My opinion on the dietary management of diabetes…

There are several conditions that seem to be everywhere nowadays; people being treated for high cholesterol, high blood pressure and diabetes are a few that stand out. It’s not uncommon for people to bring in a pile of prescriptions for me to dispense, and the shopping bag (yes, some people get a full bag each month, and then some) contains several diabetes medications. For the most part, I’m referring to type 2 diabetes, but sometimes this can include type 1 (auto-immune, where the body doesn’t produce enough insulin) or gestational diabetes (develops during pregnancy).

Diabetes is one of the fastest growing chronic diseases in Australia, and it’s getting worse. For facts about diabetes, check out the Australian Diabetes Council website. Basically it costs the country over $14 billion dollars each year. Current guidelines for type 2 diabetes includes lifestyle modification, healthy eating and then medication. This is all well and good, until you check what they actually recommend as a diet. They of course follow the Australian Dietary guidelines, but add in a few extra bits. All of that information can be found here.

The problem is, these recommendations are obviously not working. The people who follow the guidelines are not improving. People are still being diagnosed with diabetes in increasing numbers. The main concern is, type 2 diabetes wasn’t even a condition until the 20th century. So what did we do before this? We ate real food.

The 20th century saw an increase in the use of processed foods, use of sugars, and eventually the vilification of fat and cholesterol as the cause of heart disease and our increasing waistline. And as we are now realising, this may have been the biggest mistake of all.

Diabetes was still prevalent in the early 20th century, but the recommendations of the time were very different. As an example, this cookbook from 1917 shows foods to be used freely included fresh meat, vegetables, nuts and fats. In fact, foods considered especially important due to their nutritional value included butter, cream, meat, fish, eggs and cheeses. At the top of the list of forbidden foods sits sugar, along with flours, breads, oatmeal and honey, just to name a few.

So why do current guidelines recommend starchy carbohydrates, low fat foods and even sugar, when it’s clear that they were not recommended back in the day when it was a rare condition, rather than the norm? People are getting fatter, suffering from more medical conditions and all some professionals can say is “oh, you must not be following our guidelines, here have some more medications”. Sufferers are following the guidelines and getting sicker, and thinking it’s all their fault, or that there is nothing they can do. I have patients describing their diet, following what their diabetes dietitian says, and wondering why they are still getting worse, their blood readings are so high all the time. Usually their diet is high in processed, low-fat foods, starchy carbohydrates and fruits. Very little fat or protein. Some are even told they can have sugary, processed foods!

I have patients who come into the pharmacy to get their medications. They’ve stopped at the bakery up the road and have bread rolls, baked sweet pastries or even a coke. They get their diabetes medication, tablets or insulin. Insulin costs the government sometimes up to $600 a script, and will only cost them $6.00 (concession) or $36.90 (everyone else). Tablets can range from $10 to $100-200, and again they only pay their PBS price. They are told by their dieticians, doctors etc that if they take their medications and follow the guidelines, and everything in moderation, it’s okay. I’ll make some conversation, trying to get some idea of what they’re eating. One particular patient of mine told me, for breakfast he’d have a banana, and a piece of toast with honey, and wondered why his blood sugars was so high in the morning. I told him I ate bacon and eggs cooked in butter for breakfast, and he told me I was going to have a heart attack.

Unfortunately this is how many of this particular generation were taught back when it all changed. I grew up with margarine (I shudder now when I think of how much I ate of it and how it’s made), all because that was what my grandma was told to replace butter with, as it was healthier, and that filtered down to my family. Ultimately, the combination of the high carb, low fat, high sugar and processed diets is causing more problems than it’s supposed to be helping.

At this point, I try to help, I try to impart what I’ve learned, both personally and in my research and readings since leaving uni. Most of the time I’m shut down, it’s hard to change your entire thought process. I’ve been there. But all I can do nowadays is put the thought into someone’s mind, get them to look into real food, their diet, and how the body actually processes their foods and nutrients.

Specifically for diabetics, it’s about stabilising blood sugar levels, avoiding the blood sugar spikes that then cause a spike in insulin levels (“side effects” of long term insulin spikes include include vasoconstriction, inhibited fat burning, reduced production of glucose from other substrates, and eventually leading to insulin resistance). Meals with good fats, proteins and vegetable carbohydrates will break down slowly, fuelling the body for hours. The other advantage of avoiding the carbohydrate-heavy typical meals (specifically breakfast), is there is no “heavy crash” when the blood sugar levels suddenly drop, reducing that hungry feeling and sweet cravings.

It’s not just about the calories, it’s about the type of calories and how what you take in is used to nourish, heal and fuel your body.

It’s about avoiding those things, such as sugars and empty calories which cause inflammation, cell damage and cause us to want more empty calories. (Btw, I don’t think in calories any longer, but it’s good to get the point across).

It’s about providing your body with the building blocks for all of our cellular processes, from natural sources that haven’t been processed, or changed, or had preservatives, refined sugar and chemicals added. It’s hard to do, especially in this day and age where everyone is busy and sees food as a necessary pastime rather than a fuel and essential for health.

I would rather people not need medicines. I’ve seen people start to reverse their problems with a change in diet, and reducing their medicine load. And that is my goal for others that would give me the greatest satisfaction in my job.

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