I wrote the following as a note in facebook. I think it gives a very good idea of why and what a diabetic must do. My understanding has evolved since then, but I only make small modifications to it as it is still not wrong.
A friends father passed away today. It was a case of complications due to Diabetes. It resulted in Heart Attack.
His father did love meat, and he could have cured his disease if he could be convinced to not follow his doctors advice.
Diabetes is not an incurable disease, provided you understand why your doctor recommends the diet he does and why it is exactly the wrong kind of diet for Diabetes. Dr. Bernstein is a great example, of what can be done with patience and critical thinking.
Dr. Bernstein is a Type1 diabetes patient. He was diagnosed at 12 years of age. He discovered the cure for diabetes at the age of 35 when he got hold of a glucose meter. At that time he was suffering from ill health due to diabetes. When he discovered the cure, he stopped suffering and has been healthy since. He is now 76 years of age, and very active. He is still running his practice. In fact he is now at the age which is the average expected age for normal people. He wasn't a doctor to begin with, he became a doctor because he wanted to help other diabetes patients, and his cure was not accepted by other people. To be able to convince other people he studied to become a doctor.
Dr. Bernstein is living with this disease for the last 64 Years, of which the first 23 were without understanding and following his doctors advice. These 23 years were miserable. The next 41 years he has lived with his understanding and he is happy. How many people survive for 41 years with diabetes following their doctors advice? How many do it while enjoying life?
It is important to remember that Type1 diabetes is much worse than Type2. Type1 normally occurs due to an auto-immune condition, where the Beta cells in Pancreas have been killed. A Type1 is unable to produce sufficient insulin for signalling consumption of nutrients including glucose. A type1 diabetic is emanciated because he/she cannot store amino-acids to allow muscle growth, cannot store triglycerides to build fat storage, cannot store glycogen to allow heavy physical work. All in all they have a very difficult life. They need exogenous insulin to survive.
Type2 diabetes is a condition where the liver, muscles, fat cells have become resistant to insulin, and do not react to it. Some of it is due to the fact that muscles and liver are choc full of glucose and cannot accomodate anymore of it. Some of it is because the cells insulin receptors have been damaged. They are producing enough or maybe even a lot of insulin. That is not where the problem is. The solution given is metformin which acts like insulin but bypasses the resistance. This will work for some time. The other solution is exogenous insulin, which is like increasing the volume when you are going deaf. It works some time, and then you grow more resistant, just like growing more deaf with extra volume.
Most people are Type 2 Diabetics. Type1 normally happens to children, although the auto-immune attack can happen at any age, it is more likely to happen in children. If you got it at an old age, it is almost always going to be Type2. If Dr. Bernstein is still alive and healthy at a ripe old age of 76, even though he has Type1 diabetes, anybody with Type2 can do the same, more easily. You just need to understand the basics, and have the patience and resilience to avoid stuff that is bad for you.
Diabetes is one of the simpler diseases to understand. It is basically an inability to use glucose. The food we eat if it contains starch will convert to glucose in the body. The body normally reacts by storing the glucose as glycogen and converting the excess to fat and storing it as triglycerides in fat cells. A Type2 Diabetic person cannot store the glucose, because the cells do not see that there is glucose around. The liver does not see that there is glucose around. The result is that glucose stays high in the blood.
It is interesting to note that the ideal blood sugar level is 80mg/dl, and the max acceptable blood sugar level is 140mg/dl. Given that an average person has about 5ltrs of blood, these levels amount to 4gms and 7gms respectively. The difference between ideal and max is just 3gms, which is about a half teaspoon of sugar. So we do not want to eat anything that will provide this much sugar, at a fast rate. The recommendation of low glycemic dieting and eating multiple times a day arrives from this fact. But the real information is lost, that 3gms is the limit.
A healthy persons body will be able to get rid of 200gms of sugar in one hour, stored as glycogen. But this does not apply to a diabetic person. Typically, they are not even able to store 10gms in an hour. Given that even low glycemic foods do not have a peak that lasts for more than an hour, it is highly recommended to check with a glucose meter, when the peak occurs for each food, and take care to consume only the amount of carbs that will not cause a peak higher than 140mg/dl. This is time consuming, painful, but the only effective method of controlling diabetes.
An easy solution obviously is to not eat anything that will convert to glucose. This may sound easy to do but it has pitfalls here. If you do not eat carbs, the blood sugar level can drop to dangerous levels, because the liver does not see that there is too little glucose in the blood. It is the task of liver to supply glucose when it is running low. This makes it quite dangerous to not eat glucose.
The minimum daily requirement of glucose is about 50gms, provided atleast 100gms of protein is eaten everyday. A diet which provides these would be able to keep diabetes in check, without any bad effects. The carbs should be split into 4-6 meals and snacks, separated at equal intervals. At 5 meals it would be 10gms per meal. Another interesting thing to note is that the stomach delays emptying with protein or fat is present in the meal or snack. It does not do so unfortunately for carbs, as it cannot do any digestion for them. Protein and Fat need to be carefully split into smaller components before releasing which reduces the rate at which stomach empties.
A mixed snack/meal with a small amount of carbs with fat and proteins, eaten at regular intervals would be very helpful in keeping the blood sugar level constant the whole day. It would avoid precipituous falls and high peaks.
In the initial period the glycogen stores are full. This means that requirement of glucose will be much lower. This is the reason that Atkins diet called for a Initiation Phase where 20gms of Nett carbs (basically fiber) was only allowed. During this phase liver and muscle glycogen gets utilized. A side effect of this for diabetics is to increase insulin sensitivity. Also a side effect of a high fat low carb and moderate protein diet is that you lose appetite. This would mean that you will lose weight.
Another pitfall in switching to this diet is that any insulin or metformin must be stopped or reduced, as they would cause the blood sugar level to drop too much. This does require the experience of a doctor, who has worked with this kind of diet. Or the patient must take a lot of risks, just like Dr. Bernstein did. His books will help understand the problem, and provide a method to fix it. So read it carefully, if you can't find a helpful doctor.
The above still does not explain why fat will not be harmful even though everybody claims that the fats are the devils.
Firstly, carbs are the overriding problem here. Nobody says that you will die immediately if you eat a lot of fat. But a diabetic will die if he/she eats a lot of carbs.
Second if you have read the above carefully, you would have noticed that carbs can convert to fat, and it converts to saturated fat, a particular fat called Palmitic Acid. Everybody who calls fat bad, they call saturated fat super bad. And carbs do convert into saturated fats. So by that logic carbs are super bad. But rest assured our body is not trying to kill us by creating saturated fats. It creates saturated fats because it is very stable, and it has a high energy density, so that it can store lots of energy safely. So carbs are not a problem because the body neutralizes it as saturated fat. This does mean that Saturated fat is not a bad thing to eat. It is logical, but most people (including doctors) are not very strong in logic.
Glucose to fat conversion happens only in people that are gaining weight. This happens for people who are losing their insulin sensitivity. Normally Liver and muscle cells lose sensitivity first and fat cells last. So these people tend to gain weight, till the point that fat cells lose sensitivity. At which point they move into diabetic phase.
Thirdly protein can convert to glucose, but do so only when glucose is required, so exceeding the limits of proteins will not have a detrimental effect on glucose control. In fact there are some proteins that do not convert to glucose. Eating more of these would be helpful. These are lysine and leucine, and are found in BCAA mixes that body builders use to enhance performance. Still making protein a very large part of the diet will be problematic.
There are some other considerations but those are minor. Supplementing Magnesium and Chromium helps improve insulin sensitivity. Omega3 supplements (such as fish oil) are also very helpful. As also is avoiding any concentrated source of omega6. If an oil contains more than 10% Omega6 avoid it, or keep the consumption below a tea spoon per day of all such oils. The best oils are ghee, butter, coconut oil, olive oil, palm kernel oil, High Oleic Sunflower oil, and animal fats. There are some others which are much more expensive.
The bottom line is that Diabetes requires some sacrifice. If you equate Food with Living then unfortunately, there is no solution for you. You are bound to suffer, and you can only hope for a quick death in the form of a heart attack, rather than lose the kidneys and the be on dialysis for a long time. If you have diabetes, hopefully this article has provided you with some pointers, and a drive to analyze your situation critically.