Voice of the Diabetic

Voice of the Diabetic

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NUTRITIONAL STRATEGIES FOR MANAGING DIABETES

By Brooks Kent

The following was the keynote address delivered at the annual seminar of

the Diabetes Action Network, on July 3, 2000, as part of the annual convention

of the National Federation of the Blind, held in Atlanta, Georgia.

I'm Brooks Kent. As President of the Atlanta Association of Diabetes Educators,

I'd like to welcome you to our city. I 'm a nutritionist and dietitian by trade.

It's a fantastic career for somebody whose passion is food! Food is one of the

ways that we celebrate life. In the beginning, when babies cry, we feed them.

Throughout life, we celebrate all of our holidays around food. At the end, when

someone dies, we take food to the family. What happens when we are told that

we have to change the very way that we eat that many of the foods we most enjoy

are limited to us?

It' s hard to make the changes that are so necessary for our health. Fortunately,

many of the recommendations for people with diabetes have changed. We no longer

ban sugar from the diet. It isn t the poison that we once thought it was. We

know that, with careful planning, all foods can fit. The latest dietary guidelines

have been produced and released. These are known as THE DIETARY GUIDELINES FOR

AMERICANS 2000. Notice that they are not just for people with diabetes or with

chronic heart disease. They are for all Americans, in order to make us healthier

and stronger, and better able to enjoy the lives we lead.

Tonight, I m going to go over these brand new dietary guidelines. Has anybody

here seen them? Have you noticed how they have changed? I think these guidelines

make a good basis for all of us as we learn how we can eat a healthy diet. I

m sure there will be questions you ll want to ask as we go along.

#1. Aim for a healthy weight.

The first guideline concerns weight. Uncle Sam actually wants you to take

out the tape measure and measure your waist. Anything over 35 inches for women

and 40 inches for men is considered a risk factor. How many of us can say that

we re under those figures? Did you know that it's the first 10 or 20 pounds

that will make the biggest difference? When I first started diabetes education,

I d constantly encourage people all the time about "getting down to your ideal

body weight." We now know that getting rid of that little abdominal pouch, just

a few of those extra pounds around the middle, will take us a lot closer to

our blood glucose targets.

#2. Be physically active each day.

The second guideline addresses physical activity. How are you doing with that?

Are you physically active? Are you doing pretty well? Do you know how much exercise

is recommended as good, physical activity? Actually, the recommendation is 30

minutes daily, of moderate physical activity. But what does the word "moderate"

mean? "30 minutes of moderate activity" actually means something like walking

two miles in 30 minutes. Have you ever tried to do that? That s pretty intense!

So it's going to take some effort on everybody s part to get out and do a little

more exercise.

For those of you who find it difficult to exercise outside, that s okay. There

are plenty of exercises that can be done in a chair. Would you like to try a

few right now? The first thing I m going to ask you to do is put your hands

on your shoulders. Now, lift them up as high as you can go. Stretch those fingers

out. Now, curl your fingers in. Go back down to touch your shoulders. Let s

do it to the count of ten. We ll go up on one, down on two. Ready? One, two,

three, four, five, six, seven, eight, nine, ten.

How do you feel now? Do you feel any better? Just that little bit of exercise

gets your heart pumping, doesn t it! Remember that following the guideline for

exercise is something that we all need to do. We know that exercising is vital

for our health.

#3. Let the pyramid guide your food choices

How many of you are familiar with the food guide pyramid? Did you know there

is a different one for diabetes? It differs in several ways from the one for

the general public? One example is cheese, which is normally listed in the dairy

group with milk and yogurt. On the diabetes pyramid it is now in the meat group.

This is because cheese doesn t have very much carbohydrate. When you have diabetes,

cheese acts more like a meat than like a dairy product. The beans which are

typically in the meat group are very high in carbohydrates, so we ve moved them

over to the starch and grains group. And what about potatoes, corn, peas, and

the winter squashes like hubbard, acorn and butternut squashes? Those indeed

are vegetables, but we group them as starchy vegetables because of their starch

content.

Now, somebody tell me where to put a tomato? I'm sure you made an A in biology

if you said tomatoes were fruit; but, when you have diabetes, you count your

tomato as a vegetable.

Another way to use the pyramid is as a guide for the number of servings for

a day. For instance, for people with diabetes, the number of servings for grains,

starches and beans is six servings or more. For members of the general public,

it goes as high as eleven servings , which would be appropriate for a 2800 calorie

diet -- a little high for most of us. Most women, especially those desiring

weight loss, need somewhere around 1600 calories each day.

#4. Choose a variety of grains daily, especially whole

grains.

Did anyone hear about the report that was published a month ago, on the effect

of fiber in managing your diabetes? For a long time, we've thought fiber was

a major player in controlling diabetes and now the research substantiates it.

Any time you add fiber to your diet, it is beneficial. This does not mean your

white rice is off limits ( you re only going to get two more grams of fiber

if you use brown rice instead), but we d like for you to increase the fiber

intake in your diet at every opportunity. Adding fiber is something you want

to do very slowly, while incorporating extra water. Do not try to do it all

at once.

Now, let me give you a list of words to look for on labels, words that should

be first on the list of ingredients you look for. These are words like brown

rice, bulgur (a cracked wheat), also look for graham flour, whole grain corn,

oatmeal, popcorn, pearl barley, whole oats, rye or whole wheat.

#5. Choose a variety of fruits and vegetables daily.

We have excellent evidence now this will help all of us. There was a study

published by the American Dietetic Association in 1998, the DASH Diet Study.

The "Dash" diet actually stands for "dietary approaches to stop hypertension."

Most people who have diabetes are also at very great risk for hypertension,

so one of the things we d like you to do is to find other ways of controlling

your blood pressure. The DASH Study indicates one of the best ways is to eat

eight to ten servings of fruits and vegetables every day. That s right! Eight

to ten! Along with that, we d like you to eat two servings of low-fat dairy

products. Now, that s a lot of fruits and vegetables. How many fruits do you

think I could include in that, if I am helping you with your diabetes? Not a

whole bunch! So, you ll have to eat lots and lots of vegetables. We ve also

found that all of those fruits, vegetables and dairy products can decrease your

blood pressure as much as we could with medication. it's pretty impressive how

your diet can make that much difference.

#6. Keep food safe to eat.

How many of you were out in the Atlanta heat today? Here, it's not a good

idea to take chicken salad on a picnic. Just make sure you keep things clean,

make sure your food is properly refrigerated and that you keep your food safe.

#7. Choose a diet low in saturated fats and cholesterol,

and moderate in total fat.

One of the things about low-fat and low-carbohydrate foods is that they protect

our kidneys as well as our hearts and arteries. I have a particular passion

for protecting people s hearts! I don t want you all to have the same heart

problems I have, so I d like to see you all decrease the amount of fatty foods

in your diets, and increase the number of beans and legumes that you include.

This can be tasty as well as healthy.

#8. Choose beverages and foods to moderate your intake

of sugars.

We all know, but we need to remember, that sugar is not now considered to

be the poison it used to be for people who have diabetes. On the other hand,

sugar can present a problem, because it is a very concentrated form of starch

or carbohydrate. What's more, it fills us up, and keeps us from eating foods

that are much more nutritious, that would benefit us. It's important to moderate

the amount of sugar you consume. Did you know that for the general population

soda pop is the number one source of added sugar? That is followed by sweets

and candies, cookies and cakes, fruit drinks and fruit "ades." I can t tell

you how many kids think that these fruitopias are the way to go!

#9. Choose and prepare foods with less salt.

Again, the main purpose of this guideline is to combat hypertension; but there

are also a lot of other things about salt we really don t understand. We think

there may be some problems with salt we don t even know about yet. While not

everyone who has diabetes is salt sensitive, you are much more likely to be

"salt-sensitive" if you have diabetes. In Japan, where they have a very healthy

diet, we find a much higher incidence of stomach cancer, and we think it has

something to do with their high intake of sodium. A high intake of sodium is

also a contributing factor to the formation of kidney stones. There are lots

of reasons to watch the amount of salt you have in your diet.

#10. If you drink alcoholic beverages, do so in moderation.

There s that wimpy word, moderation, again! Moderation means one drink per

day for women and two drinks per day for men. We know a healthy diet can be

had which includes alcohol, and some studies have shown that alcohol may actually

lower the incidence of cardiac disease for people who have diabetes. However

if it's one drink per day for women and two drinks per day for men I don t want

ya ll to save up all your drinks for Saturday night!

The new dietary guidelines are now available to everyone. There is a lot of

other information in them besides the ten guidelines I have shared tonight.

Actually, it is a 39-page booklet, which can be obtained by calling (202) 418-2312.

it's also on the Internet through the U.S. Department of Agriculture. Let me

give you that website also. It is www.usda.gov/cnpp. Or, you can just go to

the USDA web site and ask for "dietary guidelines," and the search box will

take you there.

Questions from the audience:

Isn' t it true that when you use canned tomatoes in cooking the serving

amount is different than when you use fresh tomatoes?

Actually, when we use tomatoes or anything that is pre- cooked, we should

decrease the portion size. If you take a fresh tomato, it would take almost

the entire tomato to give you one serving of the same vegetable, raw. What happens

when you cook the tomato or the vegetable? It shrinks as it cooks. Are you still

getting the same amount of tomato or onion, for example? A smaller quantity

will give you the same amount in the serving size. So, we ask that you cut back

on the amount in your servings of cooked vegetables.

In that same vein, what about your green leafies? I have a question for all

of you. Green, leafy vegetables, are they "free foods"? No, they are not free

foods. We do have to consider them as part of the daily diet. We can add a green,

leafy vegetable to any meal or snack without having to worry about it, but it

does contain carbohydrate, and has to be counted.

What about catsup?

Catsup has both sugar and salt. Catsup labels will tell you there are between

four and five grams of carbohydrate in each tablespoon, which would mean one

tablespoonful is a free food. Beyond that, however, if you are a six-packet

catsup person, you ve just added two carbs to your diet.

Can you say something about Splenda?

Splenda (sucralose) is a wonderful, new artificial sweetener, on sale mid-September.

I tasted it at the American Dietetic Association meeting last year. It has been

approved for pregnancy as well as all types of diabetes. Anyway, it tastes just

like sugar, and it can be used in cooking, which you can t do with the aspartame

products. Some people don t like Sweet n Low, which we have been using for cooking.

Splenda can be used in cooking and it is teaspoon for teaspoon at the same ratio

as you would use sugar. You can also bake with it. You have to order it and

I will give you the phone number to use. It is (800) 777-5363. it's a wonderful

sweetener, and it's going to add a lot of choices for a lot of people.

There' s been a lot of publicity about testing of aspartame.

The artificial sweeteners have probably been tested more than anything else

that we put in our mouths. They' ve gone through many, many clinical trials

to determine their effects on people. There are so many things going around

about these artificial sweeteners right now but I would say that moderation

is the word for all of these things. I have heard a lot of negative things about

aspartame, but none of them have been supported through scientific evidence

or research. Aspartame was checked very, very carefully before it was released

onto the market and approved for use. It is considered to be a safe product.

If you are hesitant about using aspartame then choose another sweetener. Remember,

though, that it does give you a lot of flexibility that you might not have otherwise.

It gives you the satisfaction of having some sweetness in some products that

you might not otherwise be able to enjoy.

Don t try to cook with it, though. Has anyone ever tasted a diet soda after

it has been left outside in the sun all day at the filling station? Isn' t it

horrible? That is because aspartame is made from protein, and protein "denatures,"

breaks down, with heat.

I live in Indiana and it's been a test market for Splenda.

Yes, Splenda is in some things that are on the market right now such as Log

Cabin Syrup and in the reduced-calorie, Ocean Spray Cranberry Juice Cocktail.

I think someone also asked about fructose, the product called "Fifty/Fifty."

What is fructose? It' s a sugar made from fruit. It' s the same thing that we

get in orange juice. I d be very cautious about using Fifty/Fifty. I normally

teach people to look at the total number of carbohydrates rather than just the

amount of sugar that is contained in a food product. If you just look at the

amount of sugar included, it can be very deceiving. After all, a carbohydrate

is either a starch or a sugar. Our bodies don t care where the sugar comes from.

They don t care if it's from a sugar or a starch. By looking at the total carbohydrate

count, the amount of starch and sugar in your diet is already figured for you.

I teach everyone I instruct how to count carbohydrates. It is a very simple

thing to do. All you have to do is know the amount of carbohydrates in the amount

of food you are eating. If you are on an insulin pump, it's the only way that

we can teach you to manage your diabetes. To use the pump effectively, you have

to learn carbohydrate counting. Anyone who has been using the EXCHANGE LIST

to manage their diabetes can easily learn to count carbohydrates. All you need

to know is how much carbohydrate you are getting in each meal, and keep that

consistent throughout the day. If you are on insulin, you obviously can have

a little more flexibility in how much Regular or Humalog insulin to inject,

by counting carbohydrates. If you are not on insulin, carb counting is an excellent

way to control your diabetes with diet.

Carbohydrate counting is very simple and you can easily fit it into your meal

plan. All of the starches and sugars that you want to include in your diet can

be included if you don t overdo the carbohydrate intake at any one particular

time. How many of you are doing carbohydrate counting? For those of you that

have not learned to do it, I would suggest you talk to somebody on your diabetes

management team. It will give you the freedom to eat a lot of foods you thought

were off limits.

Someone asked me about eating rice bran. The bran from the rice, or any grain,

is where the fiber is found. Any time you can add more fiber to your diet, it

will improve your blood sugar control. Another form of bran would be something

like Metamucil. Again, you want to be very careful and increase your intake

of fiber slowly. You want to drink lots of water. Don t overdo it. You ll have

a lot fewer friends if you go at it too hard.

One more thing about carbohydrate counting. Most people who are trying to

control their diabetes with diet do not have a problem with what they eat. Rather,

they have a problem with how much they eat. That is what makes the difference.

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