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How does diet affect diabetes?

In simple terms, diabetes is a metabolic disease characterized by insulin failure. Insulin, a hormone produced by special cells within the pancreas, is essential for metabolism, especially of glucose (blood sugar), the body's major fuel.

There are two major types of diabetes —juvenile-onset or Type 1, in which the body fails to produce insulin, and adult-onset, or Type 2, in which the body is unable to fully utilize insulin. Without adequate insulin, body cells cannot properly utilize glucose, which then accumulates in the blood and is also excreted in the urine

To restore the body's proper metabolic balance, one must provide insulin and adjust the diet to maintain normal glucose levels. Thus, a patient with Type 1 diabetes must take shots of insulin, and someone with Type 2 diabetes must adjust his or her diet (and perhaps take insulin or other medications) to restore normal metabolism.

Because diabetes is a chronic metabolic disease, the diabetic diet is designed to help assure good nutrition as well as to counter complications of diabetes. Thus, dietary goals are directed to controlling blood sugar, as well as preventing heart and kidney diseases, major complications of diabetes.

In general, the diabetic diet:

• Limits intake of simple sugars.

• Reduces intake of fat, cholesterol, and sodium.
• Increases intake of complex carbohydrates.
• Increases fiber intake.
• Provides sufficient protein for growth, development, and maintenance of body tissue.
• Maintains ideal weight.

Contrary to popular belief, the dietary regimen for diabetes does not require sacrificing favorite foods. In fact, when a dietitian works out an eating plan with a diabetic patient, the result is usually a diet that the entire family can adopt. Indeed, the overall diet recommended by the American Diabetes Association closely parallels the dietary guidelines for good nutrition for the general population set forth by the U.S. Department of Agriculture for all healthy Americans.

Specific dietary recommendations vary according to the type of diabetes. Type 1 patients must match food intake with the insulin dosage and exercise to assure a steady supply of glucose without abnormal highs and lows. Since the body quickly metabolizes sugars of all kinds into glucose, the typical diet for Type 1 diabetes limits sugars to less than 15 percent of the total

daily carbohydrate intake. Sugar should come from natural food sources, such as fruit and milk, rather than from refined sugar.

In contrast, the diet for Type 2 diabetes places more emphasis on restriction of total calories than on sugar consumption. The majority of patients with this form of diabetes are overweight, and in most cases, losing the excess weight brings the disease under control.

However, sugar is not the only important dietary concern for people with diabetes. Diabetics have a four­fold increased risk of heart attacks. They also have an increased incidence of high blood pressure, adding to their already heightened risks of heart attack and kidney failure. Thus, a diabetic diet reduces intake of fats and cholesterol to minimize these risks. Sodium restriction helps control blood pressure and lowers the risk of kidney failure.

In general, the intake of fats should comprise less than 30 percent of total calories, with emphasis on unsaturated fats. Daily cholesterol intake should be less than 300 milligrams.

Protein should account for 12 to 20 percent of total calories, compared with about 25 percent in the typical American diet. A high-protein diet also increases the kidneys' work load. Since many high-protein foods — especially meat, whole milk, and cheese — are high in fat and cholesterol, one must make selections carefully. Skim or low-fat (1 percent) milk, fish, and lean poultry are good choices. A combination of grains and legumes also provides high-quality protein as well as starches.

Starchy foods should account for 55 to 60 percent of the total daily caloric intake. Good choices include pasta, potatoes, cereals, breads, vegetables, and fruits. These foods also provide dietary fiber, which may help control diabetes.

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