This newsletter keeps you up-to-date with new articles, Web pages, and books that I have written.

• I list and link most of these on my Diabetes Directory at www.mendosa.com/diabetes.htm and in the site’s menu.

• From time to time Diabetes Update may also include links to other Web pages of special interest.

My most recent contribution is:

• Net Carbs
  Several of you have asked me about net carbs. This is the term that vendors of low-carb products use to show that what they offer has fewer carbohydrates than the FDA allows them to specify in the Nutrition Facts panel. These vendors subtract sugar alcohols, glycerin, polydextrose, and fiber from total carbohydrates. The standard terminology, available carbohydrates, excludes only fiber. While fiber certainly has no effect on blood glucose, the question is what effect — if any — sugar alcohols, glycerin, and polydextrose have. The answer will probably surprise you. My article is on my website at http://www.mendosa.com/netcarbs.htm.

Book Review:

A Cookbook that is Low Carb and Low GI

• This is, I believe, the first low-carb cookbook that takes it one essential step further by incorporating the glycemic index. Not only are the ingredients low in carbohydrate but the carbohydrates that it includes are low glycemic as well. An appendix contains a GI value and carb count for each of the ingredients used in the more than 325 recipes in the book. Since not all of the ingredients have been tested yet, the authors had to estimate some of them.

  The authors are Lucy Beale and Sandy G. Couvillon. Lucy, a weight-loss expert, consulted with me quite a few times as she prepared the manuscript. Her co-author is a registered dietitian.

  The recipes use table sugar (sucrose), because the authors are concerned about safety and health issues with the use of artificial sweeteners. Personally, we use sucralose (Splenda), which they consider the best of the lot. Using Splenda, instead of brown sugar, for example reduces the carb count per serving of their wonderful Crustless Cheesecake from 10 to less than 4 grams of available carbohydrates.

  We have been able to try only a few of the many great-sounding recipes so far. We are most interested in some of Lucy’s hearty entrées and one-pot dinners. What with protein powder shakes for breakfast and salad or sandwiches (with low-carb bread) for lunch, we have those meals covered. I don't want to spend much time cooking, so I especially appreciate such simple recipes like Basil Pot Roast and several chicken dinners, including Paprika Chicken and Chicken with Olives and Capers.

  The one that intrigued me the most is Chicken Piccata because it makes use of one of the lesser known glycemic index strategies — using acidic foods to reduce our blood glucose level. The recipe contains lemon juice as well as capers, which are preserved in vinegar, and both are acidic.

  Before eating a generous serving of Chicken Piccata with a small helping of Uncle Ben’s Converted Rice (the lowest glycemic rice you can get), my blood glucose level was 91 mg/dl. Two hours after the first bite it had risen — to 93.

  You are probably thinking that I emphasize how good Chicken Piccata is for my blood glucose because it tastes bad. After all, I have been accused preferring to eat “bad-tasting stuff” like guar gum, soy milk, and habanero pepper sauce.

  In this case, however, even these people can agree that the Chicken Piccata is one of the best-tasting chicken recipes ever. Not only that, but the recipe — which has only eight ingredients — is also easy. Truly, a winner!

  The Complete Idiot’s Guide to Low-Carb Meals just came out in January 2004. The publisher is Alpha Books, a member of Penguin Group (USA) Inc. This 410-page trade paperback lists for $18.95. It is a worthy addition to your low-carb bookshelf along side of earlier books by Dana Carpender and Fran McCullough.

• Computer Engineer Juris Kadomsky in Riga, Latvia, who himself has had diabetes for many years, has developed the Insulin Dose Calculator. This program will automatically analyze the foods you are about to eat and will recommend an accurate insulin dose based on the individual characteristics of your body.

  Apart from protein, fat, and carbohydrate values, the latest version also takes into account the glycemic index values, which makes the calculation of doses even more precise. The site now has both Russian and English versions of this Windows program that you can download to your computer at no cost. Russian and English forums are also available to discuss the program as well as any other diabetic issues.

  For more information and to download the English version of the program, go to:
  http://juri.dia.ru/eng/.

• The American Academy of Family Physicians has just issued a new physician guide for blood glucose testing. It is mailing the guide to more than 94,000 family doctors. That’s important, because nearly 80 percent of the people with diabetes rely on primary care doctors to help them manage their disease.

  You can read the organization’s summary online at “Blood Tests to Help You Manage Your Diabetes”. There you can click through to the complete 24-page report, Self-control: A Physician’s Guide to Blood Glucose Monitoring in the Management of Diabetes.

  Testing times are based on the kind of medicine you take and on how well your blood glucose levels are controlled. Common frequencies are:

  • If you have type 1 diabetes and are taking insulin: test 3 or 4 times a day
  • If you have type 2 diabetes and are taking insulin and diabetes pills: test 3 or 4 times a day
  • If you are taking diabetes pills only and have not achieved your target A1C: test 2 to 4 times a day
  • If you are taking diabetes pills only or you are controlling your diabetes well with diet and exercise only: ask your doctor how often you should test

  The AAFP doesn’t tell you when to test. It leaves that up to your doctor. It does provide target goal ranges based on recommendations from a panel of medical experts. Your fasting (before breakfast) range should be 80 to 120 mg/dl. After breakfast, lunch, or dinner is should be less than 180 mg/dl. Before lunch or dinner it should be 80 to 120 mg/dl. Shoot for 100 to 140 mg/dl before bed, and 70 to 110 mg/dl at 3 A.M.

  Many people don’t test much or at all because they don’t know to do with the test results. Here the AAFP provides a big help.

  What does SMBG at the recommended times tell me?

  Time of Test	Can Be Used to Ö
  Fasting blood sugar (FBG) nighttime (3-4 A.M.)	Adjust medication or long-acting insulin
  Before a meal	Modify meal or medication
  1-2 hours after a meal	Learn how food affects blood glucose values (often the highest blood glucose levels of the day, depending on the size of the meal and the amount of medicine you take)
  At bedtime	Adjust diet or medication (last chance for the next 8 hours)

  Source: Blood Tests to Help You Manage Your Diabetes

  The AAFP lists other reasons to check your blood glucose:

  • If you have symptoms of low blood glucose (hypoglycemia),which include dizziness, shaking, sweating, chills and confusion
  • If you have symptoms of high blood glucose (hyperglycemia),which include sleepiness, blurred vision, frequent urination, and excessive thirst
  • To learn how meals, physical activity, and medicine affect your blood glucose level
  • To document how well your blood glucose is controlled if you have a job in which poor control could cause safety problems
  • To help you decide if it is safe to drive or perform other tasks that require concentration, if you are taking insulin or have had hypoglycemia in the past

  Finally, the AAFP lists six reasons why you might want to check your blood glucose more frequently than the schedule above:

  • If your diabetes medicine changes
  • If you begin taking other kinds of medicines
  • If you change your diet
  • If your exercise routine or activity level changes
  • If your level of stress increases
  • If you are sick. When you are sick, even without eating, your blood glucose levels may run high

• Another important report this month finds that most of us get far too much sodium (table salt) and too little potassium in our diet. The report comes from the Institute of Medicine of the National Academies, the group that sets desirable levels of nutrient intake for Americans. They call the report Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2004), and you can read it free online at http://www.nap.edu/books/0309091691/html/.

  This 532-page report covers a lot of ground, but our imbalance between too much sodium and too little potassium is most striking. The typical Western diet is high in salt and low in potassium — just the opposite of what evidence shows is best for good health and reducing the risks of chronic disease, the report says.

  More than 95 percent of American men and 75 percent of American women ages 31 to 50 consume more than the established upper limit of 5.8 grams of salt (2.3 grams of sodium) per day. This increases the risk of developing high blood pressure (hypertension), which can in turn lead to strokes, heart attacks, and kidney disease. Blood pressure tends to rise in direct relationship to the amount of sodium a person consumes. About 25 percent of American adults and more than half of those age 60 and older have high blood pressure.

  Some people are especially sensitive to the harmful effects of salt. This includes people with diabetes and kidney disease, the elderly, and African-Americans.

  We need some salt to replace what we lose through sweat and to get a diet that gives us enough of the other essential nutrients. How much? The report says that healthy 19- to 50-year-old adults should consume 1.5 grams of sodium and 2.3 grams of chloride each day — or 3.8 grams of salt.

  The best strategy to reduce the amount of salt we consume is probably to eat less prepared and processed foods. Americans and Canadians get 77 percent of their salt from these sources, the institute says.

  To lower blood pressure, blunt the effects of salt, and reduce the risk of kidney stones and bone loss, adults should consume 4.7 grams of potassium per day, the report says. However, most American women 31 to 50 years old consume no more than half of the recommended amount of potassium, and men’s intake is only moderately higher. Some people who are following low-carb diets may get even less when they reduce the amount of fruits and vegetables that they eat.

  This imbalance seems to have an obvious solution. What if we simply substituted one of the salt substitutes for sale in our supermarkets for the sodium we normally cook with and put on the table? After all, potassium chloride is a common ingredient in salt substitutes.

  Brands available in your supermarket may include Morton Salt Substitute, Nu-Salt, NoSalt, and Diamond Crystal Brand Salt Substitute. Each of these brands substitutes potassium for salt. That might be good for some people, but dangerous for others, especially those with heart problems and anyone who uses a lot of it. That’s why web sites for these brands typically say something like “Remember to consult a physician before using any salt substitute.”

  The safer way, of course, is to eat those foods that are higher in potassium. You can easily find out how much potassium just about any food has. You can search the wonderful website of the USDA Nutrient Data Laboratory in many ways. In this case you want one of the “Reports by Single Nutrient”, specifically Potassium Sorted by Nutrient Content.

  Even better is a table in the report that compares how much potassium each of the food groups has on a per calorie basis. I reproduce that table here.

  Comparative Amounts of Potassium in Various Food Groups

  Food Group	Potassium mg/00 kcal	Examples
  Leafy greens	1500	spinach, lettuce, romaine, cabbage, kale
  Fruit of vine-base plants	1200	tomatoes, cucumbers, zucchini, eggplant, pumpkin
  Root vegetables	975	carrots, radishes, turnips, cabbage, onions
  Beans and peas	500	kidney beans, peas, green beans chick peas, soybeans
  Tree fruits	430	apples, oranges, bananas, apricots, grapes, strawberries
  Tubers	400	potatoes, sweet potatoes, yams
  Milk and yogurt	350	skimmed milk, whole milk, yogurt
  Meats	230	beef, lamb, pork, poultry, fish, rabbit
  Nuts	110	walnuts, cashews, almonds, brazil, hazelnuts
  Eggs	90	chicken eggs
  Cereal grains	90	wheat, rice, oats, rye
  Cheese	50	edam, stilton, cottage, cheddar

  Adapted from Dietary Reference Intakes for Water, Potassium, Sodium, Chloride, and Sulfate (2004), Food and Nutrition Board, Institute of Medicine of the National Academies, Table 5-10, page 220, online at http://www.nap.edu/books/0309091691/html/