EXPERT > Doctor In The House

Healthy Holiday Eating Habits

By Dr. Laurie Tom
Interviewed by Rasa Fournier
Wednesday - November 24, 2010
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Dr. Laurie Tom
Endocrinologist at Queen’s Medical Center and president of the American Diabetes Association, Hawaii Leadership Board

Where did you receive your schooling and training?

After Punahou, where my classmate was Barack, I did undergrad work at Creighton University, then attended the UH John A. Burns School of Medicine followed by internal medicine residency in the UH integrated medical residency program. Then I did my specialty training in endocrinology, diabetes and metabolism in California at Harbor-UCLA Medical Center.

How long have you been practicing?

I’ve been in solo private practice at the Queen’s Physician’s Office Building since 1992.

In a nutshell, what is diabetes?

Diabetes is the name of a group of disorders where the body does not metabolize food and carbohydrates and sugar normally, resulting in a high blood glucose, referred to as blood sugar. There are mainly two types of diabetes, type 1 and type 2. Type 1 accounts for 5 percent to 10 percent of all diabetes. It’s an autoimmune condition in which the insulin-producing cells of the pancreas are destroyed. The pancreas is an organ behind your stomach, in the abdominal cavity. Essentially, the pancreas cannot make insulin, so the patients need to take insulin to survive.

Insulin is necessary for the body and its cells to metabolize or use glucose, which is broken down from the foods we eat that contain carbohydrates and sugar. Type 2 diabetes makes up the majority of diabetes and is a lot more complex because many different things are happening in the body. These patients are resistant to the action of insulin, their pancreas doesn’t make enough insulin, and the liver releases too much glucose. Plus there are other defects involved. Athird type of diabetes is gestational diabetes, the onset of which occurs during pregnancy, usually during the third trimester.

Can eating too many sweets lead to diabetes?

Eating sweets is not going to make you have diabetes, but if you eat too many sweets, that can lead to you being overweight and obese. Being overweight or obese is very much tied to increasing one’s risk for type 2 diabetes - 80 percent to 90 percent of people with type 2 diabetes are overweight or obese. Other risk factors include a family history of diabetes, if you’re in a high-risk ethnic group, had gestational diabetes or a baby weighing more than 9 pounds. In Hawaii, our Native Hawaiians are at the highest risk, but we’re also seeing growing numbers in the Filipino and Asian populations. Our western diet is high in fat, carbs and calories, which leads to obesity. Fat tissue accumulated in the abdominal cavity secretes things that are antagonistic to insulin action and toxic to your pancreas cells.

Why is insulin important?

Insulin gets secreted in response to the glucose rising and it helps take your glucose into the cells. People with diabetes have insulin resistance and it may start 10 years before you even know you have diabetes. There are genes for insulin resistance, but even if there’s no family history of diabetes, just getting older increases the risk. One in five after the age of 60 get diabetes, even if they’re not obese.

With the coming holidays, what’s the best way to prevent diabetes or manage it through diet?

During the holidays, the tendency is to overindulge. One thing you can do when cooking is use healthier ingredients. Let’s say you’re making stuffing: Use a healthier bread, a whole-grain bread, as opposed to white bread. You could look for sugar-free ingredients. However, there’s a tendency for people to think that sugar-free means they can eat all they want. Sugar-free foods still have calories.

If you’re going to a party, know what to avoid. Minimize things like gravy or extra calories. Tell yourself you’re going to only have one plate and that’s it. When you’re at a party, don’t hang around the table where the food is. When you have a piece of pie or cake, just have a sliver and consciously enjoy the flavor of it as opposed to scarfing it down.

Eat lots of natural foods such as green vegetables and fruits. Eat the healthier and lower-calorie vegetables first, so that when you eat the higher-calorie starch and protein, you won’t be as hungry and won’t eat as much as you normally would. Fruits contain vitamins, fiber and other nutrients, and it is better to eat more natural sugars than artificial sugars and products. However, if you have diabetes, you don’t want to eat a lot of fruits because they will make your sugar high.

If you eat right and exercise, you’re less likely to get diabetes?

Diabetes-prevention studies were performed here with people who have pre-diabetes, glucoses above normal but not in the diabetes range. These people are at high risk for developing diabetes. What’s proven to prevent their onset of diabetes or delay it is regular exercise. The protocol in these studies was exercising five days a week for 30 minutes, 150 minutes a week. If you’re overweight, you’ve got to lose weight. Losing 7 percent of body weight helped, so if you’re 200 pounds, if you lost 14 pounds that was sufficient to keep the glucoses controlled.

What are symptoms of pre-diabetes?

The danger is you can have no symptoms. That’s where awareness of the risk factors comes in. Get tested if you’re in a high-risk ethnic group or have other risk factors. Symptoms of high blood sugar include frequent urination and increased thirst. When the sugar is high, you might urinate frequently because the sugar is excreted in the urine and water follows. You become dehydrated and more thirsty. If you don’t know it’s because of high sugar and you drink soda and orange juice, your sugar goes even higher so it’s this vicious cycle - high sugar, frequent urination, increased thirst. Other symptoms: Sometimes women have more bladder infections or vaginal yeast infections, or you just feel tired. You can have unexplained weight loss, because you’re eating things but you’re not really metabolizing the calories because you don’t make enough insulin to take the glucose into the cells. With frequent urination, the sugar that goes out in the urine is actually the calories from what you’ve eaten going out. Your body is actually starving, so you lose weight. Other symptoms include fatigue, blurred vision, erec-tile dysfunction and cuts or sores that don’t heal well.

Any final words?

Even if one eats “healthy” or vegetarian, they can still be overweight if they overeat. Try to maintain a healthy weight by eating reasonably and exercising regularly, which are necessary to control diabetes and also prevent it. Controlling diabetes will help prevent its complications so that life with diabetes can still be healthy, productive and joyful. Happy Holidays!