Introduction

Diet and exercise is a common prescription for a healthy life. For people with Type 2 diabetes, it is especially important to follow a healthy diet and get lots of exercise. Often this is enough to get blood sugar levels under good control, especially early in the illness.

For a person with Type 2 diabetes, a healthy diet has to include three elements. These are foods:

• Low in saturated fat
• Balanced or low in carbohydrates
• Low in calories, if you are overweight

The following is a description of each of these essential elements in detail  along with some tips on how to exercise and lose weight.

Eating Foods That are Low in Saturated Fat

Saturated fats are animal fats. They are found in meats, in dairy products like milk, cheese and ice cream, and in some kinds of cooking oils, such as lard. We have known for a long time that when you eat a lot of saturated fats your cholesterol and triglycerides tend to go up. When your cholesterol is high, you are at a higher risk of developing hardening of the arteries and getting heart attacks and strokes. When you have diabetes, you are especially prone to developing heart attacks and strokes, so you should do everything you can do to lower your risk of heart disease, and following a low saturated fat diet is very important. Also, if you tend to have high triglycerides (fats in the blood), then following a low-fat diet will help bring your triglycerides back down.

Not all fats are the same, though. Saturated fats are bad for you, but monounsaturated fats, in moderation, seem to be good for you. Monounsaturated fats include olive oil, canola oil, and nut oils. If you cut out the saturated fats in your diet and replace them with monounsaturated fats, you can avoid filling up on carbohydrates. As you will learn below, carbohydrates are hard on your blood-sugar levels. Talk to your doctor or your nutritionist about how to integrate foods with monounsaturated fats into your diet.

Eating Foods That are Balanced or Low in Carbohydrates

Carbohydrates are sugars and starches. Examples of carbohydrates are: pasta, bread, rice, potatoes, yellow vegetables, sugars, fruit, fruit juice, baked goods, and regular sodas. You can tell how much carbohydrate is in a food by reading the label. When you eat any kind of carbohydrate, your stomach and intestine turn them into simple sugars. In other words, all carbohydrates are eventually turned into sugar.

When you eat a meal, that meal includes three things: fat, protein and carbohydrates. It turns out that the only part that makes your blood sugar go up is the carbohydrate part. In other words, if you ate an entire meal that had only fat and protein in it, your blood sugar would not go up. That doesn’t mean that the fat and protein don’t have calories—in fact, the fat has more calories by weight than the carbohydrate does. But it is only the carbohydrates that get turned into the glucose that goes into your bloodstream.

So if you want to predict how a meal will affect your blood sugar then all you need to account for is the amount of carbohydrate in the meal. If you want to get really good at assessing your meals, you can buy books or take lessons in “carbohydrate counting."

When you have diabetes, you need to try to balance how much carbohydrate you have at each meal. For example, if you had a breakfast that included a big glass of orange juice, sugared cereal with strawberries on top and a piece of toast, most likely your blood sugar after that meal would be way too high. That meal contains mostly carbohydrates—except for the little bit of fat and protein in the milk in your cereal. Instead, in order to better control your blood sugar, you should cut out some of the carbohydrates and substitute a little fat and protein.

A good nutritionist trained in diabetic teaching will help you review what you usually eat to find the meals that have too much carbohydrate in them. To figure this out for yourself, you could start checking your blood sugars two hours after a meal. If you keep track of what you are eating and then look at your blood sugar levels after meals, you can pick out which meals probably had too much carbohydrate in them.

Eating Foods That are Low in Calories if You are Overweight

The majority of people with Type 2 diabetes are overweight. If you are overweight and you really want to control your blood sugar without medicines, the only way you are going to be able to do that is by losing weight. For reasons that are not currently understood, being overweight makes it hard for your body’s insulin to work. It causes what we call insulin resistance. That’s the bad news. The good news is that if you lose some weight—often only about 10 pounds, even if you are more than 50 pounds overweight—you can usually get your blood sugars back down to normal.

Tips for Losing Weight

We all know that losing weight is hard to do. But you can be successful if you make up your mind that it is important for your health. Here are some tips I’ve learned from treating my patients and from reading a lot of medical literature:

Take it slow
If you lose weight too quickly by going on a crash diet, you will probably only gain it right back when you stop. Aim to lose at most two pounds of weight per month. That will add up to fifty pounds over two years, and that’s about how much time you should give yourself to reach your weight goals.

Decrease the total number of calories in your diet
Try not to focus on decreasing only one kind of food in your diet. For example, if you focus only on eating low-fat foods you’ll probably just overdo it on carbohydrates and not eat fewer calories at all in the end. In fact, if you look closely at foods advertised as low-fat, you will find that they are loaded with carbohydrates. The same applies with following an Atkins-style low-carb diet—you will not lose weight by substituting the carbohydrate calories with fat calories. In order to lose weight, you have to eat fewer calories. Period.

Move around
Those with the best weight loss results are those who follow a low-fat diet and exercise, at the same time. Our weight is controlled by a pretty simple equation: Energy In (what you eat) = Energy Out (what you burn by exercising). If you eat too much or exercise too little you will gain weight. Anything—anything—that you do during the day to move around is good! You should spend at least thirty minutes every day exercising. For some, this could be briskly walking to work. For those who are able to do more strenuous exercise, it could be jogging, aerobic classes, or a sport. IMPORTANT—if you have not been active and you are considering starting an exercise program, please check with your doctor first. If you are at risk for heart disease, you may need to have a stress test to check out your heart before you begin.

Get your family and friends involved
It is impossible to lose weight if you don’t have a little bit of help from your environment. For example, if you are trying to follow a low-calorie diet but you have to cook regular high-calorie meals for your family, it will be very difficult to find success. Or, if your friends bring lots of cakes and candy to work and urge you to have some, you’re going to have to show enormous will-power to refuse. Bring your family to your meetings with your doctors or nutritionists. Ask them to help you and tell them why it is so important.

Set aside time during the day to pay attention to yourself
Most of the patients that I see tell me they would like to exercise but they just can’t find time during the day. I know what they mean since I can never find time myself. But don’t forget that when we tell you to exercise it is not for your vanity or to make you look better in a bathing suit. We want you to exercise because exercise is the best and most powerful treatment that we have for Type 2 diabetes. There is something about moving around that helps your insulin work better. It is literally the best thing you can do for yourself. You have to make it a priority in your life.

Understand that your diet and exercise regimen has to become a permanent part of your life
Unfortunately, you are not going to be able to go on a diet for a few months, lose weight, and then go back to your old eating habits and stop exercising. That never, ever works. Our bodies and brains are very smart and as soon as you lose weight, the brain starts sending powerful subconscious signals that usually result in gaining the weight back. Studies have shown that, after you lose weight, your body’s metabolism actually slows down so that you need fewer calories than when you were heavier. Many people who diet reach a certain weight and plateau. Many patients who have tried dieting know this experience of “hitting a wall.”  The good news is that, if you continue to follow the diet and exercise program for years, you won’t gain weight back. So, try to find a regimen that you can live with for the rest of your life.

If you are having trouble losing weight, ask your doctor about new drug treatments that might be able to help.
Here are the medicines that we can use:

Xenical:  This drug is a fat-blocker. You take it with every meal and it interferes with the digestion of fats, a major source of calories. Also, if you eat too much fat while you are on Xenical, you will have horrible diarrhea. This also may help to keep you from overindulging. The only drawback with Xenical is that you have to take it with every meal. If you don’t take it, you’ll be able to splurge without any side effects and it won’t work. So you have to have a little will power to make yourself take it with every meal.

Meridia:  This drug works in the brain to decrease your appetite. It can have some side effects and you should only take it if your doctor decides it is safe for you. Luckily, it doesn’t seem to have the same terrible side effects on the heart that “phen-fen” was discovered to have a few years ago. However, Meridia’s only problem is that, when you stop taking it, you will have to work very hard not to gain the weight back.

Glucophage:  Glucophage is a drug that we use to treat Type 2 diabetes, which also helps people lose weight. I often give it to patients who are overweight and at high risk for getting diabetes. High-risk patients include those who have a family history of diabetes and their blood sugars are borderline high. If you have diabetes, are overweight, and are taking one pill for your diabetes which is not glucophage, talk to your doctor about whether you can switch to glucophage, since it might help you lose weight as well as control your diabetes.

Also, don’t forget that if you are seriously overweight, have diabetes, and have unsuccessfully tried for years to lose weight through diet, exercise and medication, you can always consider surgery. We have new laparoscopic techniques for “stomach stapling” which are much less invasive and which give very good weight loss results. You can ask your doctor for a referral if you are interested.

Putting it All Together

A healthy diet and exercise are important for everyone, but for people with Type 2 diabetes, they are also the first-line treatment. To review, steps to both a smarter diet and a regular exercise regimen include:

• Cut out saturated fats (animal fats).
• Include some monounsaturated fats (olive oil, canola oil, nuts and nut oils).
• Cut down on and balance your carbohydrates (sugars and starches).
• Lose weight if you are overweight.
• Exercise: Talk to your doctor if you have never exercised before and want to start an exercise program – if you are at risk for heart problems you should have a stress test before you start.
• Plan to follow this program for the rest of your life and find ways to make it something you can live with.
• Get your friends and family involved so that you don’t have to do this alone.