Following a diagnosis of diabetes, many of my patients commonly ask: what foods should I eat and what foods should I avoid?

These are important questions. Dietary therapy is crucial in the effective treatment of diabetes. You may be taking your medicines as prescribed by your doctor regularly, but if you do not avoid the consumption of certain foods and drinks, it may be difficult to achieve optimal treatment goals, which are good blood sugar control and prevention of complications of diabetes.

In this post, we will discuss in details foods and drinks you need to avoid or minimise if you have diabetes and why this is important.


What is diabetes?



Diabetes, also called diabetes mellitus, is a
a serious, long-term disease that occurs when there are abnormally high levels of sugar (glucose) in the blood.

Insulin is a hormone that regulates blood sugar – it facilitates the movement of sugar into the cells and lowers blood sugar.

Diabetes is caused by an absence or insufficient production of insulin by the pancreas, or an inability of the body to properly use insulin. Any of these situations can make it difficult for your body to take up sugar into its cells thereby resulting in an accumulation of extra sugar in your bloodstream.


Diabetes statistics



Diabetes is a major health problem that is increasing rapidly worldwide. In 2019, an estimated 463 million people (nearly half a billion people) had diabetes globally, representing about 9.3% of adults 20–79 years.

The estimated number of people (20–79 years) living with diabetes rose from 285 million in 2009 to 463 million in 2019, which is an alarming 62% increase within 10 years.

According to World Health Organisation, an estimated 2.2 million and 1.5 million deaths were directly caused by diabetes in 2012 and 2019 respectively.

To further highlight the substantial burden that diabetes imposes on society from an economic perspective, the total annual cost of diabetes in the United States in 2017 was estimated to be 327 billion dollars. This included 237 billion in direct medical costs (healthcare costs) for people with diabetes and another 90 billion in other costs due to disability, premature death, or work loss.

About 50% (one in two people) of the people who have diabetes do not know they have the condition.



Effects of diabetes



If not well-controlled, diabetes can, over time, lead to serious consequences, causing damage to a wide range of vital body organs and tissues, including the kidneys, eyes, heart and nerves.


- Heart attacks and strokes. Diabetes is a well-established risk factor for heart attacks and strokes. People who have diabetes have about 2 to 3 fold (200 to 300%) increased risk of heart attacks and strokes.

- Kidney disease. About 1 in 3 adults with diabetes will develop long-term damage to the kidneys {chronic kidney disease), which may progress to kidney failure, a condition requiring either dialysis or a kidney transplant.

- Eye problems. It is common for people living with diabetes to develop eye disease, which may include diabetic retinopathy, macular edema (which usually develops along with diabetic retinopathy), cataracts, and glaucoma. All can lead to blurry vision, vision loss, and even blindness. Research shows that blindness that is due to diabetic retinopathy is still the leading cause of adult-onset blindness.

- Nerve damage (neuropathy). This is the most common diabetes complication, occurring in up to 50% of people living with diabetes.

- Foot problems. Reduced blood flow combined with nerve damage in the feet increases the chance of foot ulcers and infection, which may eventually lead to limb amputation. About 85% of all lower-limb amputations throughout the world are a result of diabetes, making it the leading cause of nontraumatic lower-limb amputations.



Why you should avoid certain foods and drinks


The food you eat contains macronutrients, namely carbohydrates, fats and protein. These are the nutrients your body use in the largest amounts for energy or “fuel” needed for proper function.

Of the 3 macronutrients, carbohydrates, more commonly called carbs, has the biggest influence on your blood sugar levels. The reason is that when consumed, your body breaks it down to mostly sugar and glucose, which are released into your bloodstream. When the sugar floods the bloodstream at a rate that is much more than the cells can take, the blood sugar levels can rise to harmful levels.

Scientists have developed a tool called glycemic index which scores carbohydrate-containing foods from zero to 100 depending on how fast the food causes the blood sugar to rise. Pure sugar has the highest glycemic index score of 100 because it causes the most rapid rise in blood sugar levels.

Foods are assigned to one of three categories: low, medium, or high glycemic index:

- Low glycemic index foods: 55 or less

- Medium glycemic index foods: between 56 and 69

- High glycemic index foods: 70 or higher.

Foods with a high glycemic index or high carbs can cause dangerous blood sugar spikes in people with diabetes, thereby leading to negative impacts such as:

- reduced effectiveness of antidiabetic drugs,

- poor blood sugar control, and

- increased risk of diabetes complications.

Furthermore, diets high in carbs and fats on a long-term basis can contribute to obesity, which, like diabetes, is also a major risk factor for heart disease and stroke.


Foods and drinks to avoid



Following the above explanations, it is important to minimise or avoid the foods and drinks listed below if you have been diagnosed with diabetes.

1. Sugary drinks

Sugary drinks or sugar-sweetened beverages are drinks with added sugar including regular soft drinks/sodas, flavoured juice drinks, sports drinks, energy drinks, electrolyte replacement drinks, and coffee and tea beverages with added sugars.

These beverages are sweetened by high-fructose corn syrup (HFCS), sucrose, or fruit juice concentrates.

These sweeteners are loaded with fructose. For instance, HFCS, which is the most common added sweetener in processed foods and beverages, contains 55% fructose and 45% glucose. Also, sucrose or table sugar consists of 50% fructose and 50% glucose.

In the US diet, sugary drinks are the single largest source of added sugar and the top source of energy intake.

There are strong reasons people with diabetes should avoid sugary drinks.

First, they are very high in carbs. For instance, 330ml of Coca-Cola contains around 35g of sugar – which is about nine teaspoons of sugar.

Secondly, they have a high glycemic index. Coca-Cola for instance has a glycemic index of 63.

In addition, research has demonstrated a link between regular intake of sugary drinks and weight gain/obesity, diabetes, heart disease, kidney diseases, non-alcoholic liver disease, tooth decay and cavities, and gout, a type of arthritis.

Evidence from research shows that fructose, a major constituent of sugary drinks, contributes significantly to the negative health impact of sugary drinks. It has been shown to promote insulin resistance, diabetes, belly fat and bad cholesterol levels.

Consequently, experts recommend that people with diabetes should avoid sugary drinks and replace them with healthier alternatives such as:

- plain water,

- unsweetened coffee and tea, and

- diet drinks

For most people, including people living with diabetes, plain water is the optimal beverage, because it is calorie-free, cheap and readily accessible. Some studies show that substituting plain water for sugary drinks may lead to a reduction in body weight and blood sugar levels.

Unsweetened coffee and tea have also been shown in several studies to have favourable effects on diabetes and heart disease, possibly due to their high polyphenol content.

Diet drinks are sweetened with non-energy-bearing sugar substitutes (artificial sweeteners) such as
saccharin, neotame, acesulfame-potassium, aspartame, sucralose, advantame, stevia, and luo han guo (or monk fruit). They may be an acceptable alternative to sugary drinks as they provide few to no calories.

2. Refined carbs

Refined carbs are foods that have been heavily processed to remove many of the other nutrients they normally carry, including fibre.

This processing gives these foods a desirable flavour and texture, but it also means the carbs are rapidly broken down to sugar which is released into the bloodstream. Refined carbs are low in fibre, an important nutrient that helps slow the absorption of sugar into the bloodstream.

As a result, refined carbs score highly on the glycemic index. For instance, white rice has a glycemic index of 89.

Therefore, experts recommend that people living with diabetes or at risk of the condition should avoid or minimise consumption of the following foods which are regarded as refined carbs:

- white rice

- and anything made with white flour only, including white bread, pasta, some cereals and many baked goods.

- Cornstarch /African corn pudding (Pap, akamu or ogi)

Experts recommend that to the extent possible, people with diabetes should substitute highly processed refined foods with whole foods such as unprocessed maize, millet, oats, wheat and brown rice. These foods are rich in fibre and help to reduce blood sugar levels.

3. Trans-fats

Trans fats are a type of unsaturated fat found in food. There are two broad types: naturally occurring and artificial trans fats.

Artificial trans fats are produced through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature. This partially hydrogenated oil is less likely to spoil, so foods made with it have a longer shelf life.

You can find artificial trans fats in a variety of foods, including baked and fried foods, and pre-packaged snacks and foods, such as frozen pizza, pies, cakes, cookies, biscuits, wafers, and cooking oils and spreads such as margarine and peanut butter.

Research has established that artificial trans fats are very harmful to health. By increasing the level of “bad” cholesterol and lowering the “good” cholesterol, artificial trans fat increases the risk for heart attacks and stroke.

Regulatory authorities in many countries, including the US Food and Drug Administration, have prohibited food manufacturers from adding artificial trans fat to foods and beverages.

Therefore, people with diabetes should avoid foods that contain artificial trans fats.

Unlike artificial trans fats, naturally-occurring trans fats are found naturally in meat and dairy products. They do not pose a serious health risk and need not be eliminated because they are present in very small quantities.

4. Breakfast cereal

Most breakfast cereals are highly processed and high in carbs. As a result, they score highly on the glycemic index.

Below are the glycemic index scores for some popular breakfast cereals.

Corn flakes: 93

Coco pops: 77

Instant oatmeal: 83

African corn pudding (Pap, akamu or ogi): 85

Because of high carbs, high glycemic index scores and very little protein, many of these breakfast cereals are unsuitable for people living with diabetes. You should avoid or minimise these foods if you have diabetes.

A high-protein breakfast is a better option for people living with diabetes. It will fill you up and keep you going till lunchtime, and at the same time minimise fluctuations in your blood sugar levels.

5. High glycemic index fruits

Most fruits have a low glycemic index and so may not pose any problems for people with diabetes.

However, two important fruits have been singled out as they rank highly on the glycemic index system. They are watermelon and pineapples. Their glycemic index scores are shown below:

Watermelon: 72

Pineapple: between 51 and 73 (depending on the origin and ripeness)

However, the two fruits are not forbidden for people living with diabetes. You can still eat them, but because they can cause harmful spikes in your blood sugar levels, you should eat them in moderation.

6. Honey

Honey is a sweet, thick liquid food made by bees using the sugar-rich nectar from flowers.

It is a natural sweetener, composed mainly of water and sugars, including fructose, glucose, maltose and sucrose.

Compared to refined sugar (table sugar), honey is sweeter and has a bit more carbohydrates and calories per teaspoon:

1 tablespoon of raw honey has about 60 calories and 17 grams of sugar/carbs

1 tablespoon of refined sugar has about 50 calories and 12 grams of sugar/carbs

Because honey is high in carbs and sugars, it may raise your blood sugar levels if you eat too much of it.

But if consumed in moderation, honey may be a better option compared to refined table sugar, even for people living with diabetes, for the following reasons:

- Honey is sweeter and yet has a slightly lower glycemic index compared to table sugar (honey glycemic index = 58 to 61 vs table sugar glycemic index = 63) (11, 20).

- Honey is a naturally sweet product with complex composition. It contains over 200 components, in addition to sugars and water, including small amounts of protein, vitamins, minerals, trace elements, enzymes and polyphenols, including flavonoids from pollen. On the other hand, table sugar, though obtained from natural sources such as sugar cane or sugar beets, is highly refined as it undergoes a technological process, leading to an almost pure compound —sucrose.

- Finally, some research suggests that honey may lower blood sugar and provide benefits in the treatment of diabetes, including anti-inflammatory properties that might also reduce diabetes complications.

Bottom line, if you have diabetes and your blood sugar is well controlled, you can consume honey (ensure it is raw natural honey), but moderation is key and it is best to use honey as a replacement for other sugars rather than using honey as an additional sweetener. Conversely, if your blood sugar is still poorly controlled, it is best to avoid honey and other sweeteners.


7. Potatoes

White and sweet potatoes are starchy vegetables with a high glycemic index as shown below:

Sweet potato: 70

White potato: 82

Potatoes are also high in carbs, mainly in the form of starch with small amounts of simple sugars such as sucrose, glucose, and fructose. The carb content of potatoes ranges from 66–90% of dry weight (22).

A combination of high glycemic index and high carbs means that potatoes may not be suitable for people living with diabetes and should be minimised or avoided.

8. 100% fruit juice

On the surface, 100% fruit juices may seem healthy for everyone, including people with diabetes, especially since they contain some vitamins and other nutrients.

However, fruit juices are also low in fibre and high in carbs from natural sugars, making them not very ideal for people with diabetes. For instance, 8 oz (236 mL) of 100% apple juice contains 29 grams of carbs.

In addition, some researchers have demonstrated an association between regular consumption of fruit juices and greater weight gain and increased risk of diabetes.

Therefore, people with diabetes should consume 100% fruit juices in moderation. Whole fruits are healthier alternatives. They are rich in fibre which helps to stabilize blood sugar levels and improve satiety thereby keeping you full for a while.

9. Cakes and pastries

These are sweet baked products made from ingredients such as refined flour, sugar, salt, eggs, solid fats (butter or margarine), egg and milk.

Some common examples include all sorts of cakes, pies, tarts, doughnuts, croissants, danishes, and scones.

There are many reasons why people with diabetes should avoid these foods. They are high in bad fats (saturated fats and sometimes artificial trans fats), high in carbs and also score highly in glycemic index.

If you have to eat something in between meals, choose nuts (cashew nuts, peanuts, walnuts) or non-starchy vegetables (beets, broccoli, cabbage, carrot, eggplant, cucumber) instead of cakes and pastries.


For pictures, references and more, visit:


https://www.yourhealthng.com.ng/2021/10/28/diabetes-foods-and-drinks-to-avoid/

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