|
|
Some Basic Science Underlying the Diabetes Diet Part 2Articles - Dr. Bernstein Shares His Insights More and more of our professional readers have been ordering the Dr. Bernstein audio series, to give to their patients. This week Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S. continues to explain Some Basic Science Underlying the Diabetes Diet and gives you some clues to how he has stayed healthy for over 70 years.The Diabetes Diet
Part 2 of 2 / Part 1 Avariety of physiological factors other than the food you eat can and will affect blood sugars. Some of these, such as exercise and insulin resistance, are obvious and well known. Others are rarely if ever addressed in diabetes diets, but they’re crucial if you are to be successful in normalizing your blood sugars. Most of these are in some ways applicable to nondiabetics as well. The pages that follow contain simplified discussions of these phenomena, in order to get you jump-started. For those who want to know more, I’ve provided the page numbers in Dr. Bernstein’s Diabetes Solution where further details can be found (all page number references are to the 2003 edition). THE DAWN PHENOMENON If I check my blood sugars every few hours, they will be constant over that period. At the end of 18 hours roughly at bedtime I’ll need to inject more insulin to continue to prevent gluconeogenesis. It would stand to reason that I should be able to inject the same amount to cover the next 18 hours. But that’s not necessarily the case. If I did inject the same amount and arose more than 8H hours after my bedtime shot, when I checked my morning blood sugar, I’d find that it had not remained constant despite the same amount of long acting insulin but had risen significantly higher than it was at bedtime. If I did the same thing a week later, I’d get the same results — an overnight rise in blood sugars. Why? Although the mechanics of the Dawn Phenomenon aren’t yet entirely clear, research suggests that the liver deactivates more circulating insulin self-made or injected during the early morning hours than at other times of the day. With inadequate circulating insulin to prevent gluconeogenesis, your blood sugars may be higher in the morning than they were at bedtime.* This isn’t a problem for a nondiabetic, because a nondiabetic would just make more insulin. Investigators have actually measured blood sugar every hour throughout the night under similar circumstances and have found that the entire blood sugar increase occurs about 8–10 hours after bedtime for most affected people. The amount of the increase may vary from person to person. My increase is significant; someone else’s may be negligible. Though it is more apparent in type 1 diabetics, many type 2 diabetics also show signs of the Dawn Phenomenon. Later, when we discuss the diet guidelines, you’ll note that the amount of carbohydrate I recommend for breakfast is half that of lunch and dinner. The reason is the Dawn Phenomenon. DELAYED STOMACH-EMPTYING The medical name for delayed stomach-emptying is gastroparesis diabeticorum (Latin for the “weak or paralyzed stomach of diabetics”). Nerve damage from high blood sugars over a long period of time can result in the failure of the stomach to empty predictably. This means that for those with gastroparesis, the same meal can have different effects on blood sugars from one day to the next, depending on how rapidly or slowly it empties from the stomach. This makes predicting insulin requirements less than simple, but there are treatments that are effective for many diabetics with this condition. --------------------------------------------------------------------------------- INSULIN RESISTANCE CAUSED THE CHINESE RESTAURANT EFFECT The small amount of digestible carbohydrate in lettuce should not by itself have caused her blood sugar jump, even considering the quantity she ate. The explanation lies in what I call the Chinese Restaurant Effect. Some Chinese restaurant meals contain large amounts of protein or slow-acting, low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, that can make you feel full. During and after meals, the stomach empties a slurry of food mixed with liquid into the small intestine. The liquid passes through the small intestine and is absorbed, mostly in the large intestine. The solids stretch the walls of the small intestine as they slowly pass through. Cells in the upper part of the small intestine release hormones that signal the pancreas to produce insulin when they’re stretched. (The pancreas is the gland responsible for manufacturing, storing, and releasing insulin in the body.) Large meals cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these hormones. A very small amount of insulin released by the pancreas can cause a large drop in blood sugar, and so the pancreas produces the less potent hormone glucagon to fine-tune the potential excess effect of the insulin. Glucagon acts to increase blood sugar. The problem arises when the insulin-producing cells of your pancreas the pancreatic beta cells make little or no insulin. Glucagon is still produced, but adequate insulin is not available to offset its effect. The first lesson here is: Don’t stuff yourself. The second lesson is: There’s no such thing as a freebie. Any solid food that you eat (even pebbles) can raise your blood sugar if you’re diabetic. Trivial amounts, however, such as a small stick of celery, will have negligible effects. THE HONEYMOON PERIOD At the time they are diagnosed, type 1 diabetics usually have experienced very high blood sugars that cause a host of unpleasant symptoms, such as weight loss, frequent urination, and severe thirst. These symptoms subside soon after treatment with injected insulin begins. After a few weeks many patients experience a dramatic reduction of insulin requirements, almost as if the diabetes were reversing. Blood sugars may become nearly normal, even with low insulin doses. This benign honeymoon period may last weeks, months, or even as long as a year. If your treatment is conventional, the honeymoon period eventually ends and the roller coaster of blood sugar swings ensues. There are several hypotheses as to why conventional treatment won’t let the honeymoon go on forever, but my experience with patients indicates that with proper treatment it can. Essential to this is a low-carbohydrate diet and normal blood sugars. This will help preserve whatever insulin-producing pancreatic beta cells you may have. (The same is true for type 2 diabetics. Beta cell burnout the destruction of beta cells caused by excessive demands on the pancreas and by the toxic effect of high blood sugars upon beta cells — can be avoided, halted, and in some cases reversed if you get on the Diabetes Solution program and get your blood sugars normalized.) The bottom line here is that if you have been newly diagnosed and are experiencing a blood sugar honeymoon, get with the Diabetes Solution program as soon as possible. We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet. Copyright © 2005 by Richard K. Bernstein, M.D. Author’s Note For information on how you can purchase Diabetes
Diet, go to www.Diabetes-solution.net "Getting to the Heart of Diabetes" is a guide to understanding
CVD, diabetes and insulin resistance. This is a small guide with 4 chapters,
Diabetes, Insulin Resistance, Controlling Diabetes and Warning Signs for heart
attacks and strokes. After reading the booklet, your patient can take the next
step by putting their new knowledge into action. As part of the program patients
receive the following free of charge…………. Other Products by Dr. Richard K. Bernstein.
|
 |
|
Chapter
2
For
the first time, you can now listen and learn from Dr. Bernstein, how to
control your diabetes. 
Get Adobe Acrobat Now