Diabetes and Nutrition: Maybe It Wasnít the Bun
This blood sugar business can be tricky and confusing. Do you silently cheer
when your blood sugar is low when you expected it to be high? Are you mystified
when the number jumps into the oh-no! range after youíve been so "good"? The
first thing you think to blame is the bun on the burger or the croutons in the
soup. Letís look closer. You may be peeling the wrong banana.
Where Should Your Blood Sugar Be
Normally the body tightly regulates blood sugar in the range of 60 to 115 mg of
glucose per deciliter (mg/dl) of blood (less than 1/25 of an ounce in less than
6 tablespoons of blood). If you have diabetes, your blood sugar regulation is
not as efficient, and you try to achieve the same normal numbers with a regimen
of food balancing, physical activity, and medication. It is established
knowledge that the closer your blood sugar is to that range, the better your
long-term health will be. The American Diabetes Association evaluated the
research on blood sugar levels and advises that you try to keep your blood sugar
under 126 mg/dl as much as you possibly can. Everyone with diabetes should
discuss their blood sugar goals for early morning, before and two hours after
meals, and at bedtime with their doctor or certified diabetes educator (CDE).
Which Foods Contribute to Your Blood Sugar Fluctuations?
The amount of carbohydrates in your diet, and the type of carbohydrates, are the
most significant dietary factors that cause blood sugar fluctuations. Remember,
carbohydrate includes starches and sugars. So, any food that is starchy (breads,
cereals, potatoes, rice, beans, and noodles, for example) or sweet (fruits,
juices, syrups, candy, soft drinks, and ice cream, for example) will contribute
to your blood sugar level after theyíre eaten.
Natural sugar foods
Some foods may not taste particularly sweet but contain significant amounts of
natural sugar. They include milk, carrots, tomatoes, ketchup, and some tart
fruit juices such as grapefruit and even lemon juice. These are very healthful
foods and should be included in your diet if you wish. The goal isnít to
eliminate them, just budget them. The popularity of smoothies and juiced
vegetable-fruit blends presents a challenge to managing dietary carbohydrates. I
like to say, "If you canít put them down, youíve got to tally them up." Those
carbohydrates do count. A 12 oz. smoothie with fruit pieces, milk, yogurt, or
protein powder may have as much as 50 grams of carbohydrate. Also, take a close
look at canned meal replacements like Slimfast. Even if itís all you eat at a
meal, build the carbohydrate into your budget. Depending on your activity level
and medication regimen, you might actually need more carbohydrate to prevent
hypoglycemia (low blood sugar).
Artificially sweetened foods
Artificially sweetened foods and beverages are sometimes blessings and sometimes
not. Donít be surprised if one day, after a trip to the movies, your blood sugar
shoots up. It could be that the "diet" soda you bought was the real thing. This
error happens more times than youíd think. Itís a delight to get a "no sugar
added" yogurt or ice cream. But read carefully: there is carbohydrate (usually
milk sugar, lactose) in that food. One major brand of no-sugar-added yogurt
recently replaced some of the aspartame with fructose. Although it wonít spike
your blood sugar, itís best to count that fructose into your total carbohydrate
(at least it still tastes yummy).
Look out also for some "light" foods that have removed some of the original
caloric sweetener (such as sucrose, corn syrup solids, or high fructose corn
syrup) and replaced it with a very low calorie sweetener (such as aspartame or
asulfame-potassium). There is usually still quite a bit of sugar in that food or
beverage. Logic tells us that even if a sweet and tasty food is advertised as:
"no sugar added", it must have something going on. If "sugar" is defined only as
"sucrose" (table sugar), then food producers can sweeten it with honey, apple
sauce, fruit juice concentrate, rice syrup or any of a host of other
carbohydrate-rich products that can still affect your blood sugar. Try to look
at the label or product information before dining on those.
Sugar alcohols (sugar-like molecules such as sorbitol) will have a negligible
effect on your blood sugar but they are quite high in calories. I suppose our
eyes see "sugar free" and we want that to mean no sugar, no carbohydrate, no
calories and scrumptious taste. Well, maybe one day it will, but not yet.
About half of the protein molecules in your food can be turned into glucose in
your liver. This means that a 12 oz. portion of chicken or fish at dinner
containing about 84 grams of protein (remember the exchange list? 1 oz. of meat
has 7 grams of protein) will turn into about 42 grams of glucose by morning. My
advice is to cut the protein serving in half (6 oz.) and enjoy 2-3 carbohydrate
exchanges. Your kidneys may thank you someday.
The glycemic index
Thanks to studies on the "glycemic index" (the power of a food to raise your
blood sugar) of foods, it is now known that some high carbohydrate foods, even
pure table sugar (sucrose), have surprisingly little effect on blood sugars.
Fortunately these are also filling and nutrient-rich foods. Enjoy an occasional
splurge on these: all beans and peas, most vegetables, and nuts. Just remember
that these are still carbohydrates, and need to be balanced with exercise or
Which Foods Donít Contribute to Your Blood Sugar?
Fat, such as oil, butter, margarine, or mayonnaise (or any fat exchange) will
not goose your blood sugar. Yet, many people suspect that the butter on a
buttered bagel raises their glucose when one slice of toast with jelly doesnít.
Logic leads you to the conclusion that the toast and bagel are bread so whatís
the difference?...you guessed it. The bagel weighs in at the equivalent of 4 to
5 slices of bread. This is significantly more carbohydrate than one slice of
bread, even with a bit of jelly. Similarly, people sometimes think that the fat
of fried plantain or potato must have been the culprit and raised their glucose,
because the boiled version behaved itself. Look again. Fried stuff tastes better
so we usually eat more of it! There is potato in both meals, but the larger
portion of fried potato results in more carbohydrate in that meal. The
underlying message to this is that portions count Ė larger portions mean more
carbohydrate and higher blood sugar.
Watch out for "hidden" sugar in foods. In cooking, sugar helps with browning.
Added sugar also enhances flavors, especially in fast foods. And when a muffin
or goodie shouts "fat free" on the label, itís usually loaded with sugar. These
are all examples of where sugar can hide in food. Watch out and steer clear.
The right fats
You donít need to aim for a very low-fat diet. You can keep your calories under
control and still enjoy dressings and spreads. Just remember to select fats that
are low in saturated fat, low in hydrogenated oils, and rich in mono-unsaturated
fat. Olive and canola oils are the champions, here. Select soft margarines in
the tub, not the stick. These choices will help you to keep your "bad" blood
cholesterol down and your "good" blood cholesterol up. Check the "Nutrition
Facts" labels for fat content.
Sugar-free soft drinks will not raise your blood sugar. However, some research
has shown that when carbohydrate cravings are not satisfied with a real
carbohydrate, artificial sweeteners may increase the desire for starchy or sweet
foods leading a person to overindulge on carbohydrate-rich foods. My advice is
to be sure to include some real carbohydrates that you can indulge in: popcorn,
flavored rice cakes, or cubed fresh fruit!
If youíve read this far and realize that your starches and sugars are a wee bit
too much, but you canít imagine eating less of them Ö then introduce yourself to
walking. (I would always rather walk it off than to give it up). Start with a
call to your doc or CDE for the "OK" and make your walk 5 to 7 days a week for
15 minutes the first week. Add 5 minutes every week until you meet yourself
coming and going.
Sweet Without Sweeteners
Our sweet taste buds can be fooled ... some of the time. Cinnamon and nutmeg
always seem to "sweeten" foods and beverages without adding carbohydrate. Some
work at the US Department of Agriculture even suggests that about Ĺ tsp of
cinnamon may help to lower blood sugars.
To get the best blood sugar control whether you have Type 1 or Type 2 diabetes,
start with a convenient blood glucose meter to measure your blood sugars, and a
daily carbohydrate goal from your doc or CDE. Once you have developed a routine
amount of carbohydrate at each meal, you will soon see how to take the mystery
out of controlling blood sugar.