Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.
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How Can I Maintain A Healthy Diabetic Diet?

Wednesday, 21 Jul 2010 10:36 AM

Question: Several diets for diabetes say to eat plenty of starchy foods (bread, pasta, beans, etc.) and at least five servings of fruits and veggies. What fruits won’t increase the risk of glucose spikes? Won’t starch also cause the risk of glucose spikes following meals? I am also confused about fructose. Some reports indicate that fructose is not converted to glucose in the body (but may be used directly as an energy source) and therefore does not affect the whole insulin/glucose metabolism story. Others indicate that type 2 diabetes was induced in rats by overfeeding them with fructose. How would this be possible if fructose had a completely different assimilation pathway?

Dr. Hibberd's Answer:

Good diabetic diets are essentially calorie restricted diets that are preferably high in fiber and low in fat. The latter is especially important now that diabetes is recognized as a major risk factor for heart attack, and targets for cholesterol are much lower for diabetic patients and cardiac patients than for the rest of us.

The most common conventional diabetic diet is the 1800 calorie for type 2 diabetics, but most type 1 diabetics will consume far more than this to merely sustain their weight!

Diabetic diets are not usually lower than 1200 calories per day, while 1000 calories a day are occasionally used for those needing to lose weight. On the other hand, younger very active type 1 diabetics may require 2,400 to 3,500 or more depending upon their activity levels and co-existing conditions.

Calorie restriction is paramount in diabetic management, with the sugar content restricted, or at least of a type that will not cause huge, immediate spikes of blood glucose that so often occurs with simple sugars. Remember that these diets are also intended to supply some form of immediate glucose release to accommodate those on insulin.

I agree with you that there has been an overemphasis on bread and pasta products that supply some immediate glucose, and this is not always needed for all diabetic patients, especially when they are not on injectable medications such as insulin, exenatide, or pramlintide. Consultation with a dietician, which I highly recommend for all diabetic patients, accommodates individual differences. The truth is that most diabetic diets are quite useful for those of us who are not diabetic!

High fiber diets will enhance a more even glucose absorption and minimize peaks of glucose values. Fructose will elevate your blood glucose level as you have already discovered. In fact, all sugar compounds will have an effect on blood glucose levels though the effect on blood glucose may be blunted by a difference in the number of metabolic steps needed for conversion. Such metabolic steps can cause less abrupt elevations than pure glucose compounds that are directly absorbed into the bloodstream. A food's effect on blood glucose level may be less pronounced than simple glucose (sugar) compounds that are directly absorbed. Glucose compounds, which cause immediate peaks, are absorbed rapidly with no intermediate metabolic steps.

Try to consume fruits and vegetables with high fiber content. The fiber will reduce glucose peaks and allow the food to be absorbed more slowly causing a less abrupt rise in blood glucose (sugar) level. The best fruits are also high in fiber while the low amount of fiber in fruit juices will cause more rapid rises in blood glucose levels. If you choose orange juice, select the high pulp variety. Basically, go slow with bananas, careful with oranges, melons, grapes, and tangerines, and eat all of the apples you like. Try to incorporate as much fiber into your diet as possible, as this will not only slow the peaks in blood glucose levels, but will enhance your colon health and function while benefiting your cholesterol and triglyceride levels (blood fat levels) as well.


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