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The Diabetes Diet, Chapter 3 – Part 3

The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 3 of Chapter 3
Essential Guidelines for the Diabetes Diet

Keeping It Simple
There are no complicated formulas or calculations in the Diabetes Diet. In the following pages I will show you the foods that you ought to emphasize in your diet and the foods you ought to eliminate.

There are two kinds of carbohydrate, fast-acting (concentrated) and slow-acting (dilute). Eat a limited amount of the slow (for which I provide guidelines in the pages to come) and eliminate the fast/concentrated. That’s about as complicated as it gets. Next time you’re in a restaurant or at a buffet, you can look at the foods that are available and have a very good idea what you should eat and how much — without a calculator and an index.

The guidelines are simple and are provided so that you can use your own common sense to judge what’s acceptable in your diet and what’s not. Before long, you’ll find it all very easy.

NO-NO FOODS: SAY GOOD-BYE TO THE REAL HEART-ATTACK FOODS
If you have tried weighing glycemic load against glycemic index, or other similarly murky concepts, in order to figure out what and how to eat — forget it. It doesn’t have to be that arcane or difficult, and you don’t need a math degree. In the pages that follow are several lists. Most important is the list of common foods that contain fast-acting carbohydrate and should be eliminated from your diet. This includes virtually all grain products. Pure bran (hard to find) is the exception. So-called complex carbohydrate like brown rice, whole wheat flour in “sugar-free” cookies, pasta (whether al dente or cooked to mush), breakfast cereals (including noble oatmeal), corn, and other grain products are transformed into glucose so rapidly that in terms of their effect on blood sugar and insulin requirements, they are just like table sugar.

Other foods — ones that contain very small amounts of simple sugars — fall into a middle area. A single stick of chewing gum or tablespoon of salad dressing that contains 1 gram of carbohydrate is not going to wreak havoc on the ability of most diabetic adults to control blood sugar. But if you’re the kind of person who — like the old commercial said —can’t eat just one, but chain-chews gum or likes to have a major league baseball–sized wad going, you should probably avoid chewing gum (although small amounts of “sugar-free” chewing gum may help the digestion of those with delayed stomach-emptying; see Diabetes Solution, Chapter 22). If you eat salad only because you love the dressing, then you’ll have to use your judgment and your blood sugar profiles* and possibly switch to a vinaigrette or dressing that leaves out sugars entirely (such as the Blue Cheese Dressing or the Parmesan Dip in the recipe section of this book).

In or Out? A Simple Test
Here’s a really simple and objective way for you to tell if a food is in or out. Sometimes you’ll find yourself at a restaurant, hotel, or reception where you have no idea whether the food you’re about to be served has fast-acting, concentrated carbohydrate in it. Your waiter probably has little idea, or will tell you what he thinks you want to hear, so don’t even ask. I’ve found that the easiest way to make certain is to use Clinistix or Diastix test
strips. These are made for testing for the presence of glucose in urine and are available at most pharmacies. I find them handy for testing for sugar or starch in foods. Say you want to find out if a soup, salad dressing, or sauce has sugar or flour in it. Put a small amount in your mouth, mix it well with saliva (saliva is essential to the test because it
breaks down table sugar and starches to glucose), then spit a tiny bit onto the test strip. You can tell by the color it turns approximately how much, if any, fast-acting carbohydrate it has in it. The absence of color change on the test strip indicates no glucose. A very slight color change may be acceptable for foods you’ll eat in small amounts. You can also use this method with solid foods, but you’ll have to chew the food first. This is a method that can be very useful for finding and eliminating fast-acting or concentrated carbohydrate from your diet. Carry a pack of the sticks with you and when in doubt, test.

*See Diabetes Solution, especially Chapters 4 and 5.

Powdered Artificial Sweeteners

If you’re wary that artificial sweeteners might contain chemicals that could cause ill effects (cyclamates, remember, were banned in the United States because lab rats got cancer after eating the human equivalent of truckloads), I’d recommend first that you weigh the theoretical risk of lab rats and cancer against the very real, exhaustively researched ill effects caused by sugar. So far the harm resulting from the use of sugar is of considerably more concern, particularly for diabetics, than risks associated with artificial sweeteners.

If you want to research artificial sweeteners and find which you like best and which seem of lowest risk, I encourage you to do so. If you feel that you don’t need to use sweeteners, then by all means avoid them.

Food Count Bibles
Here are a few of the books of food values that can be helpful in figuring out your meal plan.
•The NutriBase Complete Book of Food Counts (Avery, 2001). $14.95 (paperback). My favorite.
•Bowes & Church’s Food Values of Portions Commonly Used, 18th ed., Jean A. T. Pennington and Judith S. Douglass (Lippincott Williams & Wilkins, 2004). $49.95 (plastic comb bound).
•The Complete Book of Food Counts, 5th ed., Corinne T. Netzer (Dell, 2000). $7.50 (paperback).

Personally, I have seen no ill effects from them, and I find them quite pleasant as additions to desserts like my nopie pumpkin pie, which is just unsweetened pumpkin pie filling mixed with some cinnamon and stevia or another sweetener. Without the cinnamon and sweetener, in my opinion, the pumpkin is about as tasty as Kleenex. With it, it’s a pleasant treat.

If you’ve rarely used artificial sweeteners and think you won’t care for them, let me assure you that it really doesn’t take long to get used to them.

At this writing, there are several artificial sweeteners available from different manufacturers under different names, and some, such as Equal and Sweet’n Low, are multiple sweeteners sold under the same brand name in different packaging.

Here, to simplify your shopping, are acceptable sweeteners currently or soon to be available:

• Saccharin tablets or liquid (Sweet’n Low)
• Aspartame tablets (Equal, NutraSweet)
• Acesulfame-K (Sunette, The Sweet One) — Not yet available in tablets or liquid form.
• Stevia powder or liquid — Has not been approved in the European Union.
• Sucralose (Splenda) — This is actually a sugar (the –ose ending indicates sugar), but one that the body does not recognize and does not break down. It is not yet available in the United States in tablet or liquid form, except in things like Da Vinci syrups. Demand is such, however, that a liquid version may soon be available in the United States.
• Neotame — Newly approved by the U.S. Food and Drug Administration (FDA) but so far only being marketed to manufacturers.
• Cyclamate tablets and liquid — Not yet available in the United States, but sold in Canada under the name Sugar Twin.

These sweeteners vary in their availability and cost. All can be effectively used to satisfy a sweet tooth without, for the most part, affecting blood sugars.

Note that the only acceptable powder on the list above is stevia. Other powders contain an additive to increase bulk. That additive happens to be sugar, most often in the form of glucose or maltodextrin or both, and though the packet label will claim it’s 0 carb, or 0 calories, that’s only because the serving size comes in under the FDA radar —that is, 0.9 gram of dextrose doesn’t constitute a “significant amount.” But I have learned from experience that it will rapidly raise blood sugar a significant amount if you consume a few packets.

Bottom line: Don’t use powdered sweeteners except stevia. If you are the kind of person who likes your coffee or tea sweet, then carry a container of the tablets of your choice — or stevia powder — with you in your purse or pocket.

A new “natural artificial” sweetener, called tagatose, will soon be available under the brand name Naturlose from Spherix, Inc., in the United States. Derived from milk, it’s claimed to be 92 percent as sweet as sugar and said to have similar bulk, with no aftertaste and no effect on blood sugars. Whether it really does have no effect on blood sugar remains to be seen. It is being marketed as requiring no added glucose or maltodextrin to bulk it up, so if it is indeed sold in powdered form without added sugars, it may be a valuable addition to the arsenal.

In many cases, what manufacturers and nutritionists and doctors call “no effect on blood sugars” or “negligible effect” has significant enough effect to make blood sugar control more difficult.

Another new artificial sweetener, neotame, is being sold as an additive by the makers of NutraSweet. It is supposedly 8,000 times as sweet as table sugar. Its use as a food additive should pose no problems, but if it becomes available as a powder over the counter, it will probably be mixed with a sugar as in the instances cited above.


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.