I am often asked how I maintain an A1C of < 6.0. I get the impression that the person asking is disappointed when I am unable to give a simple answer. In fact, there is no simple sound bite answer. The simple sound bite answer is I eat properly but eating properly has many facets to it. Type 2 diabetes is a complicated disease. Proper nutrition is also rather complicated. It may be best to explain by reviewing how I got from A1C of 20.9 to my last A1C of 5.0.
When I was diagnosed in February 2005 I was close to death. When I arrived at the Emergency room at the Seattle Veterans Hospital My blood glucose was 570 mg/dl. I was badly dehydrated, potassium levels were very low, triglycerides were 1570, I had acute ketoacidosis and a number of other things severely out of whack. I had no choice; I had to make some radical changes. Initially all I had to go by were the ADA recommendations that were not working even though I took the medications I was prescribed and I did my best to follow the dietary advice I had been given. I was very lucky to see blood glucose under 200 mg/dl and usually it was 250 mg/dl or higher.
I was taught to count calories and carbs using the exchanges program. It didn’t take long to find out that method is very inaccurate and had major flaws in it. First, trying to determine portion sizes by comparing to the palm of my hand or size of my fist did not take into account the different density of different foods. Second, the exchanges method simply lumped foods into carb, fat and protein categories which ignores the fact that most foods are a combination of all three. Third, ADA was telling me to treat all carbs the same which made very little sense to me since I know fiber and sugar did not metabolize the same and are both carbs.
The first breakthrough for me was learning about the PCF ratio. The PCF ratio is the ratio between the calories in protein, carbohydrates and fats in the foods I consume. The PCF ratio made a lot more sense to me since it recognizes all sources of protein carbohydrates and fats in everything I ate. This added an extreme level of complication to meal planning since I had to weigh or measure what I was preparing, consult nutrition database books and do the math to get it balanced. I was told ADA did not support the PCF ratio method because it was too complicated and people would not follow it. I felt a bit insulted by this comment from a Certified Diabetic Educator. It sounded condescending as if the ADA felt we were simple minded irresponsible children incapable of doing what was necessary to control blood glucose.
Granted, the PCF ratio concept and implementation is far more complicated than the exchanges method. When the Exchanges Program was implemented in the early 1950’s far less was known about diabetes and nutrition. Also there were not computers or the internet which made sharing of information much more difficult and the math required for implementation of the PCF ratio method almost impossible.
The next step in my saga was learning about software to help me use the PCF ratio. The first thing I used was a handheld device. It was ok but lacked a large food data base and several other features that I found desirable. I tried several other software options before finding the one I use today. Good nutrition software made the task of planning meals that were properly balance much easier. Good software will have a large data base of foods, the ability to enter recipes, entire meals and meal plans that can be saved and reused cutting down on the meal planning time.
The PCF ratio has flaws in that it does not take into account the differences in carbohydrates fats and protein sources and the types of each. Proteins are also called amino acids. There are 22 known amino acids. Carbohydrates come in several different forms. There are at least 48 varieties of fat in the research quality standard reference database. With its flaws, the PCF ratio is still much better than the exchanges program for getting control of blood glucose.
When learning about the PCF ratio I learned there are good fats and bad fats and I needed to concentrate on the good fats sometimes called Essential fatty acids while decreasing the bad fats. About this time I also learned about Omega 3 which is a family of essential fatty acids. The best of the Omega 3s is EPA and DHA which we get from fish oils. I also learned about the glycemic index and that I needed to select carbohydrates that are low on the glycemic index.
For me, applying the Glycemic index to the PCF ratio made the PCF ratio even better. Now I try to make sure most of the carbohydrates I consume are low on the glycemic index. The glycemic index is a ranking of carbohydrate foods by how quickly they raise blood glucose. A big surprise here is that sugar, while bad for raising blood glucose is not the worst culprit. Again it is not even as simple as sugars since there are many varieties of sugar and they all have different glycemic index ratings. There are foods such as high amylose rice and many varieties of potato that are higher on the glycemic index than is all sugars.
Even the glycemic index combined with the PCF ratio is not a complete answer. Research that has come to light in the past 5 years adds another layer to the complexity of proper meal planning. The new research has identified inflammations as a common thread in a number of chronic diseases. Reducing inflammation with an anti inflammatory diet can help reduce the inflammation but it again is not a complete answer. It is possible to only eat anti inflammatory foods but not have them in the proper balance. And it is also possible to have anti inflammatory foods that are higher glycemic. I am hoping instead of getting discouraged at this point you are starting to see that a good dietary strategy takes into account several different elements.
Beyond the ideas already mentioned, there are certain foods that are helpful because of their ability to assist in controlling blood glucose such as cinnamon, buckwheat, beans, prickly pear cactus and a number of others. There is also research that says vitamin D is very helpful as well as getting other vitamins and minerals in balance. There is a proper balance between sodium and potassium and potassium helps in the transport of blood glucose into the cells. Other minerals are also very helpful such as chromium, magnesium and others.
There are many websites selling magic cures and tell you, “If you just buy and use my product your diabetes will be well controlled or cured.” It has become fairly obvious to me and I hope to you also that there is not one simple answer but rather a complete strategy for controlling type 2 diabetes that takes into consideration many factors. There are many giving advice. When checking the advice being given first consider if they are trying to sell you something. Are they just talking the talk or do they also walk the walk?
I know this article probably raises more questions than it answers. I wrote a small book on the subject and that took over 160 pages. I maintain a website at Diabetic-Diet-Secrets.com where I try to share all I have learned and it is well over 1000 pages and I am sure I have not answer everything as I am always getting questions that are not covered on the site. The site has over 13,000 links. Many of those links are to sites that I have found helpful and focus on a specific area. The point I am trying to make is there is a lot to learn. Probably the most important thing I have learned is there are no silver bullet answers. With all I have already learned I know there is still a lot to learn. I often get questions that stump me and I have to go digging for the answers and those searches usually bring up more questions.
When I am discussing diabetic information with people I consider diabetic experts I still find areas where they are in disagreement and I even find myself disagreeing with experts I highly respect on certain points. Learning to control type 2 diabetes is a journey. My best advice is to select a guide that has already successfully traveled the path you are on to better health. Good luck and here’s to your health.
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