I n Chapter 1 we discussed how diabetics and nondiabetics might reactto a particular meal.
Here we'll talk about how specific kinds of foods can affect your blood sugar.
A curious fact about diet, nutrition, and medication is that while we can make accurate generalizations about how most of us will react to a particular diet or medical regimen, we cannot predict exactly how each individual will reactto a given food or medication.
The foods we consume, once you take away the water and undi- gestible contents, canbe groupedinto threemajor categories that pro vide calories or energy: protein, carbohydrate, and fat. (Alcohol also provides calories, and will be discussed later in this chapter.) Seldom will food from one of these groups containsolelyone type of nutrient.
Protein foods often contain fat; carbohydrate foods frequently contain some protein and some fat.
The common foods that are virtually 100 percent fat areoils, butter, some types of margarine, and lard.
Since our principal concern here is blood sugarcontrol, we'll con centrate on how these three major sources of calories affect blood sugar.
If you're a long-standing diabetic and have followed standard ADA teachings for years, you'll find that much of what you'reabout to read is radically at odds with the ADA's dietary guidelines — and with good reason, asyou'll soon learn.
When we eat, the digestive process breaks down the three major food groupsinto their building blocks.
Thesebuildingblocks are then absorbed into the bloodstream and reassembled into the various products our bodies need in order to function.
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PROTEIN Proteins are constructed of building blocks called amino acids.
Through digestion, dietary proteins are broken down by enzymes in the digestive tract into their amino acid components.
These amino acids can then be reassembled not only into muscle, nerves, and vital organs, but also into hormones, enzymes, and neurochemicals.
They can also be converted to glucose, but very slowly and inefficiently.
Weacquiredietaryprotein from a number of sources, but the foods that are richest in it — egg whites, cheese, and meats (including fish and fowl) — contain virtually no carbohydrate.
Protein is available in smaller amounts from vegetable sources such as legumes (beans), seeds, and nuts, which also contain fat and carbohydrate.* Protein and carbohydrate are our two dietary sources of blood sugar.
Protein foods from animal sources are only about 20 percent protein by weight (about 6 grams per ounce), the rest being fat, water, and/or undigestible "gristle." The liver(and to a lesserdegree,the kid neys and intestines), instructed by the hormone glucagon,* can very slowly transform as much as 36 percent of these 6 grams per ounce into glucose* — if blood sugardescends too low, if serum insulin lev els are inadequate, or if the body's other amino acid needs have been met.
Neither carbohydrate nor fat can be transformed into protein.
In many respects— and going against the grain of a number of the medicalestablishment's accepted notions about diabeticsand pro tein — protein will become the most important part of your diet if you are going to control blood sugars, just as it was for our hunter- gatherer ancestors.
If you are a long-standing diabeticand are frustrated with the care you've received over the years, you have probably been conditioned to
Phosphate, a by-product of protein digestion, requires calcium in order to be eliminated fromthebody—about 1gramof calcium for every 10ouncesof pro tein foods.If you don't eat much cheese, cream,milk (too high in carbohydrate), yogurt, or bones, all good sources of calcium, it would be wise to take a calcium supplement.
This will prevent slow loss of calcium from your bones.
I recom mend calcium in formulations supplemented with magnesium and vitamin D. +And other so-called counterregulatory hormones, suchas Cortisol and growth hormone. $ This amounts to about 7.5percentof the totalweight of a protein food.Sayyou eat a 3-ounce (85 grams) hamburger, no bun, for lunch — the protein in it can slowlybe transformed by the liverinto no more than 6 grams of glucose.
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think that protein is more of a poison than sugar and is the cause of kidneydisease.
I wasconditionedthe sameway— many years ago, as I mentioned, I had laboratory evidence of advanced proteinuria, sig nifying potentially fatal kidney disease — but in this case,the conven tional wisdom is just a myth.
Nondiabetics who eat a lot of proteindon't getdiabetic kidneydis ease.
Diabetics with normal blood sugars don't get diabetic kidney disease.
High levels of dietaryprotein do not cause kidney disease in diabetics or anyone else.
There is no higher incidence of kidney dis ease in the cattle-growing states of the United States, where many people eat beefat virtually every meal, than thereis in the stateswhere beef is more expensive and consumed to a much lesser degree.
Simi larly, the incidence of kidney disease in vegetarians is the same as the incidence of kidneydisease in nonvegetarians.
Itisthe high blood sugar levels thatare unique to diabetes, and to a much lesser degree the high levels ofinsulin required to cover high carbohydrate consumption (caus inghypertension), that cause the complications associated with diabetes.
FAT
The Big Fat Lie Callit the BigFat Lie.
Fat has,through no realfault of its own, become the great demon of the American dietary scene.
It is no myth that more than half of Americans are overweight, and the number of obese Americans is growing.
Current dietary recommendations from the government, and nearly every "reputable" organization with an opinion, are to eat no more than 35 percentof calories as fat— which veryfew peoplecan maintain — and there aresomerecommendations for evenlowerper centages than that.
The low-fat mania in our culture has spawned an increase in sugar intake.
All a candy or cookie has needed is the label "fat free" to send its sales through the roof.
The fallacy that eatingfat will make you fat is about as scientifically logical as saying that eating tomatoes will turn you red.
This is the kind of fallacious thinking behind the prevailing "wis dom," which maintains that there is an unavoidable link between di etary fat and high serum cholesterol.
And that if you want to lose weight and reduce cholesterol, all you need to do is eat lots of carbo hydrate, limit consumption of meat,and cut out fat as much as possi-
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ble.
But many contemporary researchers exploring this phenomenon havebegun to arrive at the conclusion that a high-carbohydrate diet, especially rich in fruit and grain products,is not so benign.
In fact, it has been shown — and it is my own observationin myself and in my patients— that such a diet can increase body weight, increase blood insulin levels, and raise most cardiac risk factors.
In an unbiased, clearheaded, and award-winning article in the re spected journal Science of March 30, 2001, the science writer Gary Taubes explores what he calls "The Soft Science of Dietary Fat." (A link to the full text of this article is available at www.diabetes-book.com.) Taubes cites the failure of the antifat crusadeto improve the health of Americans:
Since the early 1970s, for instance, Americans'average fat in take has dropped from over40% oftotal calories to 34%;average serum cholesterollevelshave dropped aswell Meanwhile, obesity in America, which remained constant from the early 1960s through 1980, has surged upward since then — from 14% of the population to over 22%.
Diabetes has increased apace.
Both obesity and diabetes increase heart disease risk, which could explain why heart disease incidence is not de creasing.
That this obesity epidemic occurred just asthe govern ment began bombarding Americans with the low-fat message suggests the possibility... that low-fat diets might have unin tended consequences — among them, weight gain. "Most of us would have predictedthat if we can get the population to change its fat intake, with its dense calories,* we would see a reduction in weight," admits [Bill] Harlan [of the NIH]. "Instead, we see the exact opposite." I urge you to have a look at the article, which will give you a notion of the kinds of competing personal, economic, and politicalinterests that go into the formulation of"scientific" guidelines.
The U.S.
Centers for Disease Control and Prevention (CDC) re leased data in the year 2004 indicatingthat 66.4 percentofU.S. adults were overweight and 32.2 percent were obese.
Furthermore, the inci dence of overweight in children and adolescents aged 2-19 years in-
*Contrary to traditional thinking,a studyrecently publishedin the Journal ofthe American College of Nutrition demonstrated that the metabolizable calories in fats are about the same as in carbohydrates.
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19JS 1902 1969 1976 1983 1990
Year
Fig 9-1. From 1955to 1990, even as the percentage of calories consumed asfat declined, thepercentage ofoverweight Americans increased by nearly half.
creased from 11 percent to 19 percent in the period 1988-94 through 2003-04.
These statisticsareoccurring even though people are eating less fat.
The advent of our agricultural society is comparatively recent in evolutionary terms — that is, it began only about 10,000 years ago.
For the millions of years that preceded the constant availability of grain and the more recent year-round availability of avarietyof fruits and vegetables, our ancestors werehunters and ate what was available to them in the immediate environment, primarily meat, fish, some fowl, reptiles, and insects — food that was present year-round, and predominantly protein and fat In warm weather, some may have eaten fruits, nuts, and berries that were available locally in some re gions and not deliberately bred for sweetness (agriculture didn't ex ist).
If they stored fat in their bodies during warm periods, much of that fat was burned up during the winter.
Although for the past two centuries, fruit, grain, and vegetables have, in one form or another, been available to us in this country year-round, our collective food supply has historically been interrupted often by famine — in some cultures more than others.
The history of the planet as best as we can determine is one of feast (rarely) and famine, and suggests that famine will strike again and again as it has in the last few decades in a variety of places.
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