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Diabetes Diet

Diabetes Diet

Super Salads

When we follow a low-carb diet to control our diabetes and to lose weight, the first carbohydrates to go are starchy foods. Then, we reduce two sugars, sucrose (table sugar) and fructose.

Starchy foods have a high glycemic index, particularly tubers like potatoes and grains like wheat and wheat products, including bread, bagels, and baguettes. The trouble with sucrose is that it’s half fructose (the other half is glucose). And the trouble with fructose, including high-fructose corn syrup and agave nectar, is its impact on the liver, which metabolizes it. That raises our triglyceride levels and leads us to secrete more insulin, which in turn leads to more insulin resistance. Fructose also leads to high blood pressure.

What’s left? Fiber, of course. In the U.S. we count fiber as a carbohydrate, although much of the rest of the world counts it separately. Having some fiber in our diet is probably a good thing, but we can’t live on it.

But beyond starch, sugar, and fiber are the green leafy vegetables. The mainstay of salad. That’s what’s left.

Even Dr. Richard K. Bernstein, the leading exponent of a very low-carb diet for controlling diabetes, thinks that it makes sense for us to eat some slow-acting carbohydrates. While “there is no such thing as an essential carbohydrate,” as Dr. Bernstein writes in Dr. Bernstein’s Diabetes Solution, he also writes that “it seemed reasonable to conclude that, since our prehistoric ancestors consumed some plants, plant foods might well contain essential nutrients that were not yet present in vitamin supplement and not even been discovered.”

All of a sudden Dr. Bernstein found that he was eating salads as well as cooked vegetables. He says that he now relishes salads.

I certainly do too. A big salad is my main meal, which I eat at lunchtime giving my body enough hours to digest it before going to bed.

A couple of years ago I wrote here about what I put in my salads. But I keep discovering new ingredients that I relish.

My best find, I think, is BroccoSprouts, which just like the name indicates is sprouted broccoli. I wrote about BroccoSprouts here a year ago and still add them to almost every salad.

More recently I found a preparation of one of my favorite vegetables. Whole Foods markets now usually have artichoke hearts. In the produce section you can find “ArtiHearts Fresh Natural Artichokes” from Monterey Farms.

Five years ago I wrote in my “Diabetes Update” newsletter reviewing a book, Prickly Pear Cactus Medicine. Many people in Mexico use it to prevent high blood glucose levels, and it has one of the lowest glycemic indexes of any food. When I reviewed that book, I was concerned that the prickly pear cactus sold here was the species that tastes better than the one studied more for its glucose-lowering effect. Of course, it’s probably the former, but I now eat and enjoy it anyway, because it is undoubtedly low carb and good tasting. Sold in bottles or cans as “Tender Cactus” and “Nopalitos,” the prickly pear cactus that Whole Foods and major supermarket chains sell isn’t prickly. Someone else has removed the thorns for us.

I happened to have planned to write this much about salads anyway. But this morning I ran across a new study in BMJ, originally called the British Medical Journal. It is among the world’s most influential and widely read peer-reviewed general scientific journals in the field of medicine. Just yesterday BMJ published “Fruit and vegetable intake and incidence of type 2 diabetes mellitus: systematic review and meta-analysis.”

The study concluded that their meta-analysis supported recommendations to promote the consumption of green leafy vegetables in the diet for reducing the risk of type 2 diabetes. My conclusion is that something that can reduce the risk of our getting type 2 diabetes can’t be harmful for those of us who are already living with this condition.

This article is based on an earlier version of my article published by HealthCentral.

Diabetes Diet

Sugar-Free Chocolate

If you don’t like chocolate, you can leave now and read my other posts. But if you do like chocolate,  please stick around.

Everybody still here? I thought so. Chocolate is most people’s top comfort food.

But many of us who have diabetes do all we can to avoid sugar. Regular sugar, or sucrose, is half fructose. And fructose has lately earned a bad rap. If you wonder why, you might want to check out a couple of my reviews, one from 2007 and another from 2008.

Most of us have tasted enough sugar-free chocolate to doubt that it anybody can make it taste right. But somebody has. So now you can eat your chocolate without the sugar and enjoy the great taste. Kiss chocolate guilt goodbye!

In the interest of science I have been taste-testing chocolate bars that Mary Jo Kringas sent me at no charge. Somebody had to test them!

Mary Jo started the conversation by telling me that she developed a chocolate bar sweetened with inulin from chicory root and from erythritol. They are 60 percent cocoa solids.

Inulin is soluble fiber. It passes through much of our digestive system intact and therefore doesn’t raise our blood glucose level.

Erythritol is one of the sugar alcohols. But unlike the commonly used maltitol, it has a glycemic index of zero.

That sounded good enough for me to go to the trouble of asking Mary Jo to send me a case of her chocolate bars and to eat them. I knew that I had to do a taste test on your behalf.

Since my rather mature taste buds might be fallible, I convened a tasting panel of three younger testers. The panel consisted of a 20-year-old university student named Rachel, a 21-year-old manager of an ice cream store named Lauren, and a 58-year-old psychotherapist named Barry.

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Diabetes Diet

Potato Poison

Many people with diabetes have already stopped eating potatoes for several reasons. Now we have one more.

Some varieties of potatoes raise our blood glucose level faster and higher than just about anything. The glycemic index of a baked russet potato is 111 on the scale where glucose equals 100.

A cup of hashed brown potatoes has 46 grams of carbohydrate. That’s more than a whole day’s ration of carbohydrates for people following the best known very low-carb diet for people with diabetes.

About 80 percent of a potato’s carbohydrate comes from starch, a white, tasteless, and odorless powder. But starch is cheap, and adding salt and fat can make it palatable.

Since hashed brown potatoes and french fries count as a vegetable, the potato is America’s most important vegetable crop. More than 30 percent of the vegetables that we eat are potatoes, and we eat 142 pounds of them each year.

Maybe people with diabetes eat fewer potatoes than other Americans. I hope so. But everyone who eats lots of potatoes not only indulges in a very high glycemic and very high carb food but also is at risk of potato poisoning.

Potatoes are a member of the deadly nightshade family. This family includes Jimson weed, mandrake, belladonna, tobacco, as well as potatoes and tomatoes. While potatoes, tomatoes, and other members of the nightshade family are important food sources, they are often rich in alkaloids, which are toxic to humans and animals and can range from being mildly irritating or fatal, depending in part on how much we eat. By affecting the nervous system, this poison causes weakness and confusion. Some people are especially sensitive to foods in the nightshade family and experience allergy-like symptoms from the alkaloids. These alkaloids protect the plant from attacks by microbes and insects by dissolving their cell membranes.

But this poison hasn’t discouraged us from eating lots and lots of potatoes. Cooking them long enough and avoiding the green parts and sprouts reduces their toxicity. But when people eat foods in the
nightshade family, the alkaloids can create pores in the lining of the gut. This increases intestinal permeability, and if enough of the alkaloids gets into our bloodstream, this destroys the cell membranes of our red blood cells.

The large amount of potatoes that we eat is what makes them a concern to Loren Cordain, who has been has been a professor in the Department of Health and Exercise Science at Colorado State University since 1982. His new paper, “Consumption of Nightshade Plants, Human Health and Autoimmune Disease Implications,” interested me so much that I bought a copy for $21.29. It was worth the money.

We eat somewhat less tomato products, and relatively few bell peppers, chili peppers, and eggplants, some of the other food crops in the nightshade family.

“When the gut becomes ‘leaky,’ it is not a good thing,” Dr. Cordain writes, “as the intestinal contents may then have access to the immune system, which in turn becomes activated, thereby causing a chronic low level system inflammation.” The increased intestinal permeability, particularly in people with diseases of chronic inflammation — like type 1 diabetes — and diseases of insulin resistance — like type 2 diabetes — particularly troubles Dr. Cordain.

His conclusion is “to eliminate or drastically reduce potato consumption, and for autoimmune and allergy patients to be cautious with the consumption of tomatoes, chili peppers, and eggplants.”

Until recently, I had a weakness for hashed brown potatoes, as I have written here. Even though I knew that potatoes are both high glycemic and high carb, that wasn’t enough to stop me. But knowing that they are poisonous did.

This article is based on an earlier version of my article published by HealthCentral.

Diabetes Diet

Losing Weight the Easy Way

With all the attention this week being given to the FDA’s review concerning heart problems connected with Avandia, one of the major diabetes drugs, you may have missed the bad news for what could have been the first new prescription drug for obesity in more than a decade. Another FDA advisory panel voted against Qnexa, which Vivus Inc. developed.

In year-long clinical trials people who took the highest dose of Qnexa averaged a 10.6 percent weight loss. Those taking a placebo lost 1.7 percent of their body weight.

Unfortunately for Vivus and for people who want to lose weight, the side effects of Qnexa outweighed its benefits in the minds of most of the FDA’s panel members. These weren’t niggling concerns. They include the possibility that people taking Qnexa would be depressed and think suicidal thoughts, have their memory and concentration impaired, be at greater risk of kidneys stones, and could suffer from heart problems.

If the FDA still approves Qnexa in spite of the panel’s recommendation against it, this could be the easy way for the great majority of people with diabetes to lose the 10 percent of our weight that our doctors have told us that we need to do. Almost everyone who has type 2 diabetes is overweight. Our government’s statistics show that 85 percent of all American adults with diabetes are overweight.

If an effective weight loss drug is no longer an option for us, we could be left with our own resources. Still, I know that drugs we already have to control our blood glucose can also help some of us with type 2 diabetes to lose weight. I lost a lot of weight by taking Byetta, and friends of mine are achieving weight loss success with Victoza.

But since all drugs carry with them the risk of side effects, which is the FDA’s biggest concern, many of us would like to be taking as few drugs as possible. We can’t do it with with willpower alone, as Gina Kolata emphasizes in her book Rethinking Thin.

In 2007 I decided to do without drugs entirely and yet I lost even more weight. The strategy that I adopted was the only proven way, a very low-carb diet, very much like the one that Dr. Richard K. Bernstein has himself followed for years and has taught successfully to thousands of his patients with diabetes. By following the recommendations in his
Dr. Bernstein’s Diabetes Solution, I was able to bring my weight down from 170, when I started low-carbing in December 2007 to 151 last October.

But this year has been murder for my weight. In all my traveling since February I lost control. While I had no problem staying on a very low-carb diet, I ate too much fat and protein when eating out and wasn’t able to reliably check my weight on a daily basis so that I could immediate take corrective action. Consequently, my weight crept up as
high as 169 a few months ago.

Only by carefully watching what I eat and weighing myself every morning have I been able to start bringing it back down to where I am more healthy, feel better, and my clothes fit. Today my weight is down to 162, but I still have a way to go to reach my ultimate weight goal of 155.

I know that I’ll do it. I also know that we still don’t have any easy way to lose weight and to keep it off.

This article is based on an earlier version of my article published by HealthCentral.

Diabetes Diet

The Chia Controversy

When one of my favorite researchers wrote on April 20 that “the potential adverse effects of long term, chronic chia seed consumption may outweigh the potential benefits,” I took notice. Loren Cordain, Ph.D., is a professor in Colorado State University’s department of health and exercise science. Dr. Cordain wrote one of the most intriguing books on nutrition, The Paleo Diet, which recommends that we avoid grains and dairy since our paleolithic ancestors weren’t able to eat those foods.

Dr. Cordain’s report in his April 10 newsletter is more detailed in his criticism of chia seeds. An excerpt is available online, but the guts of the chia seed report sells for $6.95 plus shipping and taxes.

My 2007 post here on chia seeds got lots of attention, including more comments — 112 to date — than any other. So I was concerned enough to contact the world’s leading researcher on chia seeds.

Wayne Coates, Ph.D., is professor emeritus in the office of arid lands studies at the University of Arizona, Tucson. Dr. Coates has researched chia seeds for three decades and wrote the definitive book on the subject, Chia: Rediscovering a Forgotten Crop of the Aztecs (The University of Arizona Press, 2005).

Dr. Coates purchased a copy of the chia seed report. He shared it and his comments with me.

“I do not want to get into a long discussion about this,” Dr. Coates writes, “but would like to make a few comments. In his article, Table 1 gives the nutrient profile for chia seeds. Interestingly he does not give the source of the data, and furthermore, he says it gives the ‘entire’ nutrient profile of chia seeds. In no way it is complete, and since the source is not identified, one can easily question its value as a reputable source.

“He talks about anti-nutrients in chia, yet he promotes flaxseed. The anti-nutrients in flaxseed are well-documented for both humans and animals. He criticizes the gel (which is soluble fiber) as possibly impairing fat absorption and the high fiber content as protein to be poorly absorbed. In some cases, there may be some negative effects, but the positive effects of consuming fiber in the diet in terms of bowel function and prevention of coronary heart disease are well-documented.

“He also does not like the fact that chia contains phytic acid. Phytic acid has been shown to have antioxidant, anticancer, hypocholesterolemic and other beneficial effects. So again, it is unclear why he states this is a negative aspect of chia.

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Diabetes Diet

Water Everywhere

It is especially important for those of us who have diabetes to drink a lot of water, as unexciting as it is compared with all the other beverages that we have available. So I do my best to make it a bit more exciting.

For starters, I filter all my tap water, even though Boulder, Colorado, where I live, has perhaps the highest rated water supply in the country. We are, after all, the only American city that owns its own glacier, and because it is melting so fast we have a lot of runoff!

Then, I keep a couple of canteens in the fridge all the time. Cold water tastes better to me, perhaps because it reminds me of drinking out of cool mountain streams, something that I could do when I was a kid.

Now, I often drink carbonated water. For years I bought plastic (and sometimes glass) bottles of the stuff at supermarkets. I tried all the brands of sparkling water and finally found one that I really like, Germany’s Gerolsteiner, and available only in high end markets, like Whole Foods. I dislike the most common brand available in restaurants, San Pellegrino.

But I got tired of the expense and trouble of carting cases of the stuff home every week and of the landfill waste. So, with the encouragement of one of my correspondents I invested in a device that carbonates my own water. A company called SodaStream makes it and delivers a new cartridge every couple of months when I need one. The water that it carbonates tastes every bit as good as the bottled stuff without all the disadvantages that that stuff has.

I drink it straight — as I am at the moment. Or I make sparkling lemonade with TrueLemon and stevia for a total of zero calories.

We can also flavor carbonated water with lots of different flavors. The SodaStream device comes with samples of many flavors, and the calorie-free ones include orange, berry, lemon-lime, diet root beer, diet pink grapefruit, and diet cranberry-raspberry. Another possibility are the many DaVinci flavors.

I just make sure to cut off my water supply by dinner time. I already make enough trips to the bathroom at night.

Drinking a lot water is the single diet recommendation that all the health experts agree on. They do differ on the amount that they recommend.

Loren Cordain, professor of exercise physiology at Colorado State University in Ft. Collins, Colorado, and the author of the important book, The Paleo Diet, points out that our paleolithic ancestors drank nothing but water. While paleolithic sounds like it was a long time ago, it was only about 10,000 years before now — the time just before the agricultural revolution — and that’s a blink of an eye in terms of human evolution.

Barry Popkin, professor of nutrition at the University of North Carolina at Chapel Hill, and the author of The World is Fat, emphatically recommends that we drink nothing but water. And lots of it.

But it isn’t true that the U.S. government recommends drinking at least eight glasses of water a day. That is an old urban myth, as I wrote in my first book What Makes My Blood Glucose Levels Go Up…and Down? Dr. Jennie Brand-Miller, Kaye Foster-Powell, and I co-authored this book together to explain the glycemic index, and the water section was one that I wrote.

When we are thirsty, water remains our best choice. Even when we are hungry, having a drink of water is a great idea. It can help us feel fuller and therefore make us less likely to overeat. This goes a long way toward keeping our blood glucose levels where we want them to be.

This article is based on an earlier version of my article published by HealthCentral.