Cooking for Diabetes

Are you new to diabetes? Are you wondering what to eat? Hopefully the following will give you some encouragement and ideas.

Who says that having diabetes means you can’t still whip up delicious, homemade food? When you know the basics of meal planning, you can make almost any recipe work.

So, don’t throw out your cookbooks or toss your favorite recipes. Instead, learn some tips about how to cook wisely.

1. Cook with liquid fats in place of solid fats – no definitely not. You may use both and the solid fats are excellent. Just avoid any trans fats.

Solid fats often include saturated fats, which you should limit, or trans fats, which you should avoid totally.

If a recipe calls for solid fat like butter, lard, or hydrogenated shortening, try trans-fat free margarine (never use margarine), spreads, or shortening instead. Check the label to see whether the product will work for cooking or baking.

Many liquid fats -- oils such as canola, corn, olive, and grape seed -- can be healthy when used in moderate amounts (and these fats have added to the epidemic of obesity. Some oils have stronger flavors that may affect the taste. Experiment to find which oils work best with which recipes.

2. Switch to low-fat dairy (Please consider medium fat to whole milk).

Many dairy products used in cooking and baking are high in fat. You can lower the fat content without compromising taste (do be careful of complete low fat).

3. Use less fat altogether.

Or, if you’re whipping up a treat that calls for chocolate or chocolate chips, try cocoa powder, or use mini-chocolate chips and use fewer of them.

When cooking up a soup or stew, skim off the fat that floats to the surface while it’s on the stove. Or, place the pot in the refrigerator. When the fat has hardened at the top, it's easy to skim off. (I do not agree with removing all fat, as you body needs some fat for the intestines to be healthy).

4. Be smart about carbs.

Choose those that give you energy that lasts and fiber.

When a recipe calls for "white" flour, "white" rice, or other refined grains, try substituting whole-wheat flour, brown rice, or other whole-grain flours or grain products. You can also use ground nuts such as almond or hazelnut (filbert) meal. Or you can mix several of these whole-grain ingredients together in the same recipe. (Be cautious with whole-grain flours as they do spike your blood glucose levels).

5. Skimp on the sugar.

Sugar can quickly raise your blood sugar, unlike the carbs from vegetables or starches, which are absorbed more slowly.

Many times, you can cut the amount of sugar without seriously affecting taste or texture, though you may need to add more flour. An exception: You can’t cut corners if something you're baking needs yeast, because the yeast needs the sugar in order to do its job. If you’re using a sugar substitute, check the product label to be sure it’s designed for baking.

6. Experiment with flavor.

Reach for ingredients other than sugar, salt, and fat to satisfy your taste buds. Try out different herbs, spices (cinnamon, cardamom, nutmeg), mustards, and vinegars (balsamic, sherry).

Some spices may even have health benefits of their own. Cinnamon, for example, may help lower blood sugar levels.

You can also cut the amount of salt in a recipe, unless the recipe includes yeast, which needs the salt for rising. Or skip the salt entirely when you’re cooking, and then sprinkle a little on at the table when it’s time to eat.

Another way to reduce how much sodium you get is to choose fresh over canned and frozen foods, which tend to be higher in salt. If you’re cooking with nuts, check that they aren't salted.

7. Ask a pro.

If you have favorite recipes that you’d like to make diabetes-friendly, ask your doctor for a referral to a nutritionist. They’re experts at helping plan meals that are appropriate for people with diabetes or other health issues.

If you don't agree, please read the full article here. I say that people are still promoting low fat and high carbohydrate, which over the years since 1977 has been shown not to be healthy for us.

Carbohydrate Restricted Diet May Prevent Type 2

According to a new comprehensive financial analysis reported in the Journal of the American Medical Association and The Washington Post by the University of Alabama at Birmingham, diabetes leads a list of just 20 diseases and conditions that account for more than half of all spending on healthcare in the United States.

U.S. spending on diabetes diagnosis and treatment totaled $101 billion in 2013, and has grown 36 times faster than spending on heart disease, the country's No. 1 cause of death, researchers reported.

University of Alabama at Birmingham Professor of Nutrition Barbara Gower, Ph.D., conducts research on diet composition and disease risk and says that diabetes can both be prevented and reversed with a carbohydrate restricted diet.

Type 2 diabetes (Bold is my emphasis) can be managed with diet alone in many cases. However, this message is not getting to the patients; they are told to take drugs. A clinic at UAB treats diabetics with a diet that dramatically reduces carbohydrates. In most cases, patients can eliminate all medication.

"They are thrilled to stop injecting insulin, and they question why "no one ever told them" they could control their diabetes diet alone," Gower said. "The conventional advise to diabetics is to eat carbs, and then inject insulin - or take other drugs.

"The medication is needed because diabetes is a disease of carbohydrate intolerance; if the patient does not eat carbs, they do not have to use medication," she said.

"I use the 'cigarette' analogy. We know it is bad to smoke, so we tell patents not to smoke. Why don't we do the same thing with sugar and processed starches? The excuse I hear is that 'people won't stop eating sugar and starches.' However, by the same analogy, we could have thrown up our hands and said, 'people can't give up smoking.'"

"We need to treat diabetes like lung cancer and COPD; all of these diseases are preventable with lifestyle," Gower said. "Further, even with established, long-term, type 2 diabetes, it can be managed with diet. It is not impossible to eat a low-carb diet that is healthful and satisfying. We do it all the time, and we teach our patients to do it. They love it.

"Carbohydrates are not essential nutrients for the human body, and with proper instruction, patients can adjust their diets to minimize them."

What I believe may not agree in total with the above, but I do believe this - In nutrition there is always more than one solution and our bodies all react differently - even if people are fed identical meals. Hopefully the above study does help people as described.

The Holidays Often Bring Added Stress

How many of you dread the holidays? I know I used to, before diabetes, as I detested the constant hassles of the holidays with a certain relative. If there was something I had said or done, I was sure to hear about it three times over and in a negative manner, even if it had been something positive to begin with.

I also have a friend that presently will avoid family gatherings during the holidays, just to avoid food and the lectures he receives about not eating enough. He was diagnosed with prediabetes five years ago and because he started to ask questions, he had been able to learn and not develop diabetes. His wife is very upset because he will not go to holiday events when the families are in attendance. He finally told her that his mother was the reason and kept demanding that he eat more than he wanted and would pester him in the days leading up to the gathering and for days after if he did not eat all that she put on his plate.

So this year his wife finally agreed that they should not go to any events that his family would be attending and did convince her family that they would not attend any family event where his family would be present. Her family did trick them and when they arrived, and saw his family, they left immediately. And when the phone calls started from his mother, she finally understood the stress being placed on him by his mother. She even told her family to forget them coming to any holiday gatherings because of their trick.

When I last saw him, he said they were actually looking forward to starting their own holiday traditions. Whether her family or his family was invited would depend on how they treated them and the grandchildren. When his mother insisted on loading the plates and distributing the food at their place, she would never be allowed to come back and this was carefully explained to her, as they did not want the stress she was putting on the family. He told me that she told him and his wife they should be thankful that she did not want them to starve and to eat more food than they were eating.

He said he asked her if she wanted the entire family to develop diabetes. She said she was not putting sugar in their food. At that point, he said he did try some education and she would not believe that diabetes was caused by anything but sugar. He said he finally told his mother that until she talked to a doctor about diabetes and learned that carbohydrates were converted by the body into glucose, she would not be welcome in their home. His wife said she would not because she knew it was sugar that caused diabetes and carbohydrates were necessary for our bodies to remain strong and healthy.

At that point, she asked her family what they knew about diabetes and both my friend and his wife were surprised that they actually knew and she was told that one of her father's brothers had type 2 diabetes. She then told her parents why they did not want to spend any of the holidays with his parents and it was because his mother only believed sugar caused type 2 diabetes and loaded up the plates with carbohydrates. Her parents said they would not trick them in the future and now understood why they did not appreciate his mother loading the plates when he was trying to limit the carbohydrates.

Are You Staying within Your Calorie Budget?

I know some people with type 2 diabetes are, but many are not because they are totally immersed in counting carbohydrates and they ignore calories. How many calories have you eaten today, how many should you eat? Many can guess how many calories do you need? The 2000-calorie-a-day standard is just a ballpark figure, used by FDA to calculate daily values on food labels. The following table will give you more of a range. The weakness of the table is no information is listed for active adults and for children and adolescents.

Here are the typical calorie needs of inactive adults, according to the U.S. Department of Agriculture:

WOMEN

• Ages 19-30: 2,000 calories

• Ages 31-50: 1,800 calories

• Ages 51-plus: 1,600 calories

MEN

• Ages 19-30: 2,400 calories
• Ages 31-50: 2,200 calories
• Ages 51-plus: 2,000 calories

These age ranges are for people in good health and not for people with chronic diseases like type 2 diabetes. In addition, I would question the age ranges above 51, as there could be other ranges that need clarification for people over 70. Since I am not an expert in counting calories, my guess would be that for people with type 2 diabetes should probably be less that the calories above.

Again, get out the blood glucose meter and use this before and after consuming a meal. This will also tell you if you are eating too many calories. People that are very active can probably consume more calories. There are calorie calculators like this at the Mayo Clinic website. Just be aware that all calorie calculators are based on a one-size-fits-all basis.

Just like carb counting, there are variables to consider. Metabolism is a big variable – do you have an unusually slow or fast burning metabolism. Fortunately, a doctor can give you a breath test to check that. This knowledge will help the doctor and you set an individualized calorie goal.

A majority of adults need or want to lose weight. For this, there is a one-size-fits-all calorie formula. This will work for some people, but many will not have success. If you change your level of exercise, you may lose more weight and faster than anticipated.

For people with type 2 diabetes, stick with the carbohydrate count and start learning the calorie count. This is because some foods are higher in calories than the carbohydrate count and a few foods are higher in carbohydrate count than calorie count.

How Much Protein?

Because there are different guidelines for protein needed I will show the chart first, which is from the Institute of Medicine (IOM).

Exactly how much protein you need changes with age:

1. Babies need about 10 grams a day.
2. School-age kids need 19-34 grams a day.
3. Teenage boys need up to 52 grams a day.
4. Teenage girls need 46 grams a day.
5. Adult men need about 56 grams a day.
6. Adult women need about 46 grams a day (71 grams, if pregnant or breastfeeding)

You should get at least 10% of your daily calories, but not more than 35%, from protein, according to the Institute of Medicine.

The key measure is the Dietary Reference Intake (DRI), a system of nutrition recommendations from the Institute of Medicine of the U.S. National Academy of Sciences. Used by both the United States and Canada, the DRI supersedes the Recommended Dietary Allowances (RDAs), which is still used in food labeling.

Protein from animal sources such as meat, poultry, fish, eggs, milk, cheese, and yogurt provide all nine indispensable amino acids, and for this reason are referred to as ‘complete protein.'

Doctors still want you to limit saturated fat and select leaner cuts of meat. I would only agree on limiting processed meats like hot dogs and sausage. According to researchers at the Harvard School of Public Health, to help lower the chance of heart disease, it's a good idea to limit the amount of red meat, especially processed red meat, and eat more fish, poultry, and beans.

Other researchers say if you are trying to get more omega-3s, you might choose salmon, tuna, or eggs enriched with omega-3s, and if you need more fiber, look to beans, vegetables, nuts, and legumes.

Some of us with type 2 diabetes can have real problems with protein, especially if they have kidney disease and need to limit their amount of protein. Without kidney disease and following a vegan diet, then the problem becomes consuming enough protein. That is why I listed the table for protein consumption at the beginning.

Most of the studies proclaiming low-carb diets are good also have the diet as a low fat and were replacing the carbohydrates eliminated with protein. Some said this was good and others make no comments. The reason for the low fat is that many do not recognize the fallacy of Ancel Keys and that his conclusions have been debunked.

I do not agree to the low fat argument and think fat needs to be the macronutrient added as long as protein is at the level needed providing kidney disease is not a problem. A good discussion with a nutritionist may be necessary as well as the doctor if there is a kidney disease. No, I did not say a dietitian, as they generally want the carbohydrates to stay up and especially the whole grains. Gallbladder issues may also limit the amount of fat you can tolerate.

Please read this blog by David Mendosa about protein. He covers the many sides of protein that I do not.

Nutrition for People with Diabetes

In covering the new nutrition guidelines (a PDF file) from the ADA (American Diabetes Association) from last October, I was more than a little harsh because of the registered dietitians on the guideline committee. Yes, the guidelines are developed by a select committee of nutrition experts and the guidelines are evidence-based. Much of the evidence is from randomized clinical trials, but some is called expert opinion or expert consensus if we are to believe that is possible in dietary nutrition. When many of the authors of the ADA nutrition guidelines are beholden to Big Food and Big Ag, one must wonder if personal 'expert' opinions were not injected in the guidelines.

There are some new concepts not in prior guidelines. This may be the most positive aspect to come out of the 2013 guidelines.

Eating patterns. This has not been discussed in guidelines before and for people with diabetes, this is a milestone in change. Be recognizing that there are many types of eating patterns, this makes individualizing a meal plan more realistic. The types of meal plans include:

• The DASH (Dietary Approaches to Stop Hypertension) eating plan
• The Mediterranean-style eating plan
• Vegetarian and vegan diets
• Low-fat diets
• Low-carbohydrate diets

This allows room for other eating plans and making people with diabetes feel more relaxed about their food plan. Just because a friend may like a vegan diet, does not mean that your personal preferences have to be the same. It is your personal food plan that is important to you. It will make your likes and dislikes, cultural background, religion, economic situation, and glycemic goals more important for your eating pattern.

Macronutrients. These are carbohydrate, protein, and fat.

Carbohydrate – I have been one to criticize the American Diabetes Association for promoting high carbohydrate diets, but I need to consider that with the new guidelines that their promotion has changed.

Until I see the Academy for Nutrition and Dietetics (AND) stop promoting Big Food, the people with type 2 diabetes will still need to be very careful in what the registered dietitians are promoting in the number of carbohydrates they recommend. Many are still promoting 60 grams of carbohydrates for each meal and 15 to 25 grams of carbohydrates for snacks. One that I heard about recently was promoting almost 280 grams of carbohydrates per day. Most of us with type 2 diabetes cannot consume that many and will gain weight rapidly doing this.

Many of the registered dietitians have switched to promoting percentages to mask the number of carbohydrates they are promoting. They have been recommending that it is up to the individual, but they still promote a higher percentage of carbohydrates. With most type 2 diabetes patients needing to lose weight (about 85 percent), reducing the number or percentage of carbohydrates consumed is the most efficient method and if possible adding exercise to this.

Another trick dietitian's use is alternating between grams of carbohydrates and percentage of carbohydrates to confuse those they are supposedly teaching. But more often, they are just issuing mandates and mixing the terms in to make it sound like they are individualizing the treatment for you.

The two following paragraphs are typical examples of the language used to make the type 2 patient think they are doing what is best for them.

“There’s a considerable amount of space in these recommendations devoted to lower-carb eating plans and some of the research does, indeed, show positive effects of lower-carb eating patterns, particularly in terms of weight loss. However, the authors of the guideline do point out that one of the downsides with low-carb diets is that there isn’t a standard definition of “low carb.” The authors describe “very low” carbohydrate intake as being from 21 grams to 70 grams of carbohydrate per day and “moderate” carbohydrate intake as comprising between 30% and 40% of total calories. But there’s no general consensus about this.”

“The recommendations also, for the first time, recommend limiting the intake of sugar-sweetened beverages. Monitoring carbohydrate intake, whether by counting carbs or watching portions, is still considered an effective means of controlling blood glucose. And substituting low-glycemic-index carbohydrate for high-glycemic-index carbohydrate may modestly improve glycemic control.”

Since there are no existing guidelines for the different carbohydrate levels, I only offer these as a suggestion from a previous blog. If you believe differently, I have no objection, but please be consistent and follow your personal chart. I will have more in the next blog for protein and fat.

Potatoes, Rice, and Bread = Carbohydrates

When reading blogs written by people required to follow the dogma of the American Diabetes Association (ADA), I can only say that the advice needs to be scrutinized very carefully. They tend to treat topics like carbohydrates as a “one size fits all” mantra.

This means you should trust your meter and what it is telling you about the foods you are consuming. Then adjust your portion size to fit what your meter is telling you. Yes, some people can eat all three foods in the title above, and others must eliminate all three from their menu. This means that each individual must find their level and follow it. Periodically you may need to retest to see if anything has changed as this can happen.

We must understand that the ADA promotes the USDA MyPlate solution for starches. Promoting them as the source of nutrients can be misleading as many of the vitamins and minerals can be found in other foods and often in higher quantities. There are people that cannot tolerate gluten found in grains, but these people are often ignored in their advice.

The question included potatoes, rice, and bread, but bread is often the main topic of discussion and brown rice is just given a mention. Potatoes are often completely ignored and a broad statement is made about starches. While potatoes are starches, some types of potatoes create lower blood glucose problems than others. Here again, testing is the only way I know that will give you answers of what types will work for your body chemistry. I am still able eat some potatoes, but not as often or as much as before diabetes.

What I have been surprised about is the rice. One variety (white rice) that everyone has told me to avoid, I can have a decent size serving and have only a small increase in blood glucose. Now brown rice does raise my blood glucose more than 60 mg/dl with just a small serving. This is why each person needs to find out what their body tolerates and not rely on others and what works for them.

Educators will not tell you that if you have a weight problem, elimination of wheat from your diet may help the most in weight reduction. They will only say to eliminate the highly processed bread and use whole wheat bread. Both contribute to the weight problem and it is the quantity of bread consumed. If you can tolerate wheat, consider greatly limiting the quantity.

Everyone needs to be confident of what they eat in relation to the level the food will raise your blood glucose. Meters today are slowly becoming more accurate and we need to trust them. I still find changes that I need to make as I age and my body becomes more sensitive to certain types of carbohydrates.

Are You Allowed Sweets As A Type 2?

I almost gave this blog passing marks, until I reread it and wondered when calories had replaced carbohydrates as a measure for determining the quantity of food we eat.

Then I need to ask what are they basing “consumed adequate quantities from the recommended food groups” on in their statement. We are all in trouble if it is the USDA Plate model for nutrition.

This appears to be just another “one size fits all” blog. It would be great if this was true and then we could probably agree on more issues in caring for diabetes. In the real world outside the medical community and especially the world of the American Diabetes Association, individual variances are common and must be allowed.

Yes, we need to be concerned about the number of calories we consume on a daily basis to avoid increasing our weight, but carbohydrates are the rule of consumption for people with diabetes, be they medications free, using oral medications, or using insulin.

The blog is correct when it says, “We now know that both sugar and starch can raise blood glucose. In fact, some starches can raise blood glucose more quickly than some sugary foods. For example, white bread will elevate blood glucose more quickly than a chocolate chip cookie containing equal amounts of carbohydrates.”

Calories or carbohydrates all can be measured on a bell curve. Some people with diabetes are able to eat the average and have no problems with weight gain or blood glucose levels. Other people have problems and must consume less than the average calories and carbohydrates while there are some that can consume more than the average. This has to be based on the body chemistry of the individual, the condition of their pancreas and the lifestyle of the individual.

So please keep this in mind when you read blogs that generalize like this one. If you wish to have treats, as in sweets, make sure that you have made allowances for them

Telling It Like It Is About Carbohydrates

This cardiologist is not afraid to speak out about issues. Dr. William Davis has stirred the soup with his blog of April 26, 2011 and he titled it “Real men don't eat carbs”. His understanding about wheat is excellent and makes one wonder why people with diabetes are told to eat so much whole grains.

The price we as men pay for eating “healthy whole grains” is indeed a dilemma. The mantra spouted at us by our physicians, certified diabetes educators, and many of the diabetes dietitians has to make us wonder why we are being called on to eat so many carbohydrates.

Dr. Davis explains it this way. The carbohydrates, and especially those contained in “healthy whole grains”, impair our maleness. If this doesn't get your attention, it certainly grabbed mine. Dr. Davis gives us four reasons for reducing or even eliminating carbohydrates from our diet.

First he says that amylopectin A from wheat because it promotes visceral fat, which increases estrogen levels. Estrogen reduces the effectiveness of the male hormone testosterone. In addition low testosterone and high estrogen can cause depression in males, weight gain, and low libido.

Second, visceral fat, which accumulates, triggers prolactin to be released which in males causes the growth of breasts. Third, the increase in visceral fat activates other chemicals, which impair endothelial functions underlying erectile dysfunction. And fourth, the increased blood sugar provokes the process of glycation, which can also affect maleness.

Read Dr. William Davis's blog here.

Just Diagnosed and In a Panic? Part 3

As a newly diagnosed person with diabetes, this is the lesson that most find a way to ignore, avoid, or outright forget. Carbohydrates are the biggest concern in the management of diabetes. Some like to insist it is sugar, but the truth is sugar is a carbohydrate. A simple carbohydrate and comes in many forms. It is sugar that is added to more foods than ever before. It was in the form of high fructose corn syrup, which is now renamed corn sugar. It is added to more and more of our highly processed foods to get people to eat them. In the U.S., this is one of the causes of our obesity epidemic.

In addition to the simple carbohydrates, there are complex carbohydrates like whole grains, and starchy vegetables. Carbohydrates are a source of energy, but not the only source.

Because of the uniqueness of each individual, I do not like to recommend the amount of carbohydrates each should eat. A few are able to handle a fair number of simple carbs, but most cannot. Many people have trouble with some complex carbohydrates. This is why I strongly urge each individual to use their meter to find out how their body reacts. That is also why each person with Type 2 has to become their own science laboratory to determine what works for them.

Some people are able to eat many carbohydrates while others need to limit their carbs. When it comes to ranges, here again there are varying ranges depending on who you read. Most of the time the ranges are for the entire day and you will need to divide them into your meals depending on how your react at different times of the day. Some have large morning meals while many skip the first meal of the day and have the largest meal in the evening. You meter can assist you in making this evaluation.

I will not recommend low carb, medium carb, or high carb regimens as each person must decide for themselves according to what their meter tells them. I will say that the guidance from the American Diabetes Association (ADA) is out of line for me. The American Associations of Diabetes Educators and the American Dietetic Association have the same mantra, meaning they follow the ADA.

The other source of energy is fat. Yes, I do not follow the low fat mantra of many health groups as new studies are showing this to be not quite the truth everyone likes to believe. In fact many of the things we hold on to are slowly being proven wrong and the studies from decades ago were to satisfy an agenda of the authors of the studies.

David Mendosa has no agenda and reports on both sides of many issues. His blogs on Health Central about fat and about diet are very enlightening. Dr. William Davis has his blog and here he likes to report on the whole grains mantra everyone is familiar with. His blogs about wheat and fat are well thought out. Here are four of his blogs, blog 1, blog 2, blog 3, and blog 4.

Why do I agree with them? Because even before I had diabetes, I would crave foods high in fat. After having a serving or two of these foods, sausages or beef with fat, my carvings disappeared for several weeks or longer. By not eating wheat or other whole grains for several days or weeks, I often feel much better. When I over eat wheat or other whole grains, I know it and often find myself fighting minor depression.

Finally, every person with Type 2 diabetes must experiment and find what works for them. Be cautious about the mantras of our diabetes professionals until you know they are okay for you and that your meter has told you that they are okay. Moderation and exercise will help you manage diabetes.

For reading Part 1 and Part 2 of this blog, click on the links.