New England Health Advisory

As the incidence of Type 2 diabetes increases, more people are interested in learning about controlling blood sugar levels by changing their eating habits. To share an in-depth look at how blood sugar is affected by food, I first want to provide some background science on diabetes and blood sugar.

Diabetes 101: The Basics

The normal range for blood sugar is between 90 and 110. A person with a blood sugar reading of over 126 is said to be diabetic.

The key hormone responsible for regulating blood sugar levels in the body is insulin. Insulin is secreted in response to an influx of glucose into the blood stream following a meal. Type 2 diabetes develops when too much insulin is secreted because the glucose metabolism is not functioning optimally.

Insulin resistance occurs when the pancreas is required to produce more insulin to metabolize the same amount of glucose and keep the blood sugar level constant. The body’s cells are no longer able to utilize the glucose present because they are full, leading to excessive insulin and glucose in the blood stream and raising the blood sugar level.

One of the reasons diabetes is such a serious disease is the lack of early detection of insulin resistance. By the time the body has become insulin resistant and the blood sugar levels are elevated, the disease has already progressed. The blood sugar level of 126 is an arbitrary number assigned by conventional medicine to diagnose diabetes. The reality is that while blood sugar is climbing to that level, there are other warning signs that the glucose metabolism is not functioning properly and a person is on the way to becoming insulin resistant and diabetic.

These factors include: increased belly fat, sugar cravings, high triglyceride levels, low LDL levels, high blood pressure and increased inflammation. Conventional medicine using newer medication to treat diabetes now favors making the cells more insulin sensitive instead of adding insulin. Increased insulin causes you to have a raging appetite and to crave sugar. More insulin is needed to metabolize the same amount of glucose because your body is becoming insulin resistant.

The good news is that you can take charge of your health and regulate your blood sugar levels through a healthy diet and lifestyle by following the simple guidelines below. Insulin resistance can be prevented, and in some cases completely reversed, by making changes in diet and lifestyle. This is by no means a license to stop taking any of your prescribed medications, but rather to enhance your diabetes treatment and share the results of your lifestyle changes with your health care provider to see if the changes are significant enough to warrant a change in medication.

Regulating Blood Sugar Levels

The question I want to answer today is, “How does what I eat affect my blood sugar level?” Keeping a constant blood sugar level is important for everyone—people with diabetes and for those without. The more your blood sugar rises and falls, the harder your body has to work to maintain a balance. The consensus prescription for maintaining a constant blood sugar level includes regular exercise, eating small amounts of saturated fats and trans fats, and eating a high fiber diet to reduce the glycemic load on the body. So what does your body need? The three macronutrient groups the body needs to function properly are protein, fat, and carbohydrates. Protein and high-fat foods do not cause a rise in blood sugar; whereas carbohydrates do.

In order to understand the differences between carbohydrates from fruits and vegetables versus those from processed foods, it is helpful to know a little background science on carbohydrates. When consumed, carbohydrates are ultimately broken down into glucose to be used as energy for your cells and for all of the biochemical processes in your body. As you’ve probably figured out by now, not all energy is created equally.

Carbohydrates are divided into monosaccharides, disaccharides and polysaccharides. Monosaccharides are the simplest sugars. They cannot be broken down further. They include glucose and fructose. The disaccharides are carbohydrates composed of two sugars that can be broken down into their individual components, including sucrose, lactose and maltose.

The polysaccharides are long chains of monosaccharides held together with glycosidic bonds. They include cellulose and starches found in potatoes, bread, legumes and whole grains. In order for your body to break a polysaccharide down into glucose, all of the glycosidic bonds need to be broken. The longer the chain, the more bonds need to be broken and the longer it takes for the glucose to enter into the blood stream and cause a rise in blood sugar levels. The body does not digest cellulose, the fiber in a food, and it simply passes through the digestive system.

The Glycemic Index and Glycemic Load

In order to identify how the body uses carbohydrates for energy, I want to introduce the concepts of the glycemic index and the glycemic load. The glycemic index was developed to show the effects of a particular food on blood sugar levels. Each food in the glycemic index (GI) is given a score from 1 to 100, with 100 being the value assigned to pure glucose. Foods are considered to be low GI if they are under 55, medium GI between 56 and 69, and high GI over 70. It’s important to keep in mind that the values assigned are laboratory-derived values and that each person’s unique genetic makeup will allow for variations in metabolism for the same foods.

The glycemic index also takes into account the amounts of fat, fiber, total carbohydrates in a food and method of food preparation. Raw carrots have a lower GI value than cooked carrots because the cooked version has less fiber. (Fiber is broken down by cooking.) Most fresh green vegetables have a very low GI value due to the high amount of fiber they contain. Fruits also fall under the low GI category even though they contain fructose mainly due to the amount of fiber contained in the specific fruits.

Whole-wheat foods and sweet potatoes fall under the medium GI group and sugary cereals, white bread and white potatoes fall under the high GI group. Just because a food has a higher GI value does not mean that it is off limits for diabetics or anyone looking to stabilize blood sugar levels. It does however mean that you will need to balance the food with lower GI choices and monitor portion sizes.

The foods with the highest GI values are the ones that will produce the greatest increase in blood sugar levels. The foods with lower GI values will have less of an effect on blood sugar levels because glucose enters the blood stream more gradually, thus allowing the body to secrete smaller amounts of insulin slowly over time and the cells to absorb what they need without becoming overloaded.

The other concept to become familiar with is the glycemic load (GL). The glycemic load takes into account not only the GI value of the food, but also the portion size of the food. As you increase the portion size the GI value of the food stays the same, however, the GL value increases. To calculate the GL value of a food you would multiple the GI value by the amount of carbohydrates in your serving and divide by 100.

You’re probably starting to think that you need to get out a calculator just to eat. I’m certainly not suggesting that, as it would surely take the pleasure out of eating. However, if you are diabetic and you have to be conscious of the total number of carbohydrates you consume, then you are probably already counting carbs in your meals. Using the GI and the GL values as a guide will allow you to estimate the fluctuations in blood sugar that a particular food will cause.

Many readers are likely looking for a definitive answer to the question of, “If I eat chocolate cake with frosting is my blood sugar going to go up to 400?” But the answer really depends on your unique reaction to each food and the combination of other foods eaten at the same time. The glycemic index and glycemic load can be useful tools to help with meal planning, but the actual change in blood sugar in response to a specific food is unique to the person. The more insulin resistant you are the more your blood sugar will fluctuate when you stray to sweets, sugary soft drinks or other refined carbohydrate foods.

The most important rule to remember when eating is to keep your blood sugar balanced. Studies have shown a greater incidence of heart attacks when blood sugar drops suddenly from high to low than when it was stabilized. Testing and trial and error will determine what works best for you because each person is unique in their ability to metabolize glucose and in their level of insulin resistance.

How to Stabilize Blood Sugar Levels

I know that this information may sound overwhelming, but it really is crucial to preventing a host of downstream problems that stem from insulin resistance and diabetes, including heart disease, chronic inflammation, kidney disease and even some cancers. You can allow your cells to recover from insulin resistance, and become more insulin sensitive, but it won’t happen overnight.

In order to keep your blood sugar at an optimal stable level:

• Eat lean protein at each meal to help control appetite and stabilize blood sugar.
• Eat a meal or snack every four hours so that your blood sugar levels don’t drop too much and cause your body to become ravenous.
• Finish eating two to three hours before bed to allow for complete digestion so that your body can dedicate sleep time to rejuvenation and repair instead of digestion.
• Don’t eat a high glycemic index food alone. Consume it with a balanced meal to balance out the overall glycemic load. You can have dessert, but do so only after eating a protein and vegetable meal.
• Control your overall glycemic load by choosing lower GI food and watching portion sizes and total carbohydrates per serving. This will allow your blood sugar to stay more stable.
• Eat a variety of fresh fruits and vegetables at every meal. They are low GI and full of fiber and antioxidants and vitamins to help you feel full and stay healthy.
• Aim to increase your fiber intake especially in the form of soluble fiber from beans, whole grains, legumes, fruits and veggies, and nuts and seeds.
• The fiber will slow the absorption of sugar into the blood stream

Whether or not you are diabetic, keeping your blood sugar level in the healthy range is important for optimal health. By incorporating these simple suggestions for low GI value foods into your diet, you can be on your way to taking control of your blood sugar levels. Think about enjoying the high GI value foods as an addition to your meal, not as the main course and you will always be able to incorporate your favorite foods into each meal.

Yours in health,

Juliette Shimkets
Contributing Editor
New England Health Advisory

By Inger Pols

In the last issue, I began a series on how to make healthier food choices. I discussed how refined flour is stripped of its nutrients and then “enriched” with lab-created versions of the nutrients. I discussed how flour can spike blood sugar levels and suggested some healthier bread choices. Today, I’m going to look at traditional starch options like pasta, rice and potatoes to see why pasta comes out as the best choice.

I want to talk briefly about why the Glycemic Index is a helpful guide (but not an absolute rule) and look at how it applies to bread to provide context when we look at how pasta, potatoes and rice measure up.

As I discussed on Monday with the bread issue, certain foods spike blood sugar levels. The Glycemic Index is the scientific system that measures and monitors those increases across all carbohydrates. The lower the number, generally speaking, the better because that means the food will be digested more slowly, will result in less insulin spiking and will provide more protection from diabetes, high blood pressure, high triglycerides, heart disease and obesity.

In addition to helping you to avoid certain health conditions, lower Glycemic Index (GI) foods also aid in weight control. A study of overweight teenagers eating a low GI breakfast showed that they ate 45% fewer calories throughout the day than when they began their day with a high GI breakfast. Foods that stimulate insulin have been shown to increase calorie consumption at the next meal and research shows that if calorie intake is equal, eating lower GI food will result in weight loss.

Problems with the Glycemic Index

But there are a number of problems with relying completely on the index as a food guide. First, GI food measurements are imprecise. Generally speaking, the test is done several times and the results are an average of those outcomes.

For example, a baked russet potato has been shown to have a GI value as low as 56 and as high as 111. As a result, it is listed in the high 70s on most indexes. The GI index for fruit increases as it ripens and changes depending on the food processing method and time. Grinding or cooking will increase the GI as will cooking for longer periods of time.

The GI of any one food is also altered significantly based on what it is combined with. I recommend eating healthy fat, protein and fiber with every meal because it reduces insulin spiking and decreases the likelihood that higher sugar foods will be stored as fat. But how much you eat matters too: Some foods have a high GI but you likely wouldn’t eat a lot of them, so their overall “load” is lower, while others may be lower, but you are more likely to consume a good portion. And lastly, individual responses to carbohydrate digestion vary, as do insulin responses, and those responses have been shown to vary based on the time of day the food is consumed.

As a result, the Glycemic Index can be a helpful tool but should not be relied upon in absolute. It is helpful for making relative comparisons and tradeoffs. Something that falls in the 80s is a less healthy food choice than something that lands in the 40s. Generally speaking, it’s a good idea to minimize consumption of foods with scores over 55 on the GI. But some of those foods have great nutritional benefits, so that doesn’t mean you should never eat them. Instead, consume them in moderate portions, on occasion, combined with fiber, healthy fats and protein. It’s easy to see why a processed bakery product might need to be eliminated, but a potato or watermelon can be eaten in moderation.

Now let’s talk about how the Glycemic Index applies to pasta and rice compared to bread.

Bread, Potatoes, Rice and Pasta

In addition to being nutrient devoid, traditional white bread and most whole wheat bread (made from enriched white flour) is high on the Glycemic Index. Typical white or wheat bread and bagels fall in the 70s, while pita bread lands in the high 50s. I love a good French bread as much as the next person, but baguettes fall in the mid-90s!

As you go toward more whole grain products, the Glycemic Index declines, with multigrain bread in the high 40s and sprouted grain breads in the low to mid-40s. Whole grain, multi-grain and sprouted grains are lower GI choices that also offer more nutrient value. (Ezekiel bread, for example, is a complete protein source offering all nine essential amino acids and 18 amino acids in total, all from plants; it’s more than just bread.)

It seems logical that pastas would go much the same way as breads, with traditional white and wheat pastas being significantly higher glycemically than whole grain and sprouted grain versions. But that is not the case.

Earlier I said that white bread and baked potatoes have GI scores in the 70s, but there are some better potatoes choices: Boiled, new or sweet potatoes are all in the mid-50s. In addition, brown rice comes in at 55 on the GI, while white rice shows up between 56-64. (Note: Though the Glycemic Index between brown and white rice may seem close, brown rice has much greater nutrient density and is a better food choice.)

Even though some potatoes and brown rice have levels in the mid-50s on the GI, which makes them viable options on occasion, pastas have an even lower GI. During processing, ungelatinized starch granules get trapped in the sponge-like gluten (protein) network inside the pasta dough. This does not occur in the processing of bread or rice and as a result, pastas tend to have a lower Glycemic Index overall.

Traditional spaghetti comes in at 41 on the GI scale, with its whole-wheat version at 37, making these clear winners, with a few caveats.

An Exception: Brown Rice Pasta

There is one surprising exception: brown rice pasta. Brown rice pasta comes in at a whopping 92 on the Glycemic Index: A surprise to me since brown rice itself is not high on the GI and whole grain brown rice is a nutrient-rich food. I’m still researching what it is about the transformation from rice to pasta that makes brown rice so high on GI scale. But until I learn more, avoid brown rice pasta and stick to traditional pastas.

I do continue to recommend whole grain brown rice as a healthy, nutrient-laden option on occasion; it’s got a host of health benefits and comes in at 55 on the GI scale. (Asian noodles also have a relatively low Glycemic Index, so I recommend experimenting with udon, rice vermicelli or hokkein for variety.)

As always, try to limit serving size and frequency; we Americans tend to eat enormous plates full of pasta whereas Europeans eat much smaller portions. And always cook your pasta al dente: The longer you cook it, the higher the Glycemic Index, as the gelatinous protein network breaks down. (One GI table showed that spaghetti boiled for 10-15 minutes came in at 44, but when boiled for five minutes, it dropped down to 38. Regardless of the exact cooking time, which will vary by product, be sure not to overcook. Try for that al dente firmness that leaves more of the protein intact.)

When you do eat pasta, combine it with healthy fats, proteins and carbohydrates to create a balanced meal; here’s where fresh homemade vegetable sauces made with healthy fats can take your meal to a whole new health level. And here’s a tip if you are concerned about blood sugar: Add some acid like vinegar or lemon to help lower the GI of the meal.

While you do get some additional nutrient value from a whole grain, multi-grain or sprouted grain pasta, the glycemic difference of whole wheat is not significant versus traditional pastas. Some of the newer whole grain and sprouted grain versions have not even been tested yet and while their scores may be lower, the baseline for traditional pasta is pretty good to begin with.

While I encourage you to experiment and try some of these nutrient-rich grain products–variety in food choices is always a good thing–if the taste does not appeal to you, it’s OK to indulge in some traditional pasta on occasion. Mangia!

To your health!

Inger Pols
Editor of New England Health Advisory

P.S. We receive a lot of emails from our readers, but last week, we were honored to receive an actual paper letter! Not only that, but its content was so interesting and thought provoking that we published it on our website. Please take a moment to read it and add comments.

By Al Sears, M.D.

If you enjoy breakfast or lunch on-the-go, I understand. Our lives are so busy; we don’t always have time to cook.

But beware: Some “convenience foods” aren’t worth it. You’ll pay for it with added inches to your waistline. And those excess pounds lead to chronic diseases like obesity, cancer, and heart disease.

Here are three foods that will put you on the fast track to fat:

Breakfast Cereal: This one is a little deceptive. No one thinks of cereal as being a threat to their health.

But no matter which one you choose, breakfast cereals are high on the glycemic index (GI). For many people, a dose of high-glycemic carbs in the morning is the prescription for building excess body fat.

You’d almost be better off eating a candy bar or a piece of cake.

The GI of an average piece of chocolate cake is between 31 and 38… a Snickers bar is about 43. Not bad.

Compare that to the GI of Kellogg’s Corn Flakes… which registers a whopping 132. That means corn flakes break down into sugar in your bloodstream faster than pure glucose!

And if you add fuel to the fire by putting sugar on your cereal, you’re sending an overwhelming surge of sugar into your system.
Remember, high blood sugar triggers a wave of insulin. And insulin is the hormone that sends the message to build and store fat.

Even “healthy” cereals like Grape-Nuts have a GI of 80. That’s also very high.

It might be a fast fix when you’re rushing in the morning, but cereal in the morning will make you fat. Avoid it at all costs.

French Fries: Possibly the worst foods you can eat. First off, potatoes are high-glycemic and not good for you in any form. But when you take potatoes and deep-fry them in trans fatty oil, you have a recipe for sickness and disease.

While white potatoes aren’t the best choice, the oil they’re cooked in adds much more danger than the potatoes do. If you need a potato fix now and then, opt for a baked potato or, better yet, sweet potatoes. They’re loaded with carotenoids, vitamin C, potassium, and fiber.

Bagels and Breads: Don’t fall for the “whole-grain goodness” trap. When it comes to the glycemic index, it matters very little whether breads are made from whole grain or not. Grains spike your blood sugar, and you know what that means.

Forget about the commercials you see on TV. Unless you are very poor and can’t get enough calories without them, you should avoid grains at least until you get as lean as you want to be. You’ll be better off without them.

In the morning, take a few extra moments and scramble some eggs. Before you throw the eggs in, sauté some sliced tomatoes and spinach. Maybe some onion, too. In less than 10 minutes, you can have a breakfast that will make you feel pumped and energetic for the whole morning.

And if you need a fast lunch, try a wrap instead of a sandwich. More and more restaurants offer wraps these days. They come in all styles – spinach is my favorite. (Try and avoid the heavy flour tortillas.)

To your good health,

Al Sears, M.D.

Bibliography

1.    Whitehouse MW, Macrides TA, Kalafatis N. “Anti-inflammatory activity of a lipid fraction (Lyprinol®) from the N. Z. green-lipped mussel.” Inflammopharmacology. 1997;5:237-46.

By Inger Pols

This is part three of a five-part series on the five supplements I think every adult should take. Earlier this week, I sent you parts one and two, which focused on whole-food based multivitamins and ubiquinol. You can read them by clicking here.

Fiber is commonly known for keeping people regular, but did you know that it also helps prevent heart disease and Type 2 diabetes? Fiber is best delivered naturally by eating plant foods, grains and legumes, but most of us don’t eat enough fiber and are deficient in this vital nutrient. It’s not only important to eat enough fiber, but to eat it at the right time as well.

Fiber is a carbohydrate that our body does not digest or absorb. Fat, protein and other types of carbohydrates are broken down and then absorbed, fiber passes through your stomach, small intestine, colon and ultimately out of your body, intact. There are two kinds of fiber necessary for healthy digestion: Soluble, which means it dissolves at least partially in water, and insoluble, which does not dissolve in water.

Insoluble fiber helps with movement through the digestive system. It also increases stool bulk and can assist with regularity. Wheat bran, nuts, vegetables and whole-wheat flour are some sources of insoluble fiber. Soluble fiber dissolves into a gel-like material and helps to lower blood cholesterol and glucose levels. Carrots, peas, beans, apples, citrus fruits, oats, barley and psyllium are examples of soluble fiber sources.

Fiber helps with regular bowel movements and in maintaining bowel health. Some evidence suggests that a high fiber diet can lower the risk of developing hemorrhoids and diverticular disease (when small pouches develop in your colon).

But fiber does more than just keep us regular, it also helps with weight loss and weight maintenance. It slows the absorption of sugar, which helps control blood sugar levels for those with diabetes and has been shown to reduce the risk of developing Type 2 diabetes. Fiber also helps with heart health by lowering cholesterol levels, reducing inflammation and lowering blood pressure.

With all these great benefits, fiber is definitely something we should get more of. But many experts say we are a fiber-deprived nation. According to the National Academy of Sciences’ Institute of Medicine, men under age 50 need at least 38 grams of fiber a day and women of the same age need at least 25 grams. Men over age 50 need at least 30 grams a day, and women need 21. It’s important to note that recommendations are tied to overall caloric intake, so if your daily calorie intake is higher, you need more fiber. And overall, according to the Harvard School of Public Health, more fiber is better.

The typical American consumes 15 grams of fiber a day or less, so most of us have some catching up to do on our fiber consumption. Fiber levels vary significantly by food source, so it’s important to look at what you’re eating to assess how much more fiber you need to consume. Refined or processed foods have little fiber content because the process of grain refinement strips the outer coat or the bran from the grain. Taking the skin off fruits or vegetables will also yield less fiber.

Studies show that whole-grain cereal fibers such as wheat and oat bran have good amounts of fiber, but there’s less research seen on vegetables because it’s easier to brand an oatmeal product than a banana. We often think of bread or whole wheat as a good fiber source, but one slice of whole-wheat/whole-grain bread has only 1.9 grams of fiber, while whole-wheat spaghetti brings in 6.2 grams per cup.

A medium banana or orange yields about 3 grams of fiber, while a cup of raspberries contains 8 grams. A medium carrot contains 1.7 grams and an ounce of almonds (about 23 nuts) contains 3.5 grams. But the real bounty lies in vegetables and beans. A cup of peas comes in at 8.8 grams, a medium artichoke at 10.3 grams, a cup of black beans has 15 grams, lentils 15.6 grams and a cup of split peas packs 16.3 grams of fiber.

In addition to making sure you’re getting the correct overall level of fiber, it’s important to consume fiber with every meal to balance blood sugar levels and to inhibit weight gain. This occurs in several ways: Fibrous foods take more time to chew and so allow time for the signal to reach your brain indicating you are full and should stop eating. Fiber rich foods also tend to make you feel fuller longer, so you eat less.

Fibrous foods tend to have fewer calories by volume than non-fiber rich foods, so eating the same portion size of a food rich in fiber will likely mean you’re eating fewer calories than in a low fiber food. Any time you eat food with high sugar content in isolation, it’s more likely to be stored directly as fat than if it is eaten in the context of a balanced meal. If you eat on the run a lot and find it hard to eat fresh vegetables or beans with your meal, keep a fiber supplement handy and take it with your meal.

It’s important to keep in mind that some of the fiber sources listed above are also high in sugar content. Bread and pasta—even whole-wheat versions—are higher on the glycemic index, as are many fruits and even a few vegetables, meaning they will raise blood sugar level. While they are certainly better than empty calorie processed foods, it’s better to focus more on beans and vegetables, particularly green vegetables, as fiber sources. If you do eat a lot of bread or fruit, try consuming them in combination with vegetables, beans or a fiber supplement.

In America, we often drink our meals, whether it’s a smoothie, a rich coffee drink or alcohol, all of which are high in sugar content. If you’re having a liquid meal or drinking anything with high sugar content without an accompanying meal rich in fiber, you should take a fiber supplement along with your beverage to mitigate blood sugar spikes and to inhibit that sugar from being stored in your body as fat.

Every time I eat a meal or snack, or drink anything with sugar, I either eat or take in supplement form a small amount of protein, fiber and healthy fat, like omega-3s. I also keep extra fiber handy to supplement anytime I eat something not fiber rich. Ensuring that my body has that healthy combination of protein, fat and fiber helps manage blood sugar, keep hormones balanced, and maintain my weight, even if I indulge.

When possible, try to eat a diet rich in fiber from a variety of sources. We tend to eat the same foods over and over again—our go-to favorites—but variety in type and source of fiber, as with all nutrients, is important. So mix it up, but also supplement as needed with capsules or powder containing both soluble and insoluble fiber to ensure your meals and snacks are balanced.

Fiber pills are handy to take when away from home and easy to swallow along with whatever liquid you are consuming. I prefer fiber in pill form, as I can take my base dose in the morning with my other supplements and have additional pills on hand for any time my meal or snack is imbalanced.

Powder forms are another option, as they are readily available, inexpensive and they work fine when you mix them into a smoothie or a liquid you are already drinking.

One caveat: When increasing fiber consumption, do so gradually over the course of several weeks as overloading your body too rapidly can cause gastrointestinal distress. And to be most effective, fiber needs water, so be sure you adequately hydrate as you increase your fiber intake.

To your health!

Inger Pols
Editor of New England Health Advisory