: Joe Dunn (©2023).
"Sugar or honey? " - "It depends sweetie pie !"
I am neither doctor nor dietician but I've exercised regularly; though never really dieted. After my eldest daughter developed Type 1 Insulin Dependent Diabetes (IDDM) whilst at university at the age of twenty, with no prior warning and no family history of blood sugar abnormalities, I became determined to understand a little of the issues which surround this complex problem. This article is for the 'loved ones' of diabetics. What is Type 1 and Type 2 diabetes and what the heck's a Hypo? Why do diabetic sportsmen and sportswomen reduce their Insulin intake before taking demanding physical exercise? For sure, diabetes is a condition that has to be managed.
A friend of mine's son developed a form of Diabetes in his adult life known as LADA that lies somewhere between Type 1 and Type 2 diabetes. There's an explanation of this at the end of this paragraph.
The notes which I made whilst trying to provide myself with a simple understanding of the mechanics of blood sugar are taken from sources which are not my own; but the following is the summary of what I found. It is a complicated subject that in part, focuses on Physiology and in part on Nutrition and Diet. What becomes clear is that the influence of diet and exercise on health is more profound than you may have imagined.
As a non-medical man, I cannot suggest that a well managed diet or nutritional regime will prevent anyone from developing Diabetes; for the cause of most cases of Type 1 Diabetes is far more complex, whereas Type 2 Diabetes (sometimes called 'late onset' Diabetes) is often associated with increasing age and obesity. Also watch out for dietary products that can cause more harm to you than good (see later in this article). For example, do you know the difference between Diet Coke and Coke Lite ? Have you heard of a chemical called 'Aspartame' which is in some diet drinks? Look it up on the Internet later on !
The following script makes pretty HEAVY reading, but if you want to keep one eye to the 'wind of life' then you might be interesting enough to read on. Alternatively you may wish to 'pass by on the other side' or bury your head in the sand in the hope that it won't affect you or a member of your family. Like food and exercise itself, you can take it or leave it.
There are many references to Glucagon and Glycogen in the paragraphs that follow. Apart from sounding the same and having similar spellings, Glucagon and Glycogen are completely different chemical substances. Try not to get them confused like I did !
Latent auto-immune diabetes in adults (LADA) is a slow-progressing form of auto-immune diabetes. Like the auto-immune disease type 1 diabetes, LADA occurs because your pancreas stops producing adequate insulin, most likely from some "insult" that slowly damages the insulin-producing cells in the pancreas. But unlike type 1 diabetes, with LADA, sufferers often won't need insulin for several months or even years after they've been diagnosed.
Many researchers believe LADA, sometimes called type 1.5 diabetes, is a subtype of type 1 diabetes, while others do not recognise it as a distinct entity. Other researchers believe diabetes occurs on a continuum, with LADA falling between type 1 and type 2 diabetes. People who have LADA are usually over age 30. Because they're older when symptoms develop than is typical for someone with type 1 diabetes and because initially their pancreases still produce some insulin, people with LADA are often misdiagnosed with type 2 diabetes.
If you've been diagnosed with type 2 diabetes and you're lean and physically active or you've recently lost weight without effort, talk with your specialist doctor about whether your current treatment is still the best one for you.
At first, LADA can be managed by controlling blood sugar with diet, losing weight if appropriate, exercise and possibly oral medications. But as your body gradually loses its ability to produce insulin, it'll eventually need insulin shots.
Here's the story:-
Natural simple sugars come from many different sources. They are refined from crops like cocoa, sugar cane and sugar beet (Sucrose). Sugar is also found in milk (Lactose), in fruit (Fructose) and for example in products like honey.
It is a fact that sugar, especially refined sugar taken in any 'excessive' quantity, is toxic to a human body and will make many bodies fat depending on the energy spending levels of that body. This in turn will cause a strain on the health of the body, probably the mind, and certainly the waistline. But what is excessive and why?
The 'significant' quantities of sugar that are derived in our digestive systems by eating Carbohydrates is quite well advertised, but understanding the theory will help some individuals in the management of their own body.
A body must have some sugar to run on to produce energy; rather like a car needs fuel. Carbohydrates and sugar together are a ready source of fuel, in that when you need energy, your body will use what sugars it can find in the system and then burn fat to make up any shortfall. So that if you cut down on your Carbohydrates and sugar intake, the body will have to turn to burning fat sooner to keep itself running. This will help in keeping the body from becoming fat. When this fat is burned, 'Keytone' bodies are formed.
It should be noted that an overload of Keytone bodies caused by too much fat burning can lead to the blood becoming excessively acidic, which is not so good either. Therefore somewhere along the line, a balance has to be struck.
For better understanding, Carbohydrates may be divided into simple Carbohydrates such as the simple sugars just mentioned; and complex Carbohydrates such as Fibre and Starch. Starch is a combination of large sugar molecules.
In normal healthy individuals, sugar acts as a stimulus and causes the pancreas to secrete one of the body's mega-hormones into the bloodstream. That hormone is called "Insulin". Sometimes Insulin is known as the 'hunger hormone' because 'over production' of Insulin can make you feel hungry for more Carbohydrates, despite having just eaten. Insulin secretion automatically controls upward swings in blood sugar levels of normal individuals, but must be injected by some diabetics to do the same job; though this action is not nearly as efficient as happens automatically in a healthy body. Significantly, blood sugar levels can also be controlled by diet.
The Pancreas, Insulin, Glucagon and Cholesterol
Insulin is manufactured and secreted by the specialized beta cells in the 'Islets of Langerhans' within the pancreas to stop blood sugar levels getting too high (Hyperglycaemia). Remove the pancreas and you will be diabetic. In normal individuals blood sugar levels do not vary too much, because of the harmonious and compensating hormonal actions of Insulin and Glucagon. In the case of a diabetic, their pancreas does not manufacture the correct amount of Insulin (Type 1 Insulin Dependent Diabetes Mellitus). In this case Insulin injections are needed to stop the blood sugar levels from getting too high. However, if the body does not respond to Insulin in the correct manner or sufficiently, this is called Insulin resistance (Type 2 Diabetes Mellitus) and in some of these cases, blood sugar levels may be controlled by diet and exercise. A high and harmful blood Insulin level is called Insulinemia.
In addition to Insulin, the pancreas also produces and secretes Glucagon which is a hormone made in the alpha cells of the pancreas. Glucagon assists in the breakdown of Glycogen (stored sugar) to Glucose when blood sugar levels fall, to prevent the blood sugar from falling too low (Hypoglycaemia). That's what a Hypo is ! In other words it raises the level of Glucose in the blood to meet energy needs. Glucagon also breaks down the previously stored Fat (the spare tyre around your waist) to provide energy.
Glucose (blood sugar) is the body's main fuel and all carbohydrates absorbed by the body are eventually converted to Glucose. Think of a Carbohydrate in terms of how much of a rise in Glucose it causes. Foods high in sugar may give an instant energy 'rush', but they also trigger the pancreas to secrete Insulin and the brain to release Seratonin, which is a substance that produces a feeling of 'appetite satisfaction' and which prepares the body for sleep.
The rise in Glucose following Carbohydrate consumption is commensurate with the type of carbohydrate eaten. In a normal body, the subsequent release of Insulin will lower the level of Glucose back to where it should be; by directing cells to utilize the Glucose. Glucose is either used immediately to provide energy, or it is stored in the form of a complex form of Glucose called Glycogen that is held in the liver and in muscle to be utilized later to meet energy needs. Any excessive Glucose in the system is stored as Fat.
Protein on the other hand, doesn't stimulate significant amounts of Insulin production. When Insulin levels fall; for example following the consumption of a protein-rich meal, or in between meals or during 'fasting' hours at night; then blood sugar (Glucose) levels fall. Glucagon is then released into the bloodstream.
The bad effects caused by 'over-production' of Insulin are certainly worthy of note. An excess of Insulin production could be caused by eating a Carbohydrate-rich meal. This will suppress Glucagon secretion, whilst any Protein eaten may be trying to promote Glucagon secretion. In this case, the normal Glucose operation for energy becomes unbalanced because Insulin effectively inhibits the action of Glucagon. Thus the breakdown of Glycogen to Glucose through the action of Glucagon plus the breakdown of previously stored Fats (Triglycerides) is not efficient.
When an energetic body is not using up all the blood sugar (Glucose) produced by excessive Carbohydrate consumption, this causes the excess sugar to be stored as Fat in fat cells and Amino Acids (Protein) in muscle - an undesirably viscous circle.
The next point to note is that Insulin signals our liver to make 'Cholesterol', which belongs to a family of substances called 'sterols'. Cholesterol is not really a fat, but it combines with fat (Triglycerides) as it circulates around the bloodstream in small packages called Lipoproteins. In moderation, Cholesterol is a vital substance in the formation of steroids, bile, acids and hormones and must be provided to the cells in your body - it is broken down into two groups; HDL and LDL. Another name that you will hear is Lipids. These are enzymes that the Liver needs to make Cholesterol, whose level is measured from a 'Lipid' profile taken from a blood sample.
The HDL (high-density lipoprotein) Cholesterol is sometimes known as 'good' Cholesterol and the LDL (low-density lipoprotein) as 'bad' Cholesterol. LDL ferries Cholesterol to coronary arteries where it imbeds and participates in the growth of plaque; though LDL is important for normal brain function. The body takes about 15% of it's Cholesterol from food, but importantly the body manufactures about two-thirds of its own LDL Cholesterol in the liver whereas HDL trucks Cholesterol away from the arteries - taking it to the liver where it is disposed of. This helps to explain why marked dietary changes do not necessarily reduce Cholesterol levels proportionately. Some experts now believe that people with higher than 'desired' Cholesterol levels should take "Statins" which are expensive drugs that block or lower 'Lipid' levels.
Do you now think that lots of HDL and not too much LDL will keep you free of trouble from heart (cardiovascular) disease ? WRONG - it's not that simple ! Like diet and the tie-up between Carbohydrates and Insulin, it's a balancing act which even the experts have trouble in agreeing upon; though they do agree that more exercise and a better diet are the keys to success. Cholesterol levels are measured in mg/dL or milligrams per 100 milli-litres. Experts break down the ideal LDL levels in a person depending on whether they are in a 'high-risk for heart disease' group or not. For example, people with heart disease and diabetes should aim to have an LDL level of below 100ml/dL. In lower risk people, experts recommend a target LDL level of below 130 -160 mg/dL and if you can get the level down to 70 mg/dL, so much the better. Those having LDL above the 100 mg/dL are sometimes recommended to take Statin medication - this they say will reduce the chance of heart attack or stroke by 37 per cent. The HDL Cholesterol target should be above 38 mg/dL and the target Total Cholesterol level should be in the range of 140 - 260 mg/dL (or 3.6 - 6.7 mmol/l) but ideally below 200 mg/dL. The Cholesterol to HDL ratio should be less than 4.51 and the Triglyceride level should be less than 200 mg/dL.
The downside of LDL Cholesterol is that it deposits excess amounts of itself on arterial walls and reduces blood circulation. If you want to cut down on your Cholesterol, then cut down on your Insulin production. Do this by eating less sugar and Carbohydrates and your pancreas won't need to produce so much Insulin to regulate your blood sugar level.
When borderline diabetics get into a position where they cannot control their diabetes with pills, diet and exercise then they must inject Insulin to prevent high blood sugar levels. The first major side effect of this will be an elevation in their Cholesterol level. Diabetics have a significantly higher level of total Cholesterol and Triglycerides than an fully healthy member of the population. If you are a diabetic, then you must try to eat foods that do not require such large injections of Insulin to counteract rising sugar levels.
We are in the twenty-first century but the Insulin / Cholesterol connection is not widely realised. Large meals should preferably never be eaten before going to bed, especially those high in Carbohydrates, because Cholesterol is primarily manufactured at night.
One of the most important aspects of nutrients in digestion is the breakdown of Carbohydrates, Proteins and Fats into smaller units that can be absorbed into the bloodstream. The stomach mix is gradually emptied into the small intestine; the first part of which is called the 'duodenum'. Bile from the gall bladder and Amylase that's an enzyme made in the pancreas and saliva glands, together with other pancreatic enzymes namely Protease and Lipase mix with the stomach contents to bring about this breakdown. Enzymes are split into 'digestive enzymes' and 'metabolic enzymes' and are secretions that cause or speed up chemical changes in substances with which they have contact.
It is also important to note that the mixing of certain foods can have tremendous implications when the smaller 'broken down' units are absorbed into the bloodstream. The sugar (Fructose) in fresh fruit, berries, vegetables and honey will not normally hurt you; but eaten at the wrong time, for example before going to bed; or in the wrong combinations, for example when taken with meat dishes, can create both digestive and metabolic problems.
The word "Metabolism" encapsulates the many processes that transform the nutrients in food to chemical substances that can be used by our bodies. The entire process is complex and metabolic rates vary from person to person. The liver plays a central role in the metabolism of foods.
Very little is generally understood by laymen like myself, about the complicated interplay between Carbohydrates, Fibre, Proteins and Fats once these foods have entered the body. In addition to Water, the content of everything we eat may be put under one of four headings :-
These are the body's energy source most responsible for raising blood Glucose levels; Glucose being a form of sugar which circulates in the bloodstream. Carbohydrates which stimulate the most Insulin secretion are called high-glycaemic index Carbohydrates, therefore try to eat low-glycaemic index Carbohydrates. Significant amounts of Carbohydrate are primarily found in grain, cereals, fruit and root vegetables though the Carbohydrate 'headline' is further split into 80 per cent Glucose and 20 per cent Fructose (a simple sugar found in fruits and berries, vegetables and honey) or Galatose and Lactose (simple sugars found in dairy products which have a lower Insulin stimulating effect than Glucose). Fructose is taken up by the liver and converted into Glucose and Triglycerates (fats). Amylase is the digestive enzyme which breaks down Carbohydrates.
This is a complex form of Carbohydrate that cannot be broken down in the digestion process because it is 'resistant' to the action of digestive enzymes. Fibre therefore provides little energy. Insoluble fibre is called roughage; if the fibre does not dissolve in water it has been found to prevent constipation and possibly colon cancer. If the Fibre dissolves in water, it can lower Fat and blood Glucose as with the soluble Fibre found in Soya beans.
This is the body's energy source most commonly found in meat, fish, poultry and beans. Protein stimulates Glucagon secretion which will raise Glucose levels by converting Glycogen and 'fat' back to Glucose. Protease is the enzyme which helps to break down eaten Protein into "fatty" Amino acids. These acids are then absorbed through the intestine and 'metabolised by the Liver' (i.e. changed by our metabolic computer) into Glucose; a process called 'Gluconeogenesis'.
Some Amino acids are used to build new protein, but there are nine essential ones that the body cannot make by itself and which must be provided from the food that we eat. The numerous Amino acids help make up body cells, hormones and neurotransmitters (substances that relay signals within the central nervous system). The fatty acid called Eicosapentaenoic acid (EPA) is vital for the proper function of the brain, mediating hormones, the immune system and blood flow. I am told that there is a product available in most chemists / pharmacies called "MoeEPA' which will give you a boost in this area. Another food which contains all nine essential Amino acids are eggs. Even if the eggs have been 'irradiated' to try and eliminate salmonella, they are still better for you than chocolate Easter eggs !
Fats are sub-divided into 'Trans-fats' and 'Saturated' fats which are the unhealthy fats that are found in the animals and which represent most of the fat that meat-eaters consume each day and 'Unsaturated' fats which are healthy fats which come from vegetable sources like olive oil, fish oil and margarine. Omega 3 fish oils which are obtained from the tissues of fish found in cold, deep water are good fats and are great for your heart, your joints, your brain and much more; whereas the consumption of animal fats slows down the brain function. As an example, cod liver oil helps to boost your immune system, improve your eyesight and protect your bones. Omega 3 fish oils are known as PUFAs - this stands for polyunsaturated fatty acids. Interestingly Omega 3 fatty acids are also considered to be essential in lowering cholesterol levels. Now fats are broken down into Triglycerides (Glyceride being the group name for fats), but some fat intake is necessary for your body's metabolic processes to work; therefore fats must be digested through the actions of the pancreatic enzyme 'Lipase'. Trouble is that Insulin inhibits Lipase production. Is that complicated or what!?
"So what's all this got to do with me" ?
The effect of taking refined sugar or processed grain products is that if they have been stripped of their coatings or husks, then they are almost immediately absorbed in a very concentrated fashion into the bloodstream. This results in the very rapid secretion of large quantities of Insulin.
You must eat and drink something, but be armed with the knowledge of what the commonest Carbohydrate culprits that cause this 'intense' Insulin secretion and high Cholesterol production are.
Here are some of them:- Corn, most factory produced cereals, most biscuits, bread made from refined flour and most root vegetables such as carrots, or potatoes in any shape or form, all white rice (though Basmati rice is a better alternative). Most fruit drinks and "sport" drinks are unacceptable unless you are very active, because usually they contain added refined sugar. Coupled with other culprits like refined sugar, corn syrup, molasses, honey, sugared 'colas' and beer, you have a recipe for a 'first class' ticket to an earlier grave than you may want. Recently I was alerted to an article on the Internet which targeted sugar-free products sometimes marketed under different trade names that contain a substance called 'Aspartame' manufactured by Monsanto Chemicals. I am not qualified to comment, except to say that before you consume dietary products and diet drinks, make sure that you research what chemicals are in them. Apparently, some products could lead you to an early death rather than save you - this is especially true for diabetics.
Eat fruit by itself as a snack either 30 minutes before or 2 hours after a meal so as to receive the best benefits of a lower Insulin secretion. If you must drink alcohol then red wine should be the preferred choice. When you take your first alcoholic drink of the day, there are good effects in terms of increased levels of HDL cholesterol, which has a positive effect on the heart; especially for those in middle age. However if much more is drunk, then the alcohol starts to attack as triglyceride levels increase and arterial furring is promoted. Beer causes a rapid increase in blood sugar levels because it has a high content of the carbohydrate Maltose. Recent research points to the fact that drinking moderate amounts of coffee may slow the onset of Type 2 diabetes.
Eating a modest amount of insoluble fibre can positively slow digestion and thus the absorption of Carbohydrates, which in turn reduces the Insulin-stimulating effect. The broad rule of thumb is that vegetables grown above ground level are good for you, but those grown under ground are higher in Carbohydrates and therefore not so good.
Most "no sugar added" foods contain ingredients which have Malt and Dextrose combinations. Consume these Carbohydrate foods in small quantities only. Eating lean meats and fats in moderation is desirable, but remember that excess Protein is converted to fat. Read the labels on breads and pastas; what you need here are whole grain products which have not been made from highly refined flour and do not have sugar added; but have retained their fibre. Whole wheat bread is next best alternative. "The whiter the bread, the quicker you're dead" is an accurate saying !
Much better for you are un-refined Carbohydrates such as whole fruits or unsweetened natural fruit juices, but not high-glycaemic fruits like water melons, pineapples, raisins or bananas. Also good are high-fibre green vegetables, dried beans and whole grain products which require further digestive alteration before absorption, thus a lower rate and quantity of Insulin secretion.
Soya bean products are really good for you. Soya foods are low in saturated Fats and free of Cholesterol. The Protein in Soya suppresses Insulin secretion which in turn directly lowers blood Cholesterol production from the liver. The soluble fibre found in Soya beans helps to regulate Glucose levels.
It is clear that calories taken in isolation are not as important as the types of food that we eat, how we control them and what metabolic processes control their assimilation. The calorie "myth" is that fat grams result in more calories than carbohydrate grams; therefore eating fewer fat and more carbohydrate grams will result in fewer overall calories and a healthier diet.
Fats certainly provide more calories per gram than either carbohydrates or protein, but fats by themselves do not necessarily cause weight gain if taken in reasonable quantities. Cutting calories in the diet only leads to temporary weight loss. Some Fats and Carbohydrates may lead to upward changes in Cholesterol levels, but it is very important to understand that some 'unsaturated' Fats will lower Cholesterol levels and some 'saturated' Fats will raise Cholesterol levels.
The Polyunsaturated Fats found in vegetable oil contain the essential fatty acids and are better for you than Saturated Fats found in meat and dairy products. Within your body, essential fatty acids are converted into chemicals called Prostaglandins which have many important functions within the body, including fighting against the complications of diabetes.
Exercise promotes overall body fitness and health, especially if taken in regular and moderate amounts. Nevertheless, moderate exercise will not significantly produce weight loss if you continue to take foods which create a need for high levels of Insulin in the bloodstream. If you are in the frame of mind to give up most of your sugar consumption to improve weight and health, then a half-hearted effort accompanied by constant cheating cannot work. If you start being strict with yourself on the subject, then "today could be the first day of the rest of your life". We are what we eat.
Hormonal influences present in pre- and post-menopausal women may also be responsible for difficulties in losing weight. Hormone therapy in the form of either birth control pills or Progesterone supplements may further aggravate the weight problem, because it increases appetite and promotes Fat storage. Oestrogen in pre-menopausal women decreases blood plasma Insulin levels. It increases Insulin sensitivity. This may well affect diabetics.
Have we become Carbohydrate addicts? Excess Insulin production in normal individuals and excess Insulin injection by diabetics kills prematurely. Those who survive to an older age often have a greatly reduced quality of life. Apparently up until the start of the 20th century, the pancreas was not called upon to secrete as much Insulin in an entire lifetime as it now is in one day, because of today's dietary lifestyle. Considering our modern day diet - is it any wonder that the incidence of diabetes and impaired Glucose tolerances continue to rise at such an alarming rate? In some cases maybe we simply wear out or exhaust the pancreas - so why not give yourself a rest by eating sensibly ?
If you have the willpower and decide to get tough and selective about the type of food that you eat, then the content in foodstuffs that is written on the packet is both a 'mine of information' and a 'minefield'. Additives with unpronounceable chemical names written in percentages; weights in pounds or grams; volumes in cc, litres and fluid ounces can be hopelessly confusing when trying to make an evaluation whilst browsing in a supermarket, with one eye on the parking meter. However you may find it compelling enough to persevere.
It might be easier to become a rocket scientist, but there are clear indications that the overall aim must be to reduce Insulin secretion whilst enhancing Glucagon secretion. This means conquering Carbohydrates and sugar.
If you fell asleep whilst reading this article - then maybe you are so unconcerned, that you believe that this problem doesn't really apply to you - the reality is that you could wake up with a start when it is too late !
If you've just had a high Carbohydrate meal with a glass of beer; the Seratonin will be doing its work and in your non-diabetic body, your pancreas will be working overtime.