Can Type 2 Diabetes be cured?

No, once you have Type 2 diabetes it won't go away. However you can control it to prevent serious complications.

Why is having breakfast so important if I am trying to lose weight?

Breakfast is the most important meal in the day. It kick starts the metabolism in the morning and stops you from eating too much later in the day. If you go for long periods without eating you are more likely to eat larger amounts at the next meal and store it as fat.

Maaori and Pacific have higher muscle to fat ratio, so it is okay for them to be bigger, is that right?

Maaori and Pacific and also South Asian people have an increased risk of developing Type 2 Diabetes even at lower weights, so it is more risky as a Maaori, Pacific person or a South Asian person to gain excess weight.

Why it is so important to reduce fat in your diet?

Question - Looking at your website I'm wondering about why you recommend reducing fat from the diet to help prevent diabetes. Is there any causal scientific link between dietary fat and diabetes?

Type 2 Diabetes is the result of insulin resistance from too much dietary sugar/carbohydrates. But how is reducing fat intake connected with diabetes or insulin resistance?

Wouldn't it be more sensible to focus on reducing not just products with added sugar (such as soft drinks and candy) but also reduce grains (such as bread, rice and breakfast cereals), starchy/low-fibre vegetables and fruit with high glycemic loads?

Answer from the Let's Beat Diabetes Dietitian
Type 2 Diabetes is caused by a reduction in the amount of insulin produced by the pancreas as well as insulin resistance (the insulin is not able to work properly). This is not caused by a high carbohydrate or sugar intake directly. There are several risk factors for developing diabetes including:
• being physically inactive
• having a parent, brother, or sister with diabetes
• Being of Maori, Pacific or South Asian ethnicity
• Having diabetes in pregnancy
• Being overweight or obese.
Being overweight and in particularly carrying extra weight around the middle, is one of the main risk factors that people can change to reduce their chances of developing diabetes (1). A large American study (the Diabetes Prevention Programme) showed that people at risk of developing diabetes can prevent or delay the onset of diabetes by 60 percent with a small weight loss, through regular physical activity and a diet low in fat and calories. Weight loss and physical activity lower the risk of diabetes by improving the body's ability to use insulin and process glucose (2).

Being overweight is caused by an excess of energy (Kcal or Kilojoules) in the diet compared to the amount of energy used up in exercise. Energy can be in the form of carbohydrate , fat, protein or alcohol. Fat provides 9Kcal (38 kilojoules) per gram, while carbohydrate provides only 4 Kcal (16 kilojoules) per gram. Therefore weight control should include reducing the amount of fat, to reduce the amount of energy taken in (3).

One of the most important complications of diabetes is cardiovascular (heart) disease. It is therefore important to reduce saturated fat (animal, dairy fat and coconut fats) from the diet to reduce cholesterol levels. There is also some evidence that a diet high in saturated fat can increase the risk of developing diabetes. A Mediterranean diet (high in unsaturated fats and fruits and vegetables) and includes wholegrains can reduce the risk of developing diabetes (5).

It is therefore important that a balance diet is consumed to prevent and delay the progression of diabetes. There has been an association shown between sugar -sweetened beverages and diabetes risk in some studies, but this may be due to excess energy intake (6). Carbohydrate intake should be moderated, but grains, such as bread , rice and breakfast cereals are low in fat, are filling and provide valuable nutrients such as fibre and B vitamins therefore we would not recommend over-restriction of these foods. Fruit and vegetables are also important for reducing the risk of heart disease.

The population that we are dealing with in this area of New Zealand tend to have a very low fruit and vegetable intake, high refined carbohydrate (sugar) intake and high fat intake (mainly saturated fat). It is a multicultural area with high rates of obesity. Therefore, the messages need to be kept very simple and targeted to those that will make the most difference within this population group.

References
1. Obesity. 2006 Nov;14(11):2107-17.
2. Diabetes Prevention Trial
3. International Journal of Obesity (2005) 29, 950-956. doi:10.1038/sj.ijo.0802980; published online 17 May 2005
4. JAMA. 2004;292:927-934
5. BMJ 2008;336:1348-1351 (14 June)

What is a Healthy Weight?

Health professionals use the Body Mass Index (BMI) as a useful measure to determine the ideal weight of men and women between the ages of 18 and 65 years.  BMI (Body Mass Index) can be calculated as follows:

A healthy BMI score is between 18.5 and 26. A score below 18.5 indicates that you may be underweight; a value above 25 for a NZ European or 26 for a Maaori or Pacific Islander indicates that you may be overweight. BMI does have its limitations for determining ideal weight, because it cannot distinguish between lean muscle and body fat.

It is important if anybody is concerned about their weight they should mention it the next time they visit the doctor or health professional.

BMI result                     -  Underweight      -      Healthy      -     Overweight     -         Obese

NZ European                 -  Less than 18.5    -    18.5 to 25    -       25 to 30       -    Greater than 30
Maaori/Pacific Islanders   - Less than 18.5    -    18.5 to 26    -       26 to 32       -    Greater than 32

Do potato chips count as vegetables?

No, potato chips do not count as a vegetable. Although potatoes do count as a vegetable, potato chips are 30% fat and are also very high in salt. Potatoes are better if they are boiled or baked, rather than fried, so that they contain very little fat. Vegetables come from plants and contain a variety of nutritients and no fat (unless they are fried or fat is added, e.g. in a sauce). It is recommended that we all eat 5 servings of fruit and vegetables per day, however they should be made up of a variety of different types and different colours to get all the nutrients we need.