Diet and Diabetes
As cliched as this might be:
You are what you eat.
Well, that’s not entirely accurate, but there’s no disputing the fact that the food we consume definitely affects our bodies.
Hopefully this is something you already know and consider when making dietary choices. After all, proper nutrition ranks right up there with regular exercise and getting plenty of sleep when it comes to not only your physical health—but also your mental and emotional wellbeing as well.
Of course, dietary considerations are important for any human, but they have an increased importance when diabetes is in the picture.
There are actually two ways of thinking about why this is so important for those who are diabetic:
- How food affects and contributes to the disease itself
- How food can create the same kinds of problems it would for anyone, but are then exacerbated on account of the existing disease
When it comes to that first point, we are mainly talking about sugar (in all its various forms).
Diabetes is a disease wherein the body has developed an impaired ability to either produce or respond to the hormone insulin. That’s a problem because insulin is essential for regulating the metabolism of carbohydrates—making sure they’re being processed in a normal manner—and the amount of glucose (sugar) in your blood stream.
Because your body is unable to process sugar and carbohydrates in an appropriate manner, you basically end up with too much glucose.
Okay, so why is that bad thing?
Taking a very broad view, elevated blood sugar levels are concerning because the extra sugar wreaks havoc in vital body systems, such as your immune, cardiovascular, and nervous systems.
To get a bit more specific, diabetes:
- Reduces the effectiveness of your immune system. Once compromised, the immune system is unable to fight off infections and heal wounds.
- Reduces blood flow throughout the body. Individuals with diabetes may develop peripheral arterial disease (PAD), which is a condition wherein blood has a harder time flowing through constricted blood vessels.
- Causes peripheral neuropathy. In other words, the heightened sugar levels actually damage nerves—sometimes to the point of destroying and rendering them unable to function.
Your body relies on those systems to keep you healthy and safe. When diabetes enters the picture, however, you have an increased risk for serious health issues.
Now, people are generally familiar with several of these risks. Blindness, kidney failure, heart attacks, and strokes are all potential issues.
Those are serious medical complications—but don’t overlook your feet!
Yes, diabetes can lead to issues in the lower limbs that are also quite serious. And specifically, we’re talking about Charcot foot and diabetic foot ulcers.
In the case of Charcot foot, PAD has created a situation where the bones in the feet—the farthest points on the human body from the heart—have received a diminished amount of the oxygenated, nutrient-rich blood coming your heart.
Without proper nutrition, the bones become weakened. This would be concerning anyhow, since feet endure tremendous force loads from even normal, daily activities, but the condition is amplified on account of nerve damage.
Neuropathy can start to develop with a variety of painful symptoms, but it can also cause nerves not to function at all.
When diabetic neuropathy has taken away your ability to feel, you cannot tell if a bone (or multiple bones) in a foot breaks. Since you’re unaware, you would likely continue doing regular activities. And in doing so, further damage can occur.
This cycle will sometimes continue until a foot is severely misshapen.
Depending on the stage of deformity, we may or may not be able to help restore normal structure. In the event we cannot, there’s a pretty significant possibility amputation will be needed.
We don’t want that and are inclined to think you don’t either!
Charcot foot certainly highlights the importance of having a diabetic foot care plan in place to catch problems early and protect your feet (so issues don’t happen in the first place!).
But this isn’t the only condition you need to be concerned about:
Diabetic foot ulcers are an even more dangerous problem.
If Charcot foot can be linked to neuropathy and PAD, ulceration is connected to neuropathy and a compromised immune system.
As with Charcot foot, a key element that contributes to the develop of ulcers—which are wounds that do not heal and continue breaking down—is damage within the nervous system.
In this case, something normally considered “minor” goes unnoticed (because damaged nerves are not permitting physical sensation).
Let’s pause for just a moment to clarify:
By “normally considered minor,” we mean things that are problems—scrapes, cuts, ingrown toenails, blisters, etc.—but don’t usually cause severe pain, dysfunction, or be thought of as “life-threatening.”
If these aren’t usually a big deal, why are they now?
This is where the compromised immune system comes into play.
With a healthy, normally-functioning immune system, the body heals cuts, scrapes, etc. in a fairly expedient fashion. Also, it’s able to fight off disease and potential infections.
But diabetes takes that away.
So, what this means is that your wounds—whether of internal origin (blisters, corns, calluses) or external origin (cuts, scrapes, burns)—heal very slowly, if at all.
On top of that, when there are openings into the body, microorganisms will take advantage of the opportunity and enter. And once in, diabetes has compromised the body’s ability to fight back.
Basically, you end up with wounds that continue breaking down and a drastically increased infection risk.
If that doesn’t sound too bad, consider this:
Diabetic foot ulcers can become gangrenous. There is no cure for gangrene (tissue death), so it needs to be removed (via amputation) to keep it from spreading.
According to the American Podiatric Medical Association, “ulceration precedes 85 percent of diabetes-related amputations.”
That alone is highly concerning, but even more so when you consider the high five-year mortality rates for new-onset diabetic ulceration:
The reported rates of between 43 and 55 percent—and up to 74 percent for patients who’ve had lower-extremity amputation—are higher than those for breast, colon, and prostate cancers.
Clearly, too much sugar in the diet is a major problem—but there’s more to the story.
As we noted, dietary choices can also exacerbate issues being caused by the disease. Let’s look at this a little closer.
- A big concern with sodium is that the more you include in your normal diet, the more your feet will swell. This is a problem because swollen feet lead to tighter-fitting shoes. When footwear is too tight, there’s an increased risk of blisters, corns, and calluses—all of which can potentially lead to ulceration (when not addressed properly).
When it comes to sodium, it’s recommended that we limit the amount at 1200mg/day, but the average American consumes closer to 3500mg/day.
- As we’ve noted, diabetes affects several body systems—including your cardiovascular system. If you recall, you need a healthy blood flow so the tissues in your lower limbs receive the nutrients required to be strong.
Cholesterol can both cause and contribute to PAD, thereby making it even harder for blood to reach your lower limbs. To make sure you aren’t putting too much into your system, try to limit the total amount of cholesterol to a maximum of 300mg/day AND less than 7% of your calories should come from saturated fat.
- Given the choice between fat and sugar, you should actually choose fat if you are diabetic (and perhaps even if you aren’t). That being said, certain kinds of fats are still worth monitoring and consuming only in limited quantities.
In this case, the concern is mainly with saturated fats—which you should limit to around 24 grams/day—and trans fats. For trans fats, it’s best to avoid them as much as possible, but definitely keep it less than 2 grams/day.
The reason for singling out these fats—and not unsaturated ones—is that they can lead to heightened cholesterol levels (which we just discussed).
At the end of the day, this is the simple truth:
If you are diabetic, you MUST pay attention to what you eat.
(And that’s still a good idea even if you don’t have diabetes!)
Managing your blood glucose levels is one part of responsible diabetic foot care—and general disease management—but it isn’t the only thing you need to do.
If you don’t already have a diabetic foot care plan, it’s time for a regularly scheduled appointment, or you’ve found something concerning in your daily foot inspection—give us a call to set up an appointment!
When you do, you will receive professional, experienced care and treatment from doctors who’ve been able to help others just like you.