CULINARY MEDICINE: WHAT TO EAT IF YOU HAVE PRE-DIABETES
Loaded SWEET POTATOES!
Pre-diabetes is one of the most common conditions I see and it is truly a wakeup call and a crossroads in your health. It is a condition where the sugar levels in your blood are elevated, beginning to cause damage to nerves, kidneys and blood vessels, but not high enough to be considered diabetes. If nothing else changes, the majority of people with pre-diabetes will go on to develop type II diabetes in the next 5-10 years. However at this crossroads many of my patients make even subtle changes in their food choices and reverse this disease.
The culprit is sugar. Not just in the obvious form of juices, sugar-sweetened drinks, and desserts but also in the form of white breads, white rice, white pastas. The key here is the glycemic index/glycemic load of the food you are eating. I will not go into the difference between glycemic index and load here, but you can read the summary at the Harvard Health website for more information.
High glycemic foods (like candy, potatoes, white bread or bagels) create large spikes in your blood sugar levels, thus causing large spikes in release of insulin. Insulin is the hormone released by the pancreas responsible for "unlocking cells" so they take in sugar out of the blood stream to be used for energy by the cells at a later time. As your blood sugars and insulin spike extremely high, repeatedly, two things happen: #1: the cells stop responding and "unlocking" when they see insulin thus leaving more sugar in the blood stream, #2: your pancreas works on overdrive producing more and more insulin which is still not enough to remove all the excess sugar from your blood stream, thus diabetes develops. With low glycemic foods (like most vegetables, and whole grains like quinoa, pearled barley) your blood sugars rise slowly and fall slowly and this helps prevent diabetes, lower cholesterol, control weight and food cravings. It's not only about how much sugar is in the food. It's more importantly about how fast that sugar is digested and gets into your blood stream.
WHAT TO EAT IF YOU HAVE PRE-DIABETES
Lets go through a few of the most common high glycemic foods and some better alternatives:
VEGETABLES: Most vegetables are low glycemic and I recommend they take up 50% of your plate at every meal. Green salads, roasted root vegetables and kale or spinach in a morning smoothie are a great way to achieve this. The exceptions: yellow corn (on the cob) and white potatoes. These are probably the most common vegetables but carry a huge glycemic load thus contributing to sugar spikes and pre-diabetes. I encourage people to substitute cauliflower or broccoli for corn, and sweet potatoes for white potatoes as these carry half the glycemic load. Try my loaded sweet potatoes as a delicious and quick weeknight meal!!
FRUITS: Most people are concerned about the sugar content of fruits. It is true fruits carry natural sugars, but due to their fiber content, they are digested much differently than highly refined sugars and tend to be low glycemic foods. They can actually help stabilize blood sugars and are great options as snacks for those with pre-diabetes. The exceptions: bananas, mangos and any canned fruits. I encourage people to substitute pears, apples, or frozen berries for bananas. If you buy or pick fruit at its peak season (when cheaper) you can freeze it and use later in smoothies or morning oatmeal.
GRAINS: Whole grains (couscous, bulgur wheat, pearled barley, quinoa, farro, old fashion oatmeal, and wild rice), which comprise the base of many of the recipes on this site, are packed with fiber, protein and nutrients. Whole grains lower cholesterol and reduce risk of heart attacks and stroke. They also keep you feeling full longer, reducing cravings for high sugar snacks between meals. The exceptions: basmati rice and white rice which both carry high glycemic loads. Of note: it DOES matter what you are eating with these grains. For example, traditional mexican diets were based largely on vegetables and legumes with a portion of tortilla or corn. The fiber content of the vegetables and legumes helped to slow the digestion and sugar spike of these more high glycemic carbohydrates. This is a much different picture than todays Mexican fast food which is mostly tortillas, rice and beef with few vegetables.
BREADS: Breads in general can carry a high glycemic load. 100% white bread, english muffins and especially bagels have a very high glycemic load. Wheat bread is essentially equivalent to white bread. If you plan to go for some bread, pumpernickle is the best option. Rye and sourdough breads are also better than any wheat or white bread. Watch out for the "7 grain" "12 grain" trick -- you want 100% whole grain bread and most breads marketed as "12 grain" are made of predominantly white wheat flour.
SNACKS: I always recommend nuts (unsalted almonds or peanuts) as a snack rather than pretzels or crackers. Those crackers, usually also packed with salt, will spike your sugar and drop you an hour later leaving you craving more. Other great snack options include: veggies and hummus, celery or apple with peanut butter, a piece of fruit, or a small cup of soup.