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Monthly Health Review, May 2001
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Maintaining Health with Diabetes
The Medicines Act of 1968 forbids recommendation for diabetes.
However, dietary advice can be given in respect of good general health
and maintaining blood sugar levels if a person has diabetes. Diabetes
is the third cause of death in the UK after cancer and heart disease,
and is the main cause of blindness. There are two types of diabetes -
insipidus, a very rare form of diabetes and Diabetes Mellitus. We are
going to concern ourselves with diabetes mellitus. It is important to
understand the differences between diabetes mellitus types 1 and 2.
What is Diabetes? (1)
Diabetes is a disorder caused by reduced or absent production of insulin
(a hormone) by the pancreas. The role of insulin is the absorption of
glucose into cells for their energy needs and in the liver for storage
as glycogen and into the fat cells for storage. Where there is a deficiency
of insulin, levels of glucose in the blood become very high, causing large
quantities of urine and excessive thirst. The inability of the content to
store or use the glucose may cause weight loss, hunger, and Fatigue. Diabetes
also results in disorders of the metabolism of fats.
Diabetes Mellitus is divided into two main 'types'. The first is known
as Insulin Dependent Diabetes Mellitus (IDDM) or type 1. This is the more
severe form and usually appears in people under the age of 35 and most
commonly between the ages of 10 and 16. Type 1 rapidly develops as the
insulin-secreting cells in the pancreas are destroyed. The cause is probably
as a result of an immune response after a viral Infection and insulin
production ceases almost completely. The life of the sufferer depends
on regular injections of insulin, without which they may lapse into a
coma and die.
The second is known as Non-Insulin Dependent Diabetes Mellitus (NIDDM)
or type 2. This usually develops gradually and mainly in people over 40.
In many cases this type is hidden and only discovered during routine medical
examinations. Not enough insulin is produced for the content's needs, especially
when the person is overweight. Often the content is resistant to the effects
of insulin. In most cases, insulin-replacement injections are not needed;
instead, a combination of dietary adjustments, weight reduction, and oral
medication controls the condition.
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Diet to help maintain stable
blood sugar levels (2)
It is a good idea for each meal to contain carbohydrate in the form
of starch (complex carbohydrates) and for the meals to be regularly spaced
throughout the day; this should achieve the best match between carbohydrate
intake and the insulin available. The quantity of carbohydrate taken should
depend on the energy requirement of the person, as we all have different
metabolic rates. The diet for maintaining stable blood sugar levels is
recognisable in general 'healthy diet' advice.
- Energy intake for obese people should be restricted to less than their
calorific output, and should not exceed the total intake for a normal
weight diabetic.
- At least half (approx. 60%) of the energy intake should be as complex
carbohydrate. This is because refined carbohydrate has a very similar
effect on the content as refined sugar. The refining process breaks down
the carbohydrate and in effect 'pre-digests' it, giving the content a fast
release of blood sugar and energy. However, as the content then tries very
hard to balance the blood sugar levels, the energy levels suddenly drop.
- Fibre-rich unrefined foods (such as whole-grains and unprocessed fruit)
should be encouraged.
- Fat should provide a maximum of 35% of the energy intake of which
no more than 10% should be saturated fats - polyunsaturated fats are
essential to health, saturates are not. A diabetic is 60-70% more prone
to Atherosclerosis and heart disease than a 'normal' person.
- Protein can be obtained from a good mix of animal (meat, fish, dairy
and eggs) or plant sources (seeds, nuts, beans, pulses) as in a 'normal'
diet.
- Salt intake should not be increased.
- Alcohol may be taken
in moderation, bearing in mind the energy value.
- Permitted artificial sweeteners can be used as sugar substitutes.
- Fresh fruit contains fructose that has to be converted by the content
into glucose for use. This provides a slower-releasing sugar than glucose
or sucrose.
Simple sugars and sugar-containing foods are excluded because they are
digested and absorbed quickly causing a fast rise in blood glucose levels.
These include all types of sugar, malt, glucose, jam, honey, marmalade,
sweets, chocolates, sweet biscuits, cakes, puddings, fruit squash and
fizzy drinks that contain sugar, and tinned fruit in syrup. Most concentrated
forms of sugar are devoid of vitamins and minerals; food processing 'denatures'
the sugar of any goodness it may have had.
The cost of a diet for a person with diabetes does not have to be any
more expensive than that of a 'normal' diet. However, if the diabetic
buys diabetic products or fruit and vegetables out of season, then their
diet may become more expensive than they would like.
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Nutrients and diabetes
Recent studies have shown that antioxidant supplementation (800iu vitamin
E, 24mg Beta Carotene and 1000mg Vitamin C) may have a beneficial effect
on LDL oxidation in those with type 2 diabetes mellitus. LDL is more susceptible
to oxidation in diabetics than non-diabetics (4). These studies are consistent
with other studies suggesting that antioxidant vitamin use may significantly
decrease risk for Coronary Heart Disease.
Vitamin C is commonly found to be marginally deficient in those with
diabetes and appears to contribute to regulating disordered blood sugar
levels (5).
The majority of people eating typical Western diets consume less than
the upper limit of the estimated safe and adequate daily dietary intake
of Chromium, which is set at 50-200mg a day. Chromium is an essential
nutrient required for sugar and fat metabolism. Insufficient chromium
intake is associated with symptoms similar to those seen in diabetes and
cardiovascular diseases. In a study carried out in China, chromium in
high amounts was very effective in relieving many of the symptomatic manifestations
of type 2 diabetes. In addition to type 2 Diabetes Mellitus, chromium
supplementation may be useful in encouraging fat loss with the retention
of muscle (6).
The majority of vitamins and minerals, particularly B complex and Magnesium
play a role in energy and glucose metabolism. Therefore, it would seem
prudent to ensure the possibility of deficiency is reduced, perhaps by
supplementation with a multi-nutrient formula. Anthocyanosides, the flavonoids
found in Bilberry (Vaccinium myrtillus) provide potential benefits to
diabetics. They have been shown to increase intracellular Vitamin C levels,
and decrease the leakiness and breakage of small blood vessels. They also
help prevent easy bruising, and have powerful antioxidant effects. The
anthocyanosides in Bilberry have a particular affinity for the blood vessels
of the eye, particularly the macula (the part of the retina used for fine
vision), and improve circulation to the retina (7).
Evening Primrose Oil or Borage (starflower) may be helpful in providing
the content with a ready-made source of GLA. Diabetes is associated with
considerable disturbance in essential fatty acid (EFA) metabolism, which
manifests as diabetic neuropathy. One of the main disturbances being the
conversion of linoleic acid to gamma-linolenic (GLA) and dihomo-gamma-linolenic
and arachidonic acids (8).
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Blood sugar levels and exercise (2)
During exercise, the amount of glucose entering the muscles increases.
This happens whether or not insulin is present; because of this the concentration
of blood sugar drops. To compensate for this drop, and prevent Hypoglycaemia,
diabetics and those with low blood sugar levels need extra carbohydrate
before exercise; this does not need to be taken into consideration in
the daily carbohydrate allowance.
Complications associated with diabetes (3)
Diabetes can result in various complications if the blood sugar levels
are not adequately controlled. Acute complications are serious in the
short term. Conditions such as diabetic ketoacidosis and non-ketogenic
hyperosmolar syndrome need emergency medical help. Hypoglycaemia is a
serious condition. Failure of the brain to receive sufficient glucose
may lead to permanent impairment. It can usually be simply addressed by
having a small amount of carbohydrate, for example an apple. The chronic
complications are serious in the long term and include Atherosclerosis,
diabetic retinopathy, diabetic neuropathy, diabetic nephropathy and diabetic
foot Ulcers. A good diet and regular moderate exercise may help reduce
the probability of diabetic-associated diseases.
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The benefit of a healthy diet and lifestyle
There is no 'easy' way out of diabetes. However, the benefits of a healthy
diet and lifestyle are many, not just in diabetes but for all of us. The
use of insulin will keep diabetics, particularly the young ones, fully
fit and able to work. Harm can come to diabetics who neglect their diet
and insulin therapy (9).
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References:
- "BMA Complete Family Health Encylopedia", Ed. Dr T. Smith. Dorling
Kindersley. 1995.
- "Beck's Nutrition and Dietetics for Nurses". H M Barker. Churchill
Livingstone. 1991. 8th ed.
- "Encyclopedia of Natural Medicine", M. Murray & J. Pizzorno. Little,
Brown & Co. 1998.
- J Am Coll Nutr 1999 Oct; 18(5): 451-61.
- "Nutritional Influences on Illness", M. R. Werbach MD, 1996.
- Curr Opin Clin Nutr Metab Care 1998 Nov; 1(6): 509-12.
- L. Caselli, "Clinical & Electroretinographic Study on Activity
of Anthocyanosides", Arch Med Int 37 (1985): 29-35. (Enc.Nat.Health)
- G. A. Jamal, "The use of Gamma Linoleic Acid in the Prevention
of Diabetic Neuropathy", Diabetic Med 11 (1994):145-49. (Enc. Nat. Health).
- "Herbal Medicine" R. F. Weiss MD. 1988. Arcanum.
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