Frequently asked questions from diabetics
by Christopher Sonnier M.D. of Carilion Endocrinology AssociatesIn my career as an Endocrinologist, I have worked with a wide range of patients faced with the challenges of living a full and healthy life as they struggle with the diabetes and other diseases generally affected by the foods we eat. I am constantly asked questions about the kinds of foods that are most beneficial to regulating diabetic conditions, or simply avoiding the onset of diabetes.
The answers about what kinds of foods to eat are simple, but carrying them out in today's fast-food, huge portions, and over-flavored world is not always easy. The problem is that it's simply difficult to find prepared foods that make sense for a healthy diet, but that we still like to eat. continued below…
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Dr. Sonnier's diabetes answers
continued from above… Here are answers to questions I'm asked most often regarding diabetes and foods that can help maintain a healthy life style.
Just what is diabetes, and what are the different types of diabetes?
Diabetes is a condition whereby the body can no longer maintain normal glucose homeostasis. And there are two types of diabetes. Type 1 and Type 2. Type 1 diabetes is an autoimmune destruction of the pancreas, making the pancreas unable to product insulin. For this type diabetes, administering insulin is the only treatment. This accounts for about 15% of all cases of diabetes and usually occurs in individuals before the age of 30. Type 2 diabetes is a genetic condition of progressive insulin resistance that leads to the pancreas trying to compensate by producing more insulin. Ultimately the pancreas is unable to keep up with the demand, and fails to make enough insulin to support the body. In the end, the pancreas itself fails resulting in the need for insulin.
How many people suffer from diabetes, or are at risk?
Currently we are in an epidemic of Type 2 diabetes, and there are also increasing numbers of Type 1 diabetes for reasons not fully known. The Type 2 epidemic is driven by the obesity epidemic that has been going on for the last decade. There are about 20 million known Type 2 diabetics at this time and it is often said, but never confirmed that there is another 50% of that number unreported. The number is expected to grow to 33 million in just the U.S. by the year 2030.
The bigger concern at this time is related to the increasing number of patients with pre-diabetes. Rough estimates put their total number around 50 million of which about 33% will progress to Type 2 diabetes over the next ten years. This population of patients seems to be growing faster each year and affecting much younger individuals then the typical 45 and older age group of classic Type 2 diabetes. There is much concern over this as if is starts at age 15 instead of 45, then the likelihood of significant long-term complications is much higher through that individuals lifespan.
Do you see any trends based on the American lifestyle and the growing number of diabetics?
The major problems are obesity caused by lack of activity, and poor diet choices. As a nation we eat too much fast food and do not maintain properly balanced diets.
What are the main challenges your patients struggle with?
The patient's main struggle is with their lifestyle choices of diet and exercise.
What are the "rules" for a diabetic diet? What can you eat/not eat?
A diabetic diet is basically a diet limited in the number of carbohydrates, but not to the extreme. The purpose of this kind of diet is to keep the metabolic rate relatively high so that calories are burned and weight loss can occur. There are now more low carb foods available on the market, but the problem has been with us in the Western diet for some time, hence the obesity epidemic.
What options do diabetics and pre-diabetics have with regard to prepared foods? Do you recommend Burger King? Olive Garden?
I recommend well balanced meals of normal portion size, eaten 3-4 times a day. I recommend limiting all the snacking between meals to fruits. I do not promote fast food; it's all bad. If you don't have any options but eating out, go to a nice restaurant, or even a deli. Anything is better than fast food.
How are complex carbs and simple carbs different?
Complex carbs are carbohydrates that are structurally more complicated, making the body work harder to break them down into simple glucose. Simple carbs are just a few steps more complex than glucose (sugar) and are not to be eaten if at all possible. A basic rule of thumb is "the sweeter something tastes the more simple carbs it contains."
Are there any percentages, averages or statistics that consumers can use to measure complex carbs and simple carbs at the same level? For instance, 30g of carbs from navy beans is equivalent to 60g of carbs from potatoes…
The concept of the glycemic index tries to take this into account, but it is not perfect. There is no simple formula to use. It all has to be learned by reading and discussing the issues with diet educators.