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A Conversation with Dietician and Diabetes Expert Hope Warshaw
Rate it! Votes (1) | Comments (0) By Cheri Sicard Posted August 6th, 2007 FabulousFoods.com Recommends: The Diabetes Food and Nutrition Bible : A Complete Guide to Planning, Shopping, Cooking, and Eating, by Hope S. Warshaw, (2001, American Diabetes Association)	The Diabetes Food and Nutrition Bible : A Complete Guide to Planning, Shopping, Cooking, and Eating

Hope Warshaw is the co-author of The Diabetes Food & Nutrition Bible (2001, The American Diabetes Association). Sixteen million Americans live with Type II diabetes, but many of these people feel they have inadequate accurate information to properly manage their condition. Still others have misguided notions about what diagnoses of diabetes will mean to their life styles and eating habits. In this informative interview, Hope talks about some of the changes in how diabetes is being treated. The good news is, eating for glucose control is no different than the healthy diet most people should be eating anyway. Read on!

Cheri Sicard: Most people have heard the term diabetes but are unclear what the disease actually is. Can you explain this in laymen's terms?

Hope Warshaw: Basically there are two main types of diabetes - Type I and Type II. Type I diabetes makes up about 5% of the population of diabetics in the United States. With Type I diabetes people have a total deficit of insulin - their body is no longer making insulin, therefore they need to take insulin, either by injection or an insulin pump. These people also need to be careful about what they eat and also, hopefully, get in some forms of healthy exercise.

Type II diabetes is the type of diabetes that is growing exponentially in the US. We're even beginning to see it, unfortunately, in children. There are about 15 million people in the US with diabetes and about 95% of these have Type II. People with Type II diabetes, depending on where in their disease process they are, have sometimes plenty - sometimes not enough - insulin around. For people who have a lot of insulin, their problem with high blood sugar is that their insulin is not being used efficiently. That is the reason their blood glucose is high, not that there is a deficit of insulin.

Type II diabetics can usually initially can follow a healthy eating plan to control the situation. Most would benefit from the loss of 10-20 pounds and some sort of physical activity program. After some years (or just starting out for some people) they may need oral diabetes medications, along with healthy eating and physical activity. Depending on how long someone has diabetes and what they do to manage it, about 30-40% of people with Type II diabetes eventually need to go on insulin.

Cheri Sicard: What do you think is the public's biggest misconception about diabetes?

Hope Warshaw: (Laughing) Lots of things! Number one is that there continues to be the notion that if you have diabetes you should avoid sugar and sweets. While that was true and was the information that was provided up until about 1994, today that is not the information that should be followed for people with diabetes. Today what we are saying about sweets and sugary foods is that if you can healthfully fit them into your eating plan, on occasion they are fine. What we really believe is the most important implication for blood glucose control regarding food is your total carbohydrate intake.

Cheri Sicard: Are the new guidelines more or less low carb?

Hope Warshaw: No. Not low carb. I would be much more inclined to use the word moderate. There is no number at this point associated with percentage of your calories should be carbohydrate. I really believe it should depend on the person's individual food habits. For instance, if you are someone who is either vegetarian or maybe nearly vegetarian - maybe you only eat a little bit of fish, chicken or beef, you would probably be eating nearly 60% of calories as carbs. People who are typical American eaters, if you will, are probably going to eat more in the range of 45% carbs.

Cheri Sicard: How important do you feel exercise is in the whole equation?

Hope Warshaw: I think it's hugely important! I think that lack of exercise is one of the biggest downfalls for Americans. I think it's one of the biggest reasons we're seeing the rise in obesity, which is in turn hugely connected to the growth rates of Type II diabetes. What people need to do is just start out with some very basic walking and also think about what in my daily life can I do to work in a little bit more physical activity. I sound like a broken record when I say things like park further away at the shopping mall, take the stairs instead of the escalator - but when people really implement those things in their daily lives, they're surprised after 2 or 3 months that it really can have an impact -- both on weight loss and on blood glucose control for people with diabetes.

Cheri Sicard: That's good news for people - they don't have to be super athletes to recognize benefits.

Hope Warshaw: Exactly. Being a dietitian, when I counsel people about food, it's sort of one after another - don't do this, don't do that - but with physical activity you can say do this, do that. And if you can burn some additional calories, it's that much less you have to take away from the food side.

Cheri Sicard: Who is most at risk for developing diabetes?

Hope Warshaw: I think we should probably limit that question to Type II Diabetes. The diseases are really totally different, it's almost unfortunate that they are both in the single category of diabetes, because I think there are tremendous misconceptions there.

For Type II diabetes, the people most at risk are those with a family history - if one or both parents or a sibling has had type II diabetes, that definitely puts you at risk. Obviously if you've had two parents with Type II diabetes, you're more at risk.

Women who have either had gestational diabetes during pregnancy once or twice, or women who have had large babies are more at risk. The risk is greater for women who are now in their 60s or 70s who had children when the testing for gestational diabetes wasn't as good. If they had babies over 9 pounds, chances are they experienced some level of gestational diabetes. Women who have had gestational diabetes develop Type II diabetes at a rate of between 40-50%, so that is just huge.

Other risk factors are people who have today what we call "Sydrome X" - or high levels of insulin, also known as insulin resistance. I think that term has sort of caught on, unfortunately, because a lot of the low carb diets have sort of promoted it in their materials. What we see in these cases is blood glucose levels that are slowly creeping up, but initially they are not high enough to be diagnosed as diabetes. These people also tend to have elevated triglycerides, low HDL and usually normal LDL, although they might have high blood pressure. Those are all pretty much risk factors for developing Type II diabetes. It's almost as though if you have elevated blood pressure, high triglycerides, low HDL and you're overweight, you can pretty much rest assured that you are walking the road!

Cheri Sicard: Can exercise and a sensible eating plan actually prevent Type II diabetes?

Hope Warshaw: Absolutely! There was a fabulous study that was done in Finland, published in the New England Journal of Medicine that showed wonderful results. The study was done for 3.2 years, there was a control group and a non-control group, and it showed that with consistent nutrition counseling and proper diet and exercise, diabetes could be prevented in a good segment of the people - and these were people who were at risk to begin with. There is actually a trial now going on in the US, which we'll probably start to hear about in September.

Cheri Sicard: In your book you talk about Nutrition Superstars, foods that provide big nutrition for the amount of calories they contain. What are some of those foods that people should incorporate into their diet?

Hope Warshaw: Well, fruits and vegetables are the top ones, diabetes or no diabetes. One of the common threads of all these sort of nutrition headlines that we consistently hear, is eat more fruits and vegetables --- whether it's for cancer prevention, aging or diabetes control and prevention.

Eating more whole grains is another good source of nutrients and of fiber. Beans and peas are a great source of nutrients - they are like little nutrient powerhouses. Beans are actually shown to cause a slower rise in glucose. So for people with diabetes, they sort get an extra bang, if you will, from eating beans.

Cheri Sicard: How much time and effort does the average Type II diabetic have to put into menus and meal planning? Is it something they really have to be conscious every second of the day and every morsel they put in their mouth?

Hope Warshaw: Well, I really think that the attitude we are trying to encourage people to take today is to not take a radical approach and not feel like you have to be "on a diet." That's what gets people into looking for magic bullets and going on the next diet that's promoted on the airways. We want people to take a more practical, long term, life long approach by looking at what are they going to do today, and what are they going to change today to move to a more healthy style of eating. Even if they are little painless switches, like changing vegetable oil for canola oil.

Cheri Sicard: So it's a lifestyle change more than a rigid diet.

Hope Warshaw: Definitely.

Cheri Sicard: What recommendations do you have for parents to develop healthy eating habits in their children?

Hope Warshaw: Actions speak louder than words!

Cheri Sicard: Do you ever use artificial sweeteners, and if so what kind, what do you recommend?

Hope Warshaw: I think low calorie sweeteners are a great benefit for people with diabetes. We actually have more low calorie sweeteners now than we've ever had, particularly with addition of Splenda. With more low calorie sweeteners there are more products on the supermarket shelves and many more options. Are they a panacea? No. When they're used in foods like hot cocoa and yogurt and things that have calories, those foods still need to be counted in, but there certainly are benefits in the use of those products.

Cheri Sicard: Obviously one meal plan is not right for everyone. Are there basic guidelines that people with Type II diabetes can follow and how important is it for them to consult with a dietician?

Hope Warshaw: Well, I'll answer your last question first. I think it's extremely, important for people to really work with a dietician. I think a one-time meeting, which is at best what many people get, is fairly fruitless. Because, if you're going to move in the direction that I've talked about - identifying behaviors to change, identifying food choices that you need to change, it's really much more of a process. People need support and they need encouragement, and I think that's what a dietician involved in a diabetes education program can really provide. So I would encourage people to find a dietician with expertise in diabetes to work with, and I would also encourage people to think about doing that not on a short term or one time basis but to do it as continuing education.

Cheri Sicard: Where can people go to find a qualified dietician?

Hope Warshaw: There is information in the back of the book, but basically there are two places I encourage people to go. Online, go to the American Diabetes Association (diabetes.org) and look under recognized education programs, which will let you click for a state-by-state listing. Recognized programs are those that have gone through a quality review, which is why I like to refer people there because they know they will get a quality program. Also I refer people to another website called diabeteseducator.org, where they can click on "find a diabetes educator."

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