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The Honolulu Advertiser
Posted on: Sunday, July 1, 2001

Exercise, nutrition help avoid diabetes

By Laurie Steelsmith

Good news! Residents of Hawai'i are reported to have a lower-than- national average risk for heart disease. The bad news, however, is that they have an above-average risk for diabetes. There are an estimated 80,000 people with diabetes in the state, according to the Hawai'i State Diabetes Control Program. Furthermore, mortality rates for Native Hawaiians with diabetes are more than two times the rate of other ethnic groups in Hawai'i.

Diabetes appears when the body cannot properly utilize simple sugar, glucose. Diabetics have high levels of glucose in their blood resulting from their bodies' inability to secrete insulin (a hormone which shuttles glucose into cells) or to properly utilize the insulin that is secreted.

Your physician can order a fasting blood glucose test to diagnose diabetes. Normal values are between 70 and 110; diabetes is diagnosed if values are greater than 140. Diabetes can be monitored with glucose and Hemoglobin A1c blood tests. Risks associated with uncontrolled diabetes include heart disease, stroke, high blood pressure, blindness, kidney disease and nerve damage.

There are two types of diabetes, Type I and Type II.

Type I diabetes, also called "juvenile diabetes" because its symptoms usually manifest early in life, accounts for only 10 percent of diabetic cases. Type I diabetics are insulin-dependent because the cells in the pancreas which manufacture insulin are not functioning. The exact cause of Type I diabetes is unknown. It may be an inherited disorder, or may be due to a viral infection or an autoimmune disorder (meaning that the immune system has made antibodies to the pancreatic cells which secrete insulin).

Type II diabetes is far more common. It represents 90 percent of all diabetic cases and accounts for the majority of cases in Hawai'i. Type II diabetes manifests later in life and does not always require the use of insulin. The insulin that Type II diabetics produce either is insufficient in amount or, what is produced, isn't functioning properly. Insulin insensitivity causes cells to become starved for sugar.

Type II diabetes is associated with obesity (one study reported that 90 percent of patients with Type II are obese), inactivity and a history of poor dietary habits.

What can you do to prevent Type II diabetes? Make the same dietary and lifestyle changes you would make to prevent heart disease and many other chronic degenerative conditions!

Eat regular, well-balanced meals and maintain a healthy weight, recommends the American Diabetes Association. Eat low-fat proteins such as skinless chicken breast, extra-lean meats, fish, and bean-based proteins like tofu. An abundance of fruits and vegetables is essential to any healthy diet. A healthy diet also incorporates complex carbohydrates rich in fiber like beans, whole-grain breads, and grains such as brown rice and barley.

A way to evaluate a carbohydrate's effect on your body is to use the glycemic index. The glycemic index rating of a carbohydrate determines how quickly it converts to glucose in your body. Typically, a fiber-rich food has a low glycemic index. Brown rice, for example, converts slowly to glucose in your body, so it's a good carbohydrate choice for stabilizing glucose levels. Some foods, like white rice and baked potatoes, have a high glycemic index; they convert into glucose very quickly, thus causing a rapid rise in blood sugar. These foods are not good choices for a diabetic. An excellent book about the glycemic index is, "The Glucose Revolution: The Authoritative Guide To The Glycemic Index" by Jennie Brand-Miller.

Limit fat intake: A high-fat diet can decrease insulin sensitivity and contribute significantly to heart disease. Avoid saturated fats and don't use margarine because its trans-fatty acids can contribute significantly to the development of heart disease.

Exercise: For diabetics, exercise helps with weight loss and increases cell sensitivity to insulin. Exercise helps decrease heart disease risks by lowering cholesterol and triglycerides (fats in the blood).

My next column will cover nutritional and herbal supplements that Type II diabetics can take to help control their diabetes. In addition, Dr. Julian Whitaker's book, "Reversing Diabetes," outlines a diet and nutritional program that many of my patients have used to bring their weight down and keep their diabetes under control.

Type II diabetes, for many people, is preventable. By making positive dietary and lifestyle changes, the people of Hawai'i have the choice to lower their odds of contracting this disease.

Laurie Steelsmith is a naturopathic physician and licensed acupuncturist in Honolulu.

Hawai'i experts in traditional medicine, naturopathic medicine, diet and exercise take turns writing the Prescriptions column. Send your questions to: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.