~Diabetes, Part 5 - The Gylcemic Index and Dietary Recommendations
The Gylcemic Index and Dietary Recommendations
The Glycemic Index lists the relative speed at which different foods are digested and raise blood sugar levels. Each food is compared to the effect of the same amount of pure glucose on the body's blood sugar curve. Glucose itself has a Glycemic Index rating of 100. Foods that are broken down and raise blood glucose levels quickly have higher ratings. The closer to 100, the more the food resembles glucose. The lower the rating, the more gradually that food affects blood sugar levels.
An admonition based more in folk medicine than scientific certainty, that is to avoid the white foods (all sugar-containing foods, rice, and all white flour and flour-based products including pasta), appears to have validity when applied to the Glycemic Index. Common foods bear the following glycemic ratings: baked potatoes, 95; white bread, 95; mashed potatoes, 90; chocolate candy bar, 70; corn, 70; boiled potatoes, 70; bananas, 60; white pasta, 55; unsweetened fruit juice, 40; rye bread, 40; lentils, 30; soy, 15; green vegetables and tomatoes, less than 15.
Some fruits rank lower on the glycemic scale than starchy vegetables, whole grains, and legumes. (Starchy vegetables are potatoes, corn, yams, and most beans.) A serving of low-carbohydrate fruit, that is, grapefruit and unsweetened strawberries, cherries, peaches, and cantaloupe is usually well tolerated.
All sweeteners can be problematic, including honey, high fructose corn syrup (which raises blood glucose levels), and fructose (which increases insulin resistance and triglycerides) (Bland 1983). Carbohydrates found in low-starch vegetables do not encourage a rise in blood glucose levels (e.g., asparagus, broccoli, Brussels sprouts, cabbage, cauliflower, celery, cucumbers, green beans, lettuce, mushrooms, onions, peppers, radishes, spinach, tomatoes, and turnips). It is especially important for an individual with diabetes to learn to read labels. Select foods with no more than 8 grams of carbohydrates per serving, until the condition is well under control. Adding vinegar, lemon juice, acidic fruits, or sourdough bread to a meal slows gastric emptying; consequently, starches and sugars enter the system in a time-released manner (Liljeberg 1996, 1998).
Since large quantities of food are extremely difficult for a diabetic to process, smaller meals are recommended. According to Diabetes Care, moderate amounts of alcohol, that is, no more than 1-2 drinks a day, appear to reduce blood glucose and insulin levels (Facchini et al. 1992). However, exceeding this amount is highly detrimental, increasing both morbidity and mortality. Unfortunately, current studies reflect too many inconsistencies to recommend types of alcohol delivering greater advantage (Rimm et al. 1996).
Sugar-sweetened soft drinks and confections are not permissible for prediabetic or diabetic patients, but the alternative, artificially sweetened beverages and foodstuffs, may not be either. Allegations have implicated aspartame as a potential risk factor for several disorders, although this remains a controversial issue. Many artificial sweeteners (marketed as a sugar substitute) may actually contain sugar, masquerading as dextrose and maltodextrin.
Stevia, an herb considered 100-300 times sweeter than sugar, is often recommended as an alternative to either sugar or aspartame. Because stevia has unusual sweetness, much less is required to provide palatability, and the risk of eliciting an insulin rush is lessened. In fact, various studies suggest that stevia has a regulating affect on the pancreas and could actually assist in stabilizing blood sugar levels. Others contend that yielding to sweet passions by consuming even artificially sweetened products never addresses the problem of sugar cravings. However, enjoying an acceptably sweet treat (on occasion) delivers a significant advantage, dispelling feelings of deprivation and restriction.
Tentative research indicates that men who frequently include hot dogs, bologna, and bacon in their diet increase their risk of Type II diabetes by about 50% (van Dam et al. 2002). While a ban on processed meats is not the objective, moderation is strongly advised.
For example, Dr. Frank Hu (a senior researcher) explained that the risk of diabetes increased when individuals ate processed meats five or more times a week. The data were collected from the Health Professionals Follow-Up Study, a project that began in 1986 by analyzing dietary information from 42,504 men, ages 40-75, who were classified as healthy and free of diabetes, heart disease, or cancer. The men were tracked for 12 years, with the researchers comparing the dietary patterns of those who developed diabetes with those who did not. After attempting to adjust for other less healthy foods that might accompany a hot dog meal, it appeared clear that freely eating processed meats was an independent risk factor for developing diabetes.
A report involving dairy consumption and insulin resistance (appearing in JAMA) attracted widespread media attention. Interest was spiked as researchers showed that diminished milk intake (a trend observed over the past 3 decades) appears to be paralleling an increase in obesity and Type II diabetes. An inverse association was noted between frequency of dairy intake and the development of obesity, abnormal glucose homeostasis, elevated blood pressure, and dyslipidemia in young, overweight, black and Caucasian men and women (Pereira et al. 2002).
Researchers showed that the 10-year incidence of insulin resistance was lower by more than two-thirds among overweight individuals in the highest category of dairy consumption. Although saturated fat contained in dairy products may raise LDL cholesterol in a subset of the population, there are several mechanisms (including milk's position of 34 on the Glycemic Index) that may protect against insulin resistance, obesity, and cardiovascular disease. A positive association was not observed between dairy intake and insulin resistance in individuals who were not overweight (BMI <25) at baseline. Milk is also a source of conjugated linoleic acid (CLA), which has shown anti-obesity effects in numerous studies.
Diabetes Care also reported that the world's most widely used drug may be a hidden key to insulin resistance (Biaggioni et al. 2002; Keijzers et al. 2002). A group of Dutch doctors recruited 21 healthy, lean, nondiabetic men and women under the age of 30 to compare the insulin effects of caffeine and the drug dipyridamole in contrast to a placebo. Dipyridamole is an anticoagulant drug (also known by the name Persantine) that has the opposite effect on hormone arousal compared to caffeine.
The researchers determined that dipyridamole had no effect on insulin sensitivity, but caffeine decreased insulin sensitivity by about 15%. While the numbers may appear insignificant, the decrease is about the same as the increase in insulin sensitivity obtained from typical prescription diabetes drugs. It appears highly probable that the positive effects of Glucophage (metformin) could be cancelled out by few cups of coffee. Moderate caffeine consumption emerges as the recommendation, but if insulin sensitivity is a problem or Type II diabetes is evidenced, zero caffeine consumption appears a wholly worthy gesture.
A variety of phytonutrients derived from spices influence insulin sensitivity (Jarvill-Taylor et al. 2001). For example, American scientists have found that 1 teaspoon of cinnamon a day may help control blood sugar levels. The common spice appears to rekindle the ability of fat cells to respond to insulin and increase glucose removal (Hodge 2000).
The factor found in cinnamon that is responsible for the diabetes advantage is methylhydroxy chalcone polymer (MHCP) (Mercola 2000). Researchers found that MHCP stimulated glucose uptake and glycogen synthesis in a fashion similar to insulin. Dr. Richard A. Anderson (lead scientist at the Beltsville, Maryland-based Human Nutrition Research Centers, a branch of the U.S. Department of Agriculture) said: "Patients could try adding 1/4 to 1 teaspoon of cinnamon to their food" (IBN 2000). It is possible that nothing positive will come from the addition, but it is also biologically conceivable the beneficial effects could prove dramatic.
Exercise: Helpful in Blood Glucose Control
Physical activity plays an extremely important role in overturning the clusters of symptoms (obesity, insulin resistance, and hyperinsulinemia) that accompany diabetes. Exercise need not be unpleasantly aggressive to be beneficial. Focusing on an activity you enjoy and incorporating it into daily activities can be as pleasant as it is gratifying. Whatever the exercise, the participants can take delight in knowing they are burning calories and reducing body fat, triglycerides, cholesterol, blood glucose, and blood pressure, while increasing insulin sensitivity, improving mental outlook, and building muscle and strength.
A retrospective study reported in the New England Journal of Medicine tracked 5990 men over 14 years, monitoring lifestyle and health status of participants. From those numbers, 202 subjects became diabetics. Researchers found that as energy expenditure increased, the incidence of diabetes decreased. For each 500-kcal increment in energy expenditure, the age-adjusted risk of Type II diabetes decreased by 6%. The protective effect of exercise is strongest in individuals most prone to develop the disease: those persons who are obese, hypertensive, or born to diabetic parents (Helmrich 1991).
A part of the exercise-induced improvement in blood glucose control is explained by looking at the nature of muscles. Muscles are more responsive than fat cells to insulin and glucose, and conditioned muscles are more responsive than unconditioned (Challem 2000). Toned and developed muscles enhance the body's sensitivity to insulin, a process that assists in blood glucose control. Also, Dr. Charles Lardinois, an endocrinologist at the University of Nevada and medical director of the Nevada Diabetes Association (speaking at the ACAM Conference in Nashville, 2001), added that skeletal muscles have a unique ability to take up glucose without the need of insulin. Glucose transporters, known as GLUT-4, regulate the process. Regular exercise induces a greater expression of GLUT-4, thus lowering blood sugar and improving insulin sensitivity.
The exercise advantage was exemplified in the Nurses' and Physicians' Health Studies, showing that physically fit people secrete less insulin after a carbohydrate load (50 grams). Those who exercised at least once a week had one-third less diabetes; studies from Finland confirmed that individuals randomized to an exercise program have a dramatic decrease in the risk of developing diabetes (Manson et al. 1991; Manson et al. 1992; Uusitupa et al. 2000).
A meta-analysis of 14 studies reported in JAMA allowed researchers to systematically review the effect of exercise intervention on glycemic control as measured by HbA1c and Body Mass Index (BMI). Studies in which the intervention consisted only of recommending increased physical activity were not included because it would be impossible to quantify the exercise intervention or compliance. The intervention had to be verified by direct supervision or through exercise diaries. The conclusion of the study was that exercise training reduces HbA1c by an amount that should decrease the risk of diabetic complications. No significant change in body mass was found between the exercise group and those acting as controls (Boule et al. 2001).
Exercise is extremely important to the dieter since there are two fundamental ways to lose weight: by increasing energy output or decreasing energy input. Simply stated, weight is lost by either exercising more or eating less. A small weight loss (even as little as 10 pounds) can often stabilize blood glucose levels and lessen the risk of diabetes. Some estimate regular exercise will reduce the insulin requirements of obese Type II diabetics by up to 100% when combined with weight reduction (Nieman 1995; Blake 2002).
As important as exercise is to the diabetic, it appears equally important to temper physical activity with appropriate amounts of rest, according to information presented at the American Diabetes Association's 61st Annual Scientific Sessions. Dr. Eve van Cauter (University of Chicago) found that chronic sleep deprivation of 6.5 hours or less each night had the same effect on insulin resistance as aging. Healthy adults who averaged 316 minutes of sleep each night (about 5.2 hours over 8 consecutive nights) secreted 50% more insulin than those who rested about 8 hours a night (Ford-Martin 2001; Mercola 2001).
STRESS (THE NEMESIS)
Countless studies caution that stress is expensive; buying into unresolved stress can lead to Syndrome X and diabetes and, if not controlled, to a shorter lifespan. A study conducted at the Mount Sinai School of Medicine showed that stress was one arm of multiple factors that strongly influence hyperinsulinemia (Heller et al. 1995).
Anxious individuals spur the sympathetic nervous system (SNS) into heightened activity, and the adrenal glands leap to respond. The medulla, the inner portion of the adrenal gland, secretes epinephrine (also referred to as adrenaline), a hormone that has significant influence over blood glucose levels. Epinephrine favors the breakdown of glycogen to glucose (glycogenolysis). In a diabetic, the additional glycogen input cannot be utilized and results in elevated blood sugar.
During periods of emotional upheaval, the chief glucocorticoid hormone, cortisol (secreted by the adrenal cortex), is also revved into action. Cortisol lessens the ability of insulin to carry glucose, a transport essential to glucose utilization. The hyperresponsiveness of epinephrine and cortisol reduces the ability of tissues to use glucose and increases the rate of protein conversion to glucose. As cortisol levels increase, DHEA (a hormone, commonly suppressed in insulin resistance) also diminishes.
Stress robs the body of essential nutrients. Diabetes and hyperglycemia, conditions fueled by stress, activate homeostatic mechanisms including polyuria (increased urination to transport sugar from the system). In the process of excreting fluids, water-soluble nutrients are also lost, many of which are essential to stress reduction and glucose management.
Stress contributes to obesity (a factor associated with Syndrome X and Type II diabetes). A stressful person often eats not because of hunger but as a reprieve from demanding, unpleasant situations. Tasty treats temporarily pacify a troubled spirit, but while the stressful individual is overeating, physical changes are occurring. If the foodstuffs have been largely carbohydrate (particularly sugar-based products), free radicals proliferate, a situation biologically similar to being exposed to radiation, cigarette smoke, or air pollution (Challam 2000). As glucose piles up in the bloodstream, the pancreas pumps out insulin to oppose the rise in glucose. The insulin release from the pancreas may be too much, and blood glucose levels plummet to hypoglycemic lows.
Because of homeostatic mechanisms, the brain transmits hunger signals in an attempt to regain strength and inner balance. If the food selected is an insulin-provoking product (such as another sugary treat or foods high on the glycemic scale), the cycle starts anew. Stress was the initiator in the eating frenzy; unstable blood glucose is too often the consequence.
C-Reactive Protein and Cytokines
C-reactive protein (CRP), a protein present in many acute inflammatory conditions, is a significant risk factor in cardiovascular disease. A growing body of evidence indicates that higher levels of CRP may also play a role in central abdominal obesity and the onset of Type II diabetes.
Researchers reported that among 159 men (ages 22-63), body fat increased as CRP levels rose (Lemieux et al. 2001). JAMA reported that men with high fasting insulin levels, as well as individuals with hyperglycemia following a 75-gram glucose challenge, often have elevated CRP levels. Interleukin 6 (IL-6), a cytokine derived from fibroblasts and macrophages, was incriminated (along with CRP) as being predictive of the development of Type II diabetes (Pradhan et al. 2001).
It appears that abdominal fat is, in fact, a major source of inflammatory cytokines. However, it should be noted that cytokine activation is not restricted to individuals who are morbidly obese. Russell Tracy, Ph.D. (University of Vermont's Laboratory for Clinical Biochemistry Research), declares that individuals who are not obviously overweight may still have a disproportionate amount of visceral fat. The increased risk of insulin resistance and atherosclerotic disease associated with visceral obesity may be explained through upregulation of cytokine secretion (Tracy 2001).
In addition, hyperinsulinemia changes the disposition of cytokines. The liver, receiving instructions from cytokines, releases stored fat and sugar into the bloodstream. As body fat increases, insulin resistance increases, as well. Self-perpetuating imbalances slam the body from several directions.
The safest and surest way to overcome this untoward situation is by losing weight. Women completing a 12-week, low-fat, energy-restricted diet lost an average of 7.9 kg (17.4 pounds) and their CRP levels dropped by 26% (Heilbronn et al. 2001). This finding is extremely important because women with the highest serum CRP levels appear about 15.7 times more likely to develop Type II diabetes compared to those with the lowest levels (Pradhan et al. 2001). In addition, French researchers showed that a weight loss resulted in a significant decrease in IL-6 levels (Bastard et al. 2000). Individuals should request hs-CRP testing to evaluate inflammation as a contributor to diabetes and its progression. Note: hs denotes high sensitivity, the only method able to discriminate subtle differences in CRP concentrations (those that go undetected by standard testing).
Aspirin, fish oil, and vitamins C and E, as well as pravastatin (and other statin drugs), reduce high levels of CRP. IL-6 is lowered by DHEA and vitamin K supplementation. A comprehensive program directed toward lowering proinflammatory cytokines is presented in the Chronic Inflammation protocol.
Continued . . .
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