Diet Guidelines Essential to the Treatment of All Diabetics
SO WHAT’S LEFT TO EAT?
It’s a good question, and the same one I asked myself more than thirty years ago as I discovered that more and more of the things that the American Diabetes Association had been telling me were perfectly fine to eat made blood sugar control impossible. In the following pages, I’ll give you a broad overview of the kinds of food my patients and I usually eat. Please remember that with the exception of the no-calorie beverages (including seltzer water and mineral water with no added carbohydrate) and moderate portions of sugar-free Jell-O without maltodextrin, there are no “freebies.” Virtually everything we eat will have some effect upon blood sugar if enough is consumed. You may discover things I’ve never heard of that have almost no effect on your blood sugar. If so, feel free to include them in your meal plan, but check your blood sugar every half hour for a few hours before assuming that they are benign.
No-No’s in a Nutshell
Here is a concise list of foods to avoid that are discussed in this chapter. You may want to memorize it or copy it, as it is worth learning.
Sweets and Sweeteners
• Powdered sweeteners (other than stevia)
• Candies, especially so-called sugar-free types
• Honey and fructose
• Most “diet” and “sugar-free” foods (except sugar-free Jell-O gelatin when the label doesn’t mention maltodextrin, and diet sodas that do not contain fruit juices or list other carbohydrate on the label)
• Desserts (except Jell-O gelatin without maltodextrin—no more than ½ cup per serving) and pastries: cakes, cookies, pies, tarts, et cetera
• Foods containing, as a significant ingredient, products whose names end in -ol or -ose (dextrose, glucose, lactose, mannitol, mannose, sorbitol, sucrose, xylitol, xylose, et cetera), except cellulose; also, corn syrup, molasses, maltodextrin, et cetera
Sweet or Starchy Vegetables
• Beans: chili beans, chickpeas, lima beans, lentils, sweet peas, et cetera (string beans, snow peas, and bell and chili peppers, which are mostly cellulose, are okay, as are limited amounts of many soybean products)
• Onions, except in small amounts
• Packaged creamed spinach containing flour
• Cooked tomatoes, tomato paste, tomato sauce, and raw tomatoes except in small amounts
• Winter squash
Fruit and Juices
• All fruits (except avocados)
• All juices (including tomato and vegetable juices— except for some people, in a Bloody Mary)
Certain Dairy Products
• Sweetened and low-fat yogurts
• Cottage cheese (except in very small amounts)
• Powdered milk substitutes and coffee lighteners
• Canned milk concentrate
Grains and Grain Products
• Wheat, rye, barley, corn, and lesser-known, “alternative” grains, such as kasha, quinoa, and sorghum
• White, brown, wild rice, or rice cakes
• Breakfast cereal
• Pancakes and waffles
• Bread, crackers, and other flour products
• Most commercially prepared soups
• Most packaged “health foods”
• Snack foods (virtually anything that comes wrapped in cellophane, including nuts)
• Balsamic vinegar (compared to wine vinegar, white vinegar, or cider vinegar, balsamic contains considerable sugar)
Most vegetables, other than those listed in the No-No section, are acceptable.
Acceptable vegetables include asparagus, avocado, broccoli, brussels sprouts, cabbage and sauerkraut, cauliflower, eggplant, onions (in small amounts), peppers (any color except yellow), mushrooms, spinach, string beans, summer squash, and zucchini. As a rule of thumb, ? cup of diced or sliced cooked vegetable,¼ cup mashed cooked vegetable, or 1 cup of mixed salad acts upon blood sugar as if it contains about 6 grams of carbohydrate. Remember that cooked vegetables tend to raise blood sugar more rapidly than raw vegetables because the heat makes them more digestible and converts some of the cellulose to sugar. Generally, more cooked vegetables by weight will occupy less volume in a measuring cup, so ? cup cooked spinach will weigh considerably more than ? cup uncooked. On your self-measurements, note how your favorite vegetables affect your blood sugar. Raw vegetables can present digestive problems to people with gastroparesis.
Of the following vegetables, each acts upon blood sugar as if it contains about 6 grams of carbohydrate in ? cup (all cooked except as noted):
bell peppers (green and red only, no yellow) (cooked or raw)
bok choy (Chinese cabbage)
celery root (celeriac)
hearts of palm
patty pan squash
In addition to the above, you should keep the following in mind:
• Onions are high in carbohydrate and should only be used in small amounts for flavoring—small amounts of chives or shallots can pack a lot of flavor.
• One-half small avocado contains about 6 grams of carbohydrate.
• One cup mixed green salad without carrots and with a single
slice of tomato or onion has about the same impact on blood sugars as 6 grams of carbohydrate.
• One-quarter cup mashed pumpkin contains about 6 grams of carbohydrate. My own opinion is that without some flavoring, pumpkin tastes about as appetizing as Kleenex. Therefore I flavor it with much stevia and spice (cinnamon) and warm it to make it a bit like pumpkin pie filling. (For other vegetables from this list, such as turnips, assume that ¼ cup of the mashed product contains 6 grams of carbohydrate.)