Diet Guidelines Essential to the Treatment of All Diabetics
Research into creating replacement cells for burned-out insulin producing
pancreatic beta cells is so promising that it’s tempting to think of a “cure” not in terms of if but when. The reality is, however, less rosy. There may one day be a cure, but to put off normalizing your blood sugars until then is simply to ignore the reality of your situation. If you’re going to control your diabetes and get on with a normal life, you will have to change your diet, and the when is now. No matter how mild or severe your diabetes, the key aspect of all treatment plans for normalizing blood sugars and preventing or reversing complications of diabetes is diet. In the terms of the Laws of Small Numbers, the single largest “input” you can control is what you eat.
THE FUNDAMENTAL IMPORTANCE OF A RESTRICTED-CARBOHYDRATE DIET
The next several pages may well be the most difficult pages of this book for you to accept—as well as some of the most important. They’re full of the foods you’re going to have to restrict or eliminate from your diet if you’re going to normalize your blood sugars. You may see some of your favorite foods on our No-No list, but before you stop reading, keep in mind a few important things. First, toward the end of this chapter we discuss the foods you can safely eat. Second, while you will have to eliminate certain foods, there are some genuinely sugar-free and low-carbohydrate alternatives.
One purpose of blood glucose self-monitoring is to learn through your blood sugar profiles how particular foods affect you. Blood sugar self-monitoring is the ultimate measure of the effect foods have on your blood sugar. If you don’t believe what you’re reading here, check your blood sugars every 2 hours after consuming food you are certain must be benign. Over years of examining profiles like the ones you will create, I’ve observed that some people are more tolerant of certain foods than other people. For example, bread makes my own blood sugar rise very rapidly. Yet some of my patients eat a sandwich of thin bread every day with only minor problems. Inevitably I find this is related to delayed stomach-emptying (see Chapter 22). In any case, you should feel free to experiment with food and then perform blood sugar readings. It’s likely that for many diabetics most or all of our restrictions will be necessary.
Patients often ask, “Can’t I just take my medication and eat whatever I want?” It almost seems logical, and would be fine if it worked. But just taking your medication and eating whatever you want doesn’t work — because of the Laws of Small Numbers—so we have to find something that does.
Many diabetics can be treated with diet alone, and if your disease is relatively mild, you could easily fall into this category. Some patients who have been using insulin or oral agents find that once on our diet they no longer need blood sugar–lowering medication. Even if you require insulin or other agents, diet will still constitute the most essential part of your treatment.
Think small inputs. You may recall from prior chapters that—for even the mildest diabetic—the impairment or loss of phase I insulin response makes normalizing blood sugars impossible for at least a few hours after a high-carbohydrate meal. Eating even small amounts of fast-acting carbohydrate raises blood sugar so rapidly that any remaining phase II insulin response cannot promptly compensate. This is true if you’re injecting insulin or if you’re still making your own insulin. Any sensible meal plan for normalizing blood sugar takes this into account and follows these basic rules:
• First, eliminate all foods that contain simple sugars. As you should know by now—but it bears repeating—“simple sugar” does not mean just table sugar; that’s why I prefer to call them fast-acting carbohydrates. Most breads and other starchy foods, such as potatoes and grains, become glucose so rapidly that they can cause serious postprandial increases in blood sugar.
• Second, limit your total carbohydrate intake to an amount that will work with your injected insulin or your body’s remaining phase II insulin response, if any. In this way, you avoid a postprandial blood sugar increase, and avoid overworking any remaining insulin-producing beta cells of your pancreas (research has demonstrated that beta cell burnout can be slowed or halted by normalizing blood sugars).
• Third, stop eating when you no longer feel hungry, not when you’re stuffed. There’s no reason for you to leave the table hungry, but there’s also no reason to be gluttonous. Remember the Chinese restaurant effect (page 95).
TESTING FOR STARCH OR SUCROSE IN FOODS
Sometimes you’ll find yourself at a restaurant, hotel, or reception where you cannot predict if foods have sugar or flour in them. Your waiter probably has little idea of what’s in a given recipe, so don’t even ask him; his response will likely be incorrect. I’ve found that the easiest way to make certain is to use the Clinistix or Diastix that should have been checked off on your supply list (Chapter 3). These are manufactured to test urine for glucose.We use them to test food. If, for example, you want to determine if a soup or salad dressing contains table sugar (sucrose) or a sauce contains flour, just put a small amount in your mouth and mix it with your saliva. Then spit a tiny bit onto a test strip. Any color change indicates the presence of sugar or starch. Saliva is essential to this reaction because it contains an enzyme that releases glucose from sucrose (table sugar) or from flour in the food, permitting it to react with the chemicals in the test strip. This is how I found that one restaurant in my neighborhood uses large amounts of sugar in its bouillon while another restaurant uses none.
Solid foods can also be tested this way, but you must chew them first. The lightest color on the color chart label of the test strip container indicates a very low concentration of glucose. Any color paler than this may be acceptable for foods consumed in small amounts. The Clinistix/Diastix method works on nearly all the foods on our No-No list except milk products, which contain lactose. It will also not
react with fructose (fruit sugar; also present in some vegetables and in honey). If in doubt, assume the worst.
NO-NO FOODS: ELIMINATING SIMPLE SUGARS
Named below are some of the common foods that contain simple sugars, which rapidly raise blood sugar or otherwise hinder blood sugar control and should be eliminated from your diet. All grain products, for example—from the flour in “sugar-free” cookies to pasta to wheat or non-wheat grain products except pure bran—are converted so rapidly into glucose by the enzymes in saliva and further down in the
digestive tract that they are, as far as blood sugar is concerned, essentially no different than table sugar. There are plenty of food products, however, that contain such tiny amounts of simple sugars that they will have a negligible effect on your blood sugar. One gram of carbohydrate will not raise blood sugar more than 5 mg/dl for most diabetic adults (but considerably more for small children). A single stick of chewing gum or a single tablespoon of salad dressing made with only 1 gram of sugar certainly poses no problems. In these areas, you have to use your judgment and your blood sugar profiles. If you’re the type who, once you start chewing gum, has to have a new stick every 5 minutes, then you should probably avoid chewing gum. If you have delayed stomach-emptying (Chapter 22), small amounts of “sugar-free” chewing gum may help facilitate your digestion.
Powdered Artificial Sweeteners
At this writing, several artificial sweeteners are available. They are available from different manufacturers under different names, and some, such as Equal and Sweet’n Low, can have brand names under which more than one form of sweetener is sold. Here, to simplify your shopping, are acceptable products currently and soon to be available:
saccharin tablets or liquid (Sweet’n Low)
aspartame tablets (Equal, NutraSweet)*
acesulfame-K (Sunette, The Sweet One)
stevia powder or liquid (stevia has not been approved in the European Union)
sucralose tablets (Splenda)
neotame (newly approved by the FDA)
cyclamate tablets and liquid (not yet available in the United States)
* Many Web sites falsely perpetuate the myth that aspartame is toxic because its metabolism produces the poison methanol. In reality, one 12-ounce can of an aspartame-sweetened soft drink generates only ½5 as much methanol as does a glass of milk.
These are all noncarbohydrate sweeteners that vary in their availability and can be used to satisfy a sweet tooth without, for the most part, affecting blood sugars. But when sold in powdered form, under such brand names as Sweet’n Low, Equal, The Sweet One, Sunette, Sugar Twin, Splenda, and others, these products usually contain a sugar to increase bulk, and will rapidly raise blood sugar. They are all orders of magnitude sweeter tasting than sugar. So when you buy them in packets
and powdered form, with the exception of stevia, they usually contain about 96 percent glucose or maltodextrin and about 4 percent artificial sweetener. If you read the “Nutrition Facts” label on Splenda, for example, it lists, as such labels must, ingredients in order from most to least: dextrose (glucose), maltodextrin (a mixture of sugars), and finally sucralose.Most powdered sweeteners are sold as low-calorie and/or sugar-free sweeteners because they contain only 1 gram of a sugar as compared to 3 grams of sucrose in a similar paper packet labeled “sugar.” More suitable for diabetics are tablet sweeteners such as saccharin, cyclamate, and aspartame. As noted above, the same brand name can denote multiple products: Equal is a powder containing 96 percent glucose and also a tablet containing a minuscule (acceptable) amount of lactose. Sweet’n Low powder is saccharin with 96 percent glucose. Stevia powder and liquid (sold in health food stores) contain no sugar of any kind and only minute amounts of carbohydrate.