Expert Q&A: A Healthy Diet for Type 2 Diabetes

Here's some good news: Healthy eating can have a dramatic impact on the
symptoms and progression of type 2 diabetes and its frequent precursor,
prediabetes. But the problem is that there's a lot of conflicting information
out there. Just what does healthy eating with type 2 diabetes really mean? No
sweets? Scheduled snacks? Low-fat, low-carb -- or neither?
To help guide you, WebMD turned to Hope Warshaw, MMSc, RD, CDE. She's been a
dietitian and diabetes educator for almost 30 years, and is the author of
numerous books on the subject, including Diabetes Meal Planning Made
Easy, published by the American Diabetes Association.
How does a healthy eating plan for someone with type 2 diabetes differ from what everyone else should be eating?


It doesn't. The nutrition recommendations from the American Diabetes
Association echo the healthy eating guidelines for the general public. Everyone
should be eating more whole grains, fruits, and vegetables and less saturated
and trans fat. Remember that the type of fat matters to your heart and blood
vessels. We've moved away from recommending a strict low-fat diet and shifted
toward an eating plan that allows for a moderate amount of fat, provided you
choose healthier fats, like monounsaturated and polyunsaturated fats.
If you have diabetes and are trying to lose weight, don't take the drastic
diet approach, like a low-carb diet. It might help you lose weight in the
short-term, but there's not good evidence that it will help you keep it off.
Here's my point: You're going to have diabetes for the rest of your life. You
need to be thinking about minor doable changes in your eating habits that you
can really maintain. Even small steps towards healthier eating result in big
rewards, like lower blood glucose and improved blood pressure and lipids.
You also don't need a special diet to tell you how to eat healthy. Most
people -- especially people reading WebMD -- already know. The big challenge is
actually doing it day after day, year after year.
What is the connection between diabetes and heart and blood vessel diseases?


The connection is huge. It is said that diabetes is a cardiovascular
disease. But lots of people haven't realized it yet. They worry more about
diabetes affecting their eyesight and kidneys. Yes, that can happen. But the
fact is that people with diabetes suffer and die much more from heart and blood
vessel disease. That's the real issue.

This is the key reason there's been a big change in the focus of diabetes
management. It's no longer just about glucose control. It's at least -- if not
more -- important for people to focus on controlling blood pressure and blood
lipids, particularly LDL cholesterol. By the time someone gets diagnosed with
diabetes, he or she may have already been living with serious risk factors for
heart and blood vessel disease for years.

What is prediabetes and what should people do if they're diagnosed with it?


Prediabetes is an in-between stage -- blood glucose is higher than normal
but not high enough to fit the diagnosis of diabetes. The diagnosis of
prediabetes should be a clear message that you're currently on the road to type
2 diabetes. If you don't take action now, you have a greater than 70% chance of
developing type 2.

But this doesn't need to happen. Results from several studies, including the
Diabetes Prevention Program, suggest that a small amount of weight loss -- 5%
to 7% of your body weight combined with 150 minutes a week of physical activity
-- can help slow down the progression. If you catch it early and do something,
you can really have an impact on either preventing or delaying the onset of
type 2.
What is the relationship between being overweight and type 2 diabetes?


It's a pretty direct relationship. About 80% of people with type 2 diabetes
are overweight. Excess weight leads to insulin resistance, and insulin
resistance leads to elevated blood pressure, abnormal blood lipids and
diabetes.
Do people with type 2 diabetes need to eat snacks throughout the day to control their glucose?


No, but there's a lot of confusion about this. Experts used to tell people
to eat snacks because the only medications we had to treat high blood glucose
levels could cause the side effect of hypoglycemia, or low blood glucose.
Regular meals and scheduled snacks were a way of limiting the problem. But now
there are several newer medicines that lower blood glucose without that side
effect. Plus, people have blood glucose meters and can check their glucose at
any time.
If snacking is your natural way of eating, there's nothing wrong with one or
two snacks a day. For instance, if a healthy snack in the afternoon -- like an
apple and some reduced-fat cheese -- prevents you from being so famished at
dinner that you gorge yourself, go ahead.
But people with diabetes should ditch the idea that they need to eat
snacks. It can be counterproductive. Some people find all the snacks really
inconvenient. Other people sit down for a snack and overeat, or they make
unhealthy choices because they don't have anything better around.
Can people with type 2 diabetes eat sweets?


Yes, people with diabetes can enjoy sweets. There's an old idea that sweets
are verboten for those with diabetes, but that's no longer correct.
It's true that the carbohydrates in sweets can raise your glucose levels,
but an equal amount of starch would have similar effect. I don't think people
with diabetes need to run around looking for sugar-free candies or insist that
their families bake them sugar-free deserts.
However, you have to be smart about sugary foods and sweets. Sweets pack in
a lot of calories and they tend to be high in fat, particularly in unhealthy
saturated fat. So anyone with diabetes needs to be careful about how many they
eat.

Can people with diabetes drink alcohol?


Yes. Generally, the recommendations for people with diabetes are the same as
they are for everyone else. For women it's one drink a day, for men it's two.
However, the amount of alcohol you drink -- and whether you drink alcohol at
all -- should be affected by how you manage your condition, what medications
you're on, and your overall health.

One precaution: some diabetes medications can increase the risk of hypoglycemia
when you're drinking alcohol. So if you're at higher risk of hypoglycemia,
practice caution.
What impact does physical activity have on type 2 and prediabetes? How much and what types of exercise are recommended?


Physical activity is crucial for people with type 2 diabetes and
prediabetes. It helps lower blood pressure and boost levels of good HDL
cholesterol, which reduce your risk of heart and blood vessel disease. It
lowers blood glucose and decreases insulin resistance. Studies show that while
exercise doesn't help much with weight loss, it's critically important for
maintaining weight loss.
As for what and how much, start with small steps -- literally! Walking is
easy. Find time to walk a few times a week for 20 minutes. Work your way up to
30 minutes five times a week. You need to find physical activities that you
enjoy, since you need to incorporate them into your life permanently. Using
weights and resistance training can be a good idea too. The higher the
percentage of muscle and the lower the percentage of fat in your body, the
better your insulin sensitivity.
Do you have any other tips on successful weight loss and control for people with prediabetes and type 2 diabetes?


If you're thinking about losing weight, the first thing you need to do is
assess whether you're really ready to make some big, permanent changes. If you
are, start by looking at what you're doing now. What are you eating and how
much physical activity do you get? Do some self-monitoring. Then once you have
a sense, target specific things you want to change. Don't try to fix your whole
life at once. You've got to focus on small changes to what you're doing
now.
You also need some support. As a dietitian (and person who works hard to
manage my weight) I know how hard it is to follow a healthy eating plan and be
physically active day after day. So, it's my belief that if people are going to
be successful in maintaining weight loss, they need to be connected and
supported. For people who are comfortable online, I think the most
cost-effective and efficient approach is joining an online program that fits
your needs. Today there are a variety of them, from Weight Watchers to Vtrim to
the Cardiometabolic Support Network.

In today's environment, I think we all can find it challenging to live a healthy lifestyle. How do you do it?


I'm 4-foot-10 inches and not getting any younger, but I really do put the
healthy eating guidelines into practice. Portion control is my 'numero uno'
strategy. In fact, my nickname at home with my food-loving husband and daughter
is the Portion Control Queen. I enjoy sweets a couple of times a week, but it's
either eating a half cup of really good ice cream or splitting a superb dessert
from a restaurant or bakery. I don't have the calories to spare on mediocre.
When it comes to burning calories, I'm out to exercise nearly every morning
Monday through Friday, either for a 2-mile walk or a longer stint at the gym.
What really motivates me is both feeling good today and my desire for a healthy
future