June 12, 2003
Meal Planning, Food and Diet
Question from Troy, Ohio, USA:
I am a 59 year old male, with type 2 diabetes (treated with Glucophage XR [metformin]) and high blood pressure (treated with an ACE inhibitor), and I have trouble keeping my upper blood pressure number under 140. In addition, I have been dieting for about two years, trying to get my weight down.
Because of my diabetes, I’ve had to watch what I eat very carefully. For me, certain foods spike my blood sugar to where medication does not continually control it. Of course, I watch my sugar intake consistently, but those with average to large amounts of carbohydrate are worse. Therefore, I have been on a modified Atkins diet (no sugars) for the past 18 months, and I have lost about 15 pounds, but still have about 30-40 more I want to lose. My cholesterol has lowered into the good range, according to my doctor. My problem is, on this diet, I have not been able to successfully get my blood pressure and blood sugar under satisfactory control.
After reading an article on high blood pressure in the May 26th issue of Time and going to the National Heart, Lung and Blood Institute (NHLBI) website, I would love to try the DASH diet they recommend for lowering blood pressure, but my other two concerns (blood sugar levels and continued weight loss) make me very cautious. What are your suggestions? Have you tested the DASH diet on individuals with diabetes? If so, what were the results? If not, do you feel I could make the DASH diet, with possibly some modifications, work for me?
Answer:
I happen not to be a big advocate of the high-protein, low-carb diet described by Atkins. This is especially true in patients with diabetes in whom the high protein content of the diet may have negative impact on diabetes-related changes in the kidney. I think that the DASH diet would be great.
I would recommend you spend some time with a dietitian to go over the concepts utilized in designing the diet, behavior modification issues that come up, and to provide plans for follow-up. Although weight loss has been clearly shown to help improve blood pressure, it does not guarantee all individuals will lower their blood pressure with weight loss. This is especially true if you have another medical problem that may contribute to the high blood pressure, such as diabetic nephropathy.
You need more insight from your physician as to whether this condition exists and the strategies used to treat it. If it is present, I would recommend getting away from a high-protein diet, stay on the ACE inhibitor, and carefully monitor blood sugar and pressure for efficacy of treatment regimen.
JTL
