Dr. Bernstein's Diabetes Solution
FROM DR. BERNSTEIN'S DIABETES SOLUTION by Richard K. Bernstein, MD
On-sale November 1, 2011 from Little, Brown and Company
Reprinted with permission from Little, Brown and Company
NOTE: Excerpts are provided on dLife.com for informational purposes only. The information contained within will not be updated by dLife and may be outdated. Please consult your doctor before acting on anything described here.
THE CHINESE RESTAURANT EFFECT
Many years ago a patient asked me why her blood sugar went from 90 mg/dl up to 300 mg/dl every afternoon after she went swimming. I asked what she ate before the swim. "Nothing, just a freebie," she replied. As it turned out, the "freebie" was lettuce. When I asked her just how much lettuce she was eating before her swims, she replied, "A head."
A head of lettuce contains about 10 grams of carbohydrate, which can raise a type 1 adult's blood sugar about 50 mg/dl at most. So what accounts for the other 160 mg/dl rise in her blood sugar?
The explanation lies in what I call the Chinese restaurant effect. Often Chinese restaurant meals contain large amounts of protein or slow- acting, low- carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, which can make you feel full.
How can these low-carbohydrate foods affect blood sugar so dramatically?
The upper part of the small intestine contains cells that release hormones into the bloodstream when they are stretched, as after a meal. These hormones signal the pancreas to produce some insulin to prevent the blood sugar rise that might otherwise follow the digestion of a meal. Large meals will cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these "incretin" hormones. Since a very small amount of insulin released by the pancreas can cause a large drop in blood sugar, the pancreas simultaneously produces the less potent hormone glucagon to offset the potential excess effect of the insulin. If you're diabetic and deficient in producing insulin, you might not be able to release insulin, but you will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something indigestible, such as sawdust. Even a small amount of an indigestible substance will cause a blood sugar increase in type 1 diabetics if not covered by an insulin injection.
Complicating matters further, pancreatic beta cells also make a hormone called amylin. Amylin inhibits the effectiveness of glucagon and works on the brain to cause satiety. It also slows stomach-emptying to discourage overeating. With few or no beta cells, diabetics don't make enough amylin, and consequently they tend to remain hungry after eating and show an exaggerated Chinese restaurant effect. Since the first edition of this book, amylin substitutes have become available and have found an important use in the prevention of overeating (see page 214).
The first lesson here is: Don't stuff yourself. The second lesson is: There's no such thing as a freebie.* Any solid food that you eat can raise your blood sugar.† If you can't control your overeating, see page 260.
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I'm always amazed when I hear how much time quarterback Peyton Manning puts in at practice. More than 15 seasons playing NFL football at the highest level and he still finds areas in his game that require fixing. It's been 10 years for us in the game of type 1 diabetes and I still have so much to learn. Not to compare my diabetes management success to Peyton Manning's football success. If anything, I'm more like Peyton's brother, Eli. I...