November is National Diabetes Month, which presents a valuable opportunity to raise our awareness about this serious, but often very preventable disease. Although Type I diabetes is linked to genetics, Type II diabetes-often called "Adult Onset" diabetes—develops largely as a result of our diet and lifestyle.

In the United States, at least 13 million people—or 5 percent of the population—are diabetic, although the disease remains undiagnosed in approximately half of these individuals.

American culture, cuisine and technology have conspired to make our lives more sedentary, foods high in fat and sugar more plentiful, and opportunities to eat more frequent.

There are many things we can do naturally to help prevent and treat diabetes, and taking a hard look at our diets should be of the highest priority.

International comparisons show that the prevalence of diabetes is linked positively to high cholesterol levels, and the intake of saturated fat, animal protein and sugar.

In 1979, the American Diabetes Association revised its dietary recommendations to suggest that diabetics move away from the typical high-fat, high-protein diet that had long been recommended to one that is high in fiber and complex carbohydrates, and low in fat.

The American Diabetes Association advocates that we consume 20-35 grams of dietary fiber daily. Soluble fiber, such as the kind found in oatmeal, beans and other vegetable foods, has been shown repeatedly to help control blood sugar levels by delaying glucose from entering the bloodstream, to reduce insulin sensitivity and to significantly lower total cholesterol and LDL ("bad") cholesterol. 1, 2

As numerous studies indicate, reducing fat intake—especially the saturated fat typically found in meats, cheeses and other dairy products—and replacing it with monounsaturated fat, such as that found in olive oil, can greatly increase insulin sensitivity. 3, 4

Although not all diabetic patients may decide to become vegetarians overnight, incorporating more plant-based proteins, such as soy products, beans and other legumes, as well as nuts and seeds, is a very healthy step.

Diets based on complex carbohydrates, like whole grains, beans, fresh fruit and vegetables—with reduced meat and total fat intake—not only increase insulin sensitivity for more controlled blood sugar levels, but also significantly reduce insulin requirements for most patients.

Research suggests that consuming a Mediterranean type diet—substituting carbohydrates and monounsaturated fats for saturated fats—improves both insulin sensitivity and glucose tolerance. 3

To get the right carbohydrates in your diet, choose whole, unprocessed foods-—like brown and wild rice, whole wheat pita bread, yams, oatmeal, popcorn, nuts, seeds, and most peas and beans—rather than low-fiber, refined flour products, such as processed white breads and rolls, and the majority of store-purchased baked goods.

Not only will whole, unprocessed carbohydrates promote a more gradual energy release than processed and refined foods, these healthier options are also higher in nutrients and fiber.

An excellent tool to help guide you to the healthiest diabetic food choices is the glycemic index of foods. This index is defined as a ranking of foods based on their immediate effect on blood sugar levels.

Carbohydrates are not all created equal where you digestion is concerned. Those carbohydrate foods that break down quickly during digestion have the highest glycemic indexes. Their blood sugar response is very rapid.

Carbohydrates that break down slowly and release glucose gradually into the blood stream have low glycemic indexes.

Foods with the highest index numbers should be minimized by diabetics, while foods with lower index numbers that convert to glucose more slowly should be emphasized for healthy blood sugar balance.

Many high-carbohydrate foods common to Western diets produce a high glycemic response in a way that may be conducive to body fat gain. In contrast, diets based on low-fat foods that produce a low glycemic response (low-GI foods) appear to enhance weight control, minimize insulin secretion and maintain insulin sensitivity. 5

The table below, drawn from the Glucose Revolution: The Authoritative Guide to the Glycemic Index, 6 provides an overview of commonly consumed foods and where they fall on the glycemic index.

For more information on the glycemic index, visit www.glycemicindex.com.

Although Type II diabetes is a dangerous condition, it is also a very preventable one. Taking action now by making simple dietary changes can help ensure a long, healthy and diabetes-free life.

References

1 Keenan JM, Pins JJ, Frazel C, Moran A, Turnquist L. "Oat ingestion reduces systolic and diastolic blood pressure in patients with mild or borderline hypertension: a pilot trial". J Fam Pract 2002 Apr;51(4):369

2 Tabatabai A, Li S. "Dietary fiber and type 2 diabetes".Clin Excell Nurse Pract 2000 Sep;4(5):272-6.

3 Perez-Jimenez F, et al. "A Mediterranean and a high-carbohydrate diet improve glucose metabolism in healthy young persons". Diabetologia 2001 Nov;44(11):2038-43.

4 Vessby B, et al. "Substituting dietary saturated for monounsaturated fat impairs insulin sensitivity in healthy men and women: The KANWU Study". Diabetologia 2001 Mar;44(3):312-9

5 Brand-Miller JC, Holt SH, Pawlak DB, McMillan J. "Glycemic index and obesity". Am J Clin Nutr 2002 Jul;76(1):281S-5S.

6 Jennie Brand-Miller, Thomas M.S. Wolever, Stephen Colagiuri and Kaye Foster-Powell (1999). The Glucose Revolution: The Authoritative Guide to the Glycemic Index. Marlowe and Company, New York.