Blood Sugar Regulation (week 4) Flashcards
lower the glycemic load
glycemic index and load = the extent to which foods raise blood sugar levels
type 2 diabetes is strongly related to glycemic index of the overall diet
factors which influence glycemic index of carbs:
-processing (whole fruit vs fruit juice)
-cooking method (boiling vs baking)
-fermentation
-what they are eaten with (fats or proteins)
focus on the quality of carbs before macronutrient ratios. replace refined carbs with complex carbs
lower glycemic swaps
higher GI carbs
-instant quick oatmeal
-white rice
-white or wheat bread or bagels
-crackers
-chips
lower GI alternatives:
-steel-cut or rolled oatmeal
-black, wild, or brown rice
-sprouted 100% whole grain or sourdough bread
-crackers made with whole nuts and seeds
-hummus and sliced veggies
include gradual steps + lower glycemic options for similar foods
-create handout/chart for future clients
-review clients food journal together and brainstorm alternatives
sweetened beverages
sugar sweetened beverages have very high glycemic loads
-short term: reactive hypoglycemia
-long term: advanced stages of dysglycemia
sweetened beverages = greater risk of type 2 diabetes than same total bolume of sugar from food
sugary drinks include soda, fruity drinks, sweet energy drinks
healthier options:
-sparkling mineral water
-unsweetened teas
-dilute
sweeteners
four main groups of sweeteners:
-caloric sweeteners (honey)
-natural non-caloric sweeteners (stevia)
-sugar alcohols (erythritol)
-artificial sweeteners (sweet and low)
caloric sweeteners
natural sugars or sugar based substances
-contain calories
-provide a source of energy
-contribute to blood glucose levels and insulin secretion
examples:
-honey
-sucrose (table sugar)
-maple syrup
-molasses
-agave
some have higher glycemic index/load than others
contain different ratios of mono and disaccharides
20g of sugar from sweetener = 20g of sugar
the least processed, the better micronutrient content
natural non-caloric sweeteners
plant based sources
do not contribute to blood glucose
intense sweetness comes from phytochemicals
examples:
-stevia
-monkfruit extract
studies on stevia show:
-does not contribute to increased glucose and insulin to a significant degree (minimal)
-may increase function of pancreatic beta cells and insulin secretion in response to glucose
often recommended in management of T2D
sugar alcohols (polyols)
names end in “ol”
chemical structure partially resembles sugar and partially resembles alcohol
not 100% non-caloric
have some impact on blood glucose, but much lower than caloric sweeteners
examples:
-xylitol, erythritol, sorbitol
range of effects on intestinal microbiota (antimicrobial and prebiotic effects)
practical use of natural non-caloric sweeteners
blending caloric with natural non-caloric sweeteners can achieve flavor profile while lowering the glycemic load
blood sugar swings & cravings:
-sweeter than sugar = heightened desire for sweeter foods (hyper-palatability)
-brain expects calories = cravings
-insulin response to sweetness, even without sugar/calories
studies mixed on insulin response:
-vary by individual/sweetener
-could lead to hypoglycemia
-may slow weightloss and limit improvements in insulin signaling
-may influence the composition and function of the gut microbiota
artificial non-caloric sweeteners
synthetic chemicals
-provide intense sweetness
-do not contain calories
-used in sugar free or low calorie products
examples:
-aspartame
-sucralose
-saccharin
100x - 1000x sweeter than real sugar
pancreas increases production and release of insulin in the blood
-contribute to insulin resistance
studies show:
-individuals with T2D consuming artificial sweeteners had higher levels of insulin resistance
-duration of us of artificial sweetener use influenced the level of insulin resistance
-ingestion of sucralose vs just water causes a greater increase in blood glucose and insulin levels
-do not stimulate feelings of fullness but instead cause cravings for more food
toxicity concerns:
-cancer risk
-linked to headaches, mood disorders, and neurological issues in susceptible individuals
altering the gut microbiome:
-120 healthy adults given saccharin, sucralose, aspartame, or stevia for 2 weeks
-saccharin and sucralose promoted glucose intolerance
-fecal microbiome samples transferred to mice = mice showed similar glycemic responses to the corresponding humans
individuality and balanced meals
macronutrient balance varies based on many factors:
- Age
- Season of year, and season of life
- Climate and region
- Day-to-day variations in activity level and type
- Digestive function
- History of metabolic conditions
- Other medical conditions
- Genetics
- Body composition
- Hormonal cycles
- Stress levels
- Bio individual glycemic response to specific foods
- Microbiome
- Food intolerances and hypersensitivity
- Goals and preferences
- Cultural customs and influences
build awareness of signs and symptoms to personalize macronutrient ranges:
-blood glucose
-sleep
-cognitive performance
-mood
metabolic flexibility = freedom to shift macronutrients per circumstance
total caloric intake
focus on food quality
centering our relationship with food around how we feel
more than “calories in calories out”
the type, timing, and context of calories affects: glucose, body weight, energy levels
however…
too much fuel, no matter the macronutrient ratios, can cause metabolic issues
it is all about balance
low carb, high fat diets
effective at improving:
-insulin resistance
-glucose levels
-A1C
-HDL
-triglycerides
-weight loss
study:
20% carb vs 60% carb
-controlled dietary proteins and total caloric intake
-low carb diet = greater weight loss, higher metabolic rate, improved blood sugar control and insulin resistance, and reduced A1C levels
ketogenic diets
ketogenic diets (approx 10% carb, 25$ protein, 65% fat)
-net carbs below 20-25g per day
-improve glucose metabolism and insulin sensitivity
-reduce obesity
-improve lipid metabolism (in some individuals)
potential drawbacks long term:
-loss of microbiome diversity
-altered hormones
-difficulty with fat digestion (liver/gallbladder issues)
-low levels of fiber and phytonutrients
cyclical - period windows of ketogenic diet followed by moderate carb intake
saturated fat and omega 6’s
different fats have different effects on glucose metabolism and insulin signaling
potential for diets high in saturated fat to induce insulin resistance
distinguish between “high carb + high fat” vs “low carb + high fat”
limits to the research: diet design
-carb source = high glycemic corn starch
-fat sources = hydrogenated coconut oil, corn oil, and lard (SFA and high omega 6 PUFA)
-does not tell us about the effects of saturated fats within context of a diet based on whole foods rich in fiber, vitamins, minerals
compounding factors in observational data in humans exists:
-healthy user bias: many individuals who consume diets rich in saturated fat often participate in other less healthful diet/lifestyle habits
diets high in saturated fats have been associated with increased inflammation and insulin resistance
potential mechanisms:
-pro-inflammatory prostaglandin formation
-alterations in microbiome and increased translocation of LPS
-activation of toll-like receptors = alter gene expression in a pro-inflammatory way
-accumulation of fat within non-adipose cells = impairs insulin signaling
-composition and fluidity of cell membranes
-mitochondrial stress
-mitigated by including fiber, omega 3’s, vitamins, minerals, anti-inflammatory polyphenols in the diet
omega 3’s
omega 3 PUFAs - beneficial effects on insulin sensitivity:
-alter gene expression positively
-improve lipid handling in the liver
-reduce inflammation via anti-inflammatory prostaglandin synthesis
-lower toll-like receptor activation
-increase insulin receptor function in peripheral cells
dietary fat takeaways
dietary fats:
-help maintain stable energy between meals
-lower glycemic response to foods
-increase satiety
aim to increase high quality omega 3’s and reduce concentrated forms of omega 6 such as corn, soy and safflower oils
aim for high quality sources
if you follow a higher fat diet, include sources of fiber and polyphenols
focus on healthy whole food sources of fat during mealtimes
moderate high carb + high fat
vs
low carb + high fat ketogenic diets
Protein Benefits
glycemic control: lower glycemic load, takes longer to digest
appetite regulation: increased satiety and reduced appetite. high protein breakfast = lower blood sugar levels and reduced appetite later in the day
thermogenic effects: increased energy expenditure
muscle synthesis: maintenance, repair, and growth. increase muscle = increase glucose uptake and utilization
protein & insulin - a mixed bag
ingestion of dietary protein = increase insulin and glucagon secretion
glucagon = conversion of amino acids into glucose (gluconeogenesis)
insulin = muscle growth and repair / speeds glucose uptake
high levels of insulinogenic amino acids (leucine):
-beneficial for muscle protein synthesis in physical activity
-excessive amounts could exacerbate insulin resistance in pre-existing metabolic conditions
Dairy:
-designed for growth
-beneficial at low to moderate amounts / fermented forms
-higher intake = increased risk for insulin resistance and type 2 diabetes
uniquely beneficial aminos
L-carnitine: improves markers of insulin resistance
glycine: protects against insulin resistance. collagen is high in glycine. gelatinous soups and collagen powders.
plant-based: can be equal to or more effective at glycemic control compared to adding animal based proteins. concerns about food sensitivities and accumulation of heavy metals
protein takeaways
protein benefits:
-glycemic control
-appetite regulation
-high thermic effect
-muscle synthesis
BCAAs - stimulate muscle growth and repair, but excessive levels may exacerbate insulin resistance in metabolic conditions + sedentary lifestyles
aim for whole food sources first - consider potential downsides to powders and personalize recommendations
dairy is particularly insulinogenic and large amounts may slow improvements
fiber
benefits of fiber for blood sugar:
-slows down glucose absorption
-improves insulin response
-improves serum lipid profiles
-promotes a sense of
fullness and reduces cravings
-supports healthy gut bacteria
-supports healthy blood pressure
-supports body weight regulation
fiber research
journal of american college of nutrition:
-glucomannnon (konjac) soluble fiber: lowered blood sugar / body weight as effectively as diabetic medication
new england journal of medicine:
-6 week trial: moderate vs high fiber diet
-moderate diet: 24g total, 8 g soluble)
-high fiber: 50g total, 25g soluble
result: high fiber diet:
-decrease pre-meal blood glucose levels
-decrease triglyceride levels
-decrease post meal blood glucose levels
american board of family medicine -
randomized controlled studies over 30 years
-fiber should be a primary disease management strategy. reduced HbA1c and fasting glucose.
soluble vs insoluble
many foods contain both soluble and insoluble
both are beneficial
soluble fiber:
-most effective for glycemic control
-gelatinous texture
minimum recommended intake:
-30-38 for men
-21-25 for women
-many studies suggest even more
to avoid GI upset:
-increase hydration
-start low and gradually increase intake
funcitonal categories
insulin sensitivity enhancers:
-target the function of insulin receptors in peripheral tissues
-chromium, magnesium, vitamin D, alpha-lipoc acid, cinnamon, omega 3 fatty acids
carbohydrate absorption and metabolism:
-reduce or slow absorption of glucose from digestive tract
-speed the excretion of glucose in urine
-boost glycolysis and cellular respiration in mitochondria
-slow gluconeogenesis and glycogenolysis in the liver
-magnesium, L-carnitine, dietary fiber
antioxidants:
-counter oxidative stress that contributes to insulin resistance and impaired blood sugar regulation
-vitamin C, vitamin E, coenzyme Q10
vitamin & mineral cofactors:
-cofactors for many of the enzymes involved in metabolism
-zinc, magnesium, B vitamins
adaptogens:
-may help normalize stress response
-chronically elevated stress hormones = glucose dysregulation
glandulars:
-aims to nourish the corresponding gland in the body
-pancreas, liver, adrenal glands
therapeutics for gut health:
-intestinal microbiome can impact blood sugar regulation
selecting therapeutic nutrients
what stage of dysglycemia is my client experiencing?
reactive hypoglycemia:
-low to normal fasting glucose
-hangry, unsteady, anxious
-trouble sleeping
approach:
-nutrients that nourish and calm nervous system and adrenal glands
-reducing stimulants/caffeine
-increasing intake of proteins, fats, fiber
-avoid foods that cause blood sugar spikes
advanced stages of dysglycemia:
-fasting glucose levels starting to creep upward
-signs of insulin resistance
approach:
-nutrients that help lower glucose and increase insulin sensitivity
selecting therapeutic nutrients
what is happening in the other foundations?
what recommendation could help both foundations?
berberine is a powerful dysbiotic agent, can lower candida and SIBA, and lowers blood glucose levels
magnesium can help with sleep and boosts blood sugar regulation
What stands out as missing in the diet already?
What have they tried before and what was their experience?
Magnesium
plays a role in hundreds of reactions throughout the body
needed to convert carbs into energy
improves blood glucose tolerance
helps pancreas create insulin
helps cells to recognize and respond to insulin
foods with magnesium include:
-dark leafy greens
-legumes
-nuts
-seeds
-whole grains
documented decrease in magnesium content in fresh produce over past several decades
estimated that 80% of magnesium content of whole foods is lost in processing
studies show that oral magnesium supplementation can improve HbA1c, insulin resistance, and other markers
vitamin D
indirectly supports by improving immune balance and reducing inflammation
directly supports glucose management. activation of vitamin D receptors in pancreatic beta cells stimulate insulin production
sunlight = most abundant natural source of vitamin D
foods with vitamin D include:
-fish (wild caught slamon)
-fish roe
-cod liver oil
-pork fat from animals raised with adequate sun exposure
-pasture raised chicken eggs
-some mushrooms
low vitamin D status associated with impaired metabolism and glucose intolerance
vitamin D supplementation at an average dose of 4000 IU per day significantly reduces fasting glucose and fasting insulin levels
chromium
has a beneficial role in supporting blood sugar regulation
increases the effects of insulin activity
foods with chromium include:
-meats
-whole grains
-most veggies
-nuts
chromium supplementation may support the reduction of fasting glucose levels, insulin levels, and insulin resistance
B vitamins
involved in metabolic processes
B complex - codependent and synergistic relationships
essential to the body’s stress response
play central roles in the production of neurotransmitters and adrenal hormones
depletion through increased metabolism/use, impaired absorption, and increased urinary excretion
especially helpful for experiencing reactive hypoglycemia and/or has a taxed HPA axis
myo-inositol
belongs to vitamin B complex group
enhances insulin signaling and glucose uptake
sources:
-endogenous synthesis
-fruits
-veggies
-legumes
-grains
-uts
improves insulin sensitivity in women with pcos
this may help regulate menstrual cycles and improve fertility
prevention of gestational diabetes
myoinositol + selenium can improve thyroid hormone levels
L-carnitine
endogenous synthesis using lysine and methionine
foods rich in L-carnitine:
-red meat (beef and lamb)
-poultry
-fish
-dairy products
-eggs
-found in small amounts in avocados and certain nuts like almonds
helps transport long chain fatty acids from the cytoplasm to the mitochondria
directly supports fatty acid oxidation
helps maintain insulin sensitivity and metabolic flexibility by:
-removing harmful lipids from ells
-repairing cell membranes
-preventing excess accumulation of metabolic byproducts in cells
alpha lipoic acid
improves the insulin cell receptor function in membranes
translocation of GLUT4 to cell surface
antioxidant + helps recycle other antioxidants (C, E, glutathione)
antiinflammatory
cofactor for mitochondrial enzymes involved in the breakdown of amino acids
endogenous synthesis
foods:
-red meat
-carrots
-beets
-spinach
-broccoli
-potatoes
alpha-linoic acid in food has not been found to raise plasma levels in humans
therapeutic supplemental doses upwards of 600-1800mg
vinegar
acetic acid
improves insulin sensitivity and regulate postprandial glucose
may help with weight management. increases satiety and reduces appetite
lowers total cholesterol and triglyceride levels and increase HDL cholesterol
antimicrobial properties: may inhibit growth of dysbiotic microbes in stomach and itnestines
berberine
found in berberis plant group
clinical studies:
- .5 grams of berberine 3x a day helped reduce blood glucose levels similar to the effects of metformin
berberine in treatment of T2D saw decrease in:
-HbA1c
-fasting blood glucose
-postprandial blood glucose
-insulin
-triglycerides
-increase in total antioxidant capacity
stimulates GLUT4 translocation
effective in non-alcoholic fatty liver disease = beneficial effects on intestinal microbiome in individuals with dysbiosis and high levels of LPS
gymnema
gymnema acids inhibit sugar receptors on taste buds
makes sweet foods less appealing = possible reduction in sugar intake
blocks receptors in intestines = lower sugar absorption
studies suggest it can:
-improve insulin sensitivity
-stimulate insulin secretion from the pancreas
-inhibit the process of gluconeogeneisis in the liver
curcumin
increases insulin production and secretion / glucose uptake
suppresses hepatic glycogenolysis and gluconeogenesis
common dose is around 500-1500 mg/day in dividied doses
cinnamon
study gave individuals with T2D either 1, 3, or 6 grams per day of cinnamon
after 40 days all three levels of cinnamon reduced
fasting serum glucose by 18-29%
triglycerides by 23-30%
LDL cholesterol by 7-27%
total cholesterol by 12-26%
fenugreek
seeds have been shown to increase insulin synthesis and release from pancreatic beta cells
high in soluble fiber = slow absorption of sugar
adaptogens
plants that normalize stress response
bi-directional connection between stress and blood sugar
-elevated stress hormones elevate blood glucose
-reactive hyperglycemia can contribute to dysregulation of stress response
many adaptogens contain antioxidant and anti-inflammatory compounds:
ginseng improves insulin secretion, glucose uptake, and reduces oxidative stress in individuals with T2D
glandulars (PAALS)
you may find glandular extract from bovine or porcine endocrine glands in many blood sugar regulation formulas
common glands include:
-pancreas
-adrenals
-liver
-hypothalamus
-pituitary
-thyroid
by consuming extracts from healthy endocrine tissues, one can provide nutrients that support the function of that organ within the human
risk for hypoglycemia
any of these supplemental approaches have potential to dramatically lower blood sugar and could lead to dangerous levels of hypoglycemia in individuals taking blood sugar lowering medications
be sure to research contraindications before recommending to your client and educate them on the importance of monitoring their blood glucose levels
probiotics
heterogeneity of research studies:
-multi strain formulas (not strain specific)
-controlled trials tend to compare against different controls like placebo, no treatment, against a different species/strain
-duration/dosage vary
-populations vary greatly whether diabetic or pre-diabetic or obese
-outcomes measured vary widely
probiotics
Lactobacillus acidophilus La5, Bifidobacterium lactis Bb12
These are found in a few types of yogurts in numerous probiotic and synbiotic blends.
In studies, probiotic yogurts prepared with these strains:
-Decreased serum uric acid in patients with metabolic syndrome. Uric acid tends to be elevated in metabolic syndrome and is thought to promote
visceral fat storage and insulin resistance.
-Increased total antioxidant capacity compared to baseline and improved
markers of oxidative stress.
-Decreased HbA1c when compared with placebo.
-Improved LDL-HDL ratios (lowering LDL cholesterol and increasing HDL).
Lactobacillus acidophilus NCFM
This strain can be found in numerous food-based products like yogurt and toddler formulas, as well as a wide variety of supplement formulas.
Bifidobacterium lactis HN019
This strain can be found in numerous multi-strain formulas in the market both in the United States and internationally.
Lactobacillus casei Shirota
This strain is primarily found as a fermented milk product.
meal timing
when a person eats is arguably as important as what they eat
identical meals in evening and morning = evening meal has higher glycemic response
breakfast largest meal of day and dinner smallest meal = improved glucose tolerance, insulin function, lower BMI, and decreased chance of overweight/obesity
late night eating can promote inflammation throughout the body
time restricted eating
TRE:
-not a specific diet
-does not necessarily restrict caloric intake
-a type of intermittent fasting
Late TRE:
-showed no significant improvements in glucose tolerance and insulin response, or even adverse results
Early TRE:
-aligns with body’s natural circadian rhythms
-earlier in day:
-pancreatic beta cells more responsive
-cells better able to utilize food for energy
when food is limited to a species active period of the day = improved metabolic health + improved gut microbiome health
early time restricted eating research
controlled trial: 8 men, prediabetic, overweight, prehypertensive
5 weeks: 6 hour eating timeframe, with dinner consumed by 3pm
7 weeks washout period
5 weeks: 12 hour eating timeframe
food and caloric intake remained identical between two study arms
results: early 6 hour eating pattern:
insulin sensitivity improved
pancreatic beta cell responsiveness improved
reduced hunger cravings in evenings
lasting beneficial effects
more research also shows a 10 hour eating window is also great. reducing from 14 to 10
meal timing takeaways
improve metabolic health
support blood sugar regulation
reduce the number of medications for those with prediabetes, diabetes, or metabolic syndrome
useful tool for those not able/willing to change composition of diet
evaluate clients dinner and late night snacking habits
move last meal to an earlier time
replace after dinner snacks with sparkling mineral water or non-caloric herbal teas
reduce snack cues in the environment
reduce total eating window to 6-10 hours provides positive impacts on glycemic control and metabolic health
caffeine use
caffeine stimulates release of stress hormones: adrenaline and cortisol
stress hormones increase in gluconeogensis and glycogenolysis = increased blood glucose
chronically elevated cortisol over time contributes to insulin resistance
combination of morning caffeine and light or no breakfast results in a brief window of high energy/glucose followed by a crash
consume a protein/fat rich breakfast with or before daily coffee
physical activity
physical activity helps transport glucose to muscle tissue
muscle contractions = insulin dependent GLUT4 translocation
muscle tissue = high glucose disposal
loss of muscle occurs more rapidly as we age
recommendations:
minimum 2 times a week
8-12 reps per exercise for healthy adults
10-15 reps for elderly adults
HIIT
Walking
diet example
Diet
Replace quick oats with whole rolled oats in your morning oatmeal and add 1
tablespoon of collagen peptides and 1/2 cup frozen blueberries as they are
cooking. Once removed from heat, top with tbsp of ground flax for added fiber
and omega-3 fatty acids. See if the berries help reduce added sweeteners. Begin
pouring your sweetener into a spoon before pouring it on the food and limit it to
one tablespoon.
- 3 days per week, substitute the oats with a high-protein, savory breakfast. Find
the handout attached for ideas like eggs poached over steamed broccoli and
quinoa. - Replace fast food lunches at work that contain bread with either a taco bowl or a
homemade packed salad with a protein. See the link provided for ideas on
preparing salads ahead of time and some recommended menu items for local
restaurants. - Begin exploring flavors of unsweetened sparkling water. A future goal is to
remove all sodas from the diet, but you’ve expressed a desire to wait on
attempting that goal, so consider using this time to explore some other options
that you might enjoy. - Consume the last meal or snack of the day at least 3 hours before bed.
