Diabetologist’s opinion MB Olga Turowska

Doctor, The Transformation Programme is a holistic weight loss programme. It involves the introduction of a new nutritional culture based largely on soups and positive changes in various aspects of life. Insulin resistance, pre-diabetes or diabetes are common diseases that accompany overweight and/or obese patients. Can you briefly characterise these diseases and describe how they differ from each other?

MB O.T.: Insulin resistance is a pre-diabetic state. It is accompanied by type 2 diabetes and is part of its pathogenesis. Insulin resistance is also associated with prediabetes, that is, abnormal glycemica while on an empty stomach, and/or impaired glucose tolerance. Before the occurrence of abnormal blood glucose levels, we are dealing with the state of insulin resistance – the state of increased tissue resistance to insulin.

What are the causes of insulin resistance and diabetes? What factors increase the risk of getting sick?

MB O.T.: One of the mechanisms that accompany excessive body fat and insufficient physical activity is the phenomenon of increasing insulin secretion. This mechanism has a compensatory task: to prevent hyperglycaemia, because adipose tissue, unlike muscle tissue, has hormonal and metabolic activity that promotes hyperglycaemia. However, over time, like any overloaded compensation mechanism, it gradually fails. Due to excess insulin, reactive hypoglycaemia occurs, i.e. a drop in glucose several hours after a meal. Thus, sensitivity to insulin becomes reduced. Subsequently, prediabetes occurs (abnormal glycemica while on an empty stomach, impaired glucose tolerance), and finally type 2 diabetes develops.

How are these conditions diagnosed?

MB O.T.: For practical purposes, in the diagnosis of insulin resistance, we use a ratio of blood sugar level to insulin level, while on an empty stomach (the so-called HOMA-IR or QUICK index), which correlates fairly well with insulin sensitivity determined with euglycemic clamp (a test performed in a hospital). 

Pre-diabetes and diabetes are diagnosed with an oral glucose tolerance test, an oral stress test with 75 g of glucose.

Can insulin resistance or diabetes be cured with the right nutrition?

MB O.T.: Causal treatment – healthy eating habits and proper physical activity are the best for dealing with not only insulin resistance, but all negative effects associated with unhealthy lifestyle and abnormal body weight.

What other habits should accompany healthy eating to minimize these diseases?

MB O.T.: We have to realize that insulin resistance is an important mechanism causing negative health consequences in people with excessive body weight. Even if we could find the ideal drug against insulin resistance, it will not correct all the effects of an unhealthy lifestyle, nor will it provide a significant reduction in body weight. Stress, sleep deprivation, poor sleep hygiene, disturbances in circadian rhythm, lack of physical activity, irregular meals, skipping breakfast, binge eating in the evenings, eating between meals, consuming high-processed foods (i.e. ready meals reheated in a microwave oven) all result in metabolic disorders. In the case of diseases associated with impaired insulin sensitivity, physical activity and healthy eating habits are crucial as they prevent the abnormalities from escalating. In addition, we can use supportive pharmacological treatment.

Going back to nutrition – what are the general nutritional and health recommendations for people with insulin resistance or diabetes?

MB O.T.: What is very important, is: eating regularly, eating breakfast; avoiding: heavy meals, eating between meals, consuming highly processed foods. You should choose products with a low and medium glycemic index, the total meal index should be in the lower or medium values. Simple sugars, i.e. colloquially speaking „sweet products” should be avoided all together.

Cooking increases the glycemic index of products. Can people with insulin resistance or diabetes eat soup?

MB O.T.: f course they can, as long as the soup is prepared in the right way. Vegetables shouldn’t be overcooked, cereal products shouldn’t be boiled in the broth, but instead added to the soup. It is also good if the soup contains meat – it reduces the total glycemic index and glycemic load of the meal.

Not overcooking the products is the key recommendation for proper preparation of meals, in the diet recommended for people suffering from diabetes and prediabetes. It helps to reduce the total glycemic index and glycemic load of a meal – very important for achieving the correct glucose levels after meals. Regular meal times, and avoiding snacking between meals, are crucial for the proper nutrition of people affected by carbohydrate disorders.

Are there any soup ingredients that people with insulin resistance or diabetes should avoid? Should these ingredients be completely eliminated, or just limited?

MB O.T.: Doctors recommend avoiding products with a high glycemic index, such as: white rice, boiled carrots and potatoes, pumpkins, and broad beans, because these products promote the occurrence of postprandial hyperglycemia. Whole grain cereal products, which have average glycemic index include: oats, bran, pasta cooked al dente, groats, wild and brown rice. Remember to prepare your soups the right way: to reduce glycemic index, avoid overcooking dishes, the glycemic index will be also reduced from the addition of protein, fat or fiber, i.e. a small amount of oil or lean meat.

One of the principles of the Transformation Programme is to eat one portion of fruit in the first part of the day. Juicy fruits are recommended. Can one serving of fruit per day be consumed by people with insulin resistance or diabetes?

MB O.T.: There are no contraindications to the consumption of one portion of fruit a day by patients with insulin resistance or diabetes. Remember to choose the right type of fruit and portion size.

What fruit is it best to avoid?

MB O.T.: It is best to avoid fruit with high glycemic index, such as soft, ripe bananas, soft plums, grapes, watermelons. Choose fruit which is sour and hard. Eat the fruit in the first half of the day; it is recommended to add it to sour milk or kefir.

What about milk and dairy products (in the Transformation Programme, we eat milk soups, milk in coffee is allowed, one glass of kefir or sour milk per day is also recommended)?

MB O.T.: Only 30% of the adult population is able to digest milk. The rest ceases to produce the enzyme necessary to process milk sugar. If the patient has the correct lactose tolerance, there are no contraindications to eating dairy products. One should remember about the difference between milk, cream, butter and fermented dairy, which includes curdled milk or kefir. Fermented products contain little lactose and galactose, while milk is rich in these sugars. Kefir and curdled milk are a perfect addition to fruit portions, lowering the glycemic index of a meal.

From the diabetologist’s point of view, what is your opinion about plant milk substitutes?

MB O.T.: Vegetable milk substitutes are healthy also for patients suffering from diabetes. Allergy to cow’s milk proteins or lactose intolerance, very popular in modern society, require the elimination of not only sweet milk, but also other dairy products. It should be remembered that cow’s milk is an excellent source of vitamin D and iodine – essential for maintaining healthy bones and producing thyroid hormones. In the case of a shortage of these vitamins and minerals, one should remember about their supplementation.

What elements of the Transformation Programme are particularly important and beneficial for diabetics?

MB O.T.: The Transformation Programme is a collection of nutritional recommendations regarding adequate hydration and the correct selection of nutrients, both in terms of quantity and quality. Conscious buying is very important – reading labels, avoiding processed products. What is extremely important for my patients, is: their positive motivation and attitude to changing their current, bad habits, and easy to apply recommendations for a healthy lifestyle.

In the case of healthy people, I recommend drinking water with honey before bedtime, and also as a remedy for headache. This advice does not apply to diabetics. Is that right?

MB O.T.: Unfortunately, honey, despite its healing properties, is counterindicated in diabetes. It is a simple sugar, quickly absorbed in the gastrointestinal tract, causing a rapid increase in glycaemia, and is not recommended for patients suffering from diabetes. The only exception is the treatment of hypoglycaemia, a sudden drop in blood sugar.

Would you recommend the Transformation Program meto your patients?

MB O.T.: The Transformation Programme is not just another diet that can be recommended to patients. The Transformation Programme is the science of healthy eating, the consumption of rational portions and regular meals. It is a study of healthy nutrition and healthy life style.