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Customizing the Diet Chapter 5 – Part 1

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 1 of Chapter 5
Customizing the Diet
“Fast-acting, concentrated carbohydrate is the ultimate heart-attack food, particularly for those with a sedentary lifestyle.”

If you found yourself thinking as you went through the No-No foods section in Chapter 3 that all of this information goes against conventional thinking — you’re right. For years, “heart-attack food” was synonymous with red meat, eggs, and butter. The evidence is in. That is utterly and completely wrong.

Fast-acting, concentrated carbohydrate is the ultimate heart-attack food, particularly for those with a sedentary lifestyle.

It used to be that my patients faced an uphill battle with their friends and family, who were convinced that my advice was wrong, or wanted them to try more “fun” foods.

The low-carbohydrate craze has changed that somewhat, but you may still face well-meaning but uninformed friends and family who want you to eat less “bad fat” and more “complex” carbohydrates.

You can patiently express appreciation for their affection and care but ignore their advice. When they see you looking healthier, slimmer, fitter, and more energetic than you have in years, they might just ask to borrow this book.

It’s a good idea, before you start, to get a baseline measure of your cardiac risk and renal (kidney) profile. When you get a follow-up measure six months later, you’ll demonstrate conclusively that our diet has lowered both classes of risk factors. It doesn’t matter whether you’re diabetic, overweight, or obese. There is, however, one caveat. Autoimmune disorders such as diabetes are usually found in clusters. So, for example, it is not unusual for diabetics to develop a low thyroid state (hypothyroidism) either before or after they develop diabetes. This can occur at any age and will absolutely increase several cardiac risk factors, such as LDL, homocysteine, and lipoprotein(a). Fortunately, thyroid supplementation can reverse this condition. (Most physicians, however, perform the wrong thyroid function test. See page 435 of Diabetes Solution, 2003 edition.)


GENERAL PRINCIPLES FOR
TAILORING YOUR MEAL PLAN

If you use blood sugar–lowering medications such as insulin or oral agents, the first rule of meal planning is: Don’t change your diet unless your physician first reviews the new meal plan and reduces your medications accordingly. Most diabetics who begin our low-carbohydrate diet show an immediate and dramatic drop in blood sugar levels after meals, as compared to blood sugars on their prior, high-carbohydrate diets. If at the same time your medications are not appropriately reduced, your blood sugars can drop to dangerously low levels.

Your meal plan should be geared toward blood sugar control — and weight loss if you’re overweight — and also toward keeping you content with what you eat. So with those things in mind, one of the first things I do when I “train” my patients is “negotiate” a meal plan with them.

I say “negotiate” because I have never seen a one-sizefits-all diet work. One person may find the idea of sardines for breakfast delightful, another may find it disgusting. To work up an individualized plan, we start by making a list of what you eat and when, including snacks, on a typical day.*

If you’re a diabetic, I would also ask you to provide me with data sheets showing your blood sugar profiles, meals, and any blood sugar–lowering medications you’d taken during the previous week or two. These sheets should include any physical exercise you may have performed. My patients and I use Glucograf II data sheets (see page 111) for this purpose. (You’ll find their use detailed in Chapter 5 of Diabetes Solution.)† We would also take into account your height, weight, and age.

This information would give me an idea of what you like to eat and what effect particular doses of blood sugar–lowering medications have on your blood sugars.

Other important factors I take into account:
• If you have delayed stomach-emptying
• If you’re taking medications for other ailments that might affect your blood sugar

In negotiating the meal plan, I’d try wherever possible to incorporate foods you like. There are no prescribed meals. There is only one absolutely hard and fast rule:
Avoid fast-acting, concentrated carbohydrate.

If you’ve tried dieting to lose weight or to get your diabetes under control, you may have found that simply cutting back on calories according to preprinted tables or fixed calculations can be frustrating and can even have the opposite effect.

*I don’t recommend snacks for diabetics who use insulin to correct elevated blood sugars before meals.

If your “diet” calls for a supper that doesn’t satisfy you, it’s almost a given that later on you’ll find yourself compelled to have a snack. If you’re like most people, your snack will be snack food, a bowl of cereal, a banana, a bowl of ice cream — in other words, something loaded with fastacting carbohydrate. The result? You end up with high blood sugars and more calories than you would have consumed if you’d started with a sensible meal.

My aim is to help you avoid this. It’s best to start with a plan that allows you to get up from the table feeling comfortable but not stuffed. Studies have shown that fat and protein both leave you considerably more satisfied than fast-acting carbohydrate.

Since all of my diabetic patients bring me glucose profiles, over the years it has not been very difficult to develop guidelines for carbohydrate consumption that make blood sugar control relatively easy without causing too great a feeling of deprivation, even for those trying to lose weight.


We would like to thank the publisher Little Brown and Company and Dr. Richard K. Bernstein, for allowing us to provide excerpts from The Diabetes Diet.

Copyright © 2005 by Richard K. Bernstein, M.D. All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information storage and retrieval systems, without permission in writing from the publisher, except by a reviewer who may quote brief passages in a review.

Author’s Note:
This book is not intended as a substitute for professional medical care. The reader should regularly consult a physician for all health-related problems and routine care.

For more information on Dr. Bernstein’s and to purchase his books, CD’s or get access to his free monthly webinars, visit his website at DiabetesBook.com.