Chapter
10:
Diet Guidelines: Treatment for All Diabetics /
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Perhaps someday
there will be a miraculous replacement for the burned-out
beta cells of your pancreas, but until then, if you're
going to control your diabetes and get on with a normal
life, you will have to change your diet. No matter
how mild or severe your diabetes, the key aspect of
all treatment plans for normalizing blood sugars and
preventing or reversing complications of diabetes
is diet. In the terms of the Laws of Small Numbers,
the single largest "input" you can control
is what you eat.
The Fundamental Importance
of a Restricted-Carbohydrate Diet
The next several
pages may well be the most difficult pages of this
book for you to accept—as well as some of the most
important. They're full of the foods you're going
to have to restrict or eliminate from your diet if
you're going to normalize your blood sugars. You may
see some of your favorite foods on our No-No list,
but before you stop reading, keep in mind a few important
things. First, toward the end of this chapter we discuss
the foods you can safely eat. Second, while you will
have to eliminate certain foods, there are some genuinely
sugar-free alternatives.
One purpose of blood glucose
self-monitoring is to learn through your blood sugar
profiles how particular foods affect you. Over years
of examining these profiles, I've observed that some
people are more tolerant of certain foods than other
people. For example, bread makes my own blood sugar
rise very rapidly. Yet some of my patients eat a sandwich
of thin bread every day with only minor problems.
This is inevitably related to delayed stomach-emptying
(see Chapter 21). In any case, you should feel free
to experiment with food and then perform blood sugar
readings. It's likely that for most diabetics all
of our restrictions will be necessary.
Patients often ask, "Can't
I just take my medication and eat whatever I want?"
It almost seems logical, and would be fine if it worked.
But, as explained earlier, it doesn't work, so we
have to find something that does. We have.
Many diabetics can be treated
with diet alone, and if your disease is relatively
mild, you could easily fall into this category. Some
patients who have been using insulin or oral hypoglycemic
agents find that once on our diet they no longer need
blood sugar–lowering medication. Even if you require
insulin or other agents, diet will still constitute
the most essential part of your treatment.
Think small inputs. You
may recall from prior chapters that the impairment
or loss of phase I insulin response makes normalizing
blood sugars impossible for at least a few hours after
a high-carbohydrate meal. Even eating small amounts
of fast-acting carbohydrate raises blood sugar so
rapidly that any remaining phase II insulin response
cannot promptly compensate. This is true if you're
injecting insulin or if you're still making your own
insulin.
Any sensible meal plan for normalizing blood sugar
takes this into account and follows these basic rules:
- First, eliminate all foods that
contain simple sugars. As you should know by now—but
it bears repeating—"simple sugar" does
not mean just table sugar. Most breads and other
starchy foods, such as potatoes and grains, become
simple sugars so rapidly that they can cause serious
postprandial increases in blood sugar.
- Second, limit your total carbohydrate
intake to an amount that will work with your injected
insulin or your body's remaining phase II insulin
response. In this way, you avoid a postprandial
blood sugar increase, and avoid overworking any
remaining insulin-producing beta cells of your
pancreas (research has demonstrated that beta
cell burnout can be slowed or halted by normalizing
blood sugars).
- Third, stop eating when you no
longer feel hungry, not when you're stuffed. There's
no reason for you to leave the table hungry, but
there's also no reason to be gluttonous. Remember
the Chinese Restaurant Effect (page 87).
Testing for Glucose or
Sucrose in Foods
Sometimes you'll
find yourself at a restaurant, hotel, or reception
where you cannot predict if foods have sugar or flour
in them. Your waiter may have no idea what's in a
given recipe. I've found that the easiest way to make
certain is to use the Clinistix or Diastix that should
have been checked off on your supply list (Chapter
3). These are manufactured to test urine for glucose.
We use them to test food. If, for example, you want
to determine if a soup or salad dressing contains
table sugar (sucrose) or a sauce contains flour, just
put a small amount in your mouth and mix it with your
saliva. Then spit a tiny bit onto a test strip. Any
color change indicates the presence of sugar. Saliva
is essential to this reaction because it contains
an enzyme that releases glucose from sucrose or flour
in the food, permitting it to react with the chemicals
in the test strip. This is how I found that one restaurant
in my neighborhood uses large amounts of sugar in
its bouillon while another restaurant uses none.
Solid foods can also be tested
this way, but you must chew them first. The lightest
color on the color chain label of the test strip indicates
a very low concentration of glucose. Any color paler
than this may be acceptable for most foods. The Clinistix/Diastix
method works on nearly all the foods on our No-No
list except milk products, which contain lactose.
It will also not react with fructose. If in doubt,
assume the worst.
No-No Foods: Eliminating
Simple Sugars
Named below are
many of the common foods that contain simple sugars,
which rapidly raise blood sugar or otherwise hinder
blood sugar control and should be eliminated from
your diet. Virtually all grain products, for example—from
the flours in "sugar-free" cookies to pasta—are
converted so rapidly into glucose by the enzymes in
saliva that they are, as far as blood sugar is concerned,
essentially no different than table sugar. There are
plenty of food products, however, that contain tiny
amounts of simple sugars and will have a negligible
effect on your blood sugar. One gram of carbohydrate
will not raise blood sugar more than 5mg/dl for most
adults. A single stick of chewing gum or a single
tablespoon of salad dressing made with only 1 gram
of sugar certainly poses no problems. In these areas,
you have to use your judgment and your blood sugar
profiles. If you're the type who, once you start chewing
gum, has to have a new stick every 5 minutes, then
you should probably avoid chewing gum. If you have
delayed stomach-emptying, chewing gum may help facilitate
your digestion.
Powdered Artificial Sweeteners
Sweet'n Low, Equal, The Sweet One, Sugar Twin, and
similar powdered products in paper packets usually
contain about 96 percent glucose and about 4 percent
artificial sweetener. They are sold as low-calorie
sweeteners because they contain only 1 gram of glucose
as compared to 3 grams of sucrose in a similar paper
packet labeled "sugar." More suitable for
diabetics are tablet sweeteners such as saccharin,
cyclamate, and aspartame (Equal in the United
States). Note that the same brand name can denote
two different products: Equal is a powder containing 96
percent glucose and also a tablet containing no glucose.
Stevia powder and liquid (sold in health food stores)
contain no sugar of any kind.
So-Called Diet Foods and Sugar-Free Foods
Because U.S. food-labeling laws have permitted products
to be called "sugar-free" if they do not
contain common table sugar (sucrose), the mere substitution
of another sugar for sucrose permits the packager
to deceive the consumer legally. Most so-called "sugar-free"
products were, for many years, full of sugars that
may not promote tooth decay but most certainly will
raise your blood sugar. If you've been deceived, you're
not alone. I've been in doctor's offices that have
candy dishes full of "sugar-free" hard candies
especially for their diabetic patients! Sometimes
the label will disclose the name of the substitute
sugar.
Here is a partial list
of some of the many sugars you can find in "sugar-free"
foods. All of these will raise your blood sugar.
- carob
- honey
- saccharose
- corn syrup
- lactose
- sorbitol
- dextrin
- levulose
- sorghum
- dextrose
- maltose
- treacle
- dulcitol
- mannitol
- turbinado
- fructose
- mannose
- xylitol
- glucose
- molasses
- xylose
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