Article 1 - Eating Right and the Glycemic Index

Reprinted from article as seen in “DELTA MEDICAL JOURNAL” winter edition 2005.

Written by Robert Salmon R.Ph.,C.D.M.

          I have had the pleasure of presenting my thoughts about diabetes to different groups in north Mississippi. I have met very few people in the categories of inherited weakness to develop diabetes, those with glucose intolerance (pre-diabetic) or early stages of type 2 diabetes, who understood what they could do for themselves to reduce the effects of diabetes and increase the chances of delaying the onset of/advancing to later stages of diabetes.
          I find there is a great need for people in early stages of this progressive disease to have reasons to modify their diet and change their lifestyle.
          This is a very complex disease and any attempt to simplify it will leave out many important issues.  The body is awash in hormones, and many have direct and indirect effects on our blood sugar metabolism.
          There are “gut hormones” being studied with great promise for diabetes and appetite reduction. Glucogon has the opposite effect as insulin.
          Sex hormones in their role in intra-abdominal (gut) fat are a direct contributor to insulin resistance - possible topics for later issues.
          The following are my thoughts about carbohydrates and their role in early stages of diabetes: 
          Eighteen million people have diabetes and 90% are type 2 diabetics.
          The problem is only going to get worse. The numbers get more dangerous with age - at age 65 and older, 18% of population has diabetes and 40.8% have impaired glucose tolerance (so-called borderline or pre diabetes). Our population is aging.  In 1986, 11% were over the age of 65. By the year 2020, the number will double.
          One out of 7 healthcare dollars is spent on chronic complications of diabetes and the cost of diabetic care is 3.6 times higher than for non-diabetic… $105 billion or more for direct cost.

          The chronic complications of diabetes are:
1)    Microvascular
          a) eye (retinopathy)
          b) nerves (neuropathy)
          c) kidneys (nephropathy)
2)    Macrovascular
          a)  cebrovascular (blood vessels in the brain)
          b) peripheral vascular (blood vessels out in body)
          c)  coronary heart disease (blood vessels in the heart)

          In pre-diabetes or early stages of type 2 diabetes, the blood sugar levels after eating (postprantial) is the most important in the progression of this disease as opposite to fasting blood sugar. Problems with group 2 (macrovascular) are seen first in type 2 diabetics.
       From 1971 to 2000, the amount of food we eat has risen.The amount of protein has remained constant, fat has declined slightly (even saturated fat) and carbohydrate consumption has risen. Therefore, in the past 30 years, there has been an increase in calorie consumption and the increase is due to increasing carbohydrate consumption.
       There are 2 major hormones that regulate the way our bodies utilize the food we eat. They are insulin and glucogon. The amount of proteins (amino acids) in the diet compared to glucose, which come from carbohydrates, determines the amount of these hormones that are released.
       These remarks are especially important for those of us who do not have diabetes, those who have good chance of developing it, those with impaired glucose tolerance  (pre-diabetes) and early stages of diabetes.
        In early stages, fasting blood sugar (blood sugar after 5-6 hours of no food) usually remains normal but blood sugar 1 ½ to 2 hours after eating begins to elevate.
        In early mornings before breakfast, blood sugar is normal but is elevated after eating. Problems, though not yet severe, begin to accumulate.
        Problems with blood vessels in brain, heart, & body usually begin first; later problems start in kidneys, eyes, & nerves. These problems may have no obvious effects on the body, but they are happening and tend to accumulate until “real” symptoms appear. Let me make this clear. By the time most people are diagnosed, they have developed many problems that may not be reversible and tend to get worse.
        One of the main causes of these problems in diabetes is elevated blood sugar (bs). Blood sugar sticks to proteins in the body. You know how a glaze such as honey, coke or brown sugar sticks to ham or roast.
         Blood sugar sticks to proteins in red blood cells, nerves, kidneys, blood vessels, almost any place where there proteins. Proteins lose their natural ability to function when sugar sticks to them. With-in each cell are proteins that carry on chemical processes that are responsible for energy production as well as other things that makes us alive. Sugar will stick to these proteins slowing down these life-giving processes. The more sugar that’s sticks to them, the less effective each cell becomes.
         Insulin resistance is considered the corner stone of impaired glucose tolerance (also called pre-diabetes) and type 2 diabetes. Many say intra abdominal fat (gut fat) is the leading contributor to insulin resistance.
         Mostly we think of insulin as something to control blood sugar in diabetics, but it does much more than that.

          I want us to consider 2 of those things:

          First, it helps get blood sugar into cells.

          Second, it slows down energy production and allows fat storage.   Simply put, the greater amount of insulin in the system, the more the body tends to store fat instead of burning it as fuel for energy. When blood sugar goes up after a meal, our body responds by producing insulin to help clear the blood of this extra blood sugar.

          Now the question is, ”what can be done to keep our blood sugar lower after we eat resulting in lower insulin levels which in turn reduces the amount of fat stored (especially around the waist) and also allows fat to be burned as fuel for long term energy between meals”.
          Fats, proteins and carbohydrates are the only kinds of foods we eat (macroneurients). Carbohydrates are the only ones that increase blood sugar.  Proteins may help to reduce blood sugar and is the subject of on going research. We know the amount of proteins (amino acids) compared to glucose, will help determine how much insulin is released.
          Carbohydrates are mostly responsible for increasing blood sugar. I will focus on them. We know that fat around our waist contributes to insulin resistance. Insulin resistance results in higher blood sugar levels after meals and higher insulin levels to get the blood sugar down. With more insulin in the system we tend to burn less fat for energy and store more fat around the middle. We gain weight and have less energy. We need to eat less carbohydrate in order to keep our blood sugar lower. We know all carbohydrates are NOT the same.
         Some raise blood sugar levels very little, some raise them much more. The knowledge of which carbohydrates are acceptable and which are not may help people who are interested in doing something to slow the progression of these dreaded disease.
         To assure better health, I have prepared a shortened version of the “GLYCEMIC INDEX” chart.  This approach to eating is important to all of us, non-diabetic as well as diabetic.
         This chart compares other carbohydrates to glucose (blood sugar) as to how fast they will increase blood sugar when the same amount of each is ingested.
         Glucose is given the value of 100. As the number for each carbohydrate gets higher, you should consume a smaller portion of it, if at all. Those with values below 45 are relatively low and should be substituted for those with higher numbers if possible. I have color coded the chart for easy reference. You should try to avoid those in red.

          Some key points:

          Sucrose (table sugar) has a value of 64 as compared to a baked potato with 85. Did you know that a baked potato would increase your sugar faster than table sugar? Look at breads, rice, cereals, and fruit. With the exception of apricots, dried fruits are high.

          In summary…

          To healthy individuals and those individuals with early stages of diabetes, blood sugar values after meals seem to be the most relevant. Insulin resistance in type 2 diabetes is a major factor. It allows higher blood sugar levels after meals and increased insulin levels to control this blood sugar increase.
          Carbohydrates are the only one of the 3 types foods that will increase blood glucose. All carbohydrates are NOT the same in regards to the rate they increase blood sugars.
          If we eat fewer carbohydrates and try to replace the high glycemic carbohydrates with lower glycemic carbohydrates, we will induce lower blood sugar levels. With lower blood sugar levels, the insulin levels will tend to be lower.  With lower insulin levels we will store less fat around the waist and burn more fat as fuel. As gut fat is reduced, we become more sensitive to insulin. We will need less insulin to lower our blood sugar.  If we need less of it, then we will tend to burn more fat for energy and store less fat around the waist. The cycle goes on…

Remember to eat high quality protein with each meal and choose to eat fewer carbohydrates that have a higher number on the “glycemic index. Of those you do eat, make sure they are not colored in red.

Glycemic indexes are available from “The Diabetic Shoppe” 662-647-2591.

For more information about receiving your diabetic supplies or custom fitted diabetic footware, contact the Diabetic Shoppe. 662-647-2591