This is the forth in a weekly series of diaries that deal with healthy positive approaches to the process of ageing. They all carry a tag of [ageing gracefully] and can be found by searching on that tag.
Last week's diary discussed general information about diabetes, I saved the subject of diet and nutrition for a second diary because it covers a lot of information. A number of the comments in the previous diary helped me to focus the content in this one.
Diet, exercise and medication are the pillars of diabetic management. Sometimes diet and exercise alone can do the job, at least for a while. There is no such thing as an eat whatever you want diabetic diet. Diabetes is a defect in carbohydrate metabolism and accommodations have to be made to it. However, there is more than one workable approach to the task. Since what we eat runs our entire body, a sound diabetic diet must address general health issues and other health problems that a person may have. People with diabetes are considered to be at higher risk for cardiovascular disease than the general population. That risk should be addressed in any diabetic diet. I have both cardiovascular and gastrointestinal issues that I need to accommodate.
There were several people is last week's diary who were commenting on the program of Dr. Richard Bernstein. I read the first edition of his book when it came out in 1990. While I found some useful information in the book I decided that the dietary regime that he was proposing didn't really fit my needs. I am sure that the low carbohydrate approach can be an effective means of glycemic control if it is consistently followed. However, it didn't provide me with an adequate ability to accommodate some of my other issues. There have been several subsequent revisions of the material and I am not familiar with it in its present format.
I looked at the American Diabetes Assoc., ADA exchange diet that one is most likely to be handed by a doctor along with the diagnosis. I also found that not to accommodate my needs and interests. I've never belonged to the ADA and don't know much about their activities. In every field of health concern there are somewhat similar voluntary associations and their programs and positions always have fans and critics.
My approach to dietary management has been to try acquire some sound basic information about the health conditions that I have to deal with and some scientific information about nutrition. This has equipped me to be able to develop a program for myself and to make changes in it when there were changes in my circumstances. So, I follow the Richard Program which has worked well for Richard. I'd like to share some of the information that I acquired along the way that I think might be useful to other people.
This chart illustrates one of the basic mechanisms in carbohydrate metabolism.
A workable dietary strategy attempts to slow the rise in BG and thus make less demand on the available insulin. Carbohydrates are not all the same. They differ in a number of respects. Table sugar is a simple carbo that is quickly converted to BG. Whole wheat bread is more complex and takes longer the break down resulting in slower conversion to BG. They can be rated on what is known as a glycemic index.
Here is an illustration of the different BG response for two different carbos.
A diet that puts it emphasis on a low total carbo content is taking a similar approach in reducing the glycemic load. Selecting low GI foods is going to be useful for any diet.
Another aspect of carbos that needs to be considered is fiber content. Here is an article from the Joslin Diabetes Center. This is an organization that whose materials I have found to be pretty consistently reliable and useful.
Fiber is a type of carbohydrate (just like sugars and starches) but since it is not broken down by the human body, it does not contribute any calories. Yet, on a food label, fiber is listed under total carbohydrate. So this gets kind of confusing for people who have diabetes. Carbohydrate is the one nutrient that has the biggest impact on blood glucose. So, does fiber have any effect on your blood glucose?
The answer is that fiber does not raise blood glucose levels. Because it is not broken down by the body, the fiber in an apple or a slice of whole grain bread has no effect on blood glucose levels because it isn't digested. The grams of fiber can actually be subtracted from the total grams of carb you are eating if you are using carbohydrate counting for meal planning.
The average person should eat between 20-35 grams of fiber each day. Most Americans eat about half that amount. A study in the New England Journal of Medicine showed that people with diabetes who ate 50 grams of fiber a day — particularly soluble fiber — were able to control their blood glucose better than those who ate far less.Here is a graph that illustrates the differences in BG load produced by different levels of fiber content.
Using fiber runs counter to simply tracking the total carbohydrate content of a meal. The foods that have high fiber content, grains and legumes, also have the highest content of vegetable protein. They are the basis for a sound vegetarian diet. I learned a lot about nutrition in exploring vegetarian diets. At one point I followed such a diet for about 3 months and found it to be something I could do. However, I have no philosophical investment the matter, so I didn't make an ongoing commitment to it. I do find value in keeping the meat content of my diet at a modest level. I eat only one meal a day with meat in it and that is always either chicken or fish. I have found the approach used in a Mediterranean diet useful.
A necessary part of dietary planning is getting information about the nutritional content of foods. For packaged foods the standard labels like this are useful.
There are other necessary considerations in dietary planning than just the measurable clinical impact. My situation is simpler because I live alone and can deal exclusively with my own needs. When meals have to be prepared for more people it becomes more complicated. As with exercise, the diet that works is one that you are able to follow consistently. You have to find foods and recipes that you get some enjoyment from. Being able to monitor your BG makes it possible to experiment with dietary options and gauge their impact. Diabetes is a complex situation. For a number of reasons, a diet that works for one person may not be the answer for someone else.