The Relationship Between Fruit and Prediabetes

In the war against carbs, fruit has taken a hit. Unfortunately, this wonderful food group has been lumped into the same boat as added sugars, refined carbohydrates, and artificial sugars. But what’s the real deal with fruit and prediabetes?

I could go on and on about the benefits of fruits. They’re rich in antioxidants, they provide anti-inflammatory nutrients, they’ve been linked to a reduced risk of disease/cancer, and most importantly, they taste delicious! I don’t want to imagine a world where my fruit intake is limited. You don’t have to live that way either.

My #1 goal for Four Summers Life is to help as many people decrease their risk of Type 2 diabetes as possible. As a dietitian, using an approach that is evidence-based is non-negotiable. So, it pleases me that science continually indicates that an increase in whole fruit consumption has been shown to decrease one’s risk of Type 2 diabetes. This relationship has especially been seen in data that tracked the consumption of a range of fruits like grapes, apples, blueberries, bananas, and grapefruit. For example, one study showed up to a 33% reduced risk of Type 2 diabetes for every three servings per week of blueberries!

Fruits are not just sugar, so we shouldn’t oversimplify them. Fruits are also composed of fiber, water, vitamins, minerals, and phytochemicals. Collectively, these components of fruit have been shown to decrease your risk of diabetes, not increase it. Fruit has also been shown to be protective against other conditions such as heart disease, strokes, weight gain, cognitive decline, hypertension, high cholesterol, and much more.

What about fruit juice?

Fruit juice is a very different product than whole fruit. In fruit juice, many of those beneficial nutrients I mentioned above have been stripped away. Without the magic of fiber and all the nutrients that are bound to that fiber, fruit juice can lead to less optimal blood sugar levels almost instantly.  

Though contrary to popular belief, fruits and high blood sugars do not technically have a causal relationship.  It’s probably not the whole fruits that are causing a blood sugar spike, but rather the body’s insulin resistance. Insulin resistance is a condition where the body’s cells don’t respond normally to insulin. For those with this condition, glucose can’t enter the cells as easily as it should, so it builds up in the blood. Would you like to optimize your ability to metabolize and benefit from healthy carbs like fruit? The Four Summers program works to reduce your insulin resistance by increasing your plant intake, reducing your stress, and increasing your physical activity. Contact me now on the contact page to sign up! 

I’ll meet you where you’re at to achieve your goals. For example, let’s say you’re currently experiencing blood sugar spikes when eating fruit. We will first work to optimize your insulin resistance. In the meantime, you may want to choose mostly low sugar fruits and pair them with healthy fats and proteins to prevent blood sugar spikes. Examples of low sugar fruits include any variety of berries (raspberries, blackberries, blueberries) and melons (honeydew melon, cantaloupe, watermelon). Here are some tips on plate planning. 

References

Du H, Li L, Bennett D, Guo Y, Turnbull I, Yang L, et al. (2017) Fresh fruit consumption in relation to incident diabetes and diabetic vascular complications: A 7-y prospective study of 0.5 million Chinese adults. PLoS Med 14(4): e1002279.

Christensen, A.S., Viggers, L., Hasselström, K. et al. (2013) Effect of fruit restriction on glycemic control in patients with type 2 diabetes – a randomized trial. Nutr J 12, 29.

Alonso, A., De la Fuente, C., Martín-Arnau, A., De Irala, J., Alfredo Martínez, J., & Martínez-González, M. (2004). Fruit and vegetable consumption is inversely associated with blood pressure in a Mediterranean population with a high vegetable-fat intake: The Seguimiento Universidad de Navarra (SUN) Study. British Journal of Nutrition, 92(2), 311-319. doi:10.1079/BJN20041196

Borgi, L., Muraki, I., Satija, A., Willett, W. C., Rimm, E. B., & Forman, J. P. (2016). Fruit and Vegetable Consumption and the Incidence of Hypertension in Three Prospective Cohort Studies. Hypertension, 67(2), 288–293. 

Zhao, Cai-Ning; Meng, Xiao; Li, Ya; Li, Sha; Liu, Qing; Tang, Guo-Yi; Li, Hua-Bin. 2017. "Fruits for Prevention and Treatment of Cardiovascular Diseases" Nutrients 9, no. 6: 598

Zheng J, Sharp S J, Imamura F, Chowdhury R, Gundersen T E, Steur M et al. (2020) Association of plasma biomarkers of fruit and vegetable intake with incident type 2 diabetes: EPIC-InterAct case-cohort study in eight European countries BMJ; 370 :m2194 doi:10.1136/bmj.m2194

Why not just do the keto diet instead?

So you’ve just been diagnosed with prediabetes. A quick web search will likely suggest the keto diet as a surefire way to manage your blood sugar spikes and prevent yourself from developing type 2 diabetes.

High fat + moderate protein + low carb = healthy right?

Many people DO see improvements in their blood sugar levels after adopting the keto diet. It appears to be the magic bullet to addressing this issue. No carbs, no spike. But are there any risks involved?

After adopting keto, many may experience blood sugar spikes through the roof from eating just a small portion of carbohydrates, which reinforces the idea that carbs are evil and should be avoided.

Pssst… A message to the inner carb lover in you: You haven’t discovered how evil carbs are. That’s because carbs are not evil. In fact, carbohydrates from whole, plant-based foods provide countless benefits, which I’ll explain later.

Insulin Resistance

The keto diet may deliver on some short-term goals for blood sugar management, but it can also increase your intolerance to carbohydrates by creating a resistance to insulin. What creates insulin resistance? A diet high in saturated fat can lead to excess fat droplets in our muscle cells. This condition can cause your cells to become resistant to insulin and lead to an inability for your cells to use carbs as fuel. Therefore, leading to a higher circulation of glucose in the bloodstream.

By avoiding carbs altogether, we’re simply masking the root of the problem.By eating a large amount of saturated fat, you may have created a brand-new problem.

What are the other risks of low carb/keto diets?

Some possible side effects of ketosis include: insulin resistance, high cholesterol, hyperlipidemia, increased risk of heart disease, constipation, acid reflux, osteopenia/osteoporosis, fatty liver and increased risk of GI disorders. Are these potential dangers worth the short-term benefits?

What are the disadvantages of carbohydrate restrictions?

The keto diet restricts many fruits, veggies, legumes and whole grains. That includes bananas, strawberries, papaya, quinoa, lentils, chickpeas, oats, carrots, potatoes, apples, cantaloupe, watermelon, etc. Not only would you miss out on so many delicious foods, you’d be missing out on their health benefits too. Whole plant-based foods have been shown to decrease your insulin resistance and improve your gut microbiome. A healthy gut microbiome is associated with decreased risk of type 2 diabetes and a host of other chronic diseases including inflammatory bowel disease, asthma, heart disease and rheumatoid arthritis. These carbohydrate foods also provide countless micronutrients and phytochemicals. Why would you want to restrict these foods and miss out on all their benefits?

The Four Summers Life program promotes a diet pattern consisting of all three macronutrients (carbs, proteins and fat). By not excluding any one macronutrient, you can reap all the benefits of these nutrients while developing a lifestyle that you can sustain for the long term. Keto and other low carb diets can help insulin resistant people maintain blood glucose control by instructing them to avoid carbohydrates. Four Summers addresses your insulin resistance at the root.

References

Zhao et al. (2018). Gut Bacteria Selectively Promoted by Dietary Fibers Alleviate Type 2 Diabetes. Science, volume 359, Issue 6380, pp. 1151-1156

Rakoff-Nahoum, S., Foster, K & Comstock, L. (2016). The evolution of cooperation within the gut microbiota. Nature, volume 533, pp 255-259

Wibisono C et al. (2015) Ten-year single-center experience of the ketogenic diet: factors influencing efficacy, tolerability, and compliance. J Pediatr. Volume 166, Issue 4

Brinkworth GD, Noakes M, Clifton PM, Bird AR. (2009). Comparative effects of very low-carbohydrate, high-fat and high-carbohydrate, low-fat weight-loss diets on bowel habit and faecal short-chain fatty acids and bacterial populations. British Journal of Nutrition, volume 101, Issue 10, pp 1493-1502

Shanshan, L et al. (2014). Low carbohydrate diet from plant or animal sources and mortality among myocardial infarction survivors. Journal of the American Heart Association, volume 3, Issue 5

Heikura, I. et al. (2020). A short-term ketogenic diet impairs markers of bone health in response to exercise. Frontiers in Endocrinology, Volume 10

Durack, J. and Lynch, S. (2019). The gut microbiome: relationships with disease and opportunities for therapy. Journal of Experimental Medicine, Volume 216, Issue 1, pp 20-40

Zupec-Kania, B, Zupanc, M. (2008). Long-term management of the ketogenic diet: seizure monitoring, nutrition, and supplementation. Epilepsia, volume 49,  Issue S8, pp 23-26