Diabetic diet

The diet most often recommended for people who suffer from diabetes mellitus is high in dietary fiber, especially soluble fiber, but low in fat (especially saturated fat). Patients may be encouraged to reduce their intake of carbohydrates that have a high glycemic index (GI). However, in cases of hypoglycemia, they are advised to have food or drink that can raise blood glucose quickly, followed by a long-acting carbohydrate (such as rye bread) to prevent risk of further hypoglycemia.

Early history of diabetic diet

There has been long history of dietary treatment of diabetes mellitus - as Ramachandran & Viswanathan (1998) note, dietary treatment of diabetes mellitus was used in Egypt as long ago as 3,500 B.C., and was used in India by Susrate and Charaka some 2,500 years ago. In the eighteenth century, these authors note, John Rollo argued that calorie restriction in the diabetic diet could reduce glycosuria in diabetes. However, more modern history of the diabetic diet may begin with Frederick Madison Allen, who, in the days before insulin was discovered, recommended that people with diabetes ate only a low-calorie diet to prevent ketoacidosis from killing them. This was an approach which did not actually cure diabetes, it merely extended life by a limited period. The first use of insulin by Frederick Banting in 1922 changed all that, and at last allowed patients more flexibility in their eating.

Exchange scheme

In the 1950s, the American Diabetes Association, in conjunction with the U.S. Public Health Service, brought forth the "exchange scheme". This was a scheme that allowed people to swap foods of similar nutritional value (e.g. carbohydrate) for another, so, for example, if wishing to have more than normal carbohydrates for pudding, one could cut back on potatoes in one's first course. The exchange scheme was revised in 1976, 1986 and 1995 (Chalmers & Peterson, 1999, p85). However, not all diabetes dietitians today recommend the exchange scheme. Instead, they are likely to recommend a typical healthy diet: one high in fiber, with a variety of fruit and vegetables, and low in both sugar and fat, especially saturated fat. A diet that is high in plant fibre was recommended by James Anderson (Anderson & Ward, 1979; cited in Murray & Pizzorno, 1990). This may be understood as continuation of the work of Burkitt and Trowell on dietary fibre, which in turn, may be understood as a continuation of the work of Price (Murray & Pizzorno, 1990). Murray and Pizzorno discusses the high-carbohydrate, high-plant fibre diet (HCF diet) in connection with diabetes (Murray & Pizzorno, 1990, pp277ff.).

Carbohydrates

The American Diabetes Association in 1994 recommended that 60-70% of caloric intake should be in the form of carbohydrates. This is somewhat controversial, with some researchers claiming that 40% is better,^[1] while others claim benefits for a high-fiber, 75% carbohydrate diet.^[2]

An article summarizing the view of the American Diabetes Association^[3] contains the statement "Sucrose-containing foods can be substituted for other carbohydrates in the meal plan or, if added to the meal plan, covered with insulin or other glucose-lowering medications. Care should be taken to avoid excess energy intake." Sucrose does not increase glycemia more than the same number of calories taken as starch. Although it is not recommended to use fructose as a sweetener, fruit should not be avoided because of its fructose content. Benefits may be obtained by consumption of dietary fibre in conjunction with carbohydrate; as Francis (1987) points out, evidence suggests that carbohydrate consumed with dietary fibre will have a less major impact on glycemic rise than the same amount of carbohydrate consumed alone.

What has not generally been included in diabetic diet recommendations is the variation in effect from different carbohydrates. Glucose is the only carbohydrate which participates in the primary metabolic control mechanism using insulin. That mechanism is ubiquitous amongst animals, from invertebrate nematode worms through the vertebrates, including humans.

Despite it is a common belief that table sugar contributes to the development of diabetes, it has medium (55-69) GI that actually lowers blood glucose levels than the equal amount of calories obtained from starch and other carbohydrates. Leading international diabetes associations (e.g., Canadian Diabetes Association CDA) recommends that table sugar be actually part of the diabetes diet.

In humans, some carbohydrates are not digested or absorbed—a prime example here is cellulose, which can be digested by ruminant animals and by termites (both using gut flora), but not by humans. In humans, cellulose and related carbohydrates are roughage, or dietary fibre, and pass through the human digestive system unchanged. Humans lack the enzymatic machinery needed to digest dietary multi-saccharides; we can handle only one or two di-saccharides and no larger ones except starch or glycogen. All other multi-saccharides which contribute to human nutrition will have been pre-processed by gut flora, with accompanying gas and other effects; the classic example is lactose, which most adult humans cannot digest—having lost lactase production after childhood—and the gastro-intestinal effects (eg, cramping, bloating, diarrhea) which sometimes follow for the lactose-intolerant. Indeed, only a few of the mono-saccharides can be absorbed by humans; most cannot. And of those, at least one, fructose, is somewhat problematic. It is metabolized only in the liver, and in men, in sperm, since only those tissues contain the fructase needed. The liver is affected by high levels of dietary fructose by characteristic unfavorable alterations in blood lipid profiles, and possibly in a connection to insulin resistance and so to Type 2 diabetes mellitus.

Low-carbohydrate alternatives

Some studies show low-carbohydrate diet and low GI diet may be effective in dietary management of type 2 diabetes, as both approaches prevent blood sugars from spiking after eating.^[4][5]

Dr. Richard K. Bernstein has a diet plan that is substantially different from the plan recommended here and he is harshly critical of the standard ADA diet plan for diabetics. His plan includes very limited carbohydrate intake (30 grams per day) along with frequent blood glucose monitoring, and regular strenuous muscle-building exercise, and for diabetics using insulin, frequent small insulin injections if needed. His treatment target is "near normal blood sugars" all the time.^[6]

Another critic of the ADA program is Ray Kurzweil, who together with Dr Terry Grossman, co-author of "Fantastic Voyage - Live long enough to live forever", (pub 2004) describes the ADA guidelines as "completely ineffective".^{[citation needed]} Their observations are that the condition, particularly in its early stages can be controlled through a diet which has sharply reduced carbohydrate consumption.^{[citation needed]} Their guidelines for patients with type 2 diabetes is a diet that includes a reduction of carbohydrates to one sixth of total caloric intake and elimination of high glycemic load carbohydrates.^{[citation needed]} As a previously diagnosed diabetic who no longer has symptoms of the disease, Ray is a firm advocate of this approach.^{[citation needed]}

Vegan and Raw/Live Foods alternatives

Recent studies have shown that a vegan diet may also be effective in managing type 2 diabetes. Raw food protocols for treating Type 2 diabetes can be found in Dr. Gabriel Cousens, MD's book "There Is a Cure For Diabetes" and the documentary he appears in with six diabetics and other doctors, "Simply Raw: Reversing Diabetes in 30 Days". Also of note are the writings of Victorian Boutenko whose son's diabetes disappeared after converting to a raw foods diet.^[7][8]

Timing of meals

For people with diabetes, healthy eating is not simply a matter of "what one eats", but also when one eats. The question of how long before a meal one should inject insulin is asked in Sonsken, Fox and Judd (1998). The answer is that it depends upon the type of insulin one takes and whether it is long, medium or quick-acting insulin. If patients check their blood glucose at bedtime and find that it is low, it is advisable that they take some long-acting carbohydrate before retiring to bed to prevent night-time hypoglycemia.

Special diabetes products

Recently, Diabetes UK have warned against purchase of products that are specially made for people with diabetes, on the grounds that:^[9]

• They may be expensive,
• They may contain high levels of fat
• They may confer no special benefits to people who suffer from diabetes.

Research has shown the Maitake mushroom (Grifola frondosa) has a hypoglycemic effect, and may be beneficial for the management of diabetes.^{[10][11][12][13][14][15]} The reason Maitake lowers blood sugar is due to the fact the mushroom naturally acts as an alpha glucosidase inhibitor.[1] Other mushrooms like Reishi,^[16][17] Agaricus blazei,^{[18][19][20][21]} Agrocybe cylindracea[2], and Cordyceps^{[22][23][24][25][26]} have been noted to lower blood sugar levels to a certain extent, although the mechanism is currently unknown.

Alcohol and drugs

Moderation is advised with regards to consuming alcohol and the use of some drugs. Alcohol inhibits the glycogenesis in the liver and some drugs inhibit hunger symptoms. This, together with impaired judgement, memory and concentration caused by some drugs can lead to hypoglycemia.

See also

• Diabetes management
• Low GI Diet
• Food guide pyramid
• Glycemic index

Further reading

Francis, D. (1987) Diets for Sick Children (Oxford: Blackwell) has chapter on diet and diabetes (Chapter 5, pp128–144). More on dietary recommendations for diabetics can also be found in Ireland, J.T., Thomson, W.S.T. & WIlliamson, J. (1980). Diabetes Today: A Handbook for the Clinical Team. (Chapter 9, pp112–120, is the chapter on diet).

References

Notes

External links

• Low GI Cooking and Recipes