Diet Guidelines Essential to the Treatment of All Diabetics
Meat, Fish, Fowl, Seafood, and Eggs
These are usually the major sources of calories in the meal plans of my patients. The popular press is currently down on meat and eggs, but my personal observations and recent research implicate carbohydrates rather than dietary fat in the heart disease and abnormal blood lipid profiles of diabetics and even of nondiabetics. If you are frightened of these foods, you can restrict them, but depriving yourself will be unlikely to buy you anything. Appendix A details the current controversy and the shaky science behind the present, faddish high-carbohydrate dietary recommendations, and lays out my concerns and opinions. Egg yolks, by the way, are a major source of the nutrient lutein, which is beneficial to the retina of the eye. Organic eggs contain large amounts of omega-3 fatty acids, which are good for your arteries.
Tofu, and Soybean Substitutes for Bacon, Sausage, Hamburger, Fish, Chicken, and Steak
About half the calories in these products come from benevolent vegetable fats, and the balance from varying amounts of protein and slow-acting carbohydrate. They are easy to cook in a skillet or microwave. Protein and carbohydrate content should be read from the labels and counted in your meal plan. Their principal value is for
people who are vegetarian or want to avoid red meat. Health food stores stock many of these products. For the purpose of our meal plans, as described in the next chapter, remember to divide the grams of protein listed on the package by 6 in order to get “ounces”of protein (see page 167).
Certain Commercially Prepared and Homemade Soups
Although most commercial and homemade soups contain large amounts of simple sugars, you can learn how to buy or prepare lowor zero-carbohydrate soups.Many but not all packaged bouillon preparations have no added sugar and only small amounts of carbohydrate. Check the labels or use the Clinistix/Diastix test, observing the special technique described on page 136. Plain consommé or broth in some restaurants may be prepared without sugar. Again, check with Clinistix/Diastix.
Homemade soups, cooked without vegetables, can be made very tasty if they are concentrated. You can achieve this by barely covering the meat or chicken with water while cooking, rather than filling the entire pot with water, as is the customary procedure. Alternatively, let the stock cook down (reduce) so you get a more concentrated, flavorful soup. You can also use herbs and spices, all of which have negligible amounts of carbohydrates, to enhance flavor. See “Mustard, Pepper, Salt, Spices, Herbs,” below. Clam broth (not chowder) is usually very low in carbohydrate. In the United States you can also buy clam juices (not Clamato), which contain only about 2 grams of carbohydrate in 3 fluid ounces. Campbell’s canned beef bouillon and consommé contain only 1 gram carbohydrate per serving. College Inn brand canned chicken broth contains no carbohydrate.Most bouillon cubes are also low in carbohydrate; read the labels.
Cheese, Butter, Margarine, and Cream
Most cheeses (other than cottage cheese) contain approximately equal amounts of protein and fat and small amounts of carbohydrate. The carbohydrate and the protein must be figured into the meal plan, as I will explain in Chapter 11. For people who want (unwisely) to avoid animal fats, there are some special soybean cheeses (not very tasty). There’s also hemp cheese, which I know nothing about. Cheese is anexcellent source of calcium. Every ounce of whole milk cheese contains approximately 1 gram carbohydrate, except cottage cheese, which contains more. Generally speaking, where dairy products are concerned, the lower the fat, the higher the sugar lactose, with skim milk cheeses containing the most lactose and the least fat, and butter containing no lactose and the most fat.
Neither butter nor magarine in my experience will affect your blood sugar significantly, and they shouldn’t be a problem as far as weight is concerned if you’re not consuming a lot of carbohydrate along with them. One tablespoon of cream has only 0.5 gram carbohydrate—it would take 8 tablespoons to raise my blood sugar 20 mg/dl. The cheese puffs I describe in the next chapter (page 174) are low in carbohydrate and can be used instead of bread to make sandwiches.
Although personally I don’t enjoy yogurt, many of my patients feel they cannot survive without it. For our purposes the plain whole milk yogurt, unflavored, unsweetened, and without fruit, is a reasonable food. A full 8-ounce container of plain, Erivan brand, unflavored whole milk yogurt contains only 11 grams of carbohydrate and 2 ounces of protein. You can even throw in some chopped vegetables and not exceed the 12 grams of carbohydrate limit we suggest for
lunch. Do not use nonfat yogurt. The carbohydrate goes up to 17 grams per 8-ounce container. Yogurt can be flavored with cinnamon, with Da Vinci brand syrups, with baking flavor extracts, or with the powder from sugar-free Jell-O brand gelatin (if the package doesn’t list maltodextrin as an ingredient) without affecting the carbohydrate content. It can be sweetened with stevia liquid or powder or with Equal or Splenda tablets that have been dissolved in a small amount of hot water. Erivan brand yogurt is available at health food stores throughout the United States. If you read labels, you may find brands similarly low in carbohydrate in your supermarket; two such brands are Stonyfield Farm and Brown Cow Farm.
There are many soy products that can be used in our diet plan, and soymilk is no exception. It’s a satisfactory lightener for coffee and tea, and one of my patients adds a small amount to diet sodas. Others drink it as a beverage, either straight or with added flavoring such as those mentioned for yogurt. Personally, I find the taste too bland to drink without flavoring, and I much prefer cream diluted with water.
When used in small amounts (up to 2 tablespoons/1 ounce), soymilk need not be figured into the meal plan. It will curdle if you put it into very hot drinks.
As noted in the No-No foods section, of the many brands of soymilk on the market,WestSoy offers the only unsweetened ones I’ve been able to find, although other unsweetened brands are available in various parts of the country.
If you or someone in your home is willing to try baking with soybean flour, you will find a neat solution to the pastry restriction. One ounce of full-fat soybean flour (about ¼ cup) contains about 7.5 grams of slow-acting carbohydrate. You could make chicken pies, tuna pies, and even sugar-free Jell-O pies or pumpkin pies. Just remember to include the carbohydrate and protein contents in your meal plan.
Soybean flour usually must be blended with egg to form a batter suitable for breads, cakes, and the like. Creating a blend that works requires either experience or experimentation. Some recipes using soy flour appear in Part Three, “Your Diabetic Cookbook.”
Of the dozens of different crackers that I have seen in health food stores and supermarkets, I have found only three brands that are truly low in carbohydrate.
• G/G Scandinavian Bran Crispbread, produced by G. Gundersen Larvik A/S, Larvik, Norway (distributed in the United States by Cel-Ent, Inc., Box 1173, Beaufort, SC 29901, phone  525- 1437). Each 9-gram slice contains about 3 grams of digestible carbohydrate. If this product is not available locally, you can order it directly from the importer. One case contains thirty 4- ounce packages. They are also available from Trotta’s Pharmacy (877) 987-6882.
• Bran-a-Crisp, produced by Saetre A/S, N1411, Kolbotn, Norway (distributed in the United States by Interbrands, Inc., 3300 N.E. 164th Street, FF3, Ridgefield,WA 98642). Each 8.3-gram cracker contains about 4 grams of digestible carbohydrate. Bran-a-Crisp may be ordered directly from Interbrands, Inc., by phone or e-mail if you cannot find it locally. Phone (877) 679-3552; e-mail: [email protected] A number ofWeb sites sell these crackers— just search for Bran-a-Crisp if you want to order that way, or order from Trotta’s Pharmacy.
• Wasa Fiber Rye. These crackers are available in most supermarkets in the United States and in some other countries. One cracker contains about 5 grams of digestible carbohydrate. Many of my patients feel that this is the tastiest of these three products. Although some people eat these without a spread, to me they taste
like cardboard. My preference is to enjoy them with chive-flavored cream cheese or butter. Crumbling two G/G crispbreads into a bowl and covering them with cream or cream diluted with water can create bran cracker cereal. Add some Equal or Splenda tablets (dissolved in a bit of hot water) or some liquid stevia sweetener and perhaps a baking flavor extract (banana flavor, butter flavor, et cetera), or one of the Da Vinci syrups.
If eaten in excessive amounts, bran crackers can cause diarrhea. They should be eaten with liquid. They are not recommended for people with gastroparesis (delayed stomach-emptying), since the bran fibers can form a plug that blocks the outlet of the stomach. The carbohydrate in these crackers is very slow to raise blood sugar. They are great for people who need a substitute for toast at breakfast.
Note: In the United States, labeling regulations require that fiber be listed as carbohydrate. There are many different kinds of fiber, soluble and insoluble, digestible and undigestible, and so, because there is no requirement to distinguish in labeling between them, these listings can complicate computation of carbohydrate content. Use the carbohydrate amounts that I have listed above instead of those listed on the package labels.