10
Diet Guidelines Essential to the Treatment of All Diabetics
Breakfast Cereals
Most cold cereals, like snack foods, are virtually 100 percent carbohydrate,
even those claiming to be “high protein.” Additionally, many contain
large amounts of added sugars. Since they are made from grain, small
amounts, even of whole-grain cereals, will cause a rapid rise in blood
sugar (according to the glycemic index, a measure of how rapidly foods
are metabolized into glucose, brown rice actually raises blood sugar
faster than white rice). Even bran flakes are mostly flour. If you have
been eating bran flakes to improve bowel function, you can substitute
psyllium husks powder, which is entirely indigestible fiber. Use only
the sugar-free variety of Metamucil or other such products. (You can
get the husks powder at a health food store and mix with water. If you
don’t care for the texture or taste, you can drink it mixed in diet
soda.) You can also make your own cereal from pure bran. Cooked cereals
generally contain about 10–25 grams of fast-acting carbohydrate per
half-cup serving. I find that even small servings make blood sugar control
impossible.
Snack Foods
These are the products in cellophane bags that you find in vending
machines and supermarkets. They include not just candy, cookies, and
cakes, but pretzels, potato chips, taco chips, tiny crackers, and popcorn.
These foods are virtually 100 percent carbohydrate and frequently have
added sucrose, glucose (the label may say dextrose), corn syrup, et
cetera. Although some nuts (e.g., macadamia) are relatively low in carbohydrate,
who can sit down and eat only six macadamia nuts (about 1 gram of carbohydrate)?
It’s simpler just to avoid them.
So-Called Protein Bars
Although drugstore and grocery shelves are full of bars that claim
to be “protein bars,” most are really nothing more than candy bars with
“healthy” packaging. The FDA recently analyzed twenty different brands
and found that all but two contained much more carbohydrate than stated
on the labels. These were removed from the marketplace, but many more
remain. This is another case of when it sounds too
good to be true, it probably is.
Milk and Cottage Cheese
Milk contains a considerable amount of the simple sugar lactose and
will rapidly raise blood sugar. Skim milk actually contains more lactose
per ounce than does whole milk. One or 2 teaspoons of milk in a cup
of coffee will not significantly affect blood sugar, but ¼ cup
of milk will make a considerable difference to most of us. Cream, which
you have probably been instructed to avoid, is okay. One tablespoon
has only 0.5 gram of carbohydrate. Furthermore, it tastes much better
than substitutes and has considerably more “lightening power.” The powdered
lighteners for coffee contain relatively rapid acting sugars and should
be avoided if you use more than a teaspoonful at a time or drink more
than 1 cup of coffee at a meal. A coffee lightener worth considering
is WestSoy brand soymilk, which is sold in health food stores throughout
the United States. Although several WestSoy flavors are marketed, only
the ones marked 100% Organic Unsweetened are unsweetened. It comes in
plain and vanilla and contains 5 grams of carbohydrate in 8 ounces.
Other unsweetened brands, such as Vitasoy and Yu Natural, are available
in various parts of the country. One catch—soymilk curdles in very hot
coffee or tea.
Cottage cheese also contains a considerable amount of lactose because,
unlike most other cheeses (hard cheese, cream cheese), which are okay,
it is only partly fermented. I was unaware of this until several patients
showed me records of substantial blood sugar increases after consuming
a container of cottage cheese. It should be avoided exceptin very small
amounts, say about 2 tablespoons.
Fruits and Fruit Juices
These contain varying mixtures of simple sugars and more complex carbohydrates,
all of which will act dramatically on blood sugar levels, which you
can prove with a few experiments with blood sugar measurements. Bitter-tasting
fruits such as grapefruit and lemon contain considerable amounts of
simple sugars. They taste bitter because of the presence of bitter chemicals,
not because sugar is absent. Orange juice, which may be high in vitamin
C, also contains about as much sugar as a nondiet soft drink. Although
eliminating fruit and fruit juices from the diet can initially be a
big sacrifice for many of my patients, they usually get used to this
rapidly, and they appreciate the effect upon blood sugar control. I
haven’t eaten fruit in more than thirty years, and I haven’t suffered
in any respect. Some people fear that they will lose important nutrients
by eliminating fruit, but that shouldn’t be a worry. Nutrients found
in fruits are also present in the vegetables you can safely eat.
In our society, we generally reserve the name “fruit” for sweet fruits,
such as apples, oranges, and bananas, all of which you should avoid.
There are, however, a number of biological fruits (the part of certain
plants that contains pulp and seeds) that are benign for the diabetic,
such as summer squash, cucumbers (including many types of pickle), eggplant,
bell and chili peppers, and avocado. These tend to have large amounts
of cellulose, an undigestible fiber, rather than fast-acting carbohydrate.
In addition to being tasty and versatile, they can also promote digestive
health for some people. (It’s worth noting that cellulose, found in
vegetables and fruits, is essentially the same fiber that makes up much
of the shady elm on the corner. It has undigestible calories your body
won’t metabolize because we don’t have the enzymes to break the special
celluose chains of sugars down into digestible form.)
Vegetables
Beets. Like most other sweet-tasting vegetables, beets are loaded with
sugar. Sugar beets are a source of table sugar.
Carrots. After cooking, carrots taste sweeter and appear to raise blood
sugar much more rapidly than when raw. This probably relates to the
breakdown of complex carbohydrates into simpler sugars by heat. Even
raw carrots should be avoided. If, however, you are served a salad with
a few carrot shavings on top for decoration, don’t bother to remove
them. The amount is insignificant, just like a teaspoon of milk.
Corn. Not a vegetable at all but a grain, as noted above. Nearly all
of the corn grown in the United States is used for two main purposes.
One is the production of sweeteners. Most of the sugar in Pepsi-Cola,
for example, comes from corn. The other major purpose is animal feed,
e.g., fattening up hogs, cattle, and chickens. Corn for consumption
by people, as a “vegetable” or as snack foods, comes in third. Diabetics
should avoid eating corn, whether popped, cooked, or in chips—even 1
gram of corn (a couple of kernels of popcorn) will rapidly raise my
blood sugar by about 5 mg/dl.
Potatoes. For most diabetics, cooked potatoes raise blood sugar almost
as fast as pure glucose, even though they may not taste sweet. Giving
up potatoes is a big sacrifice for many people, but it will also make
a big difference in your postprandial blood sugars.
Tomatoes, tomato paste, and tomato sauce. Tomatoes, as you know, are
actually a fruit, not a vegetable, and as with citrus fruits, their
tang can conceal just how sweet they are. The prolonged cooking necessary
for the preparation of tomato sauces releases a lot of glucose, and
you would do well to avoid them. If you’re at someone’s home for dinner
and are served meat or fish covered with tomato
sauce, just scrape it off. The small amount that might remain should
not significantly affect your blood sugar. If you are having them uncooked
in salad, limit yourself to one slice or a single cherry tomato per
cup of salad. (See page 380 for a recipe for a low-carbohydrate, tomato-free,
Italian-style red sauce that can be good over, say, a broiled, sautéed,
or grilled chicken breast or veal scallopine.) Onions fall into this
same category—despite some sharp flavor, they’re quite sweet, some varieties
sweeter than others. There are other vegetables in the allium family
that can be easily substituted, although in smaller quantities, such
as shallots and elephant garlic.
Commercially prepared soups. Believe it or not, most commercial soups
marketed in this country can be as loaded with added sugar as a soft
drink. The taste of the sugar is frequently masked by other flavors—
spices, herbs, and particularly salt. Even if there were no added sugar,
the prolonged cooking of vegetables can break the special glucose bonds
in the cellulose of slow-acting carbohydrates, turning them into glucose.
As you know from above, the amount of carbohydrate claimed on the Nutrition
Facts label can vary considerably from what’s actually in the can. Add
to that the common inclusion of potatoes, barley, corn, rice, and other
unacceptable foods, and you have a product that you will generally want
to avoid. There are still some commercial soup possibilities that fit
into our scheme. See the corresponding
heading on page 150.
Health foods. Of the hundreds of packaged food products that you see
on the shelves of the average health food store, perhaps 1 percent are
low in carbohydrate. Many are sweetened, usually with honey or other
so-called natural sugars. Indeed, many so-called natural foods can be
very high in carbohydrate. Since the health food industry shuns artificial
(nonsugar) sweeteners like saccharin or aspartame, if a food tastes
sweet, it probably contains a sugar. There are a few foods carried by
these stores that are unsweetened and low in carbohydrate. You’ll find
some of these listed later in this chapter.
Get Adobe Acrobat Now