food

I have a friend who’s got some peculiar ideas about diabetes, which he claims to exhibit acute symptoms of when he doesn’t eat right. He also has what I think of as some peculiar ideas and methods in managing his diet, and yet I have to admit:

• his approach is science-based, even when I can’t follow his conclusions
• the food he prepares is healthy and delicious
• he’s better at weight management than I am.

He and I been talking about food a lot lately. I’m grateful to be able to talk to someone who’s knowledgeable and effective in what he does, and can talk to me about my choices, and even express wondering reservations about them, without seeming to be scolding, or condescending, or conveying the idea that he knows how to “fix“ me—and that it’s his job to do so. (Most recently, our talks helped me to realize that I’d become very lax with my fat intake management.)

So with that prompt and another, I put together some thoughts about what I think and what I do about managing diet these days. This review of principles is partly descriptive and partly a call to myself to return to principles that have worked for me before.
[edit 2011/02/18: This post really has motivated me to be more scrupulous, and apparently that’s been paying off in the latest blood glucose readings.]

Current principles for long-term management of diet

Eat food. As you may have read, food activist Michael Pollan distills human wisdom about diet into seven words: “Eat food. Not too much. Mostly plants.” He goes on to say:

A little meat won’t kill you, though it’s better approached as a side dish than as a main. And you’re much better off eating whole fresh foods than processed food products. That’s what I mean by [“Eat food”…There are lots of edible foodlike substances in the supermarket, often] in packages festooned with health claims, which brings me to a related rule of thumb: if you’re concerned about your health, you should probably avoid food products that make health claims. [A] health claim on a food product is a good indication that it’s not really food, and food is what you want to eat.

For diabetics, “not too much” has a specific meaning. My body does not respond to food, and particularly to easily soluble carbohydrates (sugars and starches), particularly in large quantities, in a normal way. Just to complicate things, high quantities of animal protein and fat consumed together promote insulin resistance, and thus diabetes. In short, I need to strike, pretty much at every meal and snack, an optimal balance of nutrients that is going to satisfy me and is not going to make me sicker. Complacency will kill me, most likely after it cripples me. I could just knock fifteen years off my life expectancy now, and apologize in advance to the people who will have to take care of me—or I can log and meter my eating for the rest of my life. As my friend stresses, and as is confirmed in study after study, keeping a complete record of everything that passes one’s lips throughout the day has been shown time and again to be the single most effective tool for weight loss.

Get hungry. Type 2 diabetics may forget what hunger feels like. Once blood glucose levels leave the normal range—whether they are chronically too high or periodically too low—people experience food cravings. We feel “hungry” in the sense of feeling not-so-good-and-food-will-make-us-feel-better. We may be not just eager but literally anxious to eat. We may feel this pretty much most of the time. Real hunger is a different feeling—a kind of emptiness in the middle, sometimes accompanied by mild transitory pain: the “pangs” of hunger. When I’ve found the sweet spots for content, size and timing of meals, the false hunger abates. Some time after the last meal, true hunger may appear. Oddly, its effect (and affect) is not “MUST. HAVE. FOOD. NOW.” It’s more like “Oh, I guess I should eat something.” I need to welcome this novel feeling, and nurture it by not eating too much, too often. I first discovered this phenomenon on a three-meal-a-day schedule, and have found it holds true on my current five-or-six-meal a day schedule—as long as I’m clear that “may eat” is not the same as “must eat”, and I remember to factor quantity of food and hunger, not just the clock, into a predictable schedule.

There is no magical food. There is no diabolical food. There are some very good foods, and some not so good. From a combination of research and experience:

• Wild-caught fish is the animal protein of the gods.
• Vegetables are God’s gift to satiety, and I sometimes credit them with saving my life.
• Olive oil protects the at-risk heart; hard animal fats stress it.
• Beans and legumes judiciously mixed with whole grains, and with an eye to the carb count, provide complete protein, without the fatty overhead of most meats.
• Excess sodium—not just table salt, but the multitude of sodium compounds used in processed foods—raises blood pressure, the universal risk factor for cardiac disease.

• Various specific foods like bitter melon, nopal, buckwheat, and possibly cinnamon, seem to reduce blood glucose. However, no one food or combination of foods will have as much impact on blood sugar and general health as reaching and maintaining a healthy weight.

There are "expensive" foods. Animal protein is expensive in terms of dollars. Other foods are much easier on the pocketbook and much harder on the waistline. These are sometimes called "energy-dense"; you may know them as "high-caloric"; earlier and franker generations called them "fattening". Containing high quantities of fat, or of simple or refined carbohydrates, they provide little benefit for their caloric cost.

One special consideration is the so-called "white foods" like sugar, white bread and flours, and white potatoes. These have a high glycemic index and a relatively low satiety factor, and are often eaten in quantities that produce a high glycemic load. All of this adds up to simple carbohydrates being dumped into the bloodstream, over and above their caloric expense.

There is not a one-to-one correspondence between the whiteness of a food and its glycemic index, nor necessarily between glycemic index and glycemic load. Pasta, as one example, has a more complex biochemistry that may put it in its own category. Still, the "minimize white foods" rule can serve as a good rough guide—especially when eating out, where fatty sauces, excess portions, and the temptations of dessert can quickly undermine your best efforts at home.

Don’t starve. There are various ways of starving oneself; almost all fad and crash diets depend on it. I need a diet—in the general sense of the totality of what I eat—that is sustainable. Whenever I consider a modification to my plan, I need to ask myself: Can I continue to sustain this practice for the rest of my life? If the answer is no, then what’s the point?

Avoid food fads and pseudoscience. If an internet search on a food topic—acidity and alkalinity of foods, say, or glycemic index—produces a page of nearly identical language, claims of miracles cures, claims of suppression by the medical establishment, repeated appeals to the non-peer-reviewed “research” of someone who has a vague claim to the title “doctor”—I do not walk, I run to the nearest exit. I am in food fad land and food faith land, and my brain as well as my health is in danger.

Physics trumps biochemistry. Dietary management of diabetes can seem dauntingly complicated. On the other hand, a few simple principles have gone a long way toward restoring my health:

• Eat lots of vegetables.
• Minimize processed foods and high-glycemic carbohydrates (counting both index and load).
  (Avoiding “white foods” is an inexact and still useful guide.)
• Be moderate in consumption of everything else.

And although my biochemistry has changed, the physics of weight loss and weight maintenance has not changed:

• calories consumed < calories expended = weight loss
• calories consumed = calories expended = weight maintenance
• calories consumed > calories expended = weight gain

Do the math.

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A version of this post originally appeared in an article ©2011 OffTheGridNews.com. Reprinted with permission. All rights reserved.

Revised and expanded 2011-03-05