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Halloween is one of those holidays that are challenging for those with diabetes. Diabetes is a condition marked by elevated blood sugar levels. It is currently one of the most prevalent metabolic disorders around the world. In fact, type 2 diabetes now affects more than 20 million Americans.
Diabetics need to be extra cautious of what they add to their plate-especially during the holidays. There are many dishes that are loaded with sugars of all kinds. Sugars are naturally occurring carbohydrates. These include brown sugar, cane sugar, confectioners’ sugar, fructose, honey, and molasses. They have calories and raise one’s blood glucose levels (the level of sugar in the blood).
There are many different types of sugars that tend to have little to no effect on one’s blood sugar levels. They are:
- Sucralose (Splenda)-It is 600 times sweeter than sugar, yet has no effect on blood sugar, says Keri Glassman, RD, CDN, of Nutritious Life. In addition, Splenda passes through the body with minimal absorption. These attributes have helped it become the most commonly used artificial sweetener worldwide, according to an article published in October 2016 in Physiology & Behavior. However, there are studies that show it to be a cancer-causing agent when heated above 350 degrees. And another study showed beneficial gut bacteria like bifidobacteria and lactic acid bacteria were significantly reduced, while more harmful bacteria seemed to be less affected. The Food and Drug Administration (FDA) recommends an acceptable daily intake (ADI) of 5 milligrams (mg) or less of sucralose per kilogram (kg) of body weight per day. A 132-pound individual would need to consume 23 tabletop packets of the artificial sweetener per day to reach that limit.
- Saccharin (Sweet ‘N Low)-It is calorie-free and is about 300 to 500 times sweeter than sugar. It was the first artificial sweetener, with chemists discovering it as a derivative of coal tar by mistake in 1879, according to Encyclopedia Britannica. Studies by the National Toxicology Program of the National Institutes of Health concluded that saccharin shouldn’t be on the list of potential carcinogens. Saccharin is currently FDA-approved. A 132-lb individual would need to consume 45 tabletop packets of the artificial sweetener per day to reach the ADI of 15 mg of saccharin per kg of body weight per day.
- Aspartame (Equal)-It is a nonnutritive artificial sweetener that is 200 times sweeter than sugar. While not zero-calorie, it is still very low in calories. A study published in December 2014 in the journal Cytotechnology, has shown linkage to leukemia, lymphoma, and breast cancer. “Other research shows a [possible] linkage to migraines.” People with phenylketonuria (PKU), a rare condition in which they are unable to metabolize phenylalanine (a key component of aspartame), should not consume this sugar substitute. A 132-lb individual would need to consume a whopping 75 tabletop packets of the artificial sweetener per day to reach the ADI of 50 mg of aspartame per kg of body weight per day, notes the FDA.
- Stevia (Truvia)-Steviol glycosides are sweeteners derived from the leaf of the stevia plant, which is native to Central and South America. It is calorie-free. However, it doesn’t have a 1:1 ratio (cup-for-cup) with sugar when using it in foods and drinks. Thus, one needs to remember a little stevia can go a long way. It can also gain a bitter taste when too much is used depending on the brand. According to the 2019 Standards of Medical Care in Diabetes, published in January 2019 in Diabetes Care, nonnutritive sweeteners, including stevia, have little to no impact on blood sugar. The FDA has approved the use of certain stevia extracts, which it has generally recognized as safe (a term that is applied to food additives that qualified experts deem as safe, and therefore not subject to the usual premarket review and approval process). Memorial Sloan Kettering Cancer Center notes that people have reported side effects, like gastrointestinal symptoms, after eating high amounts of stevia. But to date, there is no solid scientific research to prove these claims. The FDA recommends an ADI of 4 mg or less of stevia per kilogram of body weight per day. A 132-lb individual would need to consume nine tabletop packets of the artificial sweetener per day to reach that limit.
- Sugar Alcohols (or polyols)-They are derived from the natural fibers in fruits and vegetables, according to the Joslin Diabetes Center. They include Xylitol (sourced from corn and birch trees), Sorbitol, Mannitol, and Isomalt. They may have a laxative effect and cause indigestion, bloating, and diarrhea in some people, the FDA points out. Products containing sorbitol and mannitol must bear a label warning that excess consumption can cause a laxative effect, per the FDA. The gastrointestinal symptoms arise because sugar alcohols are not completely absorbed in the digestive tract, says Lynn Grieger, RDN, CDE. She explains that unabsorbed carbohydrates from these sweeteners pass into the large intestine, where they are fermented by gut bacteria to produce gas. Sugar alcohols do contain some carbohydrates and are nutritive sweeteners, so they can affect blood sugar levels. If one counts carbs to manage diabetes, a common rule of thumb is to subtract half the amount of the sugar alcohol carbs listed on the nutrition label from the total carbs listed, according to the University of California in San Francisco. Also, they do have a 1:1 ratio with sugar when it comes to food and drink. When baking with yeast and making hard candies, these should not be used. And they are harmful to dogs.
- Erythritol-It is also a sugar alcohol sweetener, but unlike the others just mentioned, it has less than 1 calorie per gram, notes the International Food Information Council Foundation, and doesn’t have a big effect on blood sugar levels, per the American Diabetes Association. It’s an ingredient in the stevia-derived sweetener Truvia and is marketed under the brand-name Swerve. Swerve measures 1:1 ratio with sugar. Thus, one can use it like table sugar, or in cooking and baking recipes that call for sugar. If other sugar alcohol sweeteners give one tummy trouble, this may be a better option for them. It is less likely to produce the gas, bloating, and diarrhea that happens from fermentation by gut bacteria because only about 10% of the erythritol consumed enters the colon, per past research. The rest leaves the body through the urine. There’s no ADI for erythritol.
- Monk Fruit (Luo Han Guo fruit extract and Siraitia grosvenorii Swingle fruit extract)-This nonnutritive sweetener comes from a plant native to southern China. The extract contains 0 calories per serving, per the International Food Information Council Foundation, and per the FDA, is 150 to 200 times sweeter than sugar. The FDA has not questioned notices submitted by monk fruit sweetener makers that the extract is “generally recognized as safe.” The agency doesn’t specify an ADI for monk fruit sweetener. It also has a 1:1 ratio with sugar.
As one can see, there are many artificial sweeteners to help one reach their blood sugar goals. Just remember that maintaining them will be easier if one practices moderation and don’t allow sweet-tasting food and beverages to lead one to overconsume them. A major goal should be to reduce all types of sweeteners in one’s diet, including sugar substitutes so that one becomes accustomed to the naturally sweet taste of food. In fact, the American Diabetes Association recommends that in the case of beverages, it’s best not to rely on zero- or low-calorie options as a replacement for ones that contain sugar beyond the short term; but instead, to consume as little of any type of sweetener as one can, and simply drink more water.
There are two types of fiber: water-insoluble and water-soluble. Water-insoluble fibers bind or attract water, becoming very viscous and add bulk to the stool. This bulking helps maintain normal bowel function by acting as a scouring agent in the bowel. Water-soluble fibers actually dissolve in water and are further altered by the bacteria in our intestines. However, all fibers can slow the absorption of sugar and fat from food, and therefore help prevent spikes in blood sugar and blood fat after eating, possibly reducing the inflammatory response to food. Fiber can also prevent the absorption of some fat and cholesterol altogether, lowering blood triglyceride and cholesterol levels.
Calling fiber indigestible is not entirely accurate. Although we do not produce the needed enzymes to digest many of the fibers we eat in our diets, many of the bacteria that live in our intestines are able to break down, or ferment, fibers. It provides important nutrition for the bacteria to live and prosper, and so they are called pre-biotics. Many have heard of the fiber, fructooligosaccharides (FOS)/inulin. A few examples of inulin-containing foods are legumes, jicama, onions, and Jerusalem artichokes.
Fiber is further important in normal detoxification functions in the body. Much of this detoxification occurs in the liver. When the liver detoxifies these substances, the end products are frequently eliminated in the bile, a liquid substance made in our liver, and secreted via the gall bladder into our intestinal tract. When we eat a high fiber diet, the fiber from our meals binds these toxins and allows us to eliminate these waste products. Without a lot of fiber in the diet, these toxins can be reabsorbed, go back to our liver, and need to be processed again. Requiring the liver to reprocess these toxins requires more energy and may result in higher levels of these toxins in the bloodstream.
The United States Department of Agriculture (USDA) recommends adults eat 14 grams of dietary fiber per 1000 calories eaten in the diet. For most of us, this translates into 21-28 grams of fiber per day. However higher fiber diets may have additional benefits for those people with diabetes, including reducing blood sugar, lowering insulin, and lowering cholesterol. A typical recommendation to patients is 35-40 grams of fiber per day ideally achieved through the diet alone, with additional fiber intake (usually as a powered supplement) for weight loss or to selectively target reduction in post-meal blood sugars. Many people need to increase their water intake when they increase their fiber intake to avoid constipation because of the water-binding/bulking effects of water-insoluble fibers. Fiber, in combination with fish oil, has extra benefits on triglycerides and total cholesterol.
Vegetables (like kale, collard greens, chard, arugula, and lettuces), whole grains (like quinoa, barley, oats, and rye), nuts and legumes (beans, peas, soy, black, pinto, and lentils) remain the single best sources of fiber in the diet. Quick sources of supplemental fiber include ground flaxseed (freshly ground to preserve the oils present in the seeds), powered fiber supplements, chopped nuts, and/or oat bran. All of these can be sprinkled over salads, mixed in protein-shakes or water, or added to yogurt, salads, and vegetable medleys.
Psyllium, oat bran, glucomannan (Konjac), corn bran, peas, and agar have all been studied in people with type 2 diabetes. They all demonstrated substantial reductions in blood glucose, hemoglobin A1c, triglycerides, LDL cholesterol, and/or weight in study participants. Wheat fiber has also been studied but did not result in improvements in blood glucose or cholesterol in people with diabetes, though this was a very small and short study. Some people cannot tolerate fiber supplements (psyllium being the most commonly reported) as it produces gas, bloating, cramping, and constipation. These are the signs of food intolerance. Also, it is important to determine wheat/gluten sensitivity before choosing to supplement with oat, wheat, rye, or barley bran as a fiber source.
There are many herbal supplements that aid in reducing blood glucose levels. A few are:
- Curcumin (a compound found in turmeric)-It has been shown to both boost blood sugar control and help prevent the disease. In a nine-month study of 240 adults with pre-diabetes, those who took curcumin capsules completely avoided developing diabetes while a sixth of patients in the placebo group did.
- Ginseng-It has been used as a traditional medicine for more than 2,000 years. Studies suggest that both Asian and American ginseng may help lower blood sugar in people with diabetes. One study found that extract from the ginseng berry was able to normalize blood sugar and improve insulin sensitivity in mice who were bred to develop diabetes.
- Fenugreek-It has been used as a medicine and as a spice for thousands of years in the Middle East. In one study of 25 people with type 2 diabetes, fenugreek was found to have a significant effect on controlling blood sugar.
- Psyllium-Studies show that people with type 2 diabetes who take 10 grams of psyllium every day can improve their blood sugar and lower blood cholesterol.
- Cinnamon-Consuming about half a teaspoon of cinnamon per day can result in significant improvement in blood sugar, cholesterol, and triglyceride levels in people with type 2 diabetes.
- Aloe Vera-It has been used for thousands of years for its healing properties. Some studies suggest that the juice from the aloe vera plant can help lower blood sugar in people with types 2 diabetes. The dried sap of the aloe vera plant has traditionally been used in Arabia to treat diabetes.
- Bitter melon-This is a popular ingredient of Asian cooking and traditional Chinese medicine. It is believed to relieve thirst and fatigue, which are possible symptoms of type 2 diabetes. Research has shown that the extract of bitter melon can help diabetics with insulin secretion, glucose oxidation, and other processes.
- Milk thistle (aka silymarin)-It has been used for its medicinal properties for thousands of years. Milk thistle may reduce insulin resistance in people with type 2 diabetes who also have liver disease. It contains high concentrations of flavonoids and antioxidants, some of which may have a beneficial effect on insulin resistance. The role of milk thistle in glycemic control is little understood.
- Holy basil (Tulsi)-It is commonly used in India as a traditional medicine for diabetes. Studies in animals suggest that holy basil may increase the secretion of insulin. A controlled trial of holy basil in people with type 2 diabetes showed a positive effect on fasting blood sugar and on blood sugar following a meal.
- Neem-It has been long used as a treatment for diabetes. Aqueous extract of neem leaves significantly decreases blood sugar level and prevents adrenaline as well as glucose-induced hyperglycemia. Aqueous leaf extract also reduces hyperglycemia in streptozotocin diabetes and the effect is possibly due to the presence of a flavonoid, quercetin. The plant blocks the action of epinephrine on glucose metabolism, thus increasing peripheral glucose utilization. It also increased glucose uptake and glycogen deposition in isolated rat hemidiaphragm.
- Gymnema Sylvestre-It has been linked with significant blood-glucose-lowering. Some studies in animals have even reported regeneration of islet cells and an increase in beta-cell function.
- Nopal (prickly pear cactus)-Inhabitants of the Mexican desert have traditionally employed the plant in glucose control. Intestinal glucose uptake may be affected by some properties of the plant, and animal studies have found significant decreases in postprandial glucose and HbA1c.
- Okra (bhindi)-It is a rich source of fiber, beta-carotene, lutein, vitamin B6, and folate. B vitamins slow the progress of diabetic neuropathy and reduce levels of homocysteine, a risk factor for this disease. This vegetable has a very low glycemic index. 100 grams of bhindi contains only 7.45 grams of carbohydrates. It is one of the few vegetables, which is also dense in protein. Diabetics are often advised to keep their diet high in protein as it helps keep them satiated and prevent bingeing on other sugary foods. 100 grams of bhindi has less than 33 calories. In addition to the blood-glucose-lowering compounds, okra is also a powerhouse of antioxidants. It is also enriched with anti-inflammatory properties.
There are several vitamins and minerals that aid in reducing blood sugar levels:
- Chromium-It is required for the maintenance of normal glucose metabolism. Effects of chromium on glycemic control, dyslipidemia, weight loss, body composition, and bone density have all been studied. Considerable experimental and epidemiological evidence now indicates that chromium level is a major determinant of insulin sensitivity, as it functions as a cofactor in all insulin-regulating activities. Chromium facilitates insulin binding and subsequent uptake of glucose into the cell. Supplemental chromium has been shown to decrease fasting glucose level, improve glucose tolerance, lower insulin levels, and decrease total cholesterol and triglycerides while increases HDL cholesterol in normal, elderly, and type 2 diabetic subjects. Without chromium, insulin action is blocked and the glucose level is elevated. Although a low recommended daily allowance has been established for chromium over 200 mg/day appears necessary for optimal blood sugar regulation. A good supply of chromium is assured by supplemental chromium because chromium appears to increase the activity of the insulin receptors, it is logical to expect that an adequate level of insulin must also be present. Those using chromium supplements should be cautioned about the potential for hypoglycemia, and monitoring renal function is prudent.
- Vanadium-Several small trials have evaluated the use of oral vanadium supplements in diabetes. Most focus on type-2 diabetes although animal studies suggest that vanadium has also potential benefits in type 1 diabetes. In a subject with type 2 diabetes, vanadium increased insulin sensitivity as assessed by euglycemic hyperinsulinemic clamp studies in some but not all trials. Two small studies have confirmed the effectiveness of vanadyl sulfate at a dose of 100 mg/day in improving insulin sensitivity.
- Magnesium-These mineral functions as an essential cofactor for more than 300 enzymes. Magnesium is one of the more common micronutrient deficiencies in diabetes. Low dietary magnesium intake has been associated with an increased incidence of type 2 diabetes in some but not in all studies. Magnesium deficiency has been associated with complications of diabetes, retinopathy in particular. One study found patients with the most severe retinopathy were also lowest in magnesium.
- Nicotinamide (vitamin B3)-It occurs in two forms, nicotinic acid, and nicotinamide. The active coenzyme forms (nicotinamide adenine dinucleotide NAD and NAD phosphate) are essential for the functions of hundreds of enzymes and normal carbohydrate, lipid, and protein metabolism. The effects of nicotinamide supplementation have been studied in several trials focusing on the development and progression of type 1 diabetes a meta-analysis and one small trial in type 2 diabetes. Nicotinamide appears to be most effective in newly diagnosed diabetes and in subjects with positive islets cell antibodies but not diabetes. People who develop type 1 diabetes after puberty appear to be more responsive to nicotinamide treatment. Study results have offered more support for the idea that nicotinamide help to preserve β-cell function than for its possible role in diabetes prevention.
- Vitamin E-This essential fat-soluble vitamin functions primarily as an antioxidant. Low levels of vitamin E are associated with an increased incidence of diabetes and some research suggests that people with diabetes have decreased levels of antioxidants. People with diabetes may also have greater antioxidant requirements because of increased free radical production with hyperglycemia. Increased levels of oxidative stress markers have been documented in people with diabetes. Improvement in glycemic control decreases markers of oxidative stress as does vitamin supplementation. Clinical trials involving people with diabetes have investigated the effect of vitamin E on diabetes prevention insulin sensitivity glycemic control, protein glycation, a microvascular complication of diabetes, and cardiovascular disease and its risk factor.
- Okra Water: 5 okra pods, medium-sized; 3 cups of water. Directions: Take the okra pods and wash them thoroughly. Cut off the ends of the pods. Now, with the help of a knife split the pods in half. Take a mason jar or a tumbler with three cups of water and put the pods in it. Let the pods soak overnight. Squeeze the pods into the water and take them out. Drink the water.
- Chocolate Candy: 1 cup coconut oil; 1/3 cup xylitol; 3/4 cup cacao powder; 1/4 teaspoon stevia extract; 1/3 cup coconut flour. Directions: If you have granulated xylitol, begin by putting it in a food processor or coffee grinder and whiz it around for a minute or two until the xylitol is powdered. It will dissolve SO much easier if you don’t skip this step. Next, place your coconut oil in a saucepan and heat over medium-high heat until it is liquid. Add your xylitol and stevia, continuing to warm until the sweeteners are dissolved. Be careful not to boil. Add the cacao powder and coconut flour and stir until dissolved in the mixture and well combined. Finally, pour your chocolate into some type of silicone tray and place it in the freezer until solid. After the candies have hardened (it doesn’t take long), pop them out of the tray, place in a ziplock baggie, and store them in the refrigerator or freezer.
- Homemade Peanut Butter Cups: 1/4 cup nut butter; 1-2 tablespoons sweetener of choice (optional) ; pinch salt (optional); 1/2 cup chocolate chips (optional); 2 teaspoons coconut oil. Directions: For the base: Carefully melt the chocolate chips and stir with the optional oil until smooth. Spread about 1 tsp up the sides of mini cupcake liners. Freeze. Meanwhile, stir nut butter together with the optional sweetener and salt. Add about a teaspoon of filling to each liner, then cover with another tsp chocolate. Freeze again to set. Variations: *Nut Butter & Jelly: Make the base. Fill with nut butter and jelly. *Dark Chocolate Coconut: Use melted coconut butter as your base (stir in a little sweetener of choice if desired). Fill with melted chocolate chips. *Inside Out: Stir 1/2 cup powdered peanut butter with 1/4 cup coconut oil and 4 teaspoons pure maple syrup or sweetener of choice. Use this instead of the chocolate coating in the base. Melt 3 tablespoons chocolate chips as filling. *Chocolate Banana: Use mashed banana instead of nut butter for the filling. *Strawberry Jam: Combine 3 tablespoon coconut butter with 2 teaspoons mashed strawberry and optional sweetener of choice to taste. Use this as your base, and fill with nut butter of choice. *Raspberry Truffle: Fill the base with raspberry jam.
- Vegan Candy Corn: 1/4 cup cashew butter (or peanut butter); tiny dash salt; 1/4 cup powdered sugar; tiny pinch turmeric; a few drops beet juice. Directions: Mix the first three ingredients together in a bowl until it becomes a crumbly dough. (Note: if your nut butter is from the fridge, let it sit awhile or heat it up so it’s easier to mix.) If the dough is too gooey, you can add a little extra sugar. Taste the dough and add a little more salt if desired. Now transfer the crumbles to a plastic bag and smush very hard into a ball. Remove from the bag and form three little balls, the turmeric to one ball, and knead until it’s all one color. Do the same with the red. Roll balls into skinny strips—the skinnier the strips, the smaller the resulting candy corns, and press strips together. Cut into triangles or other shapes. As stated above in the post, these aren’t supposed to taste exactly like store-bought candy corn; they’re yummy in their own right. You can store it in the fridge or freezer. Or bake them: 350 F for 3-5 minutes, then allow to cool for at least 10 minutes before removing from tray.
- Ginger Lemon Tea with Cinnamon: Servings: 8 Ingredients: 1 oz. fresh ginger, thinly sliced; 1 cinnamon stick; 8 cups water; 1 medium lemon; ¼ cup honey. Directions: Juice ½ of the lemon using a citrus juicer. Reserve juice. Discard the seeds and peel. Slice the remaining half lemon horizontally. Set aside. Place ginger, cinnamon stick, and water in a large stockpot. Bring to a boil over high heat. Reduce heat and simmer for 15 minutes. Remove from heat. Discard the ginger and cinnamon. Stir in the lemon juice and honey into the ginger tea. Pour individual cups. Garnish with a slice of lemon. Serve and enjoy.
- Tea for Blood Sugar Management: 25 grams holy basil; 20 grams cinnamon; 20 grams Gymnema Sylvestre; 10 grams fenugreek; 15 grams orange peel; 10 grams ginger. Directions: Mix the following herbs and spices together. Dried leaves and spices can be stored for a long period of time in a glass jar in a cool dark place. Makes a total of 100 grams of the mix. To prepare the tea: Take a teaspoon of the herbal mix and add it to a cup or use paper tea filters. Add 8 ounces hot water into the cup and cover for 10 minutes so the herbs are infused in water. Enjoy this tea 15 minutes before meals or 1 hour after meals.
Jolene Grffiths, Master Herbalist