Diabetes and the ADA guidelines...

Lately, I've spent a LOT of time trying to help a friend of mine with Type 2 Diabetes figure out what she's supposed to eat versus what her physician, yeah, and internal medicine doc, is telling her to eat. He then sent her to a nutritionist, more like a dietary technician as this person not only doesn't have a degree in nutrition, but just regurgitates what she's read or been taught by the Diabetes Association.

So, let's look at what the American Diabetes Association has to say on what a person with diabetes should be eating:

1. Eat lots of vegetables and fruits. Try picking from the rainbow of colors available to maximize variety.
2. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans with meals.
3. Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce.
4. Include dried beans (like kidney or pinto beans) and lentils into your meals.
5. Include fish in your meals 2-3 times a week.
6. Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey.
7. Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese.
8. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.
9. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats.
10. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream.
11. Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes.

Sounds great, right? Nice and healthy? That's what I used to think… Let's break it down number by number. I've gone ahead and put the ones with which I have problem in red type.

1. Vegetables and fruits. Great. However, if you have diabetes… you HAVE to be careful about eating fruits! Fruit sugar is fructose. Fructose is a simple sugar. Table sugar (sucrose) is made up on one molecule of glucose and one molecule of fructose. However, fructose is different than glucose in that it up-regulates its own transport and metabolism. That means, the more fructose one eats, the more sensitive one becomes of its effects. Think drug use… the more you have, the more you want. Not only does the body treat it differently, but because it does not raise the blood glucose levels (and thus has a low glycemic index), it's thought to be 'safe' for diabetics.

However, its been shown to raise blood pressure, decrease insulin sensitivity, lower glucose tolerance, increase apolipoprotein-B concentrations, and cause microvascular disease glomerular hypertension, kidney damage, fatty liver, and more.

I promise to post a reference list for those wanting to read some of the studies that have been coming out in major medical journals for the last 10 years. It seems that fructose is the demon in the "sweet" world! Since the introduction of High Fructose Corn Syrup (HFCS) in the early 1970s, our American population has gotten fatter and unhealthier. Have you looked at nutrition labels lately?? It is in EVERYTHING!!

2. Eat non-starchy vegetables such as spinach, carrots, broccoli or green beans. Yeah, buddy!! This one, is one with which I heartily agree! If you eat veggies with each meal, you'll up your dietary fiber intake and eat your vitamins. Check out this comparison chart of the fiber content in food!!

Fresh & Dried Fruits	Serving Size	Soluble Fiber (g)	Insoluble Fiber (g)	Total Fiber (g)
Apple, with skin	1 medium	4.2	1.5	5.7
Apricots, dried	4 medium	1.8	1.7	3.5
Banana	1 medium	2.1	.07	2.8
Blackberries	1/2 cup	3.1	.07	3.8
Blueberries	1 cup	1.7	2.5	4.2
Figs, dried	3 medium	3.0	2.3	5.3
Grapefruit	1/2 fruit	2.4	0.7	3.1
Kiwi fruit	1 large	2.4	0.8	3.2
Orange	1 medium	2.1	1.3	3.4
Pear	1 medium	0.8	3.2	4.0
Plums	2 medium	1.2	1.0	2.2
Prunes, dried	4 medium	1.3	1.8	3.1
Raspberries	1/2 cup	0.9	2.3	3.2
Strawberries	1 cup	1.8	2.6	4.4

Nuts, Seeds & Beans	Serving Size	Soluble Fiber (g)	Insoluble Fiber (g)	Total Fiber(g)
Almonds, raw	1 ounce	0.7	3.5	4.2
Black beans, cooked	1/2 cup	3.8	3.1	6.9
Black-eyed peas, cooked	1/2 cup	2.2	1.9	4.1
Flaxseeds	2 tbsp.	2.7	2.1	4.8
Garbanzo beans, cooked	1/2 cup	1.2	2.8	4.0
Kidney beans, cooked	1/2 cup	2.9	2.9	5.8
Lentils, cooked	1/2 cup	2.8	3.8	6.6
Peanuts, dry roasted	1 ounce	1.1	1.2	2.3
Pinto beans, cooked	1/2 cup	5.5	1.9	7.4
Psyllium seed husks	2 tbsp.	7.1	0.9	8.0
Sesame seeds	1/4 cup	0.7	2.6	3.3
Split peas, cooked	1/2 cup	1.1	2.4	3.4
Sunflower seeds	1/4 cup	1.1	1.9	3.0
Walnuts	1 ounce	0.6	2.5	3.1
White beans, cooked	1/2 cup	3.8	0.4	4.2

Vegetables	Serving Size	Soluble Fiber (g)	Insoluble Fiber (g)	Total Fiber (g)
Artichoke, cooked	1 medium	4.7	1.8	6.5
Asparagus, cooked	1/2 cup	1.7	1.1	2.8
Broccoli, raw	1/2 cup	1.3	1.4	2.7
Brussels sprouts, cooked	1 cup	1.7	1.9	3.6
Carrot, raw	1 medium	1.1	1.5	2.6
Green peas, cooked	1/2 cup	3.2	1.2	4.4
Green Beans, cooked	1/2 cup	0.8	1.2	2.0
Kale, cooked	1 cup	2.1	5.1	7.2
Lima beans, cooked	1/2 cup	2.1	2.2	4.3
Okra, cooked	1/2 cup	3.1	1.0	4.0
Potato with skin	1 medium	2.4	2.4	4.8
Soybeans (edamame)	1/2 cup	2.7	2.2	4.9
Squash, summer, cooked	1/2 cup	1.3	1.2	2.5
Squash, winter, cooked	1/2 cup	1.7	1.4	3.1
Sweet potato, peeled	1 medium	2.7	2.2	4.9
Tomato with skin	1 medium	0.3	1.0	1.3
Zucchini, cooked	1/2 cup	1.4	1.2	2.6

Whole Grains	Serving Size	Soluble Fiber (g)	Insoluble Fiber (g)	Total Fiber (g)
Barley, cooked	1/2 cup	3.3	0.9	4.2
Brown rice, cooked	1/2 cup	1.3	0.1	1.4
Millet, cooked	1/2 cup	2.7	0.6	3.3
Oat bran, cooked	3/4 cup	2.2	1.8	4.0
Oatmeal, dry	1/3 cup	1.4	1.3	2.7
Oatmeal, cooked	1 cup	2.4	1.6	4.0
Popcorn, air popped	3 cups	3.2	0.4	3.6
Pumpernickel bread	1 slice	1.5	1.2	1.7
Quinoa (seeds), dry	1/4 cup	2.5	3.8	6.3
Quinoa, cooked	1/2 cup	1.7	2.5	4.2
Rye bread	1 slice	1.9	0.8	2.7
Wheat bran	1/2 cup	11.3	1.0	12.3
Wheat germ	3 tbsp.	3.2	0.7	3.9
Wholegrain bread	1 slice	2.8	0.1	2.9
Whole wheat bread	1 slice	1.6	0.3	1.9
Wholegrain pasta, cooked	1 cup	4.1	2.2	6.3

3.Choose whole grain foods over processed grain products. Try brown rice with your stir fry or whole wheat spaghetti with your favorite pasta sauce. Now… if you haven't read "Wheat Belly", by William Davis, MD, then PLEASE DO!! Dr. Davis keeps a blog at www.wheatbellyblog.com/ and updates regularly. So if you don't have the time to read the book, or the money to buy it and can't get to the library… read the blog!! He even answers questions.

Now, with that being said… HOW CAN GRAIN BE BAD FOR US?? For YEARS I've eaten the whole wheat bread, shoot, I'd go one farther and eat that multigrain bread. If it was crunchy, then I'd eat it! I ate brown rice, whole wheat, stone milled oats, barley, etc. Though trying to be 'healthy'… I was gaining weight, especially around my middle, and was getting sicker and sicker. Once my gallbladder started attacking me, I realized I had to change something… that set me up for finding the Paleo Diet. In this diet, they eliminate grains. ALL grains. That includes corn and rice. So… I read up on it… To explain it in full detail would take this entire blog… but to sum up a few key points, I went to Dr. Davis' blog.

Of course, anyone ... knows that it’s not just about gluten sensitivity, it’s also about the gliadin protein that stimulates appetite, the lectins that create abnormal intestinal permeability and allow access to all manner of unwanted foreign proteins into the bloodstream, the lectin effect that blocks leptin receptors and leads to obesity, theamylopectin A that accounts for wheat’s ability to increase blood sugar higher than table sugar and candy bars, and the thousand or so other components of wheat which have been fingered as causing such diverse conditions as exercise-induced asthma to death. And don’t forget neurologic deterioration, including ataxia, peripheral neuropathy, and dementia from wheat gluten in addition to the intestinal destruction it wreaks.

So, there you have it… Now on the Paleo side, we don't eat the grains as they're SO different than not only what our Paleolithic ancestors would have possibly eaten (if at all), but incredibly different than what my grandparents ate when they were growing up! Talk about genetic modification. By trying to feed the world and grow grains all around the world, we're truly killing ourselves. Philosophy aside, diabetic should NOT eat grain as it increases blood sugar!

4. Include dried beans (like kidney or pinto beans) and lentils into your meals. This is a HUGE no-no if you want to become healthy. So, from a personal perspective, my worst gallbladder attacks were after eating black beans and pinto beans. Why? I always heard eating a LOT of fat (think animal fat) caused gallbladders to go bad. Well, I ate a VERY low fat diet… when I got sick I even reduced ALL fats to under 10 grams a day. I was STILL sick!! So, why beans?? If I figure that one out… I'll be sure to let you know! Anyhow, I'd been off beans since I made the connection, but never realized that they carry a toxin called lectin. OH, THAT'S why we soak them forever! To neutralize (or try to) the lectin toxin. Ummm… why should I eat beans? Oh, cause they have LOTS of protein and fiber? I think I'll get my protein from meats (no toxins there, unless you count all the bad crap we feed our animals and all the 'medicines' we pump into them) and my fiber from veggies (see number 2 above). So, LECTINS… yep, they're in grain, too… but read here what Mark Sisson, from Mark's Daily Apple had to say about lectins and what they do to the body:

Let’s go back to the intestine again. (Some field trip, eh?) Lectins’ stickiness allows them to bind with the lining, particularly the villi, of the small intestine. The result? Intestinal damage(with impaired cellular repair potential), cellular death as well as compromised intestinal villi, which means reduced absorption of other nutrients, including minerals and protein. Add to this altered gut flora, which can allow certain harmful bacterial strains like E. coli to run rampant. Furthermore, because the body is now responding full-time to the needs of the injured gut lining, proteins and other resources are redirected from other basic growth and repair processes. Furthermore, lectins have been associated with leptin resistance, a pre-diabetic condition linked to obesity.

Perhaps the most insidious impacts lectins can leave in their wake is this: leaky gut. Leaky gut is a term for the breach in the intestinal lining created by lectins hand in hand with other antinutrients. Once the intestinal breach exists, lectins and other particles (like partially digested food, toxins, etc) can “leak” into the bloodstream.

Once lectins open the door, so to speak, out of the small intestine, they and other fugitive particles are now free to move about the body and bind to any tissue they come across (anything from the thyroid to the pancreas to the kidneys). Of course, the body reacts to these invaders by directing an attack on these particles and the otherwise perfectly healthy tissue they’re attached to. Enter autoimmune mayhem. That’s why lectins are linked with autoimmune disorders like IBS, Crohn’s, colitis, thyroiditis, fibromyalgia, chronic fatigue syndrome, and arthritis. Specific lectins have been associated with particular ailments (like wheat with rheumatoid arthritis), but more research is needed to trace and confirm these connections. What is clear, however, is the potent autoimmune destruction that can result when the intestinal lining experiences this level of damage.

So… why would one want to eat a food containing lectin? Especially when one already has an autoimmune disorder like diabetes.

5. Include fish in your meals 2-3 times a week. I AGREE!!!! Just make sure they're not 'farm raised' as those aren't fed the best foods… any if "You are what you eat" counts for our what our food eats first, then I don't want the grain-based garbage they're feeding farm-raised fish in MY body!!

6. Choose lean meats like cuts of beef and pork that end in "loin" such as pork loin and sirloin. Remove the skin from chicken and turkey. I'm quasi-OK with this. There is a LOT of research on saturated fats that come from animal meat, especially those that are grass-fed, being good for us. The great Cholesterol debate continues. MUCH reading on this subject, but one can NEVER go wrong eating lean meats… you can just add in some other cuts, too!!  Trim the fat, if you want, but don't be afraid of it!  

7. Choose non-fat dairy such as skim milk, non-fat yogurt and non-fat cheese. Again, if organic and grass-fed, the fat in dairy is OK… however, we should limit our dairy intake as we can get our calcium through our green, leafy veggies. I do LOVE my yogurt, though!!

8. Choose water and calorie-free "diet" drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks. WATER ONLY!!! Too much debate over artificial sweeteners and their effect on our body. I'm of the mentality that if it's chemically processed, then it ain't going into my body!! Besides, there's research that shows that it only makes you consume more calories in the long run!! AND… there's questions on whether it can cause an insulin spike (that's what kills dogs when they eat xylitol!!).

9. Choose liquid oils for cooking instead of solid fats that can be high in saturated and trans fats. Remember that fats are high in calories. If you're trying to lose weight, watch your portion sizes of added fats. This subject alone can go on for another blog… for days. For a quick primer on saturated fat go to Mark's Daily Apple. However, let's talk about what liquid oils ARE. Typically, they're vegetable oils. So… what's wrong with vegetable oil? Well, have you ever taken a bite of corn and thought "My Gosh, that's so fatty!!"? No? So… where do they get the oil from corn? Certainly can't express oil out of something that's close to fatfree. So… add chemicals to emulsify the corn and make 'fat'. Then, tell people to heat it and expect it NOT to oxidize. Not feeling so good about those PUFAs (polyunsaturated fatty acids), huh? Me either. That's why I'll stick to my olive oil for salads and coconut oil or other nut oils for cooking! I promise I'll talk about saturated fats soon… but onward...

10. Cut back on high calorie snack foods and desserts like chips, cookies, cakes, and full-fat ice cream. I AGREE!!!

11. Eating too much of even healthful foods can lead to weight gain. Watch your portion sizes. I AGREE!!! After all, excess is excess…

References not linked to original source:

1.Livesey G, Taylor R. Fructose consumption and consequences for glycation, plasmid triacylglycerol, and body weight: meta-analyses and meta-regression models of intervention studies. Am J Clin Nutr 2008; 88: 1419-37.

2.Brown CM, Dulloo AG, Yepuri G, Montani JP. Fructose ingestion acutely elevates blood pressure in healthy young humans. Am J Physiol 2008; 294(3): R730-7.

3.Swarbrick MM, Stanhope KL, Elliott SS, et al. Consumption of fructose-sweetened beverages for 10 weeks increases postprandial triacylglycerol and apolipoprotein-B concentrations in overweight and obese women. Br J Nutr 2008; Apr 3: 1-6 (Epub ahead of print).

4.Glushakova O, Kosugi T, Roncal C, et al. Fructose induces the inflammatory molecule ICAM-1 in endothelial cells. J Am Soc Nephrol 2008 May 28 (Epub ahead of print).