The Lie That's Killing Us: Pre-Diabetes

FatCatAnna, that was a good even review. Often we see very polarized reviews of books. And from what you say, perhaps the CDA is now leading the change. My greatest concern is that the ADA and US CDC have undertaken the DPP program as the way to "prevent" diabetes and the central hallmark of the program is nutrition education that says that you need to reduce/eliminate fat and sugar and eat a calorie deficit. There is absolutely no mention in the educational material that carbohydrates raise your blood sugar and no corresponding message to reduce carbs. With this simple act of deception, thousands, if not millions of people throughout the world will be harmed. It is criminal to not tell people with "pre-diabetes" that carbs raise their blood sugar.

Thanks for the thumbs up Brian - I hesitated posting it here at TuD - since in the past (when I took my first pump holiday) I was bashed by die hard pumpers (aka Terminators in my cat eyes). Yes, this book explains everything in a nutshell - that even if a person wasn't "prediabetic" - it's just a good way to live life overall. I'm cooking up one of the recipes today - stuffed pork tenderloin - mouth is drooling at thought of carving into that for dinner later.

I disagree for the practical reason that diabetes is a disease, while prediabetes is not. As soon as anything is classified as a disease, treatment or modification of that condition is a drug. Prediabetes can be reversed with diet, exercise and particularly resistant starch. These are not drugs - these are foods.

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You are so wrong. On several levels.

“Pre-diabetes” is EARLY DIABETES.

Diabetes CANNOT BE REVERSED. (As in made to go away. Return to eating your previous diet and it’s still there. It doesn’t go away; you are simply treating the symptoms.)

It is simply untrue that once a condition is classified as a disease, it must be treated with medication.

Medications, or “drugs” as you refer to them, are not inherently evil. Food, drugs, plastic, dirt; you name it, everything is composed of certain combinations of elements listed on the Periodic Table. Strychnine is “completely natural”; would you eat it?

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You are so wrong, in the other direction. There is robust discussion about the middle-ground of prediabetes.

There is a continuum of health conditions as measured by glucose levels, insulin levels and insulin sensitivity. Interpretations of what constitutes “normal”, “prediabetes”, and “type 2 diabetes” are arbitrary and generally agreed upon by experts in the field. They are not the “Truth.”

I never claimed that drugs were inherently evil. However, once something is classified as a drug, regulations now declare that foods tested in clinical trials to treat or prevent that something have to be declared as drugs. That’s a wonderful way to shut down research, which is very bad, given the severity and magnitude of type 2 diabetes.

Pre-diabetes is an indication that someone is on a path toward type 2 diabetes. Foods with fermentable dietary fiber can be used to significantly improve insulin sensitivity, returning insulin and glucose levels to “normal” levels. Losing weight can help do the same thing, but require much more effort. These people do not have the disease if their blood sugar levels are in the “normal” levels. Your shouting that diabetes cannot be reversed is not corroborated in the scientific data.

These people DO have diabetes, it is being controlled by diet, exercise, and/or medication. A person with hypertension (high blood pressure) takes medication(s) which results in their blood pressure returning to a normal range. Does this mean they no longer have hypertension because an intervention brought their blood pressure under control? Hardly. Stop the medication (or other intervention that led to the normalization of blood pressure) and the hypertension returns. Same with D.

If someone’s blood sugar levels lie within a normal range without intervention, they do not have diabetes. It is a matter of semantics.

The sound science that I read, believe, and follow in my practice with excellent results is clearly different from the scientific data you choose to believe.

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At least your discussion about hypertension is rational and a step forward from shouting. Thank you for that. I do not know as much about hypertension.

A major difference is that we all have to eat food while we all don’t have to take anti-hypertensives. Our choice of food helps to determine which diseases we get in life - which includes everything from cardiovascular disease, cancer, and type 2 diabetes, etc. If we make better choices, we’ll have better health later in life. If, however, we make poorer choices, we will pay the consequences later in life. That does not make foods treatments for diseases. People with higher insulin levels and higher blood glucose levels are in the formulation stages for type 2 diabetes, but do not have the disease, as currently defined.

For instance, I do not believe that people with hypercholesterolemia are defined as having heart disease. This may be a better comparison as both cholesterol and glucose are blood-based biomarkers for similar but related diseases.

The difference is also semantic. According to your rules, let’s just declare that everybody in the world has a disease - it’s just in the formulation stages and hasn’t developed yet. That seems silly to me.

See http://www.regulations.gov/#!docketDetail;D=FDA-2015-Q-2352 for the data that resistant starch improves insulin sensitivity. Their decision is expected shortly and is expected to be favorable. You probably haven’t heard about it yet, but the data is consistent, is building and is gaining recognition.

So if a pre-diabetic eats these foods and returns glucose levels to normal levels, can they resume their previous behaviors, including eating these foods?

I think it is yes and no…

The clinical studies that have been published gave the resistant starch or foods containing the resistant starch to add to their “normal” diet. They were instructed not to change their diet or exercise patterns. If they were given 15-30 grams of resistant starch or higher, they saw an improvement in insulin sensitivity within hours (and lower insulin levels). This is higher than can be obtained in foods (beans, green bananas or raw potatoes). This supports the “yes”, you can go back to your previous diet.

The “no” part is less clear. I think that the development of insulin sensitivity is a progression that is linked to aging, genetics and probably other factors. Studies with resistant starch have shown improved insulin sensitivity when fed for as many as 12 weeks. Thus, the effect does not stop working over a period of 3 months. They do not know if insulin sensitivity will eventually deteriorate if resistant starch continues to be consumed over a longer period of time. The studies simply have not been done at this point in time, but probably will be done over the next decade.

I can make a guess, but we really don’t know. It would probably be wise to change your diet at the same time to help your insulin sensitivity stay within a healthy range, but the resistant starch would help to give you greater flexibility in controlling blood sugar from carbohydrates at least for the near term.

Does that answer your question?

@RhondaW – I am generally sympathetic to your statements about resistant starch since I use it to good advantage. In a few other threads you pointed to a web site that seemed like a commercial trade group to me. Do you have any business relationship with any supplement business that markets to people with diabetes?

I asked you a few days ago in another thread to disclose any business relationship with resistant starch and my request went unanswered.

If you are one of our diabetes peers and just want to participate based on sharing your experiences, that’s great. I could be wrong, but your recent joining of TuDiabetes and a pattern of concentrating on a narrow topic makes me suspicious you have undisclosed motives. What do you say?

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so i did look, at everyone, post on this, & i like some of them, i like the one Terry4 have & rgcainmd have, & if you have, Pre-Diabetes,. & if u can make, it go away, why won’t you do what, you do that, it one thing, i don’t get, better then having, diabetes, if i can make my diabetes go away i will, do it,.

https://www.youtube.com/watch?v=LFxHFQCtW5M

Resistant starch is worth adding to your routine and trying out. I use a little, but studies are NOT all rainbows and sunshine. In fact, in one of these talks, some studies (for who knows what reason) showed RS didn’t work as well with women. I think RS is healthy in general (in moderation) but I haven’t seen it help my ‘prediabetes’ … I do agree that the name ‘prediabetes’ is a JOKE. It makes people think they are at risk of getting sick IN THE FUTURE and not realizing they are sick NOW. These people make token changes to their diet that aren’t very meaningful or effective and continue to progress to diabetes.

I used to work for the manufacturer of Hi-maize resistant starch, but no longer have any commercial relationship with the business of resistant starch. However, the data supporting resistant starch is complicated and extensive. As there is no other place to find a compilation of this information, I created a website to explain it last year which you found - www.resistantstarch.us. I have received no funding for this site at any time. I have had extensive experience in unraveling this topic and continue to talk about it because I’m stunned that very few people know about it with such an extensive basis of scientific evidence. I compare it to omega-3 fatty acids, because there are more than 100 published clinical studies and it has multiple benefits. Mostly, I talk about the scientific evidence that has been published. I must have missed your previous request, as I try to respond and be as transparent as possible.

One study funded by Ingredion did show that RS did not work as well with women. Ingredion wanted to investigate further, and funded another study at the University of Alabama to investigate it more closely. Barbara Gower’s study just published in Jan 2016 and is available online. In short, they found that women with insulin resistance responded, while it did not have an effect on women who were not insulin resistant. They fed them cookies baked with resistant starch and found the benefit at 30 grams/day but not 15 grams/day. Higher doses seem to be more reliable in seeing the benefit across the studies, so the dose matters.

You should know that one of the authors of the Gower study, Dr. Richard Bergman of Cedars-Sinai Diabetes and Obesity Research Institute, invented the hyperinsulinemic euglycemic clamp technique to measure insulin sensitivity. Their explanation of the earlier study was that the women were not well controlled for insulin resistance, as they used abdominal obesity as their indication of insulin resistance instead of measuring it directly in the participants.

Gower, B. A., R. Bergman, D. Stefanovski, B. Darnell, F. Ovalle, G. Fisher, S. K. Sweatt, H. S. Resuehr, C. Pelkman, “Baseline insulin sensitivity affects response to high-amylose maize resistant starch in women: a randomized, controlled trial.” Nutr Metab (Lond), 13, no. 1 (2016). Doi: 10.1186/s12986-016-0062-5.

Interesting … I will look into all you said (sorry, can’t figure out how to respond to your other post)

One thing I found with RS that really discouraged me. I started making a ‘peanut butter cookie dough’ using potato starch. It was SOOOOO good, I tell you! OMG! Anyway, I guess due to the fat in the PB and slowed digestion, I had my blood sugar go up to the high 120’s (higher than I prefer it to go after low-carb meals) and stay there for an hour. What do you think of that?

Maybe I should try using powdered (low fat) peanut butter along with some other wet substance and make it that way …

Thanks for letting me know that you are going to look into the data. That’s a great outcome from this discussion!

Potato starch contains a lot of resistant starch as long as it is raw. If it is cooked, it becomes digestible and high glycemic.

The only resistant starch that I am aware of that can be baked is resistant corn starch from high amylose corn (Hi-maize brand) that I used to work with. The high amylose content of the starch granule makes the gelatinization temperature higher than baking temperature naturally, which means that it does not cook out when it is baked. Hundreds of clinical studies have confirmed it.

I use HI-maize to replace about 20% of the flour in anything that I bake on a routine basis. At this level, it does not change the taste of the food.

Yes, I never cook the potato starch. I also have Hi-Maize but don’t use it much due to the fact that I don’t really eat any flour at all, so nothing to mix it with. I tried making pizza crust once using 1/2 Hi-Maize and 1/2 whole wheat flour, and it still spiked my blood sugar higher than I liked. As to the potato starch, do you believe that eating it with fat causes the body to break it down due to slower digestion, so therefore you get more of the ‘resistant’ starch being broken down to regular starch/glucose just due to the body having more time to work on it?

Rhonda,
I decided to give RS another try. I had the bad experience with potato starch seeming to raise my blood sugar at the 3-4 hour mark, and I guessed it was due to eating it with fat and the slower digestion of it broke down some of the RS to normal starch. Do you think that is possible? I do plan to do some more experimentation with it. The other question I have is potato starch vs. Hi-Maize, and assuming both are eaten raw, Potato starch seems to claim a high % of RS (80% vs. 60%), but is there anything to say which is more ‘resistant’? I’m wondering if the Hi-Maize would resist digestion more since it can be cooked? Therefore not having the same thing happen if I eat that with fat?

I made some of my “peanut butter cookie dough” stuff last night with the Hi-Maize (Using PB, vanilla, erythritol, Hi-Maize and some pasteurized egg whites) It tasted good. I prefer the stuff I had made before with the potato starch, though. Anyway, I probably used less RS in the Hi-Maize stuff I used last night, but I got quite a bit more gas from it (showing me that more was getting through maybe?) and also … 82 fasting this morning! My lowest number EVER. Not to say I’m sold on it yet, but I’m definitely eating some with dinner again tonight! I’m just wondering what you think of the Hi-Maize vs. Potato. Thanks!

I think you have to be careful about cooking these starches. You can increase the resistant starch in a potato by cooling it after cooking. But I suspect if you take something like potato starch and you cook it, it just won’t be the same.