Updated: Nov 16, 2022
Here in the south, we love our southern cooking and sweet tea. Unfortunately, the consequence is that Georgia continues to have increasing rates of type 2 diabetes. As a result of my practice area, I encounter a huge number of patients with type 2 diabetes. Part of my treatment programs include some form of diet modification. I am always surprised at how little diabetics tend to know about managing their condition. The worse part is that many of them continue to consume foods that make managing their blood sugar more difficult.
It may be easy for many physicians to dismiss the actions of these patients as being non-compliant. However, diabetic patients are frequently surprised at the information I provide them, despite being previously educated by doctors, nutritionists, and other medical professionals. Most of the information they're given is incomplete. Some information is just out-dated or wrong.
Diabetics need to be well-informed about the nature of their disease and they need to know exactly how to manage it. More complete information about type 2 diabetes when diagnosed will inevitably help decrease the incidence of more severe complications. Below are some of the lies that diabetics should look out for concerning their diet.
Lie #1 - Just Lose Weight
Diabetics are under the impression that treating diabetes is all about losing weight . While there is a significant correlation between obesity and health complications such as type 2 diabetes and heart disease, losing weight will not magically cure diabetes. Many of the patients I encounter seem to prioritize weight loss over the management of their blood glucose levels. Instead, I try to encourage them to focus on managing their blood sugar, which when done as I recommend, nearly always leads in weight loss.
Lie #2 - Fruit is Good for You
Simply stated, as a general rule, diabetics should not eat fruit. There are a few fruits which have very little impact on blood sugar levels. However, most fruit is high is two forms of sugar - glucose and fructose. The most common fruits available in the U.S. will cause an increase in a diabetics' blood sugar levels.
There has been a justifiable pivot in medicine when it comes to food choices. On average, there has been an industry push to encourage patients to increase the amount of fruits and vegetables in their diet. While this is a good recommendation for the average patient that merely wants to improve their health, eating more fruits and vegetables is at least an incomplete recommendation when it comes to diabetics.
When I tell patient's with type 2 diabetes to stop eating so much fruit, they look at me with absolute disbelief. They start to ask me about how they should replenish their much needed vitamins and minerals without eating a "well-rounded diet". The question should be, "am I deficient in any vitamins or minerals?" Most people are not. However, this can be solved with over-the-counter supplements and does not require the excess calories provided by fruit.
Lie #3 - Eating More is Better
There are a number of medical professionals that are telling diabetic patients that they should eat smaller, more frequent meals. While there is evidence that suggests this type of diet modification may be helpful for patients with gastrointestinal issues and may even improve body composition, known complications of small frequent meals (SFM) includes weight gain and disordered eating, among others. However, while diabetes is associated with obesity, patients tend to confuse the two related, but different, conditions.
Why are small frequent meals probably bad for patients with type 2 diabetes? Simply, people who eat small frequent meals will likely never enter a fasting state. In human metabolism, there are two states - (1)the fed state and (2)the fasting state. In the fed state, the body's metabolism will promote energy storage. In the fasting state, the body's metabolism will switch to energy burning. If you eat every 2-4 hours, your body will never enter the fasting state. For diabetics, this means that eating small frequent meals will inevitably keep their blood sugar levels elevated.
Instead of small, frequent meals, diabetics should consider including a form of fasting into their diet. Any fasting regimen should be supervised by a licensed physician, especially when done by diabetics. Fasting can lead to hypoglycemia, a dangerous medical condition that can quickly lead to death.
Lie #4 - Keep Eating Carbs
For me, this is the most onerous of them all. Type 2 diabetes is characterized by insulin resistance. Insulin resistance is the inability to produce enough insulin and the ability to use that insulin. They've been pummeled with a ridiculous perception of nutrition depicted by the out-dated food pyramid. Is it mere coincidence that being told to eat 6-11 servings of carbs per day has been the mantra, while the rates of type 2 diabetes continues to increase?
In my opinion, the poor advice given by the USDA is more than coincidental. In fact, there is no essential metabolic process in the human body that requires carbohydrates. The brain, our largest user of energy, has the capability to use fats for energy when the blood sugar is low.
With diabetics, especially those that take insulin, carbohydrate intake needs to be carefully reduced so as not to cause hypoglycemia. For this reason, people with diabetes should consult a physician before modifying their diet or medication.
Lie #5 - Breakfast is the most important meal of the day
Not only is this silly cliche' incomplete, it causes more problems. The United States is one of the few developed nations in the world where breakfast is awarded the title of "most important meal". In many European nations, coffee and a pastry is more than enough. In the U.S., we tend to overemphasize breakfast, likely thanks to the marketing efforts of companies like Kellogg's and General Mills in the early 20th century.
For healthy people without diabetes, eating a breakfast meal high in protein and fat can help to reduce anxiety and stress later in the day. For diabetics, breakfast should be of little importance. When I ask diabetic patients about their dietary habits and breakfast, more than half of them proudly state that they eat cereal for breakfast. For some, it's a more traditional meal that includes biscuits or toast and fruit. However, it appears that most are not aware that fruit, cereal, toast, and biscuits are all incredibly high in carbohydrates!
Lie #6 - Your A1C is Good
Hemoglobin A1C is a measurement we physicians use to measure blood sugar management over a 3 month period. A number of my diabetic patients suffer from a condition known as diabetic neuropathy. A number of these diabetic patients, when I ask the results of their last A1C, respond with "oh, it was good". When we finally uncover the numbers, I typically find values between 6.0 and 8.0.
These diabetic patients are being told that these values are good, when they are not. Anecdotally, patients with hgb A1C values within this range and higher with inevitably develop diabetic neuropathy at some point in the future. Worst of all, these patients are led to believe that these numbers are normal!
We, as physicians, need to help our patients take better control of their health. A large part of that is ensuring that our patients are well-educated and equipped with the correct information. Educating diabetic patients, while it may be uncomfortable, will help them to become more compliant with treatment plans. One of the key aspects of that compliance is having a brutally clear understanding of their disease.