The diabetes epidemic

Tuesday, December 19, 2006
It's estimated that one person develops diabetes in Australia every 10 minutes. This is a staggering figure, especially when a large number of type-2 diabetes cases can be prevented by exercise and a healthy diet.

Type-2 diabetes used to be called adult-onset diabetes because it mainly affected people in their 50s or older. But now, teenagers and people in their 20s have begun to be diagnosed with type-2 diabetes. There is no cure, but eating healthily and exercising moderately will go a long way towards keeping it under control.

A diet with enough food and kilojoules to obtain or maintain a healthy body weight, low in fat (particularly saturated fat) and high in fresh unprocessed food, coupled with a reasonable amount of physical activity, is generally regarded as a straightforward and simple guide to a healthy life. Such a regime will not only help you maintain a proper weight, it can also help keep your cholesterol and blood pressure levels under control and assist in reducing the risk of heart disease and type-2 diabetes.

While genetics and lifestyle play a part in determining a person's weight, the fact remains that too many of us eat badly. Witness the growth in the takeaway and fast food industries, the increase in the percentage of people who can be classed as overweight or obese, and the growing incidence of type-2 diabetes and heart disease. High saturated-fat intakes have been linked not only to both of these diseases but to certain types of cancer as well.

The old days versus the present

In the distant past, our ancestors lived on a diet — consisting primarily of grains, cereals, fruits, vegetables, nuts and legumes — that was relatively low in saturated fat and high in foods that promoted activity. Our ancestors were very active and did not consume the quantity of food that we do today. Our diet, however, has evolved into one in which large serving sizes, saturated fats and overprocessed foods rule; it's a menu tailored to increase body weight and both our blood glucose (sugar) and insulin levels to worrying heights. Pressed for time and blessed with science, we rely heavily on foods that are quick to get to the table and don’t need a lot of preparation. Worse, some manufactured and many takeaway foods use large quantities of fat and kilojoules to make bland carbohydrates exciting — think of deep-frying for potatoes.

Carbohydrates

In tandem with lowering our saturated fat intakes, we should also concentrate on consuming more carbohydrates. Carbohydrate foods generally make us feel fuller faster than do fats, give us more energy, help stave off hunger pangs and do not easily convert to body fat. But what are they?

Carbohydrates come mostly from plants, ie., cereals and grains, fruits, vegetables and legumes, but dairy products also contain carbohydrates. Recommended dietary guidelines suggest we eat substantial servings of cereals, legumes, rice and pasta, followed by vegetables and fruits. Dairy products should be eaten in moderation then, in diminishing quantities, meat, sugar, butter and the like can be consumed. People with diabetes are recommended to evenly distribute their carbohydrate intake in three meals throughout the day.

The glycaemic index

While a high-carbohydrate diet is better for us than a high-fat diet, some research suggests that certain kinds of carbohydrate foods are better than others. During the 1980s, nutritional research resulted in the creation of the glycaemic index (GI), a ranking of carbohydrates in foods based on their impact on blood glucose (sugar) levels in the body. Originally developed to help people with diabetes, research is showing that the GI may be a valid tool to assist in weight loss and heart disease prevention.

Rapidly absorbed pure glucose has a GI of 100. Carbohydrates that break down slowly and release glucose into the blood stream gradually have low GI values (55 or less), while those that are easily digested and absorbed quickly are considered to have high GI values (70 or more).

Medium (or intermediate) GI foods have values between 55 and 70. Low-fat high-GI food doesn't have to be excluded from a healthy diet — when coupled with equal amounts of low-GI food the result is a healthy diet with an intermediate-GI rating. The most important rule to follow is to eat as wide a variety as possible of low-saturated fat, low-to-medium GI foods.

Fibre

Dietary fibre is mainly indigestible plant matter that has no nutritional value. Unable to be absorbed, it acts as roughage to help keep the digestive system healthy and filter excess cholesterol from digestive juices — essential in the maintenance of healthy gut bacteria. High-fibre carbohydrates as a rule have lower GI values and help assuage hunger pangs. A diet high in fibre is beneficial for people with type-2 diabetes, and nutritionists advise that a healthy diet includes at least 30g of fibre daily. Good fibre sources are wholegrain cereals, brans and breads, and unpeeled, raw fruits and vegetables.

High-carbohydrate foods

  • Bread, especially wholegrain and wholemeal varieties
  • Crispbreads and crackers
  • High-fibre breakfast cereals, including rolled oats, whole wheat and untoasted muesli
  • Pasta and rice (such as basmati or Doongara)
  • Other grains such as barley, bulgur and couscous
  • Legumes, including baked beans, kidney beans, chickpeas, lentils, three bean mix
  • Fruit (also a good source of fibre if the whole fruit is eaten, rather than juiced)
  • Low-fat milk products, including milk, soy drinks
  • Starchy vegetables, such as potatoes, sweet potato, yams, sweet corn

Reduce bad fats

  • Choose reduced or low-fat dairy foods (milk, yogurt, ice-cream, custard)
  • Choose lean meat; trim any excess fat from meat before cooking
  • Remove skin from chicken
  • Avoid using fats that are solid at room temperature. These contain saturated fat, also known as "bad" fat, which increases your LDL cholesterol level
  • Limit the amount of cheese, or choose low-fat or reduced-fat varieties
  • Limit processed deli meats
  • Avoid fried takeaway foods

Enjoy healthy fats

  • Stir-fry meat and vegetables in a little canola oil, or use a cooking-oil spray or a little water
  • Don't use creamy dressings on salads, instead dress with a vinaigrette made with a little olive oil and lemon juice or vinegar
  • Spread avocado on sandwiches and toast, or add to a salad
  • Eat fish at least three times a week. They contain omega-3, a type of fat that is good for your heart
  • Top pastas with tomato-based sauces instead of creamy sauces

Fats

Eating too much saturated fat is bad for your health — it raises blood cholesterol more than other forms of fat and has far more kilojoules than carbohydrates or protein. High levels of saturated fat in the diet are linked to an increased risk of heart and vascular disease, and certain cancers. The reason we consume saturated fat at all is because it is unavoidable in meat, many dairy products and some vegetable oils; its benefits are that it carries fat-soluble vitamins (A, D, E and K), it provides energy and supplies certain essential fatty acids needed to maintain the structure of cell membranes and form hormone-like substances that regulate the body’s biochemistry. It is best for healthy adults to reduce daily consumption of saturated fats to less than eight percent of total kilojoule intake. Saturated fats (known as "bad" fats) tend to be solid at room temperature and are found mainly in animal products such as butter, cream, chicken skin, fat on meat, cheese, lard and dripping. They are also found in pies and cakes, snack foods, pastries and oils such as palm and coconut.

Polyunsaturated fat is mainly found in plant foods, including sunflower, soy bean and safflower oils and nuts and seeds. It is also found in oily fish, such as salmon, tuna and sardines. Omega-3 and omega-6 fatty acids are types of polyunsaturated fats; omega-3 fats are mainly found in fish and omega-6 fats are mainly found in vegetable oils. Polyunsaturated fats (known as "good" fats) are liquid at room temperature, and can help lower blood cholesterol and reduce the risk of cardiovascular disease.

Monounsaturated fat is found in oils including canola and olive oils, and other plant foods including avocados, nuts and seeds, as well as in lean meat. They are generally liquid at room temperature, but may solidify in cold temperatures. These fats, another type of "good" fat, can help lower blood cholesterol and reduce the risk of cardiovascular disease.

Regardless of whether fat is good or bad, all fat contributes to weight gain and, in addition to reducing the amount of "bad" fat eaten, overweight people with type-2 diabetes also need to reduce the total amount of fat they eat.

Sugar

A healthy eating plan for people with diabetes can include some sugar without it adversely affecting diabetes control and weight management. However, it's still important to consider the nutritional value of the foods you eat. Added sugars in nutritious foods, such as breakfast cereals or low-fat dairy products, are preferable to foods or drinks, such as confectionary and soft drinks, that contain little or no nutritional benefits but plenty of kilojoules. Many recipes can also be modified to use less than the stated amount of sugar.

Alternative sweeteners are available and, while it's no longer necessary to always use these instead of natural sugar, they are still useful in foods that may be consumed in large amounts, such as cordials and soft drinks. Some alternative sweeteners are low kilojoule or kilojoule-free and will not significantly affect blood glucose levels, however, this is not true for all alternative sweeteners, especially those known as nutritive or carbohydrate-modified sweeteners; these are not kilojoule-free and can effect blood glucose levels, so care must be taken.

Sodium

It's a given that we should all eat less salt (sodium); it can lead to increased blood pressure and the accompanying risk of heart disease and stroke. Still, sodium is essential in our diet — the recommended daily intake is 920mg to 2300mg, but this level can be achieved through the salt found naturally in fresh foods and unavoidably in manufactured foods. Try to choose processed foods that are labelled "no added salt" or "salt-reduced", and similarly try to avoid highly salted foods such as potato chips, salted nuts and most takeaway foods. Instead of using salt at the table, flavour your food with cracked pepper, chopped fresh herbs, lemon juice or balsamic vinegar, garlic, chilli and the like. Make your own mustard, tomato sauce, chutney and sweet chilli sauce — without adding salt. Use dried ground spices, onions and leeks, wine and vinegar in cooking instead of salt.

Eat your vegies

  • An apple a day may keep the doctor away, but for keeping well and having a sense of wellbeing, turn to vegetables ... five servings a day is the recommended amount. Recent studies indicate that phytochemicals (naturally occurring plant chemicals) and antioxidants (elements that stop free radicals from destroying DNA) contained in vegetables can play a part in reducing the possibility of cancer and heart disease.

  • Eat more tomatoes (a good source of vitamin C), spinach (loaded with B vitamins, iron and folate) and broccoli (rich in fibre and calcium). Keep washed and trimmed celery, carrot, fennel, cucumber and the like in the refrigerator; you’re more likely to snack on them if they’re ready to eat. Juice vegetables when they look a little tired.

  • Serve a green salad with every main meal — keep it simple so it's less of a chore to make. Use fresh lemon juice or balsamic vinegar and finely chopped herbs for a dressing.

  • Make fresh pasta sauces from vegetables — the Italians have done so for centuries. Broccoli or cauliflower florets, sugar snap or snow peas, chopped red onion, sliced mushrooms, cherry tomatoes or finely shaved fennel can be tossed into just-drained hot pasta and eaten immediately.

  • Think about roasting or grilling your vegetables. Carrots, pumpkin, kumara, yams, turnips and beetroot can all be roasted in a hot oven and are perfectly delicious without adding anything to them. And eggplant, capsicum, zucchini and whole red onions are delectable grilled on a hotplate or the barbecue.

  • Don't forget how good homemade vegetable soup is, or how easy it is to make a vegie stir-fry with lots of chilli, ginger and garlic.

  • We are blessed with a wide variety of vegetables available in our supermarkets and greengrocers — so work your way through the huge selection. There's nothing wrong with eating the same old standards year in year out, but trying different vegetables can make meals more interesting. Select those in season, when they're at their peak.


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