The Bigger Picture of Blood Sugar

When a patient is diagnosed with prediabetes or diabetes, the education often becomes all about sugar and carbohydrates. And while those things absolutely matter, I sometimes wonder if we're focusing on the wrong things. Welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Sloan. I'm a physician assistant and registered dietitian, and we're continuing our special four-part avocados in practice miniseries. This is brought to you by Avocados Love One Today. In today's episode, we're talking about what may be getting overlooked in the Diabetes Nutrition Conversation. Joining me again is Patricia Bannon, registered dietitian and nutrition expert to discuss glycemic load, diet quality, and the characteristics of foods that may support healthy blood sugar management and diabetes risk reduction. Patricia, this is such an important conversation. I'm so excited to discuss it with you today. It's great to be back, calling. So when someone is newly diagnosed with prediabetes or type 2 diabetes, because the education is very similar there, what are some of the first things that tend to come up in terms of nutrition advice that you're seeing amongst your colleagues?

Yeah, so the conversation often starts with, you know, limit sugar and carbohydrates. They're told to cut back on sweets, refined grains, carbs more broadly, but it gets back to what we were talking about in our earlier episode. Then what do I eat? You know, they may also be told to lose weight. And, you know, weight loss could be beneficial for some people in terms of blood sugar management, but we also know leading with the scale is never appropriate or helpful, right? So I think to broaden the conversation, help our patients by helping them include fiber, helping them include healthy fats, protein, as well as a holistic look at movement and sleep and also how those foods are combined. So the goal isn't to eliminate carbs, but really to choose healthier carbs that have more fiber in them is going to help steady that blood sugar response. And avocados can fit here into this approach because they provide fiber and healthy unsaturated fats and they're naturally sugar-free.

Yes, I love that. Now, we've previously talked about food swaps and why it's really important to educate our patients on what they can substitute it with. But I would really like to get practical here and help us understand and give us some ideas of how we can shift that conversation towards what they can add that will actually support metabolic health.

Yeah, so I think the first thing is exactly that the reframing, right? Reframing the conversation to what they can add. It's gonna make it positive and actionable and give them a sense of autonomy. So encouraging vegetables, beans, whole grains, nuts, seeds, lean proteins, and healthy fats such as avocado. Pairing foods is also really important when we're looking at carbohydrate-containing foods. So pairing them with fiber, protein, and healthy fats can help slow digestion and support a more gradual rise in blood sugar. So what that pairing might look like is instead of just telling your patient to avoid toast, it might be pairing whole grain toast with an avocado and an egg. It might be pairing rice and beans with vegetables and avocado.

Food pairing is one of my favorite strategies. I love it. I think it's so effective. And it helps patients keep some of their favorite foods on the plate, like we've talked about previously, about keeping that satisfaction and satiety. I love that avocados are a great food to pair with. Now, Patricia, we hear a lot about glycemic index and glycemic load when we're talking about diabetes or like a diabetic diet, like what we learned way back in school. But I would love if you can explain to us the difference between those two and if you think that we might be able to incorporate that in overall dietary patterns.

Yeah, so the glycemic index, it ranks carbohydrate-containing foods on how quickly they raise blood sugar compared to a reference food, which is generally glucose. Now, the glycemic load reflects both the quality and the quantity of the carbohydrate on their potential impact on blood sugar. So a nice example of this is watermelon. Okay, so watermelon is a relatively high glycemic index, but it has a low glycemic load. And that's because per serving it doesn't have that many carbohydrates. It's mostly water. So it's a great guide, but it is just a guide. There's many other things that can influence this, such as portion size, food combination, and cooking methods also matter. And there's an interesting study on avocados and glycemic load. This was a study supported by the Avocado Nutrition Center. And it was a secondary analysis of the HAT study, the habitual diet and avocado trial. This was one we talked about in our weight management episode. And it's the most extensive avocado clinical trial of its kind. And in this secondary analysis, it included 961 adults with elevated waste circumference. And the participants who added one avocado a day for six months reduced the glycemic load of their overall diet by nearly 14 points compared to the control group. And what I love about this is they weren't instructed to do anything else. They weren't instructed to reduce calories or carbohydrates. So a lot of the work I do is on helping people create microhabits, you know, these small shifts with big results. So what I like here is this is a great example of that. Just by adding an avocado a day is an example of a nutrient-dense food that may help shift the overall dietary pattern.

Okay, Patricia, I'm a fan of habit stacking too. I love that. And I actually never thought about bringing avocados into, you know, a meal or something you already enjoy because you're already consuming, you know, that food that you like. So I love making food choices and healthier options easier. And that's one really, really great way. Now, I want to understand a little bit about research and what it tells us about the relationship between overall diet quality and diabetes risk, because I think this is important and it's not talked about enough.

Absolutely. So the first thing is that diabetes risk is influenced by many factors, including genetics, body composition, physical activity, sleep, and then, of course, overall diet quality. So when it comes to overall diet quality, it's really those patterns that matter. You know, the patterns of having minimally processed foods, fiber, healthy fats, vegetables, lean proteins. And avocados is one of my favorite foods to recommend for people with prediabetes because it can help improve overall diet quality while providing fiber and healthy fats. So there's two studies that really bring this to life. And these were studies that were supported by the Avocado Nutrition Center. And there are two observational studies in Hispanic and Latino populations that provide additional, although not causal, evidence. So one analysis of more than 14,000 Hispanic adults with type 2 diabetes linked avocado intake with a lower average blood sugar and better insulin response. So, in terms of diabetes management, that's really interesting. And then the other study of more than 6,000 Hispanic adults associated regular avocado intake over a six-year period with a 28% lower diabetes risk and a 31% lower risk among those with prediabetes. And of course, these can't be generalized to a larger, more diverse population, but it's really adding to the growing body of evidence in terms of blood sugar control, diabetes, and how avocados can really help benefit people.

Okay, Patricia, you know I love the science, but I love even more is making that science practical for our patients. So we've talked about this in previous episodes, but I would like to hear some ways that avocados can actually be brought into meals that support blood sugar management.

Yes. So pairing it is really key. Pairing the avocado with other sources of fiber foods and protein. I use this example a lot, right? That whole grain toast with avocado and an egg. And one thing I haven't mentioned yet is avocados can work great in frozen desserts, such as frozen yogurt bark or ice cream. You know, it's rich, it has a creamy texture. It's really a satisfying dessert option. And there's actually in the show notes, there's gonna be a link to a no-sugar added avocado banana dairy-free ice cream.

I love this ice cream, by the way. I'm like a smoothie fan. So when I saw this, I loved it. So definitely grab the link in the show notes because this is gonna be so helpful for some of your patients who maybe have a sweet tooth. And again, like we've talked about throughout this entire series, we don't just want to tell them what they have to avoid and restrict, really bringing in foods that are nutritious, beneficial, but also taste good too. So they have that element of pleasure and enjoyment while working on their health. Patricia, this has been an incredible episode. Thank you so much for sharing all of this information and thank you to Avocados Love One Today for sponsoring this series. As I mentioned, all of the research and that delicious recipe will be linked in the show notes. And be sure to come back tomorrow as we are wrapping up our avocados in practice mini series with one of my favorite topics feeding kids and families, from first foods to family meals. I hope you'll join us.