The Basic Food Groups,

 Protein, Fat, and Carbohydrates

Part II

Let’s consider how specific kinds of foods can affect your blood sugar.

Although we can make accurate generalizations about how most of us will react to a particular diet or medical regimen, each individual will react somewhat differently to a given food.

The foods we consume, once you take away the water and indigestible contents, can be grouped into three major categories: protein, carbohydrate, and fat. Seldom do any foods contain solely one type of nutrient. High Protein foods often contain fat; high carbohydrate foods frequently contain some protein and fat. The only foods that are virtually 100 percent fat are oils, butter, margarine and lard.

Since our principal concern here is blood sugar control, we'll concentrate on how the three major types of nutrients affect blood sugar. If you're a long-standing diabetic and had followed the standard ADA diet for years, you'll find that much of what you're about to read is radically at odds with its dietary guidelines—and with good reason, as you'll soon learn.

When we eat, the digestive process breaks down the three major food groups into their building blocks. These building blocks are then absorbed into the bloodstream and reassembled into the various products our bodies need in order to function.

David Joffe, Editor

Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S.

The body acquires fat in two ways. The primary source of body fat for most Americans is not dietary fat but carbohydrate, which is converted to blood sugar and then, with the aid of insulin, to fat by fat cells. Remember, insulin is our main fat-building hormone. Eat a plate of pasta. Your blood sugar will rise and your insulin level (if you have Type II diabetes or are not diabetic) will also rise in order to cover the jump in blood sugar. All the blood sugar that is not burned as energy or stored as glycogen is turned into fat. So you could, in theory, acquire more body fat from eating a high-carbohydrate "fat-free" dessert than you would from eating a tender steak nicely marbled with fat.

The other manner in which your body acquires fat is by eating it. Fat by itself doesn't taste particularly good. Pour yourself a tall, frosty mug of cooking oil and you'll likely gag trying to get it down. Take that same oil and french-fry potatoes in it, or drizzle some olive oil on your salad with vinegar, and suddenly it's delicious. The effect dietary fat has is to enhance flavor.

When you eat food that contains fat (triglycerides), your digestive system breaks it down into fatty acids. These your body can burn or store, or convert into other compounds, depending on what it requires. Consequently, fat is in flux in the body, being stored, appearing in the blood, and being converted to energy. The amount of triglycerides in your bloodstream at any given time will be determined by your heredity, your level of exercise, your blood sugar levels, your diet, your ratio of lean body mass (muscle) to
total or more specifically to visceral (abdominal) fat, and especially by your recent consumption of carbohydrate. The slim and fit tend to be very sensitive (i.e., responsive) to insulin and have low serum levels not only of triglycerides but insulin as well. But even their triglyceride levels will increase after a high-carbohydrate meal, as excess blood sugar is converted to fat. The higher the ratio of lean body mass to abdominal and total fat, the more sensitive to insulin you'll tend to be. In the obese, triglycerides tend to be present at high levels in the bloodstream all the time. (This is sometimes exaggerated during weight loss because fat is appearing in the bloodstream as it comes out of storage to be converted into energy.) Not only are high triglyceride levels a direct cause of insulin resistance, but they also contribute to fatty deposits on the walls of your blood vessels (atherosclerosis), which are a frequent factor in heart disease, strokes, and amputations not caused by injury. Research demonstrates that if one injects triglycerides into the blood supply of the liver of a well-conditioned athlete, someone very sensitive to insulin, she would become insulin-resistant until the excess triglyceride had been cleared from the bloodstream. (The most important thing to note here is that insulin resistance, as well as other risk factors for the diabetic complications I just mentioned, can be reversed by eating less carbohydrate, normalizing blood sugars, and slimming down, which we'll discuss in greater detail later on.)

If you become overweight, you'll produce more insulin, become insulin-resistant (which will require you to produce yet more insulin), and become yet more overweight because you'll create more fat and store more fat. You'll enter the vicious circle depicted in Figure 1-1.

Consider that steak mentioned earlier. As you know, the body can convert protein to blood sugar, but it does so at a very slow rate, and inefficiently. Serum insulin levels derived from the phase II insulin response or even from insulin injected before a meal are thus sufficient to prevent a blood sugar rise from protein consumption. Fat cannot be converted to blood sugar, and therefore doesn't significantly cause serum insulin levels or requirements for injected insulin to increase. Say you eat an 8-ounce steak with no carbohydrate side dish—this won't require much insulin to keep your blood sugar steady, and the lower insulin level will cause only a small amount of the fat to be stored.

Now consider what would happen if you ate the caloric equivalent of that steak as a "fat-free" dessert. Your insulin level has to jump dramatically in order to cover the carbohydrate in the dessert. Remember, insulin is the fat-building and storage hormone. Since it's dessert, you probably won't be going out to run a marathon after eating, so the largest portion of your blood sugar won't get burned. Instead much of it will be turned into fat and stored.

Interestingly enough, eating fat with carbohydrate can actually slow the digestion of carbohydrate, so the jump in your insulin level might thereby be slowed down. This would probably be relatively effective if you're talking about eating salad with vinegar-and-oil dressing. But if you're eating a regular dessert, or a baked potato with your steak, the slowdown in digestion would not prevent blood sugar elevation in a diabetic.

Much of the reason Arctic explorer Stefansson and his colleague came out of their year-long meat-only diet thinner and was that their blood sugar wasn't getting kicked up by carbohydrate—since they ate none.

Despite what the popular media would have us believe, fat is not evil. In fact, many researchers are becoming quite concerned about the dangerous potential of "fat substitutes." Fat is absolutely necessary for survival. Much of the brain is constructed from fatty acids. Without essential fatty acids—which, like essential amino acids, cannot be manufactured by the body and must be eaten—you would die. Fat substitutes such as the recently FDA-approved Olestra bring about the spectre of people trying to subsist on a no-fat diet, a diet that could kill them. (Olestra actually robs the body of important vitamins and essential fatty acids, and the FDA has required that it contain additives of those vitamins. In test markets, some consumers have been made quite ill by the product, while others don't see any effect. I don't recommend it—it's completely unnecessary.)

Diabetics are affected disproportionately by diseases such as atherosclerosis. This has led to the long-standing myth that diabetics have abnormal lipid profiles because they eat more fat than nondiabetics.* It was likewise thought that dietary fat caused all the long-term complications of diabetes. For many years, this was taken as gospel by most in the medical community. In truth, however, the high lipid profiles in many diabetics with uncontrolled blood sugar have nothing to do with the fat they consume. Most diabetics consume very little fat—they've been conditioned to fear it. High lipid profiles are a symptom not of excess dietary fat, but of high blood sugars. Indeed, even in most nondiabetics, the consumption of fat has little if anything to do with their lipid profiles.

On the other hand, high consumption of carbohydrate, as we will discuss shortly, can cause nondiabetics to develop some of the complications usually associated with diabetes.

When I was on a very low fat, high-carbohydrate diet thirty years ago, I had high triglycerides (usually over 250 mg/dl) and high serum cholesterol (usually over 300 mg/dl), and I developed a number of vascular complications. When I went onto a very low carbohydrate diet and did not restrict my fat, my lipids plummeted. Now, at sixty-seven, I have the lipid profile of an Olympic athlete, apparently from eating a low-carbohydrate diet in order to normalize my blood sugars. That I exercise regularly probably doesn't hurt my lipid profile, either—but I was also exercising when my lipid profile was abnormal.

Dare your physician. Ask him or her if his lipid profile on a low-fat diet can remotely compare to mine, on a high-fat, low-carbohydrate diet:

• Direct LDL—the "bad" cholesterol—63 (below 130 is considered normal)

• HDL—the "good" cholesterol—116 (above 30 is considered normal)

• Triglycerides— 76 (below 150 is considered normal)

• Lipoprotein(a)—undetectable (below 30 is considered normal)

Contrary to popular myth, fat is not a demon. It's the body's way of storing energy. Without essential fatty acids, your body would cease to function.