Tuesday, May 17, 2011

How Low is a Low-Carb Diet for Type 2 Diabetes?

Does the thought of bread fill you with dread? Have you been told that tofu is terrific but taffy is toxic? Is a low-carb diet the only type 2 diabetic diet for you?

Type 2 diabetics are often given dietary advice that is more appropriate for type 1's and for people with MODY. More than other diabetics, type 2's have a need for enough carbohydrate so they can think clearly, stick to their diabetes treatment plans and achieve their goals, leading happy and functional lives as they keep their blood sugar levels well controlled. This article tells you how much carb is enough carb without being too much for managing type 2 diabetes.

Type 2's often can tolerate more carbohydrate, without long-term damage to their health, than type 1's, especially after they have had a recovery period of several months to several years of consistently normal blood sugar levels. Even type 2's in remission, however, typically can tolerate a lot less carbohydrate than they used to eat.

Type 2's are often told that tofu is terrific but taffy is toxic. I think it is more helpful to focus on too much carbohydrate and too little carbohydrate rather than on carbohydrates as good and bad. As time goes by you will find yourself eating healthy carbs for the simple reason that they taste better to you and they are more filling. A low-carb diet does not have to be a no-carb diet, especially if you exercise.

Carbohydrates Are Brain Fuel

Carbs and diabetes aren't compatible, but the best diet is low-carb, not no-carb. Mainstream nutritionists tell diabetics that they have to consume about 130 grams of carbohydrate each ever day, because that is the amount of glucose the brain needs for fuel. There may be some discussion whether these 130 grams, or about 520 calories, of carbohydrate, all of which is transformed by the digestive tract into sugar, has to come from celery or sugar plums or some variety of foods in between. Even a ketogenic diet requires at least a tiny amount of carbohydrate.

Most nutritionists will allow for a minimum of 10 to 15 servings of starchy or sugar foods (including one or two servings of fruit) each and every day, however, even in diabetic diets. This amount of carbohydrate not only fuels the brain but also helps amino acids travel across the blood-brain barrier so the brain can use them to make necessary proteins.

The brain seems to require at least 40 to 70 grams of glucose every day . This sugar has to be derived from starchy, sugary, or plant foods. Moreover, the release of glucose from protein depends on whether the protein is needed for tissue repair first, so extreme low-carb diets can lead to “brain fog,” due to fluctuations in the availability of sugar to fuel the brain.

These diets also usually induce constipation, bad breath, odd body odors, and changes in the skin, although
these problems may be much more easily tolerated that the diseases the ketogenic diet is used to treat. We find that most type 2's fare better on diets that are low-carb and that emphasize slow-carb, rather than on no carb at all.

How Low is Low-Carb?

The right amount of carbohydrate in your diet is the amount that never causes your blood sugar levels to run higher than about 170 mg/dl (9.4 mmol/L). If you are extremely thin and extremely insulin resistant, you may find that you can't eat much more than a side salad and maybe a single serving of starchy food at any given meal. If you are heavy set and you have been making progress in reversing insulin resistance (remember, controlling diabetes comes before controlling your weight), then you may even be able to tolerate a tiny amount of dessert once in a while, especially if you go out and burn it off in exercise.

Testing your blood sugar levels is the key to finding the right amount of carbohydrate in your diet, and, as we mentioned in the Introduction, for identifying trigger foods that send your blood sugar levels soaring out of proportion to the amounts you eat.

Generally speaking, however, it is not a good idea for any diabetic consume much more carbohydrate than the 130 grams or so the brain needs every day for its fuel. The fact is that some of the protein in the diet will become fuel for the brain even if you do eat more carbohydrate, and these 500 calories worth of food can be the most filling, the most nutritious, and the tastiest part of your diet.

Fast Carbs Taste Good But Leave You Wanting More, Slow Carbs Fill You Up

Sugary sweet carbohydrates and wholesome plant-based carbohydrates alike end up as sugar in the bloodstream. It is not true that every speck of carbohydrate that you eat becomes sugar; some complex carbohydrates cannot be broken down by the human digestive tract.

It is also not true that every last gram of carb that you ever eat raises your personal blood sugar levels; this may be true if you have type 1 diabetes or MODY, but if you have type 2 diabetes, sometimes your pancreas can keep up, and sometimes it can't.

And despite what advocates of the glycemic index might have you believe, there are no simple numbers that tell you how fast any given food will turn into sugar after it enters your bloodstream. To compute the glycemic index, scientists recruit a group of volunteers who agree to fast and then come into the lab, where they are served a 50-gram (approximately 2-ounce) serving of a reference food such as bread or glucose, and nothing else.

Blood is drawn to see how fast blood sugar levels rise after the food is consumed. Then the volunteers come back to the lab a second time, after they have had a chance to fast again, and eat a 50-gram serving of the test food. Once again, the researchers draw blood to test how fast blood sugar levels rise. The speed of digestion of the test food is compared to the reference food, and the average across the volunteers becomes the glycemic index.

The problem with this approach is that nobody eats that way. We don't fast, eat a small serving of a single food, and then wait for it to be digested before we eat anything else. We eat varying amounts of food that take varying amounts of time to be digested in the stomach. We eat acidic foods that slow down digestion and we eat bitter foods that speed up digestion. We eat hot foods that are digested faster, and cold foods that are digested slower. And protein and fat are not digested into sugar at all (although the liver can convert some amino acids into glucose over a period of 24 hours or so).

Combinations of Foods Slow Down Sugar Absorption

Combinations of foods change the glycemic index. White bread eaten by itself has a glycemic index of 100, but a sandwich made with white bread and a pickle has a glycemic index of 45. Hot instant mashed potatoes have the impossible glycemic index value of 110 (that is, they appear to be digested into glucose faster than pure glucose itself), but steamed new potatoes have a glycemic index of 83, and cold mashed potatoes with butter have a glycemic index of 58.

Many of the systems of glycemic index measurement that give glucose a value of 100 given other foods ratings of more than 100, suggesting that somehow a food can be broken down into glucose faster than glucose can travel through the digestive tract by itself. This seems highly improbable. It's more likely that additives and preservatives cause a stress reaction that causes the adrenal glands to release cortisol to stimulate the liver to release sugar even before the food is digested. And isn't that a sign that this is a food a diabetic should never eat?

If you eat a small serving of well-chewed food, which is a better way to eat for a variety of reasons, that food will be digested more quickly. If you stuff yourself with any kind of food, low-carb or high-carb, low-calorie or high-calorie, or if you begin your meal with soup, or if combine fat with carbohydrate, your meal will be digested more slowly. But if you eat carbs, fat, and protein all together, in sufficiently large quantity, then you have the issue of whether insulin transports sugar out your bloodstream first, lowering your blood sugar levels, or it transports the amino acids from protein and the fatty acids from fat — and protein and fat always win.

Your blood sugar levels are not just about what you eat.


They are also about how much you eat.

There's nothing wrong with using the glycemic index chart as a reminder for healthy carbohydrate choices. But if you are dealing with situations where you are not selecting, buying, and cooking your own food, you may not be able to follow a strictly low glycemic index diet. And even if you can, you may find that you experience cravings that cannot be satisfied with a big serving of bean sprouts and that can lead you to go off your diabetes diet entirely.

As a rule of thumb for most type 2 diabetics, it's a good idea to plan diabetic diet meals to:
  • Get about two-thirds of your carbohydrates from raw leafy greens and lightly cooked, colorful vegetables.
  • Get most of the remainder of your carbs from whole grains and fruit.
  • Eat only small amounts of pasta, bread, potatoes, and rice, never eating more than a single serving of starchy food at any given meal.
Most of the time (the exceptions being diets for diabetics who also have colon ailments), crispy, crunchy raw vegetables are preferable to dull, limp steamed or stir-fried vegetables. Foods with texture are preferable to foods that are limp or mushy. One of the things you will discover as you keep your blood sugar levels in good control over a period of at least several weeks is that you will begin to taste the natural sugars in all kinds of plant foods, and you simply won't crave as much white sugar or artificial sweeteners.

Dental and digestive problems keep some diabetics from eating crisp, crunchy, raw plant foods. If you are limited in the kinds of foods you can eat, and you find that you have to eat foods that are higher on the glycemic index, we want you to remember just three words: Small is beautiful. Small deviations from healthy diet are easier to correct. Always save something for later to help keep your blood sugar levels normal now. The best diiabetic diet programs to lose weight always work better if you eat in small amounts at regular meal times, and small meals are the very best way to keep your blood sugar levels in good control.

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