Getting control of diabetes with diet

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With its incidence predicted to double over the next decade, diabetes has attracted more medical and media attention of late. Last month, for instance, reports in the press appeared after doctors recommended more regular blood sugar levels checks for diabetics. Diabetes sufferers have also been urged to have more frequent assessment of a blood component known as HbA1c (also known as glycosylated haemoglobin) – the level of which gives a good guide to blood sugar control over the preceding two or three months. This call has come as a result of recent research published in the Annals of Internal Medicine which shows a strong link between raised levels of HbA1c and increased risk of killer conditions common in diabetes, namely heart disease and stroke.

The recent highlighting of the importance of blood sugar control in diabetics has prompted me to devote a column to this very subject. According to a review published earlier this year in the Journal of the American College of Nutrition (JACN), one key to keeping blood sugar and HbA1c levels in check is to avoid foods that give brisk and extensive release of sugar into the bloodstream. Such foods (termed ‘high glycaemic index’ foods) include the normal fare generally viewed as undesirable for diabetics such as sweet drinks, chocolate, biscuits and cakes.

Instead of such foods, diabetics are generally advised to base their diet on starchy carbohydrates such as bread, potatoes, rice, pasta and cereals. Unfortunately, despite their wholesome reputation, tests reveal that almost all such foods tend to have glycaemic indices on the high side. Also, in their refined or processed forms, these foods also tend to be relatively bereft of fibre ” a dietary element identified as being beneficial for tempering blood sugar and HbA1c levels. Bearing in mind the known disruptive effects of foods high in glycaemic index and low in fibre, it does seem odd to me that these are the very food so often conventionally advocated for sufferers of diabetes.

Those looking to get fibre-rich and low glycaemic fuel for their bodies may get this from certain starches such as oats and wholewheat pasta. However, other foods that fit the bill in this respect and also add significant nutritional value to the diet include beans and lentils, as well as green and salad vegetables. Other foods that might assume some prominence in the diabetic diet are higher protein foods such as chicken (preferably organic), lamb, fish, nuts and seeds: the naturally low-carb nature of these foods makes them unlikely to contribute to elevated levels of either blood sugar or HbA1c.

Last month, the journal Diabetes published a study in which a higher protein diet was pitted against a traditional carb-rich diet in a group of diabetics. Despite the relatively short duration of each diet (just five weeks), the protein-based diet led to significantly reduced levels of both blood sugar and HbA1c. It was estimated that such a diet in the longer term would lead to normalisation of HcA1c levels. The application of the findings of the recent Annals of Internal Medicine study reveals that this would be expected to reduce the risk of heart disease and stroke by some 40 per cent. Although a small study, this latest research utterly mirrors my experience in practice: a diet based on foods such as meat, fish, beans, lentils, nuts and vegetables other than the potato, not starchy carbohydrates, is what helps keep diabetics from having bad blood.

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