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Modern Medicine and Traditional Chinese
Medicine - Diabetes Mellitus
Nutritional Therapy
Meal Planning
A non-diabetic produces the constantly varying amounts of insulin necessary for obtaining energy from glucose. A diabetic cannot achieve this balance. Beyond the basic requirements to provide adequate calories and necessary nutrients, there are marked differences in diet strategy for the two major groups of diabetic patients: Type 1
insulin-dependent non-obese patients and Type 2 obese patients who do not require insulin. Patients who are on insulin therapy must schedule their meals to provide regular caloric intake. In overweight patients, special attention must be given to total caloric consumption.
There is no need to disproportionately restrict the intake of carbohydrates in the diet of most diabetic patients. In fact, Dr. H.P. Himsworth demonstrated in 1930 that if carbohydrates were taken out of the diet and replaced by either protein or fats, a person would quickly develop insulin resistance and diabetes5. The key here is in the choice of
high-fiber complex carbohydrates.
One of the first dietary rules for all diabetics is to avoid all sugar and foods containing sugar, such as pastry, candy and soft drinks. While these refined sugars and other simple carbohydrates like white flour must be carefully watched, most diabetics are actually encouraged to eat more complex carbohydrates - the same bulky,
fiber-rich unprocessed foods that are now recommended for everyone. Vegetables are ideal. For example, a diabetic can eat a large plate of spinach that contains as much carbohydrate as a tablespoonful of sugar, without suffering any ill effects.
Spinach, asparagus, broccoli, cabbage, string beans and celery are among the so-called "Food Exchange Group A" vegetables that the American Diabetes Association (ADA) says can be generously included in the diabetic diet. What makes these complex carbohydrates special is their ability to slow down the body's absorption of carbohydrates by helping to delay the emptying of the stomach and thereby smoothing out the absorption of sugars into the blood. Whole grain cereals also have this ability. Fully one third of diabetic patients in clinical surveys have hyper-lipidemia, clearly indicating the need for dietary management. The most sensible approach is to limit the amount of fat in their diet and to substitute polyunsaturated fats for the saturated type when possible. Fish and poultry are especially recommended instead of fatty cuts of meat. Greasy, fried foods are strongly discouraged.
Obesity is much more likely in people who eat a high-fat diet, which is often a high calorie diet, since each gram of fat contains nine calories instead of the four calories in each gram of protein or carbohydrate. With obesity comes an increased risk of a variety of problems, not the least of which is adult-onset diabetes.
Overweight diabetics, by carefully calculating the proper daily calorie intake for their body weight and activity level, and never exceeding it, can usually bring their weight down to an optimal level - a level which is actually 10% less than the standard height and weight charts recommend. "The overweight diabetic who successfully brings their weight back to normal usually experiences a dramatic improvement in their condition. Indeed the symptoms often virtually disappear," says Charles Weller M.D. in his book The New Way to Live with Diabetes6. He goes on to state "Weight reduction and control can bring this incurable disease closer to complete remission than any medication."
The need to reduce fat is reflected in the standard diet and food exchange lists prepared by the ADA that restricts the intake of fat to 35% of calories. The reduction of saturated fats to one-third of the fat intake by substituting poultry, veal and fish for red meats, and the reduction of cholesterol to less than 300 mg/day are stressed. The carbohydrate content is 40-50 per cent of total calories, with unrefined carbohydrates recommended to the exclusion of refined and simple carbohydrates.
Currently another diet, known as the 'HCF (high-carbohydrate high plant-fibre) diet'
popularized by James Anderson7 has substantial support and validation in the scientific literature as the diet of choice in the treatment of diabetes. It is high in cereal grains, legumes and root vegetables and restricts simple sugar and fats. The calorie intake consists of 70-75 per cent complex carbohydrates, 15-20 per cent protein and only 5-10 per cent fat, and the total
fiber content is almost 100 grams/day. The positive metabolic effects of the HCF diet are many: reduced after-mealtime hyperglycaemia and delayed hypoglycaemia; increased tissue sensitivity to insulin; reduced cholesterol and triglyceride levels with increased HDL-cholesterol levels; and progressive weight reduction.
In general the HCF diet is adequate for the treatment of diabetes. However improvements can be made, primarily by substituting more natural (primitive) foods wherever possible. The Modified HCF or MHCF diet recommends a higher intake of legumes, along with restrictions of several foods allowed on the HCF diet, namely processed grains, and excludes fruit juices, low
fiber fruits, skimmed milk and margarine. It is noteworthy that if patients resume a conventional ADA diet, their insulin requirements return to prior levels.
Many diabetics have found it beneficial to eat smaller, more frequent meals, rather than the two or three big meals most people consume daily. Researchers have found that multiple frequent feedings tend to keep blood cholesterol levels lower, for the diabetic and non-diabetic alike. Vitamins and Minerals
Generally a well-balanced diet rich in vitamins and minerals is one of the most important factors in the control of diabetes and prevention of diabetic complications. One reason for stressing the need for proper levels of nutrients is the excessive urination experienced by the diabetic. Normally the body reabsorbs glucose and other watersoluble nutrients. When glucose rises to levels above 160- 170mg/dl, as it does quite frequently in even well controlled diabetic patients, it acts as an osmotic diuretic. This process overwhelms the kidney's ability to reabsorb glucose and other water-soluble nutrients, thus the increased urination, and substantial losses of nutrients such as vitamins B-1, B-6 and B-12 and the minerals magnesium, zinc and chromium pass out along with the urine. Consequently diabetes and its complications are as much a result of nutritional wasting as of elevated blood sugar.
In an article in the American Journal of Clinical Nutrition where 247 studies were reviewed8, it was found that Type 1 (IDDM) diabetics generally had deficiencies in zinc, calcium, magnesium and the more active form of vitamin D. Those with Type 2 diabetes (NIDDM) generally were found to be low in zinc and magnesium and often low in vitamins B6 and C.
The physical body needs all these water-soluble nutrients to maintain the integrity of its organ system. Perhaps one of the most important nutrients is magnesium. The medical literature is full of studies showing that diabetic patients invariably have lower blood levels of magnesium than normal, also with higher urinary losses. In a landmark study conducted in 1978 by Dr. P. McNair and titled Hypomagnesemia, a Risk Factor in Diabetic Retinopathy9, it was demonstrated that diabetics with the lowest magnesium levels had the most severe retinopathy, and that low magnesium levels were linked significantly to retinopathy more than any other factor. The article argued that simply elevating the magnesium concentration with supplements would protect the eyes.
Other nutrients are also attracting serious attention. Researchers in London recently reported that vitamin D is essential for the islet cells in the pancreas to be able to secrete insulin
properly. Their studies have shown that individuals with the lowest vitamin D levels experienced the worst blood sugar-handling problems and had a greater risk of developing diabetes. They found that those with greatest risk of developing vitamin D deficiency included the elderly who were either
institutionalized or stayed indoors, those living in climates where sunlight is scarce several months a year, and those with indoor sedentary jobs. In an effort to eliminate the widespread vitamin D deficiencies in the
institutionalized elderly, over 80% of those individuals are now being given 800 IU/day vitamin D3 supplements. Other researchers have found that the diabetic is unable to convert carotene into vitamin A. It is advisable therefore for the diabetic to ingest at least the recommended dietary allowance of vitamin A from a non-carotene source such as fish-liver oil. Diabetics and others on low-fat diets often need supplemental amounts of this fat-soluble nutrient. Also recommended is a vitamin E supplement, ranging from 400-1200 IU per day and a vitamin C supplement ranging from 1000-4000 mg per day to help prevent
small vessel disease of the extremities.
Brewer's yeast is another food supplement that is recommended for the diabetic patient. The yeast is a rich source of chromium-containing GTF (glucose tolerance factor) which is able to potentiate the insulin in our bodies. GTF also contains amino acids such as glutamic acid, glycine, and cysteine. Both brewer's yeast (9 gm/day) and trivalent chromium (150-1000 mcg/day) have been shown to significantly improve blood sugar metabolism when taken for several weeks to months. As a side benefit it has also been found that brewer's yeast and chromium supplementation lower elevated total cholesterol and total lipids, and significantly raise the levels of HDL-cholesterol, the beneficial or protective fraction of cholesterol.
Chromium is found in foods as both inorganic and organic salts. Brewer's yeast contains a form of chromium with high bioavailability, chromium-dinicotinic acid-glutathione complex. The bioavailability of chromium in liver, American cheese and wheat germ is also relatively high. Chromium is also available from a variety of sources including whole grains, potatoes and apples with skins, spinach, oysters, carrots, and chicken breast. Recent research has identified certain varieties of barley grown in Mesopotamia to be some of the richest sources of chromium.
A 1996 study of 180 Type 2 diabetics, carried out in China under the guidance of Dr. Richard A. Anderson11, found that 500 mcg of chromium picolinate taken twice daily for four months lowered the fasting glucose level to an average of 129, compared to 160 in those taking a placebo. In addition, glycosylated haemoglobin (a test of longer-term glucose tolerance) averaged an almost normal level of 7.5% in those taking chromium - significantly lower than those on placebo. All of the effects of chromium appear to be due to increased insulin sensitivity.
Another exceptionally useful trace mineral to combat diabetes is vanadium, which lowers blood sugar by mimicking insulin and improving the cells' sensitivity to insulin. A growing body of human research shows that vanadium compounds, most notably vanadyl sulfate, consistently improve fasting glucose and other measures of diabetes. These benefits were often extended for weeks after the mineral supplementation was discontinued.
In addition to taking supplements, diabetics are encouraged to eat the widest possible variety of permitted foods to ensure getting the full range of trace elements and other nutrients. It is interesting to note that certain nutrients like vitamins B1, B2, B12, pantothenic acid, vitamin C, protein and potassium - along with small frequent meals containing some carbohydrate - can actually stimulate production of insulin within the body.
Cautions
1. Fish oil capsules or supplements containing large amounts of para-aminobenzoic acid (PABA) can elevate blood sugar.
2. Supplements containing cysteine interfere with absorption of insulin by cells.
3. Extremely large dosages of vitamins B1 or C may inactivate insulin. Dosages listed above are within normal ranges.
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