9) CONTROLLING BLOOD SUGAR WITH DIET
g) Best Mix of Protein, Carbohydrates, and Fats
There are three basic food groups: proteins, fats and carbohydrates. Proteins are the basic building blocks of muscle and are composed of nitrogen containing amino acids (22 of which are considered "essential" amino acids). Fats are water insoluble and are the basic building blocks of adipose tissue or what we think of as fat, oils and grease. Carbohydrates are water soluble and made up of carbon, hydrogen and oxygen. Carbohydrates can range from simple sugars such as blood sugar (glucose) to complex carbohydrates such as potatoes, wheat, oats, corn and rice, so called "starches". The exact "mix" of these three food groups in the treatment of type 2 diabetes is the subject of much debate.
There is a huge polarization in the diet plans put forward by the experts on diabetes diets. The "traditionalists" recommend that a person with diabetes continue to eat the same amount of carbohydrate as a "normal" person (50% to 65% of their calorie intake), just spacing it out evenly over a day. The "traditionalists" do recommend that the person with diabetes limit saturated fat intake. On the other hand the "low carbohydrate, high protein" diabetes physicians recommend a person with diabetes severely curtail carbohydrate intake (down to 5% of calories in some plans), especially refined carbohydrates and the "white stuff" (i.e. "empty calorie" carbohydrates). The low carbohydrate group also seems to feel that saturated fats are not a problem and can be consumed in large amounts. Then there is a third "vegetarian" group led by Pritikin and Ornish, which says that carbohydrates in any quantity are fine and that any and all fats, including vegetable fats, are the problem. And the three groups are miles apart and deeply entrenched in their respective opinions. There is a middle ground!
One of the major reasons all three camps can claim their diet works "the best" is that virtually any diet works reasonably well with most type 2 diabetics (and with anyone else) if that diet brings the diabetics weight down to below normal and those type 2 diabetics exercise regularly. Weight control and exercise are more important than the exact composition of the diet, yet most books and most of the advice written for treatment of type 2 diabetes continues to emphasize the type of food eaten as the preferred method to treat type 2 diabetes. Diet is important, but it is the third leg of the treatment stool. Note that diet control becomes far more important if an individual is on insulin injections.
As noted by Jeremy Appleton, ND in Healthnotes Newswire (January 11, 2001)
"Half of the American population is overweight or obese,and surveys show that most Americans are trying to lose or maintain weight. But do fad diets work? That depends on the definition of “work.”
The United States Department of Agriculture (USDA) is in the process of evaluating the existing scientific evidence with regard to weight loss diets. The agency solicited public comment today in a meeting held at its offices in Washington, D.C. This input will be used for the final research design to be coordinated and implemented by USDA and its Human Nutrition Research Centers.
Preliminary results of the USDA’s research on weight loss diets may surprise some consumers—it found that all popular diets, as well as diets recommended by governmental and non-governmental organizations, result in weight loss. The relative composition of macronutrients (i.e., proteins, carbohydrates, and fats) is unimportant. Total calorie intake is the key. In the absence of physical activity, the agency reports, a diet containing 1,400 to 1,500 calories per day will result in weight loss in adults."
Now this does not hold for individuals with type 2 diabetes. The amount of carbohydrates needs to be controlled and minimized to some degree with type 2 diabetes. But the point that it is calories, not composition, that determine weight loss still applies to people with type 2 diabetes. And the "1,400 to 1,500" statement needs to be qualified by making that "1,400 to 1,500" for a typical 180 pound overweight person, or roughly 800 calories per 100 pounds. As a person loses weight, the daily required calories drop accordingly.
So what is the optimum diet mix for someone with type 2 diabetes if diet is the third most important variable? What research says is that it is not the percentages that are important, rather it is the two things to avoid. The well done multi-center double blind statistically significant research supports avoiding BOTH high glycemic index grain based carbohydrates ("high glycemic index carbohydrates", "the white stuff", "empty calories" or "refined carbohydrates" are all the same thing) and saturated fats from feedlot fed animals (beef, pork, eggs, fatted dairy) whenever possible, while eating a moderate amount of selected vegetable fats (too much vegetable fat and a person with type 2 diabetes can't lose weight!). The research also seems to support a diabetic diet in which the intake of carbohydrate calories are reduced from the 45% to 65% of the traditionalists, not to the 5% level of some plans, but to a level of 10 to 30% of the calorie intake (note that in some people the level needs to be 15% to 35% to avoid ketosis). If a person is eating 1600 calories per day, 25% carbohydrate consumption translates into 100 grams of carbohydrates. This middle ground just makes a lot more sense for a person with diabetes. We can recommend going to 10% to 30% of very low glycemic index vegetable based carbohydrates per day; we just can't recommend going any lower than 10% due to the possibility of ketosis.
What about Protein? A report by Donald K Layman of the University of Illinois, "A Moderate-Protein Diet Produces Sustained Weight Loss and Long-Term Changes in Body Composition and Blood Lipids in Obese Adults" recommends 50 grams of protein per meal. This doesn't help so much in weight loss, but it increased fat mass loss over a one year period to 11.7 kg (40% carbohydrate diet, 30% protein, 30% fat) from 7.9 kg (55% carbohydrate diet. 22.5% protein, 22.5% fat), or a difference in body fat of 8.4 pounds. This diet was not designed with type 2 diabetes in mind. For an individual with type 2 diabetes we prefer a more radical approach of 15% carbohydrate, 50% protein and 35% fat. But 50% protein is difficult to get to, especially if you exclude feedlot beef, pork and eggs. If the carbohydrate is exclusively from vegetable sources and not from grain sources, we could see pushing that to 30% carbohydrate, 40% protein, and 30% fat. In an obese person, that might be pushed to 40% vegetable carbohydrate, 40% protein, and 20% fat. It was notable that in Layman's study long term compliance was much better in the high protein group, carbohydrate intake produces hunger which encourages cheating. The important point is that the protein be from fish, white meat chicken, white meat turkey, and beans, not from feedlot beef, pork, eggs or dairy.
As for fats, there are many cultures thoughout the world who have relatively high animal fat intakes (African Masai, people of Crete, some Mongolian cultures, eskimos, Inuit, etc) and very low rates of obesity, diabetes and heart disease (almost invariably they have much lower disease rates than their agricultural based neighbors). But they all eat the products of free range animals that have relatively low amounts of fat on them and have very high amounts of omega 3 fats. Products from feedlot animals aren't like that. We can recommend fats which would have existed in Paleolithic times, fats high in omega 3's such as fats from free range chicken eggs, grass fed cattle, bison, venison, wild fish, nuts, virgin olive oil, flax seed oil, and some bean products. We can't recommend fats from refined oils (sunflower and other refined oils), saturated fats from feedlot animals, and hydrogenated fats. And all fats come with the caveat that fat consumption can sabotage any diet faster than anything else. Calories going in still need to be less than calories going out.
So exactly what does this translate to as far as your diary? Let us say you eat three meals a day, beans for breakfast, tunafish for lunch, and vegetables for dinner:
Net Carbs Calories Fiber Protein Fat Can of Lima Beans 60 gms 300 14 gms 14 gm 1.8 gm
Net Carbs Calories Fiber Protein Fat Sweet Pickle Relish 2 gms 8 0 gms 0 gm 0 gm Mayonaise (2 Tbls 22 gms) 0 gms 180 0 gms 0 gms 20 gms Tuna Fish 0 gms 350 0 gms 75 gms 5 gm Total 2 gms 534 0 gms 75 gms 20 gms
Net Carbs Calories Fiber Protein Fat 12 oz bag Mixed vegetables 48 gms 240 8 gms 8 gm 0 gm Benecol Spread (1 Tbls 14 gms) 0 72 0 gms 0 gms 8 gms Total 48 gms 312 0 gms 8 gms 8 gms That is 1,144 calories (1,056 minus fiber), good for a short 130 to 140 pound woman trying to lose weight. The 110 grams of carbohydrates represents 440 calories or 38%, but the fiber is 22 grams or 88 calories, making the actual percentage only 33% of digestible carbohydrate. Protein is 97 grams or 388 calories, or 38% of calories. Fat is miniscule at only 30 grams (two and a half tablespoons) yet it is 280 calories, or 28% of total calories. It just goes to show how fat can sabotage any diet plan. None of the carbohydrates listed here will take the blood sugar levels up to high levels in most type 2 diabetes cases. Now, if you add two snacks, it is easy to see how things could spiral out of control very easily. It also illustrates the importance of a diary.
While we obviously cannot claim to be familiar with all the hundreds of diet plans out there, the only diet plans we could find with food intake formulas like this middle ground were low carbohydrate versions of the Paleolithic diet, the diet of our ancestors 50,000 years ago. These diets ultimately define two "poisons" in our diets: refined high glycemic carbohydrates AND saturated fats from feedlot animals or refined oils. And they recommend avoiding both these "poisons" while adding as much fiber and omega 3 oils to one's diet as possible. All these positions are all well supported by a great deal of meaningful statistically valid research. And they just make common sense. Unfortunately, if you visit the modern supermarket, you will simply be unable to dupicate a paleolithic diet. So we just do the best we can. We substitute protein for fiber and try to keep "feedlot" saturated fat and refined grain based carbohydrates both very low to non-existant. And we take as much omega 3 oil capsules as we can afford.
Current Chapter: 9) CONTROLLING BLOOD SUGAR WITH DIET
a) Blood Sugar Control
b) Individualized Reactions
c) What a Diary Tells a Person with Diabetes
d) Protein Poisoning by Fruit Sugar
e) What are "Acceptable Fruits
f) Other Sugars
g) Best Mix of Protein, Carbohydrates, and Fats
h) Low Carbohydrate Diets
i) Fitting the Diet to the Individual
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