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Tips to Kick Your Sweet Tooth

A 2017 review reported similarities in brain neurochemistry and behaviour between sugar and drugs of abuse.  Sugar and starch (which both convert to glucose) are highly addictive.  Reducing a sweet palate can be a challenge.  But the benefits of good blood glucose management and consequential smoother energy levels throughout the day, make the effort well worthwhile.  Try going ‘cold turkey’.  The following tips will help you beat those sugar cravings while enriching your nutritional intake.

  • We naturally wake up in the morning a little insulin resistant as our cortisol rises to get us started for our day; therefore, eat a breakfast with no refined carbohydrates eg boiled egg, half an avocado and ½ cup mushrooms cooked in 1 teaspoon grass-fed butter, sprinkled with 1 teaspoon turmeric and a handful fresh parsley OR a smoothie with 1 cup of kefir, 1 tablespoon of organic grass-fed gelatin, 1 teaspoon cinnamon, slice of fresh ginger root, ¼ cup unsweetened quality yoghurt (eg Vaalia), 1 teaspoon organic apple cider vinegar, handful blueberries
  • Avoid all refined carbohydrates ie sugary and starchy foods eg sugar, white flours, sweets, cakes, pastries, bread, pasta, packet cereals etc; these will keep your palate very sweet
  • Cook from scratch – only then will you know what you are really eating
  • Avoid processed and takeaway foods, soft drinks, diet soft drinks, fruit juice, flavoured milk and sweetened yoghurt
  • Don’t eat/drink sugar substitutes as these will help to maintain your sweet tooth
  • Avoid sweet fruits eg bananas, mangos; ok to eat blueberries, lemons, limes and kiwifruit in moderation
  • Eat a wide range of coloured, strongly flavoured and non-starchy vegetables for vitamins, minerals and polyphenols which help reduce insulin resistance eg alfalfa & bean sprouts, asparagus, green beans, broccoli, cabbage, cauliflower, eggplant, fennel, garlic, mushrooms, capsicum, radish, shallots, snow peas, turnips, zucchini
  • Each lots of seasonal leafy green vegetables eg kale, spinach, beetroot leaves, bok choy, tatsoi, silverbeet and especially bitter greens eg rocket, watercress, chicory, endive
  • Eat lots of fresh, soft herbs – add to salads and savoury dishes at the end of cooking (by the handful) eg parsley, coriander, basil, oregano, marjoram, sage; and woody herbs eg rosemary, thyme
  • Eat sea vegetables – see your nearest health food store for arame, nori,
  •  kombu, wakame; rich source of vitamins and minerals which can be depleted by a high sugar diet
  • Take 1 teaspoon of organic apple cider vinegar in ½ glass filtered water before each meal whenever you are at home to aid digestion
  • Drink plenty of filtered water every day & add a pinch of Himalayan or sea salt to each litre of water to help balance your electrolytes; drink at least 1.5-3L/day depending upon your size, physical activity and climate
  • Start fermenting – kimchi, kvass (fermented beetroot juice), sauerkraut, kefir
  • Boost your serotonin (the happiness hormone) through exercise, good diet and restful sleep; serotonin helps to improve mood and reduce sweet cravings
  • Meditate, relax, chill to reduce stress, this helps to stave off cravings; stress increases cortisol level which in turn increases blood glucose level

 

 

 

  • Maintain a stable blood glucose level by employing as many of the above tips as possible, or better still, employ them all and go cold turkey without sugar and starch.

References:

Body Ecology n.d., 10 secrets for ending your sugar cravings for good.

DiNicolantonio, JJ, O’Keefe, JH & Wilson, WL 2017, ‘Sugar addiction: is it real? a narrative review.’, British Journal of Sports Medicine, BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine, p. bjsports-2017-097971, <http://www.ncbi.nlm.nih.gov/pubmed/28835408>.

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How to be Healthy with Type 1 Diabetes

WHY GOOD BLOOD GLUCOSE CONTROL IS SO IMPORTANT

Maintaining consistent blood glucose levels is paramount, and probably the number one priority, in the good management of Diabetes Mellitus Type 1.  Good control enables you to keep your blood glucose level (BGL) within your target range as much as possible (1).  It also enables you to act quickly and appropriately if your levels are out of range.  With a well-balanced, low sugar and low starch diet, diabetics may be able to attain blood glucose levels that are considered normal in a healthy individual.

Kicking your sweet tooth and eating regularly scheduled, balanced meals will help you to stabilise and lower your BGLs.  Eating unscheduled foods especially sugary and starchy snacks will de-stabilise your BGL.

Checking your BGL regularly (3) can help you to track the effects of exercise, lifestyle and dietary choices.  Travel, stress and illness can also affect your glucose levels.  Testing your BGL regularly informs you how your body responds to these choices and events and helps you to maintain your glucose levels within your target range.  Your risk of hypoglycaemia, hyperglycaemia and cardiovascular disease will be reduced.

It is very important to know as soon as possible if your BGL ventures outside your target range ie too low (hypoglycaemia or ‘hypo’) or too high (hyperglycaemia or ‘hyper’).  Knowing this enables you to make important decisions such as insulin intake adjustment, eating before exercise, treating a ‘hypo’ or seeking medical advice if you are ill.

understanding blood glucose levels

Labtests Online Australia (9) states that the normal fasting blood glucose range for the general healthy population is 3.0-5.4mmol/L.

Diabetes Australia (2) recommends the following target levels for Type 1 Diabetics:  before meals  4.0-6.0mmol/L; two hours after starting meals 4-8mmol/L.

Blood levels outside these ranges confer health risks and must be corrected as soon as possible ie risk of hypoglycaemia – less than 4mmol/L; risk of hyperglycaemia – 10.0mmol/L and above; or above your post meal range for an extended period.

understanding TEST RESULTS

Blood Glucose (or Blood Sugar) (9) – a blood test that measures glucose in the blood at a point in time; best done fasted ie 8-10 hours after eating.  Non-fasted blood glucose should also be monitored throughout the day with a finger prick test.

Oral Glucose Tolerance Test (OGTT) (9) – involves a fasted blood glucose measurement, followed by the person drinking a glucose drink to ‘challenge’ their system, followed by another blood glucose test one and two hours later.

HbA1c (1) – red blood cells contain haemoglobin (Hb), a large protein, which carries oxygen from the lungs to body cells.  Glucose adheres to haemoglobin forming a ‘glycosylated haemoglobin’ molecule, called haemoglobin A1c (HbA1c). The more glucose in the blood, the more HbA1C will be present in the blood.  Red blood cells live for 8-12 weeks before they are naturally replaced. The HbA1c blood test indicates the average amount of glucose in the blood over the last 8-12 weeks. A normal average non-diabetic HbA1C is 5.5%. In diabetes, 6.5% is considered good.

The drawback with HbA1c (14)(16) is that high blood levels (hyperglycaemia) can cancel out low blood levels (hypoglycaemia), thereby giving a false ‘normal’ reading.  Blood glucose levels could actually be in hypo or hyper levels as indicated by levels 1 & 2 on the graph when the HbA1c result is indicating normal as indicated by level 3 on the graph.

Fasting Serum Insulin Test (10)(12) – insulin is a hormone produced by the pancreas to control blood glucose levels; it plays a role in controlling the levels of carbohydrates and fats stored in the body; >11.9mlU/L is concerning and >25 mIU/L indicates insulin resistance. The same levels apply three hours after the last meal.

understanding hypoglycaemia

Hypoglycaemia (AKA hypo) is a potentially, dangerously low BGL ie below 4mmol/L.

Too much insulin, vigorous exercise and drinking too much alcohol can drop your BGL.

Symptoms of hypoglycaemia – shakiness, weakness, confusion, sweating, uncoordination, headache, pallor, irritability, rapid heart rate.  Seek immediate medical assistance in an emergency.

MANAging hypoglycaemic episodes

If you think you have any of the above symptoms, immediately check your blood glucose level.  If below 4mmol/L follow ‘The 15-15 Rule’ (7) below:

  1. Immediately take approximately 15g glucose (eg 4 x 4g TRUEplus Fast Acting Glucose Tablets); this is an accurate method of knowing exactly how much glucose you are consuming & ensures you do not consume more glucose than is necessary to treat the hypo
  2. Rest and relax for 15 minutes, re-check your BGL again
  3. If BGL is still low, repeat steps 1 & 2; but be aware that you may need fewer glucose tablets in the second dose
  4. Once your BGL is back above 4mmol/L, eat a small handful of raw nuts to help stabilise your BGL with protein and fat; DO NOT skip your next scheduled meal
  5. Always carry glucose tablets and raw nuts everywhere you go; don’t ever run out
  6. Controlling your BGL in this manner protects you from consuming more glucose than is necessary to resolve the hypo; remember, excessive glucose intake to treat a hypo can cause hyperglycaemia
understanding hyperglycaemia

Hyperglycaemia is insidious, in that one is unaware of the gradual and permanent damage that is occurring while blood glucose levels remain elevated beyond the normal range.

Your BGL will naturally rise following a meal.  This is normal and is known as postprandial hyperglycaemia.  But, if your BGL is above your target range for an extended period or above 10.0mmol/L, this can lead to serious hyperglycaemia.

Symptoms of Hyperglycaemia – increased thirst and urination, dry mouth, dry skin, fatigue, blurred vision, frequent infections, slow wound healing, unexplained weight loss.

Long Term Complications – untreated hyperglycaemia (4) (11) leads to neuropathy (nerve damage) in the retina of the eye which may lead to cataracts and blindness; kidney disease; neuropathy in the extremities, especially the feet, may lead to amputation; cardiovascular disease; bone and joint problems; teeth and gum infections; bacterial and fungal infections; non-healing wounds and diabetic ketoacidosis.

Causes – too much food, especially refined carbohydrates (sugars and starches) eg sweets, cake, cereals, breads, pastries (sweet and savoury), pasta, soft drink, excessive intake of very sweet fruits (mango, banana); too little, expired or spoiled insulin or medication; too little physical activity; high stress; illness and infection; faulty glucose monitor or inadequate water intake.

Prevent Dehydration – hyperglycaemia (1) is exacerbated by dehydration; increased thirst and urination indicate dehydration; dehydration causes transitory insulin resistance and BGL will rise; high BGL causes further dehydration as the

kidneys attempt to move glucose and ketones out of the body by producing increased urine.

Adequate Water Intake – 2L/day is the average amount of water required for adults, but it is very dependent upon age, weight, activity level and climate; aim for 2 litres and drink water if you feel thirsty; remember thirst can be an indication of high BGL with potential for hyperglycaemia.  However, be aware that drinking excessive water is not recommended as electrolytes may be diluted, leading to hyponatraemia (low sodium in blood) which can be fatal.

Stress & Hyperglycaemia – cortisol (15) is an important regulatory hormone which keeps one alert, awake, motivated and responsive to the environment.  However, stress causes excessive cortisol which in turn raises BGL.

Managing Hyperglycaemia – if you experience hyperglycaemia, an additional dose of insulin may be required to lower your BGL.  Monitor your BGL until it returns to your target range.  Pay attention if there is a pattern to your high BGLs?  Try to determine the cause of your hyperglycaemia and if necessary, discuss with your diabetes educator, doctor or nutritionist to improve your BGL management.  Seek immediate medical assistance in an emergency.

diabetic ketoacidosis versus KETOSIS

Diabetic Ketoacidosis – diabetic ketoacidosis is not ketosis (6)(8).  If hyperglycaemia (13) is left untreated, it can lead to diabetic ketoacidosis.  This is an emergency complication and occurs with a very high BGL and insufficient insulin to transport glucose into bodily cells for energy.  The body then makes ketones as a source of energy.  The combination of high blood glucose and high ketones in the blood is known as diabetic ketoacidosis.   This combination makes the blood too acidic, which can change the normal functioning of internal organs eg liver and kidneys. It’s critical to get prompt treatment.  Ketoacidosis is usually only experienced by type 1 diabetics, hence the term ‘diabetic ketoacidosis’.

Symptoms – similar to hyperglycaemia, plus fruity-smelling breath and/or urine, dry mouth, shortness of breath, high ketones in urine.

Risks of Ketoacidosis – coma and death if left untreated.  Seek immediate medical assistance in an emergency.

Ketosis – on the other hand, ketosis is a natural, healthy and safe state for the body, when it is largely fuelled by fat.  Being in ketosis is normal during fasting, or when on a low, refined carbohydrate diet, also called a ketogenic or keto diet.  Ketosis has many potential benefits related to weight loss, improved general health, improved cognitive function and better exercise performance.  Diabetics can benefit from better blood glucose management when undertaking a carefully planned ketogenic diet.  Remember, ketosis is not diabetic ketoacidosis.

Monitoring Ketone Levels – ketones can be monitored with ketone urine sticks or a blood ketone monitor which is similar to a blood glucose monitor, the latter being the best indication of a ketonic state.

INSULIN RESISTANCE (iR) / INSULIN SENSITIVITY

Insulin – an anabolic hormone which promotes glucose uptake, glycogenesis, lipogenesis and protein synthesis of skeletal muscle and fat tissue through the tyrosine kinase receptor pathway (cell transmembrane signalling).  In addition, insulin is the most important factor in the regulation of plasma glucose homeostasis, as it counteracts glucagon and other catabolic hormones ie epinephrine, glucocorticoid, and growth hormone.

Insulin Resistance (IR) – a pathological condition (5) in which cells fail to respond normally to the hormone insulin which is produced by the pancreas when glucose is released into the bloodstream due to the digestion of carbohydrates and proteins in the diet.  In a healthy individual, this insulin response results in glucose being taken into body cells to be used for energy. The concentration of glucose in the blood decreases as a result, staying within the normal range even when a large amount of carbohydrates is consumed.  When the body produces insulin under conditions of insulin resistance, the cells are resistant to the insulin and are unable to take up glucose as effectively, leading to high blood glucose levels.

Some Causes of IR – dehydration (especially with vomiting or diarrhoea), infection (sweating), obesity, persistent high blood glucose levels and genetics.  Insulin’s effectiveness in facilitating the transport of glucose from the blood stream into liver, muscle, fat and other cells is impaired as blood sugar rises.  The pancreas will produce more and more insulin, sometimes to exhaustion, resulting in the cessation of insulin secretion.

Dehydration – should be prevented with adequate daily water intake with unsweetened electrolytes if undertaking strenuous activity and especially exercise in hot conditions.  Vomiting or diarrhoea, if diabetic, should be treated immediately as these will quickly exacerbate dehydration causing blood to lose water thus increasing the blood glucose concentration.  Glucose and insulin cannot reach peripheral vessels due to lowered water concentration of blood.  Insulin resistance rises.  High blood sugars cause more urination which increases dehydration, a vicious circle.  Diabetic ketoacidosis is a risk in severe dehydration.  Vomiting and diarrhoea can also interfere with the absorption of medications.

Insulin Sensitivity – describes how sensitive the body is to the effects of insulin and varies from individual to individual; smaller amounts of insulin are required to lower blood glucose levels than someone who has poor insulin sensitivity.

exercisING with diabetes

Regular and strenuous exercise improves health and longevity (1).  Intense exercise induces new telomeres, which prolong life. Exercise also raises ‘good’ HDL cholesterols and lowers triglycerides, lowering risk of heart attack, stroke and atherosclerosis.  Anaerobic exercise has been found to lower ‘bad’ LDL cholesterol.  Weight bearing, resistance and impact exercises may reduce bone mineral loss associated with ageing.

CAUTIONARY NOTE:  Despite the potential benefits of exercising, Bernstein (1) states that diabetics should seek medical advice before undertaking a new exercise regime.  Such a regime must be carefully tailored for the individual’s requirements.  Studies have demonstrated that the Coronary Artery Calcium Score test is the best predictor of heart attack occurring in the next ten years.  A computed tomography (CT) scan identifies the amount of calcium in the walls of the arteries of the heart.  Before undertaking a new exercise regime, all adult type 1 diabetics and type 2 diabetics over 40yrs should be tested and referred to a cardiologist if results to either of these tests are abnormal.

Exercising may raise BGLs, making glucose regulation more difficult during exercise.  This requires careful monitoring of BGLs, insulin intake, good awareness of carbohydrate intake and noticing and responding to one’s individual responses to exercise.  It is unwise to exercise with an elevated BGL, especially if above 9.4mmol/L as BGL will rise even further during exercise, possibly entering hyperglycaemia territory.

the good neWS

Those with type 1 diabetes can lead a healthy and fulfilling life even though more effort and diligence is required than for a non-diabetic individual.  Following are the key issues for a healthy, happy life:

  • Regularly monitor your blood glucose levels – stay in your target range
  • Manage hypos with ‘The 15-15 Rule’ (7)
  • Avoid all sugars (including artificial sweeteners), starches, soft drinks, sports drinks, fruit juice, takeaways, processed foods
  • Avoid savoury starches – grains, breads (including sourdough), savoury pastries, crisps, crackers, pasta, white rice
  • Avoid all inflammatory polyunsaturated fats – corn, soybean, sunflower, canola, and safflower oils
  • Eat lots of coloured, non-starchy vegetables
  • Avoid fruits except blueberries, lemons, limes, kiwifruit
  • Eat grassfed & organic proteins
  • Eat moderate amounts of good fats – avocado, extra virgin olive oil (EVOO), grass-fed butter & cream, ghee, fresh coconut, wild caught fish for ?-3s, cod liver oil, chia seeds, flaxseeds, nuts
  • Cook from scratch so you know what you’re eating
  • Eat only 3 meals/day; don’t snack between meals
  • Fast occasionally
  • Get plenty of sleep and relaxation, learn to meditate
  • Exercise – follow a regular exercise regime, customised for you
  • Do something in your life that is meaningful and fulfilling
  • Slow down and appreciate life, express your gratitude, laugh lots, smile!
REFERENCES
  1. Bernstein, R 2011, Dr Bernstein’s diabetes solution: the complete guide to achieving normal blood sugars, 4th edn, Little, Brown and Company, New York, USA.
  2. Diabetes Australia 2015, Blood glucose monitoring,  https://www.diabetesaustralia.com.au/blood-glucose-monitoring
  3. Diabetes State/Territory Organisations 2012, Blood glucose monitoring,  http://diabetesnsw.com.au/wp-content/uploads/2014/12/DA-04-Blood-glucose-monitoring.pdf
  4. Dikeman, R n.d., How to normalize blood sugars for type 1 diabetics.pdf, https://www.dropbox.com/s/a1zr9eb8675hfk1/How to Normalize Blood Sugars for Type 1 Diabetics.pdf?dl=0
  5. Greenbaum, CJ 2002, ‘Insulin resistance in type 1 diabetes’, Diabetes/Metabolism Research and Reviews, vol. 18, no. 3, pp. 192–200, http://www.ncbi.nlm.nih.gov/pubmed/12112937
  6. Healthline 2017, Ketosis vs. ketoacidosis: what’s the difference, https://www.healthline.com/health/ketosis-vs-ketoacidosis#overview1
  7. Joslin Diabetes Center Harvard Medical School 2017, Diabetes research, care education & resources, http://www.joslin.org/index.html
  8. Ketogenic Diabetic Athleted., Nutritional ketosis is NOT diabetic ketoacidosis,  https://ketogenicdiabeticathlete.wordpress.com/2016/01/16/14-nutritional-ketosis-is-not-diabetic-ketoacidosis/
  9. Lab Tests Online AU 2016, Glucose, http://www.labtestsonline.org.au/learning/test-index/glucose
  10. Lab Tests Online AU 2014, Insulin,  https://www.labtestsonline.org.au/learning/test-index/insulin
  11. Mayo Clinic 2017, Hyperglycemia in diabetes – complications,  http://www.mayoclinic.org/diseases-conditions/hyperglycemia/basics/complications/con-20034795
  12. Medscape 2014, Insulin: reference range, interpretation, collection and panels, https://emedicine.medscape.com/article/2089224-overview
  13. Rewers, A, Dong, F, Slover, RH, Klingensmith, GJ & Rewers, M 2015, ‘Incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in Colorado youth, 1998-2012’, JAMA, vol. 313, American Medical Association, no. 15, p. 1570, http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2015.1414
  14. Stapleton, T 2016, YouTube, Is a low carb diet sustainable to manage type 1 diabetes,  https://www.youtube.com/watch?v=hxs63lOOH0U
  15. Axe 2017, Get your cortisol levels under control naturally, https://draxe.com/cortisol-level/
  16. Diabetes Self-Management 2016, HbA1c test accuracy, https://www.diabetesselfmanagement.com/blog/hba1c-test-accuracy/

 

Anne Stanfield, Nutritionist (BHlthSc Nutritional & Dietetic Medicine)