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Diabetes Group Sweetens the Snacking

Candy or cookies can be fine in moderation, new guidelines say

THURSDAY, Dec. 27, 2001 (HealthDayNews) -- Many diabetics are conditioned to see candy the way vampires view garlic. But patients with a sweet tooth shouldn't automatically shrink from candy or cake.

The American Diabetes Association now says it's OK for diabetics to eat an occasional piece of pie or a cookie or two, as long as they closely monitor their blood sugar for unhealthy surges. The reason: The kind of carbohydrates diabetics eat is not as important as how much they're eating, according to the group's new 2002 nutrition guidelines.

Although diabetes experts have been telling patients for years that modest amounts of sweets are fine, many people with the condition, especially those newly diagnosed, still believe desserts are verboten.

"When they come in, a lot of patients have a lot of misconceptions," says Lara Hassan, a diabetes educator at the Cooper Clinic in Dallas. "They leave happy in the sense that a lot of these misconceptions are clarified."

To be sure, not every diabetic can afford to eat all sweets. Some are heavy in saturated fats and loaded with calories -- a no-no for many overweight Americans who are developing diabetes in record numbers, Hassan says. On balance, though, most diabetics don't have to make radical changes in their diets as long as they eat prudently.

The latest recommendations, which will appear in next month's issue of Diabetes Care, don't contain much that veers from the ADA's last guidelines, released in 1994. Indeed, Dr. Christopher Saudek, president of the ADA and a diabetes expert at Johns Hopkins University in Baltimore, says what's new about the guidelines is not what's in them but how they were developed.

"We've really tried to distinguish between what lacks evidence and where the evidence is," Saudek says. "We're trying to put some facts into what gets into the hype behind" nutrition therapy for diabetes.

However, the new document does say there's not enough evidence to support a controversial carbohydrate-rating system called the glycemic index, which advocates have insisted is a useful gauge of food's effect on blood glucose.

Instead, the report says, when it comes to affecting blood sugar, a carbohydrate -- whether starch, fiber or sugar -- is a carbohydrate is a carbohydrate.

How many carbohydrates a diabetic should eat each day varies according to his or her weight, which determines the ideal caloric intake. But typical diabetics should get about half their daily calories in the form of carbohydrates, experts say. Since each gram of sugar, fiber or starch carries roughly four calories, that works out to about 250 grams for a 2,000 calorie-a-day diet.

To simplify matters, routine servings, such as an apple, an eight-ounce glass of milk or a slice of bread, contain 15 grams of carbohydrates. So if diabetics are trying to restrict their carbohydrate intake to 1,000 calories a day, they can safely eat 16 servings of these or equivalent foods.

Product labels now print carbohydrate content, so figuring out how many carbohydrates a particular serving holds is easy.

"I'm glad [the ADA is] finally catching up," says Dr. H. Peter Chase, referring to the carbohydrate guidelines. Chase is former director of the Barbara Davis Center for Childhood Diabetes in Denver and a leading blood sugar expert.

Rather than instruct patients, young or old, to eschew carb-rich foods, Chase says he and his colleagues tell them to take a blood glucose test two hours after the snack to make sure they're getting enough insulin. If the answer is no, they should either up their dose of insulin or cut back on the food.

Although very young children might need to receive insulin after their meals, most diabetics should probably be taking the hormone shortly before they eat.

The ADA estimates that 16 million Americans suffer from diabetes, more than 90 percent of whom have Type II, or the adult-onset variety of the disease. In Type II diabetes, cells stop responding to the sugar-processing hormone insulin or they don't make enough of the substance.

The rest have Type I diabetes, which occurs when insulin-producing cells in the pancreas stop working.

Type I diabetics must take daily injections of insulin to stay alive. Some Type II diabetics also require supplements of the hormone or other drugs to keep their blood sugar in check. But many can do so through such lifestyle changes as a healthy diet and regular exercise and by staying slim.

The new ADA guidelines suggest that those with Type II diabetes and their family members -- and everyone else for that matter -- get regular physical activity.

What To Do

As the country gets fatter, the incidence of diabetes is surging; the number of cases climbed by one-third during the 1990s, according to the Centers for Disease Control and Prevention. More than 5 million Americans have the condition but don't know it, health officials say.

To learn more about diabetes, visit the American Diabetes Association or the Joslin Diabetes Center.

For more on obesity and how to control your weight, check the National Institutes of Health.

SOURCES: Interviews with H. Peter Chase, M.D., Clinical Director Emeritus, Barbara Davis Center for Childhood Diabetes, Denver; Lara Hassan, MS, RD, CDE, nutritionist, diabetes educator, Cooper Clinic, Dallas; Christopher Saudek, M.D., president, American Diabetes Association, and director, Diabetes Center at Johns Hopkins University, Baltimore; Centers for Disease Control and Prevention; American Diabetes Association nutrition guidelines, Diabetes Care, Jan. 2002
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