The link between type 2 diabetes and CVD
A major risk factor for cardiovascular disease (CVD) is diabetes. In fact, people living with type 2 diabetes are over twice as likely to develop CVD, with the number one cause of death for people with type 2 diabetes being CVD.1,2
Diabetes can silently develop over months or even years before it’s diagnosed. According to experts, up to half a million Australians may have type 2 diabetes and not even be aware of it. Having type 2 diabetes affects the way our body uses fuel for energy, and it all starts with insulin resistance.
When we eat food containing a carbohydrate, it is broken down into its smallest form called ‘glucose’. Glucose can be used as energy, but it needs to get into our cells for this occur. This is where insulin comes into play. Consider insulin as the key to unlock the cell’s door. Our pancreas produces insulin whenever glucose is around, therefore preventing our blood glucose levels rising too high. Insulin resistance is like a rusty lock, preventing the insulin key from opening the door to the cell.
If you have type 2 diabetes, your body either resists the effects of insulin (insulin resistance) or doesn't produce enough insulin to maintain normal blood glucose levels. In some individuals, both could occur. The result? High blood glucose levels.
Chronic high blood glucose levels can damage our blood vessels.
This is one of the reasons why poorly managed diabetes can lead to an array of other health complications, including heart attack, stroke, kidney disease, limb amputation and even blindness.
There are, unquestionably, many misconceptions surrounding type 2 diabetes, especially in relation to diet. To cut through the confusion, we’ve broken down some common myths and offered some suggestions for new habits to start practicing.
Type 2 diabetes diet misconceptions
“I can’t eat carbohydrates”
False! Carbohydrates are an important macronutrient, utilised by the body to create energy to grow and move. Although carbohydrates directly affect our blood glucose levels, there is no need to eliminate them completely from your diet. There is, however, good evidence that a lower carbohydrate diet can improve insulin sensitivity.3,4
Choosing less refined, high-fibre carbohydrates such as wholegrains, fruit and vegetables, result in a slower and more gradual rise in contrast to the rapid spike of blood sugar levels caused by highly refined carbohydrates such as white bread, pastries and soft drinks. This slow rise in blood sugar levels gives the pancreas plenty of time to make insulin in response. To better manage blood glucose levels, experts also recommend eating regular meals and spreading good quality carbohydrate foods evenly throughout the day.
Habits to practice
- Keep the carbohydrate-rich food to about ¼ of your plate at mealtimes.
- Try measuring these portions out and seeing what they look like on your plate:
- ½ – 1 cup cooked rice
- 1 – 2 slices of bread
- 2 small wraps or 1 large wrap
- ½ – 1 cup of chickpeas/lentils/four bean mix
- ½ – 1 cup of cooked pasta or couscous.
“I can’t eat fruits because of their sugar content”
False! Sugar is not necessarily the direct cause of type 2 diabetes. Consuming excessive amounts of energy dense foods, often high in sugar, can lead to being overweight, a common risk factor for developing type 2 diabetes. Because of this, it’s easy to see why many people focus on the sugar content of food and disregard other great nutrients that might be in that food item. Whole fruit is a healthy source of fibre, water, vitamins and minerals, and it is low in energy. Fruit is an excellent snack choice for anyone, whether or not they’re living with diabetes.
Although there is naturally occurring sugar in fruits, most fruits have a low glycemic index, providing a slow rise in blood sugar levels. A focus point for people with diabetes would be to look at the amount of fruit and when it is eaten. A good guide is to aim for two serves of whole fruit per day, eaten at different times in the day.
“But what about fruit juice?,” you may ask. Fruit juice has a higher concentration of sugar because we’ve removed other nutrients like fibre. Frequent consumption of fruit juice has been found to be associated with an increased risk of developing type 2 diabetes, so water is always the best beverage choice.5
Habit to practice
- Aim for two serves of whole fruit per day. A serve is:
- 1 medium apple, banana, orange or pear
- 2 kiwi fruits, mandarins or plums
- 1 cup berries or grapes.
“I can cure my diabetes with my diet”
Unfortunately, there is no absolute cure for type 2 diabetes. However, there is emerging evidence that we can put type 2 diabetes into remission through lifestyle changes such as diet, exercise and body composition.6 Remission occurs when there is a temporary end to medical signs and symptoms of a disease. In the case of type 2 diabetes, blood glucose levels return to a normal range and the disease doesn’t progress. This doesn’t mean that type 2 diabetes is gone for good, however it can lower the risk of developing diabetes-related complications such as heart disease, and potentially reduce the need for diabetes medication. Evidence suggests that the key to remission is weight loss.6
Habits to practice
- Enjoy snacks based on whole foods to help improve your energy intake and support a healthy weight:
- Small hummus tub with as many veggie sticks as you like
- Sliced apple with 1 tablespoon of natural peanut butter
- 1 handful of almonds
- 1 small tub of natural yoghurt with a handful of berries.
- Get active. Aim to do at least 30 minutes of physical activity on most days of the week. Increasing your incidental exercise can help get you moving if planned exercise is tricky. Try parking a 15-minute walk away from work and taking the stairs whenever possible.
“I can’t ever eat dessert”
False! There is no specific diet for type 2 diabetes. Rather, it is recommended that individuals with type 2 diabetes adhere to a healthy diet that helps them manage their body weight and includes a variety of foods from the five food groups: grain foods (mostly wholegrain); vegetables, legumes and beans; lean meats and poultry, fish, eggs, nuts and seeds; dairy (or alternatives) and fruit. Water is also always the best drink option. There is no need to eliminate your favourite foods, as they may be enjoyed in moderation.
Habits to practice
- Record a seven-day food journal to improve your awareness of how often you have dessert and treats. If this is every day, start by reducing to every second day.
- Base your desserts on whole foods:
- Homemade chocolate chia pudding with strawberries
- Baked apples with cinnamon and yoghurt.
These are general recommendations for people with diabetes and do not take your individual circumstances into account. As always, speak to your doctor or other healthcare professional if you have questions about your health or would like personalised advice for your situation.
References
- Australian Bureau of Statistics (ABS); 4364.0.55.001 – National Health Survey: First Results, 2014-15.
- Haffner SM et al; Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339:229-234.
- The Royal Australian College of General Practitioners. General practice management of type 2 diabetes: 2016–18. East Melbourne, Vic: RACGP, 2016.
- Diabetes Australia. Position Statement: Low carbohydrate eating for people with diabetes. 2018. [cited 15 Oct 2019]
- Diabetes Australia. Fruit and diabetes. 2015. [cited 15 Oct 2019]
- Diabetes UK. Diabetes remission. 2019. [cited 15 Oct 2019]
About the author
The Healthy Eating Hub
This article was written by an Accredited Practicing Dietitian from The Healthy Eating Hub. The Healthy Eating Hub is a team of university-qualified nutritionists and dietitians who are passionate about helping people develop long term healthy eating habits through offering evidence-based and practical nutrition advice that people can put into practice straight away.