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Customizing the Diet Chapter 5 – Part 7

Sep 16, 2015

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 7 of Chapter 5
Customizing the Diet
“Fast-acting, concentrated carbohydrate is the ultimate heart-attack food, particularly for those with a sedentary lifestyle.”


Most people are creatures of habit and tend to eat the same thing every day for breakfast or lunch. I’ve had patients who have eaten the same toasted bialy for twenty years for breakfast, the same ham and cheese sandwich for lunch. In my experience, most of the variation people have in their diet comes at dinner. But let’s start with breakfast. In my experience, bacon-and-egg people tend to eat bacon and eggs almost every day, maybe varying somewhat on weekends. Cereal people tend to eat cereal every day, even if they happen to change brands or flavors. Same with bagel people.

One of the problems with most of the popular lowcarb diets on the market these days is that they introduce “habits” you would never take up on your own and then, just as you get used to them, move on to a new phase with different foods. So during phase one you might have vegetable juice, a protein food like liquid egg substitute or Canadian bacon, and coffee or tea. But most of the popular diets change to phase two after weight loss has been attained. This usually involves reverting to an approximation of old habits, such as those in the first paragraph. This is certainly not a way to keep blood sugars normal or to prevent recurrence of carbohydrate craving.

Right off the top, you know that I wouldn’t recommend skim milk or vegetable juice, and I would recommend liquid egg substitute only if that was something you liked.

So, what do you like to eat?

There was a time in the American consciousness when fixing a meal was as simple as putting together a serving of protein, one of starch, and one of vegetables, with perhaps a side of salad and a small dessert. That standard menu —a piece of meat next to mashed potatoes, green beans, and tossed salad — made meal planning a simple proposition.

What I’m advocating is really as easy to conceive as the old meat, potatoes, vegetable, salad picture — just leave out the potato.

While the columns of numbers in the typical meal plans that follow may seem a little intimidating at first, in truth, once you become accustomed to the guidelines, putting together a meal — without having to consult a cookbook for every meal — becomes a simple process.


Supper should follow essentially the same approach as lunch. There is, however, one significant difference that will only apply to those who are affected by delayed stomachemptying (gastroparesis) and take insulin. As we’ve discussed briefly, this condition can cause unpredictable shifts in blood sugar levels because food doesn’t always pass into the intestines at the same rate from meal to meal, which means that you can end up with unpredictably high or low blood sugars while you are sleeping and unable to monitor and correct them. A more complete analysis of this problem appears in Chapter 22 of Dr. Bernstein’s Diabetes Solution.

If you like cooked vegetables (from The List) for supper, remember that most can be interchanged with salads as near equivalents — O cup of cooked vegetable and 1 cup of salad each have the blood sugar effect of about 6 grams carbohydrate.

If you like wine with dinner, choose a very dry variety and limit yourself to one 3-ounce glass. One beer may actually turn out to have no effect upon your blood sugar. Still, don’t drink more than one.


For many people with diabetes, snacks should be neither mandatory nor forbidden. They do, however, pose a problem for people who take fast-acting insulin before meals.

Snacks should be a convenience, to relieve hunger if meals are delayed or spaced too far apart for comfort. If your diabetes is severe enough to warrant the use of rapid-acting blood sugar–lowering medication before meals, such medication may also be necessary before snacks.

The carbohydrate limit of 6 grams during the first few hours after arising and 12 grams of carbohydrate thereafter that applies to meals also applies to snacks. Be sure that your prior meal has been fully digested before your snack starts (this usually means waiting 4–5 hours). This is so that the effects upon blood sugar will not add to one another.

You needn’t worry, however, if the snack is so sparse (say, a bit of toasted nori) as to have negligible effects on blood sugar. Sugar-free Jell-O gelatin (without maltodextrin) can be consumed pretty much whenever you like, provided you don’t stuff yourself and provoke the Chinese Restaurant Effect. As a rule, snacks limited to small amounts of protein will have less effect upon blood sugar than those containing carbohydrate. Thus 2–3 ounces of cheese or cold cuts might be reasonable snacks for some people.

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.