Tag Archives: diabetes

quick overview: the glycemic index

16 May

Since many of the most-recommended eating plans for PCOS patients are based on the idea of glycemic response, I thought it might be a good idea to discuss a couple of things about the glycemic index (and debunk a couple of other myths). Here are a few basic facts about glycemic response, the glycemic index, and how this idea can help you eat better and reduce your PCOS symptoms.

Basics

The glycemic index is a measure of the effects of a certain kind of carbohydrate on blood sugar. Foods with a high GI are the sugars and simple starches that make your blood sugar spike and then plummet (all of those baked goods we love), plus things like potatoes (although these are not as bad as some people have suggested!), and juices or sodas or other sugary drinks. Lower-GI starches include whole grains, beans, some kinds of vegetables, or certain kinds of breads like pumpernickel or rye.

When you hear about “good carbs” vs. “bad carbs,” the difference is the GI. Higher-GI foods set up a number of bad outcomes: the spike in blood sugar causes increased hunger and cravings when it bottoms out, and this eating pattern–over time–can wear out your pancreas, raising your risk of diabetes (especially if you are already insulin resistant, which many PCOS patients are).

In other words, the lower-GI carbohydrates fuel your body without causing drastic ups and downs in your blood sugar–which makes you feel better and is easier on your pancreas. (Eating those lower-GI carbohydrates instead of the sugary or starchy foods can also help you lose weight, especially if insulin resistance is at the root of your difficulties.)

What to Eat
The best books on the glycemic index don’t advocate a radical eating plan. Rather, they mostly suggest reducing carbohydrate portion size and exchanging high-GI carbs for low-GI ones. You can easily find lists of foods by GI on the internet, but it’s really mostly simple (with a few surprises, such as the variation in GI between types of rice). Just choose whole grains, less-processed carbohydrates, and more vegetables instead of starches. (Hey, I said it was simple, not easy.)

The Glycemic Load
You might also hear doctors or nutritionists discussing the glycemic load. This is basically a formula for how much carbohydrate is in a food, multiplied by its GI. The reason it’s useful is that some foods have a high GI, but don’t contain that much carbohydrate, so they don’t affect your blood sugar much. (Carrots are the classic example here.) A food that has a high GI but is low in overall carbohydrate is usually a good choice to eat.

Is this the same as low-carb?
No, it is not. None of these eating plans are low-carb. Atkins, for example, is low-carb, and I do not believe it is a healthful diet at all. But these plans–which have more in common with, say, the South Beach Diet–all emphasize higher-quality foods, better nutrition per calorie, and a balance of macronutrients (that is, a balance between carbohydrate, fat, and protein).

Finally, a Myth
Just because I hear this all the time and read it all the time: no, pasta is not particularly high GI. It’s fine to eat pasta if you can do so wisely and in moderation. It is moderate GI and should be eaten with a low-GI accompaniment. The main reason that so many people struggle with pasta is that Americans tend to eat a lot of it–it should be a moderate serving size, not the only thing you eat at your meal. Also, many people use jarred pasta sauce, which can be a source of a LOT of sugar. Read your label! One sauce that I really like is Victoria marinara (available in most grocery stores, at least on the East Coast, and at Costco). It has no added sugar and it’s delicious.

That said, we eat much less pasta than we used to, because I do find it hard to eat just one serving of it. The main reason I used to cook it was that it was easy: boil noodles, add sauce, and there you have it: dinner! The truth is, though, that it really needs to be just PART of a balanced meal, with more vegetables and possibly a protein source, and at that point I’m cooking anyway and it might be just as easy to cook a whole grain or vegetables instead.

Recommended Reading
My favorite books on this topic are those by Jennie Brand-Miller (she has an assortment; choose the one that reflects your goals or situation!) and the Insulin Resistance Diet. I do also like the South Beach Diet, in many ways, though I find that it is too focused on artificial sweeteners for my taste.

Gestational Diabetes: New(ish) research

2 May

I just read some interesting research about gestational diabetes–the 2009 Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study has provided compelling evidence that we should be using a lower cutoff point for diagnosing GDM (gestational diabetes mellitus). If you’ve ever had a baby and had standard prenatal care, you probably took the test for gestational diabetes (gross sugary drink, then a blood draw to see how your body processed it).

The study found that even women with “intermediate” results on the test (those whose results were not “positive” for GDM but were higher than average) had more adverse outcomes in pregnancy, including higher risk of c-section. This suggests that dietary changes or other treatments might be helpful for women whose results fall into that category.

For a good synopsis of this, see Jennie Brand-Muller’s blog post on the subject. (Brand-Muller is the author of The Low-GI Diet Revolution.)

new study: Metformin safer than other diabetes drugs

16 Apr

A new study in the European Heart Journal, by Tina Ken Schramm et al, found that metformin had the best outcomes out of a group of diabetes drugs: metformin, tolbutamide (Orinase), glipizide (Glucatrol), glibenclamide (Diabeta, Micronase, or Glynase), and glimepiride (Amaryl or GLIMY). The other drugs are known as sulfonylureas, whereas metformin is a biguanide.

The study, which compared metformin against available insulin secretogogues (ISs) found that the risks of “monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.”

In other words, Met is safer. The American Diabetes Association recommends that sulfonylureas be used as a second-step treatment.

insulin resistance: basic overview

27 Feb

If you have PCOS, you have probably read about insulin resistance (or IR). Maybe your doctor has talked to you about it. Or maybe you keep seeing books out there with titles like The Insulin Resistance Diet or Syndrome X: The Complete Nutritional Program to Prevent and Reverse Insulin Resistance.

Most women with PCOS have a basic idea of what IR is. It means that your body is not as good as it should be at using insulin to control glucose levels, so you have to make more insulin than you should really need; eventually, it’s too much for your pancreas to handle and your blood glucose levels begin to rise. This is why, even though you may hear IR described as “too much insulin” and think it is the opposite of diabetes, it is really related to diabetes, and can often lead to diabetes if left unchecked. Your pancreas can’t continue to make huge amounts of insulin forever.

There are some other reasons that producing lots of insulin is undesirable. It affects the balance of other hormones in the body: for example, it spurs your body to produce more testosterone, which contributes to the symptoms of PCOS (hirsutism, acne, thinning of hair on the head). Testosterone also disturbs the menstrual cycle. It can suppress ovulation and lead to infertility or other problems of the reproductive system, such as menstrual irregularity.

Too much testosterone and insulin also set up conditions that cause weight gain and make it very hard to lose weight. In particular, insulin resistant people often carry weight around the midsection, which is the most dangerous place to have it. This fat, which is called “visceral fat,” is more hazardous to your health than fat carried in other places. (It’s not clear to me why this is; however, scientists and researchers are finding that the old view of the fat cell as something that just sits there is quite wrong, and that fat cells produce hormones.)

I will post more on this topic, including details on how to test for insulin resistance and what kind of steps you can take to fight against it; however, the important thing to remember is that if you have PCOS, you are probably at least mildly insulin resistant, and the treatments for it are mostly things that will be good for you anyway (like a healthful diet and exercise).

new news about Avandia and heart disease

28 Jun

I know, I owe you a post about anxiety–but this is of interest for PCOS sufferers too! Avandia, one of the insulin-sensitizing agents often used for diabetics or insulin resistant patients, has been linked to heart problems and strokes.

Two teams of researchers found different results about the drug, but both studies found an increased risk of heart attack.  Steven Nissen, researcher in charge of one of the studies, argues that the drug should be taken off the market.

There are other medication options in this class that have not displayed the same problem–Metformin, which is most commonly prescribed, and Actos.

Read more here!