl groups with three atoms of chlorine.
    • How it's used: Splenda tabletop sweetener and baking products. Also in yogurt, fruit juices, ice cream, dairy products, some diet beverages, and flavored waters, sometimes combined with Ace-K.
    • Advantages: Consumer groups have not raised the safety concerns with sucralose that they have with other sweeteners. Can be used in baked goods more readily than other artificial sweeteners. No effect on blood sugar levels.
    • Drawbacks: Although better suited for baking than other artificial sweeteners, it's still not a perfect substitute for sugar.

    Neotame

    • What is it? A derivative of a combination of two amino acids: aspartic acid and phenylalanine.
    • How it's used: Sweetener and flavor enhancer for other ingredients, such as mint. In some store-brand juices and gums.
    • Advantages: More stable than aspartame, meaning a better fit for baked goods. Although it shares some ingredients with aspartame, neotame has not prompted the same safety concerns with consumer groups. It does not carry a warning label for people with PKU.
    • Drawbacks: Rarely used.

    Stevia

    • What is it: Extract from the stevia plant.
    • How it's used: Dietary supplement and tabletop sweetener.
    • Advantages: Less is more. Stevia is much sweeter than sugar, so less is needed. It is an option for people with diabetes as it does not affect blood sugar levels.
    • Drawbacks: Some extracts have a bitter taste. It is billed as "natural," but technically is processed.