THE GOCHISO GOURMET: Livin’ with Diabetes

I attended the recent 70th Scientific Sessions of the American Diabetes Association in Orlando, Fla. While I mainly attended symposia involving medication treatment updates (I didn’t attend any nutrition symposia), it was still sobering to see that the incidence of diabetes is still on the rise. For instance, more than 4,300 new cases of diabetes are diagnosed each day (three new cases every minute) and 18,000 diabetes patients lose their vision every year. Every day, 200 diabetes patients die due to complications of the disease. And while diabetes previously was thought of as a disease of inactivity and excess (supersizing meals and waistlines), some of the populations on the rise come from places where people aren’t that large… like Asia. And though the National Cholesterol Education Program (NCEP) defines a metabolic waist as 35 inches or larger for women and 40 inches or larger for men, Asian diabetes patients often aren’t anywhere near that size range. In fact there are studies that show Asians tend to hide truncal obesity within smaller waistlines. In other words, we may not look fat on the outside, but we are fat on the inside.

What is diabetes?

Diabetes is usually divided into two main forms: Type 1 and Type 2. In Type 1, an autoimmune reaction destroys the beta cells in the pancreas so that no insulin is produced and the patient needs to inject insulin to maintain life. It usually occurs very early in life, so it was previously termed juvenile diabetes. However this autoimmune reaction can also occur later in life (actress Mary Tyler Moore had been married twice before receiving her diagnosis) so Type 1 also occurs in adults. In Type 2 diabetes, a combination of declining insulin production and insulin resistance eventually leads to the frank diagnosis.

Nutrition

If you do have diabetes or are living with someone who has diabetes, it would be a great idea to see a nutritionist or dietician to learn about portion sizes and which foods should be limited. There are only three macronutrients — carbohydrate, fat and protein — and severely restricting intake of one would invariably lead to over-consuming another. And the rationale is not to starve yourself, but rather portion control foods that might spike your blood sugar.

Carbohydrates

These are the starches or fillers in our diets — rice, noodles, potatoes, breads and cereals. They also come in the form of sugars and sweets, including fruits and other starchy vegetables like corn, peas and beans.

The general recommendation is to limit your starches to three servings per meal, or 10 to 12 servings per day. One serving is a 15-gram portion. For rice and pastas, this is roughly one-third of a cup. Therefore a cup of ramen noodles or a cup of rice would be your limit for that one meal. You also want to get as much of your carbohydrates as whole grain if possible — whole wheat bread instead of white bread, brown rice instead of white rice, whole grain pasta instead of processed semolina. And even if it’s whole grain, you still need to adhere to the allotted portion controls. Why whole grain if I can’t eat more? Well, whole grain also includes carbohydrates that we don’t absorb, i.e. fiber. This fiber takes additional time to digest so that it doesn’t spike our blood sugar upon digestion so it’s easier for our natural insulin to help clear those glucose molecules released into our blood stream. Think about it as trying to avoid a car that starts rolling down a hill versus a car coming at you at 90 miles per hour.

Protein

Trying to avoid all carbohydrates and consuming all protein and fat isn’t a good idea either. For starters, patients with diabetes are at an increased risk for nephropathy or a decline in kidney function. Any excess protein that’s not incorporated into muscle tissue is transformed into energy. Before this occurs, however, the nitrogen on all amino acids must be removed and excreted by the kidney. This makes the kidney work a little harder, which is tough on a kidney already under some stress due to diabetes. The general recommendation is to limit protein to three to four ounces per serving (roughly the size of a deck of cards) and to look for leaner proteins if possible. Consider poultry breasts with visible fat removed, leaner cuts of beef or pork with visible fat removed, or vegetable proteins like beans or soy protein.

Fat

Since patients with diabetes are at a higher risk for developing heart disease (even if their blood sugars are well controlled), limiting saturated fat takes on a greater urgency. Look for fat free dairy products (or reduced fat dairy products at the very least) in place of regular dairy products. Limit animal fats to a minimum — though fatty fish three times per week is fine — and remove any visible fat from beef, pork and poultry whenever possible. Substitute vegetable oils and nuts as your main fat source in place of animal fats. And remember that good fats don’t mean all-you-can-eat fats. A Mercedes may be a safer vehicle than a Jeep, but driving a Mercedes recklessly at 90 miles per hour can still kill you. And since fat is twice as concentrated in calories as carbohydrates and protein, unrestricted consumption of even good fats will add inches to your waistline… which unfortunately reduces your sensitivity to insulin.

Lifestyle measures

Even if you adhere to a healthy diet, you still need to adopt other lifestyle measures to optimize control of your diabetes, like getting regular exercise and losing a little weight. Both will help to improve your insulin sensitivity and reduce your chances for developing diabetes. In fact the Diabetes Prevention Program showed that subjects with pre-diabetes who exercised for 150 minutes each week and lost 7 percent of their body weight were 58 percent less likely to develop diabetes each year (subjects who were 60 years and older were 71 percent less likely to develop diabetes). Whatever glucose that circulates in your bloodstream needs assistance to enter the cells. This assistance comes in the form of insulin. Think of insulin as the key that unlocks the cell door. A new key can unlock the cell door with ease. With diabetes, it’s like carrying an old key that must be jiggled in the lock to unlock that door. That’s what happens when you lose insulin sensitivity — it doesn’t unlock those cell doors as readily and since blood sugar can’t enter the cells, it starts to increase. Getting regular exercise and losing weight is like getting a new set of keys.

Not just for diabetes

Though I prefaced this article as offering guidelines for patients with diabetes, they can (and should) be applied to everyone regardless of current medical history. We should all try to partake in a healthier diet that’s higher in whole grains, leaner proteins and healthier fats. Remember my motto that cholesterol and calories don’t count on holidays, vacations and your birthday. Well, on other days they do count and even for a fully vested worker, those “free” days only account for about 5 or 6 weeks — which means moderation for those other 46 or 47 weeks. And holidays and vacations only apply to those still working; there are no vacations or holidays for the retired — just your birthday.

The Gochiso Gourmet is a column on food, wine and healthy eating. Ryan Tatsumoto is a graduate of both the University of Hawai‘i and UC San Francisco. He is a clinical pharmacist during the day and a budding chef/recipe developer/wine taster at night. He writes from Kane‘ohe, Hawaii and can be reached at gochisogourmet@yahoo.com.