I get it. I know how hard it is to cut back on candy, sweets and chips. I grew up binging on lots of Bazooka bubblegum, Zero candy bars and Charles Chips. I was tall and lanky and I could eat anything I wanted and not gain weight. That changed in adulthood and so did my blood sugars a decade ago. Having a family history of diabetes, I was always curious about the impact of my own night-snacking pattern on my morning blood sugar readings. I bought my own glucometer and started checking periodically. About ten years ago I got a few results over a hundred. I was now part of the 86 million US citizens with prediabetes. I was lucky because I discovered it early. If you want to find out if you may have it, take the test. Many people don’t even know they have it. I realized it was an opportunity to take better care of my body.
Tidbits from my patients
As a nurse and diabetes educator, I learned a lot from my patients. My patients would check their blood sugars right before and two hours after they ate to assess the impact of different foods. These were great learning opportunities for both my patients and me. I remember one patient who even compared blood sugar results after eating pizza made with white flour vs whole wheat. He found that his blood sugar result after eating two slices of whole wheat pizza kept him well below the American Diabetes Association goal of 180 mg/dl, unlike the pizza made with white flour. There’s a lot more to healthy eating than just crust, but first let me explain pre-diabetes.
Prediabetes, A Do-over
The nice thing about our bodies is that they are forgiving. Even after a total screw-up if you start a new healthier path, your body will recover. Prediabetes is a stress state in the body. It is caused by being sedentary, being overweight, and having a genetic predisposition. It is also associated with insulin resistance – the body becoming less sensitive to its insulin. Insulin resistance puts even more stress on the pancreas, forcing it to work even harder to meet the demands of the body. Rising blood sugars are a sign that the pancreas is screaming for help. Think of the pancreas as the brake pads on your car: after several years of aggressive driving, they burn out. By the time someone is diagnosed with Type 2 diabetes, half of the beta cells in the pancreas that make insulin, have died.
The Diabetes Prevention Program (DPP) was a large clinical study that involved over 27 medical centers and compared the impact of making lifestyle changes vs taking the drug, Metformin, in patients with prediabetes. Blood sugar results improved the most in the lifestyle group! Those lifestyle changes were:
- Losing 7% of body weight
- Getting 150 minutes of moderate intensity exercise a week
In golfing terms, finding out you have prediabetes is like being allowed to take a mulligan. My blood sugars were just entering the prediabetes range, just entering the 100-125 mg/dl range, and I knew this was an opportunity.
What I observed from looking at blood sugar patterns
What works for diabetes, works for prediabetes and weight loss. The interesting thing is that the DPP lifestyle group was advised to reduce fat and calories, not carbs. Tracking fat grams kept it simple, and for most people reining in calories from fat also reins in calories from carbs. Furthermore, a gram of fat has 9 cal/gm while carbs and protein have 4 cal/gram. If your favorite foods are ice cream, fried foods, chips, cookies and candy, you get lots of bang for your buck by focusing on dietary fat. There were other dietary changes that not only lowered my blood sugars, but gave me more energy and helped me lose weight.
1. Stay hydrated.
I struggle with getting water. The only time I’m thirsty is after my workout every morning. But recently I have become more vigilant about drinking water (I aim for at least two liters a day) and I do notice a difference in how I feel. One study proved that drinking 500 ml of water daily increases your resting energy expenditure by 30%. A mini-review of research done on rodents also supports drinking water to help with weight loss as well as to reduce risk factors associated with obesity and type 2 diabetes. Even though it means more visits to the potty, at least it gets me out of the chair every hour which prevents other health concerns. Two birdies with one swing. I like that.
2. Get enough dietary fiber.
Healthy individuals should get at least 21 gm of fiber daily and even more if you are younger and male. Fiber not only feeds the gut microbes that boost the immune system and aids weight loss, it also helps lower bad cholesterol and blood sugars. Furthermore, foods that tend to contain fiber, also fight inflammation in the body. The best sources are from whole grains, beans and legumes, nuts and seeds, fruits and veggies – particularly the cruciferous ones like cabbage, cauliflower, broccoli and Brussels sprouts. Think oatmeal or even teff for breakfast. Since lettuce and spinach have little fiber, top your salads with fresh-cut broccoli, garbanzo beans and sunflower seeds. Bake with whole wheat flour. Snack on fruits and nuts.
3. Limit sweets, be mindful of portion sizes, aim for ones with fiber and eat them with dinner.
Most desserts are high in carbs and fat. Depending on the amount and type, carbs cab shoot up the blood sugar and fat keeps it elevated longer. Two cupcakes made with white flour with a thick coating of buttery icing is going to spike the blood sugar and the fat in the frosting will keep that level up longer than eating two servings of sorbet, which contains no fat. I found making my desserts with whole wheat flour or making fruit crisps with oatmeal topping had a better effect on my blood sugar. You can use any fruit in a crisp but with my own blueberries and rhubarb in my backyard this blueberry rhubarb crisp is a hole-in-one in our house. I found eating a dessert by itself in the evening tends to spike the blood sugars more than eating it right after dinner. The fiber and protein from dinner seem to subdue the rise in blood sugar, being mindful of all the carb portions in the meal.
4. Try to eat four cups of non-starchy veggies daily.
I know this is a tall order, but non-starchy veggies fill you up, give you lots of vitamins and minerals and are loaded with phytonutrients – think cancer and disease fighting, and energy boosting goodness. I try and get them with all three meals. For breakfast I make a smoothie with kale or I might make a frittata with lots of broccoli. All my soups have lots of either fresh or frozen veggies and dinners often include a large serving of roasted veggies. I used to think I’d get my veggie only at dinner, but now I try to add them to every meal. I even added extra to all my soups and other casseroles or recipes that don’t always call for them. You can find endless recipes on-line to “sneak” in extra veggies – even this brownie recipe calls for pureed spinach!
5. Get enough protein.
Protein is essential to every cell and function in the body. It is also essential for the development of muscle. It is our muscle mass that determines our metabolism which impacts our weight. The Institute of Medicine (IOM) recommends that 10-35% of our daily caloric intake comes from protein. That means that a 2000 calorie diet should consist of 50-170 gms of protein daily, depending on activity level and other health issues like kidney disease.
An ounce of meat, fish or poultry has about 7 gms of protein. A cup of Greek yogurt has about 23 gms of protein. Other good sources are low-fat dairy, eggs, beans, tofu, miso and tempeh and even nuts and seeds. And it’s best to get protein in all your meals and snacks – the body can only absorb so much at one time. To maximize muscle protein synthesis there is evidence that consuming 25-30 gms (equivalent to 4 oz of lean meat) per meal is the best.
Sometimes I wish we could go back in time when grocery stores were smaller with few processed foods and meals were made from scratch. Yes, now we can get produce in most areas of the country all year long, but we also have too many convenience foods that only add to the gut and don’t nourish the body. Eating healthy doesn’t have to take much time, but it does take planning. Can you imagine what our country would be like if we put as much focus on stuffing our mouth as we did putting that golf ball? Maybe then we wouldn’t even need a mulligan!