Tag Archives: prediabetes

bad carbs

Are Your Carbs Slowly Killing You?

Let’s go have a burger, but make the bun whole grain please! Ok, so fat is now in and carbs are out. It seems like there’s research to support any diet you choose to follow. Are we getting smarter or just making things so confusing people just throw their arms up in the air, say “screw that” and just eat whatever their heart desires.

But, if you desire your heart, you might want to read this to get some clarity on the controversy.

PURE research

The Prospective Urban Rural Epidemiology (PURE) study, reported in ScienceDaily.com, asked dietary questions to over 135,000 low, middle and high income people over a 10-year period from Africa, North America, South America, Asia and Europe.

There were three parts to the PURE study. One looked at the impact of dietary fats on clinical outcomes while another focused on the consumption of fruits, vegetables and legumes in relation to death, heart disease and strokes. The third component, reported in The Lancet Diabetes and Endocrinology, looked at the impact of dietary fats and carbohydrates on blood lipids and blood pressure.

A summary of the data released in August, revealed that a diet consisting of a moderate amount of fat, fruits, vegetables and legumes and avoidance of a high proportion of carbohydrate was associated with a lower risk of death.

The results were surprising and not in accordance with the current dietary guidelines of dietary fats making up 30% or less of total calories, carbohydrates making up 50% and fats making up the rest while keeping saturated fats to less than 10% of daily calories.

Making sense of the PURE data

Actually, the results do make sense. The lead researcher, Mahshid Dehghan, in an interview with Science Daily said:

“A decrease in fat intake automatically led to an increase in carbohydrate consumption and our findings may explain why certain populations such as South Asians, who do not consume much fat but consume a lot of carbohydrates, have higher mortality rates.”

Many of the participants were low income and ate a diet consisting heavily of white rice and lower on animal products and produce. White rice is a high glycemic food – making blood sugars skyrocket with each additional serving. Animal products are high in protein and produce is high in fiber which slows down digestion and the rise in blood sugar.

If you look at the graph of macronutrients below, you’ll notice that carbohydrates make the blood sugar spike with a steeper parabola than protein and fat. The larger the portion of a simple carbohydrate like white rice, and not combined with much protein or fat, the quicker and larger the blood sugar rise which puts stress on the pancreas to make more insulin to take care of the extra glucose in the blood stream. Eventually, this leads to damage of the arteries and an impaired pancreas, and an earlier death.

macronutrients and impact on blood sugar

Blood sugar and lipid connection

metabolic syndromeHow can high blood sugar affect the fats in your blood stream?

When you eat a lot of processed, white carbs – like white pasta, rice, bread, and crackers – your body quickly digests them and converts them to glucose. Your body can use some of this glucose for fuel, but any extra gets stored in the form of triglycerides.

Findings from the third study also found that a high carbohydrate diet, particularly one with refined grains, was associated with a lower good cholesterol – HDL – which is heart-protective.

A low HDL and high triglycerides are two of the five components of metabolic syndrome – one more of the 5 components and you’ve got heart disease and diabetes in your future.

Glycemic Index and your blood sugar

Glycemic IndexThere are “good” and “bad” carbs. Well, maybe there are some “bad” or unhealthy carbs that really taste good, darn it. I love you Holy Donut. But there are also some “good” carbs that also taste good.

Carbs that are lower in glycemic index are much healthier for you as explained below. Low glycemic foods include legumes like lentils, steel-cut oats, whole grain pasta, fruits and non-starchy veggies. Do you think donuts could taste as good if they were made with whole oat flour and baked instead of fried?

High glycemic foods are all your “white” foods including russet potatoes, pretzels, popcorn, rice cakes and melons and pineapple.

So, a plate of white pasta, which can be as much as four times the recommended serving, with tomato sauce (and most have added sugars), will shoot your blood sugar way up. A large bowl of Rice Chex with milk will do the same thing. Both meals are high in low glycemic carbohydrates and low in protein, fiber and fat.

The rise in blood sugar will cause your body to release extra insulin that will cause your blood sugar to plummet, as you can tell by the graph on the right. In fact, your blood sugar can drop down lower than normal, triggering an adaptive response by your body to get your blood sugar back up to normal. This adaptive response releases epinephrine leading to shakiness, irritability and even a headache. So, you go from food coma to nervous Nellie – that’s an emotional roller-coaster I wouldn’t want to be on.

What you can do

The findings from the PURE study are logical. The important message here is to:

  1. Pay attention to portion sizes of your carbohydrates – use the food label to become aware of a serving size.
  2. Make at least half of your carbs low-glycemic, moving away from the “whites”.
  3. Include a source of protein – low-fat Greek yogurt, low-fat cheese, poultry, fish or lean meat with your meals and snacks.

 

Most Mainers at risk for, or has diabetes

Does 48% scare you? Those are some pretty good bettin’ odds. That’s better than the overall odds at winning in Blackjack. The 2014 CDC data found 37% of Maine residents have prediabetes. Over 11% or 137,413 have diabetes and 36,000 of those people don’t even know they have it. Now that is really scary. How can people live with the common symptoms of uncontrolled blood sugars like yeast infections, extreme fatigue, erectile dysfunction, thirst and peeing all the time without going to their medical provider and complaining? Do people with these symptoms really think that life can’t get any better than that?

Metabolic Syndrome or Prediabetes- Reversible

metabolic syndromePrediabetes goes by several different names:  Metabolic syndrome, Syndrome X, and impaired fasting glucose are all names used for prediabetes. If you have central obesity, high blood pressure and unhealthy cholesterol, there’s a good chance you are on the road to diabetes. More specifically, if you have 3 of the 5 conditions to the left, you have prediabetes. Those odds of developing Type 2 diabetes are even greater if you have a family history of diabetes, had gestational diabetes, are older or are African-American, Hispanic, Asian, Alaska native, or Native American. You can see why the odds go up with each factor.  And just to clarify, type 1 and type 2 diabetes are really two different diseases with different causes. Type 1 diabetes is an autoimmune disease associated with sudden changes in insulin production whose cause is not associated with lifestyle changes. Type 2 diabetes is a preventable disease. You can learn about your odds here and talk to your healthcare provider.

A Prediabetes Diagnosis Should Imply A Sense of Urgency

Once prediabetes becomes diabetes, the insulin producing beta cells of the pancreas quit working – some say as much as 50%. When the pancreas can’t meet the needs of the body not only do blood sugars rise, but other metabolic changes occur, particularly with fat metabolism. The higher blood sugars and lipid levels damage the blood vessels of the body. That’s why diabetes is really heart disease with a sugar problem. Complications of poorly managed diabetes are a result of nerve and vascular damage leading to blindness, stroke, heart disease, kidney failure, and amputation. These severe complications happen over time with earlier patient reported symptoms of depression, nerve pain in the extremities, frequent infections, sexual difficulty and a change in quality of life.

Let’s Stop Diabetes

Diabetes costs Mainers $1.6 billion every year. The costs are for treatment of severe complications like hospitalizations for heart disease and stroke, amputations and prosthetics, surgery to prevent blindness and dialysis. Wouldn’t it be wonderful if we could shift that money from end-of-life treatment to early detection, education and support?

Our healthcare system is changing. Where fee-for-service was the standard of care, outcome-based results is now the gold standard. Our health care system is now a team of medical providers, nurse practitioners, physician assistants, population health nurses and medical assistants all with the aid of health informatics and data analysis. Healthcare is doing a much better job with managing chronic disease but is still weak on prevention. There is not a financial incentive yet to focus on that. The days of our medical provider being the sole conductor of our healthcare are over.  The new reality is that we need to play a proactive role in our own health.  Blood sugar levels often get overlooked. There were many times in my previous job when patients saw me for health education, unaware that they had prediabetes or diabetes. Things do get missed.

What You Must Do

Prediabetes develops over time. Blood sugar levels rise over many years and don’t suddenly hit the 100 mg/dl threshold. When I first became a certified diabetes educator the level was at 110 mg/dl, but lowering it provided earlier intervention.  Everyone should have a fasting blood glucose level done annually, especially if they have a family history of diabetes, are sedentary or overweight. And once it is done, get the results and know the significance of those results. There is support if you need it!

Barbara is a certified diabetes educator and health coach. She would love to help with any health questions and can be reached through her facebook page.

Is It Menopause or Low Blood Sugars Causing Your Night Sweats?

Do you wake up at night and throw off your covers because you are feeling hot and damp?  Do you have a family history of Type 2 diabetes?  Did you eat a lot of crackers, ice cream, pretzels or chips in the evening and wake up with soaked sheets?  There are many causes of night sweats but often times people who have not been diagnosed with diabetes or prediabetes do not consider the possibility that they might be having low blood sugars in the middle of the night and not just hot flashes from menopause.

Low Blood Sugars Could Be Causing Your Night Sweats

If you have a family history of diabetes, you are “overwaist” with a waist circumference greater than 35 for a woman, you do not exercise regularly and you eat refined carbohydrates in excessive amounts, you might have prediabetes.   Eating a large amount of sugary foods or white flour products can cause a rapid rise in blood sugar which then tells your pancreas to release extra amounts of insulin.  This extra insulin can bring your blood sugar down rapidly and actually cause a low blood sugar.  Have you ever felt shaky mid morning after eating cold cereal or pancakes with lots of syrup for breakfast.  Have you munched on a whole bag of pretzels commending yourself for them being low fat but noticed you had night sweats that woke you in the middle of the night?  Have you noticed on the days you eat more whole grains, lean protein, Greek yogurt, nuts, lots of veggies with a small night snack of fruit that you do not wake up with night sweats?  To get a better understanding let me explain what happens with Type 2 diabetes.

What Is Type 2 Diabetes?

Type 2 diabetes is a completely different disease process than Type 1 diabetes.  Type 1 is an autoimmune disorder that results in complete loss of insulin production by the pancreas.   Those individuals are dependent on insulin from a needle in order to live.  Insulin is the transporter of glucose or sugar into the cells for energy.  Without enough insulin, cells lose their fuel source.   Type 2 diabetes is really a stress state in the body, highly genetic but really a problem with insulin effectiveness.   In Type 2 diabetes the body does not recognize its own insulin – this is called insulin resistance.  Having excessive abdominal fat is associated with insulin resistance.  Because the body does not recognize it’s own insulin there is a series of events that further exacerbates the situation:

  • The cells do not get enough glucose to do their work.
  • The pancreas works even harder making more insulin in an effort to get glucose into the cells.
  • Glucose builds up in the blood stream damaging the arteries and causing blindness, nerve damage, kidney damage and heart disease.
  • The pancreas begins to tire out and makes less and less insulin.

Before full fledged Type 2 diabetes develops, the pancreas makes extra insulin in order to get the glucose into the cells.  It’s similar to your furnace.  If your furnace has not been cleaned for years it gets more inefficient at burning oil due to poor mixing with the air and your furnace ends up burning through more oil (and on top of it can back fire making a huge mess!!).   That extra insulin is a sign that your body is not working efficiently.  In addition, the extra insulin can lead to low blood sugars at certain times depending on food choices.

Diagnosing Type 2 Diabetes

Type 2 diabetes has a history.   It does not just suddenly come on like a switch.  It begins with a gradual rise in glucoses that your healthcare provider can detect as part of the Basic Metabolic Panel, especially if the blood sample is taken in the fasting state.  Normally glucose is well below 100 but as the body gradually becomes more resistant to insulin, blood sugars begin to rise.  There are two other tests that are used for diagnosis.  The Oral Glucose Tolerance Test (OGTT) that looks at blood samples two hours after drinking a sweet substance.  And the A1c that looks at an average of blood sugars over 2-3 months time.  Below are the diagnostic criteria for prediabetes and diabetes:

  • Prediabetes – fasting blood sugar 100-125; OGTT 140-199; A1c of 5.7-6.4
  • Diabetes – fasting blood sugar > 125; random blood sugar > 200; OGTT > 200; A1c 6.5 or greater

What You Can Do

Connect the dots...look for patterns

Connect the dots…look for patterns

Know your family history.  Type 2 diabetes has a strong genetic link.  Then look for patterns and connect the dots between your food choices, your energy state 2 hours after eating and the frequency and timing of your night sweats.  Have your fasting blood glucose checked and either a OGTT or an A1c.  Being diagnosed with prediabetes and being willing to lose 7% of your weight and exercising at a moderate level of intensity 150 minutes a week can preserve your pancreas, decrease insulin resistance and restore your energy.  Use a health coach or sustainable weight loss program to get you started.  You will get payback for the rest of your life!!