Chapter 6

Eating Better for Health

IN THIS CHAPTER

check Consuming the right foods to help you manage your diabetes

check Recognizing the importance of certain vitamins and minerals

check Considering supplements for other nutrients

Some people literally go days, months, or years without exercising, but everyone has to eat on a (nearly) daily basis to stay alive and healthy, with or without diabetes. What you decide to chow down on matters to your long-term health and your blood glucose. Diabetes makes your food choices even more important.

In this chapter, I explain why your meal plan is so vital to keeping fit and how to get the most out of your body every day by making healthful choices — easily. You have a lot of tasty options that can benefit your body, both today and down the road, even if you don’t know it yet.

remember No matter what you eat, limiting your portions to amounts that allow you to manage both your blood glucose and your body weight and being active help keep you fitter and more healthy.

Knowing Which Foods Make a Body Healthy

Have you ever chosen the salad for your main meal when you eat out only to find out that it had as many calories as that burger you would’ve preferred? Not everything you may consider healthful is, and many foods are more nutritious than you realize. Eating right in today’s world of confusing messages is tough for everyone — even those supposedly “in the know” about healthful eating.

Here’s what’s for certain: Eating foods as close to their natural state as possible is almost always best for your health. Processing foods (as when whole wheat is made into white flour, bleached or unbleached) strips numerous nutrients out of food, and only a select few are added back in. The result is that processed foods are far less nutritious than foods in a more natural state. Nutrients in foods work best the way they grew, and often the synergy of the nutrients in food is as vital as the individual nutrients themselves, so just taking supplements is seldom as effective either.

Natural fruits and vegetables are full of vitamins and minerals, and they are particularly rich in compounds called phytonutrients (or phytochemicals), which are found in plants and have disease-fighting and health-promoting powers; some examples are capsaicin, lycopene, lutein, quercetin, saponins, and terpenes. Most can’t be bought in supplement form, and you wouldn’t want to consume them without the benefits of the bioactive substances in whole foods anyway. Certain foods containing phytonutrients are considered so powerful for health that they may one day be one of the primary ways we prevent and manage diseases.

Choosing foods that lower inflammation

You’ve likely heard a lot already about anti-inflammatory diets. They’re supposed to be good for your health because low-level, systemic inflammation in your body can lead to plaque clogging up your arteries and insulin that doesn’t work well enough to lower your blood glucose.

An inflammatory diet is one laden with highly processed foods (many of which are “white” foods made with white flour and sugar), such as fries, pizza, and other fast foods that many Americans eat daily. This type of diet can cause your blood glucose levels to spike sky high after meals, even if you don’t have diabetes or prediabetes. Blood glucose spikes are bad for your health because they cause oxidative stress, which can lead to inflammation, insulin resistance, and so on. You get the picture.

Most of these processed foods are higher in calories and lower in nutrients like essential vitamins and minerals that make your body work well. Processing and refining foods too much takes out the good stuff (good for your body, anyway). To help keep inflammation at bay, avoid highly processed foods and sugar-rich drinks.

Because many complications from diabetes are likely related to unchecked oxidative stress in various tissues and organs, eating foods containing more antioxidant power that lower inflammation certainly can’t hurt. Focus on eating minimally processed, high-fiber, plant-based foods — that is, most fruits and vegetables, whole grains, legumes, nuts and seeds, and lean protein sources (like egg whites and whey protein). Other things have been shown to reduce inflammation, such as balsamic vinegar, fish oil, tea, cocoa, and cinnamon, but the research on those is less strong.

Particularly potent fruits to include are blueberries, strawberries, raspberries, oranges, mangoes, grapefruit (particularly pink), kiwi, avocados, concord grapes, cherries, and plums. Also eat more tomatoes, broccoli, red bell peppers, sweet potatoes, carrots, winter squash, kale, spinach, purple cabbage, and eggplant. These are the fruits and vegetables highest in vitamins A and C, folate, iron, copper, calcium, and fiber as well.

Dark chocolate and cocoa, red wine, green and black tea, and coffee also have large amounts of disease-fighting antioxidants. Don’t consume too much dark chocolate and wine, though, to avoid taking in too many calories. Also limit your coffee intake to moderate amounts because caffeine itself can decrease how well your body’s insulin works. Caffeine added to energy drinks, sports drinks, sodas, and more comes without the benefit of antioxidants found naturally in cocoa, tea, and coffee.

Focusing on fiber

One thing you can almost never get too much of in your diet is fiber — and I’m not talking about the type that comes out of a drugstore container. Fiber that you find naturally in foods benefits your health in so many ways, and adding in more is easy when you know where to look for it.

technicalstuff Having enough fiber in your diet is important for good health. First, fiber can bind cholesterol and pull it out of the body through the small intestines (hence the claim on oatmeal products that it helps lower cholesterol). Second, it increases the bulk of fecal matter (your bowel movement) moving through your intestines, leading to greater regularity. Adults commonly get more constipated as they age or if they don’t drink enough fluids. Eating adequate amounts of fiber daily along with taking in adequate water and other fluids helps combat constipation. Third, all types of fiber are important weapons in the fight against modern-day health problems that can keep you from living as well, including diabetes, heart disease, colon cancer, obesity, and high blood pressure.

Where to find fiber (hint: look for plants)

Most dietary fiber is found in plants — the closer eaten to nature the better. Many manufacturers now also add fiber to products like pasta, cereals, and breads. Be cautious about taking in too much of these “fake fiber” foods (some with more than 14 grams per item) as they can cause gas, bloating, constipation, and even diarrhea. On food labels, the “total fiber” listed on the label is the sum of the natural dietary fiber in foods plus any added fiber put into products during manufacturing.

tip Eat more of these foods to boost your fiber intake naturally:

  • All dry peas and beans (legumes), including navy, black, garbanzo, kidney, lima, and pinto beans, as well as lentils and soybeans
  • Vegetables, particularly green beans, snap beans, pole beans, beet greens, kale, collard greens, Swiss chard, turnip greens, spinach, peas, broccoli, Brussels sprouts, tomatoes, carrots, and corn
  • Whole fruits (with skins, but not peels), including raspberries, blackberries, strawberries, blueberries, cherries, plums, pears, oranges, apples, bananas, kiwi fruit, and guava
  • Dried fruits, such as apricots, figs, and dates (but watch your portions and how many carbohydrates you’re eating because these can raise your blood glucose)
  • Whole-grain foods, such as rye, oats, buckwheat, brown rice, whole-wheat breads and pasta, oat and wheat bran, milled flaxseed, high-bran-content cereals, soy flour, and popcorn
  • Nuts and seeds, including cashews, peanuts, almonds, Brazil nuts, walnuts, pecans, pistachios, and sunflower seeds (but watch the calories in these foods because they add up fast)

Get enough fiber (hint: eat more plants)

Most people don’t eat enough fiber for optimal health. At a minimum, you need at least 14 grams of fiber for every 1,000 calories you eat. Adult women need less than men because they eat fewer calories. After you reach age 50, recommended minimum fiber intake drops again for both men and women because you need fewer calories as you get older. Eating as much natural fiber as possible (even more than the minimum) should be your daily goal, no matter how young or old you are. Table 6-1 shows USDA’s minimum recommendations for fiber intake.

TABLE 6-1 Recommended Minimum Daily Dietary Fiber Intake

Age

Men

Women

19 to 50 years

38 grams

25 grams

Over 50 years

30 grams

21 grams

warning The only potential downside of eating up to 50 grams per day (besides going to the bathroom a lot), if you try to take in as much fiber as I challenge people to do, is that that much fiber may interfere with how easily your body absorbs some minerals like calcium and iron. For that reason, consider eating more foods with these minerals if you do consume large amounts of fiber, and drink plenty of water or other fluids to stay hydrated.

Taking in carbohydrates

Having a healthful diet while eating carbohydrates is entirely possible if you keep a few concepts in mind. A balanced meal plan for the average person, according to the latest dietary recommendations from the Institute of Medicine of The National Academies, contains 45 to 65 percent of calories from carbohydrate, 20 to 35 percent of calories from fat, and 10 to 35 percent from protein. The American Diabetes Association does not recommend any particular intake of calories from each of these categories, and people with diabetes follow a variety of individualized meal plans.

A lower-carbohydrate intake, in addition to potentially lowering your blood lipids and your blood glucose, does help some people lose weight faster (at least initially) and keep it off, although how well this works varies by the person. Part of the confusion about how many carbohydrates you should eat when you have diabetes comes from the research itself. Many “low carbohydrate” meal plans studied are only as low as 40 percent of calories from carbohydrates, although some people follow extremely low-carbohydrate eating (less than 10 percent of calories). If you take insulin to manage diabetes, balancing calorie intake from all sources is likely as important or more important than just focusing on carbohydrate intake alone.

remember Body weight is generally higher in people who consume carbohydrate-rich, highly processed foods that are rapidly absorbed and raise blood glucose. These are generally ones with a high glycemic index (the following sections delve farther into the glycemic index and glycemic load). Focus more on the types of carbohydrates you’re eating than on the total amount.

Losing body fat is generally harder when your insulin levels are high, which they’ll be after you release, inject, or pump enough insulin to cover your higher intake of carbohydrates, especially those that cause your blood glucose to rise rapidly. Because fat cells remain responsive to insulin, even when your blood glucose runs high, you’ll gain fat weight when your liver converts some of that glucose into fat and stores it.

remember Take all carbohydrates you eat into account to manage your blood glucose.

warning Eating fewer carbohydrates doesn’t necessarily lower the risk for type 2 diabetes if you replace the carbohydrates with a high intake of animal protein and fat. If you’re following a low-carbohydrate diet, get your protein and fat in foods other than highly processed meats (lunchmeats, bacon, sausage, and the like).

Glycemic index (GI)

How rapidly a carbohydrate is digested, or its glycemic index (GI), affects your body’s insulin responses and ability to manage your blood glucose. The more rapidly the body breaks down a food, the faster the carbohydrate is turned into glucose in your bloodstream. To manage the influx of glucose coming from carbohydrates, your body needs insulin. If you have diabetes or prediabetes, you may not be able to cover these glucose spikes with enough insulin.

GI values are usually scaled from 0 to 100, with glucose (the simple sugar, but also the same as what’s in your bloodstream) having a GI of 100. The GI of a specific food can differ by person; other factors that can affect it include the following:

  • Type and amount of carbohydrate, fat, and protein a food contains
  • Amount of fiber and the nature of any starches in it
  • Preparation (raw or cooked)
  • Ripeness
  • Acidity

For example, thick linguine has a lower GI value than thin spaghetti. Overcooking in general raises the GI value of foods, so al dente pasta is always better. Highly acidic foods like vinegar can lower the GI value of another food when eaten in combination. Cold storage increases the resistant starch content (carbohydrates that are hard to digest) by more than a third, and the acid in lemon juice, lime juice, or vinegar will slow stomach emptying.

tip To lower your blood glucose spikes related to eating carbohydrates, consider eating pasta that is not overcooked, using vinaigrette as dressing on your salads (or oil and vinegar), and eating foods with more resistant starch (like cooled, cooked oatmeal).

technicalstuff The latest GI database is accessible through www.glycemicindex.com (search each food separately). High-GI foods have a GI value of 70 or higher, including almost everything with highly refined flour or added sugars like most breakfast cereals, pretzels, sugary candy, crackers, and bread. White potatoes may be natural, but they have a high GI. Other carbohydrates cause less of a spike in blood glucose levels and are generally easier for your body to handle in moderate amounts. Sweet potatoes, rice (white or brown), oatmeal, and white sugar have GI values in the range of 56 to 69, which makes them medium-GI foods. Most whole fruits, fructose (fruit sugar), dairy products, legumes (beans), and pasta (white or whole-wheat) fall into the low-GI category (55 and lower).

An excessive intake of high-GI carbohydrate foods can increase insulin resistance even in people without diabetes. The GI values of foods have mainly been determined in nondiabetic individuals, so a given food’s effect may be exaggerated if your body releases less insulin or your insulin action is impaired. If anything, GI values may underestimate rather than overestimate the glycemic spikes caused by most carbohydrate-rich foods if you have diabetes.

tip Lowering the glycemic effect of your meals is generally beneficial to managing blood glucose spikes. Check your own response to your food by monitoring your blood glucose prior to eating and two hours after you start your meal.

In a study done in overweight adults, insulin resistance decreases when they eat a low-GI, whole-grain diet compared to a refined, “white” diet. In some studies, people with type 2 diabetes who follow a diet with a GI of less than 40 tend to improve their overall blood glucose, enhance insulin action, lower bad blood fats, and lose weight. Such positive results support the GI as an appropriate guide to eating, whether you have diabetes, prediabetes, or insulin resistance, or if you just want to stay healthy.

Glycemic load (GL)

For carbohydrates, portion size does matter. Glycemic load (GL) is a measure of both GI value and total carbohydrate intake in a typical serving. Paying attention to your GL is even more important with diabetes. A high-GI/GL diet will most likely worsen insulin resistance and overtax your body’s ability to supply insulin, so limit your intake of foods with both a medium or high GI value and a high GL.

A GL of 20 or more is high, 11 to 19 is medium, and 10 or less is low. For a single serving of a food, having a GL over 20 means it is carbohydrate dense, even if the spike in your blood glucose may be slower or smaller (like when you eat most pasta). Though GI is defined for each type of food, GL can also be calculated for any size serving of a food, an entire meal, or an entire day's meals if you want to get a feel for how many carbs you’re taking in.

technicalstuff Foods that have a low GL almost always have a lower GI value, with some exceptions: Watermelon has a high GI value (72), but the carbohydrate content per serving of this fruit is minimal, making its glycemic load (4) low. However, a serving of watermelon is just over a cup. Popcorn also has a higher GI value (72), but it takes a lot to equal a 50-gram serving with a GL of just 8.

Any carbohydrate-heavy meal with a high GL requires more insulin, but if the GI value isn’t also high — as is generally the case with high-fiber foods — your blood glucose will stay lower. Legumes, which are rich in protein and fiber, contain carbohydrates with a lower GI.

A low-GL, high-fiber diet also raises circulating levels of adiponectin, an anti-inflammatory hormone released by fat cells that can increase your insulin action and improve your blood glucose. A low-GI/GL diet plan results in weight loss as well.

tip Use GI and GL together to lower your blood glucose:

  • Choose slowly absorbed carbohydrates, not necessarily just a smaller amount of total carbohydrates.
  • Use GI to identify your best carbohydrate choices, choosing lower-GI ones.
  • Limit your portion size when eating carbohydrate-rich foods like rice, pasta, beans, or noodles to limit the overall GL.

Cutting back on sugar

Foods that are higher in fiber are usually lower in added sugars, along with having less fat and fewer calories. White (table) sugar boosts your blood glucose less quickly than white potatoes do, but the negative effects of eating a lot of sugar and other refined carbohydrates can be significant, particularly given their lack of essential nutrients (besides calories). What’s more, there is nothing inherently evil about fructose (fruit sugar), despite research suggesting that high-fructose corn syrup in beverages leads to a fatty liver. Taking in excess calories more likely leads to such health issues, not fructose by itself. That said, sugars (and carbohydrates) may be somewhat addictive as they cause the release of brain hormones like dopamine (in the pleasure center) in response to their intake.

tip You don’t have to give up white and other refined sugars completely, but limiting your intake of them is a great idea. One of the easiest ways to start lowering the sugar content of your diet is to reduce or eliminate your intake of all regular soft drinks, juice, fruit juice drinks, and sugar-sweetened iced tea or lemonade. In place of sugary drinks and fruit juices, substitute water, diet soft drinks, or other beverages containing noncaloric sugar substitutes. Despite all the recent media hysteria over non-nutritive sweeteners potentially causing people to gain weight or end up with cancer, no scientific evidence backs up these claims if you’re avoiding sugar to manage your blood glucose. Just practice moderation in your use of sweeteners of all types (natural or artificial).

technicalstuff You can learn a lot by reading food labels and checking the ingredients. Food and drink manufacturers must list ingredients in order of descending weight. In many products, refined sugar would come first if companies didn’t have creative ways to disguise it by adding four or five different sweeteners that then appear lower on the list of ingredients. “Added sugar” is a listing being included on food labels, but look for sugar equivalents, such as sucrose, dextrose, high-fructose corn syrup, corn syrup, glucose, fructose, maltose, levulose, honey, brown sugar, and molasses.

Boosting your health with protein

The latest nutritional fad is the high-protein diet, including protein shakes, supplements, and more. This approach isn’t necessarily a bad thing. The major building blocks of protein are amino acids. About half of these 20 amino acids are essential, meaning you must eat those, but your body can form the rest. Protein doesn’t cause rapid spikes in blood glucose levels. Eating protein also makes you feel full longer, whereas low-protein diets are associated with increased hunger. Consuming more lean protein together with more healthful fats may reduce your appetite and help you eat fewer calories and even lose weight if that is your goal. (The following section covers healthy fats.)

Your body metabolizes foods with lots of protein more slowly than it does carbohydrates, usually within three to four hours. Eating as much as 30 to 40 percent of your daily calories as protein, with a lower intake of carbohydrates and fats, may help with managing your blood glucose, losing weight, and keeping the weight off.

tip Because a high intake of protein from processed meats increases diabetes risk and can compromise your long-term health, pick high-quality sources of protein such as lean meats, soy products, legumes, fish, eggs, and nuts and seeds.

Some studies have shown that a diet rich in soy protein may be beneficial for people with type 2 diabetes. Soy protein consumption has a significant positive impact on heart disease risk and kidney problems in adults with type 2 diabetes with existing kidney disease. Eating soy protein lowered levels of blood glucose, blood fats, and C-reactive protein (an indicator of inflammation) and markers of kidney disease. Too much of anything — including soy — is not recommended, though.

Fitting healthy fats into your diet

Having diabetes — particularly when your blood glucose isn’t well managed — can contribute to unhealthy changes in your blood fats. High triglycerides (mainly from dietary fat, but also formed in your body when you eat highly refined carbohydrates) and bad types of cholesterol play a major role in stimulating inflammation that can cause plaque to form in your arteries (a common occurrence in people with diabetes).

Not every type of fat is bad for you — although the nutrition world is still hotly debating the healthfulness of various fats — but a high intake of certain types of fat definitely can contribute to the development of insulin resistance and bad changes in blood fats as much as an excess intake of refined carbohydrates can.

Add omegas and other healthy plant fats

Two dietary polyunsaturated fats are essential: omega-3 and omega-6 fatty acids. Both are important to include in a healthy diet, particularly when you have diabetes and your nutrition is even more important in preserving your long-term health.

Omega-3 fats are abundant in dark green, leafy vegetables (for example, dark-colored lettuce, spinach, kale, turnip greens, and so on), canola oil, flaxseed oil, soy, some nuts (such as walnuts), fish, and fish oils. Only fish and fish oils contain larger amounts of two omega-3 fats called DHA (docosahexaenoic acid) and EPA (ecosapentanoic acid), which are critical for brain and nerve function, cardiovascular health, and more. Plant foods like walnuts contain mainly a third essential omega-3 fat called ALA (alpha-linolenic acid), which your body can convert into the other two if your intake of them is low. Omega-6 fats are abundant in the corn, sunflower, peanut, and soy oils that are used in making margarine, salad dressing, and cooking oils, and these oils may help lower inflammation. Because some studies have suggested that taking in too many omega-6 fats can lead to inflammation, just try to balance out your intake of the two types to optimize your health.

Diets high in certain types of fats — like the plant-based ones found naturally in avocados — may improve your body’s insulin action. Even tropical oils like coconut that are minimally processed are now considered healthier options even though most of their fats are saturated.

tip The best advice is to simply cut down on the intake of unhealthier fats by eating more foods in their natural state, such as high-fiber vegetables, legumes, nuts and seeds, and fish.

It also now appears that unhealthful carbohydrates may impact your blood cholesterol and fats more than the fat that you eat. If you choose to eat a diet that falls within the general guidelines for all adults (20 to 35 percent of your total daily calories) and avoid lower-fat versions of snack foods that have added sugar and more refined carbohydrates in them, your blood cholesterol levels are more likely to go down.

Avoid trans and highly processed fats

Trans fats are mostly created by manufacturers when they hydrogenate or partially hydrogenate liquid oils to alter their texture. Consuming trans fats found in hydrogenated oils contributes to insulin resistance and makes keeping blood glucose and cholesterol levels under control more difficult. Their inclusion on food labels has led to fewer of them being added to foods by manufacturers, thankfully.

Found most abundantly in processed foods such as crackers, cookies, baked goods, and more, trans fats may be disguised as mono- and diglycerides, stearate, palmitate, lard, vegetable shortening, and hydrogenated or partially hydrogenated oils. Trans fats from natural sources, however, aren’t unhealthy like the manufactured ones (you’ll find a small amount in dairy products that is natural), and most foods contain very little of these anyway.

Eating even one meal high in manufactured trans or some saturated fats can interrupt the normal flow of blood through your arteries and veins for hours afterward and make your body’s response to insulin sluggish as well. On the other hand, when you eat a high-fat breakfast that contains mostly a good fat like olive oil (rather than, say, sausage), your blood glucose and insulin levels stay lower. Your blood cholesterol should decrease as you reduce trans, saturated, and highly processed fats in your diet.

technicalstuff Another fat to start watching out for is interesterified fat, which is also manufactured and now added to some processed foods in place of trans fats. This new type of altered fat is also heart-unhealthy, probably as much as trans fats, but it’s hard to know how much is in foods because manufacturers don’t have to report or list it on food labels yet.

What about fat in red meat, dairy, eggs, and nuts and seeds?

Although current research is unclear as to whether unprocessed red meats directly cause heart disease, more healthful choices are available, including fish, nuts and seeds, legumes, fruits, and vegetables. If you consume cheese and milk, pick lower-fat varieties — not because dairy fat is bad for your health but rather to take in fewer calories.

Also, diets rich in the monounsaturated fats in nuts and seeds (as well as olive and canola oil) are heart-healthy and don’t necessarily promote weight gain if eaten in moderation. Just don’t eat the whole jar in one sitting!

Eating more healthful meals and snacks

Here are some easy tips for preparing and choosing more healthful meals:

  • Cook with olive or canola oil. Go easy on the oil (or use a cooking spray) and avoid frying foods.
  • Use lean cuts of meat, including beef with all visible fat removed; skinless chicken and turkey breast; and lean ground beef, ground chicken, or ground turkey, as well as fish, tofu, and soy protein.
  • Bake, broil, poach, or grill meat, fish, and chicken instead of frying them.
  • Limit or avoid highly processed meats (like bacon, sausage, and lunch meats) because the sodium and preservatives added to them are likely bad for your health. A high intake of highly processed meats also increases your risk for type 2 diabetes.
  • Lower-fat (and sugar-free, whenever possible) varieties of dairy products, including milk, cheese, sour cream, yogurt, and ice cream, may be good options simply to lower calorie intake.
  • Eat veggies raw, steamed, microwaved, or grilled, using only light seasonings or spicy peppers rather than drenching them with creamy, cheesy, or buttery sauces.
  • Steam vegetables in a small amount of water or grill them to prevent the loss of key vitamins and minerals.
  • Use mainly fresh or frozen vegetables and fruits; canned ones often contain added salt and/or sugar. If you must use canned fruit, purchase fruit packed in its juice. Choose canned vegetables with limited added salt or rinse well.
  • Keep fresh vegetables like baby carrots, broccoli, peppers, or cauliflower handy for snacks, and eat them with a healthful dip like hummus (chickpeas and sesame tahini) and fat-free or olive oil-based dressings.
  • Snack on whole fruits rather than manufactured products containing fruit, and keep a variety of fruits, such as grapes, apples, oranges, bananas, and seasonal fruit, on hand for healthful snacks (but watch how many carbohydrates you’re eating).
  • Choose whole fruit over juice. If you drink juice, aim for 100 percent juice (not juice drinks) and limit your intake to one serving.
  • On salads, use balsamic vinegar or a limited amount of other dressings if you’re concerned about your weight. Dressings containing oils of any type are still high in calories, while fat-free or reduced-calorie varieties often have added sugar, which can raise your blood glucose.
  • Add cut-up vegetables to stews, soups, or omelets to increase their nutrient value, water content, and fiber.
  • Buy only bread products that list whole grain as the first ingredient on the food label, and use other whole-grain products whenever possible.
  • Add extra fiber into recipes for baked goods, casseroles, and soups by spooning in a few tablespoons of oat bran, wheat bran, or milled flaxseed when you prepare them.
  • For baked goods, try using only one-half to two-thirds of the sugar called for by the recipe and use healthier margarines (also reducing the amount by a third if possible or using the “light” varieties). Eat baked goods and sweets in smaller portions or just have a bite.

Getting Your Vitamins and Minerals from Foods or Supplements

Obtaining nutrients naturally through your foods if you can is always best because they contain many important phytonutrients (such as flavonols, polyphenols, catechins, and lycopenes) that aren’t available in an optimal form through dietary supplements. Taking large supplemental doses of any vitamins, minerals, or other nutrients can be counterproductive, though. For example, almost all antioxidant vitamins and minerals can actually cause damage when you take too much. Head to the later section “Antioxidants” for more on supplementing with these substances.

You can’t overdose on antioxidants if you obtain them naturally through food, though, so get them that way whenever possible. The following sections discuss some of the most important vitamins and minerals for people with diabetes.

B vitamins

The vitamins in the B family include thiamin (B1), riboflavin (B2), B6, niacin, B12, folate, biotin, and pantothenic acid. These vitamins are involved in the digestion and metabolism of food, so it’s not surprising that a deficiency in any of them can adversely affect your body’s handling of carbohydrate, protein, fat, and more.

People with diabetes are more likely to be deficient in thiamin, and supplementing with this vitamin has been shown to prevent some diabetic complications and improve insulin action in adults with type 2 diabetes. Vitamin B6 and others in the B family may be effective in preventing the formation of harmful substances in blood (advanced glycation end products) associated with diabetes complications. Vitamin B12 deficiency is also quite common in people with type 2 diabetes or prediabetes, particularly if they take metformin, which can cause depletion of this vitamin over time (as well as symptoms of nerve damage). Low blood levels of vitamin B12 are associated with neuropathy-like symptoms that may be reversible with supplements.

remember The American Diabetes Association recommends using supplements only if you’re deficient in any vitamins or minerals. Getting adequate amounts of these through your diet is recommended.

technicalstuff Vitamin B12 deficiency, verified with a blood test, has been associated with a lower bone density in the spines of women and the hips of men. If you use metformin, you have a higher chance of developing this deficiency over time; you may want to ask your doctor to check your blood levels. Low intake of folate has been associated with an increased risk of fetal defects (related to neural tube development) in pregnant women, as well as a higher risk for thinning bones and heart disease in older adults.

Make sure that your daily diet contains at least 100 percent of all the B vitamins (their content should be listed on the label), and consider taking at least a general B vitamin supplement of 100 percent of the RDA if you have any deficiencies that can’t be corrected naturally through your diet. Supplemental doses of B vitamins are generally harmless because you lose any excess through your urine, but taking megadoses of these vitamins isn’t necessary or advisable. For example, taking large doses of supplemental folate can mask a deficiency of vitamin B12 and cause other symptoms like nausea, and too much B6 can cause permanent nerve damage.

If you have diabetes, you may want to talk to your doctor about supplementing with thiamin or benfotiamine, a derivative of vitamin B1 (thiamin) with additional antioxidant properties, because both have been used to treat neuropathic pain. They may also prevent other complications, improve insulin action, and lower your blood cholesterol levels.

Vitamin D

Vitamin D is unique in that it functions as a hormone. All the cells in your body have a receptor for it. Long associated with bone health, its effects are far-reaching: It can lower the risk of developing some autoimmune diseases, certain types of cancer, diabetes, infectious diseases, heart disease, asthma, and neuropathy. Having enough vitamin D in your body also lowers your risk of dying from any cause.

The body derives most active vitamin D (about 90 percent) from limited exposure to sunlight, which is why this vitamin is often called the “sunshine vitamin.” Apparently, you need to get sunshine on your face and hands for a only few minutes a couple of times a week to create what you need in your body (depending on the time of year, of course, and where you live).

Still, many people with diabetes have low blood levels of this vitamin. Older adults also don’t create as much vitamin D in their skin with sunlight exposure, and taking in enough through your diet alone is hard.

tip Some foods naturally high in vitamin D include fish oils, fatty fish (like salmon), mushrooms, beef liver, cheese, and egg yolks, but spending time outdoors likely works better to increase levels than eating more of these foods does (unless you’re wearing excessive amounts of heavy-duty sunscreen). Because dietary supplements can raise blood levels of vitamin D, dietary experts recommend taking 600 international units (IU) of vitamin D if you’re under 50 years old or 800 IU if you’re older than 50.

Magnesium

Magnesium, an abundant mineral in the body, is involved in over 300 of the body’s metabolic reactions. It improves your insulin action, so not having enough magnesium isn’t good for your diabetes management. A magnesium deficiency can contribute to insulin resistance and raises your risk for developing type 2 diabetes (if you don’t have it already). Low magnesium levels in adults with diabetes are also associated with eye disease, nerve damage, and depression. If you’re getting muscle cramps frequently, you may be deficient in magnesium.

technicalstuff Magnesium greatly impacts your body’s energy production, synthesis of genetic materials (DNA and RNA), protein formation, and bone health because it facilitates the enzymes and pathways that make these processes work. As a result, magnesium largely controls your blood pressure, regulates the rhythm of your heart, and prevents muscle cramps. In fact, magnesium deficiency has been linked to high blood pressure, stroke, plaque formation and heart disease, cardiac arrhythmias, alterations in blood fats, platelet stickiness, inflammation, oxidative stress, asthma, chronic fatigue, depression, and more.

This mineral is widely distributed in foods like unprocessed (whole) grains, nuts, legumes, and even dark chocolate (thank goodness for that!). You can lose some magnesium through urinating more when hyperglycemic or sweating excessively (such as during exercise).

Particularly if your blood glucose management could be better, you may want to consider taking a daily magnesium supplement, along with eating a more healthful diet. Taking too much magnesium can cause temporary diarrhea, but it’s otherwise safe. But don’t take more than 350 milligrams daily.

warning If you have kidney failure, restrict your magnesium intake.

Deciding Whether You Need Other Supplements

Although diabetes can create a special metabolic situation that depletes certain vitamins and minerals from your body, you may be able to compensate with more healthful food choices, certain nutritional supplements, and improved blood glucose management. If you’re getting the recommended daily amounts of vitamins and minerals in your diet, then you may not need any supplements — which are only beneficial if you’re truly deficient. Insulin resistance and hyperglycemia can potentially cause certain deficiencies, but if you manage these conditions effectively, supplements are not universally recommended and could potentially be harmful.

Being cautious about supplements

If you decide to use home remedies or supplements, keep in mind that the term herbal or natural on a label doesn’t mean that a product is harmless. In fact, many common poisons found in plants like hemlock and deadly nightshade are “natural.” Some dietary supplements may have undesirable side effects; for example, certain forms of ginseng can raise blood pressure, and mugwort can cause dermatitis (skin inflammation).

Other “natural” supplements can interact with your prescribed medications to produce side effects or possibly negate the usual effects of the medication. For instance, people have been poisoned, in some cases fatally, by taking herbal preparations containing heliotropium while also taking a prescribed barbiturate. Also, there is no evidence showing how those supplements or herbs can interact with your current diabetes medications, so be extra careful with taking them.

tip To be on the safe side, tell your doctor about any herbal or “natural” supplements you use, especially if you take any prescribed medications.

warning Err on the side of caution when self-prescribing a supplement that can potentially improve your blood glucose, for a couple of reasons:

  • Most of the “natural” cures currently available online have no valid studies proving that they work, and many can be harmful.
  • Just because a supplement is supposedly helpful (like cinnamon to lower blood glucose), you should never assume that taking more of it is going to be more effective. You can take in toxic amounts of substances — even vitamins — if you self-prescribe large doses.

What’s more, the supplements you buy may vary widely in their actual content. Some studies have shown no ginseng in products that are sold as ginseng supplements, and the packaging for many herbal preparations doesn’t list the ingredients. Even when products do disclose the ingredients, the lists may not be accurate or complete. Up to 26 percent of all dietary supplements tested in one study contained contaminants sufficient to elicit a positive drug test in competitive athletes. Others may contain harmful and even potentially fatal contaminants.

Creatine

Creatine is a natural compound, normally found in muscle, that is involved in short-term energy production. It’s well established as an effective supplement in weight lifters and other power athletes who are gaining muscle mass, but only when they’re training. Taking creatine supplements in combination with doing resistance training may increase your strength gains from training and lower your insulin resistance, but doing so certainly isn’t a requirement if you want to get stronger by doing such training. Talk to your doctor first about whether you should use creatine if you have any issues with the health of your kidneys.

Whey protein (essential amino acids)

Leucine, an essential amino acid found mainly in whey protein derived from cow’s milk, is an important building block for muscles, and consuming adequate amounts of it is essential. Eating quality protein and getting enough calories are the preferred (and less expensive) method, but you can also find L-leucine (as well as creatine, which I discuss in the preceding section) as a dietary supplement in stores. You also get it as part of whey protein supplements or blends.

tip Take in adequate amounts of amino acids naturally through your diet by eating quality proteins (found in milk, egg whites, and more), but don’t waste your money on expensive supplements. As you age, the most important thing to do for your muscles is to stay active and recruit all your muscle fibers (by doing heavier resistance work), not focus on taking amino acid supplements.

Carnitine

Many people with diabetes or undergoing renal dialysis are deficient in carnitine, which your body produces from amino acids. If your body makes enough, you don’t need to supplement or to worry about consuming any carnitine in food. Having enough is important, though, because carnitine increases your insulin action and is essential for metabolizing fats and carbohydrates.

technicalstuff Carnitine is an important compound in your body because it transports fats into mitochondria of cells (the powerhouses) to produce energy. Carnitine is a generic term to describe L-carnitine, acetyl-L-carnitine, and propionyl-L-carnitine, but only the L-carnitine form, the one active in your body, is in food.

If you’re deficient in carnitine, you can obtain it by eating meat, fish, poultry, and milk. It’s most concentrated in whey protein (dairy products), but it’s also safe to take as a supplement of L-carnitine or acetyl-L-carnitine, usually in 500- or 1,000-milligram doses.

Carnitine supplementation can improve insulin sensitivity by decreasing fat levels and glucose in blood. It may also help lessen some diabetes complications. In a study of 1,200 diabetic patients, researchers found that treatment of type 1 or type 2 diabetes with acetyl-L-carnitine (500-milligram or 1,000-milligram doses daily) for a year relieved diabetes-related nerve pain in feet and improved sensation of vibration. Thus, it may help delay progression of neuropathic pain or reduce its severity.

Antioxidants

One of the latest crazes is everyone taking antioxidants to stay young. Supplements containing antioxidants are supposed to be able to slow aging by preventing cumulative oxidative damage in the body. However, consistent research is lacking. Elevated blood glucose is one of the conditions that can trigger such damage caused by excess free radicals (compounds that cause oxidative damage and inflammation).

remember Damage caused by free radicals in the body may contribute to the complications associated with long-term diabetes, including heart disease and eye, kidney, and nerve damage.

Normally, your body has enough antioxidant enzymes naturally to fight most or all the free radicals that are created. These radical compounds, if left unchecked, promote further insulin resistance and lower insulin secretion. Diabetes not only increases free radical generation when your blood glucose is elevated but can also depress your body’s natural antioxidant defenses. (Exercise stimulates the production of these radicals, but it also enhances your body’s natural antioxidant enzymes systems that get rid of them.) If your blood glucose levels aren’t well managed, you’re more likely to benefit from supplemental antioxidant therapies.

The antioxidants with the most potential benefit for anyone with diabetes are glutathione, alpha-lipoic acid, vitamin C, vitamin E, beta-carotene, selenium, copper, and zinc.

Glutathione is the main antioxidant enzyme found in all your cells, and, along with alpha-lipoic acid, is the most important antioxidant in your body. It protects the DNA in your cell nuclei from being oxidized. Having diabetes likely increases your need for glutathione and alpha-lipoic acid by depleting glutathione levels when your blood glucose is elevated, potentially leading to diabetes-related cataracts and other complications. Although your body can synthesize both from amino acids found abundantly in foods like asparagus, avocados, spinach, strawberries, peaches, melons, and citrus fruits, it may not always make enough to meet your body’s needs.

Alpha-lipoic acid increases glutathione levels by helping cells absorb a critical amino acid needed for its synthesis, and it works to prevent stroke, heart attacks, peripheral nerve damage, and cataracts, as well as memory loss, cancer, and aging effects. Spinach (raw or cooked) is the best source of this nutrient, also found naturally in small amounts in broccoli, tomatoes, potatoes, peas, and Brussels sprouts. Spinach is especially touted for its ability to fight diabetic cataracts and macular degeneration (the leading cause of blindness in adults).

technicalstuff Diabetic complications like cataracts involve deficient glutathione levels within the lens of your eye, and nutrients like alpha-lipoic acid, vitamins E and C, and selenium can increase your levels of glutathione and its activity, allowing for better protection of your eyes and other tissues. A combination of vitamins C and E and the minerals magnesium and zinc may improve the good cholesterol in adults with diabetes.

Alpha-lipoic acid supplements may normalize diabetes-induced kidney dysfunction and damage to nerve cells, where they additionally promote nerve fiber regeneration and stimulate a substance known as nerve growth factor. In Germany, alpha-lipoic acid has been used for years to treat painful diabetic neuropathy in the feet and hands, and it can also improve autonomic (central nervous system) neuropathy. Most people can safely take 600 milligrams once or twice daily for relief of symptoms.

..................Content has been hidden....................

You can't read the all page of ebook, please click here login for view all page.
Reset
54.144.219.156