Weight watching

Got prediabetes? Change your diet now

April 24, 2008

Editor’s note: Catherine Bennett Dunster wrote the Health+Food column from June 2007 to April 2008.

“I was just diagnosed with prediabetes. My nurse practitioner said that it will likely become Type 2 diabetes if I continue my trend of gaining weight, even if it’s only a few pounds a year. Obviously, diabetes is something I’d like to avoid. Can you tell me more about this? What should I be eating?”

A prediabetes diagnosis is an excellent reason to make changes in order to prevent the progression to Type 2 diabetes. In prediabetes, the blood-glucose levels are abnormally high, but not quite high enough to be Type 2 diabetes. Unfortunately, according to the American Diabetes Association, long-term damage to the body — especially the heart and circulatory systems — is already occurring during prediabetes, so addressing the problem now is important.

Eating to avoid diabetes? Choose seasonal vegetables and other whole foods.

There are two types of diabetes: Type 1 and Type 2. Type 2 diabetes — affecting nearly one in four Americans — is a chronic metabolic medical condition and is by far the most common kind of diabetes. People with Type 1 diabetes, also known as “juvenile diabetes,” no longer produce insulin. People with Type 2 diabetes still produce insulin, but either they don’t produce enough insulin or their bodies are unable to use the insulin they do produce in the same way they would in a healthy, non-diabetic state. The latter is called insulin resistance, and is a hallmark of Type 2 diabetes.

Glucose is your body’s major fuel for energy, and insulin is what makes it possible for your cells to use this energy source. When you consume food, your body breaks down starches and sugars into glucose. Insulin then acts to open your body’s cells to allow the blood glucose into the cells to do its work — again, fueling all that your body does.

When there is a lack of insulin or the cells ignore the insulin (as in the case of insulin resistance), the glucose accumulates in the blood. Initially, your cells receive inadequate energy; over time, the high blood glucose can damage your heart, kidneys, eyes, and nerves, causing secondary complications.

Many adults put on a few extra pounds each year. This happens for a variety of reasons: decreased activity levels, metabolic changes with aging, and go-go lifestyles that squeeze out time for thoughtful meal planning, among other things. As you’ve found, that additional weight becomes problematic for some people over time.

Being overweight is a primary risk factor for Type 2 diabetes. According to the American Diabetes Association, weight loss will help you by lowering your body’s resistance to insulin and thus allowing insulin to better lower your blood-glucose levels. Also, weight loss improves blood pressure and blood-fat levels. Since diabetics are about twice as likely as non-diabetics to get heart disease, weight loss — if you are overweight — is a good idea.

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The best news? Even modest weight loss has been shown to be beneficial in Type 2 diabetics.

Nutrition tips

Get moving. Physical activity helps insulin to work better in your body, uses up excess sugar in your blood, and facilitates weight loss. Though that’s technically not a nutrition tip, I find that those who adopt a routine exercise program are more motivated to tackle dietary changes (and stick with them!). Find activities you enjoy, and do them vigorously on a regular basis. Of course, consult your health-care provider for prior approval.

Seek variety, balance, and moderation in your food choices. And keep your portions appropriate. Headline-grabbing it’s not, but sensible eating has outlived many a fad diet.

Keep it real. Yes, the supermarket is full of items labeled especially for diabetics and plenty of products laced with non-calorie or low-calorie sugar substitutes. But real, whole foods generally provide more in the way of overall nutrition and are hands-down more satisfying. Living on a diet of highly processed and artificially flavored foods provides minimal nutrients and even less taste. Instead, choose seasonal fruits and vegetables; whole grains; dried beans, lentils, fish, shellfish, and lean meats for protein sources; and non-fat or low-fat dairy products as the foundation of your diet.

Cut the fats. Minimize foods high in saturated fats, like fatty meats, poultry skin, full-fat dairy products, and fat-rich desserts. Choose cooking methods that don’t add much fat: poaching, baking, grilling, broiling, or roasting. Avoid fried foods. Pick healthy vegetable oils such as olive and canola (and there are many more, depending on your needs). And if you’re still eating anything laden with trans fats, quit now!

Plan ahead. Most people want to do the right thing, but are often tripped up by lack of planning. Stock your refrigerator and cupboards with foods you enjoy, and give some thought every week to meal planning. Adopting some very simple routines can not only save you time but will also bring you appetizing meals as the week unfolds. Kelly Myers shares some great ideas for advance planning and cooking.

Finally, I would strongly recommend a personal consultation with a registered dietitian for help in designing a healthy eating plan specifically tailored to you, your food preferences, and your nutrition goals. A dietitian can determine your total calorie requirements; recommend amounts of protein, fat, and carbohydrates; and assist you in planning your meals. For help in locating a qualified nutrition professional in your area, visit the American Dietetic Association website.

Catherine Bennett Dunster is a registered dietitian and a former instructor at Oregon Health and Science University. She lives with her husband and two children in Portland, Oregon.

There are 9 comments on this item
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1. by RM on Apr 24, 2008 at 3:50 PM PDT

I have type 2 diabetes. Despite exercise and oral drugs for the diabetes, my A1C was getting too high (10.1) last year and my Dr was recommending insulin. I had talked to dietitians/diabetes educators at OHSU and their advice was the same general low-fat small portions advice that everybody everybody has been giving for years.

I read “The Schwartzbien Principle” and “Good Calories, Bad Calories”. Both these folks blame obesity and other health problems on carbs rather than fats.

I decided to try to avoid carbohydrates. No Atkins, no specific diet or target amount of carbs, just avoid bread, cereal, milk, sugars, pasta, etc. I dropped my A1C to below 7 in 90 days.

I can’t believe that all diabetes educators don’t suggest that people try a low carb approach.

2. by Ronnie Fein on Apr 25, 2008 at 3:43 PM PDT

I agree completely about the carbs. I have “pre” diabetes -- high glucose but not yet diabetic, and had gestational diabetes when pregnant. I am not overweight and work out 3 times a week. I have measured blood levels after eating white potatoes, white rice, regular pasta and bread, and the glucose levels always go up more when I eat these particular carbs. No more french fries or garlic bread for me. They’re just not worth getting sick over. I’ll have an occasional baked potato. For me, brown rice, farro and sweet potato seem okay. They’re tasty and filling too.

3. by James Berry on Apr 25, 2008 at 7:57 PM PDT

Catherine: great column! Thanks for the advice.

4. by fyfielda on Apr 30, 2008 at 11:21 AM PDT

Catherine: I love your columns. You are a food lover who still cares about health by providing realistic information. Once again, you make me want to stay healthy and still enjoy good food.

5. by dawn on May 9, 2008 at 5:25 PM PDT

My parents have bad health problems. My dad has type 1 diabeties and my mom has had a few strokes. My mom is probably about 30 lb. over weaght and my dad want to loose about 15 lb. I am trying to help them the best i can for their health. I don’t like them taking all kinds of medication ( my mom expetialy ) would be the best recipes i can give them so they can loose their weaght so they can both start getting healthier. I am faithfull with my vitamins and healthy eating i am always serching for new things and new ways to stay in shap and healthy. But when i see my parents and hear about more medication their doctors are putting them on I just feel so bad because at one time i had very very high colesteral. It was over 200 and at that time i was only weaghing 105 and i am 5’4. My doctor did put me on medication but when i found out the side affects i stoped taking them right away and starting changing my diet. Now without taking any medication at all just taking my vitamines ( omega 3 fish oil mainly ) and eating very healthy i don’t have no health problems what so ever and i am now at a steady weaght of 125 thats where i been trying to get to and i have been this way for the last 2 years. . I want to have my parents do the same thing i have done but it is hard for me because i now live an hour away from them. What can i do?


6. by lee Martin on Nov 30, 2008 at 11:19 AM PST

can you give a sample of food for pre diabetes something easy quick. Thanks Lee

7. by Ronnie Fein on Nov 30, 2008 at 2:27 PM PST

Hi Lee

I cook very simple foods -- grilled chicken breasts, fish (mostly roasted salmon -- smear with some Dijon mustard and white horseradish and roast at 450 degrees for about 13 minutes for fish 1-1/4 inches thick). Side dishes are usually two vegetables. Good ones for diabetics who can’t have potatoes: peel some parsnips and carrots, slice into strips and coat with a film of olive oil. Sprinkle with a tiny amount of sea salt. Roast at 425 degrees until crispy. I am the author of Hip Kosher -- lots of easy, simple, low carb choices; Amerian cuisine. Also look at Mark Bittman’s How to Cook Everything, good suggestions with alternatives. My desserts -- mostly fruit -- also roasted with a sprinkle of cinnamon. Fresh orange slices sprinkled with mint and toasted chopped almonds. Does this help?

8. by Trixie on Sep 22, 2009 at 8:30 AM PDT

Hello everyone...I’m new here and love reading about the healthy side of things. Thanks for your tips. I’ll check out your book, Hip kosher.

I was overweight to the tune of 70+ pounds. I couldn’t afford gym memberships fees or things like Weight Watchers, etc., and forget calling Jenny.

To me it isn’t about losing weight as much as it is learning to eat healthy...for life. Period.

I’ve changed my own eating habits and food, dropping 32 pounds since May. I walk daily, very briskly, and it’s free. I never skip a meal, and never eat “white” things...(sugar, bread, etc). I work from home so planning my meals is a breeze.

Good luck to everyone. I just love this site!

9. by Kim on Sep 22, 2009 at 10:48 AM PDT

Georgia, welcome! What an inspiration you are. Thanks for your story.

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