Diabetes and Stress

One piece of the diabetes puzzle that often goes unaddressed is stress. Stress is often the reason why people over eat with Type II diabetes in the first place.

Stress also can wreak havoc on blood sugar numbers as well. A dear friend of mine from medical school has type I (insulin dependent) diabetes. I will never forget the lesson I learned about diabetes and stress that day of our winter quarter Gross Anatomy Midterm.

Nothing is more stressful than being in a room full of 50 dead bodies and have 60 seconds to determine in a room stinking of formalin which way was up and which way was down, what part the tagged pins were in, write down the proper medical term and scurry off to the next body as soon as you hear the word “ROTATE”.

My friend had checked her sugar before the exam and she was sitting pretty at a 92. After the exam her numbers had shot up near 300! At first I was baffled as she had not eaten anything in that one hour period. Until I remembered what I had been learning about recently in my Physiology class about cortisol.

Cortisol is one of our emergency stress hormones that causes the liver to dump it’s stores of sugar so that we can perform at our peak when the proverbial bear is chasing us. Every doctor knows that if you give a diabetic patient an artificial form of cortisol in the form of a corticosteroid such as prednisone that it will seriously mess up their blood sugar numbers.

So, because of that little Gross Anatomy anecdote, I make a point to check in with all my diabetic patients about their stress levels. Frankly in this day and age EVERYONE is stressed out…and having diabetes does not exactly make your life that much easier.

Reducing stress is a long term goal for calming seemingly erratic blood sugar numbers. Meditation, breathing, and exercise are great ways to go about that. Cortisol is not your friend. To learn more about how stress affects the system, you can read this article on STRESS.

Diabetes and Exercise

Let me tell you about a simple little magic trick I learned about diabetes while traveling on a road trip with my Type I diabetic friend.

Her blood sugar was running very high, so we stopped at a rest stop and she proceeded to run several laps around the grass field followed by several minutes of jumping jacks and calisthenics. She checked her numbers at the end of this little mini work out and they were magically within normal limits again! I had my eye on her the entire time and she had not given herself a shot of insulin.

How did you do that? I asked in shock

“Exercise is magic for diabetics” she smiled.

Exercise is not only important for diabetics for stress management, and cardiovascular protection, but it also works like free insulin in the body. Upon our return home I pulled up some research articles on this topic and found that exercise somehow makes the cells permeable to glucose without the need for insulin.

Wow! Exercise is magic for diabetics. For both Type I and Type II patients alike, starting an exercise program is imperative to a health diabetes prognosis. Those over the age of 50 should have an EKG done prior to starting any cardiovascular fitness regime. Please check with your doctor before making any changes.

To get started with a basic fitness plan you can read this article on EXERCISE.

Diabetes: Healthy Meals

Eat three meals daily and 1-3 snacks depending on what works best.

Emphasize WHOLE FOODS and reduce the consumption of refined "white foods" such as breads, cereals, and other grains that are not whole grains.

High fiber and protein paired with complex carbohydrates are the keys to success for lowering the GLYCEMIC LOAD.

Healthy Meal Ideas for Diabetics:

Bowl of steaming brown rice topped with lemon tahini sauce or spicy peanut sauce, cubed tofu and sautéed vegetables such as carrots snap peas, mung bean sprouts, onions, garlic and red pepper.

Cup/bowl of bean soup: e.g., split pea, black bean, chili, lentil, or navy bean, with a side of vegetables and whole grain toast.

Omelet stuffed with vegetables and a slice of whole-grain toast.

Tofu or tempeh burger on a whole-grain bun with lettuce, tomato, sprouts, a side of baked, sweet potato French fries and green salad.

Baked potato topped with chili, plain yogurt, salsa and broccoli.

Whole-grain cereal (hot or dry) topped with nuts and/or seeds, milk and fresh berries.

Brown rice and black bean burrito with avocado, salsa and spinach.

Miso soup with cubes of tofu and chopped vegetables such as: bok choy, kale, carrots, watercress, collards, seaweed, and diced potatoes.

French toast or waffles (whole grain) with tahini (sesame seed butter) or nut butter and fresh fruit.

Fresh garden salad with plenty of vegetables, roasted pumpkin seeds and tahini or olive oil based dressing. Add some seasoned tofu cubes for more protein. Include a small whole grain roll or crackers to round out this meal.

Stir-fry of various chopped vegetables such as kale, chard, mushrooms, peas, bell peppers, zucchini and squash with either tofu, chicken, shrimp, scallops, or beef and served over steaming brown rice, quinoa, barley, or wheat berries.

Diabetes: Blood Sugar Control

The best meals are those that are WHOLE FOODS. In order to prevent diabetic complications you should not only learn to balance your blood sugar, but also eat snacks that are rich sources of vitamins, minerals, and polyphenols.

Goal: Eat three meals and one to three snacks daily. Choose a variety of foods to help ensure the balance of nutrients for optimal health. Eating regularly and never skipping meals helps prevent low or high blood sugar.

Tip: Each meal should contain sources of healthy fats, protein, and fiber along with carbohydrates. Fats, protein, and fiber are digested slowly and help stabilize blood sugar.

Diabetes: Healthy Snacks

Vegetables are the best snack for diabetics. Most non-root veggies are essentiall "free foods" which means they are free of calories, but rich in vitamins, minerals, and polyphenols needed to protect the damage to the cardiovascular and visual system that ensues from diabetes.

Get creative with different low calorie bean dips, cottage cheese, hummus, guacamole, and other healthy dip ideas in order to stretch your calorie allowance that much further. Two tablespoons of almond butter for instance has about 190 calories, but celery is a "free food" is high in fiber, and thus goes great with the vegetarian proteins and fats in almond butter.

Just buy it raw not roasted. Roasting destroys the fats in nut butters rendering them rancid. Rancid fats age our arteries and get stored as fats. Healthy fats are used by every single cell in the body to protect us from disease. Use your fat calories wisely!

Smart Snacks for Diabetics:

• Hummus with raw chopped vegetables or whole grain pita bread.
• Low-fat organic cottage cheese with sliced pear, plum, cherries, or ¼ cup fresh berries.
• Whole-grain toast with nut butter (cashew and almond butter are delicious alternatives to peanut butter).
• Olive tapenade spread on toasted pita bread, no salt corn tortilla chips, whole grain crackers, or rye crisp.
• Apple or pear slices with organic cheese slice or nut butter.
• Mochi with 1 Tbsp nut, seed or apple butter smothered inside.
• Low-fat organic yogurt with nutty (almonds, cashews, etc) granola or ¼ cup fresh berries.
• Tofu chive spread or roasted garlic tofu spread (both found at the PCC deli) with crackers, whole grain bread, or pita.
• Nuts or seeds (roasting them with tamari is delicious) and a piece of fruit.
• Sardines or smoked salmon on a cracker.

What is Type 2 Diabetes?

Type 2 Diabetes is the most common form of diabetes. There are 18.2 million people in the United States who have diabetes.

An estimated 13 million have been diagnosed, and unfortunately, 5.2 million people (or nearly one-third) are unaware that they have the disease. It occurs most often in people over the age of 30.

Warning signs of Type 2 diabetes may include frequent urination, unusual thirst, extreme hunger, unusual weight loss, fatigue and irritability as well as frequent infections, blurred vision, cuts or bruises that are slow to heal, and tingling or numbness in the hands or feet. Many people who have Type 2 diabetes have no symptoms.

Diabetes is a disease that impairs the body’s ability to use food. The hormone insulin, which is made in the pancreas, is necessary for the body to be able to use the sugar it makes from food (glucose). In people with diabetes, either the pancreas doesn’t make insulin or the body cannot use insulin properly. Without insulin, glucose - the body’s main energy source - builds up in the blood. When glucose builds up in the blood instead of going into cells, it can cause several problems:

• The body’s cells may be starved for energy.
• High blood glucose levels may damage the eyes, kidneys, or nerves over time.
• Increased risk for heart and blood vessel disease.

Diabetes is a chronic disease, which requires lifelong diet and lifestyle changes. The main goals are to achieve and maintain good blood sugar and lipid (fat) levels. Thus it is very important to frequently monitor blood sugar levels and keep them within the normal range.

DIETARY GUIDELINES THAT MAY HELP

Nutritional treatment for diabetes focuses on improving the body’s use of insulin through healthy meal planning, exercises and weight loss. A well-planned diet in combination with exercise and weight loss can dramatically improve the body’s response to insulin. This improvement helps prevent dramatic ups and downs in blood sugar levels. Sometimes diet and exercise may not be enough and the doctor may prescribe glucose-lowering drugs or insulin.

The nutrition plan for diabetes is the same healthy diet recommended for all people. A healthy diet should include carbohydrates and lean sources of protein, should be low in fat, and high in fiber. It is important to eat an appropriate amount of calories to achieve and maintain a healthy body weight.

There are three types of foods that fuel our body: carbohydrates, protein, and fat. Of these fuels, carbohydrates have the greatest effect on blood sugar levels.
• Carbohydrates: sources include breads, pasta, rice, cereals, grains, fruit, juices, sugar, milk, yogurt, and vegetables, including non-starchy vegetables (broccoli, leafy greens, carrots, and others) and starchy vegetables (potatoes, peas, corn, winter squash, yams, parsnips, and others).

• It is best to choose carbohydrates that are high in fiber such as, whole grain breads and cereals, and to avoid or eat small portions of food that contain refined carbohydrates (white breads, bagels, and pasta, candies, cookies, and cakes). Fiber in food slows the absorption of sugar, which keeps blood sugar from rising too quickly.

• Spread carbohydrates throughout the day by eating small meals and snacks to help to keep blood sugar levels even. Blood sugar levels may be managed more easily by eating 6 small meals or snacks throughout the day rather than 3 large meals.

• It is important that meals are not skipped; eating regularly and never skipping meals helps prevent dangerously low or high blood sugar levels.

BALANCE

Each meal should contain sources of healthy fats, protein, and fiber along with carbohydrates. Fats, protein, and fiber are digested slowly and help stabilize blood sugar. Work toward including small amounts of protein, fat, and fiber along with carbohydrates each time you eat.

• Protein: Protein increases the time that it takes for the body to digest foods and therefore helps limit sharp rises in blood sugar. Some protein should be included at each meal and snack. Choose lean protein sources such as fish, poultry, beans, nuts and seeds.

• Fat: Fat, like protein increases the time that it takes for the body to digest food. Also, a low fat diet is important for weight control and to reduce the risk of heart disease, therefore 20-30% of calories from fat is recommended. Limit saturated fats found in animal products (meat, poultry, dairy, and butter) and include sources of healthy fats (dry-roasted nuts and seeds, cold-water fish, avocado, and flaxseed oil).

• Fiber: Fiber, especially soluble fiber, helps slow the digestion and absorption of carbohydrates, which helps prevent rapid rises in blood glucose levels. Good fiber sources include beans, oat bran, nuts, seeds, pears, apples and most vegetables. Choose whole fruit rather than fruit juices; whole fruit has fiber, juice does not.

• Exercise: Exercise is a main component of blood sugar control: exercise can reduce blood sugar levels and increase the body’s receptiveness to it’s own insulin. A 30-minute walk after meals can help control blood sugar levels. Exercise in conjunction with diet changes assists with weight loss and decreases the risk for heart disease. If an exercise routine is not currently in place, check with a doctor before beginning.

References: American Diabetes Association http://www.diabetes.org
Mahan LK, Escott-Stump S. Krause’s Food, Nutrition and Diet Therapy (11th edition). WB Saunders Company, 2004.

Diabetes Diet

Eating your meals with a “Low Glycemic Load” means that you are going to stay fuller longer and thus less likely to go out and binge on a bunch of junk.

Staying full is as simple as eating foods with a high protein, fiber, and water content। Keeping yourself feeling satisfied is the most important aspect for success with any weight loss program.

Regardless of it you have diabetes or not, you are in the right place when it comes to learning the basics on how to eat correctly to stabilize your blood sugar. Stabilizing your blood sugar translates long term in to weight loss, ridding yourself of that jittery, irritable, faint feeling associated with hypoglycemia, improving energy and mood, as well as providing the foundation for an anti-aging program!

Wow all that from just one diet!

How exciting.

I bet right now you really want to buy whatever I am selling. Well I am not selling anything, except healthy diet and lifestyle.

I am simply here to teach you how to change your eating habits permanently over the long term, and field any questions or concerns that come up as you start this new adventure to a healthier you.

The most exciting thing about this diet, is that I can sum up how to do this diet in one simple sentence:

Every meal you eat should be high in protein and fiber.

Yes, it is that simple.

Memorize that.

Make that your new mantra.

Fiber is your new best friend forever!!!

Lean proteins are your new favorite friends.

The next step is to memorize what high fiber foods are and what foods are healthy sources of protein and to stock your cupboards with all these foods.

Trust me we will get fussy about the numbers later. But you need to get the basics down before you will be ready for anything like.

Most foods high in fiber are either fruits, vegetables, or whole grains. Begin to make best friends with vegetables now as for diabetics and those trying to lose weight they are essentially “free foods”, meaning the calorie count is relatively insignificant, with of course some occasional exceptions.

Here is a list of good lean protein choices: Chicken, fish, white cheese, plain nonfat yogurt, beans, and whole grains.

Now let’s keep in mind that certain proteins high in saturated fat like beef, bacon, and cheddar cheeses are just not conducive to a healthy lifestyle. Especially for those of you with diabetes we want to be on the look-out for heart disease and kidney problems. If you are having a hard time giving these up then simply treat them like the garnish for your plate. Instead of a pile of bacon you get just have one little piece.

Over time you will begin to feel so much better on this diet that it will be WORTH it for you to get rid of the offending foods. Remember “nothing tastes as good as being healthy and looking good feels”.

Be sure to drink plenty of water in between your meals. A high fiber diet will naturally require more water. Water will also help keep you feeling full. Sometimes we feel hungry when really we are thirsty.

Now most patients that have Type II diabetes (non-insulin dependent) have it because they already have a very unhealthy relationship with food, if not engage in compulsive eating patterns, and use food as a drug. For my patients having a hard time making these necessary dietary changes, I recommend counseling. Counseling may help treat the underlying problems of anxiety or depression.

While they are trying to make the necessary changes to change their emotional relationship with food, I recommend that they keep chewable fiber tablets on hand so that if all else fails they can at least lower the Glycemic Load of the binge. Now you have to be careful not to get the chewable fiber tablets high in sugar! But sometimes a glass of Metamucil or your favorite fiber supplement can help offset the huge quantity of sugar consumed. Yes this is a quick fix tip, and no it is not addressing the root cause of the problem, it is simply offering a solution to a common problem and trying to approach it realistically while we work towards a permanent solution.

Now that you are eating lean proteins and high fiber foods, the next question is…

“Can I have carbohydrates on this diet?”

Most doctors agree that in most cases a “Slow” carbohydrate diet is better than a “Low” or “No” carbohydrate diet. Personally I am not a fan of the No/Low carbohydrate diet unless it is for specific therapeutic purposes.

“So how do I know if my Carbs are “slow” or not?”

Well that is where the magic of the low glycemic index diet and the numbers assigned to certain foods come in to play. This usually is a bit too complicated for me to just start patients out with right off the bat. I prefer to have my patients on a whole foods diet of lean proteins and fruits and vegetables before playing around with various carbohydrates.

Glycemic Index numbers are determined in a laboratory by measuring how quickly a test panel of humans blood sugars rise after consuming the food. The higher the blood sugar rises, the higher the glycemic index number is as a result. For instance a piece of white bread has a high index number as it will raise your blood sugar rapidly.

Interestingly enough after analyzing the numbers on the Glycemic Index chart one can conclude that not all carbohydrates are created equally. Some will release more rapidly in to the system than others. This might explain why you have a half cup serving of pasta at dinner and your numbers are different than when you have a half cup serving of corn.

The take home message with all of this, is that if you have diabetes…especially type II, it is sincerely in your best interest to get off all the “white” refined foods and stick with the healthier choices of carbohydrates found in fruits and vegetables and whole grains as they are high in fiber as well as packed full of vitamins and minerals which will not only protect your system from long term damages associated with diabetes, but will also keep you younger and feeling more fabulous as part of an anti-aging program.

Switching to this diet can be challenging and require a great deal of support, feel free to leave your questions in the comments of this post!

~Dr. Nicole Sundene