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Preventing Diabetes: What Goes in Matters

February 19, 2019


While the virtues of healthy eating are well known and well established, many serious health risks associated with unhealthy eating habits remain largely under-recognized. Many people would be surprised to know that eating too much of the wrong types of foods to often can be just as destructive to the body as alcohol and/or tobacco use. Among the most destructive foods that are consumed, sugar is, by far, the most popular, and therefore is arguably the most destructive, especially when consumed in excess.

Maintaining normal blood sugar levels is a critical component to health and wellness. Under normal conditions, sugar in the blood (also known as blood glucose) is used by the body for energy. This function is absolutely necessary for the maintenance of life.  If the body’s ability to properly utilize blood glucose becomes impaired, blood glucose levels will rise and remain elevated. When blood glucose levels rise beyond a certain threshold, diabetes ensues. 

There are two fundamental types of diabetes: Type 1 and Type 2 diabetes. Type 1 diabetes is characterized by the inability of the pancreas to produce insulin. Insulin is a hormone, which is produced by the pancrease, that is necessary for maintaining normal blood sugar levels. Individuals affected by Type 1 diabetes are absolutely dependent on insulin injections for life. Most cases of Type 1 diabetes are not preventable or reversible. In contrast, with Type 2 diabetes, the pancreas still makes insulin but the production is impaired and/or ability of the body to utilize insulin properly is impaired. Type 2 diabetes is the most common form of diabetes, and is also highly preventable through dietary modifications. 

At onset, diabetes often goes undetected due to overlapping signs and symptoms with other conditions such as chronic stress. Classic signs and symptoms include; excessive thirst; frequent urination; intractable hunger; fatigue; and blurred vision. Diabetes, if left untreated, results in progressive damage to blood vessels throughout the body. As a result, of this blood vessel damage, affected individuals are at an increases risk of many serious complications. Some of the most notable complications include vision loss, loss of kidney function, heart disease, nerve damage, and impaired digestion. However, diabetes can have a negative impact throughout all bodily systems: literally from head to toe! 

Diabetes also poses serious financial consequences for affected individuals. Recent healthcare statistics show that persons with diabetes average 2 to 3 times greater out-of-pocket healthcare expenditures versus what expenditures would be otherwise.  Relatedly, many individuals with diabetes experience resultant financial hardship which often translates into even poorer health related outcomes.

Most cases of diabetes (especially Type 2) start out as pre-diabetes. Pre-diabetes is characterized by blood sugar levels that are elevated but not high enough to be classified as diabetes: also known as “borderline diabetes”.  If left untreated, pre-diabetes usually leads to diabetes. According to the CDC, over 80 million people are living with pre-diabetes. Alarmingly, nearly 90% of people with pre-diabetes are unaware of their condition until they are diagnosed with full blown diabetes. Even more alarming is that the number of diagnosed cases of diabetes has tripled over the past 20 years, and is expected to triple again within the next 20 to 30 years if the trend continues. The net result would be 1 in 3 Americans having diabetes!

The good news is that this dire prediction does not have to come true. Pre-diabetes is reversible and preventable thereby ultimately making many cases of Type 2 diabetes preventable!

The overwhelming majority of pre-diabetes cases are attributable to over-consumption of refined or processed carbohydrates/sugar(s) also known as simple carb foods, “bad carbs”, or high glycemic index carbs. Simple carb foods are foods that are easily broken down by the body and cause blood sugar spikes. Foods of most concern are those that are highly processed and especially those that are comprised of and/or contain sugar (i.e. “table sugar”). For many, pre-diabetes (and ultimately diabetes) can be prevented by the seemingly simple act of eliminating sugar from the diet. Unfortunately, sugar is extremely pervasive and commonplace in the American diet. Such pervasiveness is attributable to pleasure eating, and/or people unwittingly consuming sugar in food products that are not readily recognizable as a source.

Since Sugar is so commonplace in the American diet, that many people balk at the idea of eliminating it from their diet as if doing so was an unnatural thing to do.  Many people would be surprised to know that consumption of sugar is actually very unnatural. Sugars, in the forms and the volume that most commonly occur in the American diet, does not occur in nature, and (with the exception of some extraordinary circumstances) humans have absolutely no physiological requirement to ever consume them.  

One of the most important first steps in eliminating sugar from the diet is understanding what happens to in the body (short and long term) when consuming them. The following scenario is an overview of what happens in the body when consuming sugary food products such as soft drinks:   

Blood sugar levels quickly rise and yields a very rewarding feeling also known as a sugar rush.  The surge in blood sugar triggers insulin to be released from the pancreas. This is the body’s attempt to normalize blood sugar. However, since humans have not yet adapted physiologically to such a high sugar load, the pancreas tends to over-produce insulin thereby resulting in a sharp decline in blood sugar. This decline in blood sugar yields the all to familiar sugar crash feeling. When people get this feeling they want it to go away, so the most common response is to replenish with more sugar. This destructive process works in a manner very similar to drug addiction.  Adding to the destruction, the body’s response to excess sugar in the blood is converting the excess sugar to triglycerides which ultimately get stored as fat. As these fat stores accumulate with repeated excess sugar consumption, the net result is weight gain in the form of excess abdominal fat. Not only does this fat become deposited on the waistline, but it also tends to build up on the pancreas and liver. Excess fat on these organ systems causes the body to not produce and/or respond to its own insulin the way it should. This is also known as insulin resistance which is a key component to pre-diabetes. The length of time it takes to develop insulin resistance varies from person to person, but it can develop as soon as just one month of daily excess sugar consumption in some individuals! At this point, if excess sugar consumption continues: blood glucose and triglycerides will continue to rise,  the amount of fat on the liver and pancreas ultimately increases, and insulin resistance worsens. The cravings for sugar become even more insatiable, as they become both a cause and a consequence of the increasing degree of pre-diabetes. If this destructive cycle is not broken, then diabetes will ultimately ensue. 

Even in the minority of circumstances when this destructive cycle does not lead to diabetes, many of the health risks associated with diabetes are still present.  Also of significant concern, the fat deposition on the liver as a result of this process, is a well known risk factor in developing chronic liver disease and end stage liver failure, especially if the fat continues to accumulate. The fat deposition on the liver is also usually reversible when eliminating sugar from the diet. 

With knowledge of the many destructive processes that takes place in the body when consuming sugar, the need for taking steps to eliminate it from the diet becomes more self-evident.  However, when shopping for food, shoppers are surrounded by an abundance of sugar laden foods. Even many foods that purport to be healthy are often very high in sugar. As a result of this, eliminating them from the diet is understandably easier said than done. However, it is far from impossible. Small steps and small doses of knowledge progressively lead to major lifestyle changes over time. When the benefits of the small steps are realized as evinced by feeling better and looking better, that tends to encourage further steps toward eliminating sugar from the diet.

When someone is ready to eat less sugar, reading nutrition labels and the ingredient lists on food packaging is the ideal starting point. Realistically this process might start with choosing healthier alternatives to 1-2 foods in the diet, as label reading (at first) might seem like a nuisance or seem cumbersome. However, people tend to quickly become savvy shoppers as label reading becomes more intuitive after doing it enough times. Although there are no hard/ fast rules for reading food labels, there are some very important questions that can be answered by reading the labels: 

How many grams of sugar are in the product?
Keep in mind that there is no ”right” amount of sugar that must be eaten.  If the sugar content is high, then look at other foods in that same category that might have lower sugar alternatives.

Does the product have “added sugars”?
Most nutritional labels now have the category of “added sugars” in the nutrition facts portion of the label. If the product contains added sugar, then the best choice is to not select that food.

Does the product declare sugar(s) in the ingredient list?
The ingredient is the next place to look if “added sugars” are undeclared in the nutrition facts portion of the label. If the word "sugar" appears anywhere in the list of ingredients, then the product does in fact contain added sugar. If the word "sugar" does appear in the ingredient list, then the best choice is to not select that food.

Does the product have “hidden” sugars?
Food manufacturers know that many people want to avoid added sugar, so they tend to use hidden sugars to try to conceal the fact that sugar is, in fact, added.  Watch for syrups: For example, tapioca syrup; brown rice syrup; cane syrup; corn syrup; sorghum syrup are all examples of hidden sugars. Other hidden sugars include: dextrose; sucrose; malt; and cane juice.There are many more, but when in doubt, look at the nutrition facts panel for “added sugar”. These hidden sugars are supposed to be declared under added sugars on the nutrition facts panel, but sometimes they slip through the cracks.  

Is the product a processed food?
Unfortunately, this is not always self evident, but if the product has: multiple ingredients; in a box or a bag; and in the non-perishable section of the store, then there is a good chance it is processed. Many processed foods contain sugar. There are many examples of processed foods, which are high in sugar, that are unwittingly consumed due to claims of the product being a health food. A prime example of this is fruit juices. Most fruit juices cause blood sugar spikes that are similar to those yielded by sugary soft drinks. This is because the processing of the product removes most of the fiber which would otherwise result in slower digestion and therefore slower release of the sugar into the bloodstream. It is much healthier to choose the whole food alternative (i.e. oranges instead of orange juice).

Does the product contain artificial sweeteners?
Although artificial sweeteners do not cause blood sugar spikes themselves, they tend to trigger hunger in many people that consume them. A proposed reason for this is: when the sweet taste is detected by the tongue, the brain “thinks” that calories are coming and initiates its role in digestion. When the “anticipated” calories do not come, then hunger (namely in the form of sugar cravings) is the result of the digestive mechanisms that took place in the absence of calories. 

Even if people were willing to do nothing else, beyond eliminating sugar, many (but likely most) people would greatly reduce their risk of developing pre-diabetes/diabetes, and many with the condition would likely realize eventual reversal or mitigation. However, healthy eating does not end with cutting sugar. Ideally, everything that goes into the body should be capable of, and consumed for, the purpose of satisfying nutritional requirements. 

There are countless structured diets out there, but there is no one diet that works for everyone trying to prevent or mitigate diabetes. Diets work for some, but are discouraging to many due to complexity, cost, and their temporary nature. For all, the most important consideration is to adopt eating habits that include a variety of healthy foods that satisfy the nutritional requirements and the lifestyle of the individual. The plan should be goal directed toward blood glucose and (if needed) weight management, and should have the sustainability to support lifelong health. For many, such a strategy does not have to be complex: The body tells you when you are hungry and when you are not hungry. Listen to what you body tells you:  If you are hungry, then eat.  If you are not hungry, then do not eat.  If you find that you are no longer hungry while eating, then stop eating. It is unnecessary to eat to fullness. Respond to these bodily cues, along with the right foods to satisfy individual nutritional requirements, and blood sugar goals will likely be achieved and maintained.

The bottom line is that food is the single most modifiable factor when preventing or managing diabetes. While genetics and others predispositions are more or less of a factor for some, everyone has the ability to put themselves in complete control of their food consumption.

Trying to prevent or manage diabetes can be an overwhelming and discouraging task for many. People also find that generalized information, such as what is contained in this article, does not fit their individual circumstances. In such circumstances, individualized diabetic education is needed. Individualized diabetes education is considered a highly important component in diabetes prevention and management, and is shown to improve outcomes in pre-diabetic and diabetic patients alike. 

Diabetic education is available locally. The author of this article Larry LaBenne, PharmD, CDE is a pharmacist at Penn HIghlands Community Pharmacy and is also a Certified Diabetes Educator. With this unique background, he can take an integrative approach to your diabetes education by helping you understand your condition, and help you understand when and how to use your medications. If you are taking medication(s) for diabetes/pre-diabetes,and have related concerns and/or want to have a better understanding of your medications, Larry may be able to help. Call 375-6165 to schedule an appointment.