The Diabetes Diet
Richard K. Bernstein, MD, FACE, FACN, FACCWS
Part 5 of Chapter 3
Essential Guidelines for the Diabetes Diet
Bread and Crackers
One average slice of white, rye, or whole wheat bread contains 12 or more grams carbohydrate. “Thin” or “lite” breads are usually cut at half the thickness of standard bread slices and therefore contain half the fast-acting, concentrated carbohydrate,
but they are still unacceptable. So-called high protein breads contain only a small percentage of their calories as protein and are not significantly reduced in carbohydrate unless they are thinly cut. Virtually all breads contain unacceptable levels of fast-acting carbohydrate, so it’s best to avoid bread and crackers in general. There are some bran crackers that are acceptable because virtually all of their carbohydrate is indigestible fiber (see page 83).
Some diabetics with delayed stomach-emptying can include a slice of thin bread or one to two small crackers as part of their diet, but the rest of us experience very rapid increases of blood sugar after eating any grain product. This includes health food store grains, such as barley, kasha, oats, sorghum, and quinoa.
Rice and Pasta
Both pasta (when cooked al dente) and wild rice (not a true rice but actually another grain) are claimed by some nutrition authorities to raise blood sugar quite slowly. This is not true, as you can confirm by checking your blood sugar or trying the Clinistix/Diastix test. Like wild rice and pasta, white and brown rice also raise blood sugar quite rapidly for diabetics and should be avoided. The same is true of rice cakes. Al dente pasta is often touted as being “low” on the glycemic index scale because some of the grain isn’t thoroughly cooked and therefore (the reasoning goes) acts more slowly on blood sugars.
But it doesn’t act slowly enough, which is further proof that the glycemic index is best ignored by diabetics. Avoid rice and pasta — whether al dente or boiled to mush.
Most cold cereals, like snack foods, are virtually 100 percent carbohydrate, even those claiming to be “high protein.” Many have so much sugar, you might as well just eat candy. Even bran flakes are mostly flour. If you’ve been eating bran to improve bowel function, you can substitute psyllium husks powder, which is entirely indigestible fiber.
Use only the sugar-free variety of Metamucil or other such products. (You can get the husks powder at a health food store and mix with water. If you don’t care for the texture or taste, you can drink it mixed in diet soda. Some health food stores also have it in capsules, but you have to make sure you have plenty of water.) You can also make your own cereal from pure bran if you can find it in a health-food store.
*Even though some nuts are relatively low in carbohydrate, it’s very difficult, for instance, to have a snack of just four macadamia nuts. That said, there are recipes in this book that use nuts — for example, the toasted nuts in the Cream of Artichoke Soup are only a small part of a larger recipe and add a little crunch and texture.
Oatmeal, according to some low-carb diet books, has little effect on blood sugars. This could not be further from the truth. Breakfast cereals, cooked or cold, even in small servings, make blood sugar control impossible.
One of the reasons many of my new patients are overweight or obese is that they snack incessantly. A few cookies here, a bag of chips or popcorn there, a candy bar or a couple of handfuls of little crackers — pretty soon you’re on your way to overweight and obesity. These foods are virtually all carbohydrate and frequently have added sugar of one variety or another. Some nuts (macadamia, for example) are relatively low in carbohydrate, but who can sit down and eat only four? If you can, fine. Otherwise, it’s best to avoid snacking entirely. Indeed, if you’re an overweight snacker who eats for
“recreation,” you will likely find that shortly after beginning the Diabetes Diet, your need to snack will disappear. (See “Comfort Foods and Carbohydrate Addiction,” page 135.)
Protein and Diet Bars
Although drugstore and grocery shelves are full of bars that brands and found that all but two contained much more carbohydrate than stated on the labels. These were removed from the marketplace, but many more remain. This is another case showing that when it sounds too good to be true, it probably isn’t true. Most protein bars associated with well-known diets have unacceptable levels of carbohydrate. There are plenty of so-called diet products whose main ingredient is sugar.
Avoid protein or diet bars as meal substitutes unless you are absolutely certain they have virtually no carbohydrate and no stealth sugar.
Milk contains a considerable amount of the simple sugar lactose and will rapidly raise blood sugar. Skim milk contains the most lactose per ounce; heavy cream has the least.
Although 1 or 2 teaspoons of milk in a cup of coffee will not significantly affect blood sugar, a few tablespoons will make a considerable difference to most of us. Cream, which you have probably been instructed to avoid, is okay. One tablespoon has only 0.5 gram of carbohydrate, and it tastes much better than substitutes and provides much better “lightening power.”
Nondairy creamers, liquid or powder, contain relatively rapid acting sugars and should be avoided if you use more than a teaspoonful at a time or drink more than 1 cup of coffee at a meal. A coffee lightener worth considering is Wes tSoy brand soymilk, which is sold in health food stores and many supermarkets throughout the United States. Although several West Soy flavors are marketed, only the one marked 100% Organic Unsweetened is unsweetened. The plain, unflavored variety claims only 5 grams of carbohydrate per 8-ounce serving. Other unsweetened and unflavored brands, such as Vitasoy and Yu Natural, are available in various parts of the country. One catch — soymilk curdles in very hot coffee or tea.
Here’s a tip. If you drink coffee or tea at work and like it lightened, and if you share a common refrigerator with your coworkers, you probably find that when you bring in a pint of milk or half and half, it magically disappears. But your coworkers are probably conditioned to fear fat, so if you bring in a container of heavy cream, it will stay unmolested in the refrigerator — and it contains much less carbohydrate per serving.
Fruits and Fruit Juices
Most fruit juices have as much or nearly as much sugar and other fast-acting carbohydrate as regular soft drinks and will act dramatically on blood sugar levels. If you doubt this, you can prove it with a few experiments with blood sugar measurements. Some fruits and juices, despite their bitterness (for example, grapefruit and lemon) contain considerable amounts of simple sugars.
Learning to avoid juices used to be a big sacrifice for many of my patients, but it’s increasingly accepted, thanks to the popularity of low-carb diets. Eliminating fruits as well, however, is a different matter. Most of us are accustomed to the idea that fruits and vegetables are a good thing, period. Most of what we commonly think of as fruit has a less rapid effect than juice on blood sugar, but fruits still cause an unacceptably large blood sugar rise. Some people fear that they will lose important nutrients by eliminating fruit, but that shouldn’t be a worry. I haven’t eaten fruit in more than thirty years, and I haven’t suffered in any respect. Nutrients found in fruits are also present in the vegetables you can safely eat.
Most of us think of sweet fruits when we refer to fruit —apples, oranges, and bananas — all of which you should avoid. There are, however, a number of true biological fruits (the part of certain plants that contains pulp and seeds) that are just fine for the diabetic and the overweight or obese person trying to lose weight. These include summer squash, cucumbers (including many types of pickle), eggplant, bell peppers (green and red only), chili peppers, and avocado. These tend to have large amounts of cellulose, an ndigestible fiber, rather than fast-acting carbohydrate, and they do contain vitamins and other essential nutrients.
In addition to being tasty and versatile, they can also promote digestive health for some people. It’s worth noting that cellulose, found in vegetables and fruits, is essentially the same fiber that makes up much of the shady elm on the corner. It has indigestible calories your body won’t metabolize. People don’t have the enzymes necessary to break down cellulose, so it passes right through the digestive system without affecting blood sugars — so long as we don’t eat excessive amounts that provoke the Chinese Restaurant Effect (page 36).
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.