10
Diet Guidelines Essential to the Treatment of All Diabetics
Chewing Gum
Gum chewing can be a good substitute for snacking and can be of value
to people with gastroparesis because it stimulates salivation and saliva
contains substances that facilitate stomach-emptying. The carbohydrate
content of one stick of chewing gum varies from about 1 gram in a stick
of sugar-free Trident or Orbit (tastes better) to about 7 grams per
piece for some liquid-filled chewing gums. The 7-gram gum will rapidly
raise my blood sugar by about 35 mg/dl. The carbohydrate content of
a stick of chewing gum can usually be found on the package label. “Sugar-free”
gums all contain small amounts of sugar—the primary ingredient of Trident
“sugarless” gum is sorbitol, a corn-based sugar alcohol. It also includes
mannitol and aspartame. I personally use a chewing gum called XlearDent.
It contains 0.72 grams of the sugar xylitol per piece. Xylitol is an
antimetabolite (metabolic poison) for bacteria and prevents tooth decay
when chewed regularly. It may be obtained by phoning (877) 599-5327
or on the Internet at www.xlear.com.
Very Low Carbohydrate Desserts
Part Three of this book consists of low-carbohydrate recipes, prepared
and tested by chefs. It includes easy recipes for some low-carbohydrate
desserts that are truly delicious.
Coffee, Tea, Seltzer, Mineral Water, Club Soda, Diet Sodas
None of these products should have significant effect upon blood sugar.
The coffee and tea may be sweetened with liquid or powdered stevia,
or with tablet sweeteners such as saccharin, cyclamate, sucralose (Splenda
tablets), and aspartame (Equal tablets).Remember to avoid the use of
more than 2 teaspoons of cow’s milk as a lightener. Try to use cream
(which has much less carbohydrate, tastes better, and goes much further).
Read the labels of “diet” sodas, as a few brands contain sugar in the
form of fruit juices. Many flavored mineral waters, bottled “diet” teas,
and seltzers also contain added carbohydrate or sugar, as do many powdered
beverages. Again, read the labels.
Frozen Diet Soda Pops
Many supermarkets and toy stores in the United States sell plastic
molds for making your own ice pops. If these are filled with sugar-free
sodas, you can create a tasty snack that has no effect upon blood sugar.
Do not use the commercially made “sugar-free” or “diet” ice pops that
are displayed in supermarket freezers. They contain fruit juices and
other sources of carbohydrate.
Alcohol, in Limited Amounts
Ethyl alcohol (distilled spirits), as we discussed in Chapter 9, has
no direct effect upon blood sugar. Moderate amounts, however, can have
a rapid effect upon the liver, preventing the conversion of dietary
protein to glucose. If you are following a regimen that includes insulin
or a pancreas-stimulating oral hypoglycemic agent, you’re dependent
upon conversion of protein to glucose in order to maintain blood
sugar at safe levels. The effects of small amounts of alcohol (i.e.,
1½ ounces of spirits for a typical adult) are usually negligible.
Most beers, in spite of their carbohydrate content, don’t seem to affect
blood sugar when only one can or bottle is consumed.
INCREASE YOUR AWARENESS OF FOOD CONTENTS Read Labels
Virtually all packaged foods bear labels that reveal something about
the contents. The FDA now requires that labels of packaged foods list
the amount of carbohydrate, protein, fat, and fiber in a serving. Be
sure, however, to note the size of the “serving.” Sometimes the serving
size is so small that you wouldn’t want to be bothered eating it. Beware
of labels that say “lite,”“light,”“sugar-free,”“dietetic,”“diet,” “reduced-calorie,”
“low-calorie,” et cetera. Counts of calories are only going to tell
you so much, and “low fat” is going to tell you nothing about carbohydrate
content. “Fat-free” desserts may be the most dangerous of all. Even
if you’re losing weight, carbohydrate intake will impede your efforts
much more than fat will (see Chapter 9). For example, I’ve found that
it’s impossible to put weight on very slim patients following low-carbohydrate
diets by giving them 900 extra calories a day in the form of 4 ounces
of olive oil. Two recent studies support this—but only if carbohydrate
is very limited. They showed that when carbohydrate is low, the fat
is metabolized, not stored. “Low-fat” and “fat-free” foods frequently
but not always contain more carbohydrate than the foods they replace.
The only way you can determine the carbohydrate content is to read the
amount stated on the label. But even this can be deceptive. For example,
one popular brand of “sugarfree” strawberry preserves has a label that
states, “Carbohydrate—0.”
Yet anyone can see the strawberries in the jar, and common sense would
tell you that strawberries contain carbohydrate. So deceptive labeling
occurs and, in my experience, is fairly prevalent in the “diet” food
industry.
Use Food Value Manuals
In Chapter 3, a number of books are listed that show the carbohydrate
contents of various foods. These manuals are recommended but not essential
tools for creating your meal plan. The guidelines and advice set forth
in Chapters 9–11 of this book, plus perhaps the recipes in Part Three,
are all you really need to get started.
If you want the potential for considerable variety in your meals, get
all the books listed in Chapter 3. The best of these is The NutriBase
Complete Book of Food Counts. Food Values of Portions Commonly Used
has been the dietitian’s bible for more than fifty years. It is updated
every few years. Be sure to use the index at the back to locate the
foods of interest. Note that on every page in the main section, carbohydrate
and fat content are listed in the same column. The carbohydrate content
of a food always appears below the fat content. Do not get the two
confused. Also, be sure to note the portion size in all these books.
Also very worthwhile is Corrine Netzer’s Encyclopedia of Food Values,
which is of similar utility.
If you can find a copy of it, another book, Kosher Calories, by Tziporah
Spear (Mesorah Publications, 1985), although out of print, is not just
for people whose diets are restricted to kosher foods. More than 10,000
common brand-name foods available in the United States are listed. Also,
you can search the USDA’s nutrient database at www.nal.usda.gov/fnic/foodcomp/Data/SR15/sr15.html.
VITAMIN AND MINERAL SUPPLEMENTS
It is common practice to prescribe supplementary vitamins and minerals
for diabetics. This is primarily because most diabetics have chronically
high blood sugars and therefore urinate a lot. Excessive urination causes
a loss of water-soluble vitamins and minerals. If you can keep your
blood sugars low enough to avoid spilling glucose into the urine (you
can test it with Clinistix/Diastix), and if you eat a variety of vegetables,
and red meat at least once or twice a week, you
should not require supplements. Note, however, that major dietary sources
of B-complex vitamins include “fortified” or supplemented breads and
grains in the United States. If you’re following a low carbohydrate
diet and therefore exclude these from your meal plan, you should eat
some bean sprouts, spinach, broccoli, brussels sprouts, or cauliflower
each day. If you do not like vegetables, you might take a B-complex
capsule or a multivitamin/mineral capsule each day. See page 175 for
a discussion of calcium supplementation for certain people who follow
high-fiber or high-protein diets or use metformin.
Supplemental vitamins and minerals should not ordinarily be used in
excess of the FDA’s recommended daily requirements. Large doses can
inhibit the body’s synthesis of some vitamins and intestinal absorption
of certain minerals. Large doses are also potentially toxic. Doses of
vitamin C in excess of 500 mg daily may interfere with the chemical
reaction on your blood sugar strips. As a result, your blood sugar readings
can appear erroneously low. Large doses of vitamin C can actually raise
blood sugar and even impair nerve function (as can doses of vitamin
B-6 in excess of 200 mg daily). Vitamin E has been shown to reduce one
of the destructive effects of high blood sugars (glycosylation of the
body’s proteins), in a dose-dependent fashion— up to 1,200 IU (international
units) per day. It has recently been shown to lower insulin resistance.
I therefore recommend 400–1,200 IU per day to a number of my patients.
Be sure to use the forms of vitamin E known as gamma tocopherol or mixed
tocopherols, not the common alpha tocopherol, which can inhibit the
absorption of essential gamma tocopherol from foods.
CHANGES IN BOWEL MOVEMENTS
A new diet often brings about changes in frequency and consistency
of bowel movements. This is perfectly natural and should not cause concern
unless you experience discomfort. Increasing the fiber content of meals,
as with salads, bran crackers, and soybean products, can cause softer
and more frequent stools. More dietary protein can cause less frequent
and harder stools. Calcium tablets can cause hard stools and constipation,
but this is usually offset if they contain magnesium.
Normal frequency of bowel movements can range from 3 times per day
to 3 times per week. If you notice any changes in your bowel habits
more or less than these frequencies, discuss them with your physician.
HOW DO PEOPLE REACT TO THE NEW DIET?
Most of my patients initially feel somewhat deprived, but also grateful
because they feel more alert and healthier. I fall into this category
myself.
My mouth waters whenever I pass a bakery shop and sniff the aroma of
fresh bread, but I am also grateful simply to be alive and sniffing.
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