Food Cures (32 page)

Monounsaturated fats, found in olive oil and some nuts, are generally considered among the healthiest of fats. Research into the effects of olive oil on diabetes has been limited, but one Danish study found that people who ate a diet high in monounsaturated fats and low in low-quality carbohydrates had lower fasting blood glucose, lower average glucose levels, and lower peak blood glucose responses. Consider using olive and canola oil for cooking, adding a thin slice of avocado on your next sandwich, tossing olives into your salad, and snacking on an ounce of healthy nuts instead of sweets.

OTHER VITAMINS AND MINERALS

Calcium and Vitamin D.
According to the Nurses’ Health Study, which followed more than 83,000 women for 20 years, both calcium and vitamin D may help prevent type 2 diabetes. Women who got at least 800 IU of total vitamin D daily from food and/or supplements had a 23 percent lower risk of developing diabetes compared with those who consumed less than 200 IU daily.

Women who got at least 1,200 milligrams total calcium daily from food and/or supplements had a 21 percent lower risk of developing diabetes compared with those who consumed less than 600 milligrams per day. Combining vitamin D and calcium was even better—women who got at least 800 IU vitamin D
and
1,200 milligrams calcium reduced their risk of diabetes by 33 percent. Strive to add more vitamin D-rich foods to your diet. It can be difficult to get all the vitamin D you need from foods, so consider taking a supplement. (See Supplements section, Chapter 9, for more information.)

Scientists are unclear about exactly what these nutrients do to reduce diabetes risk. It could be that vitamin D regulates the insulin-producing cells of the pancreas, and calcium may improve insulin sensitivity. Of course, the synergy between the two makes sense—the body can’t absorb or use calcium without vitamin D. Improvements in insulin sensitivity are important for everyone with diabetes, but calcium also seems to help control blood pressure, which contributes to heart disease. So whether you have prediabetes or diabetes, calcium and vitamin D are wise food choices.

I recommend that women aim to eat at least three servings of calcium-rich foods daily, and to consider taking a calcium supplement if they can’t reliably fit calcium into their meals. (See the Supplements section, Chapter 9, for more information.) Men should eat no more than two or three servings of calcium-rich foods daily, and should never take a calcium supplement without approval from their doctors—some early research suggests that high calcium diets may increase the risk of prostate cancer.

Magnesium.
Scientists believe that magnesium works hand-in-hand with enzymes involved in carbohydrate metabolism. In laboratory animals, abnormally low blood levels of magnesium led to insulin resistance. Other research confirms the benefit of magnesium for people—the combined results from two large studies—the Health Professionals’ Follow-up Study, which followed more than 42,000 men for 12 years, and the Nurses’ Health Study. Compared with people who consumed very low amounts of magnesium (less than about 250 milligrams daily), high daily magnesium reduced the risk of developing diabetes by about 33 percent. The amounts that defined
high
were 377 milligrams daily for women, and 458 milligrams daily for men—both close to the RDA recommended amount of 400 milligrams per day. Strive to add more magnesium-rich foods to your diet. Because most people don’t get enough magnesium from food alone, consider taking a supplement, as well. (See the Supplements section, Chapter 9, for more information.)

BONUS POINTS

• Get your team together.
  Diabetes is a life-long, whole-body problem. Although your primary care physician may have been the one to order blood glucose testing, you need a team of professionals to guide you through all the medical details. Ideally your team will include your primary care physician, an endocrinologist (a hormone specialist) who understands the intricacies of insulin, a registered dietitian to help you fine-tune your eating plan, an ophthalmologist (an eye specialist) who can look for diabetes-related signs of damage to the retina, a podiatrist (a foot health specialist) who can help prevent complications from diabetes-related nerve damage and skin sores, and a dentist to keep periodontal disease and other infections under control. Because people with diabetes have a high risk of heart disease, your primary care physician will also be your guide to preventing and/or managing high blood pressure and/or high cholesterol (or your primary care physician may refer you to a cardiologist).
  
• Monitor your blood glucose levels every day.
  Some people fight against checking their blood sugar levels, but daily monitoring really is the only way to know if they are under control. Foods, activity level, medications, illness, and even stress can affect blood glucose. Unless you check, you won’t know whether your levels are holding steady or spiraling out of control. Your doctor will tell you how often you need to check. Some people only need to check once a day, others may need to check four or five times per day. In addition, you should ask—in advance—what to do if your blood glucose readings are abnormal.
  
• If you have diabetes medication, take it as directed.
  People who have head-splitting migraines remember to take their medications because pain is a terrific motivator. People who take medication for severe acne have no trouble remembering to take it, because they know if they miss a few doses, the consequences will be written all over their faces. But diabetes symptoms are silent, and thinking they won’t pay the price for missed meds means far too many people “forget” or to decide against taking prescribed medications, despite the grave risks of heart disease, nerve damage, and other complications. Don’t be one of them. Take medications or insulin as directed by your physician. If you have uncomfortable side effects or questions about your medication or treatment plan, talk with your doctor.
  
• Exercise.
  Next to weight control and medical treatment, exercise is the most important thing you can do to take control over diabetes. Exercise decreases body fat and promotes weight loss. But even if you don’t lose weight as a result, exercise will improve blood sugar control and your body’s response to insulin, and can even reduce triglycerides. So activity helps diabetes control directly, and also helps prevent heart disease.
  It is never too late to start a healthful program of exercise. There are virtually no risks, other than a few sore muscles at the beginning. Studies have reported significant improvements in blood sugar control after just eight weeks. A review of research discovered that all levels of activity were beneficial, from moderate-intensity walking to high-intensity resistance training with weights. The important thing is the activity, not how much weight you lose. Aim for at least 150 minutes of moderate-intensity exercise per week (that’s just two and a half hours total for the week). For most people, that means planning to be active for 30 minutes, five days per week. Feel free to add-on—you might try low-intensity activities, such as tai chi, stretching, or yoga. For fighting the complications of diabetes, any kind of activity beats sitting on the couch. The key is to find something you enjoy doing—walking, swimming, cycling, dancing—and get moving.
  
• Keep a food record.
  As you get control over your weight and blood sugar, it can be helpful to keep a log that includes some specific information about your eating habits. Every time you eat, jot down 1) where you are; 2) what time it is; 3) how hungry you are before beginning to eat; 4) how hungry you are when you stop eating; 5) the foods and amounts eaten; and 6) your thoughts or feelings at the time. Over time, you’ll start to see patterns that can help you learn to eat only when you are physically hungry, and not just as a way to relieve anxiety or stress. It can also help you to stay focused on new food habits. Some clients enjoy the process. They find that they feel empowered by it, and keep food records for months. Others just do it for a few weeks, stopping once they understand their personal eating patterns. I strongly recommend keeping the record for at least a week—you may be surprised at what you learn.
  
• Learn the value of distraction.
  Your food record will help you identify the times of day and situations in which you’re mostly likely to make poor food choices and that’s an important first step. Once you know the weak spots, you can plan new activities to take the place of unhealthy habits. One trick that many of my clients use is a combination of delay and distraction. If you get the urge to eat (you’re not physically hungry and it isn’t a mealtime), set a timer and wait 20 minutes. In that time, do something else to keep your mind off food—clean out a closet (or purse!), organize your email files, put on a fresh coat of nail polish, call a friend, schedule your outstanding appointments, pick up that knitting you’ve been meaning to finish…anything that keeps your hands busy and off food. If you still want to eat when the timer goes off, have a healthy snack. Most people discover, however, that their craving disappears.
  
• If you smoke, quit.
  Smoking increases the risk of developing diabetes. Once you have diabetes, smoking makes every problem and complication worse. Smoking raises blood glucose levels, constricts blood vessels, and causes inflammation. As a result, people who smoke have an increased risk of kidney disease, nerve damage, blood vessel damage, and foot and leg infections. One extra piece of advice: Many people gain weight after quitting smoking because they try to satisfy their nicotine cravings by eating more. NOT a good strategy for anyone, but it is particularly dangerous for people with diabetes. Talk with your doctor about the best ways to quit smoking without overeating.
  
• Drink alcohol only in moderation…if at all.
  Drinking between one-half and two alcoholic drinks per day has been shown to reduce the risk of developing type 2 diabetes by an average of 40 percent compared to nondrinkers or heavy drinkers. However, among people who already have diabetes, there is some question about the benefits of alcohol. A review of medical literature published in 2004 concluded that there doesn’t seem to be any significant risk of moderate alcohol consumption for people with diabetes.
  Moderate
  typically means drinking no more than one serving of alcohol per day if you’re a woman, and no more than two servings if you are a man. (A serving is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.) If you have diabetes, I also recommend checking with your doctor to make sure that alcohol is safe for you, and that you understand how it might affect your blood glucose levels. If you don’t already drink alcohol, don’t start.
  
• Brush and floss regularly.
  Just as unregulated diabetes leads to high levels of glucose in your blood, it also leads to higher-than-usual levels of glucose in your saliva. This high-glucose environment in your mouth allows bacteria to multiply and live quite happily, raising the risk for dental decay. Plus, diabetes makes fighting infection harder, so that if gum disease develops, you’ll have a more difficult time getting rid of it than someone without diabetes. Studies have born this out—among people with periodontal disease, those who also have diabetes have more severe gum disease than those without diabetes, with deeper gum “pockets” and a greater loss of attachment that could eventually mean tooth loss. On the flip side, getting treatment for gum disease may help with diabetes management. Research suggests that people with diabetes who gain control over their periodontal problems have
  better
  glycemic control after gum treatment than before. For healthy teeth and gums, dentists and nutritionists alike recommend that you see your dentist regularly, brush with a fluoride toothpaste at least twice a day, and remember to floss.
  
• If you have sleep apnea or daytime sleepiness, seek treatment.
  Excessive daytime sleepiness is often a sign of sleep apnea, a disorder that causes interruptions in breathing during sleep. Breathing stops for 10 seconds or more because of faulty signals from the brain, or because the soft tissue at the back the throat relaxes and blocks the airway (called
  obstructive sleep apnea
  , or OSA). This can happen several times per night. Each time, the sleeper will partially awaken, begin to breathe again, and then fall back asleep. Most people with sleep apnea don’t know what is happening, or why they feel so tired after what seemed like a full night’s rest. People with diabetes are more likely to have sleep apnea than people without diabetes. Even more intriguing is the possibility that sleep apnea may contribute to diabetes. OSA itself increases the risk of insulin resistance, and may be a roadblock to controlling your diabetes. If you have sleep apnea, or if you experience unusual sleepiness during the daytime, talk with your doctor. A full night’s sleep is not just a luxury, it’s a health necessity.
  
• Be meticulous with your foot care.
  The key words are
  clean
  and
  dry
  . Wash your feet daily in warm water, and dry with a clean soft towel. Do not soak your feet, or use hot water. Inspect your feet every day for sores, blisters, calluses, swelling, bruising, or breaks in the skin—talk with your doctor about how to treat them. Don’t walk barefoot—always wear shoes or slippers, and wear clean, soft socks with your shoes. Talk with your podiatrist about other ways to keep your feet safe.