Thursday, July 4, 2019

Retrospective #138: Fruit, the 3rd Rail for Prospective Low Carbers

Whenever I am asked about what foods one “cannot” eat on a Low Carb Diet, eating fruit is always the “3rd rail.” Like 3rd rails, life without fruit to a prospective Low Carber is “fatal.” I love fruit too, just as I love pasta, rice, bread and potatoes, but I have learned that my body can no longer tolerate “sugar,” especially simple sugars, as in fruit. I also “can’t” eat any processed carbs, as in all packaged foods, and I can’t eat all of the starchier and sugary veggies.
After water, fruit is basically sugar. All of the macronutrient nutrition in fruit is sugar. An apple is 86% water, 3% fiber, and 11% simple sugars (0% protein and 0% fat). The sugars are 20% sucrose, 57% fructose and 23% glucose. When the disaccharide sucrose breaks down, an apple is then 67% fructose and 33% glucose. That’s all “sugar”!
It’s true, an apple has some micronutrients (vitamins and minerals in the skin), and the pulp has pectin, but there are other sources for these important components in a basic “real food” diet. Do not use these “good” components as an excuse to eat fruit. Rationalization is just self-deception. Own up to it, my friend.
So, what do you tell someone who loves fruit and who wants to reduce their carbohydrate intake? Three common approaches are 1) don’t snack on fruit. In fact, don’t snack at all, but if you must snack, snack on fat (like nuts, cheese or olives), and 2) if you must eat dessert, eat fruit for dessert instead of ice cream or pie, and 3) eat mostly berries (strawberries, raspberries, blackberries and blueberries), with heavy cream (but no added sugar!). Berries have phytochemicals, fiber, minerals and vitamins too. And avoid grapes, cherries, and dried fruit (like raisins)!
Is it possible to take a more moderate stance on the issue of fruit? Sure. As far as your body is concerned, all carbs are equal. They will all break down to simple “sugars,” mostly glucose. If you are only mildly carbohydrate intolerant, that is, if you have been told you are “pre-diabetic,” you may be able to tolerate more “sugar” (carbs) in your diet. But be careful. This is a very slippery slope. Your meter will tell you what you need to know.
But this is a no-man’s land for both the patient and the clinician. Your doctor most likely adheres to the practices and “Standards of Medical Care in Diabetes,” issued by the American Diabetes Association. If you are overweight, and your A1c test is elevated, your physician will advise you that you are “at risk of diabetes.” Your doctor will then probably tell you to lose weight by eating less (on a “balanced diet”) and “moving” (exercising) more.
Your doctor, however, probably won’t tell you to eat fewer carbohydrates, and they won’t tell you to eat less fruit. And they definitely will not tell you that IF YOU DO NOT CHANGE THE FOODS YOU EAT, THAT YOUR CONDITION IS PROGRESSIVE AND THAT YOU WILL ALMOST CERTAINLY MOVE ON TO BECOME A FULL-BLOWN TYPE 2 DIABETIC.
Doctors just don’t get it, yet. Carbs in your food cause your blood glucose to rise, and if you are insulin resistant, glucose will remain circulating in your blood. The only way to lower your blood “sugar,” and your circulating (serum) insulin that transports the glucose, is to eat fewer carbohydrates, including but not limited to, fruit. It’s that simple!
I was inspired to write this column by two recent incidents. First, I read a Q & A in “Diabetes Today” in which Dr. Richard K. Bernstein referred to “sweet fruit” as something to be eaten sparingly. He has been a Type 1 now for 75 years and has an A1c in the 4s. He regards a 5.7% A1c as a full-blown Type 2 diabetic. You don’t usually hear the phrase “sweet fruit,” so it stuck in my mind. The other incident was an article, “Fruit Restriction for Type 2’s: Good or Not?” in “Diabetes in Control,” a digest for physicians. It compared two groups of newly diagnosed Type 2s: one was told to eat fruit only two times a week and the other “given the more common conventional medical advice to eat no more than 2 fruits a day.” After 3 months they measured A1c’s, weight loss and waist size and found little difference. They concluded, “We recommended that the intake of fruit should not be restricted in patients with Type 2 diabetes.” What idiots! What bleeping idiots! This is “one-size-fits-all” advice (writ large!)  If you want to live a long and healthy life with Type 2 diabetes, eat to your meter! And eat fruit very, very sparingly!

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