Advice for Diabetes

10th Oct 2016

This is going to be a loooong post so … buckle up! I’ve decided to compile a list of tips I always dish out to patients in clinic who suffer from the following

• Overweight
• At risk of metabolic syndrome
• Have metabolic syndrome
• Have diabetes

But first .. DISCLAIMER ALERT! This post is not intended to treat, override the decision of your personal doctor or cater for all problems you may have. I strongly advise everyone, particularly those with pre-diabetes and diabetes, to discuss the below suggestions with their personal physician. I believe everyone is a unique case and a one-size fits all approach to medicine, diet or exercise is naïve. ESPECIALLY if you are taking medications it is exceptionally important to discuss everything with your practitioner.

Over many years, I’ve found myself constantly scribbling down this list of suggestions that I believe are safe, evidence-based and practical for most people. I encourage you to look at the research (a selection of which I’ve included below) and be sceptical of anything anyone tells you on the internet … and yes that includes me!

What I encourage is a holistic view of disease and healthcare in general. There is no single cause of diabetes, stroke, heart attacks or high blood pressure, BUT I believe the majority of us would all benefit from the simple suggestions below.

1. REMOVE REFINED CARBOHYDRATES, SUGARS AND HIDDEN SUGARS

I hate to start on a negative note, because I like to focus on the beauty of food and the medicinal effects of eating well, but nonetheless I think it’s important to tackle this right at the beginning.

– Sugar (the white stuff)– Juices– Soda– White Rice– White Pasta– Bread (both whole and white)– Sauces and condiments– Obvious stuff (sweets, chocolate bars, crisps, pastries, biscuits, sweet granola bars)

Please learn how to read labels and keep a high threshold to what you allow in your shopping basket. Learn how to read labels. Just to confuse you, there are multiple names for sugar as well. If you see these in the list of ingredients for food just steer clear of them. I’m not suggesting we completely eradicate these products for life and equally I’m not scaring you into a restrictive way of eating. But it’s important we retrain our taste buds to appreciate what real food tastes like. Equally confusing are products ‘made for’ diabetics or marketed as ‘diabetic friendly’, just stay away from this stuff it’s not good for you. Dr Rangan Chatterjee did a fab job of demonstrating just how common and easy it is to harbour processed foods in our pantries. Watch this short video to get an idea of what foods I’m referring to and if you’re still confused ask your NHS GP or Practice Nurse about refined, processed foods.

[embedyt] http://www.youtube.com/watch?v=UPZipcHSnbA[/embedyt]

2. COLOURFUL PLANT FOCUSED FOOD

Every mealtime is an opportunity to flood your body with ingredients that have the ability to reduce inflammation, reduce stress and improve your wellbeing. Treat food like medicines … don’t forget to take them. The compounds with the power to prevent, treat and reverse disease are found mostly in PLANTS. Phytochemicals like glucosinolates, polyphenols as well as traditional micronutrients (vitamins and minerals) are all found abundantly in colourful plant based food. As well as providing defence they increase your own body’s ability to tolerate the stresses of disease and modern living. This is why in countless studies, a diet consisting largely of vegetables shows not only a lower risk of disease, but the potential for reversal.

I wouldn’t suggest measuring cup sizes or being too dogmatic about exactly how much of each ingredient you use. I would use COLOUR AS YOUR GUIDE. See what these food bowls have in common? Notice the emphasis on colour, dark greens and fibre from wholegrains?

Even breakfast can be full of vegetables and fats. For some ideas, check out my YouTube channel and Instagram for weekly recipe inspiration guiding you to health. Everytime you look at your plate, it should be brimming with colour, bursting with vitality and ‘healing food’.

3. FIBRE RICH FOOD

Legumes! Pulses, Beans, Lentils are all associated with reduced weight and risk factors for diabetes likely because of their high FIBRE content. A high fibre diet has been shown to reduce the incidence of heart disease, cancer and diabetes. Essentially all our biggest killers. Choose good quality fibres that are rich in protein and fibre such as:

Chickpea, Navy beans, Lentils, Split Pea, Black beans, Adzuki …

I always soak mine and thoroughly cook through. If short on time I use pre-packaged. Some people may have upset stomachs, allergic reactions and discomfort from eating legumes so again discuss with your practitioner and introduce them gradually into your diet. Other rich fibre sources include:

• Ground Flaxseed
• Chia seed
• Almonds
• Oat Bran

4. EAT YOUR GREENS

It goes without saying that greens are healthy, but I wanted to highlight their importance by making a section dedicated to them. Particularly the brassica vegetables, which are a group of foods we should be consuming DAILY. I have greens with every meal. They reduce the incidence of cancer, contain lots of protein and importantly the ‘phytochemicals’ that can reverse disease. If you are diabetic, or pre-diabetic greens are your lifeline. Try:

Broccoli (purple sprouting, tenderness, traditional)AsparagusCabbageRocketChinese CabbagePak ChoyBok ChoySpinachRomanesco

5. EAT REAL FOOD, EAT REAL FATS

Steer clear of fake foods, those marketed as ‘a healthier alternative to …’ and ‘low fat’ substitutes and sweeteners (sweeteners are potentially worse than sugar). One of the most damaging health messages of all time was for us to go LOW FAT. Unfortunately it’s led to an explosion of ‘diet sandwiches’, sweeteners (that can have the same effect as sugar) and margarines made from processed oils that have ingredients that can CAUSE heart attacks.

The low fat message has led to some patients being fearful about food that is GOOD for us. I’ve done a tutorial about fats here, but to re-iterate, some high fat foods found in nature can be beneficial for us! For this reason I recommend:

• Daily flaxseed (2-3 tbsps)
• A daily handful of nuts and seeds (walnut, sunflower, hemp, pumpkin, chia)
• Good quality 100% cold pressed extra virgin olive oil
• Avocados
• Dark Chocolate (85%+)

6. DEFINED PERIODS OF EATING

This is a real easy one to implement and amazingly effective. Please try this out. Only eat for defined periods of 10-12 hours in the day:

e.g If you wake up at 7am and eat at 8am, do not eat after 8pm. And try not to eat 2 hours before going to bed.

Multiple studies demonstrate that having a defined period of eating leads to better weight control, better sugar control and improving markers of disease like insulin and fasting glucose levels. There are multiple theories ranging from clock genes to positive effects on the gut microbiome (more on that here). It basically gets your body to become used to when to expect food and improves the ability of your hormones to do their job. Very easy, very effective.

7. DON’T COUNT CALORIES BUT … CARBS ARE NOT CREATED EQUAL

The quality of your food is much more important than its calorific content. Diabetes treatment is not about restriction, it’s about the right choices and they can be delicious, fulfilling and life changing for yourself and those around you. Having said this, diabetes itself is a condition where the body has become intolerant of sugar and for this reason we need to be mindful of the carbohydrate content of food. I realise that just even bringing up the subject of ‘low carb’ will irate many dieticians, nutritionists and others in the field (because of its reputation in the ‘paleo’ diet community) but I believe a focus on plant based sources of protein, fibre and fat is what pre-diabetics and diabetics especially should focus on.

Forget the soggy sandwiches, the boring pasta bowls and tea and toast in the mornings. Your bodies are starving for nutrient dense foods. This is why bowls of food, as shown above, focus on getting your carbs from colour and less on the beige stuff!

Bread, White Rice, Pastas, White potato, Cereals (even cereals marketed as ‘wholegrain’), Instant Oats, Refined Grains, white potato are OUT

Take the time to prepare and focus on your food and your food will take care of you in many more ways than you thought possible.

8. WALK AFTER MEALS

Again another REALLY EASY but effective way of improving your sugar control. Instead of ‘vegging out’ on the couch after eating (like we’re all guilty of, let’s be honest!) 15 minutes minimum walk after eating is what we should aim for. It’s a simple as that.

9. HIIT

High Intensity Interval Training is incredibly fashionable right now, but with good reason. We’ve known for decades since Tabata, and a bunch of other researchers in the 90’s, proved the effectiveness of this type of exercise for weight loss, effective fat burn and benefits for diabetes patients.

VERY EASY to implement at homeIt’s FREE (you do not need to drag yourself to a gym)It’s TIME EFFECIENT

Have a look at Joe’s (thebodycoach) beginner tutorials, if you have heart issues (angina, previous heart attacks or a strong history of heart disease in the family) discuss with your doctor before performing high intensity exercise or starting any exercise regimen.

10. MEDITATION AND SLEEP

Although this is at the end of the list, this is by no means the least important. We live in a perpetual state of anxiety. Our population stress levels are rising and as a nation we are becoming more and more depressed. Stress is an important factor in blood sugar regulation in our bodies. Hormones released as a result of stress can also lead to a cascade of inflammation promoting problems that is bad news for people already at risk of chronic disease. We can reduce this risk with meditation and a few tips to get you less stressy.

Mindfulness – join a course, enquire via your community or GP practice if there are any free courses or use a guided app like headspace. It only takes 10mins a day. The more you practice, the better the effect. As a doctor I wouldn’t recommend it if it wasn’t worth it and there wasn’t evidence.

Yoga and Stretch – Every morning, the first thing we need to do is move and STRETCH at the end of the bed. There’s a bunch of websites and YouTube channels dedicated to yoga (like Adriene’s), it’s free, you can do it in the privacy of your own house. TRY IT

Sleep – A very important factor involved in inflammation and stress pathways. Make sure you’re tucked up in time. Most people only get 5-6 hrs per night which is wholly inadequate. Try getting 8-9 hours. Set yourself a target for attempting it for 7 days. Put everything aside that you usually do in a typical week and go to sleep. See how you feel.

Electronics – electronic stimulus on the brain is well recognised. Using electronics, artificial lights, computer and TVs inhibits the hormone responsible for sleep. This hormone Melatonin is vital for determining rhythm and the correct functioning of your vital organs including the pancreas, which is heavily involved in sugar regulation. Put the electronics away at least 2 hours before bed.

11. EXTRA STUFF

The reason why I started ‘The Doctor’s Kitchen’ is to teach everybody how we can cook our way to health. How we can prevent and potentially reverse disease by using food as medicine. But that doesn’t necessarily mean replacing medicines and drugs with natural supplements and herbal alternatives.

I would like to encourage a healthy lifestyle and a healthy relationship with the food and environment through my Blog, YouTube and Instagram. So I advise the ingredients below IN THE CONTEXT of a healthy diet and lifestyle as outlined above. These are by no means ‘panaceas‘, but there is evidence to show that they may help.

Turmeric:Multiple studies show reduced incidence of diabetes in prediabetics, improved sugar control and reduced oxidative stress in as little as half a teaspoon a day! I love this spice and I use it in lots of recipes on my YT channel.

Cinnamon:It may not have anti diabetic effects as earlier reports suggested, but it is a potent antioxidant (much needed in diabetes) and it tastes great. Throw it in smoothies, desserts and even curries!

Vinegar:There has been a suggestion that ingesting 30mls of raw, unhomogenised, apple cider vinegar has positive effects on blunting the sugar spike after meals. Owing to it’s polyphenol concentration and perhaps it’s positive effect on digestive microbes, there is some evidence to suggest it improves certain cholesterol markers and reduces inflammation. There are tastier ways to improve your diabetes but some people swear by this stuff!

Flax:I recommend daily flax to everyone. It’s a fantastic source of fibre and protein, it has a nutty texture lovely in smoothies and desserts.

Amla:Dried Indian gooseberries that are then powdered. My family members have sworn by this Ayurvedic medicine for decades. Again, another rich source of vitamins, polyphenols (including tannins, ellagic acid, flavonoids) which improves blood sugar control as good as some anti-diabetic agents! No large scale studies demonstrate it’s effectiveness and I wouldn’t recommend it in place of medication for that reason. If you can tolerate its incredibly bitter taste you may want to try it under the guidance and supervision of a medical practitioner.

Omega 3:Known for it’s positive effect on inflammation, potential effects on reducing the incidence of cognitive decline and potentially reducing cardiovascular disease (although this is disputed). I doubt most of us eat our quota of O-3 per week so supplementation may be best. Dietary sources include Walnuts, Chia, Almonds, Algae and Wild Fish (sardines/salmon)

12.Final Note from the DocMake these changes gradually – Your gut (if it’s used to refined carbohydrate, sugars and processed food) is likely to throw a tantrum if you suddenly introduce high fibre whole foods with low sugar content! Give yourself some time to get used to a new way of eating. Again it would be pertinent to discuss your progress and options with your nurse or doctor as you make healthy lifestyle changes.

I truly hope you enjoyed reading this list and ACTION them. Set yourself a goal and STICK WITH IT. Write yourself a plan for 4 weeks and DO IT. The power to improve your health is now in your hands, it’s up to you to follow through with it. If you feel this information is good to share then please go ahead. Also follow me on Instagram, subscribe to this blog and the YouTube channelwhere I post videos weekly!

In health,Dr Rupy Aujla

REFERENCES:

Facts and Stats – Diabetes.co.uk – revised NOVEMBER 2015Challenges of managing diabetes in Asians -Kirpal Marwa, Shanaz Mughal, Harbinder Sunsoa, Roytoa Bibi – Journal of Diabetes Nursing Vol 8 No 2 2004Type 2 diabetes: prevention in people at high risk – Public health guideline Published: 12 July 2012 nice.org.uk/guidance/ph38Long-term effects of a diet loosely restricting carbohydrates on HbA1c levels, BMI and tapering of sulfonylureas in type 2 diabetes: A 2-year follow-up study – Haimoto H, Iwata M, Wakai K, Umegaki H. – Diabetes Res Clin Pract. 2008 Feb;79(2):350-6Restricted-Carbohydrate Diets in Patients with Type 2 Diabetes: A Meta-Analysis -Julienne K. Kirk – Journal of the Academy of Nutrition and DieteticsRegular consumption of pulses for 8 weeks reduces metabolic syndrome risk factors in overweight and obese adults – R. C. Mollard – British Journal of Nutrition (2012)Curcumin Extract for Prevention of Type 2 Diabetes – SOMLAK CHUENGSAMARN, MD – Diabetes Care UK vol 3 Nov 2012Daily flaxseed consumption improves glycemic control in obese men and women with pre-diabetes: a randomized study – Andrea M. Hutchins – Nutrition Research May 2013 Vol 33Glycemic and cardiovascular parameters improved in type 2 diabetes with the high nutrient density (HND) diet – D. M. Dunaief – Open Journal of Preventive Medicine – Vol.2, No.3, 364-371 (2012)Legume intake is inversely associated with metabolic syndrome in adults – Hosseinpour-Niazi S, Mirmiran P, Amiri Z, Hosseini-Esfahani F, Shakeri N, Azizi F. Arch Iran Med. 2012; 15(9): 538 – 544.Phytochemicals and their impact on adipose tissue inflammation and diabetes –Andreas Leiherer – Vascular Pharmacology Volume 85, Pages e1-e4, 1-72 (October 2016)Systematic Review of Herbs and Dietary Supplements for Glycemic Control in Diabetes – GLORIA Y. YEH, MD, MPH – Diabetes Care 26:1277–1294, 2003Consumption of whole grain reduces risk of deteriorating glucose tolerance, including progression to prediabetes – Tina Wirstro – American Journal of Clinical NutritionDiet and Feeding Pattern Affect the Diurnal Dynamics of the Gut Microbiome – Amir Zarrinpar – Cell Metab. 2014 December 2; 20(6): 1006–1017Time-Restricted Feeding Is a Preventative and Therapeutic Interventionagainst Diverse Nutritional Challenges – Amandine Chaix – Cell Metabolism 20, 991–1005, December 2, 2014Low-carbohydrate diets and all-cause and cause-specific mortality: Two cohort StudiesTeresa T. Fung, ScD – Ann Intern Med. 2010 September 7; 153(5): 289–298Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres – Elissa Epel – Ann N Y Acad Sci. 2009 Aug; 1172: 34–53Examination of the antiglycemic properties of vinegar in healthy adults – Johnston CS – Ann Nutr Metab. 2010;56(1):74-9Cinnamon and Health – JOERG GRUENWALD – Critical Reviews in Food Science and Nutrition, 50:822–834 (2010)AMLA: A NOVEL AYURVEDIC HERB AS A FUNCTIONAL FOOD FOR HEALTH BENEFITS”- A MINI REVIEWSANKARAN MIRUNALINI – International Journal of Pharmacy and Pharmaceutical Sciences Vol 5, Suppl 1, 2013Anti-inflammatory properties of culinary herbs and spices that ameliorate the effects of metabolic syndrome – Alois Jungbauer – Maturitas 71 (2012) 227–239