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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.)


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.


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