Wednesday, August 20, 2014

The Nutrition Debate #237: “…the why behind my broken blood sugar.”

A loyal reader and faithful correspondent recently wrote to me, as an aside, that she is “always looking for the ‘why’ behind my broken blood sugar.” I’ve didn’t reply directly to her, but I have addressed the subject in myriad posts on this blog. I have explained the predisposition of some genomes to type 2 diabetes, the mechanism by way of insulin resistance (IR) wherein one comes to have impaired glucose tolerance and impaired fasting glucose, and then progresses through beta cell failure and increased IR to full-blown type 2 diabetes. If you’re interested, offers this excellent explanation.

But, this “history” of how we have become type 2 diabetics is really irrelevant, if we are already. The fact is that if we were susceptible, either 1) we are already or 2) we are slowly becoming type 2 diabetics. So, if either is so, the real question is, what can we do about it? This requires a 2-part answer: 1) for diagnosed type 2s and 2) for diagnosed or undiagnosed pre-diabetics. The latter includes all those whose fasting blood glucose values have been between 100 and 125 on two consecutive lab tests or whose Hb A1c’s are = or > 5.7%. (Bear in mind that this A1c standard is the ADA measure; pioneer diabetologist Dr. Richard K. Bernstein and many other specialists regard an A1c of 5.8% to be full-blown type 2 diabetes. Check your post prandial glucose and see what you think; don’t wait for your next appointment.)

If you’re a diagnosed type 2, you can either 1) follow doctor’s orders: lose weight (if you’re overweight), eat a “healthy diet” (which is low-fat, high-carb, as defined by the Dietary Guidelines for Americans), and take medications while your doctor monitors your progressively worsening condition. That’s not an unfair characterization on my part. That is their expectation.

Alternatively, if you’re a diagnosed type 2, you can lose weight (if you’re overweight), eat a “healthy diet” (which is low-carb, high-fat, as common sense would dictate), and take minimal or no medications while your doctor monitors your improving health (weight, blood pressure, lipids). As Michael Eades, M.D., commented on his popular Protein Power blog some years ago, "...the low-carb diet is the best way to shed weight and improve health for the vast majority of people."

Now, if you’re an “undiagnosed or diagnosed pre-diabetic” (“those whose fasting blood glucose values have been between 100 and 125”), or have a slightly elevated A1c that’s climbing out of the healthy 4 range into the mid-5s and higher as you continue to eat the Standard American Diet (SAD), what can you do? Again, you have two options: 1) continue eating the diet recommended to you by the USDA (think about that: the U. S. Department of Agriculture’s Center for Nutrition Policy and Promotion produces the Dietary Guidelines for Americans); or 2) start eating a diet much lower in carbohydrates.

The USDA’s one-size-fits-all low-fat, high-carb diet just doesn’t make sense for diabetics or pre-diabetics (or anyone at all for that matter). It is the reason that we as a population, whether pre-diabetic, diabetic or not, are fat and getting fatter. It is how you fatten pigs and cows in the feedlot! Carb loading is how animals in the wild prepare to survive a long, hard winter when food is in short supply. You do too! You put on fat by eating grains, whether they’re purportedly “whole grains” or not. By the way, that “whole grain” loaf of bread with toasted whole grains on the outside? Those grains were brushed on and made sticky and brown using high fructose corn syrup (HFCS) or molasses, or some such.

My faithful reader and correspondent knows all this of course. It was just “wistful” thinking on her part (LOL). So, I am not writing this for her. I am writing this for those who still rely on their doctor to manage their diagnosed type 2 diabetes. If you don’t know how seriously misguided you are to do this, read The Nutrition Debate #235: "Self- vs. medical management of T2DM." And continue reading this blog for guidance on how self-management (under a willing doctor’s care) can avert the numerous, serious complications of type 2 diabetes, both micro and macro vascular, including erectile dysfunction.

And if you are pre-diabetic – whether officially diagnosed or undiagnosed (with a fasting blood sugar between 100 and 125) or with an A1c rising to and above the mid 5s, you have a splendid chance to do something about it…by changing your diet. And the sooner you start, the better.
If you currently eat according to the government’s one-size-fits- all prescriptive diet, you are probably eating about 300 or more grams of carbohydrate a day. That’s 60% of a 2,000 calorie a day diet and the amount of carbohydrate that the Nutrition Facts panel on packaged, processed food products says is the Daily Value (DV), formally the Referenced Daily Intake (RDI), according to Wikipedia. These were formerly called the “Recommended Dietary Allowance” (RDA). And that’s shocking, but a fact. The name may have changed, but the percentage hasn’t. According to our USDA, we (all of us!) are supposed to be eating a diet that is 60% carbohydrate. Of course, you don’t have to do what the government tells you to do. You can take charge of your own health and eat lower carb. Why not try a 20% carb diet (100g/day)? Can you do that?

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