糖尿病康复的关键：献给第15届联糖日及全球糖友们
今天是联合国糖尿病日，谨以此文献给第15届联糖日及全球糖友们！
2021年第15主题：人人享有糖尿病健康管理
糖尿病康复关键在于科学的健康管理，重塑健康的生活方式，而科学的饮食治疗一贯是糖尿病康复治疗的基石和世界专业共识。
纵观西方糖尿病食疗历史，从高糖饮食一个极端，走到美国艾伦医生创立的“饥饿疗法”另一个极端，一味地极度控制和减少碳水化合物摄入，最终必然导致代谢恶化之不良后果。尽管饥饿疗法因为胰岛素的问世而远去了百年有余，然而，现实社会仍有其魅影闪现，诸如吃糠咽菜的所谓强化血糖控制，还有隐藏更深、更具有诱惑性的极度高纤维素和极低碳水化合物的主食食品，这种主食中碳水化合物（非纤维素）含量不到10%，而纤维素含量却高达50%以上，试问这还算得上主食吗？还能当作主食去吃吗？！本人在今年世界中医药学会联合会糖尿病专业委员会年会上，曾发布过《小心低血糖指数陷阱》一文，旨在提醒专业人士和食品专业研发者注意。
其实，糖尿病患者比普通人更缺糖（碳水化合物），只是糖的利用和转化（代谢）出了问题，从这一机制出发，糖尿病饮食（特别是主食）设计，碳水化合物（除外纤维素）含量绝对不能低于50%，而且要选择优质的碳水化合物，将血糖指数数值设计在低血糖指数范围内的高值，糖负荷设计在中度，适当增加膳食纤维素（每日30克以内、可溶性纤维素占30%为宜）；还要补充优质蛋白和适量植物脂肪，三大营养素供热比值要合理，再就是要丰富多种维生素、矿物质和微量元素的补充。这就是本人早在2000年提出并发表的“糖尿病饮食治疗控制”思想（《糖尿病中医研究进展》第111页，《质控——糖尿病食疗的关键性转变》上海科学教育出版社）。
再次申明，纤维素是个好东西，但他是个双刃剑，过量使用纤维素，或夸大纤维素的作用，都是错误的。正如郑建仙教授指出的：“（纤维素）必然会影响到机体对某些矿物元素的吸收，而这些影响并不都是积极的”（《功能性食品学》第二版，23页，中国轻工业出版社），过量使用纤维素肯定会引发矿物质及微量元素的吸收障碍，消化负担增加，机体代谢日益恶化，最终走向健康的反面。抗性淀粉过分过量使用，道理也然。作为科学膳食设计，一定要坚持现代营养学原则，不能为了控制血糖而从一个极端走向另一个极端，不能仅仅盯住暂时的血糖控制而牺牲营养、代谢和健康。
再须指出，糖尿病不仅仅是糖代谢出问题了，而是包含脂肪、蛋白、多种营养素、激素等综合代谢紊乱，治疗糖尿病只盯着血糖、控制糖代谢是片面的；2型糖尿病本质是代谢病，人体代谢脏器就是肝脏，不是胰腺；肝脏是调控和影响血糖的核心，所以药物和饮食管理的目标脏器必然是肝脏；肝脏代谢损伤的修复与恢复，才是治本之策；全面恢复糖、脂、蛋白等代谢指标，方是万全之计。
在2019年ADA（美国糖尿病协会）年会上，主讲进餐模式对人体代谢影响的Courtney Peterson、Rona Antoni、Alpana Shukla三位专家，共同申明了“什么时间吃，按什么顺序吃，（对人体代谢与健康而言）固然重要，但是，吃什么，是影响力更大的一个核心因素”，本人创立并倡导的“糖尿病饮食质量控制”，以中医药食同源物质对膳食进行特殊营养强化，其意图是紧紧抓住糖尿病饮食“吃什么”的这一“核心因素”。
2019年ADA三位专家的研究显示，人们吃饭的模式对代谢和健康影响非常显著。什么时间吃饭、三餐量如何分配、按什么顺序吃（菜、肉、饭进餐顺序）、吃什么（饮食的内容），对人体的代谢与健康有巨大影响，如果想获得最好的血糖、体重等代谢控制以及胰岛素分泌模式，甚至是细胞寿命的延长，ADA专家建议最好的吃饭时间是：一天三餐之间要有一次12小时的间隔（晚餐在18点之前吃完，早餐在6点之后吃），三餐分配为早餐50%、30%、20%，早餐吃得像个“皇上”，晚饭吃得像个“乞丐”，最忌吃夜宵，不吃早餐也很有害；菜、肉、饭（主食）的进餐顺序，既不是菜肉饭混着吃，也不是先吃饭、后吃菜和肉，而最佳顺序是最后吃主食。
但愿人人享有糖尿病健康管理，祝广大糖友早日康复！
世界中医药学会联合会糖尿病专业委员会 理事
北京中医药学会糖尿病专业委员会 委员
北京中医药大学附属中西医结合医院原首席中医糖尿病代谢病专家 杨波
2021年11月14日
Today is World Diabetes Day (WDD). I would like to dedicate this article to the 15th WDD) and global sugar friends!
Topic 15 in 2021: DM health management for all.
The key to DM rehabilitation lies in scientific health management and reshaping a healthy lifestyle. Scientific diet treatment has always been the cornerstone of DM rehabilitation treatment and the world professional consensus.
Throughout the history of DM diet in the west, from one extreme of high sugar diet to the other extreme of "hunger therapy" founded by Dr. Allen in the United States, blindly controlling and reducing carbohydrate intake will inevitably lead to the adverse consequences of metabolic deterioration. Although hunger therapy has gone away for more than a hundred years because of the advent of insulin, there are still its ghosts in the real society, such as the so-called enhanced blood glucose control of eating bran pharyngeal vegetables, and the deeper and more attractive staple food with extremely high cellulose and very low carbohydrate, which contains less than 10% carbohydrate (non cellulose), The cellulose content is as high as more than 50%. Can this be regarded as a staple food? Can you still eat it as a staple food?! At the annual meeting of DM Professional Committee of the World Federation of traditional Chinese medicine societies this year, I published the article "Beware of hypoglycemic index trap", which aims to remind professionals and food professional developers.
In fact, DM patients are more short of sugar (carbohydrates) than ordinary people, but there is a problem in the utilization and transformation (metabolism) of sugar. Starting from this mechanism, in the design of DM diet (especially staple food), the content of carbohydrates (except cellulose) must not be less than 50%, and high-quality carbohydrates should be selected, and the value of blood glucose index should be designed at a high value within the range of low blood glucose index, The sugar load is designed to be moderate, and dietary cellulose is appropriately increased (less than 30g per day and soluble cellulose accounts for 30%); We should also supplement high-quality protein and an appropriate amount of plant fat, the heating ratio of the three nutrients should be reasonable, and then we should enrich the supplement of a variety of vitamins, minerals and trace elements. This is the idea of "DM diet treatment and control" put forward and published by me as early as 2000 (Progress of DM traditional Chinese medicine research, page 111, quality control - key transformation of DM diet therapy, Shanghai Science and Education Press).
Again, cellulose is a good thing, but it is a double-edged sword. It is wrong to overuse cellulose or exaggerate the role of cellulose. As Professor Zheng Jianxian pointed out: "(cellulose) will inevitably affect the body's absorption of some mineral elements, and these effects are not all positive" (functional food science, Second Edition, page 23, China Light Industry Press). Excessive use of cellulose will certainly cause obstacles to the absorption of minerals and trace elements, increase the burden of digestion and worsen the body's metabolism, Eventually to the opposite of health. It is also true that resistant starch is overused. As a scientific dietary design, we must adhere to the principles of modern nutrition, not from one extreme to another in order to control blood glucose, and not only focus on temporary blood glucose control at the expense of nutrition, metabolism and health.
It should also be pointed out that DM is not only a problem of glucose metabolism, but also contains comprehensive metabolic disorders such as fat, protein, multiple nutrients and hormones. It is one-sided to only focus on blood glucose and control glucose metabolism in the treatment of DM; T2DM is a metabolic disease in essence. The metabolic organ of human body is the liver, not the pancreas; Liver is the core of regulating and affecting blood glucose, so the target organ of drug and diet management must be liver; Repair and recovery of liver metabolic injury is the fundamental strategy; A comprehensive recovery of glucose, lipid, protein and other metabolic indicators is a panacea.
At the 2019 ADA annual meeting, three experts, Courtney Peterson, Rona Antoni and Alpana Shukla, who mainly talked about the impact of eating mode on human metabolism, jointly affirmed that "eating at what time and in what order (for human metabolism and health) is important, but what to eat is a core factor with greater influence", which I founded and advocated "DM diet quality control" is to strengthen the diet with homologous substances of traditional Chinese medicine and food. Its intention is to firmly grasp the "core factor" of "what to eat" in DM diet.
The research of three ADA experts in 2019 shows that people's eating pattern has a significant impact on metabolism and health. When to eat, how to distribute the amount of three meals, in what order (food, meat and meal order), and what to eat (diet content) , it has a great impact on human metabolism and health. If you want to obtain the best metabolic control such as blood glucose and weight, insulin secretion mode, and even prolong cell life, ADA experts suggest that the best eating time is: there should be a 12 hour interval between three meals a day (dinner should be eaten before 18 o'clock and breakfast after 6 o'clock) , the three meals are divided into 50%, 30% and 20% of breakfast. Breakfast is like a "emperor" and dinner is like a "beggar". Supper is the most taboo, and it is also harmful not to eat breakfast. The eating sequence of vegetables, meat and rice (staple food) is neither mixed eating of vegetables, meat and rice, nor eating first and then vegetables and meat, and the best sequence is to eat the staple food last.
I hope everyone can enjoy DM health management. I wish sugar friends a speedy recovery!
Director of DM Professional Committee of World Federation of traditional Chinese Medicine Societies
Member of DM Professional Committee of Beijing Society of traditional Chinese Medicine
Yang Bo, former chief TCM metabolic disease expert of integrated traditional Chinese and Western Medicine Hospital Affiliated to Beijing University of traditional Chinese Medicine.
November 14, 2021 In Beijing.
