The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 5 of Chapter 4
So What’s Low Carb?
Low-Carbohydrate Salad Dressings
Most salad dressings are loaded with sugars and other carbohydrates. The ideal dressing for someone who desires normal blood sugars would therefore be oil and vinegar, perhaps with added spices, mustard, and followed by grated cheese or even real or soy bacon bits. I like to add Da Vinci sugar-free raspberry syrup to mine.
There are now available some commercial salad dressings with only 1 gram carbohydrate per 2-tablespoon serving. This is low enough that such a product can be worked into our meal plans. Be careful with mayonnaise. Most brands are labeled “carbohydrate — 0 grams,” but they may contain up to 0.4 grams per tablespoon. This is not a lot, but it adds up if you eat large amounts. Some imitation mayonnaise products have 5 grams of carbohydrate per 2-tablespoon serving.
Although all nuts contain carbohydrate (as well as protein and fat), they usually raise blood sugar slowly and can in small amounts be worked into meal plans. As with most other foods, you will want to look up your favorite nuts in one of the books listed on page 52 in order to obtain their carbohydrate content. By way of example, 10 pistachio nuts (small, not jumbo) contain only 1 gram carbohydrate, while 10 cashew nuts contain 5 grams of carbohydrate. Although a few nuts may contain little carbohydrate, the catch is in the word “few.” Very few of us can eat only a few nuts. In fact, I only have two patients who can count out a preplanned number of nuts, eat them, and then stop. So unless you have unusual will power, beware. Also beware of peanut butter, another deceptive addiction. One tablespoon of natural, unsweetened peanut butter contains 3 grams of carbohydrate, which would raise my blood sugar modestly. Ten tablespoons would have a whopping effect.
Sugar-Free Jell-O Brand Gelatin
This is one of the few foods that in reasonable amounts will have almost no effect upon blood sugar — if you get the kind that is indeed sugar-free. Unfortunately, nowadays “sugar-free” powder actually contains some maltodextrin, which is a mixture of sugars and will raise your blood sugar. The ready-to-eat variety in plastic cups does not thus far contain maltodextrin — at least those I’ve found on my grocery’s shelves. Check the labels. Truly sugar-free Jell-O or other truly sugar-free brands of gelatin are fine for snacks and desserts. A 1/2-cup serving contains no carbohydrate, no fat, and only 2 grams of protein. Limit yourself to no more than 1/2 cup twice daily and none at bedtime.
My patients who eat sugar-free Jell-O at bedtime tend to experience an overnight blood sugar rise. If the only “sugar-free” Jell-O you can find contains maltodextrin, try making your own by adding some liquid stevia and Da Vinci syrup to Knox unflavored gelatin as a tasty substitute.
Sugar-Free Jell-O Puddings
Available in chocolate, vanilla, pistachio, and butterscotch flavors, these make a nice dessert treat. These all contain a small amount of carbohydrate (about 6 grams per serving), which should be counted in your meal plan. Instead of mixing the powder with milk, which will raise the carbohydrate content, use water or water plus cream. Every 2 tablespoons of cream will add 1 gram of carbohydrate.
Gum chewing can be a good substitute for snacking and can be of value to people with gastroparesis because it stimulates salivation, releasing 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 to about 7 grams per piece for some liquid filled chewing gums. The 7-gram gum will rapidly raise my blood sugar. The carbohydrate content of a stick of chewing gum can usually be found on the package label. “Sugarfree” gums all contain small amounts of sugar. The primary ingredient of Trident “sugarless” gum is sorbitol, one of the stealth sugars from page 55 — actually, it’s a corn-based sugar alcohol. Trident also includes mannitol and aspartame.
I frequently use a chewing gum called XlearDent. It contains about I gram of the sugar xylitol per piece. Xylitol is an antimetabolite (metabolic poison) for bacteria and prevents tooth decay when chewed regularly. The gum may be obtained by phoning 877-599-5327, or on the Internet at www.xlear.com. Orbit also contains a small amount of
xylitol and has more flavor that lasts longer than that of Trident or Xlear.
Truly Low Carbohydrate Desserts
This book includes 112 new low-carbohydrate recipes, created by chef and restaurateur Marcia Miele, who has learned the hard way how to “cook diabetic.” Her son Dante, a type 1 diabetic, is a patient of mine. Her easy recipes for some low-carbohydrate desserts are truly delicious — for a kid who “can’t have sweets,” Marcia has had to be very creative.
Coffee, Tea, Seltzer, Mineral Water, Club Soda, Diet Sodas
None of these products should have significant effect upon blood sugar. Some of the popular low-carb diets say to eliminate coffee as much as possible. In theory, it should increase glucagon production and therefore raise blood sugar, but I have not seen it have an adverse effect on blood sugar when used in moderation. The coffee and tea may be sweetened with liquid or powdered stevia, or with tablet sweeteners such as saccharin, cyclamate, sucralose (Splenda tablets, if and when they arrive on the market), and aspartame (Equal tablets). Remember to avoid the use of more than 2 teaspoons of 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) 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 (11/2 ounces of spirits or 3 ounces of dry wine for a typical adult) are usually negligible.
Most beers (not stout or porter), in spite of their carbohydrate content, don’t seem to affect blood sugar when only one can or bottle is consumed. If you like beer, try one, then check blood sugar hourly for the next 3 hours to see if the beer has caused an increase.
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.
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.