21 Nov Happy Holidays. Let’s Talk Sugar!
November is National Diabetes Month.
Apropos, given the holidays are coming and many of us will be overindulging in sweets and simple carbohydrates. What better time is there to talk about blood sugar, prediabetes, and hormones. Hormones? Yes, insulin, that blood sugar lowering hormone, is affected by changes in other hormones including thyroid, estrogen, and testosterone!
I’ll talk more about hormones later but let’s start at the beginning.
It starts with subtle but slowly increasing blood sugar otherwise known as prediabetes! Prediabetes is a warning to make changes in your diet, lifestyle, and weight. When your doctor says you are prediabetic, that does not mean you will develop diabetes. In fact, the Centers for Disease Control and Prevention’s (CDC) statistical data shows a progression from prediabetes to diabetes at around 2% per year, or 10% in 5 years. (1)
If you are prediabetic, you might be thinking those odds don’t sound so bad. Unfortunately, being prediabetic makes it very easy for you to gain weight and very difficult to lose it! Why is that? Insulin resistance. The higher your blood sugar level, the higher your insulin will be. The higher your insulin levels, the more likely your cells become insulin resistant.
Insulin resistance raises your blood insulin levels and blood sugar levels leading to a variety of health problems, including weight gain.
High insulin levels are also linked to early death, cancer, inflammation, high cholesterol, cardiovascular disease, dementia, metabolic syndrome, infertility …and of course, type 2 diabetes. Those are some good reasons to keep your fasting blood glucose between 80 and 100 and your fasting insulin levels between 5-10. For those of you following a keto diet, your insulin levels may be lower than 5, in which case I recommend working with a doctor. In some, very low insulin may cause hypoglycemia (very low blood sugar) which can in turn cause irregular heart rhythms, fatigue, and shakiness, AKA “keto flu”!
What type of diet works best to lower blood sugar?
I recommend focusing on what to add to your plate rather than what to take off. Think of your plate as a pie chart. You want at least half that pie to be vegetables. Three quarters is even better! Mix up the vegetables. Fresh veggies are best.
I’m lucky to have a large garden but even a small space can produce a lot. Here’s my little greens garden. I’ve been picking a few leaves daily from these plants since Spring. It’s November now and they are still growing strong! I like to add them to my eggs or turkey bacon for breakfast.
Add spices to give your vegetables flavor.
If you like one pot or pan meals like I do, stir fry a bunch of veggies (3-4 cups per person) in a little avocado oil (best oil for high temperature cooking) with ¼ lb lean chicken and ¼ to 1/2 cup of cooked rice. The more you exercise, the more rice you can have! Make it brown or wild rice if you don’t have digestive problems. Higher fiber grains slow digestion, so do not cause a rapid increase in blood sugar or insulin.
For those with irritable bowel syndrome (IBS), quinoa and white rice are better tolerated. If you are trying to lose weight, skip the rice and add another cup of veggies or a handful of nuts like cashews or peanuts. Sprinkle some ground flax seed to add fiber (and essential fatty acids).
Beans are also a good substitute for rice and other grains. If you can’t tolerate beans or flax seed (those with digestive problems and/or IBS), substitute psyllium husk powder. Psyllium has been shown to lower blood sugar and insulin.
What about dessert?
Lowering blood sugar doesn’t mean you have to avoid dessert. There are so many keto and paleo dessert recipes that do not raise blood sugar. The easiest is simply fruit covered with whipped coconut cream! Or you can make a fruit smoothie. Whenever I have a sweet craving, I add 1 tbsp of cocoa powder to my favorite 90 second almond bread recipe. Add your choice of fruit on top. My favorite is blueberries (a low sugar fruit full of healthy antioxidants). For extra sweetness, add a little bit of unsweetened coconut cream on top. Coconut cream and milk are naturally sweet.
Quick Almond Bread Recipe:
1 tbsp coconut oil
3 tbsp almond flour
½ tsp baking powder
Use a bowl or large mug. Melt the coconut oil. Add the rest of the ingredients and mix until all ingredients combined. Microwave for 80 to 90 seconds. Done!
You can have fudge too! For this recipe, I used unsweetened chocolate chips with unsweetened peanut butter.
Are there any spices that can lower blood sugar?
Cinnamon! Numerous studies have shown cinnamon to substantially lower blood sugar. A 2003 study showed that as little as 1 gram (¼ to ½ tsp) per day can be effective. The study divided people into groups of placebo, 1 gram, 2 grams, and 6 grams of cinnamon daily. The groups taking cinnamon reduced their mean fasting serum glucose by 18–29%. (2)
Chocolate and cinnamon taste good together so add a ¼ tsp to the fudge recipe. Cinnamon isn’t just for dessert. I’ve made this recipe a few times. The unlikely combination of cinnamon, ginger, and basil makes for a uniquely flavored meal!
Effects of Thyroid, Estrogen and Testosterone on blood glucose:
One of the things I see in my female patients is rising fasting blood sugar as they enter their early 40s. Despite being of normal weight and eating a healthy, low sugar diet, their blood sugar is higher than in previous years. What’s going on? Estrogen. Estrogen decreases blood sugar and insulin, increases secretion of insulin from the pancreas, increases sensitivity to insulin (decreases insulin resistance), increases insulin clearance, and aids the muscles in glucose utilization.
Whoa! No wonder so many women unexpectedly gain weight in their late 30s onward, due to changes in estrogen. Men are not immune to these changes either. Men naturally produce a very small amount of estrogen but as they enter their 50s and 60s, testosterone and estrogen can lower resulting in insulin resistance. Those with hypothyroidism experience an impaired responsiveness to insulin.(3)
Can Bioidentical Hormone Replacement prevent or treat Type 2 Diabetes?
Bioidentical Hormone Replacement alone cannot effectively treat diabetes but it may be an adjunct therapy. At the time being, there is not enough evidence to advise patients to take Bioidentical Hormones to treat diabetes but the studies are promising. Post menopausal women are at higher risk of developing type 2 diabetes and women who experience an early menopause, are at greater risk.
Unfortunately, that loss in estrogen leads to higher blood sugar and progression to type 2 diabetes. Encouragingly, many studies have shown that Bioidentical Estrogen has delayed the onset of type 2 Diabetes in women. (4) For men, Bioidentical Testosterone may also be a helpful adjunct therapy for type 2 Diabetes. Along with lifestyle changes, testosterone may help to decrease insulin resistance and improve blood sugar control. (5)
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