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So What’s Low Carb? Chapter 4 – Part 1

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 1 of Chapter 4
So What’s Low Carb?

Most of my patients initially feel somewhat deprived, but they are also grateful to feel more alert and healthier —sometimes more so than they have in years. 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.

Good question. In the days when I first developed this diet, virtually all of the carbohydrate foods I had been told were fine to eat made blood sugar control impossible, so I had to figure it out on my own. While something like the glycemic index rates carbohydrates at various levels, I have just two — carbohydrate that will make blood sugar control difficult or impossible, and that which makes it easy. This is a lot simpler than indexing or loading or exchanging — and unlike all those other methods of analyzing carb contents, it works.

The following pages contain an overview of the foods I eat and recommend to my patients. Please remember that with the exception of the no-calorie beverages (including the many different kinds of bottled waters that have no added carbohydrate) and moderate portions (half a cup) of sugar-free Jell-O without maltodextrin, there are no “freebies.” Virtually everything you eat will affect blood sugar if you eat enough of it — remember the Chinese Restaurant Effect. So if you get that “once I start eating it, I just can’t stop” feeling with a particular food, you should obviously avoid it altogether.

You may discover foods I’ve never heard of that in small amounts have a negligible effect on blood sugar. And there may be things that in small amounts do not affect your blood sugar that do affect mine. You should 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.

Name ten vegetables you’ve eaten in the last 3 days. I’ll bet most people can’t. No wonder the FDA now requires that grain products have folic acid added. The sad reality is that people are more likely to eat grain products than green products. Folic acid, which derives its common name from the word foliage (its real name is pteroylglutamic acid), is plentiful enough in whole-plant and leafy green vegetables that we really shouldn’t need to depend on supplements and treated foods. In addition, greens are a great source of bioavailable calcium, or calcium that the body can easily absorb. Most vegetables, other than those listed in the No-No list with a high level of fast-acting carbohydrate, are fine. Other vegetables to avoid would include those that fail the Clinistix/Diastix test.

As a rule of thumb, O cup of cooked vegetable, G cup mashed cooked vegetable (depending on the density of the vegetable), or a cup of mixed salad acts upon blood sugar as if it contains about 6 grams of carbohydrate. Cooked vegetables tend to raise blood sugar more rapidly than raw vegetables because cooking makes them more digestible and converts some of the cellulose to glucose. As a general rule, more cooked vegetables will fit into a measuring cup than raw vegetables, particularly leafy vegetables. If you’ve ever sautéed spinach, you know that a skillet heaping with raw leaves will give you less than half a skillet of cooked spinach.

If you have diabetes, it’s wise to keep daily records of your blood sugar and to note on your self-measurements how your favorite vegetables (or, for that matter, any food) affect your blood sugar. (See page 111 for an example of the Glucograf II data sheets I and my patients use to keep track of blood sugars.)

Raw vegetables can present digestive problems to people who experience delayed stomach-emptying. As noted before, if you have delayed stomach-emptying, also called gastroparesis, or if you think you might, the complete guide to dealing with it is in Chapter 22 of Dr. Bernstein’s Diabetes Solution.

Of the vegetables listed on the facing page (the list is by no means exhaustive), 1 cup of raw and O cup of cooked vegetable (G cup if mashed) acts on blood sugar as if it contains about 6 grams of carbohydrate. In addition to the foods on The List, keep the following in mind:

• Onions are high in carbohydrate and should only be used in small amounts for flavoring. You’ll notice that most of the recipes in this book use shallots instead (shallots are from the same family as onion and garlic — the allium family — with a flavor sort of halfway between the two). They — and chives — pack a lot of flavor in small amounts.

• One-half medium 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, cooked vegetable acts as if it contains about 6 grams of carbohydrate.

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