Questions From A Diabetes Practice – 2023 Edition

By Roberta Kleinman|2024-01-17T14:43:01-05:00Updated: July 19th, 2023|Diet & Nutrition, General Information, Health & Wellness|0 Comments
  • More Questions From A Diabetes Practice - 2023 Edition

New information and technology keeps progressing in the field of diabetes. Stay current as you can. This will help you manage your diabetes and overall health with each day.

1. Should I eat Omega-6 fatty acids or Omega-3 fatty acids or both? What are they and does it even matter?

Let’s discuss what each is before we talk about the ratio or amount you should consume. The current Western diet seems to have a higher intake of Omega 6 fatty acids when compared to Omega 3s. Americans eat about 10 times the amount of Omega 6s compared to Omega 3s.

Human beings evolved eating a ratio of 1:1 when originally comparing Omega 3s to Omega 6s. Today the ratio is 16:1. Our bodies have not yet evolved to handle all these Omega 6s. Also, earlier populations ate less sugar, no processed foods and got more physical exercise. They did not have modern junk foods.

In Japan, due to their high fish intake, their balance of Omega 3s to Omega 6s is more balanced than here in the US. The high 6:3 ratio in the Western diet may be detrimental to your health. Western diets presently contain large quantities of soybean oil. It has gone from zero use to a huge daily intake.

Soybean oil is cheap and found in many processed foods. Soybean oil can create “actual bodily changes from fat stores to changes in cell membrane health.” Other cooking oils high in Omega 6s include corn and sunflower. Omega 6s can be stored in your body fat for a very long time.

Both 3 and 6 Omega fatty acids are important but should be eaten in a more balanced and closer ratio. Both Omega 3s and Omega 6s are considered polyunsaturated fats and essential fatty acids meaning “our bodies do not have the enzymes to produce them, so they must be eaten or taken as a supplement.” Fatty acids are a fat which is simply a source of energy. Too much fat will promote weight gain.

Without eating Omega 3s and 6s, you can develop a deficiency. A deficiency in Omega 3s can cause dermatitis which presents as rough and scaly, dry skin. Omega 3s are in high amounts in the retina and brain. Lack of Omega 3s may also cause dry eye. An Omega 3 deficiency may result in a lack of attentiveness, alertness, and poor sleep quality. It can cause joint pain and leg cramps.

Omega 3s provide energy and help the cardiovascular system as well as the pulmonary, immune and endocrine systems. The endocrine system is related to diabetes. They also help lower triglyceride levels. Good amounts of Omega 3s may help reduce mental decline as we age, as well as the risk of strokes. Omega 6s also have roles in inflammation and blood clotting.

“Eating too much Omega 6s may lead to an increase in inflammation and blood clots.” The imbalance of 3 and 6 may cause chronic inflammation which is a “driver in multiple chronic diseases.” Included would be heart disease, diabetes, arthritis, Alzheimer’s and many types of cancer. That is why the ratio remains so important.

What you should do? Try to increase the amounts of Omega 3s in your diet to better balance the ratio. If you are not eating enough, talk to your health care provider about taking Omega 3 fatty acid supplements. You can continue to enjoy certain Omega 6 fatty acids in moderation but look for a balance with the 3s.

The foods that should be eaten containing Omega 6 fatty acids include cashews, walnuts, almonds, hemp seeds, avocado oil, peanut butter, eggs and tofu. The Omega 6s are linoleic acid, arachidonic acid and gamma-linolenic acid. You should eat between 12-17 grams of Omega 6s each day.

Cut down on the heavily processed Omega 6 foods. Avoid the processed and junk foods which contain Omega 6s, usually from being fried in vegetable and seed oils. Avoid or limit corn, soybean and cottonseed oil. Omega 3 fatty acids do not have an official amount guideline but most of the literature states “not to exceed 5 grams a day.” Too much can cause blood thinning and active bleeds.

Omega 3 fatty acids include:

  • EPA: eicosapentaenoic acid
  • ALA: alpha-linolenic acid
  • DHA: docosahexaenoic acid

Foods with EPA and DHA include fish and krill oils. The best fish choice meals to eat include anchovies, oysters, mackerel, sardines, wild salmon, herring, and tuna. Eat and cook food with more olive and canola oil. Foods with ALA are plant based. Flax seeds, flaxseed oil, canola oil, spinach, Brussel sprouts, walnuts and chia seeds contain ALA.

ALA must be converted by your body to EPA and DHA to use. Omega 3s can also be taken in supplement forms. Talk to your health care provider. If you do take an Omega 3 supplement, take it with a fat-containing meal for best absorption. Foods like avocados, whole eggs, low-fat cheese, nut butters, nuts and seeds would be good examples of fat containing foods.

Store supplements in the refrigerator to reduce the possibility of gastric side-effects. Side-effects may include headaches, bad breath, a fishy taste, gastric reflux, heartburn, nausea and diarrhea. Eating fish may supply more heart healthy benefits than taking Omega 3 supplements. Try to eat fish meals 2-3 times a week. Look for fish with lower mercury content.

Buy pasteurized and Omega 3 enriched eggs. Eat grass- fed beef instead of beef fed grains such as corn and soybeans which are high in Omega 6s. Choose leaner cuts of beef and if you are eating beef look for ground beef with the lowest content of fat. Drain the ground beef after cooking to remove excess fat.

Eat choice and select cuts instead of prime meats which contain a higher percentage of fat. Trim the visible fat from the meat prior to cooking. Consider eating sirloin tips, Filet Mignon, eye of roasts and steaks as well as top round roasts and steaks. Boil stew meats first to drain off excess fat before placing them with vegetables and sauces. Do not eat red meat more than 2 times per week.

2. What is Raynaud’s Syndrome? Is it more common in diabetes?

A condition known as Raynaud’s syndrome usually affects the fingers and toes “resulting in blood vessels to narrow restricting blood flow.” It is caused by overly sensitive blood vessels that vasoconstrict, vasospasm or shrink up. Over time, the small arteries can thicken limiting blood flow even more.

After an episode ends, the blood vessels dilate which then can cause swelling and throbbing in the fingers and toes. It may also occur on the tips of the ears and nose but is less common. It affects about 5% of the population and was first noted in 1862 by Dr. Maurice Raynaud. Usually, cold temperatures or stress and anxiety provoke an attack.

Symptoms can include tingling, burning and numbness, quite similar to peripheral neuropathy which is common with diabetes. The difference is in Raynaud’s, the pins, needles and numbness is generally temporary or intermittent whereas diabetes neuropathy symptoms of pins, needles and numbness does not go away.

In Raynaud’s, tips of your fingers and toes can temporarily even change color to a bluish or pale white. It is also called Raynaud’s disease or Raynaud’s phenomenon.

There are 2 types of Raynaud’s Syndrome: Primary and Secondary. Primary usually has no known causes. It is more common in women and in those under age 30. It is also more common in colder climates. Primary Raynaud’s may eventually disappear on its own.

Secondary Raynaud’s is more difficult to control, may interfere with quality of life and is associated with another previously diagnosed autoimmune disease including thyroid disease, lupus, scleroderma, Sjogren’s, rheumatoid arthritis and carpel tunnel syndrome. Carpel tunnel syndrome is more common with diabetes as up to 20% of people with diabetes have carpel tunnel.

People who take medication to control hypertension (many with diabetes) migraines, people who smoke and those taking certain cancer medications are also more at risk for Raynaud’s. Exposure to certain chemicals which may damage nerves can be a possible cause. Even people with atherosclerosis or heart disease (many with diabetes) are more at risk.

People who use repetitive hand motions such as piano players, typists and workers who use tools that vibrate such as jackhammers. People with diabetes are not more at risk except those who also suffer with hypertension or carpel tunnel disease.

How is it diagnosed?

There is no one test to diagnose Raynaud’s and it is usually diagnosed based on a history/physical and symptoms. An ANA (antinuclear antibodies test) blood test can be performed if an autoimmune disorder is suspected. A “sed rate” blood test may also be done to see if there is an inflammation process occurring.

Can it be treated?

There is no cure for Raynaud’s syndrome, tissue damage prevention is the goal.

What can you do?

  • Avoid extremely cold weather for long periods of time.
  • Dress properly by wearing layers. Use thermal gloves, and thick socks that wick away moisture. Ask about using glove warmers. Wear scarves around your neck and a face mask in extreme cold. Use earmuffs and wear lined and waterproof boots.
  • Carry and wear a sweater or jacket in the grocery store when near the freezer/refrigeration sections.
  • Warm your vehicle before you drive.
  • Do not lower house AC too much. Watch fan use or keep on a low speed.
  • Do not smoke.
  • Limit stress. Learn to manage stress.
  • Stay physically active to promote good blood flow.

What if you have an episode?

  • Rub or massage fingers or feet.
  • Use warm water or heating pads. Be careful not to burn yourself by using 10 minutes on then 10 minutes off.
  • Vasodilators or calcium channel blockers may be given.
  • Nerve surgery is usually used as a last resort for treatment.

3. I thought a square or 2 of dark chocolate was a healthful snack even with diabetes.

The basics: Cacao verses Cocoa

70% of cacao is grown in west Africa. It is also found in South America and parts of Asia. There are 2 edible parts: the seeds or beans and the fruit. Chocolate bars are made from the beans which are “fermented that are ground into a paste and then sweetened.”

“Cacao beans” have not been roasted and “cocoa” is made from beans that have been roasted. Raw unroasted cacao is healthier than cocoa since it had not been processed and contains more minerals and antioxidants. 100% dark chocolate tastes like cacao nibs which are dense, crunchy and bitter.

Dark chocolate contains 50-100% cocoa solids, cocoa butter and a bit of sugar while milk chocolate contains 10-50% cocoa solids, cocoa butter, milk and higher amounts of sugar. Dark chocolate is 70% or higher, and contains 2-3 more times of flavanols than milk chocolate. Dark chocolate should not contain any milk. Dark chocolate has more caffeine than milk chocolate and about 150-170 calories per ounce.

Dark chocolate bars

Dark chocolate has generally been considered a “good snack” since it contains antioxidants such as flavonoids, polyphenols and theobromine. These antioxidants can boost mood, increase blood flow, increase elasticity of your skin, “may decrease insulin resistance” and can fight free radicals. Free radicals raise your cancer risk by elevating cell damage.

Dark chocolate contains potassium, zinc, copper, magnesium and manganese. The dark chocolate you eat should contain at least 70% or higher amounts of cacao. It can go up to 100%. The less the % of cacao the more sugar added to the chocolate. According to the Harvard T.H. Chan School of Public Health, “the lower the amount of cacao, the more added sugar and unhealthy fats”. Milk chocolate and white chocolate do not contain the additional benefits of dark chocolate.

New research recently reported by Consumer Reports states “dark chocolate contains too much cadmium and lead-2 heavy metals that can lead to additional health problems.” 28 dark chocolate bars were tested, and all the bars contained both heavy metals. The ones with the highest metal content were “Trader Joes, Green and Blacks, Theo and Lily’s”.

The safer dark chocolate bar brands were “Ghirardelli , Taza and Valrhona”. Metals were also found in “Dove, Godiva and Lindt”. The problems associated with metal ingestion is greatest to young children and pregnant women since these metals can lead to developmental problems.

“Cadmium can damage the kidneys and liver” and both metals are known to cause cancer. Consistent exposure to these metals may also cause high blood pressure and suppress your immune system. There is no amount of heavy metals are “considered safe to eat.”

Where are these heavy metals coming from?

The cadmium gets into the chocolate from the soil itself. It starts in the beginning when the cacao is removed from the pods. This was first documented in 2014. The beans, as they dry, are exposed to lead from the air.

Humans can’t break down metals, so they start to accumulate in your body and eventually cause damage. Unfortunately, not only dark chocolate contains these metals but so do some fruits, vegetables, supplemental powders and protein powders due to our air, water and soil.

What should you do?

  • Do not offer dark chocolate to young children. Generally, it is too bitter for them, and they do not enjoy the taste.
  • Less cacao % in the chocolate bar means less heavy metals.
  • Try not to eat a square or 2 of dark chocolate more than 2-3 times a week. Space out the days you eat it.
  • Eat a square of dark chocolate that contains berries, cherries or nuts for added nutritional benefits.
  • These results were based on California guidelines which allow for even lower amounts of metal per bar than the safety standards set by the FDA.
  • The chocolate industry is currently working hard to address and correct this issue.

4. What is the latest news on Stevia, a common additive used by people with diabetes? The actual name is erythritol and what do I need to know?

“Erythritol is a food additive and sugar substitute, made from sweetened monk fruit discovered in 1848. It is used in dietary supplements. It is derived from leaves of the Bertoni plant, a herbal shrub native to South America. It has been used for years as an additive to foods and medicines.

Erythritol is a sugar alcohol like sorbitol, xylitol and maltitol. Sugar alcohols “stimulate the sweet taste receptors on your tongue.” Since 1990 it has had a “history of safe use as a sweetener and flavor enhancer.” It is regulated as GRAS (Generally Recognized As Safe), a process used by the FDA.

It may cause stomach problems such as gas, bloating, diarrhea, nausea and stomach pain, especially when eaten in large amounts. The trade names for erythritol are: Splenda Naturals Stevia, Stevia, Truvia, Pure Via, and Sweet Leaf.

Stevia is found in over 14,500 food and beverage products. It is stable at high temperatures and used in baked goods, syrups, cereals, diet sodas, diet ice teas, flavored waters, low sugar fruit juices, canned fruits, salad dressings, gum, granola bars, dairy products, sugar-free chocolate and single serve packets which can be added to foods or beverages. It is intensely sweet, 200-350 times sweeter than sugar.

“Most artificial sweeteners bind in the body but are not absorbed. Erythritol is absorbed in the bloodstream.” Researchers at Cleveland Clinic-Ohio, published in Nature Medicine, studied over 4000 people in the US and Europe and found “higher blood erythritol levels elevated the risk of experiencing major adverse cardiac responses and erythritol was connected with incident risk for major cardiovascular events.”

Even when other factors were treated such as cholesterol, diabetes, obesity, blood pressure and all other traditional risk factors are controlled, heart attacks and strokes still happened.

The outcome is “after eating/drinking erythritol, there is a prolonged period of potentially heightened thrombolytic risk.” The risk of events was higher for days after eating processed foods with this ingredient.

Erythritol is found naturally in small amounts in grapes, watermelon, peaches, pears, and fermented foods such as beer, soy sauce, wine, cheese and sake but when added to processed foods it’s “1000 times a higher quantity as compared to the naturally occurring erythritol.” The people who were studied were all middle-aged with or without heart disease.

These products are mainly marketed to the obese, those with diabetes and those with pre-existing heart disease as a no-calorie product that gives foods and beverages its sweet taste. Another smaller study showed “erythritol may act as an antioxidant reducing blood vessel damage caused by high sugar levels.”

Bottom line: More research needs to be done before any final decision is made. “Caution should be taken in cardiovascular risk patients who may already be prone to extra sticky platelets (people with diabetes). We need to make sure foods we eat are not hidden contributors to heart problems such as heart attacks and strokes.”

Talk with your health care provider, including a dietitian, before you eat these products to assess your personal risk. Remember, there are other sugar substitutes which may work better for you without weight gain.

5. What is the potassium and diabetes link?

“Some studies have linked low levels of potassium and an increased risk of type 2 diabetes. When your potassium levels are low, your body makes less insulin which may lead to high blood sugars and type 2 diabetes.” Proper levels of potassium may also reduce the risk of kidney stones, osteoporosis and high blood pressure.

98% of all adults in the US are not meeting their daily potassium recommendations. Potassium is an essential mineral called an electrolyte. Electrolytes carry impulses such as nerve impulses to other cells. It helps regulate your heartbeat, muscle contraction and nerve conduction. Potassium also regulates proper fluid balance between body fluids and cells.

If you have kidney issues or nephropathy from diabetes, your potassium levels may go up. Either too high or too low potassium can be dangerous. A simple blood test can measure your potassium levels. A normal level is 3.7-5.2 MEQ/L.

Women need to consume 2,300-2,900 mgs a day depending on their age and men need to consume 3,000- 3,400 mgs a day depending on their age. We are usually not potassium deficient due to our dietary intake and daily eating habits.

Foods high in potassium:

  • Bananas
  • Cantaloupe
  • Oranges
  • Sweet potatoes, Russet potatoes
  • Tomatoes
  • Winter squash
  • Leafy greens like spinach, broccoli
  • Soybeans
  • Lentils
  • Beans
  • Legumes
  • Salmon
  • Chicken breast
  • Cashews
  • Almonds
  • Salt substitutes
  • Yogurt and dairy milk
  • Plant milks
  • Coconut water

Causes of low potassium:

  • Dehydration
  • Sweating
  • Diarrhea/vomiting
  • Taking water pills
  • Severe burns
  • Problems with your adrenal glands

Symptoms of low potassium:

  • Fatigue
  • Weakness
  • Muscle cramps and spasms
  • Confusion
  • Palpitations
  • Tingling and numbness
  • Elevated blood pressure
  • Increased urination

Causes of high potassium:

  • Kidney damage from poorly controlled diabetes
  • Diabetic nephropathy
  • Use of ACE inhibitor medications used for heart issues
  • Heart attacks
  • Being older
  • DKA- diabetic ketoacidosis
  • Injuries
  • Infections
  • Over-use of potassium supplements

Symptoms of high Potassium:

  • Nausea and vomiting
  • Belly pain
  • Paralysis
  • Shortness of breath
  • Heart arrhythmias

Talk to your health care provider to make sure your potassium levels are and remain in the acceptable range by taking a simple blood test. Cut back on your daily sodium intake and eat potassium in your daily diet.

There is new information out there for people with diabetes each and every day. Keep reading and keep learning. It will help motivate you to take better care and control of your diabetes and overall health.



About the Author: Roberta Kleinman

Roberta Kleinman, RN, M. Ed., CDE, is a registered nurse and certified diabetes educator. She grew up in Long Island, NY. Her nursing training was done at the University of Vermont where she received a B.S. R.N. Robbie obtained her Master of Education degree, with a specialty in exercise physiology, from Georgia State University in Atlanta, Georgia. 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. More about Nurse Robbie

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