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Dieting without exercise very unwise for diabetics

There are some things we know about diet and exercise, and this is important for diabetics.

Usually diabetics are dieting to lose weight and to reduce the waistline and abdominal fat.  Dieting is not really the issue, the issue is about a sustainable food plan - for life, not about dieting to get to the initial goal weight.

However that said dieting is an important initial step, and doing the right or wrong way has good and bad results.

For diabetics maintain skeletal muscles and active muscles is important as one aspect of insulin control.  Therefore dieting which reduces the amount of this muscle - muscle mass - is inappropriate and potentially with harmful consequences.

We know that when people diet without exercise that their weight loss comes from both fat and muscle loss, and this is especially true in older people and older people tend to be getting adult diabetes.  The effect is particularly unhelpful and unhealthy for older people since we are already losing muscle mass as we age anyway, unless we do something to stop that loss such as resistance training.

Therefore, for older diabetics who are aiming to lose weight it is quite important that they exercise and diet and not just diet.  Losing more muscle than they are already does not just negatively effect their body's ability to control diabetes but also their lifestyle - we need all the muscles we have left as we get on in life.

There is good news for older people who want to exercise to improve their muscle tone. Not only does exercise make most people feel better and perform physical tasks better, it now appears that exercise - specifically, resistance training - actually rejuvenates muscle tissue in healthy senior citizens. In a very encouraging piece of research from McMaster University in Canada (2007) it was found that:

...in the older adults, there was a decline in mitochondrial function with age. However, exercise resulted in a remarkable reversal of the genetic fingerprint back to levels similar to those seen in the younger adults. The study also measured muscle strength. Before exercise training, the older adults were 59% weaker than the younger adults, but after the training the strength of the older adults improved by about 50%, such that they were only 38% weaker than the young adults.

Researchers have noted that a side-effect of people exercising to lose weight is that they tend to believe that they can eat more and still lose weight.  But for exercise-based weight loss food intake needs to be constrained - my moto is eat 20% less and exercise 20% more and over time you'll reach your weight and exercise goals.

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NUTS ! that's old news for diabetics

The October 7 Lifestyle section of Seattle Post Intelligencer "Last updated October 7, 2008 9:52 a.m. PT" breathlessly announced that "newer research has found that eating a handful of nuts or a couple of tablespoons of peanut butter five times a week can lower your risk of Type 2 diabetes."

This "newer research" was reported in 2002 by WebMD and Diabetes in Control in 2007 and is all good news but not quite deserving of the "break through" coverage of the Seattle PI.

In fact the Seattle PI doesn't prove too insightful or helpful in its analysis of which nuts to eat, or why nuts were a "formerly forbidden snack". I guess the latter could well be because of the obsession with fat, but I never imagined that people would dessert their common sense.

These days, with the MUFA craze (monounsaturated fatty acids) nuts have come back into their own, along with rather inane advice to gobble up big on olives and chocolate.  For diabetics the 2002 Harvard study is useful - especially since it showed statistically that eating nuts and peanut butter was associated with lowered risk of type 2 diabetes in women during 16 years of follow-up across 83,000 subjects.

In a nutshell, so to speak, it showed a 28% lower risk for of developing diabetes in women who ate portions five or more times per week.  The risk lowered consistently as the number of portions rose.  That's an interesting finding because at some stage you would think that weight gain would come into play if excessive quantise were consumed and the diabetes risk would increase. These researchers found that this reduction of risk was independent of obesity - that is ever for overweight women the risk was also lower among those who ate nuts regularly.

We understand more now that the fatty acids in nuts can help the skeletal muscle cells better utilize insulin which is a benefit to those who are becoming type 2 insulin-resistant diabetics - so it holds it back to some degree. Peanuts contain a high ratio of MUFA and also contain fiber and magnesium, which decrease insulin resistance, and have also been inversely associated with risk of type 2 diabetes.

But be careful here, as the Harvard researchers did not ask what kind of nuts were consumed.  That's good news since it means that we don't have to be obsessed about what kinds of nuts.

As part of a diabetic dietary plan nuts should be used to replace other food intake, and particularly as a small snack to possible help overcome food or sugar cravings.  Like everything if you overeat nuts you'll put on weight and that's not going to help - so you have to control the total calories. The good news is that nuts tend to be filling and their fat, protein and fiber helps you feel full for longer. For this reason they tend to have a low glycemic index.

Nuts in general have been found by many studies to reduce the risk of metabolic syndrome, and while noone knows why its interesting that for example peanuts have been found to contain significant amounts of resveratrol in both the kernel and skin. The average amount of resveratrol in one ounce of peanuts (without skin) is 73 mcg/g. In comparison, red wine contains approximately 160 mcg/fluid ounce. Resveratrol is believed to be connected with lower cardiac risk.

However, if you want to make an optimum selection of nuts then you should include walnuts, which have been reported to have lower levels of total cholesterol, LDL (the dangerous form) cholesterol and Lp(a) ("lipoprotein a," another lipid compound that increases blood clotting and, when elevated, is considered a risk factor for atherosclerosis). In addition to their heart-protective monounsaturated fats, walnuts' concentration of omega-3 essential fatty acids is also responsible for the favorable effects walnut consumption produces on cardiovascular risk factors (and metabolic syndrome).

A study conducted at the University of Wollongong in Australia, published in the December [2004]issue of Diabetes Care, has found that including walnuts in the diet of people with type 2 diabetes helps to lower their levels of LDL - or "bad" - cholesterol. The results showed that eating 8-10 walnuts a day provided the body with the right amount of fats and fatty acids to counter insulin resistance, one of the main factors in the development of type 2 diabetes.

Also pick up some almonds and cashews, which have important complementary benefits. And Brazil nuts, hazelnuts, macadamias, pecans, pine nuts, pistachios are also in my regular mix - unsalted of course and perhaps raw - they say unroasted is better but I'm not really sure about that as there may be found out to be benefits either way - but unroasted is generally recommended but I like dry-roasted.

I would steer well clear of peanut butter, I am sorry to say since the studies gave this stuff their blessing - its calories are too high and you have to be a genius in reading labels to understand what additives might be in it.  I would also steer clear of chestnuts except in very small portions because they has 30 times the carbs (fiber removed) of the same weight of macadamia nuts, for example. If you are super-cautious then be aware that some studies have found excess selenium to be associated with the risk of diabetes, and Brazil nuts are rich in selenium.

See Nuts & Diabetes (PDF) for a neat summary. You might also consider throwing in sunflower seeds which are a great natural source of Vitamin E.

Looking for some nutty ideas -  follow these tips to enjoy more nuts as part of your diabetic food plan:

• As a great small snack to quell hunger or sugar cravings - measure into your hand a few;
• Make your own muesli at home using rolled oats, wheat bran, grated apple skin and chopped nuts of your choice;
• Team an unsalted pure-nut spread such as cashew or peanut spread with banana on high-fiber crackers;
• Mix crushed macadamias or walnuts with breadcrumbs, herbs, olives and onion for a tasty chicken stuffing;
• Sprinkle crushed walnuts through a tuna or roasted vegetable salad.
• Blend macadamias with a variety of fresh herbs, Parmesan cheese and olive oil for a deliciously different pesto;
• Mix crushed cashews, almonds and pecans to make a topping for low-fat yoghurt;
• Add chopped pistachios onto a piece of fish grilled with lemon juice and garlic;
• Sprinkle roasted pine nuts on appropriate GI-friendly pasta dishes.
• Or how about this - steam broccoli and cauliflower, soak raisins in very hot water to plump them up, heat oil over medium-high heat, and saute garlic until slightly golden. Add pine nuts and saute another minute. Pour garlic and pine nut oil over broccoli and cauliflower and toss with drained raisins. salt and pepper to taste;
• Or try this (minus the sugar) Tangy Coleslaw with dried cranberries and walnuts.

And measure yourself when trying these various options to see how your metabolism handles them, and then you'll know what you can continue to enjoy. Go nuts, in moderation !

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Diabetic footwear design lessens foot complications

The rate of diabetic foot amputations is high in India, which has around 30 million diabetics.

The number of these surgeries can be considerably reduced with proper foot care and it is said that an ordinary running shoe is sufficient for most diabetic patients. But special footwear is required for patients who suffer foot deformities.

The Diabetes Research Centre at the MV Hospital has tied up with the Harvard Medical School, Boston, U.S for a research to design footwear for diabetic patients who face risk of amputation.

The two institutions have shared information on diabetic foot complications, its treatment and prevention, which has benefited around 900 medics and paramedics since 2003. Two workshops have already been held and the third is under way, reports MedIndia.

The MV Hospital for Diabetes was established by late Prof. M.Viswanathan, Doyen of Diabetology in India in 1954 as a general hospital. In 1971 it became a hospital exclusively for Diabetes care. Over the years this has grown to be one of the largest referral centers for diabetes, amazingly, with "more than 2,00,000 patients registered to-date".

It has a special branch to design and deliver the footwear, appropriately called The Diabetic Foot Clinic of MV Hospital for Diabetes (Royapuram, Chennai, India).

The diabetic is especially susceptible to foot complications because of the poor blood circulation to the foot and leg. This condition is called Peripheral Vascular Disease (PVD) or arterial insufficiency and nerve disease is called peripheral neuropathy.

Aspects of prevention must include the maintenance of as near to normoglycaemia (normal blood glucose level) as possible. This is accomplished by a team approach, reinforcing lifestyle adjustments in eating and exercise patterns , pharmalogical support in the form of oral or parenteral hypoglycemia agents , and last but not the least , continuous and sustained diabetes education and support. The person with diabetes must be advised on how to care of the foot.

MV Diabetic Foot provide a list of the DOs and the DONTs which are very important reading for diabetics.

This is interesting and leading work, from a very focused institution and obviously a world leader, although seemingly little known outside India.

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