Q&A: I have prediabetes. What should I eat?


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November 5, 2013

Q: What should I eat if I’ve been told by my health-care provider that I have prediabetes? I’m confused by the conflicting messages I hear and read.

A: November is an apt month to answer this increasingly common question. It’s American Diabetes Month.

You didn’t detail the conflicting messages you’ve gotten, but as a dietitian and diabetes educator, I hear and read many. Let me take a guess. Your health-care provider, to offer simple advice, might have said “don’t eat anything white” or “lose weight.” If you scoured the Internet, you probably spotted promises of reversal or a cure if you “eat only low-glycemic-index foods” or “eat low-carb.” Or you might hear pleas to become vegan.

“Many people think their number-one priority is to no longer let sugary foods and sweets pass their lips. That’s in part because diabetes has been synonymous with sugar through the ages,” says dietitian and diabetes educator Tami Ross, the 2013 president of the American Association of Diabetes Educators and co-author of “What Do I Eat Now? A Step-by-Step Guide to Eating Right With Type 2 Diabetes.”

Yes, the nutrition advice you’ll hear for prediabetes can be contradictory, oversimplified and impractical for the long haul. Yet research has revealed plenty about how a person with prediabetes should eat to remain diabetes-free as long as possible.

The central goal? Reverse insulin resistance. Insulin resistance is the body’s inability to effectively use the insulin it makes. To keep glucose in control, the pancreas goes into overdrive to produce an increasing supply of insulin. At the same time, the body’s insulin supply is slowly dwindling. At the point when there isn’t enough insulin to control glucose levels, glucose rises higher than normal and into a prediabetic range and then into the diabetic range if prediabetes isn’t diagnosed first.

Studies conducted around the globe, including the large and lengthy Diabetes Prevention Program (DPP), a multi-center study funded by the National Institutes of Health, conclude the following: Losing weight, about 5 to 7 percent from a starting weight, and keeping as much of that weight off as possible (research shows people regain at least some of the lost weight), paired with sufficient physical activity, at least 150 minutes per week, can significantly delay or prevent Type 2 diabetes. Physical activity also improves insulin sensitivity, but research shows weight loss is the more powerful weapon.

These prevention studies show that though it seems intuitive to drastically restrict carbohydrates to control glucose levels, that’s not the priority. “Research shows the winning prescription is to eat healthy, following the principles of the Dietary Guidelines for Americans, while shaving pounds and developing skills to keep the weight off forever,” says dietitian and diabetes educator Patricia Davidson, an assistant professor in nutrition at Pennsylvania’s West Chester University and chairman of the Academy of Nutrition and Dietetics’ Prevention of Type 2 Diabetes Evidence Analysis, a review of research into prevention efforts. Studies reviewed by this group showed that a small amount of weight loss achieved with a healthful eating plan quickly lowered glucose levels, blood fats and other measures that often go awry with insulin resistance, Davidson says.

The DPP encouraged participants to first get a handle on their fat consumption as a direct route to reducing total calories. How to do that? One way is to focus on how you prepare food. For example, limit the butter or oil used to saute vegetables, mash potatoes or scramble eggs. Next limit the fats and oils added to foods before eating, including butter, margarine, cream cheese, sour cream and salad dressing.

The next focus if need be? Further reduce total calories by looking at the types and amounts of carbohydrates you eat. “People think Americans eat vast amounts of carbohydrates. We don’t,” Davidson says. We get a bit less than half our calories from carbohydrates — though for many people that’s within the context of too many calories.

The bigger problem with many of our carbohydrate-containing foods is their less-than-stellar nutrition quality. Many contain too much added sugar, are made from refined grains and/or are low in fiber. We don’t eat enough low-fat dairy foods, whole grains, legumes, fruits and vegetables: the most fiber- and nutrient-dense sources of carbohydrates. Another finding Davidson shared from the evidence analysis was that when people ate a moderate amount of carbohydrates, about 45 percent of calories, and chose foods with a lower glycemic impact, this led to lower glucose levels after eating regardless of weight loss.

As for going vegetarian or vegan? Research in people with prediabetes shows big benefits if this way of eating can become your norm.

Ross approaches her clients realistically. “Yes, ideally people will lose weight, but we take it in five-pound increments. We celebrate every five pounds that come off and stay off.” She encourages people with prediabetes to focus on lifestyle changes they can make and live with forever and not to stress out if they’re not perfect. She tells them: The diagnosis of prediabetes is the yellow caution flag along the road from normal glucose levels to Type 2 diabetes. It’s your golden opportunity to heed the caution flag and take action immediately.

According to the American Diabetes Association, if you’re over age 45, you should get an A1C or glucose test. If you’re younger than 45, overweight and have another risk factor such as a family history, take the ADA Risk Test (www.diabetes.org/risk). If it shows you’re at higher risk, follow up with your health-care provider soon. Research shows about 70 percent of people with prediabetes will develop Type 2 diabetes over time.

If you discover you have prediabetes, don’t deny it. Act immediately to have the best chance of putting your prediabetes into remission (meaning glucose levels below the diabetes range without medication). The word remission is the preferred term rather than reverse or cure. It implies the strong possibility of a relapse if you regain the lost weight and/or as you age. But even if you put your prediabetes into remission, don’t erase it from your checklist of health concerns. Get tested once or twice a year to keep abreast of your glucose status.

Warshaw, a registered dietitian nutritionist and certified diabetes educator, is the author of numerous books published by American Diabetes Association and the blog EatHealthyLiveWell found on her Web site, www.hopewarshaw.com.

Have a nutrition question? Send an e-mail to localliving@washpost.com. Put “Nutrition Q&A” in the subject line and tell us where you live.

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