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.

Diabetes Decreased with High-Fat Diet

Researchers from Lund University Diabetes Centre in Sweden clarified the risk for Type 2 diabetes associated with meat, fish, and dairy.

The scientists studied 26,930 individuals’ dietary data for 14 years in which 2,860 cases of diabetes developed.

A large intake of high-fat dairy products was associated with a 23 percent lower risk of developing Type 2 diabetes, compared to those who consumed one or fewer portions per day.

The authors also found that a large intake of low-fat dairy was associated with a significantly higher risk of Type 2 diabetes than high-fat dairy.

For more than 50 years, we have been told to eat a low-fat diet to lower the risk of heart disease. Well, they told us wrong.

We followed that advice and lowered our fat intake, and the results could not be worse. We have an epidemic of Type 2 diabetes caused by low-fat dietary recommendations.

Patients need to be educated about which food sources are healthy to eat.

Research has shown that low-fat diets are detrimental in many ways. They not only promote obesity and diabetes, they also cause multiple nutrient imbalances.

The consequences of a low-fat diet can include higher rates of immune dysfunction, cancer, and chronic illness.

We were designed to utilize dietary fat for maintaining cell membranes and providing crucial nutrients to optimize the immune system.

I can make it simple for you: Avoid all low-fat food sources.

High Salt Consumption Can Cause Weight Gain

One group publishes a study and another group answers with their study. This group takes a different approach and talks about weight gain being caused by salt, actually too much salt.

Researchers say the studies - published in the Journal of Nutrition and Chemical Senses - support calls for the food industry to lower the salt, or sodium, intake of food products. Both studies were conducted by Prof. Russell Keast and colleagues from Deakin University in Australia.

While you may not be heavy handed with the salt shaker, it is processed foods and restaurant meals that are the primary culprit, accounting for more than 75% of our sodium intake.

Previous research from Prof. Keast and colleagues, including a study reported by Medical News Today earlier this year, suggested that individuals who are more sensitive to the taste of fat are more likely to eat fatty foods, putting them at greater risk of obesity.

Their latest studies build on that research, suggesting that the amount of salt in a certain food may influence how much we eat, as salt could mask our fat preferences.

For the first study, the team set out to investigate the effects of salt on the taste of fat and food preference.

The researchers enrolled 49 healthy participants aged 18-54 and asked them to taste a variety of tomato soups that had four different fat concentrations (0%, 5%, 10% and 20%) and five different salt concentrations (0.04% - no added salt - 0.25%, 0.5%, 1% and 2%).

Fast facts about salt

• Grains, meat and processed poultry, soups and sandwiches are top contributors to Americans' salt intake
• A single slice of bread can contain anywhere from 80-230 mg of salt
• One slice of pizza can contain up to 730 mg of salt.

After consuming the soups, participants were asked to rank the pleasantness and desire to eat each soup, as well as the perceived fattiness and saltiness of each soup.

Fat taste sensitivity among participants was measured by their ability to taste oleic acid - a fatty acid in vegetable fats and oils - at various concentrations in long-life skimmed milk.

The researchers found that salt is a major player in the pleasantness of a food, with rating of food pleasantness varying greatly dependent on different salt contents; a salt concentration of 0.25-5% rated as most pleasant.

For the second study, the team wanted to examine the effect of salt on food intake. They enrolled 48 healthy adults aged 18-54. As in the first study, participants' fat taste sensitivity was determined by their ability to taste oleic acid.

Over a 6-day period, participants were required to attend four lunchtime sessions. Lunches consisted of elbow macaroni and sauce, and sauces contained varying concentrations of fat and salt.

The researchers measured subjects' food intake over the study period, and participants were required to rate the pleasantness of each food. The team found that participants consumed around 11% less food and energy when their lunches contained low salt and high fat.

"However, when given high-salt high-fat foods, those same subjects consumed significantly more food and energy," explains Prof. Keast. "Those who were less sensitive to fat consumed the same amount in each salt condition." Overall, the authors say their studies indicate that salt may interfere with the body's biological processes that stop us from eating too much.

Sugar, Not Fat Is the Cause of Obesity – Part 2

Some history is in order. In 1980, the US Government issued its first Dietary Guidelines without any scientific evidence, only the say-so of “experts.” The guidelines shaped the diets of hundreds of millions of people. Doctors base their advice on them; food companies develop products to comply with them. Their influence extends beyond the US. In 1983, the UK government issued advice that closely followed the American example.

The most prominent recommendation of both governments was to cut back on saturated fats and cholesterol (this was the first time that the public had been advised to eat less of something, rather than enough of everything). Consumers dutifully obeyed. We replaced steak and sausages with pasta and rice, butter with margarine and vegetable oils, eggs with muesli, and milk with low-fat milk or orange juice. Instead of becoming healthier, we grew fatter and sicker.

Look at a graph of postwar obesity rates at this source (and about two thirds of the way down the page) and it becomes clear that something changed after 1980. In the US, the line rises very gradually until, in the early 1980s, it takes off like an airplane. Just 12% of Americans were obese in 1950, 15% in 1980, 35% by 2000. In the UK, the line is flat for decades until the mid-1980s, at which point it also turns towards the sky. Only 6% of Britons were obese in 1980. In the next 20 years that figure more than trebled. Today, two thirds of Britons are either obese or overweight, making this the fattest country in the EU. Type 2 diabetes, closely related to obesity, has risen in tandem in both countries.

At best, we can conclude that the official guidelines did not achieve their objective; at worst, they led to a decades-long health catastrophe. Naturally, then, a search for culprits has ensued. Scientists are conventionally apolitical figures, but these days, nutrition researchers write editorials and books that resemble liberal activist tracts, fizzing with righteous denunciations of “big sugar” and fast food. Nobody could have predicted, it is said, how the food manufacturers would respond to the injunction against fat – selling us low-fat yogurts bulked up with sugar, and cakes infused with liver-corroding transfats.

Nutrition scientists are angry with the press for distorting their findings, politicians for failing to heed them, and the rest of us for overeating and under-exercising. In short, everyone, business, media, politicians, consumers – is to blame. Everyone, that is, except scientists.

But, it was not impossible to foresee that the vilification of fat might be an error. Energy from food comes to us in three forms: fat, carbohydrate, and protein. Since the proportion of energy we get from protein tends to stay stable, whatever our diet, a low-fat diet effectively means a high-carbohydrate diet. The most versatile and palatable carbohydrate is sugar, which John Yudkin had already circled in red. In 1974, the UK medical journal, the Lancet, sounded a warning about the possible consequences of recommending reductions in dietary fat: “The cure should not be worse than the disease.”

I would suggest reading the rest of the long article as I can only make a mess of it and I think you would be better served reading it yourself.

Sugar, Not Fat Is the Cause of Obesity – Part 1

This article really tied together some of my thoughts about sugar and its effects on our bodies. Six names that are behind this are Robert Lustig, John Yudkin, Dr Paul Dudley White, Ancel Keys, Gary Taubes, and Nina Teicholz. There are several others mentioned, but I admit I am not familiar with them.

Robert Lustig is a pediatric endocrinologist at the University of California who specializes in the treatment of childhood obesity. A 90-minute talk he gave in 2009, titled Sugar: The Bitter Truth, has now been viewed more than six million times on YouTube. In it, Lustig argues forcefully that fructose, a form of sugar ubiquitous in modern diets, is a “poison” culpable for America’s obesity epidemic.

A year or so before the video was posted; Lustig gave a similar talk to a conference of biochemists in Adelaide, Australia. Afterwards, a scientist in the audience approached him. Surely, the man said, you’ve read Yudkin. Lustig shook his head. John Yudkin, said the scientist, was a British professor of nutrition who had sounded the alarm on sugar back in 1972, in a book called Pure, White, and Deadly.

“If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” wrote Yudkin, “that material would promptly be banned.” The book did well, but Yudkin paid a high price for it. Prominent nutritionists combined with the food industry to destroy his reputation, and his career never recovered. He died, in 1995, a disappointed, largely forgotten man.

Perhaps the Australian scientist intended a friendly warning. Lustig was certainly putting his academic reputation at risk when he embarked on a high-profile campaign against sugar. But, unlike Yudkin, Lustig is backed by a prevailing wind. We read almost every week of new research into the deleterious effects of sugar on our bodies. In the US, the latest edition of the government’s official dietary guidelines includes a cap on sugar consumption. In the UK, the chancellor George Osborne has announced a new tax on sugary drinks. Sugar has become dietary enemy number one.

This represents a dramatic shift in priority. For at least the last three decades, the dietary arch-villain has been saturated fat. When Yudkin was conducting his research into the effects of sugar, in the 1960s, a new nutritional orthodoxy was in the process of asserting itself. Its central tenet was that a healthy diet is a low-fat diet. Yudkin led a diminishing band of dissenters who believed that sugar, not fat, was the more likely cause of maladies such as obesity, heart disease and diabetes. But by the time he wrote his book, the commanding heights of the field had been seized by proponents of the fat hypothesis. Yudkin found himself fighting a rearguard action, and he was defeated.

Not just defeated, in fact, but buried. When Lustig returned to California, he searched for Pure, White and Deadly in bookstores and online, to no avail. Eventually, he tracked down a copy after submitting a request to his university library. On reading Yudkin’s introduction, he felt a shock of recognition.

“Holy crap,” Lustig thought. “This guy got there 35 years before me.”

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.

More on Nutrition for People with Diabetes

In the last blog, I covered eating patterns and started the macronutrients as covered in the October ADA dietary guidelines. Now I will write about protein and fat.

The macronutrient, protein. People with diabetes that don't have kidney disease might be surprised by this. There is no 'ideal' amount of protein that helps to improve blood glucose management, or even lowers the risk of heart disease. There are studies on both sides of this issue for both diseases and most are approached with a bias or what the author or funding agency is trying to prove.

The good news for those that have kidney disease do not have to follow a very low protein diet. More is the concern about malnourishment and the protein does not seem to affect the rate of progression of kidney disease. Even with all the hoop-la about red meat causing heart disease, it is more the highly processed meats that have an effect on the heart.

The macronutrient, fat. This section is more difficult and they are still trying to limit fat to a low fat diet. They of course want monounsaturated fats like olive oil and push vegetable oils. They are unanimous in eliminating trans fat as they should, but to curtail saturated fats with the evidence having been disproved still concerns me. I could agree if they had asked for moderation in the consuming of saturated fat.

The guidelines do say that there is no optimal mix of macronutrients. The statement is just made that evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein, and fat for all people with diabetes; therefore, macronutrient distribution should be based on individualized assessment of current eating patterns, preferences, and metabolic goals.

Yet, they continue by saying it has been observed that people with diabetes eat about 45% of their calories from carbohydrate, 36–40% of calories from fat, and the remainder (16–18%) from protein. All this means is that the authors could care less about assessing people with diabetes and allowing them to have individualized eating plans. They are going to push for high carbohydrates.

They do cover omega 3 fatty acids and advise not to be taking fish oil supplements as there is no evidence that these help protect you from heart disease. The guidelines push the importance of getting your fish oils from food sources and that people eat at least two fish meals per week. This the guidelines say will help lower the risk of heart disease.

The dietary guidelines recommend that people who are 51 years of age, those who are African-American, or those that have high blood pressure, diabetes, or chronic kidney disease limit their sodium (salt) intake to 1500 milligrams (mg) per day. Restricting salt to this level is difficult and can make food unpalatable. Evidence does not support lowering salt level to this amount and the guidelines recommend capping salt intake at 2300 mg per day or the same recommendation as for the general public.

The guidelines do advise limiting alcohol as this can mask hypoglycemic symptoms and lead to problems for those on insulin. The guidelines also recommend high dietary fiber and liberal quantities of whole grains. Big Food is speaking here and for those on low-carbohydrate diets need to limit or eliminate wheat from their diets.

In rereading the guidelines for these two blogs, it has been interesting the conflicts in the advice given and how the leanings are still high-carbohydrate low-fat in nature.

The Whole Grains Low Fat Crowd

I wonder how many more years we are going to have to suffer, yes, suffer from the teachings of the whole grains and low fat advocates. Thankfully, more people are realizing that their teachings are at the root of our obesity epidemic. Yes, it may take a few more decades to scientifically put these teachings where they belong – in the trashcan.

What started me on this? I happened to watch the program in Iowa Public TV on March 3, when Dr. David Perlmutter was talking about his program for eliminating whole grains from our food plans. He is the author of: The Better Brain Book and the #1 New York Times Bestseller, Grain Brain. He is recognized internationally as a leader in the field of nutritional influences in neurological disorders.

The program is scheduled several more times during the Public TV's campaign to obtain funds from viewers for programs and operations. Since there are no videos available, that I have been able to locate, I can only suggest that if the public TV network in your state is running their fund raising campaign, go to the website for your state ((enter your state) public TV) in your search engine and enter Dr. David Perlmutter in the site's search area. This could help you find the program – whether you contribute is entirely up to you and I am not promoting this.

Dr. Perlmutter clearly states that fat, except Trans fats, is our friend and whole grains are our enemy. He says that in addition to them helping our diabetes epidemic, they also affect many neurological disorders and by eliminating them from our food plans, many neurological problems can be improved or delayed. He listed attention deficit hyperactivity disorder (ADHD) as being helped and in the case of Alzheimer's disease, it could be delayed or greatly improved for some time. He did not promise a cure, but stressed improvements that eliminating gluten created.

He mentioned several other neurological disorders being improved, but I had an interruption and missed the names.

During his talk, he emphasized that the claims of lost nutrients the grain people were warning consumers about could be found in other foods and that their claims were not valid unless people were relying on whole grains entirely.

His books are available on Amazon and the #1 Bestseller can be found at this link. I have spent my allowance for books, but I do intend to obtain his one book later this year.

TAG – Is It Part of Your Diabetes Meal Plan?

Thanks to Joslin for bringing TAG (total-available-glucose) to my attention here. They may say it is out of vogue and not relevant for today's meal planning, but more are talking about it and blogging about it. Even TuDiabetes.org has a group called TAGers United.

Not listed as a TAG study, this 2006 study about protein, carbohydrate, and fat consumption for people with type 2 diabetes is very enlightening. The study is from 2006 and came from the University of Minnesota. While not praising or damning fat, this study was for determining the best diets for type 2 diabetes and using different ratios of protein, carbohydrates, and fat.

This study was funded by the American Diabetes Association (ADA), with some support from the Minnesota, Colorado, and Nebraska Beef Councils plus the Department of Veterans Affairs. Yet the ADA has moved very little from their low-fat mantra.

The same subjects were people with type 2 diabetes that was not treated. For 5 weeks, they were on a control diet with a protein carbohydrate fat ratio of 15:55:30. Then the same group spent 5-week periods on other ratios. The 30:40:30 ratio diet resulted in moderate decrease in 24-hour glucose area and % total glycohemoglobin (%tGHb). The 30:20:50 ratio diet resulted in a 38% decrease in 24-hour glucose area, a reduction in fasting glucose to near normal and a decrease in %tGHb from 9.8% to 7.6%. They obtained a similar result 30:30:40 ratio diet.

The long-term objective has been to develop a diet that does not require weight loss, oral medications, or insulin. The other requirement is that the diet controls blood glucose in people with type 2 diabetes. The spokesperson said, “Our studies indicate that a decrease in metabolically available dietary glucose, associated with an increase in protein and fat, over an extended period of time, can significantly lower the integrated blood glucose concentration. The decrease is comparable to that obtained using oral agents and occurs without weight loss.”

I found this information while doing research for another blog. TAG is referred to as total dietary glucose (TDG) in this study. They determined that the actual glucose from protein depends on the type of protein and it varies from 50 to 84 grams per 100 grams of protein eaten. Fat generally produces only 10 percent glucose.

Read the study for type 2 diabetes with increased fat as part of the diet.

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.