The front line to quell the obesity and type 2 diabetes epidemic in African Americans starts with food selection. What you eat and how much and how often you eat it directly correlates to the body’s ability to use the food (starches and sugars) as (glucose) energy for the body. If it can’t use it – the energy gets stored as fat – and typically, there’s not an unnoticeable place to hide it. Add physical inactivity to a high fat, high carb diet day in and day out – it’s a recipe for type 2 diabetes, the most common form of the disease. Children and adolescents are getting this lifestyle disease as well, because of diet and little or no exercise.
“You need to lose the weight, get the exercise and take your medicine,” said Dr. Yolanda Bledsoe, an internal medicine specialist in Florissant, Mo.
“Really focus on losing five or 10 percent of what your bodyweight is now. And then from there, going on, talking to your doctor about how much more you need to lose.”
A sweet binge with coconut cream pie a few years ago sent James Davis of St. Louis well over the edge. He remembers that pie well. A friend of his wife was selling the frozen pies as a fundraiser for her church.
The US Dept. of Agriculture (USDA) database of added sugars in selected foods analyzed the sugar content in each serving/slice (1 serving = 100 grams of pie) of a commercially-prepared coconut cream pie as follows: 37.20 g of carbohydrates; 36.27 g of total sugars and 32.8 g of added sugars.
“I sat down and had one slice of coconut cream pie – then I had another slice … then I had another slice…” he laughs. This sugar overload turned out to be pivotal.
Latinos, Native Americans, Asian Americans, Hawaiians and Pacific Islanders are also at increased risk for type 2 diabetes, and the medical community says millions of people are unaware of their risk, or already have diabetes and don’t know it.
Insulin is the hormone in the body that takes sugar from the blood to be used as energy for the cells. In type 2 diabetes, either the body does not produce enough insulin or the cells are ignoring it. This leads to a build up of sugar (glucose) which can cause serious diabetes complications, such as blindness, , hearing loss, heart disease, kidney failure and leg and foot amputations.
Because it is a systemic disease, diabetes affects all functions of your body and uncontrolled diabetes has sent many people to an early grave. The Centers for Disease Control and Prevention says diabetes is the sixth leading cause of death in the U.S.
Symptoms of type 2 diabetes may include excessive hunger and thirst; frequent urination, unexplained weight loss, sudden vision changes; tingling or numbness in hands or feet; feeling very tired much of the time; very dry skin; sores that are slow to heal and more infections than usual.
Davis didn’t have all of those symptoms. Shortly after finishing off the pie, he began an unending trek back and forth to the bathroom to urinate that made him realize something was really wrong. He went to the doctor.
“And I ate one whole pie in one day – that coconut cream pie and bingo, right behind that, I started running to the bathroom the next day or so, and I called the doctor,” Davis said.
“The sugar count was around 400 and something – 450, 480 – it was way up there,” Davis recalled.
For people who do not have diabetes, normal blood glucose levels range between 70 to 120 before eating, according to NIDDK, the National Institute of Diabetes and Digestive and Kidney Diseases. Blood glucose goes up after eating, but return to the normal range in a couple of hours.
For diabetics, NIDDK says desirable blood glucose ranges are 70 to 130 before meals and below 180 within one to two hours of beginning a meal, according to what your health care professional decides.
Davis had little family history of diabetes other than his grandfather. His doctor at the time prescribed lifestyle changes that helped him get his blood sugars and his health in check.
“He told me several things he wanted me to do. First of all, cut the white sugar…drink lots of water…lose about 10 or 15 pounds,” Davis said. “And since that time, it’s been five or six years or so when I was first diagnosed with it and I brought the sugar count down.”
Because his pancreas is still capable of producing insulin, Davis takes a daily pill, Glipizide, to stimulate insulin production. His primary care provider considers him a model diabetes patient.
“Patients with diabetes should be seen at least every three to four months and have regular blood work; he complies with all of his appointments, follows his diabetic diet(mostly), and exercises to the extent that he can,” said Dr. Denise Hooks-Anderson. “He has received all of his recommended vaccines, and sees the podiatrist and ophthalmologist regularly as well.”
Davis puts a dash of cinnamon in his coffee everyday. Instead of coconut cream pie, Davis’ slice of life means kicking sugary sweets to the curb, and now the only honey that sweetens his life these days is his wife, Joyce.
“My wife told me she is proud of me,” he said.
Davis walks to stay active, although admits he doesn’t exercise as much as he should. Changes he made for diabetes helped Davis with hypertension as well.
One tool to help maintain a steady glucose level is by selecting food starches and carbohydrates that are low on the glycemic index, or GI. The glycemic index is a list of carbohydrate foods that are ranked on a scale of 0-to 100, based on how the quickly the foods increase blood sugar (glucose) levels after you eat them. Research indicates that a stable, controlled blood sugar levels benefit health, while fluctuations in blood glucose may be an important factor in diabetes and heart disease. Foods that don’t contain carbohydrates do not have a GI.
High GI foods rank at 70 and above; medium GI foods are between 56 – 69; and low glycemic foods index at 55 or lower. High glycemic foods cause a quick rise and fall in blood glucose and insulin levels – spikes that occur because the body quickly absorbs them. Because they are digested so quickly, persons become hungry again faster and the spikes may also result in higher stress hormone levels.
A diet loaded with a full menu of high GI foods may also lead to eating too much, weight gain, obesity and type 2 diabetes.
Low glycemic foods, on the other hand, take longer to digest and gives the body a stable, steady supply of the energy it needs. As a result, diets abundant in low GI foods don’t get hungry again as fast, reduces overeating and helps reduce the risk of weight gain and diabetes.
Examples of low glycemic foods include non-starchy vegetables, pears, apples and berries, whole grains, nuts and legumes; and some diary foods, such as unsweetened yogurt and cheese.
Foods that have high glycemic values include starchy vegetables, most highly processed foods; most refined sweeteners and sugars (they calories with almost no nutritional value); pastas and breads made with refined white flour; and tropical fruits.
How the food is prepared and how long it is cooked changes its GI value. The American Diabetes Association as a general rule, the more cooked or processed a food, the higher the GI, with some exceptions.
Paying attention to the GI is not a substitute for carb and portion control. The ADA says balancing total carbohydrate intake, portion control, with physical activity and diabetes pills or insulin (if needed) is key to managing blood glucose levels, because studies show that total carbohydrate amounts in food is a stronger predictor of blood glucose response.
“Diabetics, we really want them to be consistent in their control of carbohydrates, i.e., everyday, having a certain amount of carbohydrates with each meal as opposed to very frequently throughout the day. That’s better control of their diabetes,” Dr. Bledsoe said. “Weight loss is a large component of helping someone to have control of their diabetes, if they are overweight. I think it is more important than the glycemic index.”
The glycemic index is only one tool to use in conjunction with a balance of good proteins and fats for healthy eating and nutrition, along with insulin or diabetes pills. Your meal plan has to work for your lifestyle as you work to maintain good glucose and cholesterol levels, normal blood pressure and a healthy weight.
For more information, go to diabetes.org, or the glycemicindex.com.
