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Diabetes - Diet and Health
Ernest H. Rosenbaum, MD

By consuming a carbohydrate-dense food diet (potatoes, rice) there is a release of the hormone, insulin, from the pancreas, and amino acids are absorbed in the body, except tryptophan, which is increased in the brain, where it is converted to serotonin (a natural occurring hormone that promotes a feeling of calm and relaxation). Serotonin causes a soothing effect.

1. There are currently 20.8 million diabetics in the United States.
2. Approximately 18.7 million diabetics have type 2 diabetes.
3. 54 million Americans have been classified with pre-diabetes (impaired fasting blood sugar or impaired glucose tolerance).
4. It has been estimated that about 20- 30% of those with impaired fasting glucose will develop type 2 diabetes in the next five or six years, and those with both impaired fasting glucose and impaired glucose tolerance tests have about a 40-60% chance of developing diabetes in the next five years.
5. A third of babies born in the year 2000 will develop diabetes in their lifetime.
6. Diabetes is the leading cause of blindness, amputations, and kidney failure, resulting in untold suffering.
7. 80% of type 2 diabetes is related to obesity and/or overweight. Currently, about a third of Americans are obese, and another third are overweight.
8. It is important to recognize that even a small amount of weight loss can possibly avert a diabetic future. A loss of about 10% of body weight and three hours of weekly exercise can reduce diabetic risk by around 50-60%. One study at the University of Colorado Health Science Center showed that a 16% reduction in diabetes risk per kilogram weight loss has become a feasible goal.
9. Weight loss is mainly achieved through eating fewer calories than one burns, but this is often a difficult goal to achieve. These lifestyle interventions are critical.
10. One substitution, such as sprinkling a tablespoon of toasted almonds on sautéed green beans instead of one teaspoon of melted butter, can save 70 calories a day. Other substitutions are of major value, especially reducing saturated fats.
11. Eating smaller portions, choosing optimal foods and increasing chewing, such as with fruits and vegetables, are very helpful in weight control.
12. Using whole grain breads and apples for dessert can help boost satiety and also increase soluble fiber intake.
13. Whole grains and soluble fiber help slow stomach emptying, which promotes satiety and the feeling of fullness, and thus decrease the urge for additional food portions. Soluble fiber also helps lower insulin levels and helps the postprandial, post meal glucose curve.
14. Including lean protein and fat helps delay gastric emptying - walnuts and toasted edamame (soybeans).

Thus, using healthy foods rather than fast foods, increasing fish intake, and increasing exercise can lead to at least a 10-pound weight loss each year. Burning more calories can help delay insulin resistance and reduce risk of diabetes.

One achievable goal is substituting low-calorie/fat foods for regular foods:
skim milk for whole milk
a grilled chicken sandwich at 310 calories versus a quarter-pounder hamburger of 530 calories
one cup sugar-free yogurt at 90 calories versus one cup fruit-flavored yogurt at 230 calories
three cups of air-popped popcorn at 90 calories versus three ounces potato chips at 330 calories
sixteen wheat thins at 140 calories versus 15 Triscuits at 280 calories
6-oz chicken breast at 200 calories versus a 6-oz steak at 344 calories
one medium potato at 140 calories versus one cup of rice at 266 calories
4 tablespoons sour cream at 120 calories versus four tablespoons of butter at 400 calories.

Diabetes and Low-Glycemic Diet An article in JAMA by Ludwig, who studied 73 obese young adults, studying rapid or slow insulin secretors, noted the higher insulin secretors lost five times as much on a low-glycemic diet and kept the weight off over an 18-month study.

Ludwig noted that potential candidates for a low-glycemic diet usually are apple-shaped with fat around their midsection rather than those pear-shaped, collecting fat around their hips and thighs. An insulin blood test can tell for sure. Insulin helps digest food, which is a build-up to drive weight gain.

Ludwig said, "A low-glycemic load diet includes fruits, vegetables, beans, nuts and whole grains and discourages sugars and starches like white bread, white rice, potato products. It does allow dairy products, even full-fat ones and urges people to look at the types of fats they consume, avoiding saturating fats rather than restricted calories."

Those secreting the most insulin with apple-shaped bodies lost 13 pounds in six months on a low-glycemic load diet. Those who were heavy insulin secretors on a low-fat plan lost five pounds in six months, keeping off 2.6 pounds at 18 months. Low insulin secretors tended to have pear-shaped bodies - heavier throughout the hips - and lost equal amounts of weight on both diets, approximately 10 pounds in six months, maintaining a five-pound weight loss at 18 months.

In another report, participants on a 55% carbohydrate and 20% fat diet versus a 40% carbohydrate and 35% fat diet, showed no difference in weight loss between low carb and low fat diets. Those with higher average insulin levels lost more weight on a low-carb diet, which also improved high-density lipoprotein, HDL, cholesterol and triglycerides more than a higher-carb, lower-fat plan. The low-fat diet did improve the LDL cholesterol more than the lower-carb diet.

The bottom line is that those who are overweight, who can't lose weight or keep it off on a low-fat diet, might do better on a low-glycemic load diet, according to Cara Ebbeling, who is co-director of obesity research at Children's Hospital in Boston.

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First appeared May 20, 2007; updated July 12, 2007