Project 101 Resilience – Pre-Diabetes and Diabetes

Diabetes Types I and II.

Type I Diabetes is a life long condition that usually begins in early childhood and is caused by the pancreas failing to excrete sufficient amounts of the hormone insulin resulting in too high a level of sugar in the blood. This type of diabetes is managed by monitoring blood sugar levels and administering insulin as needed. This used to require rigidly applied testing blood before meals manually and then injecting the insulin into the stomach area, but there have been some amazing advances that have automated the process via a pump that is safer and more efficient, particularly for children.

Patients with Type 2 diabetes are twice as likely to die from coronavirus – and being obese increases the risk even further, research reveals today.

A third of deaths from the virus have occurred among individuals with diabetes, which is linked to excess weight and a lack of exercise.

The study by the NHS and Imperial College London also found that those with Type 1 diabetes –which is not linked to obesity – were three and a half times more likely to die.

The findings provide further evidence that certain groups of patients are at much higher risk of suffering fatal complications.  Those with Type 2 Diabetes at high risk from Covid-19

The pancreas

The pancreas is one of the largest glands in the body and its main role is the secretion of hormones including insulin (when there are raised sugar levels in the blood), glucagon (when there is lower sugar levels in the blood) which maintains a normal balance. Also pancreatic enzymes, which are vital for effective digestion.

It lies across the top of the abdomen, below the liver and tucked into the duodenum section of the small intestine.

The pancreas is made up of cells (acinar cells) that secrete into small ducts that connect together until they feed pancreatic juices into a main duct running through the centre of the gland which feeds directly into the duodenum. The pancreatic juice contains not only the enzymes needed to breakdown carbohydrates, proteins and fats but also sodium bicarbonate to help neutralise the acid.

Within the acinar cells are Alpha and Beta cells that produce insulin and glucagon respectively. These are taken from the pancreas via the Mesenteric vein into the blood stream where they will balance blood sugar levels.

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Type II Diabetes

This type is also called Late Onset Diabetes and accounts for more than 90% of cases. It costs billions of dollars and pounds a year to treat. In the case of Type II it is usually the result of too much insulin being produced but the body has become resistant to it and does not respond to the hormone as it should. This results in glucose remaining at high levels in the blood rather than being transported to the cells. One of the signs that you have too much glucose in your blood is that you need to wee a great deal as the body tries to get rid of the excess sugars. A urine test is usually the way that diabetes is diagnosed although a blood test is more accurate.

Pre-diabetes

I posted on pre-diabetes two years ago, but the latest statistics are in and they make for very worrying reading. It is estimated that there are 88 million (Up 4 million from two years ago) Americans who are pre-diabetic and are at very high risk of developing full blown diabetes. CDC 2020

Since having diabetes has been added to the list of key risk factors, it is important that we as individuals take responsibility for our own health, as the medical profession has more than enough on their hands dealing with the pandemic.

According to the World Health Authority it is estimated that there are over 450 million people worldwide with diabetes. In the US around 34 million and the UK approximately 4 million have been diagnosed with type 2 diabetes.

Unfortunately it is the many millions who are undiagnosed that are at the greatest risk

You do not need to have full-blown diabetes to be suffering from some of the symptoms associated with the disease. There is a condition called pre-diabetes that can be managed with diet and exercise and does not have to lead to the development of type 2 diabetes in the future.

It is also called impaired glucose intolerance and in my experience very closely connected with lifestyle and diet and a possible overgrowth of Candida Albicans. Being overweight, not doing enough exercise and elevated LDL cholesterol levels are also part of the equation. LDL (low density lipoprotein) has smaller particles than the HDL (high density lipoprotein) and because of this it is easier for the LDL to clump and form plaque in the arteries which will narrow them causing a blockage.

Symptoms of Pre-Diabetes that can develop into full blown Type II Diabetes

There are a number of symptoms that you might experience either singularly or in combination with one or more of the others.

  • Feeling hungry all the time
  • Losing or gaining weight without much change to your diet
  • Feeling weak as if you might have the flu
  • Slow healing of cuts or bruises
  • Unexplained skin rashes
  • Bladder infections
  • Vision problems such as blurring of the eyes.

If pre-diabetes is tackled positively with food and exercise, loss of excess weight, the symptoms can disappear in a few weeks and if the healthy approach is maintained there should not be any further reason for concern.

Unfortunately some people do not suffer any symptoms at all making this a silent disease and if this is the case it might not be detected until the person is suffering from full blown diabetes.

If you are at all concerned a simple blood test will identify if you are at risk and your Doctor of Pharmacy will talk you through the process. 

Taking the first step to avoiding the development of diabetes.

The evidence is very strongly pointing toward lifestyle and diet changes as being the most effective way of dealing with the problem and it is very easy to incorporate the right foods in an appetising way as part of a healthy programme.

Even a 10% change to excess weight can make a huge difference and adding a brisk walk a day, five days a week for 30 minutes at least is also very important.

What are some of the dietary changes necessary.

Apart from getting to a healthier weight there are some other dietary changes you can make to reduce your blood sugar levels. There are certain foods that will cause your blood sugar levels to rise and I cover that later in the post, where I look at the Glycemic value of foods and their effect on the body.

Fibre is important – Apart from the nutrients that wholegrains, fruit and vegetables supply they also contain great amounts of fibre necessary to clean the circulatory system of cholesterol plaque and toxins, keeping the blood clear of unnecessary additives.

Protein is essential and it should not be taken out of the diet. Protein does not have to come from animal sources but if you choose to be vegetarian then make sure you are including beans and fermented soya products for example.

It is our liver that is instrumental in determining our cholesterol levels in combination with certain foods. However, there are some myths surrounding certain foods such as avocados and eggs, which are very misleading.

Fat is absolutely necessary in our diets and there is no evidence to show that eating plant based fats, eggs and animal lean protein moderately causes high cholesterol. It is the hydrogenated fats found in processed protein such as hams, sausages and pastries and other processed prepared foods that are likely to cause a problem.

What about refined sugars and their role in our diet?

We live in a real world and as a Candida or pre-diabetes sufferer it would be pretty miserable without some sugar in your diet. However I do recommend that for the first six weeks you give up sugar completely except for a piece of low GI fruit each day.

The types of sweeteners used by food manufacturers are not natural and many are downright toxic. The one thing that I am definitely sure about is that artificial sweeteners such as aspartame, saccharine, sucralose and acesulfame-k have no place in our food chain.

Exercise

When you exercise your body uses insulin which controls your blood sugar levels. If you’re doing moderate exercise for a longer time, your muscles take up glucose at several times the normal rate. This is the type of exercise you should be aiming for.

Start slowly for 30 minutes walking slowly over a fixed distance and then increase you pace over the same distance until you are walking briskly, just slightly out of breath. Then increase your distance each week until you are walking a mile in 15 minutes.

Once you have reached that fitness level it is very effective to add in some high-intensity activity for just a minute every 10 minutes. That might be running for a minute, skipping with a rope, cycling at full speed (static bike) etc.

Carbohydrates

The other recent trend is to demonise all carbohydrates including grains as being the culprits behind most of our modern ills. As with all food advice, one size does not fit all and I am not an advocate for cutting out all food groups entirely based on what is the trend at the moment. We need varying amounts of the main food groups as we get older and complete the transition to adulthood. However, there comes a time in later life when our digestive system is not so effective, when we need to increase certain food groups to ensure we are getting sufficient nutrients.

Our bodies have evolved over several hundred thousands of years. We were and still are opportunistic feeders. Whatever we could get our hands on. The biggest problem occurred when we no longer had to travel miles a day to either hunt or gather our food. That would have included seasonal game, fish, wild grains, berries and fruit, roots, honey etc. It would have been eaten raw until the discovery of fire and we would have not bothered cutting off the fat or counting the calories.

However, today we just have to pop into the car, drive to the nearest supermarket and fill our trollies with foods from all over the world, all year around. That is where ‘moderation’ comes in. Now that most of us, certainly in the western world have so much food available it is down to us to be careful about how much we consume of this bounty.

The glycemic value of the foods that we eat has an impact on our blood glucose levels and I have found that my clients following a lower glycemic approach to carbohydrates and the other foods have found it effective in maintaining a healthy level.

The Glycemic Index

Not all carbohydrate foods behave the same way when eaten. The Glycemic index or GI describes this difference by ranking carbohydrates according to their effect on our blood glucose levels.   Foods are ranked according to their effect in relation to pure sugar which would be 100.

So a food that is ranked at 50 has a much slower effect on blood glucose levels than sugar which causes a much faster reaction. The slower the reaction the less insulin is released into the bloodstream.

This results in less fat being stored, particularly around the hips and thighs.

A low Glycemic diet reduces the onset of dramatic fluctuations in blood sugar levels and therefore will regulate the feelings of hunger. In addition lower Glycemic foods are usually much higher in nutrients and fibre having an overall effect on health.

Low Glycemic Index foods are slowly digested, releasing sugar (glucose) into the bloodstream gradually, resulting in a slow and steady increase in blood sugar that helps keep your body functioning well for longer than high GI foods.

High Glycemic Index foods are quickly digested and metabolized, producing a rapid rise in blood sugar. It’s best to avoid these high GI foods that cause spikes in blood sugar that can result in your body “crashing” or feeling hungry again quite quickly after you eat.

LOW GLYCEMIC FOODS (under the value of 55) Can eat daily

  • Most Vegetables: asparagus, avocados, broccoli, spinach, cabbage, carrots (small portion) cauliflower, green beans, peas, celery, red cabbage, cucumber, lettuce particularly rocket, mushrooms, onions (very important as they contain chromium which naturally controls blood sugar levels), Garlic, peppers, spinach squash and yams.
  • Fruits: apples, apricots, grapes, blueberries, cherries, lemons raspberries, strawberries, grapefruit, oranges, peaches, pears, plums, prunes
  • Juices: apple, grapefruit, pineapple, tomato (unsweetened) small glass and add sparkling water to dilute.
  • Legumes: black, navy, pinto, and kidney beans; chickpeas; lentils; black-eyed peas
  • Starches: The key is to have a moderate portion and always have protein with it as this offsets the Glycemic affect. So for example:- porridge with milk (but not lots of sweeteners). Sandwich with chicken etc. Piece of toast with an egg. You must avoid white processed carbohydrates however and this includes biscuits, cakes and white bread as these are most likely to contain artificial sweeteners and trans-fats. I find that whole grain baguettes made in most large supermarket bakeries have few additives but check labels. Or make yourself
  • Milk products cheese is wonderful but only in moderation if you want to lose weight.g – Milk in tea and on cereals is not a problem but if you are trying to lose weight then go easy when pouring. A piece of mature cheddar a couple of times a week if you are exercising and eating lots of vegetables and lean protein is not an issue – much better than eating a bar of chocolate. Fermented yogurts may have some benefit on intestinal flora and help the digestive process – watch for sugar content – plain is quite boring but you can add nuts or a small amount of the low glycemic fruit to improve.
  • Sweeteners: I have used Stevia which is plant based– I don’t particular advocate because I think it just feeds your sugar craving. I am suspicious of other artificial alternatives and if you can do without entirely. If not then like salt, use pinches of sugar to sprinkle on your cereal rather than a teaspoon, it will teach your taste buds to expect less!
  • BeveragesStart the day with hot water and fresh squeezed lemon. Not only does it hydrate, give your body a Vitamin C hit but it also gets the digestive process started, helps the liver and retrains your taste buds. You should find within a week that you no longer have a sugar craving. Tea is fine – green tea is excellent as it lowers blood sugar levels. Scientists are on the fence about coffee consumption – some research indicates that it might reduce blood sugar levels and others the opposite. My advice is if you enjoy a cup of coffee then get ground decaffeinated and have a cup every day and enjoy!
  • Protein. You need protein every day but not as much as people think. If you are eating yogurts and drinking milk you will be obtaining protein but you can also eat 1 oz. cottage cheese – 1 egg – prawns – chicken – lamb, pork or fish per day. Avoid eating red meat more than a couple of times a week as this can increase sugar cravings. Oily fish are good for you so try to eat three times a week this includes fresh sardines, salmon and tuna. I would suggest that you also use goat’s cheese and feta cheese as an alternative. Also in Spinach, broccoli and Brussel sprouts.
  • Salad dressings. Make your own with low fat yogurt and lemon juice, or cider or balsamic vinegar and herbs.
  • Nuts and seeds. Walnuts, sunflower seeds, pumpkin seeds and almonds. Made up into 2oz packets and used for snacks – the healthy fat will act as a brake on the insulin production and will help with hunger pangs. Buy from a good source and make the mix yourself – unsalted of course. Find the right size zip lock bags and they will keep for ages. Take one to work with you as one of your snacks.
  • Oils– Very important to include extra virgin olive oil for dressings as this is a fat that is good for you. I Would suggest that you also use this on bread rather than butter and mix wwith seasonings to use on vegetables and salads. For cooking use ordinary olive oil and I find that rather than frying, it is a good idea to brush some oil onto your meat, fish or poultry and bake in the oven.

MEDIUM GYLCEMIC FOODS(56 -69) eat two or three times a week.

  • Vegetables: white and sweet potatoes
  • Fruits: bananas, tropical fruits (mango, cantaloupe, papaya, pineapple), kiwi fruit, raisins, figs, fruit cocktail
  • Juices: orange,
  • Starches: cous cous
  • Cereals: oats, homemade muesli (without dried sugar) Weetabix.
  • Sweeteners: honey (Manuka honey can be consumed more often)

HIGH GLYCEMIC FOODS(above 70) eat very occasionally.

  • Fruits: watermelon, dates
  • Processed foods– It is important over the initial period to avoid processed sauces, meats, meals or anything else that might have hidden sugars or too many carbohydrates. Prepare everything fresh – for example pasta sauce with fresh tomatoes, onions, mushrooms etc.
  • Snacks: popcorn, rice cakes, most crackers (soda, Stoned Wheat Thins, Water Crackers), cakes, doughnuts, croissants, muffins, waffles, white bread, baguette, bagels
  • Starches: millet
  • Most Cereals: Bran Flakes, Cheerio’s, Cornflakes, Rice Krispies, Shredded Wheat, Special K, Total or any cereal that is sugar coated.
  • Sweeteners/Sweets: table sugar, hard candy, soft drinks, sports drinks, fizzy diet drinks, chocolate except for 2 squares of dark (85%) chocolate two or three a week.
  • Alcohol. It is a good idea to give up alcohol all together for six weeks if you want to stabilise your blood sugar levels.

Eating Patterns.

I have adjusted my eating patterns in the last year as I found eating in an 8 hour window as part of the Intermittent Fasting programme to restrictive based on my personal lifestyle. Personally I now eat within an ten hour window every day which suits me best. This gives my body 14 hours each day to get on with what it needs to do in the way of processing the food I have eaten, extracting the nutrients and also allowing for some downtime for major organs such as the liver.

I also have found now I am in my late 60s that smaller meals suit me better and it is something that I recommend to my clients too. There are some who say that eating five or six times a day puts too much pressure on the liver by not giving it a break from the digestive process, but since I am giving it 14 hours off a day to recover, I think it is quite capable of managing the work load.

I am currently losing 1lb per week and eat 1500 calories a day six days a week and then one day when I have around 2000 calories with some of the higher glycemic foods added in.

There is a reason for this. In my healthy eating programme I cover the weight loss plateau when we don’t seem to be able to lose any on a consistent basis.. Part of the problem is the body thinks there is a famine and starts to store rather than release fat from the cells. By having an off day from the low and medium glycemic diet, it reassures the body that there is not going to be a famine.

  • I have a coconut water when I get up in the morning to hydrate and being rich in potassium it helps maintain a healthy blood pressure.
  • An hour later I have a green tea and piece of my homemade Irish Soda Bread which has no sugar, and is made with wholegrain flour, with butter (I don’t believe in processed spreads).
  •  I have a green tea around 11.30
  • Lunch which is a large bowl of mixed vegetables and lean protein  at 1.30pm.
  • Mid afternoon I have a piece of fruit or a couple of squares of dark chocolate…
  • followed by an Irish Soda bread sandwich with chicken or tuna and salad,
  • followed by some apple and yogurt around 7pm.
  • I drink around an additional four glasses of water throughout the day.

I am certainly not starving and my blood sugar levels are stable and I have no major cravings or hunger.

On my free day a week we might have a pasta dish or curry with brown Basmati rice and an ice-cream. If I am doing more exercise, then I will add in a sixth snack during the day.

Chromium an essential trace mineral that helps the body maintain normal blood sugar levels.

A deficiency of Chromium can lead to diabetes and this is where the primary research into this mineral has been directed.

Chromium first and foremost is a component of the ‘glucose tolerance factor’ which is required for maintaining a normal blood glucose balance. Chromium works with insulin to ease the absorption of blood glucose into the cells and it may also play a part in other activities that involve insulin such as the metabolism of fats and proteins.

This last activity has opened a line of research in the effect of chromium on weight loss, building muscle and decreasing body fat and has led to a lot of chromium based products being put on the market in recent years. There is no definite proof that it works although some studies do claim that in a study that people on chromium lost more body fat over three months than those who did not take it.

It is more important to look at the role of chromium as we age, as there is an increasing numbers of patients who are diagnosed with late onset diabetes. This is nearly always related to dietary deficiency and the concern is that with our current trend towards eating processed foods and excess weight are responsible as we are automatically taking in less chromium in raw and unprocessed foods.

Chromium is very easy to lose from the body in urine, sweat and if we engage in excessive physical activity without the appropriate diet. However, chromium is very easy to include in any healthy diet and should not be needed in supplement form.

Blood Pressure and Blood Sugar Levels.

There are still a number of studies looking at the effect of Chromium Picolinate on high blood pressure and the reasoning is that increased blood sugar does increase blood pressure. Additionally high levels of LDL or low density lipoprotein, which has small particles and when oxidised clumps and blocks the arteries, resulting in high blood pressure, may also be reduced by taking Chromium Picolinate. Hence the use of it in this form in supplements especially as it is more easily absorbed by our digestive tracts.

We do not manufacture or store chromium in the body so it is necessary to eat foods regularly that contain it. One concern however, is that the foods that we eat that contain chromium, might not be as rich in the mineral as they used to be. It depends on the levels of the mineral in the soil they are grown in which is variable, dependent on the area and farming methods in use.

Foods rich in dietary chromium.

vegetablesBroccoli has the highest levels of chromium followed by other dark green leafy vegetables, romaine lettuce, onions and tomatoes. Wholegrains, potatoes, oysters and other seafood, liver, cheese, chicken, turkey, beef and lamb also contain. As you can see there is plenty of foods that are usually included daily in our diet but only if we are cooking from scratch. If your diet is primarily industrially produced in a packet you may not be getting the chromium you need.

Just taking a supplement is not the answer if you are pre-diabetic. The body is used to processing foods to obtain the nutrients that it needs and the first place to start is a review of your diet and lifestyle.

If you have a severe sugar craving then you might then look at taking a chromium supplement to work alongside your diet. Do buy a high quality supplement as they are not all as good for you as you might think.

If you are a diabetic then you must make sure that you work with your medical advisor before taking any chromium supplement, as it will affect the dosage of any insulin you may be taking.

©Sally Cronin Just Food for Health 1998 – 2020

I am a qualified nutritional therapist with twenty-two years experience working with clients in Ireland and the UK as well as being a health consultant on radio in Spain. Although I write a lot of fiction, I actually wrote my first two books on health, the first one, Size Matters, a weight loss programme 20 years ago, based on my own weight loss of 154lbs. My first clinic was in Ireland, the Cronin Diet Advisory Centre and my second book, Just Food for Health was written as my client’s workbook. Since then I have written a men’s health manual, and anti-aging programme, articles for magazines and posts here on Smorgasbord.

If you would like to browse my health books and fiction you can find them here: My books and reviews 2020