Thursday, September 20, 2012

Diabetes Diets Are Literally Painful

The overlooked diabetic pain is dieting. If you have diabetes, it can literally hurt not to eat. However, going off your diabetes diet is not the only thing you can do about it.

No doubt you have heard the old adage, “Out of sight, out of mind.” If you are a type 2 diabetic struggling to stay on a diet, it's a no-brainer that it's easier for you if you keep the cupboards closed, if you put the salad at the front of the shelf in the refrigerator, and you don't stop to take a call on your cell phone in the parking lot of the all-you-can-eat buffet.

Ghrelin's Yellin'

But the really hard part of staying on your diabetes diet may be dictated by your fat cells. If you are both a type 2diabetic and overweight, and even more if you are a type 2 diabetic, overweight, and under a lot of stress, your body is slow to turn off its responses to a hormone called ghrelin. America's TV doctor Mehmet Oz is fond of saying, “If you are making ghrelin, your stomach's yellin'.” Ghrelin increases your central nervous system's sensitivity to pain until you eat.

Consuming food, however, turns off the pain signal. If you are overweight and even more if you are overweight and have type 2 diabetes, unfortunately, ghrelin keeps on yellin' even after you have eaten your meal.

Ghrelin Makes Diabetics Stray from Diabetes Diets

The action of ghrelin on the brain is to encourage risky behaviors that have reasonable payoffs. In overweight diabetics, this means that you will tend to risk running up your blood sugar levels by eating a big dessert or a big helping of potatoes or anything else that looks tasty, and your dietary adventurism is stimulated by the act of eating!

If you don't eat, you'll feel hungry. And if you do eat, you'll feel hungry. It is just not fair! But there really is something you can do about this dreadful complication of type 2 diabetes that seldom receives a sympathetic understanding.

Getting Your Zzzz's Helps You Stay in Charge of Your Eating

First of all, be sure to get enough rest. Six or more hours of uninterrupted sleep enables your body to “detox” excess ghrelin so you will not have the urge to eat, and eat some more, at every meal. Then, be sure to leave time to eat every meal slowly and enjoy your food. Put off eating extra at least until your body has had a chance to turn off the ghrelin signals, at least 20 minutes after you eat what is in your plan. If you rush a meal you will almost certainly want to eat more. Slow down, and you will find it easier to eat less.

Wednesday, September 19, 2012

Healthy Diabetic Snacks

What is it about Cheetos and Ding Dongs and stale donuts and similar junk foods that make them so appealing to so many people with type 2 diabetes? Is it that diabetics have no taste, or that they lose their sense of taste if their disease goes uncontrolled? Actually diabetes itself robs diabetics of their ability to taste and enjoy food--but there are many things diabetics can do about that, so they actually enjoy healthy diabetic snacks.

Diabetes and Dry Mouth

One of the reasons so many type 2 diabetics eat too much is that they cannot taste their food. Years of high blood sugar levels interfere with nerve function all over the body. There can be nerve damage in the hands, in the feet, in the heart, in the sex organs, and also in the salivary glands.

Changes in salivation happen so slowly that many type 2's just do not know that they suffer a condition called xerostomia, or dry mouth. Their salivary glands don't water when they chew their food, so the full flavor and aroma in food is not released. Many type 2 diabetics lose their ability to taste certain flavors, especially sweetness, so they naturally want more, more, more.

The good news is that just a few months of careful blood sugar control can restore both normal salivation and normal taste sensation in most type 2's. And in the meantime it is possible to change your food so you can enjoy it much more.

How Taste Perception Works

Up until a few decades ago, scientists used to think that the different kinds of taste buds resided in different part of the tongue. The tongue sense sour flavors on one side, scientists believed, and salty flavors on the other.

Sweet tastes were sensed up front, and bitter tastes were sensed in the back. If you had diabetes, of course, the nerves at the tip of your tongue would deteriorate first, so you would lose your ability to taste sweetness while you still have your ability to taste bitterness. Diabetics would want more and more sugar, causing higher and higher blood sugar levels, leading to still further damage to the sense of taste.

Nowadays scientists know that the taste buds on the tongue are not as clearly segregated as once thought. There are “islands” of taste sensitivity scattered across the tongue, although there are still definite differences in the intensity of taste perceptions on the different parts of the tongue.

These islands of taste perception work something like the pixels on a computer or TV screen. The brain combines information from the tongue with information from aromas sense by smell to create the sensory experience of food.

Just as you would see a strange picture on your screen if one of the colors went out, many type 2 diabetics sense strange flavors in their food when their mouths don't water or their nerves for taste perception are damaged. You get strange taste sensations when the sweet, salty, sour, and bitter receptors on your tongue are not balanced. If you also lack salivation, the you will not enjoy the full benefits of aroma.

Dealing with Dry Mouth Caused by Diabetes

If food tends to taste like cotton or cardboard, chances are that you have a deficiency of salivation, also known as xerostomia or dry mouth. Diabetes causes dry mouth by the same process that it causes neuropathy in the hands and feet. High blood sugar levels, over time, simply wear out the nerves that control salivation. They cannot make new mitochondria fast enough to power the nerve all the way down to its terminus in the salivary gland.

Ironically, diabetics who suffer dry mouth often want more and more of the dry, salty, high-carb foods that never satisfy their needs for taste, but that do satisfy the need for food with a crunch.

The way most diabetic nutritionists will tell you to satisfy your need for crunchy food (and it's not a bad one) is to eat crisp, raw vegetables, such as carrot sticks, celery sticks, radishes, turnip root, and jicama. Vegetables for diabetics are supposed to be a freebie. It is theoretically possible to eat too many carrot sticks, but in the real world, people are usually satiated long before carb counts would become a problem for controlling blood sugar levels. Vegetables are adiabetic-friendly food.

These raw plant foods and their kin provide a range of nutrients, a spectrum of flavors, and also natural moisture. They are better for you than chips, crisps, and crackers.

A Way to Eat Less Your Nutritionist Won't Tell You About

But if you simply must have your munchies, here is a way to eat less:

Eat a smaller number of crackers, crisps, or chips with visible grains of salt on the surface.

Don't eat the whole bag. It's never a good thing to be overshooting your sodium levels. But if you eat the smallest possible serving of a salty snack that makes your mouth water, you will enjoy the food.

Of course, if the food itself is tasteless, then you will just want to eat and eat and eat. Don't suffer tasteless food. Throw out what has no nutrition and no taste. Eat slowly, taste each bite, and see if you really want more. You may find that you are satisfied with less. Covering your salty snacks with cheesy spreads and salsas, by the way, dilutes the power of the salt to make your mouth water.

Photo credit: Thanks to Biso for sharing the salad photo on Wikimedia Commons.

Monday, September 17, 2012

Diabetics and Sugar: Should Diabetics Ever Consume Raw Sugar?

Sugar is usually treated as if it were a poison by all reasonable diabetics, but the fact is, most diabetics use at least a little sugar in their day to day diets. Sugar in very small amounts, up to about a teaspoon (5 grams), can usually be tolerated. That's not enough sugar to get a sugar high, but it's certainly enough to caramelize roasted vegetables, to sweeten a hot beverage, or to bring out colors and flavors of that small serving of fresh fruit.

Obviously, diabetics need to limit the amount of sugar they consume. And  the kind of sugar consumed can make a big difference, too. Especially if you are seeking to limit or eliminate animal products, there are big differences between brands of white sugar.

Many diabetics get much higher blood sugar levels after they eat foods to which they are sensitive or allergic. For instance, I myself get higher blood sugar levels after eating bacon and eggs without any kind of carb than when he just drinks a glass of juice. Not everyone will have that strong a reaction, but animal product additives that are included in table sugar can make blood sugar levels go off a lot more than when the sugar consumed is raw.

The ingredient that makes sugar even more "sugary" for some but not all, type 2 diabetics is bone char. Many brands of both white and brown sugar, and the white and brown sugar that are used to bulk up some brands of "no-calorie sweetener" (although not any brand of stevia), are filtered through ash from incinerated animal bones. If you happen to be extremely sensitive to beef, you may have a reaction to refined sugar, too. (And if you choose to avoid beef for religious reasons, you may want to avoid these products, too.)

In the United States, Domino, California Sugar, and Hawaiian Sugar (except for Hawaiian Sugar "Washed" Sugar) are all made with animal products. Country Cane, Florida Crystals, Jack Frost, Pillsbury, Southern Belle, and Supreme sugars do not contain animal byproducts. If you have to use sugar, use as little as possible, and use certified organic or at least animal byproducts free brands.

Daily sugar intake grams for diabetics: Best, zero, usually tolerable for maintaining normal blood sugar range, up to 15-20 (60-80 calories or 4-5 teaspoons in an entire day) if not consumed at the same time, and not in addition to other "fast," high glycemic index carbohydrates.

FAQ about sugar grams:

How many grams of sugar in a teaspoon? Usually 4 to 5.

How many grams of sugar in Coca-Cola (20 oz/600 ml)? 60 grams/300 calories, or 4 or 5 times more sugar than you can safely consume in an entire day.'

Amount of sugar in apple pie? In a whole pie, about 240 grams/960 calories. In a slice, 40 grams/160 calories, still about twice as much as most diabetics should consume in an entire day.

Photo credit: Fritz (own work), via Wikimedia Commons.

Saturday, September 15, 2012

Diabetes Foods to Avoid: Oats, Potatoes, and Wheat

Many American, Australian, and British diabetics notice changes almost like remission from diabetes when they travel abroad. The difference may be eating less wheat, potatoes, and oats.
Scientists at the University of Kuopio in Finland tested the idea that wheat, potatoes, and oats might somehow cause the changes that lead to type 2 diabetes, and rye bread might stop them. They recruited volunteers with prediabetes to donate samples of subcutaneous fat before and after a 12-week diet. (The fat samples were taken by needle biopsy.) Both groups of volunteers were given prepared meals with exactly the same total calories, total carbohydrates, fat, protein, and fiber. One group got its carbohydrates from wheat, potatoes, and oats, and the other got its carbohydrates from rye (rye crackers, rye bread, and rye pasta).

At the end of the twelve weeks, the volunteers gave another fat sample and the scientists looked for changes:
  • In the group that ate wheat, potatoes, and oats, 62 genes that increased inflammation and insulin use were more active.
  • In the group that ate rye, 71 genes that increased inflammation and insulin use were less active, and fat cells were smaller. This means that they had less surface area and tied up less insulin.
Blood sugar levels after eating equivalent amounts of carbohydrate on both diets were the same, but the rye group needed less insulin. The rye eaters also had lower levels of the enzyme hormone-sensitive lipase, which is associated with heart disease and high cholesterol.

If you take a trip to Norway and you feel wonderful, it might be the gracious people. It might be beautiful scenery or the northern lights. And it also might be the rye crisps. Striking wheat, potatoes, and oats from your list of diabetes foods and getting more carbs from rye might be helpful for any prediabetic or type 2 diabetic. All you have to do to find out is to make the switch in your diet and to take blood sugar readings regularly.

PS, It's been pointed out that it doesn't seem "fair" to test three foods against one. The way I read this is that there are only so many foods for which the scientists have the genetic data, and they are working with what they know, not what they speculate.

Source:Kallio P, Kolehmainen M, Laaksonen DE, Kekäläinen J, Salopuro T, Sivenius K, Pulkkinen L, Mykkänen HM, Niskanen L, Uusitupa M, Poutanen KS. Dietary carbohydrate modification induces alterations in gene expression in abdominal subcutaneous adipose tissue in persons with the metabolic syndrome: the FUNGENUT Study. Am J Clin Nutr. 2007 May;85(5):1417-27.

Photo credit: Thanks to jeffreyw for permitting use of his photo of cheesy potato soup and bread on Wikimedia Commons.

Are There Skinny Diabetics?

One of the ongoing mysteries of type 2 diabetes research has been that sometimes people who aren't fat nonetheless become diabetic. The reason may be genetic.

Italian scientists who conducted the Verona Newly Diagnosed Type 2 Diabetes Study have found that type 2 diabetics who have high blood sugar levels but who aren't overweight often have abnormalities in a gene called TCF7L2. When this gene does not function correctly, the beta cells may stop producing enough insulin but fat, muscle, and liver still respond to insulin properly. Usually type 2 diabetics develop insulin resistance and then their insulin-producing cells "burn out." When the problem is genetic, and with this gene, then diabetes comes without the years of insulin resistance and weight gain first.

This also means that if you are thin and diabetic, taking chromium won't help you. Chromium improves insulin resistance, and that's not your problem. This means that if you are thin and diabetic, exercise won't help you specifically help you with diabetes, load-bearing exercise will help you in a very different way. If you are insulin resistant, exercise reduces insulin resistance. If you are not insulin resistant, load-bearing exercise at least helps clear out excess blood sugars in the post-exercise period.

But if you are thin and diabetic, you just may be able to deal with your high blood sugar levels with injected insulin. That's actually easier than dieting and exercise, and maybe for you, insulin will take care of diabetes without making you gain weight. It sounds painful but once you learn how to give yourself the shots, they don't hurt at all (assuming you use a 29-gauge needle). Otherwise, you need to be very, very careful with your diet, especially about foods diabetics need to avoid, and either way you need to test your blood sugar levels regularly to know whatever you choose to do actually is working.

Selected Reference:

Bonetti S, Trombetta M, Malerba G, Boselli L, Trabetti E, Muggeo M, Stoico V, Negri C, Pignatti PF, Bonora E, Bonadonna RC. Variants and Haplotypes of TCF7L2 Are Associated with {beta}-Cell Function in Patients with Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS) 1. J Clin Endocrinol Metab. 2010 Dec 15. [Epub ahead of print]

Photo credit: Thanks to By אנדר-ויק • שיחה.אנדר-ויק at he.wikipedia [Public domain], from Wikimedia Commons.

Friday, September 14, 2012

Smoking Pot and Diabetes

A reader got my phone number and called in a question, "I hope I am not, like, you know, breaking any rules, but I would like to know, diabetes detectives dudes, if my pot smoking would, like, affect my son's diabetes." Dude, like, we are only too happy to give you an answer. You go on to mention that your son is 27 years old, also smokes pot, and lives with you. Sometimes you smoke together.

I'm not an advocate of smoking pot, but I feel the question should be answered factually. Here goes.
First of all, since the question is about second-hand marijuana smoke and diabetes, I'll answer very frankly, I don't know. If the reader's question was really about himself, however, here are my answers.

Complications, and complicating the complications. The good news is that if you use marijuana regularly, you are less likely to suffer the tingling, burning, or stabbing pain caused by diabetic neuropathy and diabetic foot ulcers. The effects of marijuana on pain are even greater if you are also depressed. The problem comes from the fact that when you stop feeling pain, you are still unable to feel. You need to be vigilant, whether you smoke pot or not, to make sure you don't get any burns, cuts, or scrapes that might be get infected and cause you serious problems. It happens a lot more often than you might think.

Marijuana and the progression of the disease. One of the common consequences of uncontrolled high blood sugars over about 10 years or so is that diabetics start needing to inject insulin. That's because the cells that make this vital hormone become so overactive that the immune system mistakes them for infection and "takes them out." There some evidence that some compounds in marijuana could make the immune system more "mellow," too, so this effect would not occur. However, the best way to prevent beta cell burnout is not to let your sugars run high in the first place! That's hard to do if you get a lot of attacks of the munchies.

Diabetics who absolutely, positively should not smoke pot. There is one group of diabetics, however, who absolutely should not use marijuana. Those are the diabetics who have hepatitis or any kind of chronic liver disease. The combination of the toxins (yes, there are toxins) released by the smoke and high blood sugars initiates a series of physiological reactions that causes fatty liver and cirrhosis of the liver. If you have liver disease and diabetes, smoking pot is actualy dangerous for you. It's not because of what it does to your blood sugar levels, but because of what it does to your liver.

Nothing in this article should be construed as an endorsement for smoking pot. This article is only intended to give the facts about marijuana and diabetes. The one thing to remember is that taking care of diabetes is pretty much a full time job, and anything that keeps you from being diligent about is bad for your health. For real, dude.

Selected Reference:

Selvarajah D, Gandhi R, Emery CJ, Tesfaye S.
Randomized placebo-controlled double-blind clinical trial of cannabis-based medicinal product (Sativex) in painfuldiabetic neuropathy: depression is a major confounding factor.
Diabetes Care. 2010 Jan;33(1):128-30. Epub 2009 Oct 6.

Photo Credit: Michael_w, via Wikimedia Commons.

How to Prevent Diabetic Foot Ulcers and Problems You Probably Didn't Know They Cause

Are you at risk for diabetic foot ulcers?

 If you have the tingling, burning, or numb sensation in your feet caused by diabetic neuropathy, chances are, you are. But there is a great deal you can do to avoid diabetic neuropathy progressing to diabetic foot ulcers. 

Here are some easy but important tips, including a few that I personally learned the hard way.

To prevent diabetic ulcers, diabetics who have neuropathy in the feet, and diabetics in general, should:

Inspect feet and toes every day for any bruises, bumps, cuts, contusions, scrapes, or infections, including fungus infections like athlete’s foot. If you can’t look at your feet yourself, it is very important to find someone who can look at your feet for you.

Of course, if you are diabetic, you already know that part. But what you may not know to be on the lookout for is dryness on your shins, calves, and ankles. Dry skin tend to crack. When it cracks, it can invite infection. Diabetics tend to be especially susceptible to nasty infections like Klebsiella, which are easy to pick up on hospital floors and in emergency rooms.

Only use warm water, not hot, and mild soap (no Lava), to wash your feet. Test the temperature of the water by using your wrist before you immerse your heat. This will help prevent burns. And only spend as much time in the water as you need to get clean. Sorry, no hot tub soaks for you if you have diabetes.

Dr. Robert Bernstein cautions against soaking your feet if you have diabetes. Too much exposure to water may loosen protective calluses. Dry feet carefully with a soft towel, and don’t forget to dry between your toes. It’s a good idea to wash your feet every day.

Before you put on your socks, make sure your feet are dry, but then moisturize with a foot cream, cold cream, lanolin, or petroleum jelly. Moisturize will keep the skin on the foot from cracking and letting infection in. I'm personally partial to moisturizing with sea buckthorn oil, which reminds me of the hair care commercial from the 1950's (yup, I'm that old) about a "little dab 'll do ya,'" but less expensive products in larger quantities will also work.

And you don't want tight-fitting socks. Specially designed "diabetic socks," that don't leave grooves on your calves and ankles when you take them off, are both better for circulation and a lot more comfortable. Diabeticsocks are pricey, you can find a wholesale diabetic sock section at most WalMarts throughout North America. Medipeds Diabetic Socks are also available at K-Mart and Sears and occasionally for as little as US $1.50 a pair on eBay.

Be picky about your shoes. Make sure you get shoes with firm heels that support and stabilize. There should be plenty of room for your toes. Break news shoe in gradually, only an hour or two at a time. 

There are open-toed sandals designed especially for diabetics, such Ambulator Conform Sandals. These sandals accommodate bunions, hammer toes, claw toes, and mallet toes, problems that are not unusual in diabetics’ feet. It's OK to buy cheap diabetic shoes as long as they have inserts to minimize skin damage in daily use.

Every time you see your primary health care provider, make sure he or she examines your feet. Do not hesitate to call if a sore on your feet is not healing well.

Try not to sit with your legs crossed. Crossing legs reduces blood flow to the feet.

Examine your shoes regularly to make sure they have not picked up any stones, tacks, nails, or street debris.

If your feet get cold at night, wear socks, but do not use heating pads, because diabetic neuropathy make prevent your feeling burns.

It’s OK to remove dead skin, but do not remove calluses covering a wound. Don't pick at dry skin and calluses. They are there for a reason.

And do what you can to control your neuropathy. One of the things about neuropathy that the experts don't tell us is that loss of sensation in the feet can result in "stepping wrong," losing balance, or tearing tendons in the knees to maintain balance. Surprisingly, taking care of your feet can save your knees and lower back. That's what the books don't tell diabetics. 

Photo Credit: By Milorad Dimic MD, Niš, Serbia (Own work) [CC-BY-SA-3.0 (], via Wikimedia Commons.

Chinese Herbal Medicine for Diabetes that Actually Works

Chinese herbal medicine is alternately praised and panned for treatment of all kinds of diseases. The problem with Chinese herbal medicine is usually one of two things. People either assume that "if it's an herb, it's good" and take the wrong herb or herbal formula, or they get a product that isn't what it's labeled to be. Fortunately, some Chinese herbs for diabetics not only are generally useful, they are also generally labeled truthfully.

One of these herbs (there are more, but I'll mention them in later posts) is astragalus. 

Actually, astragalus is a genus name for about 200 plants in the bean family. These beans are low growing prairie or pasture plants with rows of leaves that come in pairs. The family contains milk vetch, which is a favorite of grazing milk cows, and a number of plants that are greatly favored by sheep and goats. The plant that is used in traditional Chinese medicine is Astragalus propinquus. It's the plant herbalists are actually referring to when they say "astragalus." In Chinese it's known as huáng qí or "yellow leader." The root is the part that is used in medicine, and it's off-yellow to bright yellow when dried.

The way astragalus helps diabetics is by increasing the production of a hormone known as adiponectin. Adiponectin is a hormone made in the adipose, or fat, cells. It's an extremely helpful hormone for type 2 diabetics. It slows down the rate at which the liver releases sugar. It stimulates muscle cells to take sugar out of the bloodstream, lowering blood sugar levels. It increases the burning of fat, and it lowers triglycerides.

Astragalus is not the only product available to type 2 diabetics that increases adiponectin levels. The drugs Actos and Avandia do this, too. The difference with astragalus is that it increases adiponectin levels through a different biochemical process, and the herb does not have the side effects that drugs do. And it's enormously less expensive.

I don't sell astragalus (or any other herbs). You can find good brands of astragalus in many herb shops. It's such an inexpensive herb that it's almost always sold unadulterated. Astragalus by itself is not a cure for diabetes, but it may be a great help in treating insulin resistance, and using it may help you get along with smaller doses of Actos or Avandia. Always consult your physician before changing your use of any prescription drug.

One other thing: If you go to a real Chinese herbalist, you aren't likely to be given (it's almost unthinkable you would be given ) just astralagus. Chinese herbal medicine is all about using combinations of herbs for combinations of effects customized to the individual. But if you aren't trained in this kind of medicine, taking the single herb astragalus is a place to start. The proof is in your blood sugar levels, so don't forget to test.

Selected Reference:

Xu A, Wang H, Hoo RL, Sweeney G, Vanhoutte PM, Wang Y, Wu D, Chu W, Qin G, Lam KS. Selective elevation of adiponectin production by the natural compounds derived from a medicinal herb alleviates insulin resistance and glucose intolerance in obese mice. Endocrinology. 2009 Feb;150(2):625-33. Epub 2008 Oct 16

Photo Credit: Dalgial, via Wikimedia Commons.

Thursday, September 13, 2012

A Grapefruit Diet for Diabetics?

Do you remember the grapefruit fad? Maybe you are not old enough to recall the time when losing weight by eating grapefruit at every meal was in all the tabloids (alongside the martinis and cream and tuna fish diets), but in the 1950's, 1960's, and 1970's, grapefruit was the fad diet equivalent of today's cabbage soup diet.

But it turns out there really was something to it. Six researchers at the Shriners Burn Hospital and Massachusetts General Hospital in Boston, working with researchers at Harvard and Hebrew University, have found that the chemical that makes grapefruit bitter changes how fat cells use and store fat.

The chemical that has the effect on fat cells is known as naringenin. There has already been a clinical study that found that people who take a concentrated naringenin supplement experience significant lowering of LDL ("bad") cholesterol. This research team decided to see if the effects in the liver, where cholesterol is made, also occurred in fat cells.

What the scientists found was that the grapefruit chemical stimulated the genes that make the enzymes that burn fat and cholesterol. At the same time, naringenin stimulated the PPAR-alpha gene that triggers the burning of fat when we aren't eating, and the PPAR-gamma gene that makes cells more sensitive to insulin and lowers blood sugar levels.

The drugs Actos and Avandia stimulate PPAR-gamma, but they don't stimulate PPAR-alpha. They in effect lower blood sugar levels by shoving the sugar into fat cells. The chemical from grapefruit, on the other hand, lowers blood sugar levels by increasing insulin sensitivity, but it also activates fat burning genes in fat cells. The researchers said that eating grapefruit would have many of the benefits associated with long-term fasting, without the need for long-term fasting.

And because naringenin focuses its effects on the liver, there was a very special benefit for people who have diabetes and also hepatitis B or hepatitis C. The hepatitis viruses need fatty acids in liver cells to function. Grapefruit triggers the breakdown of these fats so the viruses can't get them.

So, should you run out and get jug of grapefruit juice and start chugging it down?

First of all, if you are on many prescription medications, you need to know that grapefruit juice slows down the rate at which the liver recycles them. Ask your pharmacist if it's safe to drink grapefruit juice if you take any prescription drug.

And, secondly, it's important to remember that grapefruit juice also can elevate your blood sugar levels. This undoes the benefits of increasing insulin sensitivity. Try drinking grapefruit juice instead of, rather than in addition to, other carbohydrates in your daily diet. If you need some help controlling those other carbohydrates, consider my post on healthy diabetic snacks.

Image credit: By John Steven Fernandez from Toronto/Valparaiso, Canada/Chile (Grapefruit Splash) [CC-BY-2.0 (], via Wikimedia Commons.

You may also be interested in my post on diabetes foods to avoid.

Wednesday, September 12, 2012

How Low Is a Low-Carb Diet for 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. Skinny diabetics actually run into more problems than diabetics who are overweight, because they have fewer fat cells to buffer their blood sugar levels.

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 and least painful diabetes 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 for the diabetic brain 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.

You may also be interested in the Grapefruit Diet for Diabetics.

Coconut Water as a Diabetic Beverage

Coconut water has the potential to be the next pomegranate, or mangosteen, or acai berry in the natural foods market. While it's not no-cal or no-carb, it contains an interesting combination of useful fatty acids and just a few carbs, about the same as 4 crackers, sufficiently low-carb that most type 2 diabetics can tolerate it.

If you have ever taken a vacation in the tropics, you may have seen people drinking something that looks like watery juice from a coconut. Not to be confused with coconut milk or coconut oil, coconut water is one of the most densely nutrient-packed natural beverages on the planet.

This tropical treat is the liquid that is found naturally in the coconut. Coconut milk has to be extracted from the meat. If you are counting calories to lose weight, you will be happy to know that cup of coconut water contains a measly 46 calories--and 1/3 of those calories come from protein, not carbohydrate. Moreover, that cup of coconut water contains more potassium than a 150-calorie banana.

It used to be that the only way to get the water of a coconut was to crack open your own nuts with a hammer and hope to catch the "juice" inside. Nowadays it is easy to find skinned coconuts in the produce section of major food markets. All you have to do is to slice off the top and stick a straw inside.

There are many  new canned coconut water beverages, each with all the electrolytes you would find in an ordinary sports drink but with a fraction of the sugar. There is no fiber in the water, and the lauric acid associated with immune power is actually found in the meat of the coconut or the creamy coconut oily extracted from coconut meat.

The combination of protein and carbohydrate, however, makes it a good drink for the end of your workout, giving your muscles just a little protein with just a little carbohydrate in a very few calories so they can begin to repair and reshape themselves. For a quick boost of four different electrolytes to help you recover from a hard, sweaty workout, coconut water is hard to beat.

Image credit: Miansari66, via Wikimedia Commons.

Tuesday, September 11, 2012

Diet Reversing Diabetic Kidney Disease--in Mice

The tragedy of diabetic kidney disease is that finally getting your blood sugar levels under control can prevent diabetic kidney disease but can't reverse it.

Once you have chronic kidney failure, the conventional wisdom is that you're out of luck. Researchers at Mt. Sinai Hospital in New York, however, announced in 2011 that extremely high-fat, extremely low-carb diet can reverse diabetic kidney failure, in mice.

This diet reverses the effects of diabetic kidney damage (high creatinine), although it doesn't seem to change the structure of the kidney, only its function. Could it work for people?
The researchers secured specially bred diabetic rodents and allowed them to develop diabetic kidney failure. They then put half the mice on a high-fat, low-carb diet similar to the ketogenic diet used for treating epilepsy in children, and let the other half of the mice eat high-carb. In just eight weeks, which is a very long time in the life of a rodent, the mice eating high-fat experienced a reversal disease.

Generalizing the results of this study to humans, researcher Dr. Charles Mobbs was quoted in Science Daily as saying that this was the first study showing that diabetic nephropathy (kidney failure) could be reversed by diet alone. Even though humans have much longer lifetimes than rodents, Dr. Mobbs reportedly told the online news service that people with diabetic kidney disease might go into remission even faster than rodents, in just four weeks on this extreme diet.

When rodents, or people, eat high-fat diets, cells all over the body start burning ketones instead of sugar.The brain continues to need a small amount of glucose, although even central nervous system tissue can operate largely on ketones released from fat. Since glucose is what "clogs" the filtration system of the kidneys, a short break from high glucose levels should allow them to recover.

Actually, this is what happens when people in the early stages of kidney failure start taking good care of their blood sugar levels. In the early stages of diabetic kidney failure, eating less usually is what is required. The farther the disease progresses, the more there is a need for fat in the diet.

But the kind of diet this study describes is more than low-carb. A single peanut could upset the metabolism of fat. A bowl of salad a day is out of the question. This diet requires mayonnaise, cream, butter, and a little high-fat cheese, with lots of vitamin supplements. It's not something anyone should try at home.

And if you already have kidney disease, high-fat along with high-protein just isn't going to work. In kidney disease, protein is as big a problem as sugar.

Don't run to the doctor asking to be put on a ketogenic diet just yet. But do take care to keep your blood sugar levels as normal as possible as long as possible so diabetic kidney disease never has a chance to develop.


Poplawski MM, Mastaitis JW, Isoda F, Grosjean F, Zheng F, Mobbs CV. Reversal of diabetic nephropathy by a ketogenic diet. PLoS One. 2011 Apr 20;6(4):e18604.

Image credit: Anna Frodesiak, via Wikimedia Commons.

Virgin Coconut Oil in the Diabetic Diet

Here's a reposting of an article I wrote in 2010 on the virtues of virgin coconut oil in diabetes diets--still valid today.

Virgin coconut oil is a great addition to diabetic diets, but highly refined coconut oil is to be avoided at all costs. Coconut oil is a good example of the diabetes diet principle that sometimes a good fat and a bad fat can be the same fat. That's also true of some of other common dietary fats.

Bad Fat, Good Fat, Same Fat

The industrially manufactured versions of coconut oil are refined and bleached. To make the final product liquid at room temperature, coconut oil is stripped of its main fatty acid, lauric acid, and then superheated with heavy metals in refinery towers in a process known as hydrogenation. The resulting product can be used  in food manufacture, as also as a lubricant for fan belts and as the basis of biodiesel.

On the other hand, there is probably no kind of fat that is better for your body than virgin coconut oil. It's genuinely helpful in diabetes, in chronic immune deficiencies, and in fighting cancer. It also helps you lose weight. Virgin, minimally processed coconut oil still has the lauric acid, and this fatty acid gives virgin coconut oil some unique health qualities. The health benefits of lauric acid can be explained in terms of molecular size.

Smaller Fat Molecules Healthier Than Larger Fat Molecules

Smaller fat molecules are healthier than larger fat molecules. Lauric acid is a medium-chain fatty acid, also known as an MCFA. Like the fats found in palm oil, whole milk, whole milk yogurt, butter, cream, and cheese, it's a relatively "small" molecule. It's soluble in water, so it won't "sit" in your intestines waiting for bile salts to arrive from the liver to dissolve it. Your liver can use it as fuel without further processing, and the rest of the body can use it for fuel without insulin. It's a kind of fat that won't compete with the sugars you body needs insulin to move out of the bloodstream.

Because MCFA's go directly to the liver, don't have to be decoupled from proteins, and don't depend on insulin levels, they get burned for fuel before other kinds of fat. Even if you eat too many of them, they don't trigger a process creating new baby fat cells, the way some other kinds of fatty acids do (including the otherwise healthy fatty acids found in olive oil).

With coconut oil, cholesterol is not a big consideration. There is no cholesterol in coconut oil, and consuming coconut oil will not raise cholesterol unless you are consuming more calories than you are burning overall.

Coconut oil and its MCFA cousins contain fewer calories than other kinds of fat and they burn more readily, but it's not necessarily a good plan to eat more of them as part of your plan to eat weight.

When Eating Fat Helps You Lose Fat, and When It Doesn't

If you are large enough or active enough that you can lose weight and eat 2,400 calories a day, and you get about 1,200 of those calories just from coconut oil, palm oil, butter, cream, and the milk fat in cheese, yes, you will burn fat a little faster, the equivalent of about 100 calories a day, enough to lose an extra pound a month. If you are trying to lose weight by eating 1,200 calories a day, and you eat 600 calories a day in the form of these healthy fats, you'll lose an extra pound every two months.

If you have been gaining a pound every month or two, incorporating MCFA's into your diet may be just what you need to stop gaining weight. If you are using MCFA's to lose fat, you need to know that this fat will be the "jiggly" subcutaneous fat on your thighs, or giving you jelly-belly, or lying on your "jowls" or just under your skin. It won't be the visceral fat around your inner organs. Losing this fat helps you look better and feel lighter, but it won't necessarily make you a lot healthier.

But that's a whole lot more coconut oil, palm oil, butter, cream, and cheese than your digestive tract can handle without bloating, gas, and diarrhea. It's hugely more fat than any dietitian is ever going to write into your diabetes diet (unless you have kidney disease).

Moreover, if you overeat even these healthy fats, you will still gain weight. You really really don't need to eat more fat to burn more fat. MCFA's are the right kind of fat, but you still need to eat less to weigh less. But if you're wild about coconuts, coconut water will still be OK.

Photo Credit: Ahmedhhs, via Wikimedia Commons.

Fighting Diabetic Complications with Broccosprouts

I'm ordinarily loathe to write about "super foods." Today's super food tends to become tomorrow's over-hyped super-flop.

But one of the superfoods for diabetes of 2011 is still getting good reports today, so I'm reposting my article on fighting diabetes complications with broccosprouts, like the 5-day-old broccoli sprouts pictured at the left.

A study published in the European Journal of Clinical Nutrition reveals that consuming 5 to 10 grams of dried broccoli sprouts every day (that's about a quarter-cup of loosely packed sprouts) can greatly risk of antioxidant stress caused by diabetes.

Lowering antioxidant stress is believed to lower the risk of Alzheimer's disease and cardiovascular disorders, both of which more commonly strike diabetics. Free radicals of oxygen are actually essential to health. Cells use them to send signals to each other, and free radicals of oxygen activate the immune system.

The problem for diabetics occurs when cells are flooded with so much sugar that "burning" the sugar as fuel creates more free radicals of oxygen than enzyme systems can handle. High blood sugar levels can also cause oxidative damage in the blood itself and in nerve tissues all over the body. Oxidation underlies the biochemical processes that lead to neuropathy and atherosclerosis as well as aged-related dementias such as Alzheimer's disease.

Cabbage family plants contain glucosinolates that the body transforms into isothiocyanates, which in turn regenerate antioxidants that counteract excesses of free radicals. These sulfur-bearing compounds are found in especially high concentration in sprouts of broccoli seeds, and in even higher concentrations when the sprouts are air-dried at low temperatures and dried.

There are smaller amounts of glucoinolates in cabbage, the mature broccoli you are probably more used to eating, turnips. kohlrabi, mustard greens, kale, cauliflower, and watercress.

Not everybody responds to glucosinolates with equal improvement. Some people, about 10% of the population, have genetics that keep them from responding at all.

But if you are diabetic and you smoke or you are exposed to toxic chemicals on a daily basis, adding these any of these vegetables is probably going to be of long-term benefit, but especially broccoli sprout powder. Use broccoli powder in teaspoon-sized doses in a smoothie or add to a soup after it's been cooked. About 1/4 cup of fresh broccoli sprouts would have the same effect.

Source: European Journal of Clinical Nutrition Published online ahead of print, doi: 10.1038/ejcn.2011.59 “Broccoli sprouts reduce oxidative stress in type 2 diabetes: a randomized double-blind clinical trial” Authors: Z Bahadoran, P Mirmira, et al.

Photo credit: Julie Gibbons, via Wikimedia Commons.