DR. ROACH: In the diabetic’s toolbox: diet, exercise and blood sugar control

Published 3:23 pm Monday, July 26, 2021

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DEAR DR. ROACH: I’m a recently diagnosed diabetic. Can you please give me advice on how to reverse it if possible? — H.M.

ANSWER: I’m assuming you have been newly diagnosed with Type 2 diabetes, which is caused by resistance to insulin. Type 1 diabetes, usually diagnosed in childhood or adolescence, is an autoimmune disease caused by destruction of the insulin-producing cells in the pancreas. It requires insulin.

Type 2 diabetes is a “stable” diagnosis: Once the diagnosis is made, you always have diabetes, even if your blood sugars become perfectly normal and you are off medicine, which is what I think you are asking about when you want to “reverse” diabetes. (This situation is called “Type 2 diabetes controlled with lifestyle.”) Most people can dramatically improve their control of Type 2 diabetes, even if they don’t get all the way to the point where blood sugars are perfectly normal without medicine.

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Diet is the first pillar of Type 2 diabetes treatment. Reducing simple sugars and starches, which become simple sugars rapidly in your body, is the first step. Protein, healthy fat and carbohydrates from vegetables and (not too much) fruit is the mainstay of dietary treatment, but you really should get the personalized advice of a registered dietitian nutritionist.

Exercise is the second pillar. Exercise helps your body metabolize sugar more effectively. Any kind of regular exercise helps, but moderately intense aerobic exercise is probably most important from the standpoint of sugar metabolism.

Food intake and exercise output together help to address the third pillar, which is weight control. A significant majority of people with Type 2 diabetes are overweight, but by no means all. If your weight is higher than it should be, then weight loss is critical to diabetes control.

Finally, medications are helpful. There are many new options, some of which (such as metformin, liraglutide, and semaglutide) help to promote weight loss. Many people with diabetes need medications when diagnosed but may still be able to get off medicines if they start a healthy lifestyle addressing all three pillars.

Not all medications are helpful. Some medicines (certain blood pressure and psychiatric medicines, especially) are not ideal for people with diabetes, as they promote weight gain and insulin resistance. An expert in diabetes should review all medicines, and people may need to consider changing medicines.

DEAR DR. ROACH: If the local supermarket offers regular ground beef with 7% fat or grass-fed beef with 15% fat, which is healthier to eat, please? — E.

ANSWER: Grass-fed beef has a higher proportion of healthy fats, vitamin A and vitamin E. Grass-fed cows tend to be lower in fat overall, but the way the meat (I assume this is ground beef) is being sold at the supermarket makes that no longer true. Moreover, I would decline to characterize either choice as a healthy option. While there remains vigorous debate about the health harms associated with saturated fat (much of the fat found in beef), most data are clear that eating less red meat like beef and more grains, nuts, fish, legumes, fruits and vegetables leads to significant health benefits.

That doesn’t mean you can’t have an occasional burger. Much of the fat in a burger is lost during cooking. If you do cook one, you should make the tastiest burger you can. There is not a compelling reason besides taste to choose one versus the other.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.

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