Sugar and spice is not always so nice for the 20.8 million people who have diabetes, about 30% of whom are undiagnosed. Just the right balance of foods in controlled amounts eaten during carefully timed meals and snacks is vital for living well with diabetes. For another 41 million who are pre-diabetic, following the same basic guidelines improves their chances of remaining diabetic-free or delaying its start or severity.

Diabetes Facts

Diabetes is a health condition of excess blood sugar resulting from inadequate or poorly functioning insulin, which is the body’s hormonal means of processing energy. The vast majority of diabetics are diagnosed as Type 2. Older age, obesity, family history of diabetes and physical inactivity increase risk for diabetes, and higher incidences are seen among African-Americans, Latinos, some Asian-Americans, Native Americans and Pacific Islanders. Children and adolescents are an emerging age group of increased diabetes diagnoses, particularly among the same ethnic groups.

Other types of diabetes include Type 1, when the pancreatic beta cells that make insulin are destroyed, and gestational, diagnosed in some women during pregnancy. Gestational diabetes can continue post-partum or increase the likelihood of developing the disease later in life.

Pre-diabetes is characterized by having an abnormally high blood sugar level, yet still below the diabetic threshold. Progression to diabetes can be prevented or delayed through weight loss and more physical activity. Coffee lovers will enjoy knowing that researchers at the University of California in San Diego found that people who drink coffee—including those who used to drink it but quit—are less likely to get Type 2 diabetes than those who never drank it. Unlike previous studies, this new research included people who were already at clinically evident risk for diabetes. Drinking caffeinated coffee reduced the risk of developing Type 2 diabetes by as much as 60%.

Uncontrolled, diabetes can lead to serious complications such as blindness, kidney failure, nerve damage, limb amputations and premature death. It is also associated with higher rates and risk of obesity, heart disease, stroke, high blood pressure and elevated cholesterol. Yet it can be a very manageable disease; many Type 2 diabetics lose excess weight, stick to a prescribed meal plan, exercise regularly and take oral medication to successfully control their blood sugar.

Diet Derails Diabete

To prevent, better manage and minimize diabetic complications, the American Diabetes Association (ADA) developed specific Food Guidelines for the best individual meal plans, tailored to medical categories for the very first time. “There is no ‘one size fits all’ diet,” said Ann Albright, PhD, RD, president-elect, Health Care & Education, ADA. Published in the September 2006 issue of Diabetes Care, the recommendations update prior statements using the most recent scientific data available, emphasizing the importance of weight management and physical activity. For those at risk for diabetes, the guidelines advise 14g of fiber for every 1,000 calories and nutrient-rich foods, with whole grains making up half of all grain intake. Specifics for diabetics include carbohydrates from fruits, vegetables, whole grains; legumes and low-fat milk; fiber-rich foods; saturated fats limited to less than 7% of total caloric intake; at least two servings of non-fried fish weekly; limited trans fats; and cholesterol restricted to less than 200mg/day.

“Calories, protein, carbohydrates and fiber are most important, and omega-3s are a healthy plus,” says dietitian Lisa Stollman, MA, RD and a certified diabetes educator who recommends Kashi TLC Granola Bars as a healthy snack for active diabetics. “The Kashi cereals are also excellent, as most are very high in fiber and low in sugar," she concludes.

University of Massachusetts Amherst researchers found that fruit-enriched yogurts—especially those made with blueberries or made from soy—contain active natural compounds that may curb some aspects of diabetes.

Cloves and Carbs

As part of a continuing effort to improve communication and understanding of how the carbohydrate content of a given food will affect blood glucose levels, the Glycemic (Net) Carbohydrate Definition Committee approved definitions related to glycemic carbohydrates in September 2006.

Perhaps cinnamon and spice can make it nice. Studies presented at The Federation of American Societies for Experimental Biology 2006 conference support earlier findings of cinnamon’s ability to lower glucose and improve insulin function; one quarter to half a teaspoon of cinnamon twice a day decreased risk factors for diabetes and cardiovascular disease by 10% to 30%. In a related study, extracts of cloves were also found to benefit insulin function and lower glucose in people with Type 2 diabetes and, when taken off clove supplementation for 10 days, their glucose began to rise somewhat but remained significantly lower than at the beginning of the study. The finding that an intake of 1g to 3g of cloves per day lowered risk factors of diabetes strongly suggests that cloves are beneficial for people with Type 2 diabetes.

Eat Well Be Well Foods has announced a line of diabetic-friendly healthy products. Free of sugar, sugar-alcohols, trans fats, refined and simple or “hidden” carbohydrates, these cereals, instant oatmeal, cereal and chocolate bars are described as containing “slow burning” complex carbohydrates. Because carbohydrates must be carefully balanced for effective diabetic meal plans, “simple” vs. “complex” has been the long-standing common carbohydrate description. Today it is the Glycemic Index (GI), “A scientific classification system for the glycemic response of carbohydrate-containing foods proposed by David Jenkins of the University of Toronto and his colleagues in the early 1980s, developed to help guide food selection,” presented Michael Mansueto Leidig, RD, research manager, Children’s Hospital in Boston, during “The Glycemic Index: Research or Clinical Tool” session at the American Dietetic Association 2006 Food and Nutrition Conference & Expo in Honolulu, Hawaii.

Glycemic index values are determined by measuring the blood response to various test foods relative to the resultant rise from white bread or glucose as the standard. Several factors can influence GI value, such as physical form. “When the body doesn’t have to work as hard to digest (carbohydrate), it enters quicker,” said Leidig, noting that spaghetti cooked al dente has a lower GI than spaghetti cooked twice as long. The presence of fat, protein, acidity, fiber, amylase and amylopectin all slows glycemic response, thus lowering the GI. Yet, “Low-GI foods are still important in mixed meals,” asserted Leidig, “Low GI is better for diabetes. High insulin secretors eating a low-GI diet lost the most weight,” he reported.

Grains and the GI

Jell-O Sugar Free Reduced Calorie Pudding Snacks use a sweetener system of xylitol, sucralose and acesulfame potassium. The pudding is certified by the American Diabetes Association.

Leidig finds that while vegetable, fruit and dairy are relatively easy to guide for patients, grains are the most challenging. His key guidelines for low-GI foods are non-starchy vegetables including carrots and peas, non-tropical whole fruit, unsweetened milk, soy and yogurt. His recommendation for starchy foods includes barley, brown rice, al dente pasta, quinoa, steel cut oats, All Bran, Bran Buds—any wheat or oat-based cereal with a minimum of 4g of fiber over corn/rice-based varieties; Rye, pumpernickel or 100% whole wheat breads like Mestemacher, Hunger Filler or Natural Ovens containing 3g to 4g of fiber per ounce; and snacks with 3g of fiber per 100 calories like Rye Crisp Ryvita. Leidig encourages practitioners who counsel diabetics to become familiar with the International Table of Glycemic Index and Glycemic Load Values but cautions, “Don’t provide values to them.”

 As part of a continuing effort to improve communication and understanding of how the carbohydrate content of a given food will affect blood glucose levels, the Glycemic (Net) Carbohydrate Definition Committee, led by Julie Miller Jones, PhD, of the American Association of Cereal Chemists (AACC) International’s Board of Directors approved definitions during September 2006 related to glycemic carbohydrates:

n Available carbohydrate is carbohydrate that is released from a food in digestion and which is absorbed as monosaccharides and metabolized by the body.

n Glycemic response is the change in blood glucose concentration induced by ingested food.

n Glycemic carbohydrate is carbohydrate in a food that elicits a measurable glycemic response after ingestion.

n Glycemic impact is the weight of glucose that would induce a glycemic response equivalent to that induced by a given amount of food.

“The work of this committee was to try to define the terms so that food manufacturers might know what terms to use,” said Jones who is also professor of Food Safety and Nutrition, College of St. Catherine, St. Paul, Minn.

Companies are capitalizing on the GI trend. The Natural Whole Food Bar (TNB) announced the results of its glycemic evaluation. The official report received from Dr. Alexandra Jenkins, PhD, RD, director of research for the Glycemic Laboratories Inc. in Toronto, is that the “Crunchy Almond” bar has tested out at a GI of 22.2 and the “Crunchy Peanut” has tested out at 24.9. The results, according to Jenkins, indicate that The Natural Whole Food Bars “have a low glycemic index.”

Matters of Taste

Research presented at The Federation of American Societies for Experimental Biology 2006 conference showed that one quarter to half a teaspoon of cinnamon twice a day decreased risk factors for diabetes and cardiovascular disease by 10% to 30%.

Besides getting the numbers to work, what about taste? Diabetic Food Critic Bytes is a website where diabetics can share their food critic opinions. Sean Hughes, founder and “head critic,” introduced www.diabeticfoodcritic.com as a tool for diabetics to help find goodtasting food. The site features columns on various supermarket products based on taste, packaging and dietary information reviews. "The website has a rating system of 100 to 500, with 100 being the highest rating a product can receive. (Consider 100 as a good blood sugar reading.) It has an easy-to-read list that a reader can view to see previous reviews and what rating the product received. We also encourage our visitors to provide suggestions on what foods should be reviewed and feedback on previous reviews," Hughes said. NS

Sidebar: Chromium Picolinate and Insulin Resistance

In August 2005, the FDA issued a favorable response to a qualified health claim petition filed by a supplier of chromium picolinate. The FDA’s Center for Food Safety and Applied Nutrition noted that, “One small study suggests that chromium picolinate may reduce the risk of insulin resistance, and therefore possibly may reduce the risk of Type 2 diabetes.” In its usual cautionary stance, the FDA added, “the existence of such a relationship between chromium picolinate and either insulin resistance or Type 2 diabetes is highly uncertain.” (See www.cfsan.fda.gov/~dms/qhccr.html.) However, a more positive report on chromium’s potential role in human metabolism can be found at Oregon State University’s Linus Pauling Institute’s website on Micronutrient Information Center, which notes one research paper as saying that chromium supplementation was found to improve some measure of glucose utilization or to have beneficial effects on blood lipid profiles in 12 out of 15 controlled studies of people with impaired glucose tolerance. (See http://lpi.oregonstate.edu/infocenter/minerals/chromium.)

—PF Editors

Sidebar 2: On the Web: DIABETES

www.diabetes.org — American Diabetes Association

www.ajcn.org/cgi/reprint/76/1/5.pdf — International table of glycemic index (GI) and glycemic load (GL) values

www.PreparedFoods.com — Type “Sweet Combinations” into the LINX search field on the home page for information on formulating with various sweetener systems