Life would be so much easier if we could just survive without food, but unfortunately our bodies need food. They use it to produce the fuel to keep us going.
This fuel is got from 3 main sources:-
- Glucose, mainly from the digestion of carbohydrates, with some coming from protein if needed.
- Fats, from the diet and from stored body fats.
- Ketones – which are derived when fats are metabolised.
Cells in the body differ in which food source they like to use. For instance heart muscle cells prefer to use fats though they will use other sources if necessary. Some cells can use glucose or ketones but would prefer ketones while yet others are entirely dependant on glucose eg. red blood cells, and the retina, lens and cornea in the eyes. So we need to provide all these ‘fuel sources’ in our diet.
Love the word or hate it, diet is at the heart of diabetic treatment and control.
With the modern day concepts surrounding the idea of a diet – something you go on to lose weight and stop when you have achieved your objective (or have the hell in from achieving diddly squat!) I think I prefer to consider what we diabetics do as a ‘way of eating’ (WOE). After all this is the way we have to eat for ever, we cannot decide “I have had enough” and go back to our old ways, not if we want a happy, healthy life that is.
Most folk have the vague concept that diabetics ‘can’t eat sugars’. Whether they are totally correct here depends on what they mean by the word ‘sugars’. We tend to think of sugar as that granular white or brown stuff we add so lovingly to tea or coffee or to our delicious cakes and other baked goods.
If only that were all we had to worry about!
Unfortunately once one starts to look into the way our body digests foods some horrible facts come to light – just about everything we eat turns to ‘sugar’, or to give it it’s correct name, glucose.
The Main Food
There are three main food groups, proteins, fats and carbohydrates.
Proteins are broken down into amino acids, used for growth and repair of the body. We only need about 1-1.5 grams a day of protein per kg of lean body weight to preserve muscle mass. Which leaves plenty over to be used as fuel. 58% of protein is converted to blood glucose i.e. 100g of protein can produce 58g of glucose, but very slowly and inefficiently. Proteins are only used as energy as a last resort.
Fats, (though we tend to think of them as those useless little devils who cause the scales to lie), are essential as they serve as the main structural material in the membranes surrounding our cells. They are also used in the manufacture of some steroids and hormones that help regulate the growth and maintenance of tissue in the body.
Dietary fats (the ones you eat directly) are not converted to blood glucose and therefore cannot be stored as body fat via this route as long as you are not eating carbohydrates. However, if carbohydrates are eaten their breakdown into glucose stimulates the release of insulin. This insulin inhibits the breakdown of fats for energy and instead sends them towards metabolic pathways which causes them to be stored as bodily fat.
Stored fats on the other hand,(those that cause the unwanted bulges) can be converted to blood glucose, but your system has to work really hard to process stored fat into glucose, and that fat has to have been glucose in the first place.
Confused? It works like this: When you have more glucose in your blood than your cells need, and the storage capacity of your liver is full up, the glucose has to go somewhere. This extra glucose is converted in the liver into fatty acids and taken to the fat cells in the adipose tissue, where it is changed into triglycerides and stored, against a time when there is not enough glucose present from digested food and some other means of getting it is needed. This is the ‘stored fat’ that can be used for energy.
Carbohydrates are essentially chains of sugar molecules and break down in the body into glucose. “But” I can hear you say, “I thought bread was a carbohydrate, that cannot be a sugar surely?” Oh yes it can, and is, once our digestive system gets its hands on it.
You will hear the terms ‘simple carbs’ and ‘complex carbs’.
Simple carbs are technically termed monosaccharides, in other words a carb containing one sugar unit or disaccharides, a carb containing two sugar units. These are the ones that taste sweet. Lets take a look at the common ones:-
Fructose is a monosaccharide and is found in fruit, corn syrup and honey. It is actually sweeter than what we know as sugar and is often added to processed foods. The manufactures can then say there is ‘no sugar added’ – sticky legal issue here! Fructose is changed into glucose by the liver.
Sucrose, the one we all know about, is a disaccharide made up of the sugars glucose and fructose. This is generally derived from sugar cane, sugar beet or sugar maple trees. It is also present in varying quantities in most fruit and vegetables.
Lactose is also a disaccharide, being made up of glucose and galactose. Again the liver is responsible for changing galactose into glucose. Lactose is found in milk and in cottage cheese.
Maltose is a disaccharide which is made up of two glucose molecules, so you get an instant double whammy! It is found in grains.
You will notice that all these end in ‘ose’. If you see that ending associated with food you can be sure that it is a sugar of some sort and should be avoided. Only cellulose is okay because, though it is a complex sugar, we humans do not have the enzyme that would enable us to digest it – we leave that up to the herbivores like cows and sheep.
Complex carbs are termed polysaccharides and contain many sugar units. For example starch is made up of thousands of sugar molecules all strung together. These taste good but are not sweet, for example potatoes, grains or tomatoes.
It does not actually matter whether the carb you eat is simple or complex, once it is digested it becomes glucose.
Different types of carbohydrates break down into glucose at different rates. Some break down rapidly and cause glucose levels to spike while others are slower acting and cause a more gradual rise.
Within two hours 90% of the carbohydrates you eat show up in the blood as glucose. So the more carbohydrates you eat, the higher your glucose levels rise.
So now we know what the different food groups do, where do we go from here. Ah, now here is where it gets interesting, especially if you were head of your debating society at school.
We can all probably agree that the reasons for dieting are……
- To control our diabetes by getting our blood glucose as close to ‘normal’ as possible.
- To control our blood pressure and cholesterol levels so as to protect our hearts.
- To get our weight within the right range, especially in type 2’s where reduced weight serves to reduce insulin resistance.
- To do our best to prevent diabetic complications or to minimise the effects of the ones we already have as much as possible.
- To be generally more healthy.
Where the debate comes in is just how to go about achieving these aims.
Did I hear you mutter “Follow the diabetic diet of course” – but what is the ‘diabetic diet’? That is something that has been argued about for as long as diabetes has existed and we are no closer to the answer. Maybe this is because we are all individual beings and what works for one does not work for all. And perhaps that very fact is telling us something – find out what works for you and go with it!
Take control of your disease yourself. Read, research, question and experiment until you have the eating plan that works for you and achieves all the reasons for dieting that are listed above. It will not be instantaneous nor necessarily easy but in the long run it will be worth it.
When I have spoken to people about this approach i.e. deciding on which diet works best for them I have sometimes been told “But my doctor/dietician gave me a diet when I was first diagnosed. Surely they know best what I should eat?”
Hmm! If only that was totally true how easy it would be. However one needs to take into consideration that ones health care providers are, in general, very busy, having to care for vast quantities of ill people. They do not have the time to treat each persons dietary need individually — that would require them to virtually come and live with you for an extended period of time! You are the only one living with your body 24/7 and thus only you can find out what works and what doesn’t in your particular case.
They will have given you a general guideline on healthy eating as agreed by the present authorities. I say present authorities because these guidelines tend to vary from time to time, often markedly. There is nothing about a diabetic diet that can be termed an exact science!
Dietary treatment over the last century
The dietary treatment for diabetes has changed markedly over the years, and particularly so in the last decade. Before the 1920s, the diabetic diet was largely a rigid, no sugar, no-carbohydrate diet.
This changed slightly when insulin was discovered in 1921 and although the carbohydrate allowance was increased slightly, sugar was still completely avoided.
From about the 1930s to the 1950s, although the calorie allowance was increased, the carbohydrate allowance for a diabetic was still minimal, enough only to prevent ketosis.
The 1960s allowed for an increase in carbohydrate to approximately 150 gram per day, as research came to light indicating that it was not carbohydrates themselves that were the problem.
The 1970s to 1980s saw the advent of the high carbohydrate (low sugar), high fibre, low-fat diet, which was fairly well accepted.
More recently, has seen the “launch” of the glycaemic index and what the current diabetic recommendations are for a high carbohydrate, low glycaemic index, high fibre, low-fat, moderate sugar diet.“
If you are serious about getting on top of this disease you will find that you need to become an expert on nutrition and the way foods work in your body – you will be your own best diet analyst!
This said, there are a few factors upon which we do find general agreement.
- Lean meat, poultry and fish are good.
- Green leafy vegetables are as well.
- High fibre vegetables like broccoli, cabbage, cauliflower, peppers and asparagus are great.
From that point on diets start to vary considerably in their content. We will be looking at the most common ones individually later. But first I would like to discuss the article that is of top of the list in importance when it comes to your diet – this is not food, strange though that may seem, it is your blood glucose meter.Unfortunately one cannot see into ones body to judge how the food we ingest is affecting it. The only way we can find out is to measure the effect it has upon our blood glucose level (BG’s).
We need to eat those foods that have as little effect upon our BG’s as possible and avoid those that send them spiking. Certain foods we need to eat no matter what their reaction because they provide essential nutrients.
A diet should be easy to work out then shouldn’t it – just test each food and leave off the bad ones? Yea right, who said anything in life is easy? It would work of course but the application of it would be, well, interesting.
For instance, testing for the effect of each individual food requires you, after fasting for around 8 hours, to take a bg reading. You then eat a measured sample of the food and retest every half hour for around 4 hours to see what happens.
This requires 9 bg readings, thus 9 strips and 9 finger-pricks. If you take your average Sunday dinner of say, Roast beef, Yorkshire pudding, Roast potatoes, Brussels sprouts and Carrots plus a glass of alcohol and a pudding this could result in at least 8 different tests (over time – remember the fasting bit) with it’s 72 finger-pricks – not many people have that much staying power. That is just for 1 meal containing 8 types of food – now list the many kinds of food you normally eat – you would make a dedicated seamstress’s pincushion proud!
I am not saying never test, on the contrary. You need to test frequently until you have a diet that suits and is giving you good control. The minimum for newly diagnosed diabetics would be before and 2 hours after each meal. Later this can drop to a couple of times a week if you feel you are happy with that.
Many of us prefer to keep testing more often to be sure we have control – control freaks ? Maybe!
If your prescribed diet plan gets your bg’s down where you want them you can try adding a food and test to see what happens. Spike – out; no change or very minor – in.
If the diet plan is not working perfectly, but you like it, then maybe you could test certain individual foods within that plan that you suspect might be the culprits in raising you bg’s.
I will attempt to put forward the different diet plans without prejudice, working on the principal, stated so often in this text, that what works for you may well not work for me and visa versa. However I reserve the right to mention both the pros and cons of each type, despite what the proponents of each one give you in the hype about it.
Any diet needs attention paid to the calories in it. You need to eat the correct amount of calories to get and keep your weight within the correct range and to have enough energy to go about your daily tasks. A person sitting in front of a computer all day will not need the same calorie intake of a stevedore.
The food types have specific calories associated with them, gram for gram:-
- Carbohydrates – 4 calories per gram
- Protein – 4 calories per gram
- Fats – 9 calories per gram
Below you will find an assortment of diets to choose from. Each has their enthusiastic supporters and their equally vocal opponents. It is up to you to find the one that works for you. As I have said before, read, question and then make up your own mind and try things out. Only you know what works for you!
- The Food Pyramid Diet.
- The High Carbohydrate Diet.
- The Exchange Diet.
- The Carb Counting Diet.
- The Glycaemic Index Diet.
The diets we have dealt with above are the high carb, low fat diets. Now what about those diabetics who cannot control either their blood glucose or their weight on a high carb diet? Are they stuck with this for life?
Not so, there is an alternative, the Low Carbohydrate Diet.