Diabetes Self-Management Blog

Tired of carb confusion? Some experts say people with diabetes should eat as few as possible. The ADA says they’re OK, just keep track of them. I wrote two weeks ago that vinegar can help with carbohydrate metabolism. What’s the real story?

My quest to understand carbohydrates and diabetes has taken me into the realm of bariatric surgeries, all kinds of diets, and most recently, vinegar. I think I’m finally starting to understand what’s happening with carbs, and I hope you can use some of these ideas.

Carbohydrates are sugars, starches, and fiber. For most people, they are the main source of energy, because our cells use simple sugars as fuel. Starches and complex sugars have to be broken down into simple sugar before they can be used for fuel.

In the old days, people had to grab carbs wherever they could. Roots and stems and leaves, mangy fruits with thick skins, things like that. Lots of fiber, which doesn’t break down into sugar. We had to chew them up for a long time just to be able to swallow them. Then our stomachs and intestines had to work on them for hours to break them down to the point where we could absorb and use them. By the time this happened, the food would have reached the far end of the small intestine or “distal ileum.”

Our intestines evolved to handle the very complicated and fibery carbs that our ancestors ate. So most of the glands that tell the pancreas to produce insulin and that tell the liver and muscles to cooperate with the insulin, are in the distal ileum, waiting for carbs to show up and stimulate them.

Unfortunately, almost none of the carbs we eat now ever reach the distal ileum. Most modern carbs come from grains and sugars. Grains are grass seeds, like wheat, rice, and corn. The seeds usually have been ground up into flour, fine powders that are quickly absorbed.

In many cases, we skip the starches entirely and go right to the sugars, which may get into our system even faster. Even when we eat starchy vegetables like potatoes or squash, or whole fruits, we usually don’t eat the skins, which aren’t as tough as skins used to be anyway.

So those important glands in the distal ileum don’t get turned on, because the starches and sugars are all absorbed before they get there. The result, for genetically sensitive people, is impaired insulin production and increased insulin resistance. That, I suspect, is why bariatric surgeries have been effective for diabetes. It has nothing to do with weight loss. It’s rearranging the digestive tract so that carbs do make it to the distal ileum.

One of the hormones that distal ileum glands produce is Glucagon-like peptide 1 (GLP-1.) Writing in the journal Clinical Diabetes, doctors Kathleen Dungan and John Buse write that GLP-1 “stimulates glucose-dependent insulin release from the pancreatic islets. In addition, it is thought to… slow gastric emptying… stimulate beta-cell proliferation… and improve satiety.” (Meaning you will feel full faster.)

GLP-1 is too fast acting to be a good drug. But drugs like exenatide (brand name Byetta) mimic GLP-1 but last longer. Such drugs can help replace GLP-1, but not as well as the original. And what about the distal ileum’s other chemicals? Are we going to replace them with drugs, too?

So if you’re not having surgery — and I’d rather you didn’t — what kind of carbs will make it to the distal ileum? Will whole grains do it, or sprouted grains, or anything at all? I’m gong to report on that in a couple of weeks, and I’d like to hear first about your relationship with carbs.

But vinegar seems to have many of the same benefits as GLP-1, in stimulating insulin production, slowing carb absorption, and decreasing insulin resistance in the liver. I think vinegar might signal the distal ileum to produce hormones like GLP-1. So it may be, as I wrote two weeks ago, that vinegar is one way to get around the carb puzzle. It’s not a cure, and it doesn’t seem to work for everyone, but for many, it’s may be a very valuable way to deal with carbs.

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