21 September 2012
Not that it'll help, but I'll begin with a quote:
If you can't convince 'em, confuse 'em. - Harry S. Truman
Yep, the man got that just about spot-on right and in recent weeks I've found I was getting less convinced by the day. The more I researched the science behind this particular topic, the stronger my sense of confusion became and a dawning lack of conviction grew.
What was I less convinced about? It's a tough one, this - namely the 'given' message here in the UK about eating 'healthily' with Type 2 diabetes. As you'll have gathered over recent weeks, this is a topic dear to my heart.
The bottom-line dietary advice provided by the NHS (who are supposed to be the experts and our 'look to' advisers, after all) is to "include starchy carbohydrates with each meal, eat more fruit and vegetables, to eat at least 2 portions of oily fish a week and to cut down on saturated fat, salt and sugars."
Diabetes UK say something pretty similar, and produce a nice coloured leaflet, "Eating well with Type 2 diabetes", which (although it cautions readers to limit sugars and sugary foods) states in it's second main point that readers should "include starchy carbohydrate foods such as bread, pasta, chapatis, potatoes, yam, noodles, rice and cereals" at each meal. They also go on to say that the 'starchy' carbohydrates should "make up about half of what you eat and drink".
OK, so that's good advice from 'reliable' sources, huh? Well, in some (you could even say most) respects, you can't say a great deal against it, especially if you view it as sensible dietary advice for the general population. However, when it comes to Type 2, there is one stand-out point that I beg to disagree with, actually.
It's that very first bit where it suggests a Type 2 diabetic should eat "starchy carbohydrates at each meal". Hang on a tick - can we pause and think about this for a moment.
After a very speedy canter (thanks to Google) through the science of human metabolism - call it metabolism 101 if you like - what I've read quickly reveals that.our bodies convert carbohydrates in the food we eat to glucose in order to make use of it as a source of energy for just about every part of our bodies. OK, so what?
Well, for one thing - our bodies don't actually seem to 'need' to be totally reliant on carbohydrates for energy, as some of the 'authorities' suggest. Our bodies seem (given a little time to adjust) to be able to adapt quite happily to utilising fats as an energy source instead. Indeed, that seems to be what pre-agricultural humankind used to do as a matter of course, and what some extant societies still manage to do pretty darned successfully. Hmmm, maybe those Paleo people have a point after all? Let me think about this for a second.
OK, so let's assume that those "starchy carbs" are not written-in-stone essentials then - that is they do not need to be the first choice option at meal times. Fine so far, but this'll call for a pretty radical shift in the way we think about our food intake... won't it?
Yes, I guess it will. But the clincher to this mind shift is...?
If an individual is trying to control their blood glucose to 'near normal' levels both before and after eating, and avoid 'spikes' in BG levels to minimise the risks of 'diabetic complications' (oooh, what a lovely term that is!), how on earth can this guidance (from the NHS and Diabetes UK, don't forget) be good advice? Having read around, this now seems to be completely counter-intuitive to me.
After all, it proposes incorporating a specific food category (carbohydrates) as a significant - that's right... a 'significant' - contribution to a 'healthy' diet. But yep, you got it right - that category is carbohydrates... the very stuff which the body breaks down really readily into glucose. Call me dumb, but doesn't this mean it is, therefore, the single food category most likely to lead to a high BG spike?
Head spins, brain reports "does not compute" and confusion reigns.
Let's take a look at some evidence, shall we. OK, this is 'only' empirical evidence gathered over a short period, from a very restricted sample size (of one!) to say the least, and it concentrates purely on blood glucose, not overall health. However, given those provisos, it sure has begun to look valid from where I'm standing!
To do this, we'll step back a couple of weeks to when lovely hubby first came off medication. At that point, we started off by buying into the low GI idea. This meant following the 'expert' advice and including carbohydrates. Minimising sugars, but choosing the more complex 'good' ones, such as 'wholegrain' foods which take longer to digest than the processed alternatives so 'slow' the rise in BG levels. That was the path we headed out on.
We identified some baseline 'good' BG figures to aim for and tried to keep within the limits suggested by these, whilst eating the low GI way. So far, so good?
Er, no actually, and we found it pretty challenging to adhere to the guidance whilst keep hubby's BG levels nice and stable with the low GI approach. Even relatively small amounts of 'good' carbs sometimes seemed to have quite drastic effects on his BG.
It was in part those definitions, like 'a rise' and 'spike', which first tripped us up. How do you figure what level of 'elevated' BG is an acceptable one, and what sort of increase you should label as a 'spike' and should be worried by?
More reading ensued, and we seemed to be getting a handle on it all. What we did find though, was that as we selected foods to keep my lovely hubby's BG meter readings down to manageable figures, the amount of carbohydrates in our diet was gradually decreasing.
Finally, we seemed to come to a bit of a crossroads. That was when we started reading more about the specifics of a low carb diet, and when my man began getting serious about following a low carb regime. Hence we changed what we eat (trying to lose the fear of fats!) and, since then, he's not felt so restricted and the 'strict' BG control seems so much more easily achievable for him.
Some blood glucose comparisons:
The Low GI approach
5.0 mmol/l - fasting average
6.3 mmol/l - 2-hour post-prandial average
This was not (we thought) too bad at all, but choosing foods to maintain this was beginning to feel a bit restrictive. What's more, we still encountered some surprisingly high spikes to kick the averages up a bit.
The Low Carb approach
4.6 mmol/l - fasting average
5.3 mmol/l - 2-hour post-prandial average
Better! It seems to be a little easier and less restrictive to follow, and BG figures are definitely trending in the right direction.
I'm still confused though. Now my bafflement comes from the fact that the very organisations I expect to be able to rely upon to guide us to a healthy way of life when dealing with an extremely well known and understood metabolic disorder seem happy to sidestep some of the basic biochemistry which drives how our bodies function. Er, why? Call me cynical.... but did someone mention money, honey?