Conventional wisdom and advice regarding the dietary control of diabetes is that meals should contain a good amount of starchy carbohydrate. I am vigorously opposed to this notion of two main counts. Firstly, science shows that reducing carbohydrate intake is generally highly beneficial in the management of diabetes (see here for some more detail on this). Secondly, why would diabetics want to base a significant proportion of their diet on foods that are the precise foods diabetics do not handle well in their bodies. The idea that diabetics should eat plenty of starchy carbohydrate defies both science and common sense.
It should also be remember that even if no carbohydrate is eaten the body can switch to other fuel sources (protein and fat) to make it. This means that the body’s absolute requirement for carbohydrate is actually 0 grams a day. Now, I wouldn’t recommend that a diabetic (or anyone else) eats no carbohydrate. Particularly if instigated quickly, this is likely to lead to episodes of low blood sugar (hypoglycaemia) which can be serious and even life-threatening. However, a gradual reduction in carbohydrate intake, paralleled by careful reduction in medication (if appropriate) is generally an effective way to improve diabetic control and reduce the need for medication. It should also help diabetics reduce their risk of the complications of diabetes which can have a significant impact on the quality and quantity of someone’s life.
In my experience, once diabetics understand these principles, they usually act on them and get the expected benefits from them too. But that does mean to say that every single meal will be ideal from a nutritional or diabetic management perspective. From time to time, food can be eaten because it looks and smells good, not because it’s ‘nutritionally correct’. Sometimes, not-so-healthy foods are all that’s on offer, particularly outside the home. What is one to do in these circumstances?
Well, one thing I recommend is that wherever possible, diabetics (and others) carry with them healthy snacks that can take the edge of the appetite and reduce their desire for unhealthy foods. Also, even when there is no choice, have appetite under control is important as it will generally mean less unhealthy food is consumed, which will help limit the damage. As far as snacks go, my preference is nuts. One reason for this is that they have considerable appetite sating potential (they ‘do the job’). Their consumption is also associated with a reduced risk of cardiovascular disease, risk of which is heightened in diabetes.
Just recently I came across a study which explored the role that nuts might have in type 2 diabetes [1]. The review mentions research linking nuts eating with improved cardiovascular health, as well as work which has shown that eating nuts with a sugar-disruptive food tempered the sugar disruption caused by that food.
The review points about that levels of HbA1c (which is measure of blood sugar control over the preceding 2-3 months) have not been affected by the addition of nuts to the diet. However, HbA1c results are generally slow to change, and the duration of studies may not have been long enough to see benefits in this particular parameter.
The authors also point to research which finds that nut-eating is associated with reduced oxidative stress (free radical damage) after meals. This is something that would be expected to help reduce the risk of chronic disease. The authors recommend that nuts be incorporated into the diets of diabetics, even though their ability to influence overall glycemic control remains to be established.
I think it’s also worth considering that nut eating has been shown to help reverse metabolic syndrome ” considered to be a precursor of type 2 diabetes. You can read more about that here. In the article linked to here I make the point that one of the benefits of nuts is that they are rich in magnesium. There are several studies that link higher magnesium to lower risk of metabolic syndrome [2-4]. There is also, as it happens, evidence linking higher magnesium with relative protection from type 2 diabetes too [5].
References:
1. Jenkins DJ, et al. Possible benefit of nuts in type 2 diabetes. J Nutr. 2008;138(9):1752S-1756S
2. McKeown NM, et al. Dietary magnesium intake is related to metabolic syndrome in older Americans.Eur J Nutr. 2008;47(4):210-6.
3. Song Y, et al. Magnesium intake, C-reactive protein, and the prevalence of metabolic syndrome in middle-aged and older U.S. women. Diabetes Care. 2005;28(6):1438-44.
4. He K, et al. Magnesium intake and incidence of metabolic syndrome among young adults.
Circulation. 2006;113(13):1675-82.
5. Larsson SC, et al. Magnesium intake and risk of type 2 diabetes: a meta-analysis. J Intern Med. 2007;262(2):208-14
Great blog post John, thank you.
Since eating nuts as a snack, I’ve been able to balance my blood sugar levels better as a type 1 diabetic. At the same time I went low carb too. My diabetic nurse and my specialist before her, are always delighted with my blood sugar levels when tested.
I might add not recommended to me by the NHS but of course an excellent Nutrition consultant.
I’d highly recommend snacking on nuts and fruit sometimes with the nuts to any diabetic.
Nuts are a great food for many reasons. However, many nuts sold are not fresh (one health food shop owner told me that they are mostly off!) and rancid oils are not healthy. So be careful where bought and keep sealed and in the dark. Hilda
How lovely to be able to tell people that they should eat MORE of something!
I find when working with diabetics the big problems they have with eating nuts is that they perceive them as being fattening and they have been told to aovid fat.
But it is useful for them to have nuts as a snack and in my experience helps them balance blood sugar levels.
Hilda, Hi.
The potential (or possibility) for rancification of oils in nuts is interesting and one I have noted as appearing in a number of written works. It looks to have the potential for an interesting line of further study that time has not yet permitted. Even in the sketchiest of thumbnails that I have in constructed in my mind to date I would be inclined to think that ‘oils’ are significantly factorial in several foremost health conditions of our time.
Might I be correct to carry in my head the broad generalisation that those of the naturally occurring oils that in the modern age that we might regard as therapeutic tend to the shorter chained ones, and that the shorter chained ones are also tend towards being the least stable and most likely to oxidise?
Oxidation in extracted oils is fairly well documented, but can you or anyone suggest any further reading in re. the oxidation of oils ‘intrinsic’ to nuts and seeds etc.? The next logical line of inquiry is to consider the bodies response to ingestion of rancid fats.
I expect the health food assistant is correct to point out the concerns, but I also wonder if such concerns might be overplayed.
I have had severe problems with artery blockage also was diagnosed with diabetes type 2. Having gone through a bypass & several angioplasties within last 17 years. About 3 years ago heart surgeon recommended a new bypass but I refused; start studing to know what to do if avoid a bypass. I start eating a lot of nuts, specially wall nuts & lot of fruits/fresh vegetables. A year ago a mild heart pain occured on exersion, after angiography I was told that my one of the main artery (a by passed artery) was totally blocked but luckily a new blood wain grown up supplying blood to the affected area. I was suggested to continue eating the same food I was eating. This day my heart health is improved and I run some time to catch my buss without any pain. My diabes is also well controlled thanks the nature of nuts.