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Sugar Free, Gluten Free, And Vegan Are NOT Carb Free

Feb 21, 2017

Woman, 53 years of age. Type 2 diabetes and is obese. Patient’s daughter was getting married. She was very motivated to lose weight for the wedding and she did. Her A1C lowered from 7.5% to 6.6%. She cut back on her carbs to <100gm/day, increased her activity and took her metformin regularly. She lost 22 pounds over 6 months. The wedding was 2 months ago and she has gained 6 pounds. That may not seem like much, but it was enough to raise her A1C and open her eyes.

I asked her what she thought happened. She said she started munching at night on gluten free vegan cookies. She would eat the whole bag. She thought Gluten Free meant “free.” I asked her to show me the picture of the nutrition facts. Sure enough, as many as she ate, they really added up. The Nutrition Facts said they were 5-6 cookies per serving. For the serving size of 5-6 cookies it is 19 grams of carbs. It also says there are 9-10 servings per container. If she ate the whole bag, which she said she did, that comes out to about ~181 grams of carbohydrate for her evening snack. And, she had become less active, and did not take her medications regularly anymore.

I discussed with her that the wedding was behind her now. That was her motivating force. What now would be her motivation to stick with her plan? She told me it was for her health, not only in the long run, but she felt so much better and felt better about herself when she was on track.

We discussed a plan. A simple plan. I taught her how a lot of claims on packages do not mean “free.” Retaught her how to read nutrition facts. Discussed a plan for her to resume her medications and activity. Time will tell, but knowing her, I think she’ll follow through because I did not tell her what to do. We made a plan together she thinks she can work with.

Lessons Learned:

  • Always ask the why. Why do you want to manage your diabetes? Why do you want to lose weight? Whatever the reason our patients come to us, ask the why.
  • Celebrations, especially those that are very personal such as a wedding, whether the patient’s or the patient’s family members, or anything deeply personally related, is a motivation for many.
  • Teach patients how to read food labels. Keep it simple. For example, for diabetes, first teach to look at serving size and servings per container, and total carbohydrate count. Teach that the total carbohydrate count is for the serving size, not the whole container.
  • Teach patients what their personalized carb counts should be.
  • Come up with a plan together with the patient. The patient knows what the patient can and will do. Make sure it’s doable.


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