It has been quite a while since I shared some of the common questions asked by my diabetes patients, just like you. The questions often run the gamut focusing on medications, complications, proper eating, exercising habits and what is in the recent news concerning diabetes. Some questions come up regularly and I decided to share them with you in this newsletter. Please feel free to write in any questions on your mind so we can share the answers with the rest of our newsletter readers!
What is best to drink when you have diabetes: regular water, 100% fruit juice, soda (regular or diet), or flavored/sparkling/still water?
Answer: Soda sales reached 15 billion gallons in the U.S. during the year 2000. Soda sales have recently been declining and have gone down by 1.2% in 2016 due to healthier drinking alternatives, more consumer awareness and added-sugar taxes used in certain cities. Soda companies have tried to spark sales by adding smaller cans and different drink choices with lower sugar content. Regular soda for a patient with diabetes is ultimately the worst choice as the amount of sugar is an average can of soda is 16 teaspoons with 40 grams of carbohydrate and 150 empty calories. Sugar is not “the enemy” when you have diabetes since fruits, vegetables, dairy products and whole grains contain sugar.
The problem with soda is the amount of sugar along with it being processed and entering your blood stream so quickly. Regular soda is often referred to as “liquid sugar” since it raises blood sugar in as little as 30 minutes. Soda contributes to obesity (empty calories) which is one of the leading risk factors for type 2 diabetes. It can also elevate fatty deposits in the liver. Regular cola contains high amounts of phosphoric acid which leads to tooth enamel decay, osteoporosis which leeches calcium from the bones, and may lead to the formation of kidney stones.
A patient who was recently diagnosed with diabetes brought a super-sized regular cola soda from a 7/11 to her initial self-management visit as a snack. After some diabetes education she allowed me to test her blood sugar which was over 300mg/dl. She stated she felt thirsty even though she was still drinking and tired, both of which are symptoms of elevated blood sugar. The next visit was one month later. She had committed to eliminating regular soda from her diet and she had seen great improvements. She already lost 6 pounds just from this one change. Diet soda is a better choice for people with diabetes since it has less sugar but “does contain additives and artificial sweeteners”. There is recent controversy about diet soda even for those with diabetes, so use your judgement. “Artificial sweeteners “may set up hormone responses that make you “crave more sweet things” by triggering receptors and may affect good gut bacteria. Diet soda can contain caffeine and is never considered nutritious. It may also increase the risk of metabolic syndrome which is a precursor to diabetes.
100% fruit juice is not a better option for those with diabetes. There is no fiber in the juice and blood sugars raise quickly when consumed. It is wiser and more satisfying to eat the whole fruit instead.
Sparkling or flavored waters are now the latest craze selling at record amounts. Although they do not contain calories and are a much better choice than soda, they are not completely perfect. The “flavor essences” are mainly citric like lemon, lime, orange and grapefruit and fruit acids which could cause enamel erosion when consumed regularly. The fruit acid flavor changes the PH to about 3 in flavored water where regular water PH is between 6-8. The more acidic the beverage, the more tooth erosion and sensitivity may occur.
Flavored waters can make your teeth more sensitive to heat, cold and dental decay. The most reasonable advice is to eliminate regular soda and fruit juice, limit diet soda and sparkling or flavored calorie free waters and stay hydrated with regular water. You can add herbs including mint, basal or cucumber slices to the water without adding citric acid. When drinking flavored, calorie-free waters use a straw to limit exposure to your enamel. Chewing sugar free gum with xylitol is a smarter idea than brushing teeth after eating or drinking to save enamel. Plain water helps the body with multiple functions such as regulating body temperature, reducing constipation, carrying oxygen and nutrients to the cells, preventing dehydration and replacing needed fluids especially during the hot and sticky summer months.
What are prebiotics and probiotics?
Answer: Another nutritional craze being talked about are pre and probiotics. Research points to gut bacteria being a source of promoting good health to everyone including those with diabetes. “Prebiotics are non-digestible food ingredients which act as a food source for and promote the growth of good bacteria in the gut”. Prebiotics are not bacteria but the fertilizer needed to help the good bacteria in your gut flourish. Prebiotics can be found in many food products. Included are asparagus, flax, barley, onions, leeks, garlic, artichokes, bananas, soybeans and whole wheat foods.
Probiotics are “live active cultures” which are also found in food and are similar to the bacteria present in the gut. Probiotics are in fermented foods such as yogurt, Kefir, aged cheeses like Gouda and Swiss, sauerkraut, Kimchi, miso and tempeh. Both pre and probiotics can help the body fight infection, digest nutrients, produce energy, counter- act the negative aspects of antibiotics that kill good gut bacteria, absorb phytochemicals, impact immune function and help use vitamins found in our food. These foods tend to all have a low glycemic index which is beneficial for diabetes. They may cause bloating especially if consumed in large quantities in a short period of time. Pre and probiotics can be found in supplement form in either tablets, powders, capsules or liquid. Remember, they are not FDA regulated so consult with a health care provider prior to starting any supplement. Look for capsules which are least affected by temperature change and always choose brands that contain multiple strains of bacteria. Make sure to refrigerate those that specifically request refrigeration.
What about energy drinks, regular or sugar-free, when you have diabetes?
Answer: Energy drinks are extremely popular, with the global forecast to reach 61 billion by 2021. According to the World Health Organization “energy drinks may pose a danger to public health”. The American Beverage Association says “they are safe”. Most of these energy drinks contain large amounts of caffeine, sugar, taurine, carnitine and guana (a plant from the Amazon which is a “legal stimulant)”. Energy drinks, whether with sugar or sugar-free, have shown to increase heart rate, blood pressure and stress levels which are all negative responses. They have also been shown to raise insulin resistance and increase blood thickness which causes possible blood clots. There are no hard facts that it can hurt everyone that consumes them, but those with diabetes, heart disease, pregnant women and adolescents should realistically avoid them due to the large amount of caffeine and guana.
The high caffeine content could cause anxiety, insomnia, muscle twitching, irritability, dizziness, tremors, restlessness and G.I. upset. Healthy adults should have about 400 milligrams of caffeine daily, so if you have a cup of coffee at breakfast, an ice tea or diet soda at lunch and a sugar-free energy at 3-4PM you will be agitated and have exceeded your caffeine safe level. Instead of using energy drinks for a boost, eat sensible meals, never skip meals, exercise regularly, get enough sleep and have a snack of protein and carbohydrate such as a small apple with 8 almonds or 2 whole grain crackers with a cheese wedge to get you comfortably to dinner.
Patients have the most interesting questions. Sharing the information with you may help you benefit as well. Enjoy!
Have a question or comment? Post below or email me at RKleinman@adwdiabetes.com if you would like to share them with ADW diabetes.
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.