Chapter
10:
Diet Guidelines: Treatment for All Diabetics /
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Some, such as sorbitol and fructose,
raise blood sugar more slowly than glucose but still
too rapidly to prevent a postprandial blood sugar
rise in people with diabetes.
Other "diet"
foods contain either sugars that are alternates to
sucrose, large amounts of rapid-acting carbohydrate,
or both. Many of these foods are virtually 100 percent
rapid-acting carbohydrate (e.g., sugar-free cookies),
so that even if they were to contain none of the above
added sugars, consumption of a small quantity would
easily cause rapid blood sugar elevation.
There are exceptions—most
diet sodas, sugar-free Jell-O brand gelatin desserts,
and No-Cal brand syrups (available in the New York
metropolitan area). All of these are made without
sugar of any kind. These you need not restrict. See
the "So What's Left to Eat?" section later
in this chapter.
Candies, Including "Sugar-Free" Brands
A tiny "sugar-free" hard candy containing
only 2 1/2 grams of sorbitol can raise blood sugar
almost 13 mg/dl. Ten of these can raise blood sugar
125 mg/dl. Are they worth it?
Honey and Fructose
In recent years a number of "authorities"
have claimed that fructose (which is now sold as a
powdered sweetener) and honey are useful to diabetics
because they are "natural sugars." Well,
glucose is the most natural of the sugars, since it
is present in all plants and all but one known species
of animal. These substances will raise blood sugar
far more rapidly than either phase II insulin release,
injected insulin, or oral hypoglycemic agents can
bring it down. Just eat a few grams of honey or fructose
and check your blood sugar every 15 minutes. You will
readily prove that "authorities" can be
wrong.
Desserts and Pastries
With the exception of sugar-free Jell-O and similar
gelatin products marked "carbohydrate—0"
on the nutrition label, virtually every food commonly
used for desserts will raise blood sugar too much
and too fast. This is not only because of added sugar,
but also because flour, milk, and other components
of desserts are very high in rapid-acting carbohydrate.
Bread and Crackers
One average slice of white, rye, or whole wheat bread
contains about 12 grams carbohydrate. The "thin"
or "lite" breads now available in U.S. supermarkets
are usually cut at half the thickness of standard
bread slices and contain half the carbohydrate. So-called
high-protein breads contain only a small percentage
of their calories as protein and are not significantly
reduced in carbohydrate unless they are thinly cut.
Brown bread, raisin bread, and corn bread all contain
as much or more fast-acting carbohydrate as rye, white,
or whole wheat. Some diabetics with gastroparesis
(Chapter 21) can tolerate the inclusion of 1–2 slices
of thin bread or a few crackers as part of their low-carbohydrate
meal limits. Unfortunately, most of us experience
very rapid increases of blood sugar after eating any
product made from any grain (bread, crackers, pastry
shells, et cetera).
Rice and Pasta
Although pasta is made from flour, much pasta is derived
from a different kind of wheat (durum semolina) than
is used in bread. Both pasta and wild rice (which
is actually not a true variety of rice but another
grain entirely) are claimed by some nutrition authorities
to raise blood sugar quite slowly. Just check your
blood sugar levels after eating them and you'll prove
these "authorities" wrong. Alternately,
you might try the Clinistix/Diastix test described
on page 123. Like wild rice and pasta, white and brown
rices also raise blood sugar quite rapidly for most
of us and should be avoided.
Breakfast Cereals
All cold cereals, like snack foods, are virtually
100 percent carbohydrate. Many contain large amounts
of added sugars. Since they are made from grain, small
amounts, even of whole-grain cereals, will cause a
rapid rise in blood sugar.
Cooked cereals generally
contain about 10–25 grams of fast-acting carbohydrate
per half-cup serving. I find that even small servings
make blood sugar control impossible.
Snack Foods
These are the products in cellophane bags that you
find in vending machines and supermarkets. They include
not just cookies and cakes, but pretzels, potato chips,
taco chips, tiny crackers, and popcorn. These foods
are virtually 100 percent carbohydrate and frequently
have added sucrose, glucose (the label may say dextrose),
corn syrup, et cetera.
Milk and Cottage Cheese
Milk contains a considerable amount of the simple
sugar lactose and will rapidly raise blood sugar.
Skim milk actually contains more lactose per ounce
than does whole milk. One or 2 teaspoons of milk in
a cup of coffee will not significantly affect blood
sugar, but 1/4 cup of milk will make a considerable
difference to most of us. (Cream, which you have probably
been avoiding, is okay. One tablespoon has only 0.4
gram of carbohydrate.) The powdered lighteners for
coffee contain relatively rapid-acting sugars and
should be avoided if you use more than a teaspoonful
at a time or drink more than 1 cup of coffee at a
meal. An excellent coffee lightener is Westsoy brand
soybean milk, which is sold in health food stores
throughout the United States. Although several Westsoy
flavors are marketed, only the one marked "unsweetened"
is unsweetened. It contains 4 grams of carbohydrate
in 8 ounces. Soybean milk can be stored in the unopened
container for up to one year without refrigeration.
Once opened, however, it must be refrigerated. One
catch—it curdles in very hot coffee or tea.
Cottage cheese also contains
a considerable amount of lactose because, unlike most
other cheeses, which are okay, it is only partly fermented.
I was unaware of this until several patients showed
me records of substantial blood sugar increases after
consuming a small container of cottage cheese. It
should be avoided except in very small amounts, say
about 2 tablespoons.
Fruits and Fruit Juices
These contain a mixture of simple sugars and more
complex carbohydrates. A few experiments with blood
sugar measurements will show you how rapidly these
foods can raise your levels. Bitter-tasting fruits
such as grapefruit and lemon contain considerable
amounts of simple sugars. They taste bitter because
of the presence of bitter chemicals, not because sugar
is absent. Although deleting fruit from the diet can
be a big sacrifice for many of my patients, they usually
get used to this rapidly, and they appreciate the
effect upon blood sugar control. I haven't eaten fruit
in twenty-five years, and I haven't suffered in any
respect. Some people fear that they will lose important
nutrients by eliminating fruit, but that shouldn't
be a worry. Nutrients found in fruits are also present
in the vegetables you can safely eat.
Vegetables
- Beets. Like most other sweet-tasting
vegetables, beets are loaded with sugar. Sugar
beets are a source of table sugar.
- Carrots. After cooking, carrots
taste sweeter and appear to raise blood sugar
much more rapidly than when raw. This probably
relates to the breakdown of complex carbohydrates
into simpler sugars by heat. Even raw carrots
should be avoided. If, however, you are served
a salad with a few carrot shavings on top for
decoration, don't bother to remove them. The amount
is insignificant, just like a teaspoon of milk.
- Corn. Nearly all of the corn grown
in the United States is used for two main purposes.
One is the production of sweeteners. Most of the
sugar in Pepsi-Cola, for example, comes from corn.
The other purpose is animal feed, e.g., fattening
up hogs, cattle, and chickens. Corn for consumption
by people, as a vegetable or as snack foods, comes
in third. Diabetics should avoid eating corn,
whether popped, cooked, or in chips—even 1 gram
of corn will rapidly raise my blood sugar by about
5 mg/dl.
- Potatoes. For most people, cooked
potatoes raise blood sugar almost as fast as pure
glucose, even though they may not taste sweet.
Giving up potatoes is a big sacrifice for many
people, but it will also make a big difference
in your postprandial blood sugars. Raw potatoes,
if you happen to like them, as well as sweet potatoes
or yams, should also be on your nix list.
- Tomatoes, Tomato Paste, and Tomato
Sauce. Tomatoes are actually a fruit, not a vegetable,
and as with citrus fruits, their tang can conceal
just how sweet they are. The prolonged cooking
necessary for the preparation of tomato sauces
releases a lot of glucose, and you would do well
to avoid them. If you're at someone's home for
dinner and are served meat or fish covered with
tomato sauce, just scrape it off. The small amount
that might remain should not significantly affect
your blood sugar. If you are having them uncooked
in salad, limit yourself to one slice or a single
cherry tomato per cup of salad.
- Commercially Prepared Soups. Believe
it or not, most commercial soups marketed in this
country can be as loaded with added sugar as a
soft drink. The taste of the sugar is frequently
masked by other flavors—spices, herbs, and particularly
salt. Even if there were no added sugar, the prolonged
cooking of vegetables can break down the long
chains of complex, slow-acting carbohydrates and
cellulose, turning them into simple sugars. There
are still some commercial soup possibilities that
fit into our scheme. See the corresponding heading
in the "So What's Left to Eat?" section
on page 132.
- Health Foods. Of the hundreds of
packaged food products that you see on the shelves
of the average health food store, perhaps 1 percent
are low in carbohydrate. Many are sweetened, usually
with honey or other so-called natural sugars.
Since the health food industry shuns artificial
(nonsugar) sweeteners like saccharin or aspartame,
if a food tastes sweet, it probably contains a
sugar. There are a few foods carried by these
stores that are unsweetened and low in carbohydrate.
You'll find some of these listed later in this
chapter.
So What's Left To Eat?
It's a good question,
and the same one I asked myself twenty-five years
ago as I discovered that more and more of the things
I had been eating made blood sugar control impossible.
In the following pages, I'll give you a broad overview
of the kinds of food my patients and I usually eat.
Please remember that with the exception of the no-calorie
beverages and moderate portions of sugar-free Jell-O,
there are no "freebies." Virtually everything
we eat will have some effect upon blood sugar if enough
is consumed. You may discover things I've never heard
of that have a benign effect on your blood sugar.
If so, feel free to include them in your meal plan
(and let me know about them).
Vegetables
Most vegetables, other than those listed in the No-No
section, are acceptable—such as asparagus, avocado,
broccoli, brussels sprouts, cabbage and sauerkraut,
cauliflower, eggplant, onions (in small amounts),
peppers (any color), mushrooms, spinach, string beans,
summer squash, and zucchini. As a rule of thumb, 2/3
cup of cooked vegetable or 1 cup of mixed salad acts
upon blood sugar as if it contains about 6 grams of
carbohydrate. Remember that cooked vegetables tend
to raise blood sugar more rapidly than raw vegetables.
On your self-measurements, note how your favorite
vegetables affect your blood sugar. Raw vegetables
can present digestive problems to people with gastroparesis.
Meat, Fish, Fowl, Seafood, and Eggs
These are usually the major sources of calories in
the meal plans of my patients. The popular press is
currently down on meat and eggs, but my personal observations
and recent research implicate carbohydrates rather
than dietary fat in the heart disease and abnormal
blood lipid profile of diabetes. If you are frightened
of these foods, you can restrict them, but depriving
yourself will be unlikely to buy you anything. Appendix
A details the current controversy and the shaky science
behind the present, faddish high-carbohydrate dietary
recommendations, and lays out my concerns and opinions.
Tofu, and Soybean Substitutes for Bacon, Sausage,
Hamburger, Fish, Chicken, and Steak
About half the calories in these products come from
vegetable fat, and the balance from equal amounts
of protein and slow-acting carbohydrate. They are
easy to cook in a skillet or microwave. Protein and
carbohydrate content should be read from the labels
and counted in your meal plan. Their principal value
is for people who are vegetarian or want to avoid
red meat. Health food stores stock many of these products.
Certain Commercially Prepared and Homemade Soups
Although most commercial and homemade soups contain
large amounts of simple sugars, you can learn how
to buy or prepare low- or zero-carbohydrate soups.
Many but not all packaged bouillon preparations have
no added sugar and only small amounts of carbohydrate.
Check the labels or use the Clinistix/Diastix test
as described on page 123. Plain consommé or broth
in some restaurants may be prepared without sugar.
Again, check with Clinistix/Diastix.
Homemade soups, cooked
without vegetables, can be made very tasty if they
are concentrated. You can achieve this when making
stock by barely covering the meat or chicken with
water while cooking. Do not fill the entire pot with
water, as is the customary procedure. Alternately,
let the stock cook down (reduce) so you get a more
concentrated, flavorful soup. You can also use herbs
and spices, all of which have negligible amounts of
carbohydrates, to enhance flavor. See "Mustard,
Pepper, Salt, Herbs, Spices," below. Clam broth
(not chowder) is usually very low in carbohydrate.
In the United States you can also buy Snow's Clam
Juice (not Clamato), which contains only 2 grams of
carbohydrate in 3 fluid ounces.
Cheese, Butter, and Cream
Most cheeses (other than cottage cheese) contain approximately
equal amounts of protein and fat and small amounts
of carbohydrate. The carbohydrate and the protein
must be figured into the meal plan, as I will explain
in Chapter 11. For people who want to avoid animal
fats, there are some special soybean cheeses. Cheese
is an excellent source of calcium. Every ounce of
cheese contains 1 gram carbohydrate, except cottage
cheese, which contains more.
Butter will not affect
your blood sugar significantly, and shouldn't be a
problem as far as weight is concerned if you're not
consuming a lot of carbohydrate along with it. One
tablespoon of cream has only 0.4 gram carbohydrate—it
would take 8 tablespoons to raise my blood sugar 16
mg/dl.
Yogurt
Although personally I don't enjoy yogurt, many of
my patients feel they cannot survive without it. For
our purposes the plain whole-milk yogurt, without
fruit, is a reasonable food. A full 8-ounce container
of plain, Erivan brand, unflavored whole milk yogurt
contains only 11 grams of carbohydrate and 2 ounces
of protein. You can even throw in some chopped vegetables
and not exceed the 12 grams of carbohydrate limit
we suggest for lunch. Do not use nonfat yogurt. The
carbohydrate goes up to 17 grams per 8-ounce container.
Yogurt can be flavored with cinnamon, with No-Cal
brand syrups mentioned below, with baking flavor extracts,
or with the powder from sugar-free Jell-O brand gelatin
without affecting the carbohydrate content. It can
be sweetened with stevia liquid or powder. Erivan
brand yogurt is available at health food stores throughout
the United States. If you read labels, you may find
other brands, such as Summerfield Farms, equally low
in carbohydrate.
Soy Milk
There are any number of valuable soy products that
can be used in our diet plan, and soy milk is no exception.
It's a fine lightener for coffee and tea, and one
of my patients adds a small amount to diet sodas.
Others drink it as a beverage, either straight or
with added flavoring such as the flavor extracts used
for baking. Personally, I find the taste too bland
to drink without flavoring. When used in small amounts
(up to 1 ounce), soy milk need not be figured into
the meal plan. It will curdle if you put it into very
hot drinks.
As noted in the No-No foods
section, of the many brands of soy milk on the market,
the Westsoy "unsweetened" flavor is the
only unsweetened one I have been able to find. Other
unsweetened brands are available in various parts
of the country.
Soybean Flour
If you or someone in your home is willing to try baking
with soybean flour, you will find a neat solution
to the pastry restriction. One ounce of full-fat soybean
flour (about 1/4 cup) contains only 7.5 grams of slow-acting
carbohydrate. You could make chicken pies, tuna pies,
and even Jell-O or chocolate mousse pies. Just remember
to include the carbohydrate in your meal plan.
Soybean flour usually must
be blended with egg to form a batter suitable for
breads, cakes, and the like. Some recipes using soy
flour appear in Appendix D.
Bran Crackers
Of the dozens of different crackers that I have seen
in health food stores and supermarkets, I have found
only two brands that are truly low in carbohydrate.
- G/G Scandinavian Bran Crispbread,
produced by G. Gundersen Larvik A/S, Larvik, Norway
(distributed in the United States by Cel-Ent,
Inc., Box 1173, Beaufort, SC 29901). Each 9-gram
slice contains only 2 grams of carbohydrate. If
this product is not available locally, you can
order it directly from the importer. Enclose a
check for $39 to receive one case containing thirty
4-ounce packages.
- Bran-a-Crisp, produced by Saetre
A/S, N1411, Kolbotn, Norway (distributed in the
United States by Interbrands, Inc., 3300 N.E.
164th Street, FF3, Ridgefield, WA 98642). Each
8.3-gram cracker contains 3 grams of carbohydrate.
Bran-a-Crisp may be ordered directly from Interbrands,
Inc., by mail if you cannot find it locally. Just
enclose a check in the amount of $36 for a case
of twenty-four 4.4-ounce packages.*
Although some people eat these
without a spread, to me they taste like cardboard.
My preference is to enjoy them with cream cheese or
butter. Bran cracker cereal can be created by crumbling
two or three crackers into a bowl and covering them
with cream or cream diluted with water. Add some Equal
tablets (dissolved in a bit of hot water) or some
liquid stevia sweetener and perhaps a baking flavor
extract (banana flavor, butter flavor, et cetera).
If eaten in excessive
amounts, bran crackers can cause diarrhea. They are
not recommended for people with gastroparesis (delayed
stomach-emptying), since the bran fibers can form
a plug that blocks the outlet of the stomach. The
carbohydrate in these crackers is very slow to raise
blood sugar. They may be purchased at many health
food stores and are great for people who need a substitute
for toast at breakfast.
Note: In the United States,
labelling regulations require that undigestible fiber
be listed as carbohydrate. To determine the amount
of digestible carbohydrate in a product (which will
affect your blood sugar), subtract the dietary fiber
content from the carbohydrate content.
Toasted Nori
When my friend Kanji sent me a beautifully decorated
canister from Japan, I was most impressed and intrigued.
You can imagine my dismay when I removed the cover
and found seaweed. My dismay was only temporary, however.
I reluctantly opened one of the cellophane envelopes
and pulled out a tissue-thin slice. My first nibble
was quite a surprise—it was delicious. When consumed
in small amounts, I found, it had virtually no effect
upon blood sugar. Once addicted, I combed the health
food stores searching for more. Most of the seaweed
I tried tasted like salty paper. Eventually, a patient
explained to me that Kanji's seaweed is a special
kind called toasted nori. It contains small amounts
of additional ingredients that include soybeans, rice,
barley, and red pepper. It is available at most health
food stores, and is a very tasty snack. Five or six
pieces at a time have had no effect upon my blood
sugar. The Clinistix/Diastix test showed no glucose
after chewing. A standard slice usually measures
11/4 x 3 1/2 inches and weighs about 0.3 gram. Since the
product contains about 40 percent carbohydrate, each
strip will have only 0.12 gram carbohydrate. Larger
sheets of toasted nori should be weighed in order
to estimate their carbohydrate content.
Sweeteners: Saccharin, Aspartame, Stevia, and Cyclamate
I carry a package of Equal (aspartame) tablets with
me, particularly when I go out to eat. Cyclamate is
not currently available in the United States, but
may be returning. Aspartame is destroyed by cooking
and is much more costly than saccharin, which has
a bitter aftertaste, but it will work for sweetening
hot coffee or tea. I find that using one Equal tablet
for every saccharin tablet rather than two saccharin
tablets or two Equal tablets eliminates saccharin's
aftertaste and keeps costs down. Equal tablets are
available in most pharmacies and many supermarkets.
Acesulfame-K is a new artificial
sweetener being marketed in tablet form outside the
United States by Hoechst, AG, of Germany. It is not
degraded by cooking. It is added to some "sugar-free"
foods in the United States under the brand name Sunette,
and is combined with glucose in the packaged powder
called The Sweet One, which you should avoid for obvious
reasons. Other noncaloric tablet sweeteners will be
appearing on grocery shelves in the United States
in the future. Stevia, an herbal sweetener, has been
available in health food stores for many years. It
is not degraded by cooking and is packaged in powder
and liquid forms.
No-Cal Brand Syrups
These artificially sweetened liquid flavors are sold
by many supermarkets in the New York metropolitan
area. (They are distributed by H. Fox and Co., Inc.,
Brooklyn, NY 11212.) The available flavors include
strawberry, raspberry, black cherry, chocolate, and
pancake/waffle topping. This product contains no calories,
no carbohydrate, no protein, and no fat. It takes
a bit of imagination to put it to good use. For example,
I sometimes spike my coffee with the chocolate flavor,
or my tea with fruit flavors. I put the pancake/waffle
topping on my eggs in the morning after heating it
in a skillet.
Flavor Extracts
There are numerous flavor extracts often used in baking
that you can use to make your food more exciting.
They usually can be found in small brown bottles in
the baking supply aisles of supermarkets. Read carbohydrate
content from the label. Usually it's zero and therefore
won't affect your blood sugar.
Mustard, Pepper, Salt, Spices, Herbs
Most commercial mustards are made without sugar and
contain essentially no carbohydrate. This can readily
be determined for a given brand by reading the label
or by using the Clinistix/Diastix test. Pepper and
salt have no effect upon blood sugar. Hypertensive
individuals with proven salt sensitivity should, of
course, avoid salt and highly salted foods (see page
318).
Most herbs and spices have
very low carbohydrate content and are used in such
small amounts that the amount of ingested carbohydrate
would be insignificant. Watch out, however, for certain
combinations such as powdered cinnamon with sugar.
Just read the labels.
Low-Carbohydrate Salad
Dressings
Most salad dressings are loaded with sugars and other
carbohydrates. The ideal dressing for someone who
desires normal blood sugars would therefore be oil
and vinegar, perhaps with added spices, mustard, grated
cheese, or even bacon bits. There are now available
some commercial salad dressings with only 1 gram carbohydrate
per 2-tablespoon serving. This is low enough that
such a product can be worked into our meal plans.
Be careful with mayonnaise. Most brands are labeled
"carbohydrate—0 grams," but may contain
up to 0.4 grams per tablespoon. This is not a lot,
but it adds up if you eat large amounts. Some imitation
mayonnaise products have 5 grams of carbohydrate per
2-tablespoon serving.
Nuts
Although all nuts contain carbohydrate (as well as
protein and fat), they usually raise blood sugar slowly
and can therefore be worked into meal plans. As with
most other foods, you will want to look up your favorite
nuts in one of the books listed in Chapter 3 in order
to obtain their carbohydrate content. By way of example,
10 (small, not jumbo) pistachio nuts contain only
1 gram carbohydrate, versus 10 cashew nuts, which
contain 5 grams of carbohydrate. Although a few nuts
may contain little carbohydrate, the catch is in the
word "few." Very few of us can eat only
a few nuts. In fact, I don't have a single patient
who can count out a preplanned number of nuts, eat
them, and then stop. So unless you have unusual will
power, beware. Also beware of peanut butter—another
deceptive addiction. One tablespoon of natural, unsweetened
peanut butter contains only 3 grams of carbohydrate,
but imagine the effect on blood sugar of downing the
contents of a jar.
Sugar-Free Jell-O Gelatin
This is one of the few foods that in reasonable amounts
will have no effect upon blood sugar. It is fine for
snacks and desserts. A 1/2-cup serving contains no
carbohydrate, no fat, and only 1 gram of protein.
Just remember not to eat so much that you feel stuffed
(see "The Chinese Restaurant Effect" in
Chapter 6). You can enhance the taste by pouring a
little heavy cream over your portion. One of my patients
discovered that it becomes even tastier if you whip
it in a blender with cream when it has cooled, just
before it sets. If you add No-Cal chocolate syrup
or chocolate-flavored baking extract and some stevia
before whipping, you will have a delicious chocolate
mousse. Of the many flavors of sugar-free Jell-O that
are available, I like apple, Hawaiian pineapple, and
watermelon. Unfortunately, very few supermarkets seem
to carry the apple flavor, and I wonder if it still
exists.
Sugar-Free Jell-O Puddings
Available in chocolate, vanilla, pistachio, and butterscotch
flavors, these make a nice dessert treat. Unlike Jell-O
gelatin, they contain a small amount of carbohydrate
(about 6 grams per serving), which should be counted
in your meal plan. Instead of mixing the powder with
milk, use water or cream diluted with water.
Chewing Gum
Gum chewing can be a good substitute for snacking.
The carbohydrate content of one stick of chewing gum
varies from about 1 gram in a stick of sugar-free
Trident to about 7 grams per piece for some liquid-filled
chewing gums. The 7-gram gum will rapidly raise my
blood sugar by about 35 mg/dl. The carbohydrate content
of a stick of chewing gum can usually be found on
the package label. "Sugar-free" gums all
contain small amounts of sugar—the primary ingredient
of Trident "sugarless" gum is sorbitol,
a corn-based sugar alcohol. It also includes mannitol
and aspartame.
Frozen Diet Soda Pops
Many supermarkets and toy stores in the United States
sell plastic molds for making your own ice pops. If
these are filled with sugar-free sodas, you can create
a tasty snack that has no effect upon blood sugar.
Do not use the commercially made "sugar-free"
or "diet" ice pops that are displayed in
supermarket freezers. They contain fruit juices and
other sources of carbohydrate.
Very Low Carbohydrate Desserts
Appendix D of this book consists of low carbohydrate
recipes, prepared and tested by chefs. It includes
easy recipes for some low-carbohydrate desserts that
are truly delicious.
Coffee, Tea, Seltzer, Mineral Water, Club Soda,
Diet Sodas
None of these products should have significant effect
upon blood sugar. The coffee and tea may be sweetened
with liquid or powdered stevia, or with tablet sweeteners
such as saccharin, cyclamate, and aspartame (Equal
tablets). Remember to avoid the use of more than 2
teaspoons of cow's milk as a lightener. Try to use
cream (which has much less carbohydrate). Read the
labels of "diet" sodas, as a few brands
contain sugar in the form of fruit juices. Many flavored
mineral waters, bottled "diet" teas, and
seltzers also contain added carbohydrate or sugar,
as do many powdered beverages. Again, read the labels.
Alcohol, in Limited Amounts
Ethyl alcohol (distilled spirits), as we discussed
in Chapter 9, has no direct effect upon blood sugar.
Moderate amounts, however, can have a rapid effect
upon the liver, preventing the conversion of dietary
protein to glucose. If you are following a regimen
that includes insulin or a pancreas-stimulating oral
hypoglycemic agent, you're dependent upon conversion
of protein to glucose in order to maintain blood sugar
at safe levels. The effects of small amounts of alcohol
(i.e., 1 1/2 ounces of spirits for a typical adult)
are usually negligible. Most "light" beers
contain only about 3 grams of carbohydrate per can
or bottle. (See Chapter 9.)
Increase Your Awareness
of Food Contents
Read Labels
Virtually all packaged foods bear labels that reveal
something about the contents. The FDA now requires
that labels of packaged foods list the amount of carbohydrate,
protein, fat, and fiber in a serving. Be sure, however,
to note the size of the "serving." Sometimes
the serving size is so small that you wouldn't want
to be bothered eating it.
Beware of labels that say
"lite," "light," "sugar-free,"
"dietetic," "diet," "reduced-calorie,"
"low-calorie," et cetera. "Fat-free"
desserts may be the most dangerous of all. Even if
you're losing weight, carbohydrate intake will impede
your efforts much more than fat (see Chapter 9). These
foods frequently but not always contain more carbohydrate
than the foods they replace. The only way you can
determine the carbohydrate content is to read the
amount stated on the label. But even this can be deceptive.
For example, one popular brand of "sugar-free"
strawberry preserves has a label that states "carbohydrate—0."
Yet anyone can see the strawberries in the jar, and
common sense would tell you strawberries contain carbohydrate.
So deceptive labeling occurs, and, in my experience,
is fairly prevalent in the "diet" food industry.
Use Food Value Manuals
In Chapter 3 a number of books are listed that show
the carbohydrate contents of various foods. These
manuals are recommended but not essential tools for
creating your meal plan. The guidelines and advice
set forth in Chapters 9–11 of this book, plus perhaps
the recipes in Appendix D, are all you really need
to get started.
If you want the potential
for considerable variety in your meals, get all the
books listed in Chapter 3. Food Values of Portions
Commonly Used has been the dietitian's bible for
over fifty years. It is updated every few years. Be
sure to use the index at the back to locate the foods
of interest. Note that on every page in the main section,
carbohydrate and fat content are listed in the same
column. The carbohydrate content of food always appears
below the fat content. Do not get the two confused.
Also, be sure to note the portion size in all these
books. Another book on the list, Kosher Calories,
is not just for people whose diets are restricted
to kosher foods. Over 10,000 common brand-name foods
available in the United States are listed.
Vitamin and Mineral Supplements
It is common practice
to prescribe supplementary vitamins and minerals for
diabetics. This is primarily because most diabetics
have chronically high blood sugars and therefore urinate
a lot. Excessive urination causes a loss of water-soluble
vitamins and minerals. If you can keep your blood
sugars low enough to avoid spilling glucose into the
urine (you can test it with Clinistix/Diastix), and
if you eat a variety of vegetables, and red meat once
or twice a week, you should not require supplements.
Note, however, that major dietary sources of B-complex
vitamins include breads and grains. If you're following
a low-carbohydrate diet and exclude these from your
meal plan, you should eat some bran crackers, bean
sprouts, spinach, broccoli, brussels sprouts, or cauliflower
each day. If you do not like vegetables or bran crackers,
you might take a B-complex capsule or a multivitamin/mineral
capsule each day. See pages 153–154 for a discussion
of calcium supplementation for certain people who
follow high-fiber or high-protein diets.
Supplemental vitamins and
minerals should not ordinarily be used in excess of
the FDA's recommended daily requirements. Large doses
can inhibit the body's synthesis of some vitamins
and intestinal absorption of certain minerals. Large
doses are also potentially toxic. Doses of vitamin
C in excess of 500 mg daily appear in the blood and
may interfere with the chemical reaction on your blood
sugar strips. As a result, your blood sugar readings
can appear erroneously low. Vitamin E has been shown
to reduce one of the destructive effects of high blood
sugars (glycosylation of the body's proteins), in
a dose-dependent fashion—up to 1,200 IU (international
units) per day. It has recently been shown to lower
insulin resistance. I therefore recommend 400–1,200
IU per day to a number of my patients.
Changes in Bowel Movements
A new diet often
brings about changes in frequency and consistency
of bowel movements. This is perfectly natural and
should not cause concern unless you experience discomfort.
Increasing the fiber content of meals, as with salads,
bran crackers, and soybean products, can cause softer
and more frequent stools. More dietary protein can
cause less frequent and harder stools. Normal frequency
of bowel movements can range from 3 times per day
to 3 times per week. If you notice any changes in
your bowel habits other than these, discuss them with
your physician.
How Do People React To
The New Diet?
Most of my patients
initially feel somewhat deprived, but also grateful
because they feel more alert and healthier. I fall
into this category myself: my mouth waters whenever
I pass a bakery shop and sniff the aroma of fresh
bread, but I am also grateful simply to be alive and
sniffing.
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