Newly diagnosed with Type 2 diabetes? Visit with a nutritionist, Dr. Hersh advises
Q: My doctor just told me my diabetes screening test was positive and I have Type 2 diabetes. She started me on a medication. Any recommendations for diet changes?
A: Insulin is a hormone that regulates the body’s metabolism, helping control both the storage and utilization of the cells’ major energy source, blood glucose. Diabetes mellitus (commonly referred to as simply diabetes) is a disorder of energy metabolism, resulting in abnormally high blood glucose and lipid levels. It's a common chronic condition, affecting more than one in every 10 Americans.
Type 2 diabetes, which accounts for 90% to 95% of all diabetes cases, is due to the body's cells becoming resistant to insulin, so patients need higher levels of insulin to regulate their blood glucose. It runs in families and is more common in certain ethnic groups (for example, African Americans). Risk factors include being overweight, a sedentary lifestyle and having a poor diet; the increase of these in our population has almost doubled the incidence of Type 2 diabetes over the last 10 years.
Everyone should learn to improve their diet, get regular physical exercise, and maintain a healthy weight. This is even more important as we age, and yet more important in diabetics.
Improving your diet means learning to eat healthy foods in moderate amounts at regular mealtimes. The best way to do this in a personalized way is to consult with a nutritionist. Let them know your preferences and other things that are important to you. Examples include what to do when dining out, possible conflicts in your schedule that may disrupt regular meal times, food preferences and social/life factors.
Your nutritionist will teach you about healthy carbohydrates such as fruits, vegetables, whole grains, legumes and low-fat dairy products, versus less healthy carbohydrates such as simple sugars, grains that have been refined and stripped of their bran/fiber/other nutrients, others. You will also learn about healthier fats (such as avocados, nuts and certain oils) versus saturated fats, trans fats and those with high cholesterol.
One simple method your nutritionist may recommend (and one recommended by the American Diabetes Association) is the "plate method." You start with a 9-inch or so diameter plate. The meal you prepare will fill this plate half with non-starchy vegetables (such as carrots, broccoli, cauliflower, mushrooms, leafy greens and tomatoes), a quarter with lean protein (such as certain fishes, chicken, beans, legumes, low-fat dairy products and tofu) and the last quarter with a healthy carbohydrate (such as peas or brown rice).
In general, whole foods are better than processed foods. In addition, you may or may not be advised to count carbohydrates and/or calories. But food selection and portion control are needed no matter what. The counseling you get from your nutritionist will go into a lot more detail.
Here are some general tips to help you out. You may need to modify these so they fit with how you like to do things:
Plan your meals in advance, even considering making a list of what you will eat for each meal for the week. The overall plan should include snacks as well;
Make a shopping list, and do not buy things that aren't on the list. Many people find it is easiest to be disciplined as to what foods to get in the planning stage. And if you do not have the "bad" foods available, you will cannot eat them;
Never shop for groceries while hungry. This is one of my own rules, as I find too many impulse buys occur because I'm hungry while shopping;
Eat your meals at regular times;
Stick to the plan as much as possible. Consistency is key. The lifestyle changes you make will need to become your new normal for the health benefits to be realized over the long run.
You also need to figure out an exercise routine. This should include strength training (using stretchy bands, weights, etc.) at least a couple of days a week and almost daily aerobic activity (brisk walking, biking or other activities; stretching should be combined with your aerobic activities). Regular exercise has huge health benefits.
In most Type 2 diabetics, diet and exercise are just part of the care plan. About 60% of Type 2 diabetics also need oral medications that help their system increase its insulin production and better utilize insulin. Up to 15% use only insulin, another 10% to 15% use insulin and pills, and the rest need only diet/lifestyle modification without medications.
It is common that what people need to control their diabetes changes over time (for example, as they adjust their diet, lose weight, get more exercise, etc.), whether it's the addition or discontinuation of a medication, changes in dosages, etc. One study showed that 5% to 85% of newly diagnosed Type 2 diabetics were able to achieve "remission" (diabetes is a lifelong condition, but remission means you no longer require medication to control it) with weight loss of less than 5% to over 15%, respectively.
The overall goal is to have a healthier, longer, more satisfying life. This means making healthier lifestyle choices and sticking with them. It is OK, and expected, that you will not be perfect, and that you will have days when you do not meet your diet and/or exercise goals. That's fine. But overall, lifestyle change means your new norm will include these goals.
To prevent/identify possible complications, regular checkups should include annual eye examinations, regular measurements of HgbA1c (a blood test that can measure "average" levels of glucose to determine if your overall blood sugar is well controlled), foot examinations, dental examinations, blood pressure monitoring, cholesterol monitoring and other screening exams and routine checkups as recommended by your primary care provider.
Jeff Hersh, Ph.D., M.D., can be reached at DrHersh@juno.com.
This article originally appeared on MetroWest Daily News: Nutritionist can offer good diet choices to combat Type 2 diabetes
