Type 2 diabetes causes a host of health problems. Many can be prevented with simple lifestyle changes. Here's how.
It's hard to put our heads in the sand when it comes to type 2 diabetes. It's Australia's fastest growing chronic disease, with almost 1500 Australians diagnosed each week and Diabetes Australia predicts 1.2 million will be living with the condition by 2010.
While medications and insulin injections help, what you eat also has a major impact by keeping blood glucose levels stable, and can help ward off complications you'd rather not face in five, 10 or 20 years. "Studies show that in some cases dietary changes can have similar effects to medication," says dietitian Kate Marsh. "The problem is some people start with medication and see it as an alternative to dietary changes – which should be your first choice."
So, we've reviewed the research and found the best ways to change your diet for maximum benefit. These may be simple, but they'll improve your health now – and in the future.
Step 1: Diet
1. Be carb-conscious
Our bodies digest low-GI foods more slowly, which means more stable blood glucose levels (BGL). Long-term, it adds up to fewer complications, too. A 2007 study of non-diabetic elderly patients found that age-related macular degeneration (AMD), which leads to blindness, could be connected to a high-GI diet. For people with diabetes – who are more prone to eye disease – high-GI carbs cause unwanted 'spikes' in your glucose levels. "The big thing we know is that peaks in your BGL, even for a short period, can contribute to complications," says Kate. "Peaks happen if you eat large amounts of carbohydrate at one time or choose high-GI foods, so it's about switching to foods with a lower GI to keep glucose levels stable."
Make the change... switch from wholemeal bread to wholegrain, swap processed cereals for oat-based porridge or natural muesli and swap rice for pasta or noodles. Can't live without rice? Basmati has a lower GI than Jasmine. And spud lovers can indulge in the lower GI Nicola potato, or eat sweet potato.
2. Switch to good fats
Trans fats. Saturated fats. Polyunsaturated and monounsaturated fats. Omega-6 and omega-3 fatty acids. Confused? No wonder. First, let's get one thing straight: some fat is good for you, but too much (especially bad fats such as trans fats) can lead to obesity, insulin resistance and rigid arteries.
Make the change... by cutting down on fatty meats, full-fat dairy, butter and processed foods. Switch to healthier oils such as olive and canola and eat more fish. Studies show omega-3s found in fish can lower triglycerides and blood pressure, not to mention reduce depression. "Fattier fish will give you more omega-3s – like fresh tuna, salmon, mackerel and sardines," says Kate. "Flake (shark), swordfish and deep sea perch (orange roughy) are higher in mercury, so don't over-eat those varieties." If you're eating a tuna or salmon steak, cook it in a pan or on the BBQ. If it's a white fish, try baking it wrapped in foil so it stays moist. And if you can't access fresh fish? "Canned fish on a sandwich is an easy option."
3. A vegan diet
Eating a vegan diet rich in fruit, vegetables and wholegrains could be the best thing you do for your blood glucose control, according to a recent study. It may not be for everybody, but people with type 2 diabetes put on a low-fat vegan diet showed massive improvements in blood glucose control, blood fats and weight loss. In further studies, GI founder Canadian Professor David Jenkins is altering the much-criticised Atkins diet into a vegan-inspired Eco-Atkins eating plan, which swaps meat with protein from soy, nuts and gluten. After 28 weeks, the group he's studying had lost 10% of their starting weight, improved their insulin sensitivity and lowered their cholesterol levels.
Make the change... by increasing the amount of fruit and veg you eat. "I always try to get people to eat more plant-based foods," says Kate. If you don't want to go vegan, aim to fill at least half your plate with vegetables.
4. Go slow on salt
Watch any TV cooking show and the message is, seasoning your cooking liberally is a good idea. Wrong, says Kate. About 50% of people with diabetes also have high blood pressure, and a diet high in salt can exacerbate this. "Salt is in everything and it increases blood pressure," explains Kate. "High blood pressure can also increase the load on the kidneys, so I recommend people stay away from adding salt to meals and try to make sauces from scratch."
Make the change... stop cooking with salt, and taste your food before you season. "Most people find their taste buds easily adapt when they cut down," says Kate. "Replace salt with other flavours: lemon juice, lime juice, chilli, garlic, onion, curry powder."
5. Love your legumes
Chickpeas, kidney beans, lentils... if you don't know what to do with them, it's easy to put them in the too-hard basket. But they offer many health benefits, including improved insulin sensitivity and blood glucose control. "It's easy to stick with potatoes, peas and carrots," explains Kate, "but legumes are great for people with diabetes. They're low-GI and really filling. They're full of fibre so great for lowering cholesterol."
Make the change... with creative cooking. "Treat legumes like any other vegetable," says Kate, "if you cook a stir-fry, add a few chickpeas, if you're making a dish with mince, add kidney beans; for curries, add lentils – they absorb flavours."
6. Eat more nuts
As a complete snack food, nuts can't be beaten. People with diabetes have a higher risk of heart disease. The healthy fats, vitamins, minerals, fibre and plant sterols found in nuts have been found to help maintain healthy blood vessels, reduce inflammation, lower cholesterol levels and improve insulin efficiency. "A recent study found that including almonds with a meal reduced the rise in blood glucose level after eating, making them particularly beneficial to people with diabetes," says Kate.
Make the change... by incorporating nuts into snacks and meals. Snack on a handful of raw, unsalted nuts; add chopped almonds to cereal; or add a handful of toasted walnuts to a salad.
7. And last but not least... make breakfast a priority
Eat a good breakfast. Missing breakfast can worsen insulin resistance, the underlying problem in type 2 diabetes. Kate says, "People note the link between eating and changes in blood glucose levels so think, 'If I'm not eating my BGL will go down,' but prolonged fasting can actually make it go up." Not only does breakfast mean you'll improve your BGL, studies show people who miss breakfast make poorer food choices and eat more later in the day.
Make the change... with foods that keep you going, such as porridge topped with nuts or wholegrain toast with an egg.
Step 2: Exercise
If the thought of regular exercise makes you want to turn the page, STOP. Exercise is as important as diet in managing blood glucose levels. Exercise increases insulin sensitivity, making the insulin you produce work better – reducing your blood glucose levels. Any exercise will help. To get better results...
Lose a little weight
Losing just 5-7% of your body weight can have a huge impact on whether you develop diabetes and, if you have it, with managing it, according to a 2002 clinical trial known as the Diabetes Prevention Program (DPP). But don't quit if you're not seeing the scales move. Says diabetes lifestyle management expert and founder of The Glucose Club, Adam Fraser: "Some people measure the effectiveness of exercise by how much weight they've lost. Even if you don't lose weight, exercise can get rid of dangerous fat around your organs."
To shed weight faster
A brisk walk is great. But a 2007 study undertaken at the University of NSW and the Garvan institute found interval training is better, helping you shed fat three times faster and reducing insulin resistance by up to 32%. So what is it? Dr Fraser explains, "You do your normal pace then go really fast for a short burst then you go back to your normal pace. Clients lose weight much quicker. Insulin sensitivity is better, glucose and cholesterol levels drop, blood pressure reduces."
To drop HbA1c levels fast
Studies show resistance training (training using weights) three times a week can reduce HbA1c (a measure of blood glucose levels) by 1.%, which is huge. A drop of 0.9% can reduce your chance of complications by between 20âˆ'50%. Resistance training builds muscle, reduces your cholesterol, and improves your mental state and quality of life.
How I'm beating diabetes
Denise Rogers, a 47-year-old office manager, says her diabetes diagnosis was a big wake-up call.
How long have you been living with type 2 diabetes? I was diagnosed three years ago after consulting a doctor for lower back pain – but because I was obese, inactive and had high blood pressure, my doctor recommended a range of blood tests. My BGL was 14 (target range is 4-8) and my blood pressure 160/110.
How did the diagnosis affect you? My manager was the carer for her friend who has type 1 diabetes – not the same, I know, but he was only diagnosed when he suddenly went blind. It made me realise that I was facing a serious illness.
What changes did you make to your lifestyle? The first change was that I started walking regularly. I only walked from home to the local shops and back the first day – 900m. It took about 10 minutes! I now walk 4km a day with my daughter, Terri, and do longer walks with my husband, Des, on weekends. I have also made a lot of changes to my eating habits. And I drink lots of water. I lost 25kg in the first 11 months.
How is your health at the moment? My BGL is fairly constant at 5.7, and my cholesterol, insulin and blood pressure are all quite good.
Do you have any future health goals? Yes, I plan to lose 10% of my body weight in the next 12 months and a further 5% the following year.
What advice would you offer others? Read the advice on the Diabetes Australia website and the 'Healthy Living' section on the Heart Foundation website. Choose a healthy eating plan and increase your physical activities. Start immediately. Make an appointment with a Diabetes Educator. Chat to people who have changed their lifestyles. I don't believe that one plan fits all!
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