Health Guide

Blood sugars

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. 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.