Blood Sugar Regulation (week 4)

Question 1

lower the glycemic load

Answer 1

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

Question 2

lower glycemic swaps

Answer 2

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

Question 3

sweetened beverages

Answer 3

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

Question 4

sweeteners

Answer 4

four main groups of sweeteners:
-caloric sweeteners (honey)
-natural non-caloric sweeteners (stevia)
-sugar alcohols (erythritol)
-artificial sweeteners (sweet and low)

Question 5

caloric sweeteners

Answer 5

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

Question 6

natural non-caloric sweeteners

Answer 6

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

Question 7

sugar alcohols (polyols)

Answer 7

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)

Question 8

practical use of natural non-caloric sweeteners

Answer 8

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

Question 9

artificial non-caloric sweeteners

Answer 9

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

Question 10

individuality and balanced meals

Answer 10

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

Question 11

total caloric intake

Answer 11

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

Question 12

low carb, high fat diets

Answer 12

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

Question 13

ketogenic diets

Answer 13

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

Question 14

saturated fat and omega 6’s

Answer 14

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

Question 15

omega 3’s

Answer 15

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

Question 16

dietary fat takeaways

Answer 16

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

Question 17

Protein Benefits

Answer 17

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

Question 18

protein & insulin - a mixed bag

Answer 18

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

Question 19

uniquely beneficial aminos

Answer 19

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

Question 20

protein takeaways

Answer 20

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

Question 21

fiber

Answer 21

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

Question 22

fiber research

Answer 22

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.

Question 23

soluble vs insoluble

Answer 23

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

Question 24

funcitonal categories

Answer 24

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

Question 25

selecting therapeutic nutrients

Answer 25

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

Question 26

selecting therapeutic nutrients

Answer 26

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?

Question 27

Magnesium

Answer 27

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

Question 28

vitamin D

Answer 28

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

Question 29

chromium

Answer 29

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

Question 30

B vitamins

Answer 30

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

Question 31

myo-inositol

Answer 31

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

Question 32

L-carnitine

Answer 32

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

Question 33

alpha lipoic acid

Answer 33

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

Question 34

vinegar

Answer 34

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

Question 35

berberine

Answer 35

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

Question 36

gymnema

Answer 36

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

Question 37

curcumin

Answer 37

increases insulin production and secretion / glucose uptake

suppresses hepatic glycogenolysis and gluconeogenesis

common dose is around 500-1500 mg/day in dividied doses

Question 38

cinnamon

Answer 38

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%

Question 39

fenugreek

Answer 39

seeds have been shown to increase insulin synthesis and release from pancreatic beta cells

high in soluble fiber = slow absorption of sugar

Question 40

adaptogens

Answer 40

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

Question 41

glandulars (PAALS)

Answer 41

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

Question 42

risk for hypoglycemia

Answer 42

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

Question 43

probiotics

Answer 43

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

Question 44

probiotics

Answer 44

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.

Question 45

meal timing

Answer 45

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

Question 46

time restricted eating

Answer 46

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

Question 47

early time restricted eating research

Answer 47

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

Question 48

meal timing takeaways

Answer 48

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

Question 49

caffeine use

Answer 49

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

Question 50

physical activity

Answer 50

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

Question 51

diet example

Answer 51

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.