Type 2 Diabetes, a Dietary Disease #317: Patient, heal thyself.

“Physician, heal thyself” is a familiar proverb attributed to Luke the Evangelist (4:23). It was made famous, and is often quoted from the Latin translation of the Bible, as Cura te ipsum, or simply “cure thyself.” According to a citation in Wikipedia, “The moral of the proverb is counsel to attend to one's own defects rather than criticizing defects in others.” I prefer to think of it in a more positive and proactive way; I say: Take control of your own life.

I say, don’t blame one’s condition in life on others, or even look back at one’s own mistakes. Instead, think of your life in the present and make wise choices. A former co-worker once referred to my outlook on life as Jungian. I trace its origin in my psyche to a program I took many years ago called “the est Training .” It was, as promised, transformational.

A knowledgeable reader of this blog, whose views I respect, related this philosophical view to the current Dietary Guidelines debate. In a recent comment he said, “It's been pretty well documented…that T2D is a self-inflicted malady. You might not have been pointing the gun (‘guidelines’ do that for you), but you pulled the trigger.” I replied, “I like that. You have to accept responsibility first, if you are going to do something about it.” Right?

The relevance to Type 2 Diabetes, which I have coined “a dietary disease,” is that you control pretty much every thing you put into your mouth…and thus you could control your Type 2 Diabetes from this bite forward. Thus, you can “cure thyself.” You just have to believe in this Way of Eating and have the strength to follow it religiously. It’s not easy to “give up” so many foods to which you have become habituated, but this much I can tell you: You won’t have to wait for the hereafter to see results (LOL). You will see results almost overnight. You will lose weight without hunger, and your doctor will be astounded at your improved health markers every time you visit.

Luckily, for me, I started eating Very Low Carb on the advice of my doctor. I weighed 375 pounds, and my doctor had been trying for years to get me to lose weight. It was summer of 2002, and he had just read the New York Times Sunday magazine cover story, “What If It's All Been a Big Fat Lie,” by Gary Taubes, an award-winning science writer.  When my doctor next saw me, he said, “Have I got a diet for you!” I tried it, strictly following the original Atkins Induction plan (20g of carbs/day). Over the course of time, I lost 170 pounds.

My doctor’s heresy in recommending such an “extreme” diet in 2002 wasn’t as irresponsible as the mainstream medical establishment would have you believe. Low Carb – even Very Low Carb – dieting has been around for a long time. It just went out of fashion about the time older doctors practicing today got their training. Saturated fat and cholesterol were declared verboten for heart health, and all fats were targeted for reduction in the diet. As a result, carbohydrates were ascendant, achieving and maintaining to this day 60% (300g/day) of the calories recommended on a 2,000kcal diet. As a result, we as a nation have gotten fatter and sicker.

Now, in the face of advancements in the science of healthy eating, and in the absence of good science to support the dangers of saturated fat, dietary cholesterol, and salt, the worm is turning. The 2015 “Guidelines” have totally banned trans fats and eliminated the limit on total fat. In addition, it has dropped the limitation on dietary cholesterol. The DGAC states “cholesterol is no longer a nutrient of concern for overconsumption.”

And in the opinion of many who follow these developments, as the multitude of dangers from highly processed, oxidized and rancid polyunsaturated fats from vegetable oils such as corn and soy beans are exposed, we will eventually return to eating healthy, natural, saturated fats like butter, coconut oil, lard and tallow.

I was lucky. My doctor suggested Very Low Carb for me. But if your doctor doesn’t suggest you try eating Low Carb, I hope he/she will at least support your decision to try it. Let him/her see you at frequent intervals, if they want to, to check on your progress. I benefitted from my doctor’s monitoring of key blood markers monthly for the first year, and he learned a lot too. Why don’t you suggest yours do the same? I warrant it will work….

Type 2 Diabetes, a Dietary Disease #316: With so much carb restriction, what can I eat?

If you’re newly diagnosed and you’ve investigated your choice of “treatment plans,” and you are willing to consider treating your condition as a “dietary disease,” you next need to know how to choose what to eat! Most folks faced with this challenge ask, “With so much carb restriction, what can I eat?!!”

Most of us have lived our lives eating a surprisingly limited variety of foods. Culture, convenience and habit play a big role, so the answer will be different for everyone. Generally, in recent times that limited variety has consisted largely of carbohydrates. That’s how we got into this mess!! So the foods we have eaten for most of our lives are necessarily going to have to change. And that change will be a process of elimination, which will, for most people, further reduce the variety of foods going forward.

Naturally, most people have come to think of carb restriction as deprivation. And, in the sense that you will need to forego many of the things that got you into trouble, that’s fair. But another way to think of it is to ask yourself if what you ate gave you intestinal distress (cramping and diarrhea), as it does to gluten or lactose intolerant people, wouldn’t you readily and speedily give it up? By this way of thinking, foregoing excessive carbohydrates in the diet is a more moderate (if similarly life-long) change; you are restricting eating excess carbs to avoid future blindness, lower extremity amputations, and end-stage kidney disease! Plus, you are avoiding a much higher risk of heart disease, stroke, sexual dysfunction and certain cancers! This motivates a lot of people.

Under these circumstances, I think you’ll agree that learning what you can safely eat takes on a much more positive aspect. And you have a lot of good choices. Let’s start with the basics: There are three “macronutrients”: protein, fat and carbohydrates. Most animal protein is “complete protein” (contains the essential amino acids), and also contains some fat (mostly saturated). That’s okay. Even dietary cholesterol is okay. In 2014 the Dietary Guidelines Advisory Committee said “cholesterol is no longer a nutrient of concern for overconsumption.”

So, every meal should contain some animal protein and fat. After that, a small amount of carbohydrate is okay, but entirely optional. We need to eat protein and fat, but there is no minimum dietary requirement for carbs. But, if we’re going to consume carbs, let them be 1) unprocessed, whole foods, 2) non-starchy vegetables such as greens, and 3) low in “sugar.” I avoid peas, beets, carrots and corn (except for locally grown ears in summer: LOL).

Good advice I gleaned from Dr. Richard K. Bernstein’s book, “The Diabetes Diet” (Little, Brown, 2005), was to eat the same food every day for one or even two meals each day. For him, an 81yo Type 1 Diabetic, this eliminates the food variable from his insulin regimen, but I find that I am perfectly content to just eat eggs (any style), and coffee with cream, for breakfast. No juice. No bread. This meal is very filling and carries me way past lunch. Five hours after breakfast I usually eat a can of sardines in EVOO. Just one small can. And a small bottle of water.

Five hours later I eat another small meal for supper: a small serving of animal protein with fat, and a moderately sized serving of low carb vegetables prepared with fat. Examples are: asparagus spears or cauliflower florets tossed in olive oil and roasted; steamed broccoli finished with garlic butter; young green beans tossed in melted grass-fed butter; a salad of romaine, endive, mushrooms, and chopped hazelnuts or slivered almonds, tossed in a homemade (not store bought) vinaigrette dressing, with grated Romano or Parmesan.

The meat course is always small and always enough: one roasted chicken thigh (skin on); two small lamb chops (a rack of 8 is enough for two people for two meals!); one 8 ounce filet mignon, cut in half to serve two; ¾ pound of cod (for 2), poached stovetop with celery and fennel; stove-top shrimp with mushrooms and broccoli; veal stew baked with bacon, mushrooms, onions and sour cream. The choices are endless, if you think about it.

If these seem like small meals, they are. But because they have lots of satiating protein and fat, they are filling. Animal protein is expensive, you say. True, but you eat so much less of it when you limit carbohydrates. All the food on this menu plan is unprocessed and nutrient dense. They satisfy the body’s nutritional needs, so you will eat less. These small meals, with very limited carbs, will allow you to go without snacking between meals and without feeling hungry. It will also quickly lead to weight loss, if that is a parallel goal to blood sugar control.

It’s really pretty amazing. Use your meter and the measuring tape (waist - hip ratio) or scale to check your progress. You will soon be convinced that Type 2 Diabetes is a Dietary Disease, and you have all the tools you need to control it and put it in remission.

Type 2 Diabetes, a Dietary Disease #315: “Carbohydrates and Sugars” Redux

In “The Nutrition Debate,” the precursor blog to this series, column #31 (out of 305), “Carbohydrates and Sugars,” had many thousands of hits. And since my new emphasis is on the recently diagnosed Pre-Diabetic and Type 2 Diabetic, demystifying carbohydrates and sugars is a good place to start. So, let’s get down to basics.

The premise for educating the reader about carbohydrates, including sugars, is that you have independently researched the medical condition, T2DM, and its precursors, Pre-Diabetes and Metabolic Syndrome, and the “history” of how these conditions develop, and have concluded, that all of these conditions are dietary diseases. It is still something of a mystery that not everyone who eats the Standard American Diet (SAD) develops them, but it is widely accepted that 1) a genetic predisposition is required and 2) that the SAD triggers a metabolic “expression” in those who eat it and are so predisposed. Today, this affects about a third of the U.S. population.

One “expression” of this metabolic dysfunction is the associated development of obesity. In fact, they are so closely related that the word “diabesity” has been coined to link them. Most medical sites actually cite obesity as a “cause” of diabetes. That is simply wrong. In fact, the exact opposite is true. The principal cause of obesity is Insulin Resistance (IR), a medical condition that develops and underlies Type 2 Diabetes and its precursor conditions. The actual mechanism is described in #308 here and again in #313 here.

So, what is the SAD? According to Wikipedia, “The typical American diet is about 50% carbohydrate, 15% protein, and 35% fat. Are you surprised? You shouldn’t be. For over 35 years our government has been urging us to eat a diet that is 60% carbohydrate, 30% fat and 10% protein! And it still does! Check out the Nutrition Facts panel on processed food packages and do the math yourself. Your government has been leading you down this primrose path. And these guidelines, including the 2015 Dietary Guidelines for Americans released last month, still lead us on this misguided path. You, I presume, have concluded that it is no longer in your best interests to follow them.

So, if you’re going to eat fewer carbohydrates, it’s necessary to know something about the nutrient composition of food. All foods are composed of protein, fat and carbohydrates. Period. (Alcohol is not a “nutrient.” LOL)

1) All carbohydrates are saccharides; that’s Latin for “sugars.” For nutritional purposes, they are divided into two broad classes: simple sugars and so-called “complex” carbohydrates. In the blood, they are all called glucose.

2) Simple sugars are further divided into compounds of one or two molecules (monosaccharides and disaccharides). Examples include sucrose (table or cane sugar, a disaccharide composed of one molecule each of glucose and fructose). It is the same disaccharide sucrose found in fruit, together with the monosaccharides free glucose and free fructose. Sugar in fruit has the exact same effect on your blood sugar as table (cane) sugar.

3) Disaccharides break down quickly and easily into glucose and another monosaccharide. The glucose circulates in the bloodstream until it is absorbed by receptor cells. Excess glucose is returned to the liver for storage. When the liver stores are full, these sugars are converted by lipogenesis to fat. Repeated slugs of liquid sugar hitting a full liver can ultimately lead to “fatty liver disease.” All fruit juices and soft drinks are such “slugs.”

4) Complex carbohydrates are comprised of longer chains of just glucose molecules. They are divided into two classes: oligosaccharides comprised of 3 to 10 glucose molecules linked together, and polysaccharides, comprised of more than 10 molecules of just glucose. Examples are all starches (breads, cereals, potatoes, rice and pasta).

5) The so-called complex carbohydrates are commonly (and erroneously) thought to be better dietary choices than simple sugars. In my view, that’s like saying arsenic is better for you than cyanide because it works more slowly. Remember, bread is how the glycemic index is defined. It has an “index” of 100. After highly processed and “refined” (more aptly “stripped”) white flour, and water, the third ingredient in every loaf of bread is some form of added sugar. And sprouted (malted) grains only mean that the process of breaking down those grains to glucose and other “sugars” began at the bakery. By processing, the “complex” food becomes “simple” sugars.

6) While some chains of glucose in whole, unprocessed foods take a little longer than processed ones to be digested by enzymes, remember a) they are all glucose molecules and b) all glucose in your blood will raise your blood sugar. And if you have Insulin Resistance, your blood sugar will remain elevated and be harmful to your health. Just remember: If you are IR, you are Carbohydrate Intolerant. Type 2 Diabetes is a Dietary Disease.

Type 2 Diabetes, a Dietary Disease #314: Carolina Panther Eats Horse

A few days ago, on a Facebook post, there’s an image of a panther, and the caption says, “I’m hungry enough to eat a horse.” I replied, “Yeah, and he won’t be hungry or eat again for a week, ‘cause in a fasting state, he will be in ketosis, burning the fat he put aside. That’s the ‘normal state’ for all mammals.” To which the poster said, “Dan…this is a Carolina Panther ready to eat the Denver Broncos!!!” “Oops,” I replied. “How embarrassing (LOL).”

This exchange says two things: 1) I’m living under a rock and 2) hunger for people who are “carb addicted” is a condition far too familiar in our society today. As to the first observation, I plead “guilty.” People who read this column know that I am obsessed with the many benefits of low-carb eating. And the absence of hunger is the first and most surprising one. The corollary benefit is that it makes losing weight “a piece of cake.”

When you eat protein and fat for energy (and some incidental carbs), you just have to listen to your body. The fat and protein will make you feel full and won’t raise you blood sugar the way carbs will. Your glucose metabolism will be steadier – smaller peaks and smaller valleys. It’s the dips in blood sugar that make you feel hungry and tell your body to eat. It’s a rollercoaster that never ends.

Why, you ask, do carbs do that, while protein and fat do not? It’s because your body thinks you can eat more carbs. It must be harvest season. The fruits are ripe. The vegetables are ready to be picked. Even the animals are fat (from eating the carbs they graze on). So, your body is signaling you to “eat hay while the sun shines,” ‘cause soon it will be dark and cold and you need to fatten up to get ready for the long winter (or crop failure).

Your body does this miraculous thing with hormone signaling. Insulin was thought for decades to be just 1) a transporter of glucose in the bloodstream and 2) a gateway, via receptors, for the uptake of glucose at the cellular level. In a person with normal glucose metabolism, it does these things well. In a person with a degree of Insulin Resistance, insulin struggles with the receptor part, so the pancreas makes more and more insulin. Therein lies a BIG problem. Until the glucose is “taken up,” the blood insulin level remains elevated.

Recently, another important role for insulin was discovered. High amounts of insulin in the bloodstream signal that energy from carbs is still present there, and so the body does not need to switch energy sources. It can hold on to the energy-dense fat reserves set aside for that long winter or crop failure. Problem is, in today’s world, winter never comes. There’s an endless supply of fattening carbs to keep our blood insulin level elevated enough to shut off access to the body’s fat energy supply stored in body fat - thighs, abdomen, etc.

The result? You guessed it: You’re so hungry you could eat a horse. In fact, you’re starving! That’s not just a figurative term. You are literally starving, because your body doesn’t have access to your body’s fat reserves when your blood insulin level remains elevated. When you eat carbs at each dip in your blood sugar, your blood sugar goes up and then down again, every couple of hours. So you snack between meals, on more carbs. You know the drill. Eventually the pancreas can’t keep up, your blood sugar does not come back down and this condition is called Diabetes. Now you know why you have taken this rollercoaster ride…and what to do about it.

Your blood insulin level, however, will drop after a long fast and/or after the glycogen reserves (in muscle and liver) are mostly used up. It will stay lower so long as you eat small meals of mostly protein and fat. As your glycogen stores are used up, you will excrete (pee) a lot of water. That’s not fat, but it is encouraging to see it on the scale. Then, as you body slowly adapts to not expecting carbs (“it must be winter”), you will start to break down body fat and use it to fuel your body. Remember to drink water, and eat salt, and mostly protein and fat. You won’t be hungry and you will burn stored fat and lose weight.

Type 2 Diabetes, a Dietary Disease #313: What Does Insulin Resistance Have to Do With It?

This blog and this column in particular are intended for the recently diagnosed Pre-Diabetic, Type 2 Diabetic, or family member or friend of someone who thinks they or another they care about may be one of the one-in-three Americans who have developed a degree of Insulin Resistance (IR). Insulin Resistance is a relative term. It is a continuum and worsens progressively if no dietary changes are made. 

Most clinicians who treat diabetes and obesity do not measure IR or even serum insulin; instead they measure your blood glucose, either fasting (FBG) or with the HbA1c test that counts the percentage of glucose cells on the surface of your red blood cells. The A1c test is preferred today because it gives a better indication of your overall glucose metabolism. It incorporates the “excursions” (height and duration) that your serum glucose has taken, thus measuring fasting and after meal (postprandial) values, 24/7, over the 3-month life of red blood cells.

For all intents and purposes, however, Insulin Resistance = Carbohydrate Intolerance. The degree that you have IR is directly correlated with the degree to which you have become Carbohydrate Intolerant. To mitigate and potentially reverse IR, and thus to increase your “insulin sensitivity” (the inverse of IR), there are several things you can do: 1) eat a low carbohydrate, or ideally, a very low carbohydrate diet, 2) exercise, and 3) take certain oral anti-diabetic medications. For Pre-diabetics and Type 2 Diabetics, the most commonly prescribed oral medication, Metformin, appears to work in this way, as a secondary outcome. The primary outcome is to suppress unwanted hepatic (liver) glucose production from excess amino acids.

As explained in #308 here, Insulin Resistance is also the cause of weight gain, not gluttony or any other “character fault.” In brief, your body craves carbs (which convert to glucose) because your insulin resistance leads to elevated circulating (serum) insulin. Your pancreas produced the extra insulin because it sensed you needed it to help your cells take up the circulating glucose accompanying the transporter/gateway hormone insulin. And, so long as your circulating insulin is elevated, your metabolism signals that the body does not need to break down stored fat for fuel. As a result, you have an energy deficit. Put simply, you are hungry, so you scarf down more carbs (“energy in”) for quick energy and to restore your “energy balance.”

This, unfortunately, can go on for days, months, years, and even decades. So long as you have an elevated serum insulin, your body will be unable to utilize its own body fat for energy, and you will be hungry and crave carbs. So you eat, and overeat, but only because your body is unable to use its own fat for energy.  The only way to interrupt this syndrome is to lower the level of insulin circulating in your blood. And that will only happen after a few days in of low carb intake so that your stored glucose (called glycogen) in the liver and muscles is used up.

Then, when your serum insulin level is sufficiently lowered, other hormones will signal the brain, and your body will automatically switch to breaking down and burning stored fat for energy balance. Your stored fat is now part of the “Energy In” in the formula “Energy In = Energy Out.” And when you are burning your own fat, you will not be hungry. You will not crave carbs. And because you are using stored fat as part of “Energy In,” you will lose weight – so long as you don’t eat more food than you need to be satisfied. If you are aware of your “hunger” and you’re flexible, you will discover that three or even two really small meals a day, of healthy animal protein and fat (“no” carbs), will provide all the energy you need or want. No snacks are needed!

In addition to weight loss, your glucose metabolism, as measured 4 times a year with an A1c test, will improve. As you lose weight, your blood pressure should improve too. And with a low carb or very low carb Way of Eating, your HDL cholesterol should increase (mine doubled) and your triglycerides should plummet (mine by 2/3rds). Your systemic inflammation markers should also improve, and you will need to take fewer meds.

You will in fact feel totally energized. You body likes to eat high quality, nutrient dense, real food, and it likes to consume its body fat reserves, the stores it put aside for that very purpose. The body is a self-healing organism. It wants to be healthy. It is the natural state of the mammalian species to be lean and strong. Why not give it a chance to be all that it can be? All you need to do to be healthier is to cut back on the carbohydrates in your diet.

That’s why we say that Type 2 Diabetes is a Dietary Disease.

Type 2 Diabetes, a Dietary Disease #312: Isn’t your Very Low Carb WOE…well, extreme?

A person who is neither Pre-Diabetic nor a clinically diagnosed Type 2 invariably asks me, “Isn’t your Very Low Carb (VLC) eating program…extreme?” In a word my answer is, “yes.” I am highly Insulin Resistant (IR); therefore, I am Carbohydrate Intolerant. Carbs are “poison” for me. However, IR is a relative term; it is on a scale measured in percentage; its inverse (1/IR) is Insulin Sensitivity, a measure of how well your cells take up glucose carried in your blood by insulin. And the degree to which you are Insulin Resistant will determine how many carbohydrates you can safely eat. The determining factor for you will be your degree of IR/Carbohydrate Intolerance.

How does the “treatment-naïve” (untreated) patient with a slightly elevated fasting glucose or hemoglobin A1c determine the degree of IR/Carbohydrate Intolerance they have developed? Well, there are laboratory tests, like the IGTT or Impaired Glucose Tolerance Test. Upon my diagnosis 30 years ago, my GP sent me to an Endo who ordered this 2 hour test in a hospital outpatient setting. It confirmed the GP’s preliminary diagnosis: I had T2DM. At the time (1986), the prevailing clinical standard for an office diagnosis of frank Type 2 Diabetes was 2 consecutive visits with a Fasting Blood Glucose (FBG) ≥ 140mg/dl. In 1996 the standard changed to ≥ 126mg/dl.

There’s also the HOMA2 that I once asked an endocrinologist to do for me. He said he had read about in being used in research but had never ordered it. He did though, for me. It included a fasting serum insulin and gave a 2-part result: Insulin Sensitivity (the inverse of IR) and Beta Cell Function. Beta cells make insulin in the pancreas. I had been eating VLC for years, so my result was remarkably good: Beta cell function = 68.2% and Insulin Sensitivity (IS) = 94.6% (IR = 1.057). This supports the hypothesis that eating VLC (and exercise) increase IS, and that the unstressed pancreas of Type 2s can still possibly create new beta cells. I can only imagine how poor my beta cell function would be today, and how high my IR would be, if I were still eating what “the doctor ordered.”

Today, while the Fasting Blood Glucose test is still in common use, the new diagnostic standard is the A1c test. It measures the percentage of glucose on the surface of your red blood cells. Since red blood cells have an average life of about 3 months, this test is a better measure of the rise and fall of your blood sugar 24/7 for a longer time. It also captures the after-meal spikes which are a better measure of Insulin Resistance/Carbohydrate Intolerance than a simple fasting measurement. Both the A1c and fasting glucose lab tests are “convenient” (inexpensive).

But be careful. This is the point I described in Type 2 Diabetes, a Dietary Disease #306. You are at a juncture. If you leave the matter of “what's next?” entirely up to your “treatment team,” including clinician and RD or CDE, after you fail to lose weight following advice to “eat a balanced diet and exercise,” your clinician will treat your symptom (high blood glucose) by prescribing a pill (or pills) to lower your blood sugar. As such, so long as you continue to eat a balanced diet, the cause of your elevated blood sugars will not be addressed, and your disease will progress! The cause is the Insulin Resistance that has resulted in your becoming Carbohydrate Intolerant and Pre-Diabetic or a Type 2.

This errant course of treatment is in part based on the erroneous belief that being overweight or obese caused your Type 2 Diabetes. That’s one reason your doctor wants you to lose weight. But, in fact, the opposite is true. Read Type 2 Diabetes, a Dietary Disease #308 for an explanation of “What Causes Type 2 Diabetes.” Insulin Resistance is the the actual precipitating cause of Type 2 Diabetes, and it causes obesity. Insulin Resistance, for us who are genetically predisposed, is “expressed” through a diet that is composed of excessive carbohydrates.

So, the only course of “treatment” that treats the cause of Pre-Diabetes or Type 2 Diabetes is one that reduces the carbohydrates in your diet. The government sanctioned dietary pattern (reference the HHS/FDA Nutrition Facts Panel: Footnote 5) is 60% (300g) carbs, 10% (50g) protein and 30% (65g) fat (% by calories, not grams). On a 2,000 kcal/day diet, a Low Carb dietary pattern could be 20% carb, 20% protein, 60% fat; that would be 100 grams of carbohydrate a day. This is not so “extreme,” yet it is only 1/3rd what is recommended, and a 2/3rds reduction. Or even say 10% carb (50g/day), 20% protein and 70% fat. Either plan would be a huge improvement and would almost certainly reverse a Pre-Diabetes condition, putting the condition in “remission,” so long as you continued to eat no more than 100g (or 50g) of carbs a day. Remember, IR is on a scale, and everyone’s varies.

Of course, if you’re “healthy” (i.e. not Pre-Diabetic or a Type 2, and not yet genetically “expressed” but a little thick around the middle), you could probably stay healthy, and lose the extra weight, if you ate 40% carbs, 20% protein and 40% fat. That’s 200 carb g/d and still a 1/3rd reduction from the 300g (60% carb) government plan.

Type 2 Diabetes, A Dietary Disease #311: How Can I Manage My Type 2 Diabetes?

Type 2 Diabetes is a Dietary Disease. Your blood sugar (glucose) rises and falls depending on what you eat. It’s that simple. When you eat carbohydrates, there is a direct and simple relationship to your blood sugar level. It goes up. And when you eat more protein than your body needs, there is, to a lesser extent, a secondary and delayed rise in blood sugar. Fat, the third macronutrient, has virtually no effect on blood sugar.

Carbohydrates – including simple sugars and more “complex” carbs, especially those in packaged foods that have been refined to the point where they are close to simple sugars – will have the most impact on your blood sugar. In contrast, unprocessed, whole vegetables, although also carbohydrates, will digest more slowly. However, all carbohydrates – simple, processed or “whole” (unprocessed) – will become glucose “under the curve” (in your blood) within an hour or two of eating. That’s better than a few minutes, but it’s still an elevated blood sugar.

So, for starters, you need to educate yourself about what carbohydrates are and what foods contain them. Do your homework! And you will need to study the Nutrition Facts panel on processed foods, paying attention to the carbohydrate grams. And don’t forget to check the portion size. It is usually much smaller than you will eat.

You will also need to learn what effect carbs have on your blood sugar. Everyone is different, depending on your degree of Insulin Resistance (IR). (To understand the relationship between IR and blood sugar, see “Type 2 Diabetes, a Dietary Disease #308.” As a frame of reference though, if you fasting blood glucose is not between 70 and 100mg/dl, you have a degree of Insulin Resistance. If it is between 100 and 126mg/dl, you are Pre-Diabetic. If your fasting blood glucose is ≥ 126mg/dl, you are, frankly, a Type 2 Diabetic. How do you know what yours is?

You’re thinking that your doctor will test your fasting blood sugar (or A1c) if he or she suspects you have IR or are Pre-diabetic or Diabetic . True, but he/she can only monitor your Type 2 Diabetes. Remember, Type 2 Diabetes is a Dietary Disease, and only you can manage your diabetes. And to do that you need to buy a meter and test.

First you need to test your blood after an overnight fast. And until you know how your blood sugar responds, you should test both before and after “test” meals. To find out how high your blood sugar spikes, test before and then 1 hour after starting to eat. To find out how close to “normal” it returns, test 2 hours after that meal. If your blood sugar doesn’t drop 2 hours postprandial (after eating) to near where you began, you are Pre-Diabetic. If it isn’t below 140mg/dl, you have Type 2 Diabetes and you have eaten too many carbs in that meal. Blood sugar in a “healthy” (non-insulin resistant) person never goes above 140mg/dl even 1 hour after a big carb load.

You will learn quickly what you should eat and what you shouldn’t. Carbs are hidden everywhere, especially in plain sight. Fruit, unfortunately, is just a simple carbohydrate: sugar (sucrose = glucose + fructose) and water. At least the whole fruit contains a little fiber and pectin, but it is otherwise not much different from a candy bar. Fruit juice is worse. Because it’s liquefied, and thus partially predigested, it is several candy bars at once! It will send your blood glucose through the roof. As will all fruit drinks and all other sugar laden soft drinks.

Bread has a glycemic index of 100, meaning it is the very definition of a high glucose food. The ingredients list of virtually all breads begin with flour (highly processed and 100% carbohydrate), then water, and then always sugar in some form. Even the “sprouted” grains in Ezekiel bread are just sugar. Sprouting or malting is just a method of breaking down the complex grains to simpler sugars. Wiki “malt” or “malting” if you don’t believe me.

Protein digests more slowly than carbohydrates, and has many bodily functions before the excess breakdown products of protein, amino acids, are shunted to the liver for storage. There they cannot be reconstituted as protein; however, the liver can make glucose from them. This secondary process, called gluconeogenesis, is a good thing. The body needs multiple ways to make glucose. Glucose is essential (in small amounts), whereas carbohydrates are not. But the liver of Type 2s makes glucose even when the body doesn’t need it. That’s why clinicians prescribe Metformin to Pre-Diabetics and to Type 2s: to suppress this unwanted glucose production.

So, to take charge of your Pre-Diabetes or Type 2 Diabetes, you need to monitor your blood sugar. And to do that, you have to manage what you eat and eat to the meter.  Test your blood sugar before meals and 1 hour after you eat to see your peak (and 2 hours to see how far it falls). It’ll take time to learn what affects your blood sugar level and by how much. How strictly you follow a Low Carbohydrate Way of Eating (WOE) will determine how your blood sugar responds. But you are in charge. Remember: Type 2 Diabetes is, simply, a Dietary Disease.