|
Healthy Living April Issue
SWEET TOOTH, BITTER HARVEST:The Sugar and Diabetes Story
All Diabetics Are Not the Same
Diabetics are often divided into four categories. Of these four categories, there
are actually two main types of diabetes: insulin-dependent diabetes mellitus
(IDDM), often referred to as Type I, and non-insulin-dependent diabetes
mellitus (NIDDM), often designated Type II.18 Although some diabetes purists will
take pains to use the terms IDDM and NIDDM, in this chapter I will use the terms
Type I and Type II. A third type of diabetes occurs in pregnancy and is called
gestational diabetes mellitus. The fourth category of diabetes takes in a host of
rarer causes of the disorder such as those due to hormonal abnormalities or other
medical conditions.
Type I diabetes is the most severe form of the disease. It typically occurs in
childhood (but can develop at any age) and for this reason was previously called
"juvenile diabetes." The most common cause of Type I diabetes is
destruction of the insulin-making cells in the pancreas by the person’s
own immune system. This is referred to as "autoimmune destruction." The
specific factors that trigger this autoimmune process have proved elusive. Although
some cases have been linked to viruses or chemical toxins, much is still unknown
about the beginnings of the Type I diabetes process.19 There does seem to be a
genetic susceptibility to the disease, plus an environmental factor that triggers
the disease process. Some of the most interesting recent research links some cases
of Type I diabetes to an abnormal immune reaction to milk protein. We now know
that children who are breast fed for a shorter time or who are started on cow’s
milk earlier have an increased risk for this type of diabetes.20 In fact, the
drinking of cow’s milk may be the trigger that initiates the disease in over
half of all Type I diabetics.21
Regardless of the cause of their Type I diabetes, affected individuals lose their
ability to make adequate amounts of insulin and are left with an absolute life-
and-death need for insulin shots. Without those shots, they go into a condition
called diabetic ketoacidosis, which is fatal if not promptly treated. Because of
their absolute need for insulin, individuals with Type I diabetes are usually
diagnosed early in the disease process. Typically they have symptoms like excessive
urination (polyuria), excessive thirst (polydipsia), excessive hunger, and excessive
eating (polyphagia). They often are also bothered by fatigue and weight loss.
Why does the Type I diabetic develop these symptoms? The answer is best arrived at
through a brief review of some of the main facts about blood sugar and how it is
controlled. The main fuel for our bodies is a simple sugar called glucose. There is
a potential problem, however, with this fuel source. It can only get into each cell
of the body if insulin is present. Some have compared insulin to a key that opens
"the doors" in body cells so that the vital fuel, glucose, can get into the
cell. However, if there is an insufficient amount of insulin (as in Type I diabetes)
or if the locks on the doors are "gummed up" so that the insulin key has
difficulty opening them (as can occur with the insulin resistance of Type II diabetes),
then blood sugar levels can rise. When blood sugar levels rise sufficiently, the
ability of the kidney to contain the sugar is overwhelmed, and sugar comes out in the
urine. The sugar takes water with it, thus leading to the excessive urination so
familiar in uncontrolled diabetes. The loss of water results in another diabetes
symptom: increased thirst. At the same time, sugar is not moving into the
body’s cells adequately. In a sense, the body’s cells are starving for
energy. This can cause fatigue, weight loss, and excessive hunger.
Fortunately, only about 5 to 10 percent of diabetics in America fall under the Type
I diabetes category.22 The remainder are Type II diabetics. These individuals
either have a problem called "insulin resistance" or a less severe
underproduction of insulin than those with the Type I variety. In actuality, most
fully developed Type II diabetics have both of these problems.23 There appear to
be many different causes of Type II diabetes; most seem to have a genetic basis.
The majority of individuals with this type of diabetes have a family member that
had also been diagnosed with the disease. For example, many Native Americans have
this genetic tendency; however, it appears they did not have diabetes until they
adopted a Western diet with an overabundance of sugar and fat. Simply put, it
usually takes a combination of two factors to develop adult onset diabetes. One is
genetics, and the other is a poor diet-like that consumed by the average
American.
Many individuals with Type II diabetes generate plenty of insulin but their body is
resistant to it. This condition of insulin resistance can be addressed by lifestyle
changes. By maintaining an excellent diet, achieving an ideal weight, and embarking
on an exercise program, many Type II diabetics can control their blood sugars with
these lifestyle changes alone. Some may need diet changes plus a pill to help
control their blood sugar.
Because of the more subtle nature of Type II diabetes compared to Type I, it often
goes undiagnosed. A person with Type II diabetes may not have any of the classic
diabetes signs like excessive urination, excessive thirst, excessive hunger,
fatigue, or weight loss. At any point in time, it is estimated that fully 50
percent of Type II diabetics have not yet been diagnosed.24 Of course, unrecognized
diabetes still does its damage steadily and silently. About 20 percent of newly
diagnosed Type II diabetics already had damage to their eyes (retinopathy).25
Sometimes an unsuspecting person will be told they have diabetes when a routine
blood screening reveals high blood sugar. If the blood sugar is above 125 after
an overnight fast, it indicates diabetes. Individuals can have diabetes, however,
with fasting blood sugars below that level. If a doctor suspects diabetes in a
person with a relatively low fasting sugar, further testing can be done. The oral
glucose tolerance test checks for diabetes by measuring a person’s blood sugar
response to a sugary beverage. Pregnant women routinely have such a test to make
sure they are not diabetic. Some doctors recommend that others in the general
population should have a glucose tolerance test. Depending on the physician, some
will recommend the test for those with significant obesity and/or genetics.
Others advise the glucose tolerance test in anyone with fasting sugars higher than
a certain level. Some will check all those with fasting sugars over 105; some very
conservative doctors will advise the test to all their patients who have fasting
sugars consistently over 95, since this usually indicates that at least the
individual has the gene for Type II diabetes. A glycosylated hemoglobin level
(discussed later in the chapter) may be able to substitute for the glucose tolerance
test in detecting diabetics with fasting blood sugars less than 125.26
Although Type II diabetes can be picked up by such blood tests for elevated sugar,
many Americans do not seek out health professionals for such preventive services.
They wait until they are sick. This is unfortunate. As a result, many Type II
diabetics only become aware of their disease when they experience potentially
irreversible problems like eye or kidney disease, nerve problems, or a heart attack.
Regarding gestational diabetes, two to five percent of all pregnant American women
are affected.27 This translates into about 200,000 children being born to mothers
with gestational diabetes each year.28, 29 This is significant, because those
children experience an increased risk of health disorders such as birth trauma,
lower blood sugars at birth (neonatal hypoglycemia), and even premature death in
infancy (perinatal mortality).30 The message is clear: if you are a diabetic who
becomes pregnant, or if you develop gestational diabetes, you should have your blood
sugar monitored closely. Your diet and lifestyle need to be well regulated.
Furthermore, any woman who develops gestational diabetes has a genetic tendency
for diabetes. She is at high risk to develop full blown diabetes later in life.31
Practicing healthy habits throughout her life span thus becomes critical.
Controlling Diabetes: Can the Ravages of Diabetes be Prevented?
Recently, a landmark Diabetes Control and Complications Trial (DCCT) was completed.
This six-year study looked at 1441 Type I juvenile diabetics. Those diabetics
who strove to keep their blood sugars as close to normal as possible (using insulin
and lifestyle changes) had 76 percent less chance of developing diabetic retinopathy,
a serious eye disease.32 They also experienced 54 percent fewer cases of significant
kidney disease and 60 percent fewer cases of nerve problems involving the hands
and/or feet (peripheral neuropathy).33 The participants also significantly lowered
their blood cholesterol levels, suggesting that tight control could decrease heart
disease risk by up to 35 percent.34 These improvements are summarized in Figure 3:
Results of Blood Sugar Control in Type I Diabetics.
Diabetics in this study who keep their sugars as close to normal as possible are
said to be practicing "intensive therapy" or "tight control."
This begs a question: in the research just referred to, exactly how intensive was
"intensive" (or how tight was "tight control")? The DCCT had very
clear blood sugar goals. Fasting blood sugars in the morning as well as blood
sugars before each meal were to be between 70 to 120. After-meal levels were to
stay below 180. Furthermore, a middle-of-the-night sugar at 3 AM was to
stay above 65. To find out how well the participants were adhering to these goals,
an additional blood test called glycosylated hemoglobin was taken regularly. This
test measures the amount of sugar that becomes attached to a person’s red blood
cells. The amount of attached sugar in turn is directly related to the average
amount of sugar in the blood throughout the life span of the red blood cells.
Since red blood cells typically live for 90 to 100 days, the glycosylated hemoglobin
value gives an approximation as to the average blood sugar level over a
three-month period. In the DCCT study, levels were about 6.05 percent. This
compares favorably with a value of 7.5 percent, which is considered the upper limit
of normal in a non-diabetic population.35
How does intensive therapy differ from the standard or conventional way of treating
diabetes? First, intensive therapy always refers to treatment using insulin.
Second, with intensive therapy there are no fixed doses of insulin. For example, a
diabetic on this type of program does not take a fixed amount of insulin every
morning. The amount of insulin is adjusted according to the level of blood sugar
at the time the insulin is given. This differs from the old way of giving insulin
that is still called a "conventional fixed dose program."36 That approach
assumed that insulin requirements would be the same each day. In fact, we now know
that insulin needs can vary tremendously from day to day. This knowledge of changing
insulin needs provides the rationale for intensive therapy.
Intensive insulin therapy attempts to artificially simulate how our bodies’
insulin-producing organ, the pancreas, works: the pancreas constantly secretes
insulin into the blood so that there is always some insulin present. This is what
is called the basal insulin level. The pancreas also secretes extra insulin in
response to the food we eat.37 To reproduce this effect of basal insulin some
diabetics will use a long-acting insulin shot, while others will use an insulin
pump that works continuously to deliver this basal insulin level. To reproduce the
food-related insulin surge, whether on shots or on the pump, additional regular
insulin or a new short-acting insulin (Humalog) is given. If the shot method is
used, at least three shots per day are given on the intensive insulin program.
To evaluate the body’s needs for insulin, frequent blood sugar monitoring is
necessary. Blood is obtained for this purpose by pricking the finger with a small
needle-like instrument called a lancet. Then this blood is analyzed by a home
sugar-monitoring device. The diabetic who is on an intensive schedule usually
pricks his or her finger a minimum of four times and an ideal of seven times per day:
before each meal and at bedtime, plus ideally an hour after each meal.38
Although tight control makes a profound difference for the Type I diabetic, it is a
much more cumbersome and expensive process in the short run. Many have felt that the
DCCT results could be extended to apply to Type II diabetics; this interpretation is
not based on any facts obtained from that study.
In my opinion, we should not be too quick to try to rigorously control the blood
sugars of a Type II diabetic with an intensive insulin program. In addition to the
time, expense, and discomfort involved in finger pricks and multiple injections,
there are even more pressing concerns. Before we look at those concerns, some words
of explanation are in order. Although Type II diabetics are called "non-
insulin dependent," remember, this simply means that they do not have a life or
death need for insulin shots. Many doctors nonetheless put these individuals on
insulin to better control their blood sugars. In fact, the National Institutes of
Health indicate that 50 percent of known Type II diabetics in America are either using
insulin alone or insulin in combination with oral medications.39 This greatly
confuses many in lay circles. They erroneously think that just because someone is
on insulin, they are a Type I diabetic. More often than not, a diabetic who is on
insulin has the Type II variety. After all, estimates are that there are over 3.5
million insulin-using Type II diabetics in our nation. This compares with only
800,000 Type I diabetics in total.40 Now that we have paused to recognize that many
Type II diabetics use insulin, we need to look at one of the most worrisome problems
with this practice. It is what I call "the vicious cycle of insulin use."
The cycle begins with a sobering fact: using insulin aggressively stimulates weight
gain. In the DCCT, the average participant on the intensive program weighed 10
pounds more than the control subjects after 5 years.41 This is especially ominous
for the Type II diabetic. Type I diabetics are often thinner and more resistant to
weight gain relative to the Type IIs. However, some tend to gain weight after the
onset of the disease. Type IIs often have overweight problems at the onset of
diabetes, and experience further weight gain as the disease progresses.
In my medical experience, when I am asked to see a Type II diabetic who has been
placed on insulin to try to improve blood sugar control, I generally expect them to
have gained a significant amount of weight. This introduces the next part of that
vicious cycle. Weight gain contributes to the Type II diabetic’s resistance
to the effects of insulin; thus, as weight increases so do insulin needs. The cycle
comes full circle when insulin dosages are further increased, only to stimulate
further weight gain. The significance of this dilemma has been appreciated by the
National Institutes of Health. Because of the tendency of intensive insulin therapy
to promote weight gain, they have stated, "Intensive treatment may not be
appropriate for diabetics who are overweight,"42 which includes most Type II
diabetics.
The tight control of diabetes with insulin also introduces other problems. The DCCT
study participants ran a much higher risk of low blood sugar (hypoglycemic) reactions
than those who were not practicing intensive therapy. Although hypoglycemia is usually
no more than a physically uncomfortable inconvenience, severe reactions can actually
be life threatening.
At this point, someone may point out: yes, there are problems with insulin therapy for
the Type II diabetic, but is it possible for these individuals to keep their blood
sugars in an ideal range by using oral medication-without all the finger sticks
and insulin? It is true that early in the course of the disease it is often possible
for a Type II diabetic to use medication to optimally control their sugars. However,
over time, the oral medications often become insufficient to keep blood sugars in
the tight control range demanded by intensive treatment.
Even if blood sugars can be controlled with pills by mouth, this does not prove the
wisdom of using them. Although I do use oral medications in some of my diabetic
patients, the practice is part of one of the longest standing controversies in
medicine. The main drugs that continue to be used for blood sugar control belong to
a class called the sulfonylureas. Common drugs in this family include DiaBeta,
Micronase, Glucotrol, Glynase, Amaryl and Diabinese. Today, if you look up any of
these drugs in the Physician’s Desk Reference, you will find a warning in bold
print entitled "Special warning on increased risk of cardiovascular mortality.
"43 That warning goes on to explain the findings of a study published back in
1970 by what was called the University Group Diabetes Program (UGDP). Researchers
found that diabetics who took tolbutamide, an oral pill used in the study, had more
than double the risk of dying from heart disease as those who treated their diabetes
with diet alone. Today, some urge that the drugs in this family are vastly different
now than the tolbutamide of the 1960s. However, the FDA still requires that even the
newest drugs in this class carry a bold print warning that reads, "Although only
one drug in the sulfonylurea class (tolbutamide) was included in this [UGDP] study,
it is prudent from a safety standpoint to consider that this warning may also apply
to other oral hypoglycemic drugs in this class, in view of their close similarities
in mode of action and chemical structure." Some of the newer medications for
diabetes such as Precose, Glucophage, and Rezulin are not in the same class and have
differing mechanisms of action. Thus they may be less likely to increase the risk
of heart disease, although they have not been on the market long enough to make a
firm determination in this regard.
My conclusion, based on published medical research and my personal experience, is
that careful blood sugar control is important in Type II diabetics. However, the
use of insulin and oral agents in these individuals carries the potential to do
more harm than good. Thus, the most important question in my mind always is: how
can I help my Type II diabetic patients control their sugars without drugs? Such
an approach stands to reduce the complications of high blood sugars while
decreasing the risk of problems from treatment.
Exercise - First Element Needed in a Comprehensive Diabetes Lifestyle Program
Exercise plays a powerful role in lowering blood sugar levels. Evidence suggests
that muscles in motion reduce resistance to insulin; that is, insulin sensitivity
is improved by regular physical exercise.49 More simply put, exercise-in a
sense-works like insulin in a diabetic: it helps sugar go out of the blood and
into the muscle tissue. In fact, the prestigious Joslin’s Diabetes Medical
textbook indicates that lack of exercise is "a key factor" in the development
of insulin resistance as people get older.50 Since diabetics need insulin on a daily
basis (either their own body’s insulin or injected insulin) so do diabetics
need daily exercise to optimally control their blood sugars and their disease.
Exercise not only helps diabetics control their blood sugars, it also helps non-
diabetics decrease their risk of ever developing diabetes in the first place. One
study showed that exercise dramatically decreased the risk of developing diabetes
among those who were at high risk for the disease.51 As the amount of energy
expended in exercise increased from 500 calories per week to 3500 calories per week,
the risk of developing diabetes dropped by 48 percent. In other words, regular
exercise nearly cut the risk of developing diabetes in half, as shown in Figure 4:
Exercise and Risk of Diabetes. Interestingly, those who were at the highest risk of
developing diabetes benefited the most from regular exercise. Individuals classified
as high risk in this study included those who were overweight, had a family history of
diabetes, or had high blood pressure. The bottom line is that exercise is important for
everyone. However, it is especially critical for the diabetic and for those at high
risk of developing the disease.
Proper Diet-Second Element in a Comprehensive Diabetes Lifestyle Program
Until recently, diabetics were told that in order to control their blood sugars they
had to eliminate most of the carbohydrates from their diet. They were told to avoid
sugar, but the message did not stop there. Plant foods-naturally rich in complex
carbohydrates-were also on the "hit list." The result left diabetics
gravitating to a heavy meat diet.52 The medical community did not realize at that
time what we have already noted; namely, a high protein diet promotes kidney
destruction. With heavy meat consumption also came increased ingestion of cholesterol
and saturated fat. Galloping atherosclerosis then followed close behind. "Missing
the forest for the trees" was certainly true in this case. The trees were the high
blood sugars, the forest was the whole patient. Yes, eating a low carbohydrate
(high meat) diet can control the blood sugars, but the number one cause of death
among diabetics is heart and blood vessel disease. In fact, the American Heart
Association has gone on record that fully 80 percent of diabetics die of some form
of heart or blood vessel disease.53 The root cause of heart and blood vessel
disease is atherosclerosis. This process is, of course, accelerated by meat with
its high content of cholesterol and saturated fat. Ironically, then, by treating his
or her blood sugar with a high meat diet, a diabetic may likely trade the control
of blood sugar for an early death from heart disease. Since it is the complications
and afflictions of diabetes that need to be particularly avoided (not just the control
of blood sugars) the diet needs to be tailored to avoid or treat these complications
as well as control the blood sugar.
Obesity is often one of the main determinants of insulin resistance (the primary cause
of Type II diabetes). Thus it is imperative for an obese diabetic to lose weight if
control of the disease is to be obtained by lifestyle changes alone. Meat is also
dense in calories and makes weight loss more difficult. On the other hand, whole
fruits, vegetables, and grains (without fatty toppings) are much less dense in
calories, thus facilitating an excellent weight loss program.
Meat and Death from Diabetes
Notwithstanding the fact that meat can help control blood sugars in diabetics, a large
Southern California study done among Seventh-day Adventists showed that those that
ate meat six or more times per week were at 3.8 times greater risk of dying from
diabetes than those who ate meat less than once per week, as illustrated in Figure 5:
Meat and Death from Diabetes.54 Other research indicates an additional benefit to
diabetics who avoid meat and animal products. These animal-derived items have no
fiber in them whatsoever. And fiber is emerging as a critical ingredient in the
control of blood sugar. In fact, some are suggesting that an abundant supply of
fiber is one of the main reasons that a vegetarian diet benefits diabetics.
Fiber Facts
Fiber is a term that refers to plant constituents that are resistant to human
digestive enzymes.55 Almost all of the different types of fiber are actually
indigestible carbohydrates (the only exception is a fiber called lignin).56 Some of
the other fiber types include cellulose, hemicellulose, pectins, and gums.57 Fiber
is generally classified as either soluble (dissolves in water) or insoluble. As we
will see shortly, these two types of fibers have different benefits. One of the
bonuses of eating a balanced diet of natural plant foods is that we tend to get
liberal amounts of both the soluble and insoluble fibers.
There are many foods rich in fiber. A high content of insoluble fiber is found in
wheat (especially the bran) and bananas. Foods strong in soluble fiber include most
fruits, vegetables, legumes (fresh or dried), oats, brown rice, and barley. Most
foods that are strong in soluble fiber are also strong in insoluble fiber. Examples
of foods high in fiber are shown in Figure 6: Good Sources of Soluble and Insoluble
Fiber.58
Fiber, Insulin, and Blood Sugar
Research makes evident that foods that are high in fiber lead to a slower rise in
blood sugar, and as a result, require less insulin to handle the meal.59 Fiber,
especially soluble fiber like the pectins and gums, slows the emptying of food from
the stomach60 and helps to slow the absorption of simple sugars in the small
intestine.61 This should be contrasted with high fat meals that can result in high
blood glucose levels for up to 5 hours after the meal.62
Addition of these types of fibers to the diet has been demonstrated to improve diabetes
control.63 Indeed, eating a low fat, high fiber, vegetarian diet keeps blood sugars
low even when fruits are eaten. Dr. James Anderson and colleagues at the University of
Kentucky found that by using a high carbohydrate and high fiber diet, the need for
insulin was greatly reduced. Blood sugar control was better and fasting levels of
cholesterol and triglycerides fell. These and other benefits of the high carbohydrate,
high fiber diet are listed in Figure 7: Diabetic Benefits of a High-Carbohydrate,
High-Fiber Diet.64, 65, 66
Many nutrition experts recommend that our diets should contain between 20 and 35 grams
of fiber per day when it comes to issues like cancer prevention.67 However, even higher
amounts of fiber seem optimal for diabetes control. Studies that demonstrate consistent
decreases in insulin requirements by improving fasting and post-meal blood sugar
levels have used between 25 and 35 grams of fiber for every 1000 calories eaten.68 This
can easily bring daily fiber consumption into the range of 50 to 100 grams per day.
Consumption of soluble fiber also appears to be important in non-diabetics. As we
have already noted, whether or not a person has diabetes, these fibers prevent the
rapid rise in blood sugar, with a resulting lower peak level. Therefore, insulin
requirements are actually decreased when these fibers are added to the diet.69 This is
no small matter. As important as insulin is in controlling our blood sugar, ongoing
research demonstrates that higher blood insulin levels increase the speed at which the
blockages of atherosclerosis develop.70, 71 Thus, we should help our bodies by placing
fewer demands for high insulin output. One way we can do this is by eating less sugar
and choosing more fiber-rich foods.
One group of non-diabetics that may especially benefit from the insulin-sparing
effects of a high-fiber vegetarian diet consists of those with high blood pressure.
Individuals with elevated blood pressure (so called "essential hypertension"),
even if they are not overweight and not diabetic, tend to have tissues that are less
sensitive to insulin.72 The body responds to this lack of tissue sensitivity by making
more insulin to get the job done. Therefore, if hypertensives adopt a better diet,
their blood vessel walls will be exposed to a reduced amount of insulin.
Other Benefits from Fiber
Fiber from plant foods helps dilute, bind, inactivate, and remove toxic substances and
carcinogens found in our food supply. Fiber helps prevent colon cancer, and may help
against several other cancers as well.73 A diet rich in fiber helps in healing peptic
ulcer disease.74 Fiber is effective in curing and preventing chronic constipation.
It can also be effective in curing chronic diarrhea.
We have come a long way since fiber gained worldwide attention in 1970. It was then
that Dr. Denis Burkitt, a renowned British physician, published a report that very
effectively sounded the alarm. He observed that in countries where diets include large
amounts of fiber, there were few cases of the many degenerative diseases common in the
Western world today. These diseases are listed in Figure 8: Diseases Associated with a
Low Fiber Diet.75
Remember, fiber is found only in plant foods such as fruits, vegetables, grains, and
nuts. Fiber is not present in any animal products. There is no fiber in meat, milk,
eggs, or cheese. Yes, a cow eats plenty of fiber and is a vegetarian by nature, but it
retains no fiber in its flesh or its milk.
More on Proper Diet: Meal Timing on an Optimal Lifestyle Program
Most people do not realize that their glucose tolerance decreases as the day
progresses. This means that toward evening, your body’s ability to handle sugar
decreases. In a study of subjects with Type II diabetes, absolute blood sugar levels
were 10 to 15 percent higher when eating six times a day (three meals and three snacks)
compared to just three meals a day.76 Years ago, before very precise insulin types
were available, a snack at bedtime was recommended for diabetics because the insulin
levels peaked in the middle of the sleep period. The bedtime snack helped prevent
hypoglycemia, or low blood sugar. Today, with the types of insulin available, this is
not only unnecessary, but counterproductive. Our heaviest meal should be in the
morning, emphasizing fruits and grains. This prepares us for the most active part of
the day. A substantial meal for lunch, including several servings of vegetables, is
also important. As the day progresses, our ability to handle blood sugar decreases,
so a lighter meal in the evening (ideally, for obese Type II diabetics, no evening meal)
with no refined sugar is the best rule to follow. Asking your doctor to tailor your
insulin injections so that this program can be followed can produce great benefits.
What Other Problems Does Sugar Present?
It is important to recognize that when eaten apart from fiber, simple sugars are
associated with dental cavities, obesity, high triglycerides, malnutrition, and
decreased resistance to disease. This is true whether the simple sugar is in the form
of white sugar, brown sugar, honey, molasses, corn syrup, maple syrup, milk, or fruit
juice. Furthermore, there is concern that higher amounts of sugar in the blood can
combine with LDL cholesterol to produce a compound that is damaging to the lining of
blood vessel walls, thus stimulating atherosclerosis. This "glycated LDL"
(LDL combined with sugar) may become oxidized LDL that increases the risk of heart
disease.77 See Chapter 3, "Heart Disease-Conquering the Leading Killer,"
for information on the problems with oxidized cholesterol.
Refined sugar has effects that also impact our quality of life. A high sugar diet
and the consuming of fruit juices and sodas increase the severity of premenstrual
syndrome symptoms in college girls.78 Sugar also may decrease cognitive or intellectual
function, especially in children.79 Some hypothesize that the reason for this mental
deterioration is a result of the body overreacting to refined sugar consumption. A
load of sugar stimulates the pancreas to release excessive amounts of insulin, which
in turn leads in a few hours to a blood sugar that is lower than normal.80 Therefore,
children may get poor grades on their tests although they are well prepared. Eating
natural but not refined sugar, such as is found in apples, oranges, pears, etc., should
be encouraged because these foods are packed with nutrients, including fiber, along
with the unrefined sugar. At the risk of being redundant, let me reiterate: fiber slows
the rate of simple sugar absorption, allowing utilization of the energy from the food we
eat at a steadier rate.
One classic study examined the effects of eating apples in one of three different
physical forms: as whole apples, as applesauce, or as apple juice. Even though the
same number of calories was consumed from each preparation, eating the apples kept
blood sugars steadier than drinking apple juice or using applesauce alone. The change
of blood sugar levels through a period time after eating apples in the three forms is
shown in Figure 9: Effects of Food Processing on Blood Glucose Levels.81
Note that the blood sugar levels peaked for all three at the same level 30 minutes
after eating. Then all levels decreased as sharply as they rose, but each to a
different low point. The level for the apple juice consumer fell the lowest, to 50.
The level for the apple sauce eater went down to 61, while the whole apple eater had a
high 66 level as his lowest point. The raw apple eater’s level stayed constant
at the high level for the remaining two hours, while the level for the other two stayed
at lower values. Although this study was done in non-diabetics, the blood sugar
peaks are more pronounced (higher) in diabetics consuming the juice or sauce in
comparison with the whole apple, thus indicating that the natural whole apple will
produce a steadier blood glucose that the body can more easily handle. This study
demonstrates that eating food in its natural state is the safest
and-ultimately-the most satisfying way to enjoy sugar.
A Better Alternative
Research studies as well as my personal experience as a physician make an eloquent
point: if we adopt new and better ways of eating and living-and stick with
them-we will likely develop an enjoyment for that new lifestyle. In other words,
instead of continuing to eat foods that are characterized by excessive sweetness,
regardless of whether the sweet taste comes from sugar or from artificial sweeteners,
why not let your taste develop for foods that are naturally sweet? Try to find more
enjoyment in a crisp apple, a ripe banana, or perhaps even a home grown carrot or a
garden-fresh squash. Our taste buds are trainable.
Although I can think of many examples among my patients of "trainable taste
buds," there is one example from someone who is not my patient that is
especially "close to home"-my father. When I was growing up in Michigan,
my father, although not a diabetic, was suffering from a number of minor health
problems. As a mechanical engineer, he was not acquainted with medical or health
subjects. He happened across a book called "Sugar Blues" and became
convinced that his overweight condition and health problems were related to his high
sugar intake. He had always been an avid milkshake drinker, and an ardent consumer
of Reese’s peanut butter cups and chocolate covered cherries, among other
sugary foods. One evening he intrigued the family by announcing he had decided to
give up refined sugar entirely. My mother, however, continued to cook for our family
the way she always did. When it came time for the dessert, my father would leave and
go work in the garden. When he came home from work and chocolate-chip cookies
were baking he would go outside and do some chore to avoid the aroma and accompanying
temptation. We all quietly wondered how long he could continue with his decision.
After about four months, my father came home and another sweet dessert was baking,
but the appeal and desire were no longer present. In fact, he described the odor as
a "sickening sweet." He now enjoyed apple pies made without sugar (my mother
finally broke down and would make him desserts with no refined sugar) as much as he
had enjoyed his former desserts. My uncle, who would frequently visit us from Texas,
commented on how it was worth the trip just to see how "Bud" obviously
relished and delighted in plain simple foods. My father’s weight came down
and his health problems disappeared, but his enjoyment for food and life, if anything,
improved. As a young boy, this obvious "before and after" difference that I
had observed in my own father launched my interest in lifestyle and health. Although
it required disciplined sacrifice for a few months, the results demonstrate that taste
buds can be trained for the better.
Putting It All Together: Principles of Diabetic Nutrition
Many of my diabetic patients request that I give them a very specific menu that will
help control their diabetes. However, for most diabetics, menus are not as important
as knowing (and practicing) the dietary principles of diabetic control. This is
especially true for the non-insulin dependent Type II diabetic. The principles
are really very basic-we have looked at all of them in this chapter. The more
natural fruits, vegetables, and whole grains the better (nuts are also good in
moderation). The less meat and dairy products the better. The less refined sugar
the better. The more fiber the better. Eat a good breakfast and little if any supper.
If you are overweight it is of utmost importance that you reduce your weight to your
ideal weight (thus, the less fat in the diet the better) and follow an eating style
that allows you to attain and maintain this reasonable weight. Aerobic exercise, at
least 30 minutes in duration, should be part of the daily diabetic routine.
I am happy to provide my patients with delicious recipes incorporating the balanced
low fat, low sugar, high fiber vegetarian diet that is best for diabetes. I avoid
giving them a menu, however. Once they understand the principles, I let them
thoughtfully plan their own meals. I would give the same advice to each reader. Do
not feel bound to some restrictive way of eating. Take the principles to heart.
Experiment with different options. You will be surprised at how enjoyable a healthy
lifestyle can really be.
The Surprising Truth - Even for Non-Diabetics
Some people find it hard to believe this simple truth: the diabetic lifestyle I have
been describing is also the best lifestyle for non-diabetics. Whether you are
concerned about preventing diabetes or merely trying to optimize your health, this
program will also pay you rich dividends. And you will not have to sacrifice pleasure
either.
Almost every day at the Lifestyle Center of America in Oklahoma you will find diabetics
enrolled in our live-in programs for the purpose of reversing their disease
process. You will also find some others-individuals from the surrounding
communities who come to enjoy a meal in our dining room. They are often eating the
very same fare that the diabetic across the room is enjoying.
Often our fear of change is largely driven by ignorance. Pick up a good cookbook or
find a friend who can make some tasty meatless entrees, and embark today on a more
vegetarian-type of eating program. A list of cookbooks that specialize in
healthful menus can be found in Appendix II. You will find what our neighbors around
the Lifestyle Center of America have found: food can taste good, your life can have
enjoyment, and you can still be on the finest diet and lifestyle to reverse, control,
or prevent diabetes, in addition to reducing your risk of many other diseases.
Go to Alternative Living Index Page
|
|