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Diabetes Update: Net Carbs

Number 68; March 1, 2004

By David Mendosa


Earth from Its Moon

Reduce, Reuse, Recycle

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:

    Low-Carb Meals

    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.

Announcements:
  • 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/

  • HTML Format
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    Archives:

    I now send out Diabetes Update once a month. Previous issues are online:

    1. Diabetes Update Number 1: Diabetes Genes of December 10, 2000
    2. Diabetes Update Number 2: DiabetesWATCH of December 18, 2000
    3. Diabetes Update Number 3: Starlix of January 3, 2001
    4. Diabetes Update Number 4: Native Seeds/SEARCH, Tepary Beans of January 17, 2001
    5. Diabetes Update Number 5: Insulin Makes You Fat of January 31, 2001
    6. Diabetes Update Number 6: Available and Unavailable Carbohydrates of February 15, 2001
    7. Diabetes Update Number 7: Dates of March 1, 2001
    8. Diabetes Update Number 8: Quackwatch of March 15, 2001
    9. Diabetes Update Number 9: The Cost of Insulin of March 30, 2001
    10. Diabetes Update Number 10: Sof-Tact Meter of April 2, 2001
    11. Diabetes Update Number 11: iControlDiabetes of April 16, 2001
    12. Diabetes Update Number 12: Cinnamon, Tagatose of May 2, 2001
    13. Diabetes Update Number 13: Glycemic Index of May 15, 2001
    14. Diabetes Update Number 14: Eat Your Carrots! of May 31, 2001
    15. Diabetes Update Number 15: Glycemic Load of June 21, 2001
    16. Diabetes Update Number 16: Homocysteine of July 2, 2001
    17. Diabetes Update Number 17: Chana Dal Tips of July 15, 2001
    18. Diabetes Update Number 18: Lag Time in AlternativeLand of August 2, 2001
    19. Diabetes Update Number 19: Fiber of August 15, 2001
    20. Diabetes Update Number 20: How Diabetes Works of August 30, 2001
    21. Diabetes Update Number 21: Insulin Resistance of September 14, 2001
    22. Diabetes Update Number 22: Trans Fats, Honey, CU of October 1, 2001
    23. Diabetes Update Number 23: Pedometer Power of October 15, 2001
    24. Diabetes Update Number 24: Is Glycerin a Carbohydrate? of October 31, 2001
    25. Diabetes Update Number 25: Kill the Meter to Save It of November 15, 2001
    26. Diabetes Update Number 26: Protein, Fat, and the GI of December 1, 2001
    27. Diabetes Update Number 27: Insulin Index of December 14, 2001
    28. Diabetes Update Number 28: Fructose of January 4, 2002
    29. Diabetes Update Number 29: Aspirin of January 14, 2002
    30. Diabetes Update Number 30: Stevia of January 31, 2002
    31. Diabetes Update Number 31: Gretchen Becker’s Book of February 19, 2002
    32. Diabetes Update Number 32: The UKPDS of March 4, 2002
    33. Diabetes Update Number 33: Financial Aid of March 18, 2002
    34. Diabetes Update Number 34: Pre-Diabetes of April 1, 2002
    35. Diabetes Update Number 35: More Glycemic Indexes of April 15, 2002
    36. Diabetes Update Number 36: Gila Monsters of April 30, 2002
    37. Diabetes Update Number 37: Is INGAP a Cure? of May 15, 2002
    38. Diabetes Update Number 38: Native American Diabetes of June 3, 2002
    39. Diabetes Update Number 39: FDA Diabetes of June 19, 2002
    40. Diabetes Update Number 40: Diabetes Support Groups of July 1, 2002
    41. Diabetes Update Number 41: New GI and GL Table of July 15, 2002
    42. Diabetes Update Number 42: Diabetes Sight of August 1, 2002
    43. Diabetes Update Number 43: DrugDigest of August 18, 2002
    44. Diabetes Update Number 44: Hanuman Garden of September 3, 2002
    45. Diabetes Update Number 45: Guidelines of September 16, 2002
    46. Diabetes Update Number 46: Trans Fat of October 4, 2002
    47. Diabetes Update Number 47: Nutrition.Gov of October 16, 2002
    48. Diabetes Update Number 48: Our Hearts of October 31, 2002
    49. Diabetes Update Number 49: Our Kidneys of November 15, 2002
    50. Diabetes Update Number 50: A1C<7 of December 2, 2002
    51. Diabetes Update Number 51: Diabetes Searches with Google of December 16, 2002
    52. Diabetes Update Number 52: e-Patients of January 2, 2003
    53. Diabetes Update Number 53: Email News of January 16, 2003
    54. Diabetes Update Number 54: Third Generation Meters of January 31, 2003
    55. Diabetes Update Number 55: Hypoglycemic Supplies of February 14, 2003
    56. Diabetes Update Number 56: Food Police of March 1, 2003
    57. Diabetes Update Number 57: Vitamins of April 1, 2003
    58. Diabetes Update Number 58: Lancets of May 1, 2003
    59. Diabetes Update Number 59: Accurate Meters of June 1, 2003
    60. Diabetes Update Number 60: Chromium of July 1, 2003
    61. Diabetes Update Number 61: Traveling of August 1, 2003
    62. Diabetes Update Number 62: My Book of September 1, 2003
    63. Diabetes Update Number 63: Hot Tubs of October 1, 2003
    64. Diabetes Update Number 64: Home A1C Testing of November 1, 2003
    65. Diabetes Update Number 65: Detemir of December 1, 2003
    66. Diabetes Update Number 66: Erectile Dysfunction of January 1, 2004
    67. Diabetes Update Number 67: Acidic Foods of February 1, 2004


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