I came across a very recent article on "How many servings of fruits a day can lower risk of type 2 diabetes?" written by Lakshita Jain, certified clinical dietician and a lecturer. The link is given at the bottom of the post.
While it was in my mind to make an exclusive post on fruits, but this article triggered me to make this post.
It is not only Lakshita, but even Dr Promod Tripathy who conducts a program called " Freedom from diabetes " and Dr Biswaroop Roy chowdhury who created a lot of sensation in digital media when he claimed that he can reverse type 1 by a plant based diet predominantly with fruits...
It is not only India, in USA too, there are lot of well qualified MD doctors some of them with Ph.D such as Cyrus khambatta, Neal barnard , Dr Greger, Dr Esselstyn, Mc dowel ...and many more are running diabetic programs and recommending fruits as a part of healthy diet for diabetes.
Even organisations like ADA, AHA, CDC, WHO....also recommend fruits for diabetes as a part of healthy diet.
In spite of that most diabetes eat very little fruits or avoid all together, ignoring all advice, fearing blood sugar spike.
In this post, we will discuss why fruit is important for diabetes?
How fruits metabolism takes place in our body?
Why most diabetes tend to avoid fruits?
what type of fruits one should eat and how much?
How will you know if you are intolerant to fruits?
Who all should avoid fruits?
Interesting?
So Fruits are important for everyone including diabetes!
The main component of fruits is water which varies from 80-96% depending upon the type of fruits and this water comes from under-ground through the roots of the tree, the stem, the branches and then all the way to the fruit...fruit water being the most purified form of water available in the earth and water alone does not raise blood sugar and is very much essential for human body.... Our body consists of 60% water.
The other components of the fruits are Fructose, Glucose, Fiber, Micronutrients such as Vitamins and minerals, anti-oxidants and Phyto-nutrients.
No doubt that vitamins,minerals, anti-oxidants, fiber, Phyto-nutrients from fruits don't spike blood glucose. These are very much essential for human body to keep you fit, fight free radicals, fights body inflammation, and keep you disease free. Vitamin C is a strong anti-oxidant found in all fruits , that protects your health , protects from infections, give you immunity, unfortunately does not get stored in body. Being a water soluble vitamin , it gets excreted through urine and therefore need to be replenished on a daily basis. A latest research indicates that it is very helpful in people with auto immune disease. No wonder, our ancient Muni , Rishi's used to live with fruit only diet in mountains and forests . Today , most indians fast with fruits on religious festival days .....in west many people call fruit diet as a detoxification diet.
The two components of fruits which fuel our cells namely Glucose & Fructose - all fruits have a Glucose & Fructose ratio of 50:50 roughly though the components may vary with the type of fruit by say 10-15%.
Do you know that fructose has a very low Glycemic index of 20 when Glucose has glycemic index 100 ? But we mistake Fructose as a culprit , as fructose is much more sweeter than Glucose..But the fact remains is that Fructose does not spike blood sugar.
So if you notice your blood glucose spikes with a fruit like banana or a mango it is the glucose component which spikes? So the villain is glucose not the Fructose in fruit...
We will come to fructose later in the post ? But here it is worth mentioning that it is not that all the people notice blood glucose spikes with all the fruits....
Will give you an example...I was avoiding Alphanso Mango last year mango season...as my blood glucose used to spike up to 140-150 after eating an Alphanso with my breakfast.
But this season, even after eating 2 Alphanso mango's with my breakfast, my PP blood glucose was only 120-125. It gave me confidence and this season I must have taken at least 7-8 kg of mango's during last 2 months. So, it is because, I seem to have reduced my insulin resistance and enhanced my insulin sensitivity through modifying my main diet and life style.
In other words, if eating a fruit like mango is spiking your blood glucose, it means you continue to have strong insulin resistance or you may be severely insulin deficient (beta cells partially defunct) which you need to work upon.
However, in spite of Insulin resistance, you still can have fruits which may not spike your blood glucose... Some tips are small servings with every meal, select specific fruits which does not spike.... You will find many... Also avoid over ripen fruits......semi ripe spikes less than full ripe fruits.....You may find some useful tips for selecting fruits for diabetes from many articles ..one such Link is given below ... The second link... So, you need not avoid fruits all together unless you have severe allergic to some specific fruits.... Or other 4-5 reasons as mentioned towards the end of this Post .
Now coming to the Fructose component of the fruit, what makes Dr Biswaroop of India and Neal barnard & Cyrus Khambatta of USA to advocate Fruit / fructose to reverse diabetes? What is the science behind such recommendation? Cyrus Khambatta, Ph.D and Robby both live with Type 1 diabetes for last few decades predominantly with fruit diet with ultra low fat and they claim they have reduced insulin requirement by half. ( please refer the article - 3rd link ) Both of them are running diabetic clinics and 1000's of followers including type 1's vouch in favour of fruits as I could read from their face book page- most of the Type 1's were wearing CGM and or Dexcom and so they were able to monitor blood glucose status in a better way & continuously ..............( unfortunately in India there is hardly any Type1 with CGM/ Dexcom ...it is costly and not funded by insurance ....so it is not popular ) .....So what is the science behind fruits & fructose ???
Before we discuss Fructose metabolism, let us see how Glucose is metabolised in our body- once we eat glucose,it directly goes to your blood and it then requires insulin so that the Glucose is used by our body cells for fuel.
Fructose does not require any digestive enzymes, it does not go to your blood....does not call for insulin....in stead, Fructose travels from small intestine to Liver with the help of GLUT5 & GLUT 2 transporters. Then the Liver processes the fructose and converts it partly in to Lactate & partly in to Glucose ( both ultimately fuel our cells ) ... Less than 1% of fructose is converted in to triglyceride.
So, basically, fructose in fruits does not need much help from pancreas/ Insulin for its absorption. It is the liver which processes the fructose.
Having said that, never go to the extreme end of consuming excessive stand alone fructose in form of HFCS (High fructose corn syrup), it could be toxic for health............But fructose in fruits in our daily diet is harmless...if consumed sensibly depending upon your diabetic status. It does not demand much insulin. So your pancreas is happy.
But there are exceptions...Who should avoid Fruits?
(1) People with strong IR or people with the extreme end of insulin deficiency,...( Type 2) ....though you may still take select fruits and watch portion size. Always check your blood Glucose to confirm your limits in stead of relying on hear-say.
(2) if you have Fructose intolerance or allergy to specific fruits...You may feel bloated, windy, gas, even pain in stomach.
(3) some people may lack fructose transporter GLUT 5 ... So you may have symptoms as mentioned in point-2.
(4) some people with SIBO- small intestine Bacterial overgrowth..some friendly bacteria from Gut overflows upwards to the small intestine.......SIBO Symptoms are as mentioned in point 2. However, those people can eat Low FODMAP fruits diet after consulting their doctors.
(5) people with IBS (irritable bowel syndrome). At times SIBO / IBS go side by side. They can also have a Low FODMAP diet.
Nice information. In my place two fruits Gova & Papaya besides Banana are seen every corner of a street. Plus the people bring every apartment by cycle. Cheap and affordable for all.
An excellent & informative article. I am type -2 diabetic for last 21 years. I take one Riomet 500 morning evening. I take all types of fruits especially with breakfast.
My PP readings after 2 hrs. used to be around 120. But after reading an article I started checking after half an hour of staring my meal. I was shocked to see glucometer reading varying from 170 to 190 depending upon the type of fruit I have consumed. It goes down to around 150 after 1 hr & 120 to 140 after 2 hrs.
Is PP reading upto 190 after 1/2 hr of starting meal is acceptable ?
When should PP reading be taken - 2 hrs from start or finishing of meals?
Dear Surtal Thanks for your response....first of all I can see that you seem to be doing very fine with Metformin only drug for the last 21 years . I am sure you must be very active in your daily activities I guess from your life style .
Now coming to your query, I have seen many studies that such blood sugar spikes do occur post meal even among healthy non-diabetes. The only variant is that the peak occurs for some one in 30mnts, someone in 45 mnts and someone may take 1 hour or even little more than 1 hour to spike depending upon his own metabolic competencies, physical acitivity and the type & Quantity /calories of food consumed and even the sequence of eating the macronutrients such as Carbs, Protein , Fat....for example, if one takes protein or Fat first and carbs at the end of the meal, the time taken to spike could be more than if one takes carbs first followed by protein/ Fat.
Now coming to the numbers, it would depend upon many variables as mentioned in the above paragraph...and for diabetes one more variable factor is status of IR.
It is universally accepted that post meal, insulin action begin to take place and it takes time to carry the excess blood sugar to cells and the time duration may vary from person to person ... spikes in 30/45/60/75 mnts , depending upon one's Insulin resistance status. However , does it come down in 2 hours or it remain high....???? A person with high insulin resistance may take still longer time to cool down its blood sugar or worse , it may not come down at all after 2 hours.
And the most important parameters to watch is HBA1C....which is an average reading of 90 days & of 24 hours each day ...........if that is within your goal ...you are doing fine. ....with my latest 5.8 HBA1c , I am still being considered pre-diabetes as per ADA ( more than 5.7 is considered pre-diabetes) though I feel I am no longer a diabete 😂..
Given below please find some guidelines and reference range on HBA1C, FPG, OGTT and Random Blood Sugar test from ADA ( American Diabetes Association).
As you can see OGTT ( oral Glucose tolerance test ) is done after 2 hours.
Thanks for the prompt reply. As discussed earlier in one of my posts, my break fast generally consists of
1. Papaya, Pomegranate &/ or anyother fruits like mango or Apple
2. Sprouts or half fried/boiled egg
3. Soaked overnight peeled Almonds(7-10), 4 halves of wall nuts & a few pieces of Raisins. All are soaked overnight.
4. A cup of tea with a dash of milk without sugar
5. One piece of biscuit.
Lunch & dinner are generally salad, vegetable & Lentil.
A cup of tea with small quantity of roasted peanuts at 4.00 PM
I take a a piece of plum or Guava & a few pieces of Jamuns or half Pear in the evening @ 6.00 pm.
Do stretching exercises and Yoga & Pranayam for about 1 hr. in the morning. Take brisk walk for at least 45 minutes daily or go for a game of golf in evening
My A1C varies between 6.0 to 6.5.
I have gone through the article on Glucose test. Test is done 2 hrs after taking Glucose. That means we should measure PP after 2 hrs. of start of taking meal, not after 2 hrs of finishing the meal. Am I correct?
Dear Surtal Good to see that you are doing well and that too only with one drug metformin. I like your lifestyle 👍
But there always exists an opportunity for improvement- there is nothing wrong in trying out small changes here and there to see if it makes a difference in your health.
I would have considered the following changes, if I were in your place.
(1) egg may have some nutritional benefits....but it contains saturated fat and protein from animal sources, which increases IR, increases cholesterol as per research done by Cyrus khamabatta, Ph. D and Dr Esselstyn, and many others. So, you may consider to give it a pass for few months to see if it makes a difference! It made a difference for my well being .
(2) so also milk contains saturated fat to some extent and I would avoid for the reasons as mentioned in point 1. Apart from this, milk may contains some hormones, chemicals since cows are frequently given injections, vaccinations to keep it healthy and at times synthetic hormones to produce more milk.
(3) while walnut may give you some omega 3, but it may not be sufficient.I take flax seed powder/ chia seed soaked.. 1 tablespoonful a day... Both flax and chia are rich sources of omega 3 and a lot of fiber.. and protein.
(4) Hope you are testing your vitamin D & B12 level regularly. Sunlight exposure 10-15 minutes every alternate day between 10 AM to 2 PM. Vitamin D supplement you should take if required......& B12 is a must for people taking metformin.
(5) you need to take some fermented food get some friendly bacteria for your Gut- can be prepared at home: examples are
Kombucha. ...
Sauerkraut. ...
Pickles. ...
Miso. ...
Tempeh. ...
Natto. ...
Kimchi-
Idly batter - make idly mixed with other whole grains like oats, barley....
Kefir/Yoghurt / plain curd/ butter milk....though dairy product...but limit to half a cup per day...instead of regular milk tea you take. But then it could be your last option if you don't or can not prepare anything else....Because you need for your gut.
Now I could see that in India Greek yogurt is available with ultra low fat.
(6) I would add 1 cup of Oats (whole grain steel cut oats) may be during breakfast or dinner. You can add your flax seed powder quota in oats , giving a nutty flavour.
(7) Hope you are taking leafy greens at least one portion a day.... Whatever leafy greens you like.
(8) I would avoid biscuits... In stead take some makhana or roasted chana.
(9) not to exceed your daily calory limit - BMR
(10) I do a IF for 14-15 hours.
From 7 PM to next day 9 AM.
(11) please don't get obsessed with PP timings. At different places different practises are followed. At some places they check 90 minutes from start of meal, some places 120 minutes after meal.... The readings are only for guidance and trend monitoring. Whatever practice you follow, stick to that one practice so that you can compare your own readings apple to apple and watch the trend.
What is important finally is your Hba1c ....keep your next target of 6 ...
You need to go through my main post and the links given below the main post to understand the science! You may please refer the 3rd link in the main post. Further, I would like to attach a latest article dated 21st March , 2021 by Cyrus Khambatta, PH.D on this subject.
My understanding and experience on the subject is that I eat fruits for its micro nutrients such Vitamins, minerals, Bioflavonoids, phyto nutrients, anti-oxidants , soluble fibre which are very much essential for overall health of diabetes. In the process I may eat Some glucose & fructose along with the essential vitamins , minerals.....but that in no way it affects my blood glucose level ...I am doing very fine ...much healthier than the High Fat diet that I was practising Once upon a time when I joined this forum .
If by eating a fruit , blood glucose spikes, that person may have a Strong IR. So naturally those people need to be watchful as I have already stated in my post.
Further, As per Cyrus Khambatta, ph.d people those who practise low carb, high fat diet- especially animal Fat animal Protein in the diet , their IR goes from bad to worse which I tend to believe as I found a tremondous improvement in my own health conditions with my current plant based whole food diet with fruits as against LCHF diet earlier when fruits used to spike blood glucose level and so I used to minimise fruits with LCHF which actually worsened my condition.
Non-Diabetes eat a lot of fruits without any health issue lifelong .
You may please tell us what kind of diet you practice ?
And you may like to post your results for benefit of members.
Those of you , who would like to know carbohydrate vs Fat for diabetes and for those of you , who missed my previous posts, I would like to clarify the science behind this as per research carried out by Cyrus Khambatta and what worked for me ! I had given relevant links in my previous posts.(1) once diagnosed with Diabetes, It is very common that all people around you would advise you to reduce carbs - people would say carbs is the culprit, so reduce carbs ....... and so on .......though most doctors would advise you to eat a Balanced diet .. all reputed international organisations such as ADA/ AHA/ WHO/ CDC and all Nations Health and family welfare dept would recommend a balanced diet.
(2) But you normally follow advice based on Hear-Say from people all around you , and you reduce carbs , increase your Fat & Protein .....and most would eat protein and fat from animal sources.
(3) But your body cells needs Glucose and it is easy for your body to convert Carbs to glucose ..... but you are not eating enough carbs.....so your body is forced to convert a part of your protein and fat in to glucose by a process called Gluconeogenesis. So finally whatever you eat , finally body would convert it in to glucose.
(4) yes, you may be able to reduce your blood sugar spike temporarily, but you are not looking at your other health parameters..The irony is that when you minimise carbs and maximise fat & protein , your lipid numbers goes up because if high fat , your kidney is put under pressure to clear out the nitrogenous waste.....so the result is Heart failure & Kidney failure....which are the top two killers among diabetes.
(5) Not only this, once you eat excessive fat in your diet , your muscle cells get clogged with Fat molecules ..and the body cells does not allow glucose molecules to enter in these cells. .this is how you develop Insulin resistance - as per the research carried out by Cyrus Khambatta , ph.d, excessive fat and protein are the top 2 reasons of progression of insulin resistance!
(6) How to know that you have developed IR ?
It is very simple , if by eating a small amount of carbs , your blood sugar spikes, and by eating a fruit if your blood sugar spikes. it means you are having a strong IR and your muscle cells are clogged with Fat. That means you are eating a lot of fat especially from animal sources.
(8) so what I learnt what is the best way to manage your diabetes , at the same time , avoid heart abd kidney failure ? Avoid / Minimise Fat, Protein from animal sources which are known to cause IR as per research by Cyrus Khambatta, Neal Barnard , Esselstyn... . All links are given in my previous posts along with long term diet trial results that were carried out at various countries for 10-20-39 years.
So, I give due importance to the carbs that it deserves, I stick to whole plant foods, whole grains , legumes , vegetables, fruits, some seeds /nuts ....
.....these have a lot of fiber which not only reduces spike and select the ones which suits to your body.... initially for the first 3-6 months , I had spikes since I had IR due to my low carb high fat diet... but gradually I had overcome ....I still keep changing my different food items , cooking process.....but within the Whole plant food ....zero processed food.
I have come a ling way ....
If you have a look at my blood report during my LCHF days...
(9) On fruits , I have given my personal experience.. made one comprehensive post...and I have nothing more to add. There is everything in it...who should eat and who should avoid !
Anyway, I will make a sperate post on this as to why and how I transitioned from LCHF to whole plant food
I landed into this group only yesterday, though I am a diabetic for 22 years.
Additionally at 68, I suffer from hyper tension for close to 15+ years, prostrate enlargement, a minor injury in brain(2015) with a complicated result with loss of smell and taste for about an year.
Till Feb 2021 it looked I was in good health, though during my recent trip to USA only, the real hidden problems started showing up!
I was diagnosed with heart problem and 2 stents were fixed. Also I was warned that kidneys are in a bad shape (CKD), and unless I undergo correct treatment I will land with dialysis!
As the expenses, by Indian standards was TOO TOO high, I decided to accept the risk, and fortunately was able to return to India in about 45 days from stent fixing.
On consulting specialists here for cardiac, kidney and diabetic, lot of changes have been done to medicines that I was taking.
IN USA itself they advised to change the hypertension medicine as that was damaging the kidneys. But they allowed diabetic medicine to be continued after stent fixing, putting me on insulin while in hospital.
Now the diabetic medicines also have been changed (names I am not listing unless you permit me to mention them). With a lot more restriction on food because of CKD.
Really I don't know what to eat or what not to eat!
The changed diabetic medicines seem to be not effective (only around 7 days over) and I have been told to check for about 30 days, and then if necessary i will be advised to opt for insulin!
Before the above change fasting and PP readings were around 80 and 250, but now after the change it has increased to 175 and 350! With the 3 month average at 9.8
As such, with the above notes I have no data further to share and will post more as and when I keep reading further/asked questions.
Unfortunately i never had the habit of consuming much of fruits, I have continued that way after diabetes was diagnosed during 2000.
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