Food for Thought

Diabetes: 10 ways to reduce your risk

It’s never too late to make a difference. Living well with diabetes and reducing your risk of complications or turning back the clock if you have pre-diabetes doesn’t mean being on a ‘diet’. It means eating nutritious foods, making smarter food choices, and making the effort to move more. In the last decade research has yielded overwhelming evidence that lifestyle changes such as these can make a real difference to your risk of developing diabetes and to the quality of your health if you already have it. These tips from The Diabetes and Pre-diabetes Handbook by Prof Jennie Brand-Miller, Kaye Foster-Powell, Prof Stephen Colagiuri and Alan Barclay (Hachette Australia) will help you lower your risk of heart disease as well as helping you feel great and have more energy overall.

1. Reduce how much you eat.
   For most people with type 2 diabetes and pre-diabetes, the first priority has to be reducing body weight and that means reducing how much you eat. You don’t have to lose a lot of weight for it to help – 5-10% will make a difference. Key foods to reduce are those high in saturated fats and/or added sugars, and alcohol. This doesn’t mean just downsizing your daily chocolate bar from king size to standard. It means saving the chocolate bar for very special occasions only.
   
   
2. Cut back on saturated fats and cholesterol.
   This is absolutely essential for everyone with type 2 diabetes. You must get and keep your LDL (bad) cholesterol down. Don’t obsessively avoid high cholesterol eggs and prawns (shrimps). It’s the saturated fats in those lamb chops and chocolate chip cookies that are having the greatest effect on your cholesterol levels. If you’ve been eating healthily and doing regular exercise for at least three months and your cholesterol levels still haven’t improved, talk to your doctor about cholesterol-lowering medications. A practical intermediate step may be to try one of the reduced fat margarines that have added phytosterols for a further three months. Provided you can eat the 4–5 teaspoons a day of margarine without gaining weight, these margarines can reduce your blood cholesterol levels by around 10%.
   
   
3. Modify your carbohydrate intake.
   This means thinking about carb quality and quantity and getting familiar with the sources and amounts of carbohydrate in your diet. There’s no point buying the ‘99% fat free’ product if it packs in 120 g of high GI carbs per serving (See November 2006 GI News for 'The low-down on reducing the GI of your diet'). For carb quality, make sure that you are eating the low GI ones as much as possible. As for quantity, 50–60 g of carbohydrate at any one sitting is a good average. Replacing some carbohydrate in your diet with monounsaturated fat can reduce your post-meal blood glucose levels and lower your triglycerides, but you have to be careful with this. Too much added fat may lead to weight gain. Talk to your dietitian about the proportion of fat to carbohydrate that’s right for you.
   
   
4. Eat more regularly.
   Whether you want to eat three meals a day or small meals plus snacks is up to you. However, if you use insulin or take medication that stimulates insulin production from your pancreas, it will be helpful if you can maintain some consistency in the times you eat your meals and the amount of carbohydrate you eat at those meals. A regime of multiple insulin injections usually gives you more flexibility in your food intake.
   
   
5. Increase your protein intake, but don't go overboard.
   Protein won’t increase your blood glucose level and is valuable for satisfying appetite. The usual recommended protein intake is 15–20% of your total energy intake. Most people in industrialised societies already eat around 15%, so you could eat a little more if it takes your fancy. Legumes, fish, lean red meat and skinless chicken are good sources that pack more than just protein. But don't go overboard. High protein (greater than 25% of energy), low carbohydrate diets may not be safe in the long term for managing diabetes. People with kidney disease (about 1 in 3 people with diabetes) should avoid a high protein intake, because research shows that a more moderate intake helps preserve kidney function.
   
   
6. Eat more of the healthy foods (such as fruit and vegetables).
   It isn’t all about cutting back. Most people don’t eat anywhere near enough of these foods. Fresh, dried and canned fruits are all suitable, and you can eat as much as you like of most non-starchy vegetables (leafy greens, carrots, tomatoes, onions, etc).
   
   
7. Cut back on salt.
   Chances are you’ve got high blood pressure too. Reducing your sodium intake by not adding salt to food when cooking or at the table, and choosing salt reduced or low salt foods at the supermarket, is a great start. If you think you have done this but your blood pressure is still high, you might need medication as well. See your doctor for further advice.
   
   
8. Be active every day
   Regular moderate physical activity is essential for managing diabetes or pre-diabetes and for reducing heart disease risk. Doing housework or gardening, or going for a brisk walk on a regular basis, all count towards increasing your activity level. Boosting them with regular, moderate-intensity exercise sessions can help you manage your blood glucose levels and reduce the risk of diabetes complications and heart disease. How does it work? Exercise and activity increase glucose and insulin uptake and can:
   
   
   • Help lower your blood pressure
   • Reduce your heart attack risk
   • Reduce your insulin requirements
   • Help you stop smoking
   • Help you manage your weight
   • Increase your levels of good (HDL) cholesterol
   • Help keep your bones and joints strong
   • Improve your mood
   • Ease depression
   • Increase your stamina, and
   • Increase your flexibility
   
   
9. Don’t smoke. If you do, quit
   Smoking is most often associated with lung and other cancers, but it may also increase the risk of developing pre-diabetes or type 2 diabetes, and many of the common complications of diabetes. In addition, smokers have more than twice the heart attack risk of non-smokers and are much more likely to die if they suffer a heart attack. Research has shown that smoking just one cigarette reduces the body’s ability to use insulin by 15%! After a cigarette it takes 10–12 hours before the insulin resistance starts to improve.
   
   
10. Limit your consumption of alcohol
    Like most things in life, moderation is the key. One or two drinks each day may actually help prevent or delay the development of diabetes, and some of its more common complications, by decreasing insulin resistance. It may also decrease the risk of developing heart disease, by providing small amounts of powerful anti-oxidants and thinning the blood. On the other hand, excessive amounts of alcohol may increase the risk of pre-diabetes and diabetes by contributing to weight gain – particularly if your drinking goes along with eating energy-dense foods. If you have diabetes or pre-diabetes, it’s important to limit your consumption of alcohol to no more than one standard drink a day if you are a woman and two standard drinks if you are a man.