Diabetes and Blood Sugar Control

"There are essential amino acids and essential fatty acids, but there is no such thing as an essential carbohydrate."
                                                                         - Dr. Bernstein (Diabetes Solution)

Note: When I talk about diabetes, I refer to type 2 diabetes (adult-onset diabetes), different from type 1 diabetes (juvenile diabetes) and from gestational diabetes (related to pregnancy).

Diabetes is in increase around the world, especially in Asia. The see the prevalence of this condition, check out this map from the IDF (International Diabetes Federation).

Diabetes is a disease where the individual is unable to utilise glucose (derived from carbohydrates) as energy source. After consuming carbohydrates, the body uses a part of it directly, the remaining will be used with the help of insulin. Insulin is secreted by the pancreas in response to a high-carbohydrate meal. The role of insulin is very important, as it brings down plasma glucose levels, and sensitises the muscle cells to take up glucose as fuel.

In diabetic patients, the cells are not sensitive enough for insulin triggered glucose uptake, leading to dangerously high levels of glucose in the blood stream. This high-glucose level, will again trigger the pancreas to release even more insulin. Over the decades, the pancreas is unable to keep up with these high demands of insulin, causing glucose levels to spike. The body will do everything to get rid of the glucose, so it will push it into the urine, prompting the patient to pay frequent visits to the restroom, leading to extreme thirst (this is especially true for type 1 diabetics).

Uncontrolled diabetes causes the body to deteriorate. It is linked to many complications: heart disease, high blood pressure, kidney disease, fatty liver disease, dementia etc.

If the main problem in diabetes is the inability to utilise glucose and the dangers of unpredictable glucose swings, then it makes sense to find an alternative energy source for these patients and to do everything to bring glucose levels back to normal.

Current conventional treatment also focuses on normalising glucose levels:

• With medication: insulin sensitisers and insulin mimetics. These medications are not very efficient in bringing down glucose levels.
• With diet: interestingly a high-carbohydrate diet is recommended by the American Diabetes Association.

Alternative energy source:
We are "designed" to derive our energy from carbohydrates and from fat. If someone is unable to use carbohydrates, the alternative is fat in the form of fatty acids. In the case of a low-carbohydrate diet, the energy required by the brain (which is not much) will be amply supplied by:

• ketone bodies: produced by the body as a result of a low-carbohydrate diet
• fat: the glycerol backbone of the triglycerides - or fat - we consume or our body releases from our fat stores
• protein: some of the protein will be converted to glucose if we are on a low-carbohydrate diet. This conversion is slow and inefficient.

If the muscle is not supplied by glucose, as a result of a high-fat diet, over time, it will adapt to burning fatty acids (from fat) as an alternative energy source.

On a high carbohydrate diet, glucose will spike, insulin will bring it down and sensitises the fat tissues to store this extra-energy. Yes, the remaining glucose (not burned in muscles) will be converted to fat and will be stored in out fat tissues. Remember: insulin is a fat building hormone.

Fatty acids cannot be converted to glucose. So a high-fat, low carbohydrate diet will result in low plasma glucose levels, therefore, in low insulin levels. This diet supplies the necessary energy both for the brain and the muscle.

In this video Dr. Bernstein (a type 1 diabetic himself in his late 70s) conducts a little experiment about the quick conversion of carbohydrate into glucose, no matter how "whole" that bread is.



About exercise:
Exercise is very much recommended for everyone. However, it is not to be confused as a method for weight loss.

If insulin is the fattening hormone, then the most important aspect of weight loss would be to lower insulin levels, which can be achieved by lowering carbohydrate levels in our diet.

Exercise will burn some glucose and fatty acids. If we overdo exercise, the brain sends a message to the liver to release its glucose stores to fuel the high energy requirements. These high levels of glucose will, in turn, trigger the pancreas to release insulin. Some of this glucose will be stored back in the fat tissue (with the help of insulin) and prepare the body for more "hardcore" exercise. Weight loss is not as efficient on high performance as it might be on lower energy expenditure. However, exercise helps build muscle, if insulin levels remain normal.

Exercise also prompts us to consume more food, not immediately after exercise, but over time, our energy intake increases. If we are on a high-carbohydrate diet, it will lead to even more fat storage, and we push ourselves to expend even more energy... A vicious circle.

For more:
1. A randomized pilot trial of a moderate carbohydrate diet compared to a very low carbohydrate diet in overweight or obese individuals with type 2 diabetes mellitus or prediabetes.

Result: bigger weight-loss is the very low carbohydrate, eat-as-much-as-you-want group, compared to the calorie restricted American Diabetes Association (ADA) diet group.

"The LCK group lost 5.5 kg vs. 2.6 kg lost in MCCR group (p=0.09). Our results suggest that a very low carbohydrate diet coupled with skills to promote behavior change may improve glycemic control in type 2 diabetes while allowing decreases in diabetes medications."

LCK = very low carbohydrate, high fat, non calorie-restricted diet

MCCR = medium carbohydrate, low fat, calorie-restricted, carbohydrate counting diet

2. The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies 

"[...] low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors. In light of this evidence from randomized controlled trials, dietary guidelines should be re-visited advocating a healthy low carbohydrate dietary pattern as an alternative dietary strategy for the prevention of obesity and cardiovascular disease risk factors."