Baffling blood sugar

I was recently asked to help out a family member control their bloods sugars. They have diabetes type 2 (adult onset diabetes) and have noticed that their blood sugar levels are often high (over 7mmol/L) in the morning before eating breakfast. Starting out the day with high blood sugars often leads to high blood sugars for the remaining of the day because it is hard to lower already high blood sugars if insulin is not involved. Morning sugars reflect what was eaten the night previous and will reflect how our body is "handling" that last meal or snack. The same can be said for any time of the day. There are 2 general reasons why blood sugars sugars can be high after a meal:

1. Too many carbohydrate rich foods were eaten, meaning either portions were too big or too many carb rich choices were eaten, or both. We need to eat some carbs at each meal, but too much can lead to high sugars. Carbs are found in 3 of the 4 food groups: fruit, grain products (rice, barley, couscous, pasta, bread, bagels, cereal, etc) and anything made from milk (milk, yogurt, Yop, ice cream, but not cheese). The idea is not to avoid carbs, but to spread them out over the day.
If we eat too many carb rich foods in one sitting, they will turn into sugar and rush into the blood stream like a tidal wave. As you may expect, the body cannot handle a tidal wave as well as it can a slow drip of sugar. It takes longer for the body to deal with high amounts of sugar in the blood and thus the sugar stays in the blood longer than wanted (= high blood sugars). People without diabetes can handle higher amounts of sugar than diabetics.
Not everyone knows that milk based foods, fruit and grain products all get turned into sugar. Usually people will only look for the sugar content on the food labels BUT some nutrients are turned into sugar after digestion- mainly starch. You can't always read the starch quantity on the label and since it affects sugar levels as well, it is important to read the total CARBOHYDRATE content in foods and NOT the sugar content. Both sugar and starch are types of carbs, so by looking at the total carb content, you are looking at the bigger picture. One "carb choice" = 15g carbs. The average person needs 2-4 carb choices per meal. The general rule for one portion is 1/2 a cup (diced fruit, cooked pasta or rice, yogurt).
If we are eating over 4 choices of carb rich foods per meal, that may explain high blood sugars.

2. The other reason for high blood sugars may be due to an imbalance in the meal. If we don't have fibre, protein with carbs/starch present in a meal, there is a high likelihood that blood sugars may be high afterwards. Carbs get digested into sugar. Protein and fibre help to slow down how fast starch is broken down and absorbed by the body. Therefore they can help to prevent a tidal wave. Think of a sugar cube placed in a glass of water. It is dissolved quickly. Now, wrap the sugar cube up in a Kleenex. It is dissolved more slowly- the Kleenex represents the fibre in the meal. We find fibre in vegetables (non-starchy) and whole grains like brown rice, whole grain bread, whole grain pasta, etc. Now, imagine putting the sugar cube in a plastic container with holes, then put into the glass of water. The container represents the protein in a meal which will also slow down how fast the sugar is broken down. Protein is found in meat, chicken, fish, eggs, peanut butter, nuts, tofu, beans and cheese.
Not only does protein and fibre slow down the digestion of sugars, but by including vegetables and meat & alternatives in a meal, we naturally eat less of the starchy side dish.
The typical balanced meal would include half a plate of veggies, 1/4 meat and 1/4 starch. That roughly translates to be about 1-2 cups of vegetables, 3-5oz of meat and about 1 cup of starchy foods. Most people find these portions are small, so if you are a big eater and find it hard to cut all portion sizes down, the most important food to eat in moderation is the starchy food.

We have to expect that eating will raise blood sugars because most meals and snacks will contain carb rich foods. The goal is to have blood sugars raise no more than 4 points. To evaluate this, you have to take blood sugars before the meal then again 2 hours after the meal. 2 hours after the meal is when the blood sugars should be the highest. If you start off with high blood sugars before the meal, at least this method can rule out problems with the current meal. Some people blame the recent meal on high blood sugars, but if you started out at 12 and ate breakfast and you go up to 14 or 15- that's NORMAL. Why were you 12 to start with is the issue to deal with.

Reflect back on what you ate last, were there too many carb choices? Did I combine fibre, carbs and protein? If not, those are great goals to start with, before chosing a fad diet or increasing medications.

Turn back the clocks, turn up the energy!

Keeping energy levels high during the colder, darker months of the year can be a challenge. As we snuggle down into our shorter days we often feel less energized and motivated to make healthy choices such as exercising and snacking. This can become a vicious cycle- eating comfort foods, feeling less energized, then turning to those same foods. Breaking the cycle is easier than you think- energizing foods don't have to taste like cardboard OR take hours to prepare. I've already spoken about how eating regularly and preparing balanced meals can help with energy levels- but what about snacks?
Snacks can not only help to boost our energy levels between meals but they can also prevent us from eating meals that are too large (which can zap energy).

An energy boosting snack should contain 3 elements:

1. Carbohydrates. This macro nutrient is the preferred source of fuel for our brain. Carbs turn into blood sugar which feed all of our cells- brain cells and muscle cells included! Eating low glycemic index carbs helps to stabilize energy levels- avoiding sugar highs and lows. Complex carbs such as fruit, whole grain crackers and pita bread are quick and easy examples.
2. Fibre. This nutrient is technically in the carbohydrate family. It provides zero calories BUT helps to slow down how quickly we digest sugar and starch. We want the process of digestion to be slowed somewhat so that the energy from the food can slowly make its way into our bloodstream. Rather than a tidal wave of energy (resulting in an energy crash) we want a constant drip. Fibre is found in whole grain foods, fruits and vegetables.
3. Protein. The role protein plays in energy levels is similar to fibre. It helps to keep us feeling fuller longer by slowing down digestion. It also brings a nice variety to the snack thus avoiding monotony. It is not a calorie free food and therefore portion sizes (like any food) should be according to your true hunger. Contrary to popular belief, protein does not technically provide energy to the body but instead is better used to boost the immune system and repair tissue. That is why it is important to include a source of complex carbs.

A few food examples are:

A handful of dried fruit and nuts
One tablespoon of peanut butter on whole-wheat crackers
Sliced veggies dipped in hummus
Air-popped popcorn sprinkled with shredded Parmesan cheese
Pita chips with bean dip and sliced avocado
Low-fat cottage cheese with fruit and almonds
A fruit smoothie made with low-fat yogurt or milk

So go forth and snack wisely in the wintry months!

The Fake Fiber

We all know that fiber (fibre?) is our friend- it can help move thing along in our digestive tract, help to prevent a whole host of diseases (colon cancer, diverticulosis, etc) and lower our cholesterol. Its not always easy to eat the right amount of fiber everyday (25-30g), especially if you don't know where to find it. So, "lucky for us", the food industry has helped us out by enriching all kinds of food with fiber. We can now find high fiber frozen yogurt, orange juice, cookies, you name it! Its taken the brain work out of fiber intake- or has it?

Not so long ago, a "new" kind of fiber was discovered- one that doesn't taste like cardboard or take 100 chews to get down. It goes by the name of Inulin and can be easily added to practically any food to increase its fiber content. So now we find ultra-high fiber pastas, breads, granola bars, etc. Ever heard of "Smart" Bread or "Smart" Catelli pasta? Rather than adding bran or psyllium (two other kinds of fiber) or using actual whole grains, they use inulin to boost the fiber content. This way you can eat your refined, white cereal products and not have to worry about not getting enough fiber! Is this too good to be true? YES.

Recent studies have tested the efficacy of inulin in lowering cholesterol, helping with bowel movements and even its ability to protect against disease. Unfortunately, inulin is much less effective in improving out health as its cousins bran and psyllium. Who would have guessed that refining our foods then trying to put back the nutrients may not work? Common sense could have told you that but in today’s society, quick fixes and miracle foods are all the rage. Time and time again we are proven that fortifying our foods with miracle nutrients is not the way to prevent health problems.

These fortified foods may be a way to help your family's transition from white grain products to whole grain, but keep in mind that a transition involves continued progression! It is not absolutely necessary to avoid at all costs white pasta, rice and baguette. It is important to keep an open mind about whole grain products which means trying to include them when you can. Why not mix brown and white pasta (or rice) to help with the taste? Or try using other higher fiber grain options such as whole wheat couscous or barely as a side dish? Even making sandwiches with one slice white and one slice brown is possible.

It seems like the more we try to perfect our diets by enriching foods with nutrients like inulin (and omega 3s and probiotics), we end up complicating things. Stick to the basics and use common sense when buying these expensive specialty products.