What Is the Best Diet for Managing Diabetes? — updated

In my previous post, What Is the Best Diet for Managing Diabetes?, I featured the 1999 Diabetes Care study that was claimed in the EASD podcast to be the most important part of the entire recommendation for managing diabetes. The study’s conclusion was:

The imperative regarding carbs in your diet is that not only must they be high in soluble fiber, but also, whatever processing was done to the food, the cellular structure must not have been disrupted.

Naturally, I was excited to give this a try. I went to Whole Foods the very next day and found some rye bread that looked be just what they were talking about: hard, dense, no fluff here:

Hard Whole Rye Bread from Whole Foods

Hard Whole Rye Bread from Whole Foods

Background

I love to eat beans and bread. I’d tried to eat this during my EPIC FAIL of a higher carb diet experiment back in March and watched my glucose control go from bad to worse. The killer was hitting a blood glucose (BG) of 180 mg/dL towards the end of the experiment, only 45 min after a breakfast of  half a cup of beans, a half slice of fluff bread and a pat of butter.

In case you just tuned in and are new to this problem of trying to keep BG down after meals, 180 is way too high; I don’t like seeing anything over 140.

Result

Long story short, this bread may be marginally better than fluff white bread, but so what! I can’t eat it. If you like tedious details, read on. Otherwise skip to “How can my results be reconciled …” below.

I decided to try to play it safe and not risk another 180 by starting with a less problematic time than breakfast. So for lunch, on June 1, I ate a small portion of beans and half a slice of the new bread. I was lackadaisical about taking the BG measurement; I was so sure it would be good. I didn’t actually remember to get it until 68 minutes after the meal.

Whatever! My 1 hour BG was up in the red zone at 166. SO DISAPPOINTING!

I thought, maybe try a little less bread? So, the next day, I tried having only 1/3 a slice of bread with the beans. This time I paid attention to the clock and got a 50 min BG of 162. BLEH!

But I Didn’t Give Up Yet

I thought, maybe because the bread says “with whole rye kernels”, there aren’t enough of them. Maybe I should try another bread. I found this one at a Natural Foods Coop:

Whole Rye Bread from Natural Foods Coop

Whole Rye Bread from Natural Foods Coop

I had such high hopes for it. Loaf was so hard you coulda killed someone with it if it were frozen. So unprocessed you could see the individual rye grains. And so disappointing, the same bean n bread lunch, June 4, jacked my BG even higher than the other one – 173.

June 5 – I thought maybe eat less of it and later in the day so my BG isn’t so ready to surge? Or maybe it’s the beans, not the bread? So I had 70g of beans and 1/3 slice of bread at 7PM.  — nope! my 50 min BG was 168!

Could It Be the Glucometer or Old Test Strips???

Instead of the beans n bread test, I came up with a new plan. I will use the breakfast meal that I discussed in my previous post which I’ve studied extensively and have 28 data points on (although not all points are displayed in the graph below):

50 min PPs

I’ll eat my salmon first (nice, low, red bars), but switch out 1/2 the beans for bread.  I’ll check my 50 min BG to see if it is better, worse or unchanged.

Just to be rule out other confounders, I obtained a new glucometer, new test strips and made sure the new equipment was functioning as expected from June 6 to June 11. The breakfasts were P-F-C identical at 34-14-29 grams:

  • June 10: standard salmon/bean breakfast, 50 min BG = 113
  • June 12: 75g beans replaced with 45g of Bavarian: 50 min BG =145, 1 hr BG =168
  • June 13: standard salmon/bean breakfast, 50 min BG = 103

How can my results be reconciled with the Diabetes Care study?

I cannot bring myself to say that the results reported in this study must be wrong. Surely it must be something else. Possibly one of these:

    • Bread processing has changed in the last 15 years and it is no longer possible to get cellularly intact bread?
    • There is cellularly intact bread out there; I haven’t found it yet?
    • Only bread made with whole grain barley should be eaten?
    • Current rye breads have been GMO’d and shouldn’t be eaten?
    • Bread should not be eaten no matter what form it’s in. The whole grain vs whole meal barley was irrelevant to the study results.

So, I went to the original journal article to see what they fed the subjects:

Carbs in 1999 Diabetes Care study

Carbs in 1999 Diabetes Care study

But wait! Look at those absolute GI numbers. Yes, the intact bread, rice, maize is lower than the processed, but it’s still higher than lentils and beans (35 – 40). What this table is telling me in light of my bread experience is that anything over 40 is going to be bad for me. Maybe some diabetics that still produce more insulin than I do can get away with it. What this table says to me is that whole grain barley porridge is worth trying but all the other items can only be tolerated in very small quantities.

I clearly do not have all the answers yet on this, but I did want to say something right now, rather than leave my previous post standing while I continue to explore what constitutes a diabetic safe carb.

EDIT, June 18, 2014: I’ve continued to experiment with bread as it affects my PP BG. My preliminary results suggest both that the GI concept as it applies to predicting carb safety for a diabetic might be flawed and that more study will be needed to pin this down. Please see my next post for details.

EDIT, August 23, 2014: I’ve continued to experiment with bread and legumes in my diet while doing more pubmed reading to determine why I was unable to observe the beneficial results of the minimally processed slow-carb diet and eventually discovered what I believe to be the answer. Which is, the superiority of this diet is that it supports a more host-friendly microbiome. This effect can only be observed over time. In addition, I discovered that I have a somewhat rare mutation in the gene DPP4, that leaves me without the ability to completely digest casein and gluten. Bottom line is that by avoiding casein and gluten and restricting the bulk of my carbs to low GI, I was able to segue into a diet that was 55% carb, 20% protein and 25% fat while keeping by blood glucose at acceptable levels. Although I take no diabetic or cholesterol lowering medication whatsoever, my most recent labs are:

  • Fasting BG: low 80s
  • HbA1c: 5.4
  • Total Cholesterol: 180
  • HDL cholesterol: 78
  • LDL cholesterol (calc): 92
  • Triglyerides: 49

I may or may not discuss this in more detail at a later date, but right now I have more interesting things to talk about!

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About Dan Hunter

Retired software engineer wading through the obfuscation, confusion and contradiction that corporate and political funding of medical research along with ego over science has created.
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