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Diet & Blood Sugar Regulation

As a follow-up on last week’s post about regulating blood sugar and diabetes, we are going to talk about how to build meals and snacks that will help to stabilize your blood sugar.

You might be thinking that this isn’t relevant to you because you are a healthy weight and do not have pre-diabetes or any family history of diabetes. This is still relevant for you though.

Why is blood sugar regulation important for everyone?

Diabetes is not a “fat person” disease, even though an increase in body weight is a risk factor for developing diabetes. Blood sugar dysregulation, or dysglycemia, is a general term describing when blood sugar levels are too low or too high. This can happen to people who have a healthy weight. To summarize the content from last week’s post, when an individual has type 2 diabetes, the cells in their body that usually take glucose from the blood in response to insulin no longer do so like they should (this is called insulin resistance). The cause for this isn’t completely known but it is likely multifactorial. The body is supposed to regulate the hormones involved in blood sugar (insulin and many others) in order to maintain a balanced blood sugar that isn’t too low or high. A number of factors are associated with high blood sugar and the body’s regulation of blood sugar that can lead to insulin resistance and then diabetes. Physical factors such as eating too many carbohydrate-rich foods that raise your blood sugar, chronic stress, illnesses, gut health, presence of endocrine-disrupting chemicals (refer to this blog post about EDC’s), and lack of physical activity can affect blood sugar. Other factors such as genetics and family history of diabetes and excess weight can also affect the development of diabetes.

We can do a lot with our diet and lifestyle to help our body out so it doesn’t have to work so hard to manage our blood sugar levels!

In last week’s blog, we talked about picking the right kind of carbs and incorporating a balance of fiber, protein, and fat along with your carbs. Let’s dive more into that!

Components of a blood sugar-balancing meal/ snack:

  • Complex carbs: 
        • Whole grains such as oatmeal, brown rice, quinoa, and whole-wheat breads and pastas provide extra fiber and nutrients such as B vitamins, iron, and other important minerals.
              • It should be noted that most plants (grains, fruits and vegetables, beans, etc.) have chemicals we classify as “anti-nutrients” that can bind up the nutrients in the grains so that we can’t absorb them.
              • Preparation method greatly affects the availability of these nutrients such as soaking, fermentation (sourdough bread), or boiling. 
        • Fruits and vegetables provide beneficial fiber, complex carbohydrates and starches, water, vitamins, minerals, antioxidants, and other beneficial compounds that help to manage blood sugar.
        • Legumes (peans, peas, and lentils) are another great complex carb choice if they don’t cause any digestive distress.
  • Nutrient-dense simple carbs:
        • Simple carbs don’t necessarily need to be completely avoided, but you can pair them with other slower digesting foods to balance your blood sugar.
        • Dairy:
              • High quality milk (organic and/ or non-homogenized if you can)
              • Yogurt with live cultures (these provide beneficial probiotics for your gut)
              • Ice cream with simple ingredients for a special treat (cream, milk, sugar, egg yolks, salt)
        • Some fruits and vegetables:
              • Fruits with more simple sugars and other nutrients: bananas (less ripe bananas have less sugar and more fiber), watermelon, mango, raisins, dates, etc.
              • Fruits with more starch: carrots, potatoes, corn, squash, etc.
              • Try to pair these items with a healthy protein or fat source.
  • Healthy fats:
        • Foods high in healthier fats:
              • Avocados, nuts and nut butters, olives, seeds (flax, chia, pumpkin, sesame). 
        • Oils:
              • The quality of the oil is almost as or more important than the oil itself. The unsaturated fatty acids present in oils are highly susceptible to damage from heat, oxygen, and other environmental factors that destroy the health benefits of the oil .
              • Good oil sources: cold-pressed oils such as avocado oil, coconut oil, and olive oil (they will have more enzymes and nutrients).
                  • Avoid cooking with olive oil though as it has a low smoke point. Use olive oil in dressings or drizzling it on freshly made foods such as bread or soup.
              • Try to limit/ avoid: fried foods (the high heats can destroy the oils), rancid oils, and poorly stored oils (store in a dark, cool room in a darker glass bottle with a tight lid).
  • Protein:
        • Meat is one of the most abundant sources of protein:
              • High intakes of red meat are associated with health risks; however, meat is one of the main sources of the B vitamins and it is the most highly absorbed form of iron. 
                  • Aim for 2-3 servings a week of lean red meats such as beef and pork
                  • Try to get organic and/ or grass-fed if you can
              • Poultry: lean cuts of chicken and turkey are great sources of protein and nutrients
              • Fish: fatty cuts of fish such as salmon, sardines, oysters, and trout are great sources of healthy omega 3’s and other nutrients
              • Organ meats such as liver are a nutrient powerhouse! Try mixing it with ground beef or turkey for extra nutrition.
        • Other nutrient-dense sources of protein: eggs (opt for “free range”), dairy (refer to the list above), and lean cheeses (feta, ricotta, mozzarella, etc.)

Tying all of this information together, you want to try to incorporate elements of all of these types of foods into your meals and snacks. This will help to balance your blood sugar. 

Other lifestyle changes to help manage blood sugar:
  • Find a way to manage the stress in your life whether that’s seeking help from a counselor, adding in stress-reducing practices, journaling, etc. 
  • Increase your overall physical activity by aiming to be physically active at least 3- 5 days a week doing something you enjoy
  • Go on a walk about a bigger meal
  • Try to eliminate endocrine-disrupting chemicals in your life such as BPA (switch to using glass storage containers and water bottles instead of plastic), phthalates, sulfates, and more (these chemicals are often present in beauty products, self-care products, and cleaning supplies)
Ultimately, you cannot always control the other factors in your life that may lead to diabetes, but there is strong evidence to show that implementing a healthy diet and exercising regularly can drastically help to decrease your risk of developing diabetes.

Please talk to your doctor if you suspect you have diabetes or if you gave diabetes and want to make some diet and lifestyle changes!

Sources:
https://med.stanford.edu/news/all-news/2018/07/diabetic-level-glucose-spikes-seen-in-healthy-people.html
https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hypoglycemia
https://www.sciencedirect.com/topics/medicine-and-dentistry/dysglycemia
https://www.cdc.gov/diabetes/basics/insulin-resistance.html
https://diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/hyperglycemia
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9561544/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7344713/
https://www.hsph.harvard.edu/nutritionsource/carbohydrates/carbohydrates-and-blood-sugar/
https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325021/
https://www.hsph.harvard.edu/nutritionsource/anti-nutrients/#:~:text=Phytates%20(phytic%20acid)%20in%20whole,interfere%20with%20normal%20nutrient%20absorption.
https://www.diabetes.co.uk/diet/glycaemic-index-diet-and-diabetes.html#:~:text=Higher%20GI%20fruits%20include%20bananas,%2C%20parsnips%2C%20beetroots%20and%20sweetcorn.
https://www.ifis.org/blog/food-lipid-oxidation-and-health#:~:text=Unsaturated%20fatty%20acids%20like%20omega,et%20al.%2C%201991).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4110403/

Blood Sugar Regulation and Diabetes

What causes diabetes? Why is blood sugar regulation so important?

To answer these questions, we are going to talk about sugar, or more specifically glucose, its role in the body, how the body controls the amount of glucose in the blood, and how dys-regulation causes insulin resistance and then ultimately, diabetes.

First, we will establish some base knowledge about what kinds of carbohydrates exist and what happens when we eat them. There are several kinds of carbohydrates categorized by their structure and how quickly they get digested and absorbed from the GI tract into the blood stream. Simple carbs are small molecules made of one or two sugars and are quickly broken down and absorbed. Complex carbs have three or more sugars linked together and are therefore more complex in structure and slower to digest. Fiber is a complex mesh of carbs that cannot be digested by the enzymes made in the human body and pass through without getting absorbed. They don’t change your blood sugar directly; however, they work to slow down the absorption of other sugars present at that time. Usually a carb-rich food such as pasta or a piece of pizza has several kinds of carbohydrates all getting digested at once. However, all carbs, once fully digested are broken down into three kinds of sugars: glucose, fructose, and galactose. These sugars are absorbed and enter your bloodstream and head right to the liver where the fructose and galactose gets converted into glucose. Once glucose enters the blood, insulin is released from the pancreas which allows glucose to enter into the cells to be used as energy. (Note: Keep in mind that glucose is not the only thing that controls the release of insulin, other substances can as well, but for this purpose, we are talking about glucose’s control of the release of insulin). Foods richer in complex carbs and fiber will help to slow the digestion and therefore the absorption of the sugars in to the blood which allows insulin to be released and offered to the cells steadily instead of all at once.

Glucose is the preferred source of energy for most of the cells in your body. It is necessary to function and live. Your body will make its own glucose if it doesn’t get supplied (during times of fasting or starvation) or it will adapt to use other nutrients for energy such as fats or proteins. Glucose in the cells in the right amounts is not the problem. The problem is when there is excess glucose in the blood or inside the cells. Persisting “hyperglycemia” or too much glucose in the blood can cause damage and disease progression to occur. Too much glucose inside the cells can also cause problems as well.

Let’s talk now about diabetes as a disease and how it can develop…

There are two main types of diabetes: type 1 and type 2. Type 1 diabetes is an autoimmune disease in which a person’s immune cells attack the cells in the pancreas that secrete insulin. Therefore, someone with type 1 diabetes produces little or no insulin and must regularly provide their body with insulin. For individuals with type 2 diabetes, the issue lies in the cells in the rest of your body that don’t respond to insulin like they should. For the purpose of this post, we are going to mainly be talking about type 2 diabetes as a lot of the risk associated with type 2 is lifestyle related.

Before progressing to type 2 diabetes, a condition called insulin resistance usually occurs first. Although the cause is not completely understood, there are several mechanisms in other cells in the body that are dependent on insulin to supply it with energy that can get disrupted or impaired as a result of chronic high blood sugar. This causes a further increase in blood glucose because the cells are not taking the glucose from the blood like they should when insulin is present. As a result of continual high blood glucose, the body continues producing more insulin to try to get it lowered. Eventually, the cells in the pancreas that make insulin can get stressed and eventually die. This further decreases the body’s ability to make insulin leading to bigger increases in blood glucose. Long-term consequences of high blood glucose are damage to tissues and proteins in the body such as your heart, kidneys, brain, eyes, and nerves, and increases to your risk for developing other diseases such as cardiovascular disease, neuropathy, and premature death. Pre-diabetes is usually diagnosed before diabetes and is based on various tests that measure the glucose levels in the blood.

You might be asking what can be done to prevent this?

Lifestyle (diet, physical activity, stress levels, etc.) is not the only factor but is a large factor in the development of type 2 diabetes. Other factors such as body weight, genetics (family history of diabetes), age, race, and ethnicity can impact your risk for developing type 2 diabetes.

Current evidence is showing promising outcomes with lifestyle interventions in preventing or delaying the development of diabetes. Interventions with diet and exercise particularly have significantly decreased diabetes risk.

Here are some dietary and lifestyle considerations for diabetes prevention:

Diet composition:
Like we discussed above, diet composition itself can affect how quickly your blood sugar rises and therefore how hard your pancreas has to work in order to make enough insulin. If you eat a diet composed of lots of simple carbs and little complex carbs and fiber, then the carbs that you eat will cause a sharp rise in blood sugar and a sudden need for lots of insulin. This can be taxing on your pancreas long-term. Eating carb-rich foods high in fiber and complex carbs like whole grains, some fruits, and most vegetables will help to slow the absorption of sugar into the blood to prevent a sharp rise in blood sugar.
Eating a lower carb diet is usually advised for those with pre-diabetes or diabetes to help manage the disease and their medications. It is not necessary for those just trying to prevent the development of diabetes as it may not be sustainable long-term. Choosing the right kinds of carbs and the composition of the rest of your meal is more important.
In addition to fiber, protein and fat are complex molecules that help to slow the digestion and absorption of sugars. Choosing a meal or snack that is balanced with whole grains, fruits, healthy fats, and protein will likely help balance your overall blood sugar.

Helpful:
– Complex carbs like whole grains, fruits, and vegetables
– Fats, proteins, and carbs at every meal and snack

Not as helpful:
– Too many simple sugars in one setting
– A lot of simple sugars, or even complex carbs without protein or fats

Amount of Food:
Too much overall energy intake can lead to increases in body weight which is a risk factor for developing diabetes. Having excess energy, in the form of carbs, proteins, or fats, can result in the same response of insulin resistance in the body’s cells.

Helpful:
– Eating the right amount of calories

Not as helpful:
– Eating too many calories overall

Physical Activity:
Regular exercise has been shown to improve blood sugar regulation and control in individuals, help prevent weight gain, and maintain overall energy balance. It is good to start slow and gradually add in more exercise in order to prevent injury. The currently recommendations are 150 minutes of exercise per week, or just 30 minutes, 5 times a week.

Other lifestyle factors:
There are many other factors such as stress (positive or negative), illness, dehydration, etc. that can influence your blood sugar. Overall, do your best to manage and control what you can and let everything else go. Worrying about things you cannot control is not beneficial!

Conclusions:
While there are so many factors at play in the development of type 2 diabetes, weight loss for overweight individuals, adequate exercise, and a balanced diet has been shown to be helpful to decrease your risk for developing type 2 diabetes. Seek the advice and counsel of your healthcare provider to figure out what you can do today to help lower your risk for developing diabetes.

Sources:
https://www.eatright.org/health/wellness/diet-trends/what-is-glycemic-index
https://www.ncbi.nlm.nih.gov/books/NBK459280/
https://pubmed.ncbi.nlm.nih.gov/8116552/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387426/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996922/#R10
https://pubmed.ncbi.nlm.nih.gov/30317615/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404204/#R11
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2738809/#B18
https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes#:~:text=Diabetes%20is%20a%20disease%20that,from%20the%20food%20you%20eat.
https://www.cdc.gov/diabetes/basics/diabetes.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4219937/
https://diabetesjournals.org/diabetes/article/54/suppl_2/S97/12821/Mechanisms-of-Pancreatic-Cell-Death-in-Type-1-and
https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6125024/
https://pubmed.ncbi.nlm.nih.gov/31451269/
https://www.ncbi.nlm.nih.gov/books/NBK585052/
https://extension.usu.edu/nutrition/research/controlling-blood-glucose-levels-through-diet
https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/diabetes-mellitus-and-disorders-of-carbohydrate-metabolism/diabetes-mellitus-dm?query=Blood%20sugar%20regulation
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898168/
https://www.cdc.gov/physicalactivity/basics/adults/index.htm

Food Portioning

How do you portion your food correctly?

I have been told many times that one of the hardest things in regard to nutrition and eating a healthy diet is the portioning. The idea that the American public has about the amount of food that we should be eating has become based on the amount of food that is given at restaurants. However, the average food portions in American restaurants have doubled or even tripled in some cases over the last few decades. Furthermore, we read on the internet that you should be eating a certain amount of calories or a number of grams of carbohydrates or protein but we have no idea what that actually translates to for food.

Maybe a personal trainer or another health professional has told you how many calories you should be eating or has told you something like “you need to eat 100 grams of protein per day”. What does that actually mean though? How do you figure out how many calories and amounts of carbs, protein, and fat are in the food you are eating?

This blog post below is a great place to start to help you learn how to read a nutrition label so that you can understand what is in the food you’re eating:

https://lifestreamclinics.com/how-to-read-a-nutrition-label/

However, most of the time, people are not going to measure out their portions or weigh out other foods like chicken or fruit that don’t have a nutrition label on them. Additionally, most people are not trying to hit a perfect number of calories and are just looking to estimate the amount of food they’re eating so that they don’t overeat.

Here are some quick tips for estimating the nutrient content of common foods*:

– 3 oz of protein (chicken, steak, salmon, etc.) is about the size of the palm of your hand and has approximately 25 grams of protein
– 1/2 cup of most carbohydrate sources (pasta, oatmeal, crackers, etc.) is roughly the size of a cupped handful or a tennis ball and contains roughly 15- 25 grams of carbs
– 1 cup of fresh fruit is roughly one serving and is the size of a baseball or a closed fist and has roughly 15 grams of carbs
– 1 teaspoon of oil or solid fat is the size of a postage stamp and is roughly 5 grams of fat
– 1 tablespoons is about the size of your thumb and is the approximate serving size of peanut butter (or other nut butters)
* These are very rough estimates
Reach out to a health professional for more help with figuring out how much food you should be eating to stay healthy!

Sources:
https://www.nhlbi.nih.gov/health/educational/wecan/news-events/matte1.htm
https://www.ncbi.nlm.nih.gov/books/NBK56068/table/summarytables.t4/?report=objectonly
https://medlineplus.gov/ency/patientinstructions/000337.htm
https://www.cancer.org/cancer/risk-prevention/diet-physical-activity/eat-healthy/controlling-portion-sizes.html
https://diabetes.org/healthy-living/recipes-nutrition/eyeball-carbohydrate-servings
https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbohydrates.html#:~:text=For%20diabetes%20meal%20planning%2C%201,counts%20as%202%20carb%20servings.
https://www.cdc.gov/diabetes/managing/eat-well/diabetes-and-carbs/carbohydrate-choice-lists.html
https://www.eatright.org/health/wellness/nutrition-panels-and-food-labels/serving-size-vs-portion-size-is-there-a-difference
https://www.mayoclinic.org/healthy-lifestyle/weight-loss/multimedia/portion-control/sls-20076148

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