Six Myths About Type 2 Diabetes

November is Diabetes Awareness Month and with the number of adults and children with Type 2 Diabetes growing every year, I think we've all become more aware of this condition than we used to be.  Nonetheless, myths and misunderstandings about this largely preventable condition abound.

Myth #1   All Type 2 diabetics need to take insulin or other anti-diabetic drugs for life.

Not so!  Even if you are currently using insulin or anti-diabetic medications to manage your Type 2 diabetes, you may be able to reduce or even eliminate your need for drugs by losing weight, exercising, and sticking to your diet plan. (No-one should discontinue any medications without consulting their physician).

Myth #2   If I’m diabetic, I shouldn’t eat fruit.

It's true that fruit contains carbohydrates and can affect blood sugar. But fruit can be a very healthy part of your diet, even if you are diabetic. Fruit contains valuable nutrients and fiber and has a milder effect on blood sugar than other types of sweets.  A healthy diabetic meal plan should contain two or three servings of whole fruit each day. Whole fruit is a better choice than processed fruits like applesauce, fruit cocktail, dried fruits, or fruit juice.

Myth #3  I only need to pay attention to carbohydrates, not protein or fat.

Limiting carbohydrates will help keep your blood sugar levels in check but it’s also important to be sure that your total calorie intake is appropriate.  Eating too much protein or fat can lead to weight gain, which can accelerate diabetes.  Diabetics also have an increased risk of heart disease, so watching your saturated fat intake is also important. Find out how many calories you need.

Myth #4   Diabetics should eat a low carbohydrate diet.

Up until 1994, the American Diabetes Association recommended a diet of about 60% carbohydrates for all Type 2 diabetics. Some diabetics can achieve good blood sugar control on this type of diet. However, many studies have shown that low-carbohydrate and/or low-glycemic diets can be very effective in helping diabetics lose (or maintain) weight and improving insulin sensitivity.  The ADA now acknowledges that lower carbohydrate diets may be helpful in some patients and recommends that diets be individualized.  Read more about the glycemic index.

Myth #5  If I’m using insulin or antidiabetic medications, I can eat what I want.

Taking medications is not a substitute for eating right, exercising, and maintaining a healthy weight.  Do everything you can to manage your diabetes with healthy lifestyle habits—even if you are taking diabetes medication. The medications will work better, you’ll need to take less of them, and you’ll stay healthier in the long run.

Myth #6  People with “prediabetes” (or a family history of Type 2 diabetes) always eventually end up with full-blown Type 2 diabetes.

Not at all. If your doctor has told you that your blood sugar levels are “borderline” or that you have “prediabetes,” this is a wake-up call!  Get serious about losing weight, eating a healthy diet, and exercising and you can very likely avoid developing diabetes.  Having a family history of Type 2 diabetes also doesn’t mean that you will also get the disease. You’re in control! 

(Read about Patrick Pete, an ND Champion who is rewriting his family's history of heart disease and diabetes.)

Related Content: I'm diabetic: Where do I begin?

Are you free for lunch?

If you are going to be in the New York City metro area on November 7th, I'd like to invite you to lunch with me and other ND users.  We’re always looking for ways to provide you with tools and content that you care about. In an effort to keep improving NutritionData for you, we'd like to hear your input. The lunches will take place in mid-town Manhattan.

If you are interested in participating, please email us at feedback@nutritiondata.com.

Diet and Breast Cancer: Is Dairy a Culprit?

Dear Monica, I enjoyed your post on diet and breast cancer.  However, I cannot believe that you did not mention the direct relationship between the intake of casein (milk protein) and the growth of mammary tumors.  T. Colin Campbell in his The China Study outlines how this protein turns on tumor growth and the lack of it in the diet turns off cancer growth. "

Before saying anything else, let me first say that I completely support anyone who does not care to consume dairy products, for whatever reason.  Dairy is certainly not essential to a healthy diet. There are plenty of other ways to get calcium and vitamin D. (And those who do not consume dairy need to take care to be sure they do.)  I recently did a podcast episode on the pros and cons of dairy. You can listen to it here.

Now, to Campbell's book: Lots of people commenting on this blog over the years have referenced this book as a definitive scientific rationale for various dietary practices.  Obviously, Campbell's prose is compelling. But I have to be honest with you: The science behind his conclusions is less so.

You're right: There are recent (2007) studies showing that milk increases the incidence of chemically-induced breast tumors in rats.  Interestingly, I also found a 2007 study showing that soy milk does the same thing. And another (2006) showing that fermented milk (yogurt) prevented tumors; and another (2001) showing that soy protein was preventive. 

It appears that studies on things that cause or prevent tumors in rats injected with carcinogens might not provide a definitive answer to the question: Do dairy products cause breast cancer in humans? For that, it makes sense to turn to studies that compare what people eat to their risk of breast cancer.

Do dairy products increase breast cancer risk in humans?

The so-called "China Study" was a nutritional analysis conducted in rural China in the 1980s. This study purportedly found a link between the intake of animal protein and an increased risk of cancer and other disease.  In the intervening 20 years, many researchers have tested this conclusion, specifically with regards to dairy and breast cancer.  Here's a brief sampling:

Enjoying Indian Cuisine: Exotic spices with healing benefits

The exhuberant Indian festival of Diwali, which takes place from October 26th through 30th this year, is a great chance to explore the healing benefits of Indian cuisine.

Although "Indian Cuisine" really includes dozens of distinct regional styles of cooking, there are certain spices that we associate specifically with Indian food.  Turmeric (the main ingredient in curry), ginger, cumin, cinnamon, coriander, mustard, and pepper are the most familiar of the classic Indian spices. But as anyone who has ever attempted to cook Indian food at home, the list of "essential" spices can be  quite long! (More on Indian cooking and spices.)

Spices do more than just flavor foods. in the Ayurvedic tradition, spices also balance and heal the body ; food is a big part of the healing arts. In the Western tradition, research has confirmed that many spices have potent biological activity. To list just a few:

• Turmeric (the main ingredient in curry) has powerful anti-inflammatory properties, comparable to the effects of hydrocortisone.  It's effective in reducing symptoms of irritable bowel disease and rheumatoid arthritis. It's also a potent antioxidant and has cancer-preventive properties.
• Ginger is also a potent anti-inflammatory, acting through the same biological mechanism as the COX-2 inhibitors like Vioxx--but without the deadly side effects. Ginger is also an anti-coagulant, which helps keep the blood from forming clots and also soothes irritated stomachs and nausea.
• Cinnamon helps lower blood sugar levels by making cells more sensitive to insulin (similar to the action of antidiabetic drugs).

Because many Indians are vegetarians, Indian restaurants are also a safe haven for vegetarians, who will find plenty to choose from on almost any Indian menu. 

A word of caution

Some Indian food, especially in restuarants, can be extremely high in fat.  To avoid eating too many calories, watch out for fried foods (like samosas or pakoras) and dishes with creamy sauces, like my favorite, Saag Paneer (creamed spinach with cheese cubes).

Eat slowly so that your body has a chance to signal your brain that it is full before you eat too much.  And, as many Indian restaurants offer buffets, keep in mind that the more different dishes you sample, the more you are likely to eat.  Choose a few favorites to savor and leave the rest for your next visit. (More tips for choosing healthy Indian food.)

Plan your own Diwali celebration this year

To sample the best of Indian cuisine and culture, look for Diwali celebrations in your area. (The White House will be celebrating Diwali, but it's probably hard to get tickets!).  I couldn't find any centralized listing of Diwali celebrations around the world but found several local events by googling "Diwali" and my city.

Or, plan your own celebration with some of these great recipes on our sister site Epicurious.com

Indian Spiced Carrot Soup with Ginger   (See ND's nutritional analysis)

Indian Shrimp Curry (See ND's nutritional analysis)

Curry Dusted Scallops with Pea Puree (See ND's nutritional analysis)

Happy Diwali!

Let's put this new fructose study into perspective

A recently published study is going to fuel the hysteria over high-fructose corn syrup. It's a terrific study. But, contrary to the headlines you are sure to see over the next days and weeks, it does NOT prove that high fructose corn (HFCS) syrup is the cause of the obesity epidemic. Let's take a closer look.

Researchers at the University of Florida found that rats who were fed a diet that was very high in fructose eventually became resistant to the hormone leptin.  Leptin is a hormone that regulates your appetite and disposition toward weight gain.  In the second half of the study, they switched the leptin-resistant rats to a high-calorie (high-fat) diet. The rats ate a lot more and gained a lot more weight than rats who had not been on a high-fructose diet. (Read more about the study: "Fructose hampers hormone that controls appetite.")

Now, what does this tell us about the effects of high-fructose corn syrup on humans? Very little. 

Aside from the obvious issue (the study was done in rats, not humans), the study had absolutely nothing to do with high fructose corn syrup. The diet that brought about leptin resistance was about 60% fructose, and contained no other form of sugar.  The typical (awful) American diet contains about 35% sugar, about half of which (roughly 17%) is in the form of fructose.

Incidentally, if every bit of HFCS in the food supply was replaced by regular old cane sugar, our fructose intake would still be around 17%.  That's because high fructose corn syrup contains about the same amount of fructose as sugar.

Like the best research studies, this one poses far more questions than it answers. For example, I'm dying to know whether you'd get the same results at 50% fructose. Or 40% or 30%. What's the threshold at which the effect starts to set in?

Secondly, I'd love to know whether you'd get leptin resistance with similar amounts of glucose or sucrose?  In other words, how much of this effect is specific to fructose and how much is just sugar? What's more significant: the amount of total sugar in the diet or the amount of fructose? How does dietary fat affect things? (In the study, the rats ate an extremely low-fat (5%) diet and the fat was lard.)

I imagine that researchers are queueing up to design studies that will answer these questions and more. (And we're still only talking about rats...)

Those who read this blog (or listen to my podcast) know that I think the hysteria over high-fructose corn syrup is misplaced. We should be alarmed by the amount of sugar in the American diet and what it is doing to our health. I think it probably is directly connected to our rising rates of obesity, whether through leptin resistance or other means. But I don't think it's worth worrying about high-fructose corn syrup, per se, while we're still getting 35% of our calories as sugar.

This whole thing reminds me a little of people who are freaking out about gas prices and dependency on foreign oil.  They're trading in their cars for models that will improve their gas mileage from 27 to 30 mpg.  But it never occurs to them to drive fewer miles.

Here's what we all agree on

I am sure that large quantities of fructose will cause health problems in rats and humans. I'm pretty sure that large quantities of any form of sugar will do that. Of course, the specific problems that develop will vary depending on what type of sugar you're over-consuming. Fructose is hard on the liver while glucose is more challenging to the pancreas.

But rather than argue about which form is more dangerous, what about working the problem from the other end of the equation? I"m talking about the "large quantities" part of the sentence.

Eat less sugar and you probably don't need to worry about HFCS

The World Health Organization recommends that you limit your intake of added sugars to 10% of calories.  They're not talking about sugars that are found naturally in whole foods, like fruit or milk. They're talking about refined sugars in things like candy, baked goods, soft drinks, and condiments.

For most Americans, this would mean cutting their sugar intake by two-thirds.  Whether or not HFCS is really that much worse than other forms of sugar (I'm still not convinced it is), I'm pretty sure that if we simply cut our consumption to a reasonable level, it simply wouldn't matter.   

Call me crazy.

Halloween Survival Guide

Halloween is coming and that usually means a big increase in how much sugar our kids are eating. (And I don't know about your house, but the kids aren't the only ones that get into the Halloween candy around here!)

Obviously, the ideal  amount of candy for kids (and kids-at-heart) is NO candy.  But this is not the time to play the hard cop. Here are some tips and strategies for allowing everyone to enjoy the holiday while containing the damage.

• Don’t let your kids start eating the candy they collect while they are still out trick or treating. If they’re eager to get home to have a piece of candy, they might be willing to stop with a slightly smaller payload.
• Set (and enforce) limits on how much candy may be eaten each day and when (i.e., only after meals).
• Halloween candy should be enjoyed instead of and not in addition to other sweets that the kids might otherwise have. Limit other sources of sugar such as sodas and sweetened drinks, sugary breakfast cereals, cookies, and desserts, while the Halloween candy is around.
• The World Health Organization recommends limiting added sugars to 10% of total calories. For a 90-pound 11-year-old, that’s about 50 grams of sugar per day. For a 40-pound six-year-old, it’s closer to 25 grams of sugar.

You can look up the amount of sugar or calories in most popular candy brands using our nutrient search tool. You'll notice that the candies that are lowest in calories are not necessarily the lowest in sugar. Candies with peanuts or other nuts, for example, are higher in calories but lower in sugar (more of the calories come from protein and fat).

By the way, although they are low in sugar and calories, I don't recommend giving sugar-free ("diabetic") candy to kids...the sugar alcohols can cause diarrhea, especially they you eat too much.

Candies that are lower in sugar (less than 20 g per “fun size” serving):

• Hershey’s Reeses Sticks
• Nutrageous
• Chocolate covered peanuts
• Hershey’s Chocolate Almond Bites
• Mr. Goodbar
• Reeses Pieces
• Kit Kat

Candies that are lower in calories (less than 100 calories per "fun size" serving):

• Bubble gum
• Twizzler's Bites
• Jelly Beans
• Bit-o-Honey
• York Peppermint Patty
• Tootsie Rolls
• Raisinets
• Gumdrops
• Skittles
• Starburst

Are there any candies that are both low in sugar AND low in calories?

The best option I could find were CocoaVia brand chocolates. Their bars and bites (with various fruits and nuts) are a bit lower in sugar and calories than most similar candy bars. Plus, they are extra high in those flavonoids that make chocolate so good for you. Unfortunately, they're not cheap.

Helping your kids enjoy the holiday in moderation is probably your best bet.

Meet Patrick Pete: Rewriting a family history of heart disease and diabetes

I have a friend who sets two or three alarm clocks to be sure she doesn’t oversleep. Sometimes it takes more than one wake -up call. 

At the young age of 39, Patrick Pete had already been diagnosed with diabetes, had surgery to place a stent in one of his arteries, and was being treated for high cholesterol. Then he was diagnosed with prostate cancer.

As he was recovering from cancer surgery, Patrick had an “A-ha” moment.

“I realized that the way things were going, I probably didn’t have a very long lifespan in front of me.  I figured I could either get depressed, or take action. I decided to take action. I started exercising and, for the first time in my life, I started really paying attention to my diet. 

"Nutrition Data helped me take control. I started by tracking my calories and fat and using the Better Choices to find more nutritious foods. I used the recipe analysis to come up with a bunch of different breakfasts, lunches, and dinners that had the right balance of protein, fat, and carbohydrates.  I really like that I can tailor it to fit my goals.

"I also want to make sure I get all the right vitamins and minerals. I try to get as much nutrition from whole foods as possible instead of just taking pills. ND helps me see what I'm missing and find foods that fill the gaps.

"When I use ND to track my intake, I can see a direct correlation between my diet and my body. When I increase my protein, I can see a difference in my work-outs. When I cut back on fat, I get leaner. I’m in the best shape of my life now. You know, when you’re 20 and in good shape, it’s just because you're 20. When you’re 40 and in good shape, it’s because you earned it! I’m proud of my body now, and my wife and daughter are, too. 

"My doctors are happy, too. My cholesterol numbers are great and my diabetes is well-controlled. And the only reason for that is that I finally made the decision to change my life. Heart disease and diabetes run in my family and I have watched a lot of people in my family die when they didn’t need to. At age ten, my own daughter already had a serious weight problem and I could see that she was headed down the same path.

You can not lead where you will not go

"Fortunately, I love to cook and cooking for my family is a way for me to teach my daughter about food. Believe me, we didn’t start out eating healthy in my family. We have to overcome that history, but I’m working at it. I’ve completely changed the way our family eats and cooks.  And we’re all healthier.

"I really believe that the only way we’re going to get our kids to be healthier is to convince parents that they need to have healthy lifestyles. We have taught our kids terrible eating habits. They’re not going to change until we change. You can’t lead where you won’t go.

"Now, I’m trying to reach out to other guys in their 30s and 40s and get them to take this stuff seriously. It’s a struggle. People usually don’t make a change until the pain of staying the same is greater than the pain of making the change.  But I want to tell people: Don’t wait! You may not get the chance to save your life.  I’m lucky. I got that chance.

"I want to tell people to be smart about their health.  Don’t trust what other people tell you. You need to do your own research. Ask for nutritional guides at restaurant.  Use the tools at Nutrition Data to learn what foods can do for you and what you’re putting into your body. And never give up!”

To read more about Patrick’s successful battle against cancer and diabetes and his ongoing quest for better health, check out his blog: U Can Be Healthy

Does brining change the nutritional value of foods?

Q. Does brining chicken (soaking raw chicken in a mixture of sugar, salt, and water overnight before cooking) change the nutritional values? Does it increase the amount of sodium and sugar in the chicken?

A. You bet it does!  When you soak chicken in a brining solution, it absorbs sodium (and sugar, if you're using it as well).  As it happens, the clever food scientists over at Cook's Illustrated recently did some analysis to find out just how much sodium is absorbed during the brining process. They found that a chicken breast brined for just 30 minutes absorbed about 350 milligrams of sodium per 100 gram serving.   

That doesn't mean that chicken brined longer would continue to absorb 700mg of sodium per hour.  As soon as the concentration of salt in the meat is the same as the concentration of salt in the brining solution, the chicken will not absorb any more sodium.

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