Saturday, 11 May 2013

Diabetes: which are the safest carbohydrates?

In my previous post, I stated that people with T2DM should eat ~150g/day of carbohydrate.
Soak & cook your own beans al-dente, for slowest release carbs.
See International table of glycemic index and glycemic load values: 2002. Below is a list of carbohydrates that have a low glycaemic load, or GL (GL = glycaemic index * grams of carbohydrate in the serving).

Non-nutritive sweeteners:

It's often claimed that non-nutritive sweeteners produce a cephalic phase insulin response. The mere anticipation of eating produces a cephalic phase insulin response. See How neural mediation of anticipatory and compensatory insulin release helps us tolerate food. An insulin response suppresses serum NEFAs, so it's not all bad.

Sugars and Sugar alcohols:

Fructose is not recommended for people with T2DM, as it "barges its way" into the liver via Glu-T5 and fructokinase. People with T2DM who have a high fasting serum glucose level almost certainly already have full liver glycogen stores, so adding to them isn't advisable. Whole fruits (not juices) are fine.
Lactose has a virtually zero GL, isn't very sweet and has/hasn't a laxative effect in large quantities (lactase-dependent). Heating lactose turns it into lactulose.
Lactulose has a virtually zero GI, is sweet and has a laxative effect in large quantities.
Galactose is not recommended, as large amounts may accelerate ageing.
D-mannose has a virtually zero GI, is sweet and doesn't have a laxative effect in large quantities. It can be used to treat urinary tract infections (UTIs) caused by e.coli, due to the fact that the kidneys filter it out of the blood and pass it out in the urine. Mannose in urine reduces the adhesion of e.coli to the inside wall of the urinary tract. See Intervening with urinary tract infections using anti-adhesives based on the crystal structure of the FimH-oligomannose-3 complex.
Trehalose has a virtually zero/moderate GI, is sweet and has/hasn't a laxative effect in large quantities (trehalase-dependent).

Lactitol has a virtually zero GI and has a laxative effect in large quantities.
Sorbitol has a virtually zero GI and has a laxative effect in large quantities.
Xylitol has a virtually zero GI, minty overtones and reduces dental plaque. However, it has a laxative effect in large quantities.
Erythritol has a virtually zero GI, minty overtones and is wee'ed-out like D-mannose, so it doesn't have a laxative effect in large quantities.


Note: Tinned starches are usually overcooked, so cook your own. Don't overcook starches, as that makes them faster-absorbing. Al dente is best.

Gram dhal a.k.a. chana dal.
Long-grain rice. Refrigerating boiled rice for 24 hours lowers the GL, by forming resistant starch. See item 275 in the table in the first link.
New potatoes. Refrigerating boiled new potatoes for 24 hours lowers the GL a lot, by forming resistant starch. See item 605 in the table in the first link. You can boil old potatoes, but they're probably not as good.
Pearl barley.
Sweet corn.
Starchy nuts e.g. peanuts , cashews and chestnuts.
Root vegetables.
Raw carrots.

If even low-GL carbs spike BG too much, this indicates severe IR in liver and/or skeletal muscle. See Insulin Resistance: Solutions to problems.

The above lists also apply to people with T1DM who are having difficulty keeping their blood glucose level between 3 and 7mmol/L.


Diana Moon said...

Soaking potatoes reduces acrylamide. Dunno what it does to the starch. Now starch is good (when resistant). Can hardly keep up.

LeonRover said...

I recognize Marks & Spencer Three Bean Salad!

Nigel Kinbrum said...

Not frying potatoes really reduces acrylamide (and flavour)!

I guess that soaking chipped potatoes reduces the starch content, as it's overheated starch that forms acrylamide. In school, we learned that soaking chipped potatoes in glucose solution made the chips (fries to you!) brown more quickly. More Maillard, less acrylamide?

Nigel Kinbrum said...

Me: "Waiter, waiter! Is this three bean salad?"

Waiter: "They used to be, sir."

Diana Moon said...

I slice my potatoes thickly (quarter them, if not big, then might slice those quarters if the potato is really big), soak them, spray them lightly with oil and bake them in a convection oven @400 degreesF.

I have the courage of my convections.

Nigel Kinbrum said...

If the oil is mostly monos + sats, it won't oxidise. What you're doing sounds mostly harmless.

Diana Moon said...

Slightly off topic, but I find that a small potato with my steak really completes the meal. I do not buy the Guyanet belief that protein in and of itself is "uniquely satiating." (His words.)

There was a whole discussion of this at CS/Evelyn's blog. Stephan linked to a study which purported to prove that this is true - sharp-eyed Jane noticed that the diet that brought on the highest PP insulin was the most satiating - it was higher protein, but had substantial carb. (I forget exact %s.)

I suspect that that's it - if I don't get a certain combination of protein/insulin, I don't get that PP insulin surge. And I'm not satisfied. I can't get no satisfaction from protein alone, therefore, I can't say it's "uniquely satiating." Only in tandem with the right amt. of carbs.

Nigel Kinbrum said...

I eat meals of P+F+C now. I just eat anything I want, without pigging-out.

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wordsilk said...

I'm a T2 diabetic. Peas, raw carrots (and cooked carrots), chickpeas, and sweet corn spike my blood glucose big time. The rest of the stuff on your list I don't know about, except konjac and cold potatoes -- cold potatoes aren't so bad and konjac doesn't spike my bg at all. Be careful what you recommend.

Nigel Kinbrum said...

Hi, and thanks for commenting.

Firstly, be aware that your n=1 experience may not apply to others. Chickpeas shouldn't spike blood glucose. Please see for things that may improve your glucose tolerance. I went from IGT (8.7mmol/L in OGTT) to NGT (3.7mmol/L in OGTT) by correcting Vitamin D insufficiency.

Secondly, you are "eating to your meter", as all diabetics should. You therefore know which foods spike your blood glucose and therefore which foods to avoid or cut down on.

wordsilk said...

Nevertheless, chickpeas spike my blood glucose greatly. I'm well aware that my experience is n=1 -- though it's actually n=2 since my dad also cannot eat peas, chickpeas, carrots, and sweet corn without spiking through the roof. Oh, and for both of us, milk, but not full cream, spikes BG. I've found GL to be frequently irrelevant. Took me a quite while to learn how to eat to my meter as all the diabetes "classes" I was required to attend pushed the ADA diet -- a bad diet for diabetics. My vitamin D levels were and continue to be excellent and were for years before I was even categorized as pre-diabetic. Managed to get from A1C 8.4 in Feb 2014 to A1C 5.2 just last week -- tried a lchf (mostly keto) diet beginning a year ago since the ADA diet was not doing anything. 100g of carbs is way too high for me (and my dad).

Nigel Kinbrum said...

Good news about your Vitamin D level. How about your Mg, Vitamin K2, Mn, Cu, Zn intakes etc?

Are you a thin T2 or a fat T2 (pardon the personal questions)? Activity levels? As your fasting BG is fine, your liver isn't IR. High PP BG is a disposal issue. Have you had any tests on your beta cells?

wordsilk said...

All my nutrient levels have always been and are currently fine. Fat T2 -- lost 70+ pounds with switch to VLC. Not very active though getting more so. Endocrinologist says I am definitely still IR. No test on beta cells that I know of. Tried RS for a couple of months: big mistake -- did nothing for my BG levels and triggered psoriasis flares again, which had 95% abated after about a month off grains.

Nigel Kinbrum said...

"Fat T2 -- lost 70+ pounds with switch to VLC. Not very active though
getting more so. Endocrinologist says I am definitely still IR."
Now we're getting somewhere!
1. How much more do you need to lose, to get a reasonable waist measurement?
2. I'm afraid you're going to have to become more active! See and click the last link in it when you get to the end. There are 3 posts linked together in total.