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The balancing act
By JANET K. KEELER © St. Petersburg Times, published March 28, 2001
Right? Wrong. Recent research shows that it is more important to spread carbohydrates evenly throughout the day rather than to worry if they come from white sugar or starchy vegetables. That is a different theory from years past, when diabetics were warned to avoid refined sugar at all costs. The new thinking on nutrition for diabetics is that portion control of all foods, not just abstinence from sugar, is a key element to controlling the disease. The candy bar, birthday cake and doughnut can still have a place in your life, but if you embrace the idea that food is fuel, you may not want to fill your tank with those types of carbohydrates.
But the reality for a diabetic, and anyone else who wants to eat well, is that all food is a possibility but some foods are more nutritious than others. Diabetes is on the rise in the United States. More than 15-million people now have diabetes, and nearly a million more will learn they have it this year. The American Diabetes Association suspects that 5.4-million cases are undiagnosed. Diabetics either don't produce insulin or their bodies don't effectively use the insulin they produce. Insulin, a hormone made by the pancreas, helps the body convert sugar to energy. When diabetes is untreated or uncontrolled, sugar spills into the bloodstream and can eventually cause kidney ailments, heart disease and diseases of the eye, among other problems. Once complications set in, they usually cannot be reversed. Though the condition is incurable, it can be managed largely with diet, exercise and medication. There are two kinds of diabetes. Type I diabetics, just 10 percent of all people who have the disease, do not produce insulin and must get a daily supply from an outside source, usually an injection. Type II diabetics produce some insulin, but their bodies need help using it. Type II diabetics often take oral medication. Diet is a crucial factor for both types. The second, much larger, group is the one most newly diagnosed diabetics find themselves joining. "When people are diagnosed with diabetes, they are either shocked, mad, sad and upset or scared. Sometimes all these things," says registered nurse Dana Lewis, an educator at the Joslin Center for Diabetes in Clearwater. "Sometimes it's a surprise. There is no flashing sign on your forehead that says 'You've got diabetes.' " Lewis is part of a staff of medical professionals who help diabetics learn to manage the disease through seminars and lectures at the Joslin Center, which is affiliated with Morton Plant Hospital. Lewis teamed with diabetes nutritionist and nurse Nancy Maza for a two-day diabetes management training seminar last month that was attended by a group of 25 people hungry to learn more. It is not easy for every diabetic to do the right thing when it comes to nutrition, and many diabetics who have avoided sugar all their lives may have difficulty adjusting to the new flexibility that research suggests is possible. There is considerable myth about diet. Not all primary care doctors and general dietitians know the latest information on treatment. There are products in the grocery store labeled "diabetic" even though there is no agency setting criteria for that. In addition, overweight people, who already have issues with food, are at high risk to develop Type II diabetes. So many overweight teenagers and young adults are developing Type II diabetes that its alternate name, adult-onset diabetes, is becoming a misnomer. Here are some tips Maza and Lewis give their students to help them learn to eat better. Not surprisingly, anyone trying to improve his or her eating habits can learn something here. Take charge of your life."It's your diabetes, not your doctor's," Lewis says. In other words, don't expect others to do for you what you need to do for yourself. Do some research, take classes such as the ones offered by Joslin. (Call the center at (727) 461-8300 for information about its programs. Medical insurance may cover the cost of training sessions if you get a referral from your doctor.) If you're online, learn more about diabetes from the American Diabetes Association's Web site, www.diabetes.org, or the national Joslin center site, www.joslin.org. "There will be times you get off track. It's going to happen," Lewis says. "Don't beat up on yourself. The important thing is that you get back on track." Stick to a food plan.Every person diagnosed with diabetes should work with a nutrition expert who understands the disease to devise an individualized food plan. Each diabetic has different needs. Some need to lose weight; others need to find a way to break their dependency on sugar-laden sodas. A dietitian can weave favorite foods into daily diets. "Being consistent day to day and meal to meal is one thing you can really do for yourself," Maza says. "Having diabetes takes a little more planning than not." Many diabetics follow an exchange diet and are allotted a predetermined amount of protein, fat and carbohydrates at meal and snack times. All diabetics watch carbohydrates closely, but those who need to lose weight must be careful about fat also. "You need to think of your plate as one-third protein, one-third starch and one-third veggie," Maza says. "The American Heart Association says that we shouldn't have any more than 9 ounces of red meat a week." Read labels.Do not be fooled by what is proclaimed on the front of a product. It's the nutritional label on the back that tells the truth, Maza says. Products are often labeled "dietetic" or "diabetic," but the terms mean little. Diabetics should be most concerned with the carbohydrate content of food, not the total sugar, Maza says. In the diet plans devised by the Joslin staff, individuals are allowed two to five "carbs" per meal. One carb, Maza explains, equals 15 grams of carbohydrates. For instance, an English muffin has about 30 grams of carbohydrates, so a person allowed 2 carbs at breakfast would be at her limit. It's also important to note the serving size on the label, because that allows the eater to relate the nutritional information to how much he ate. Who hasn't been surprised to learn that a pint of Ben & Jerry's ice cream is four servings and that the nutritional information on the container is for such a "tiny" amount? It doesn't help to not eat.Maintaining balance in the body is important for diabetics. A lack of food can make blood sugar levels drop dangerously, causing dizzy spells or blackouts. Unlike dieters, who often eat sparingly during the day in order to have a larger evening meal, diabetics need to eat evenly through the day. Carbohydrates are an important source of energy for everyone, including diabetics, and should not be completely avoided. "Carbs give you 100 percent glucose. If you depend on protein, you won't get much as fuel," Maza says. There are other factors besides nutrition that must be considered by diabetics. Medication, exercise and blood sugar monitoring are all part of the treatment for diabetes. However, developing better and more knowledgeable eating habits is a simple first step. "You are your best caregiver," Maza says. "You're the only one who can do it. With a positive attitude, you can control the progression of the disease without having it control you."
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From the Times Taste section From the features wire |
