“Which starch would you like with your dinner?” the waiter asked.

He wanted to know if I prefered a baked potato, rice, or corn on the cob with my fish and steamed veggies. Or maybe a side order of pancakes.

His question surprised me, and I could have shot back a question of my own: “What makes you think that I like to eat any starch?” But I remained civil and simply declined his offer.

While starches and sugars are the cheapest foods and are the mainstay of the typical American diet, they aren’t for me. Truly, they aren’t for anyone who has diabetes because diabetes is a disturbance of carbohydrate metabolism where our blood glucose level rises above normal. Starch breaks down into simple sugars in our digestive system and raises our blood glucose levels higher and faster than anything else we possibly could put in our mouths.

Cutting out sugar is easy, even if we have a sweet tooth. We have some great sweeteners that don’t have any carbs or calories. But we don’t have any alternatives to starch — we simply have to eliminate it or at least cut back on it as much as possible.

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“Is taking whey protein powder good or bad for people with type 2 diabetes?”

This was a correspondent’s recent question. I told him that this is such a good question that I would answer him here.

Many people supplement their protein intake with a daily scoop or two of protein powder. Years ago I did that myself.

We have a wide variety of types and brands of protein powder to chose from. Besides whey protein, we can get casein, soy, and egg white protein powder from many vendors.

Some years ago I decided that using the most complete protein was the best idea. I discovered that egg protein powder was the most complete. That means it has the best balance of the nine essential amino acids that comprise protein.

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One type of saturated fat is especially valuable for those of us who have diabetes. Oils like coconut and MCT are the easiest for us to use, as I have written in my last four posts here, including “The Best Saturated Fats.”

But too many people avoid these great fats because they believe myths about them. When I interviewed Ron Rosedale, M.D., recently, he addressed these concerns.

Dr. Rosedale is one of my most trusted experts on what to eat. His website is “The Rosedale Program,” and he also wrote one of the best weight-loss guides, The Rosedale Diet.

I asked him about the concern that some people have that coconut oil raises our LDL cholesterol level. “But, I noted, “this may be a question of small dense versus big fluffy LDL.”

“Exactly,” Dr. Rosedale replied. “That’s what it is. It has nothing to do with coconut oil per se. Lowering carbohydrates and increasing fats is going to increase the size of the LDL particles. This is a good thing, and if you are only measuring the total quantity of LDL, it will probably increase that too — but that is also a good thing.”

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The fats that our bodies can burn most easily are the ones that have medium-length chains of carbons, as I discussed in “The Best Saturated Fats.” This is especially important for those of us who have diabetes when we transition to a very low-carbohydrate diet, which gives us almost all of our energy from fats.

These fats are those that we call medium-chain triglycerides or MCTs. But what are the best MCT fats for us to use? If MCT fats are good for us, then shouldn’t we be using pure MCT?

Coconut oil has the highest proportion of MCT of any common oil, Ron Rosedale, M.D., told me when I interviewed him for my article, “The Trouble with Saturated Fats.” Two-thirds of the saturated fat in coconut oil is MCT, according to the USDA National Nutrition Database.

Among the common oils, palm kernel oil ranks a close second. But it is much harder to find in our stores and on the websites. I have bought red palm oil at my local Whole Foods Market. But I don’t know if it’s the same as palm kernel oil, and I don’t like its taste anyway.

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The best saturated fats are those that our bodies can burn most easily to fuel our energy. These are the fats that are highest in medium-chain triglycerides.

This term is such a mouthful that we usually call them just MCTs. Triglycerides are the big part of vegetable oils and animal fats. Medium-chain means that these fats are 6 to 12 carbons long, while the much more common long-chain fats thats have 14 to 28 carbons.

Our bodies need to cut down the fats that we burn for energy to chains of carbons that are no more than 12 carbons long. MCTs are already that short, so our bodies can burn them better. That’s why athletes often prefer MCTs for energy and why MCTs are especially valuable for people when they start to follow a very-low carbohydrate lifestyle to better manage their diabetes.

MCT Oil

The connection between carbohydrates and fat may not be that clear to everyone. All our nutrition comes from carbs, fat, and protein. So when we follow a very low-carb lifestyle, why can’t we just boost the protein and leave the fat alone?

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Coconut oil is a special kind of saturated fat. The trouble with saturated fat in general, as I wrote here last week, is that our bodies find them harder to burn than other kinds of fat, like the monounsaturated fat in food like avocados, olive oil, and macadamia nuts.

We manage our diabetes by controlling the spikes in our blood glucose levels. And nothing has a more dramatic affect on our levels than the starches and the sugars of high carbohydrate food. Therefore, many of us now follow a very low-carb diet.

But when we start getting most of our energy from fat rather than from carbohydrates, our bodies are just beginning to learn how to convert fat to the energy we need. So we have to make it easier for ourselves, Ron Rosedale, M.D., told me. Dr. Rosedale is a physician and scientist who wrote The Rosedale Diet.

Dr. Rosedale says to limit the amount of saturated fat during our first few weeks on a very low-carb diet. Otherwise, we will feel our lack of energy and tire easily.

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Saturated fat is controversial, even among people with diabetes who follow a very low-carbohydrate lifestyle. When we eat very few carbohydrates, we have to rely on fat for most of our energy. Ron Rosedale, M.D., wrote one of the best books on how and why to follow this lifestyle, so his views on saturated fat merit special consideration.
His website is “The Rosedale Program,” and his book, The Rosedale Diet, came out eight years ago. When I got a chance to talk with him last week, I wondered if he had changed his views on saturated fat in the meantime.

I especially wanted to talk with Dr. Rosedale because I have become more and more interested in the claims that coconut oil is perhaps our healthiest oil to cook with and to use in our salads. But coconut oil is saturated fat.

A correspondent named Suresh precisely put the question to me in a recent email. “Just lately everyone is talking about eating coconut oil because it is healthy,” he wrote. “If these remarkable claims are true, I woud like to eat a bucket load of it. Yet when you look at the ingredient of this oil, which is solid at room temperature, it is all saturated fat. So how can this be healthy?”

The key sentence for me in this context in Dr. Rosedale’s book was this: “Although derived from plants, coconut oil is also high in saturated fat, but of a different kind [not from animal sources] that may even have health benefits.” Since HarperCollins published his Rosedale Diet book eight years ago, I wondered if in the meanwhile he had looked any further into the health benefits of coconut oil.

Dr. Rosedale told me that he had written a lot more detail about why coconut oil is good. But with his agreement HarperCollins took it out. “They didn’t want to confuse people.”
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Most people say they don’t have enough time to get the exercise that the American Heart Association and the American Diabetes Association say we need to protect our hearts and manage our diabetes. Their standard recommendation of 30 minutes a day five times a week works out to 2 ½ hours a week. And that doesn’t count the time it takes to get to the trail or the gym.

When we work one or more full-time jobs, interact with our family and friends, relax and sleep a little, we often feel like we don’t have any time left to work out. If only we could find a shortcut!

Now, however, some researchers have the answer. By trading intensity for time we can much more efficiently get the physical activity we all need.

The trick is a new twist on the interval training that almost all competitive athletics use to build up their speed and endurance. The usual interval training combines bursts of high-intensity exercise with longer periods of regular intensity exercise. A former girlfriend who is both a Certified Diabetes Educator and an athlete taught me that several years ago, and I recommended it then in “Efficient Exercise for Glucose Control.”

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The important new book, Eating Your Heart Out?, is indeed about eating and your heart. But it is much more.

I think that it started as an explanation of the BalancePoint protocol. But it is much more than that too.

The authors are Richard C. Williams, Ph.D., Binx Selby, and Binx’s wife, Linda Jade Fong. I have know all three of the authors for years and consider them my personal friends. Several years ago I participated in the BalancePoint program, and Dr. Williams is a member of the diabetes support group that I founded four years ago here in Boulder, Colorado.

That said, I am not beholden to them. I didn’t ask any of them for a copy of the book, and they didn’t offer to give me one. I bought a copy of the Kindle edition of Eating Your Heart Out? from Amazon.com for $8.99.

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When I decided in 2007 that it was healthy and safe to eat nothing but low-carb meals, I wasn’t sure if I could do it for a long time. I wondered if my diet would have enough variety to remain interesting.

After all, I had stopped eating more than half the products that all our supermarkets sell. No more bread, bagels, croissants, pasta, pizza, or other products made from wheat. No more rice, corn, potatoes, and other starchy foods.

“I imagined that a very-low-carb diet would feel limiting and boring,” I wrote in “Why I Low-Carb” for Diabetes Self-Management in 2008. “I used to lust after bread and potatoes and rice. But that ‘carb lust’ passed away as I broke my addiction to it.”

Now, many years after going low-carb, I still love the great variety of foods that I find to eat. Yes, my diet really does have a great variety as I learn about different foods all the time.
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