Glen Paul: G’day, and welcome to CSIROPod. I’m Glen Paul. Type 2 Diabetes is sometimes described as a lifestyle disease because it’s more common in people who do insufficient physical activity and are overweight or obese. It’s strongly associated with high blood pressure, high cholesterol, and where excess weight is carried around the waist.
Over time high blood glucose levels damage nerves and blood vessels leading to complications such as heart disease and stroke. Uncontrolled diabetes can eventually lead to other health problems such as vision loss, kidney failure, and amputations.
So it’s of great concern that more than one and a half million Australians have diabetes, and more than twice this number are at significant risk of developing the disease in the next five to ten years.
In an effort to combat this, the same team of CSIRO scientists who produced the revolutionary CSIRO Total Wellbeing Diet books have partnered with Baker IDI Diabetes Institute to produce a groundbreaking new book covering every aspect of Diabetes prevention and control.
Joining me on the line to discuss it is CSIRO’s Dr Manny Noakes. Manny, it’s obviously a terrible disease and one where diet does play a big part, but what inspired you to develop this book on top of the wealth of advice already out there on diabetes?
Dr Noakes: Look, because there are so many people with diabetes we felt that it was important to develop a book that was specifically for diabetes, and also to dispel a lot of the myths that are bounded around the management of diabetes, particularly the management of Type 2 diabetes.
I’d also like to say that diabetes is an interaction between diet, lifestyle, and genes, and there is a genetic component. So if people develop diabetes they shouldn’t feel guilty about that, but realising that they can actually do something very positive to control that condition.
Glen Paul: OK. And how did you then research the book?
Dr Noakes: We drew on a lot of research, clinical research that we have done here at CSIRO, and as well as our Baker colleagues. We’ve done a number of clinical studies looking at the different types of dietary strategies, and exercise strategies, to control diabetes. So we had a fairly good idea of what works.
And in addition to that we consulted a number of Specialists who have a particular expertise. For example one of the individuals that contributed to the book was a Nephrologist, or a kidney specialist, and so we were able to put together information from all of the different fields of medicine and nutrition that was necessary for the kind of comprehensive coverage of managing Type 2 diabetes that’s necessary.
Glen Paul: And what sort of diets then are best for someone with diabetes?
Dr Noakes: Well the most important dietary component is to eat less – that is the fundamental issue, because excess calories drive poor diabetes control. Within that, what type of calorie restriction is going to work best, and we’ve obviously done work on high protein diets similar to the Total Wellbeing diet, and that is one of the options in the book that we recommend, and it is a diet that does contain some amount of carbohydrate that’s low in glycaemic index.
The other dietary strategies that we’ve tried are dietary patterns with more carbohydrate, but with more low GI carbohydrate. So we talk about the role of different carbohydrates on glucose control in the book, what the glycaemic index means, and why it’s important in managing diabetes.
Glen Paul: Right. Now when you get to this sort of glucose control there’s always an assumption there that the food has to be fairly bland. Now, what sorts of recipes are in the book that ensures that’s not the case?
Dr Noakes: The recipes in the book would be for anybody in the population. Just because you’ve got Type 2 diabetes doesn’t mean that you have to have anything that is so special, or different, or somehow vastly remote from what healthy eating is all about. So the book contains menu plans and recipes that I’m sure people would be delighted to be presented, and I’m sure would challenge some of the recipes that are on Master Chef today.
Glen Paul: OK. And are these recipes only for people seeking to lose weight?
Dr Noakes: No. The book talks about what to do if you’ve lost enough weight, and so the recipes provide the main meals, but obviously if people have already lost weight they can increase quantities of particular foods, like the amount of oil they use, the amount of bread that they use, and the quantities of some of the other food components. So it covers both into the spectrum.
Glen Paul: Hmm. Absolutely. And what about exercise – how is that covered in the book?
Dr Noakes: It’s covered in the book quite comprehensively. We know that physical activity is the other side of the coin in managing Type 2 diabetes, it’s extremely important in keeping blood sugar levels down, and the type of exercise that does that is not only the exercise that makes you huff and puff, which we call aerobic exercise, but also resistance exercise – the kind of exercise where you lift a weight, or exercises such as sit-ups and knee presses that build muscle. And the more muscle you have, generally the better your glucose control.
So it’s important when you lose weight that you don’t lose too much muscle, and we’ve incorporated a resistance training program that you can do at home.
Glen Paul: And just on the disease itself, how bad does a person’s diet and inactivity have to be before you start to be at risk of developing the disease?
Dr Noakes: Look, it will depend on what their genes are like rather than what their diet is like, and so it’ll differ from person to person. So for example, if you have an Asian background your diet or weight gain doesn’t have to be as bad or as great as someone from a Caucasian background, purely and simply because of your genetic makeup.
So we don’t know what your genes are exactly – we can’t identify exactly what they are at this point in time – but there is very much a genetic component. If you’ve got a family history of diabetes, then you really would be best to eat sensibly and exercise as much as you can, and have your blood sugar levels checked by your doctor from time to time.
If you’ve ever had gestational diabetes in pregnancy that also is an indicator that you’re at greater risk of Type 2 diabetes, even though it goes away after you’ve delivered the baby. So there are certain indicators that give you an idea that you’re more at risk, even though your diet might be fine now. It is important to keep monitoring what is happening to your health on a regular basis.
One thing I should say is that if you do have diabetes, you don’t always have to lose vast amounts of weight to control it better. What we know is that even small amounts of weight loss can make a significant difference to blood sugar level control, as long as it’s maintained over time.
So we’re not suggesting that everybody who has diabetes has to be skinny, but as I said losing even three to four kilos in weight, and keeping it off, is very important.
Glen Paul: So what are the general symptoms then of diabetes that people sort of should look out for before seeking medical advice?
Dr Noakes: The classical symptoms are excessive thirst, urinating a lot, unexplained weight loss, feeling very tired, lethargic, possibly even changes in mood. They’re the classical symptoms where the blood sugar is obviously rampantly high. But for many thousands of people in the community their blood sugar levels may be moderately high, and they may not have any idea that that’s the case, and they may not have any of those classical symptoms.
And so that’s why it is important to take the opportunity to have your blood sugar checked, if you’re near a chemist that does it, or if your doctor might do it from time to time, because the symptoms are often silent symptoms.
Glen Paul: Now I understand the book also enables readers to estimate their own risk of developing Type 2 diabetes within the next five years. How does that work?
Dr Noakes: There’s a nice little quiz that gives you an indication of whether your risk is low, medium, or high, by answering a dozen or so questions about your family history, your age, and some of your lifestyle patterns – bearing in mind, as I said, that your lifestyle is a significant component, but so too is the genetic component.
And of course age is a major factor – as we get older we’re more at risk of developing diabetes. Although these days as we’re getting fatter we’re seeing diabetes develop at a much younger age. And we use to call it maturity onset diabetes because it was developed in maturity, but these days it’s happening at much, much earlier in life, which is concerning.
Glen Paul: Right. So the message is then really that this book isn’t just for those with Type 2 diabetes, it’s really for anybody who feels that they might be prone to developing the disease?
Dr Noakes: It’s very much designed for people to prevent the onset of diabetes if they think they’re at risk. Anyone, I think, would find the information interesting, and everyone I’m sure will find the recipes palatable and interesting to try.
Glen Paul: Right. Well it sounds like another great book from you and the team, and it is available now in bookshops. Thank you very much for discussing it with us today, Manny.
Dr Noakes: Pleasure. Thank you.
Glen Paul: Dr Manny Noakes from CSIRO Food and Nutritional Sciences. For more information go to www.csiro.au.