A Common Sense Approach to Nutrition
Before researchers and physicians came to know that there were different forms of diabetes, before Banting, Best, Collip and McLeod figured out how to make injectible insulin, before the days when diabetic nutrition became a science, there was one way to keep alive, and that was to go on a starvation diet. All that was known was that people who had diabetes had too much sugar in their urine and blood, and so the sure fire way to hammer down on that problem was to cut out everything understood to introduce excess sugar to the body.
What we know now about Type2 is that at the center of the problem is a metabolic weakness — in simplest terms, the body has difficulty using nutrients. As my doctor explained it to me when he diagnosed me with Type 2 twenty odd years ago, I had all this junk pumping through my system. So to manage all that, we borrowed an idea, admittedly unscientific, from the environmental protection movement: I should learn to reduce and recycle. Reducing boils down to body mass, how much physical activity we pursue, and the mix of nutrients we take in. Recycling we can do through medication and exercise, both means to improve the performance of the insulin the body continues to make, and that’s how we move toward improving our metabolism of sugars, or at least compensating for our lessened ability to handle sugar in the body. In this article, we’ll look at the first of the two approaches: how to reduce the incoming junk stream. It’s not as daunting as it could be. Remember that unless you’ve crossed the threshold to dependence upon daily insulin dosing, the calorie and carbohydrate planning involved doesn’t have to be a burden — rather it’s a new habit to work on.
Start with the idea that for many people who have Type 2 the condition comes on from a long held habit of taking in more of the glucose-boosting foods and beverages than the daily requirement for proper nourishment. Then consider that the movement in recent years to get away from processed foods and choose natural foods — the farm to table concept — is already working in your favor.
As we mentioned in our recent article on dental care, a 2003 American Society for Clinical Nutrition study linked added sugars in processed foods and highly sweetened beverages marketed heavily in the 1970’s to tooth decay. If you’re in your sixties now, by the time you were a teenager you were already loading up on on things that taxed your pancreas to produce insulin way beyond what it was designed to do. But don’t be trapped into thinking that merely shifting to “low cal” artificial sweeteners or ‘diet” foods and beverages will solve the “reduce” side of the equation. Studies also show that sweetness in foods and beverages is a trigger for insulin production. What you want is to shave down the fermentable carbohydrates — some of the junk that you’re taking in. At the same time, you want to be throttling back on the junk from fats in your diet, because fats are harder to metabolize than carbohydrates. You don’t want to be using the insulin you’re still producing to handle something you really don’t need much.
A very good way to get started with this, or if you started a long time ago but you’ve drifted off your diet and maybe your A1c levels aren’t where your doctor would like them to be, is to meet with a nutritionist who has clinical experience with diabetes, or with a certified diabetes educator. If your primary care doctor or health insurance carrier has already directed you there, there’s a very good reason: The first line of attack against Type 2 diabetes is to reverse the intake of carbohydrates and fats that over time put you on a track to develop the condition. The oral medications that suppress releases of glucose from your liver, increase insulin efficiency in your tissue, and rid your system of excess sugar will help with that, but if you rely only on your meds to do the job, you risk having one or more of your meds lose their effectiveness over time.
What you learn from a nutritionist or CDE is likely to be straightforward and encouraging. To begin with, you’re not facing a self-denial program for the rest of your life, where you have to swear off favorite foods absolutely, outright and forever. You will learn to read the FDA labels which come on food and beverage packages, and which have undergone changes since last May to provide science-based information on added sugar content, vitamin and mineral value, and how much the product contributes to a healthy daily nutritional intake. You will also learn how to create a diet for yourself which will get you to an ideal weight and toward your HbA1c goal. This is hardly an austere, one-size-fits-all diabetes diet. It’s one giving you choices based on, for instance, the Diabetes Food Pyramid, which differs from the more widely known US Agriculture Department pyramid because it groups foods not by type or source but by how foods are known to affect blood glucose.
You need to follow the guidance of a professional to set yourself on a plan that works best for you, of course. But to help yourself understand how and why it works, there are resources you can tap on your own, like the Joslin Clinic materials explaining the diabetes food pyramid, including an interactive calculator which will show you how to rough out a breakfast, lunch, dinner, and snack plan based on your age and body type and how much exercise you usually take. May you be pleasantly surprised, and encouraged, as you chip away at the junk stream.