Quentin's Advice on Diet and Exercise

The following is a post [slightly reformatted with emphasis added, but not edited] made by Quentin Grady to alt.support.diabetes on June 30, 2006. It contains some sage advice to a newly diagnosed diabetic about selecting elements of Diet and Exercise. It is presented with his permission.

G'day G'day,

OK. How about some ideas on diet and exercise. Notice that is not giving advice, rather it is offering some questions that one needs to answer for oneself, with or without expert help. A mixture of both makes sense to me.

Firstly in very rough terms exercise is twice as important as diet. Stanford did a cunning experiment in which they followed two groups of people for five years. One group was ideal weight but sedentary. The other were obese but worked out regularly at a gym. Twice as many of the ideal weight but sedentary folks died as the obese but active folks.

When it comes to diet it is really mostly a matter of answering some questions. Don't bother if your answers aren't very good to start with. Being diagnosed as a T2 diabetic is only the beginning of a learning experience and it does take time to make the changes that lead to better health. Quick fixes are for the slick spammers who would take your money and leave you no better off.

Question 1. What is a whole grain cereal?

Give three examples. Conventional wisdom on diet for T2 diabetics emphasised whole grain. It is only recently that the advocates of whole grain have realised that most newly diagnosed T2 diabetics didn't know what whole grains were. A strawberry Danish doesn't qualify. All too often people do a strange slight of mouth where they read some research that suggests whole grain has benefits and feel pleased with themselves when they tuck into a wholemeal bread roll. Can you see what is wrong with that? Whole meal was whole grain UNTIL it was finely milled. Then it wasn't. Most conditions that are improved by having whole grains are made worse by whole meal or worse highly refined flour. Read the labels. Anything that suggests it is "enriched" is usually letting you in on the secret that anything of value has been removed and a little imbalanced something has been returned.

The major problem in Western diets is that foods are made to be supermarket friendly. This means the labels are likely to reveal "modified starch" Why are the starched modified? Is it to improve your health?

Don't you believe it. More often than not starches are modified so that they look nice when they are thawed out after being frozen. Does this matter? Well yes it does. There are two basic forms of starch. There is the more slowly available form of starch called amylose found in the Indian basmati and Australian Doongara rice and the amylopectin found in sticky rice. Amylose is the one diabetics need if they are to have starch and amylopectin is the one that freezes and thaws nicely but bumps up blood glucose too rapidly for the delayed release of insulin many T2 diabetics manage.

Question 2. Which whole grains can you manage?

Notice that this is a personal question. It is not a competition. You are not a failure or non-compliant if you can't manage whole grains. Some T2s manage them readily and some don't. One of our biggest hassles is that we all get the common label of T2 diabetic but that is about where the similarity ends. Some people find they can eat organic brown basmati rice. Personally I like to have a little red rice on occasions but the portion size is very small. Red rice is nutty and crunchy so the small portion size doesn't matter. For years after diagnosis I simply went without rice. Some people have tabouleh. That has a feast of nutrients in the parsley, mint and/or coriander that goes into it. Tabouleh achieved prominence recently when it was realised that many T2 were non-compliant simply because they didn't know what whole grains were or how to include them in their diet. So the recipe was published.

Question 3. Can I manage bread?

If so what sort of bread? Here in New Zealand we have Burgen bread. It has an exceptionally low GI. If there is a bread that a T2 can manage then it is likely to be one of the breads that has been fermented slowly and cooled slowly. Most bakeries used fast cooling because it improved the bakery through put. Unfortunately that produces bread that converts into almost pure glucose by the time it reaches the small intestine where absorption takes place. Far from being healthy it is as dangerous as having glucose by the tablespoon full. Many T2s simply leave bread out of their diet. Personally I don't entirely agree with that approach.

When first diagnosed I ate rye and linseed bread. One eats it in very thin slices so this acts as a form of portion control. Rye is about five times as effective as wheat in keeping one regular. People who rely on vegetable fibre often find themselves straining after a period of time. Some don't. It's an individual thing. Be warned though if you leave out all grains that this can happen. They need rye such as ryvita or kavli rye wafers to ease the problem. There are other desirable pseudo grains such as buckwheat. Buckwheat behaves a little like insulin allowing glucose to enter the muscle allowing better feelings of being energetic.

Question 4. Can I manage legumes?

Legumes are things like beans, lentils and peas. There are several reasons why successful ways of eating often include legumes. Lentils are excellent sources of folic acid for instance. The biggy for T2 diabetics is that beans are the best source of what is called resistant starch. This is starch that hasn't converted to glucose by the time it passes the small intestine. It ferments in the larger intestine. Fermentation isn't to desirable it you rush into things. Put simply you fart. The upside though is that short chain fatty acids such as propionic and butyric acid are also produced. These regulate cholesterol production and do neat things like repairing the cells in the bowel. I find it strange that we live in a modern society which would rather risk the side effects of statins than the backside effects of beans.

The reason why this is all so important to T2 diabetics is that resistant starches alter our order of metabolism. In a diet deficient in resistant starch, carbohydrate is burnt first and fat is left to go find some place to park itself. If a diet contains enough resistant starch more of the fat is burnt before the carbohydrate and so doesn't get stored. Recent research has produced the startling bit of information that the hearts of diabetics burn fat not predominantly carbohydrate as in non-diabetics. We need to burn fat. Pure and simple. As I see it part of the solution is to have a diet rich in resistant starch and that means beans or lentils or peas. Peas incidentally are about the most fart friendly of the three.

Question 5. What fruit can you eat?

Can you eat citrus fruit? T2 diabetics who eat citrus tend to have lower A1c than those that don't. This is surprising as citrus is sweet. The sweetness is table sugar. When citrus juice is stored it becomes bitter so more table sugar gets added to overcome the problem. For this and other reasons, eating citrus fruit is much more sensible for T2 diabetics than drinking orange juice. Never the less citrus fruit don't contain significant amounts of starch and so don't supply as much glucose as we anticipate.

Almost all T2 diabetics can eat berries. Berries have about 7% carbohydrate as opposed to bread which has about five times as much. Put simply is easier to regulate carbohydrate intake with berries than with bread or other cereal based sources of carbohydrate. As a rough rule fruit grown in temperate climates is easier to tolerate than fruit grown in the tropics. The only way to find out of course is to test, test, test. Read Jennifer's advice to newbies. When you have finished ... read it again. It has the basis of learning what is true for you, the only person that deep down really matters to you.

Question 6. What vegetables can you eat?

Perhaps this should have been the first question. In general vegetables have a high water content. T2 diabetics often get to be T2 diabetics because they have become almost addicted to high calorie density foods which they are unable to process. Their blood glucose levels rise dangerously and they feel lethargic so they eat more high calorie density foods. It is a dangerous spiral. The way to break the spiral is to eat what are known as free vegetables. Kate has a good list. Many T2s find potato simply doesn't work for them. The portion sizes are too small. It is much simpler to eat cauliflower.

Question 7. What fats and oils can I eat?

About a decade ago the ADA experts agreed with the consensus of the scientific community that some starches could be replaced with cis monounsaturated fat. This is the oleic acid found in olives, avocados and most nuts. Though it was published in their expert opinion the message got lost in much of the presentation to the general public. The Women's' Health Initiative, the most authorities test of the low fat hypothesis, costing 415 million dollars, involving 50 000 women for eight years with 48 coaching sessions to ensure compliance showed once and for all that low fat was the flop of the century. It didn't lead to weight loss, reduced risk of coronary heart disease or cancer ... all the things its proponents claimed it would do. If you go to a dietician and you notice that they are comparing saturated fats (bad) with POLYUNSATURATED fats (good) then you know immediately that you have found one stuck in a decade old time warp. Notice that they are not even mentioning cis monounsaturated fats since it doesn't affect cholesterol levels.

The cis monounsaturated fats are the one's that are beneficial to diabetics. One reason that they are beneficial is that make those vegetables we could beneficially be eating palatable. Take the beans we could be beneficially be eating. Beans are somewhat acid. They cook better if combined with alkaline vegetables such as chicory. Chicory though is bitter. Yes, I know it is good for improving bile flow and helps expel cholesterol but people are funny old things ... that don't tend to eat bitter foods unless they live in the tropics where bitter flavours alleviate the heat. Simple. Have the bitter vegetables with fruity flavoured olive oil.

Green vegetable have many advantages. Firstly they are basically low in calories. People argue about calorific content but there is no getting past the fact that water has as low a calorific content as you can get. Secondly their greeness hides many essential pigments such as the orange zeaxanthin and yellow lutein that protects the eyes from ultraviolet and blue light damage. Include green herbs eg parsley, mint, dill, cilantro. These haven't been tampered with as much as most vegetables so still contain an abundance of these desirable pigments. Olive oil or avocado makes the phytonutrient pigments we need for health much more readily available. Even something so common place as lycopene from tomatoes is made more available if oil is present.

The other essential fat is omega-3. There is the omega-3 found in vegetables that reduces the risk of heart attacks. There is the omega-3 found in fish oil that improves brain function and lowers blood triglycerides which is a good thing to do. There are several reasons to eat fish and shellfish. This is one of them. Another is that shellfish are one of the best sources of Vit B12, one of the cell rejuvenating vitamins and taurine a cell stabilising amino acid. In New Zealand, green lipped mussels are very popular. What is popular where you live? We all must live with what is available locally.

The one fat to absolutely avoid is elaidic acid commonly known as trans fat. This hides in labeling information as vegetable shortening, partially hydrogenated fat etc. It put on belly fat even on a subsistence diet, no amount of dieting or exercise will overcome the damage it does.

Question 8. What alliums can I eat?

Alliums are members of the onion family. They include leeks, garlic, bulb onions and spring onions. These are a rich source of quercetin. Quercetin is a pale yellow pigment that inhibits the conversion of glucose into sorbitol. Sorbitol is found in the more common path ways to destruction of cellular function. Stop glucose from converting to sorbitol and many complication can be avoided.

Question 9. What meat can I eat?

Perhaps the answer is none. Perhaps you are a vegetarian by choice. That will make things more difficult for you unless you happen to like soy and have taken the time to find out how to serve it. Joslin's recommendations for sedentary people boil down to requiring two grams of protein for each gram of fat. This is easy with lean meat and fish. It isn't with eggs and cheese. In New Zealand where venison is farmed it is easy to obtain high protein lean meat that hasn't lived a miserable life on a feed lot. Diced venison is cheap and very lean. Once again it all depends on what is available to you locally as to what is going to work for you. If you have other medical conditions, then what sort of meat you eat is something you will have to consider with expert help. Recently I have taken to thinking of meat more in terms of flavouring than the basis of meals. Bacon improves the flavour of hearty tomato soup. Chorizo improves the flavour of a bean casserole. The simplest strategy is to look around for recipes whose popularity has stood the test of time in some culture.

Question 10. What nuts can I eat?

For reasons that are not fully understood people who eat nuts get three to five more years of quality life than those that don't. (We are talking about people who aren't allergic to nuts ... the bottom line is always to act sensibly and not bore everyone else by telling us all about it. Most adults can act sensibly without being reminded that some people are celiacs, lactose intolerant, etc etc) Perhaps it is the magnesium, copper or other minerals. Perhaps it is the phytosterols that block cholesterol reabsorption. Perhaps it is the cis monounsaturated fatty acid. Perhaps it is the tocopherols ... the most common form of Vit E. The reason doesn't actually matter. Raw nuts work. Most people have the sense to drop out some other higher calorie food to compensate for eating nuts ... at least this is what is shown time and again by ad libitum trial where the participants didn't put on weight despite eating large amounts of nuts per day.

Question 11. Hey, how about you ask some questions and we'll attempt to answer them.

Best wishes, Quentin Grady, New Zealand