Hope Warshaw is a leading expert on diabetes and nutrition, with nearly 25 years of expertise as a nutrition consultant, diabetes educator, spokesperson, and author. Her best-selling books published by the American Diabetes Association include: Diabetes Meal Planning Made Easy; Diabetes Food and Nutrition Bible; The Complete Guide to Carb Counting; and the Guide to Healthy Restaurant Eating.
DiabetesMine.com (aka Yours Truly) recently caught up with Warshaw for a down-to-Earth chat about the "angst" experienced by people with diabetes in particular about following a healthy eating plan.
DM) It's hard to know what to eat with diabetes. What is the first thing you'd tell a person newly diagnosed with pre-diabetes or type 2 diabetes about eating?
HW) More than likely a person with pre-diabetes or type 2 diabetes has some weight to trim off. Therefore, I want to help them find some easy ways to accomplish this goal. One of the first things I talk about is not what people eat, but what they drink. Are you downing a Caramel Macchiato every day? Are you guzzling Gatorade? People can drink 1,000 calories in beverages through the course of the day without realizing it, so that's an A-Number-1 priority.
People can have weight melting off them just by changing what they drink.
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DM) There are lots of reasons why changing your food habits can be difficult. What do you see as the biggest hurdle for people with diabetes?
HW) Unfortunately, there's lots of misinformation out there. Fad diets can mislead people. And eating habits and food choices in America today aren't exactly what you'd call healthy. So, trying to eat healthy can at times make you feel like you are a fish swimming upstream. That's not easy to keep doing, particularly when the reward of good health might be many years away.
There's also a clear distinction between people with type 1 and people with type 2 diabetes. My book "Diabetes Meal Planning Made Easy" is directed straight to the many people with pre- or type 2 who have access to pathetically little information, nutrition guidance, and support. If there's one thing confirmed in the large multi-center trials like DCCT, DPP and the like, it's that people can make changes if they have the knowledge and support they need over time. Unfortunately, that's not the way we practice medicine and chronic care today.
For type 1 diabetes, I don't think most people are taking insulin in the way that maximally helps them. There's a lot of fine-tuning, for example of insulin pump features, that people often don't get enough education about. So for them, it's less about food and more about insulin management.
DM) So meal planning isn't for everyone?
HW) I would never say that. A healthy eating plan is important for everyone with diabetes, pre- type 1 or type 2. There is no doubt today that eating healthy day after day and year after year can help a person stay healthier with diabetes, and also prevent myriad other related and unrelated health problems. The "but" is that as a dietitian I have learned to be realistic with the people I counsel and write for. I encourage people to look at their life right now, and ask: What am I willing and able to change? Where can I have the greatest success that will motivate me to try other lifestyle changes?
And you can't just look at the food side without the whole picture, including exercise, medications, insulin, etc. I want people to live their lives and not be obsessed by the diabetes.
DM) So what are some of the most common stumbling blocks that you've seen people with diabetes run into when attempting to change their eating habits? And what are some of your top pointers for them?
HW) People tend to make "following a diabetes meal plan" more of a mountain than a molehill. I am by no means saying this is easy, but making a few changes here and there can take you a long way, and isn't that difficult if you approach it simple-step-by-simple-step.
DM) Does diabetes really require a major overhaul of your eating habits?
HW) Not really. The good news is that there's a lot that people can accomplish just by making minimal changes — things they're willing to practice over time, rather than a short-term "diet."
For example, the average American eats minimal fruits and vegetables a day. But they're healthy, low-calorie, and a good source of fiber. So I talk to my patients about how they can eat more of those per day.
We know clearly from the DPP study that some food changes, a little more physical activity, and a small amount of weight loss can prevent or delay diabetes. The winning approach is subtle rather than life-altering.
DM) What's the first-line diet approach you recommend to people with diabetes who want to lose weight?
HW) What's so frustrating to me as practitioner is that Americans love to look for the magic bullet. The thinking goes: "It took me 20 years to put this weight on, and I want to take it off in a month!"
The reality of the matter is — we know this from behavioral research — people who are going to make lifelong changes need to do so slowly, over time. So I'm very much of a "non-diet person."
DM) One of the biggest general controversies seems to be how much starch (or carbohydrate) people with diabetes should eat daily. What's your advice here?
HW) It's not about carb restriction. Our problem in America is not the amount of calories or carbs we eat. Americans eat about 50% of our calories as carb. That's well within the ADA recommendation of 45-65% of calories. Rather, America's problem with carbohydrate is the quality of carb we eat. We eat too much low-fiber and/or high-sugar foods. So to me, the real carb issue today is a discussion of quality, not quantity.
DM) You make it sound easy, but isn't eating right with diabetes a lifelong challenge?
HW) Yes, it is. But people also tend to make healthy eating more complex than it is; they make it too hard on themselves. Again, I'm not saying it's easy, and I'm not saying that you won't feel like a fish swimming upstream many times in your life. But you need to keep looking at long term health. Let that stand as a major motivator. I don't have diabetes, but I'm 4'10" and about 100 pounds and I want to stay that way. How do I do that? I work at it every day. I walk a couple miles at least 4 times a week first thing in the morning and make lots of choices in foods to eat healthy. I'm also trying to impart healthy eating habits to my daughter.
Thanks, Hope, for stopping by -- and for the words of wisdom on the never-ending food issue.