Diabetes : Diet Can Get Some Diabetics Off Meds

Miami Herald (FL)

By Howard Cohen, The Miami Herald

Tom Hanks has been box-office gold playing ordinary men caught in trying circumstances. He was a young boy trapped in the body of a man in Big, a man trapped on a desert island in Cast Away, an airport in The Terminal and with Madonna in A League of Their Own.

But Hanks' most recent role is that of a man fighting diabetes in real life.

While visiting The Late Show early in October to promote his new movie, Captain Phillips, the 57-year-old actor told host David Letterman he's had to monitor his high blood-sugar numbers for the past 20 years. His doctor told him recently he had type 2 diabetes.

"My doctor said, 'Look, if you can weigh as much as you weighed in high school, you will essentially be completely healthy and not have type 2 diabetes,' " Hanks told Letterman. "And I said to her, 'Well, I'm gonna have type 2 diabetes.' "

That's not exactly the message the local medical community wants to spread. Trying to reduce the risk, or effect, of diabetes through the changing of one's diet and engaging in an exercise routine can be worth the effort.

"A lot of the focus is on nutrition now -- 90 to 95 percent is what people eat and their lifestyle," said Dr. Leila Chaychi, assistant professor of endocrinology at Mount Sinai Medical Center in Miami Beach. "If they really take care of that, we see a lot of improvement and can take patients off of medications if they watch their diet and lose weight. A lot of patients look at what they are eating and immediately see a result, so it is related."

Taking control

Rita Stein, 81, was diagnosed with type 2 diabetes -- the kind Hanks has -- 10 years ago and has been able to maintain her blood-sugar levels through careful diet-planning sans medicine. She follows the Plate Method, promoted by Sonia Angel, the coordinator of the Diabetes and Nutrition Center at Memorial Regional Hospital in Hollywood.

"Basically, the Plate Method is an easier way of planning meals by dividing a medium-size plate into four parts, where a quarter of the plate is going to be your protein, which should be lean meats including fish, turkey or chicken. The other quarter is going to be your carbohydrate which should be a complex carbohydrate -- whole grain pasta, brown rice, things like quinoa, which is high in fiber, whole grains in general. And the rest of the plate, half, should be a salad or vegetables or both," Angel explained.

For people like Stein, who says she wasn't particularly active physically, the attention to detail pays off.

"I've been trying as hard as I can to follow her Plate Method, with one quarter protein, one quarter carbohydrate and the rest vegetables. It's not easy, but with an effort, I'm getting closer and closer to it and keeping my blood sugar well under control. The diet has helped and convinced me that's the way to go," Stein said.

A recent meal included salmon, mashed potatoes, asparagus and a green salad, along with raspberries for dessert. Stein's blood-sugar reading was 130 two hours after eating. "I always aim for under 200. It's better if it's under 150, and 130 is just where I need to be," Stein said.

Eventually, however, patients who are able to control their blood sugar by carefully monitoring their diets might still have to take medication at some point.

"Over time, even individuals with type 2 will make less insulin, and many will run out of insulin even with the best dietary activity and not be able to control their blood sugars unless they replace the missing insulin," said Dr. Luigi Meneghini, director of the Kosow Diabetes Treatment Center at the University of Miami Diabetes Research Institute. "If I take someone who is obese early on in their diagnosis and get them to lose a good amount of weight and get them physically active, I can make the hyperglycemia go away for many years."

The differences

Type 2 diabetes, the most common form, is when the body doesn't produce enough insulin or ignores it after you eat and the body breaks the sugars and starches into glucose to fuel the body's cells. This insulin resistance used to be called adult onset diabetes because peak incidents tended to develop in people in their 60s and 70s, but these age numbers have steadily declined over the past decade.

The pancreas will sometimes kick in, making extra insulin to help make up for the deficit, but over time the pancreas can no longer maintain the pace and keep blood-glucose levels normal.

Type 1 is a different physiology, usually affecting children and young adults, hence its original name: juvenile diabetes. With this type, the body's autoimmune system attacks insulin-producing cells.

"One day, the immune system decides the proteins and sugars on the surface of the beta cells look foreign and mounts a response to destroy all insulin-producing cells," Meneghini said.

Complications of unchecked diabetes include heart disease and stroke, high blood pressure, kidney disease and neuropathy (nervous system disease). Also, diabetes is the leading cause of new cases of blindness among adults 20-74 ,and more than 60 percent of nontraumatic lower-limb amputations occur in people who have diabetes, according to the American Diabetes Association.

By the numbers

The total cost of diagnosed diabetes in the United States in 2012 was $245 billion, including direct medical costs and reduced productivity.

Type 1 diabetes only impacts about 5 percent of people with diabetes and is managed with insulin therapy and diet. The prevalence of diabetes is on the rise, however, as the nation has gotten fatter over the years. About 26 million children and adults in the United States -- 8.3 percent of the population -- have diabetes, and 7 million are undiagnosed, according to the most recent figures from the American Diabetes Association's 2011 report.

The rates of diabetes among blacks (12.6 percent) and Hispanics (11.8 percent) is higher than that among non-Hispanic whites (7.1 percent), according to the American Diabetes Association.

"Hispanics have more of a tendency to have diabetes here in the United States," said Angel. "A real statistic is that in the year 2020, one out of every three kids will develop diabetes, and in Hispanics it will be one out of every two -- that means 50 percent of the kids will have it if we don't change.

"If you look at Spanish-speaking countries, they don't have the same incidence of diabetes as we do with Hispanics living in the U.S.," Angel added. "It's a combination of genetic predisposition and adaptation of the typical American diet and lifestyle. In Cuba, we have to walk everywhere."

The message: With diabetes, you are not powerless. Get moving and watch what you eat.

Follow @HowardCohen on Twitter.

©2013 The Miami Herald

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