Steps to Better Sleep

Sleep is a crucial element to health. It is the basis of our well-being and if we cut ourselves short, not only will our afternoons seem harder, but our waistlines and blood sugars can pay for it.

Suggested steps for better sleep:

  1. Black out your room. Completely. No clocks, no blinking laptops, no light. If your iPhone is your alarm, set your alarm in advance and change your setting to “Do Not Disturb,” and plug in your phone, face down.
  2. Do not check email, Facebook, social media for at least one-two hours before bed. Believe it or not, that email, notification and feed will still be there tomorrow. You need to actively take steps for better sleep. Make it a habit to put technology aside in the evening and if this is not possible, dim to brightness on your computer and phone.
  3. Don’t eat for at least 2 hours before bed. If your body is trying to digest food, you may not be able to fall asleep as soundly. This is especially true if you are eating something that doesn’t agree with you i.e. gluten, dairy, sometimes garlic and onions bother people too.
  4. On the contrary, eating carbohydrates later in the day can help you fall asleep. Carbohydrates boost tryptophan, which is a precursor to the feel good hormone serotonin. As well, the practice of consuming carbohydrates in the latter part of the day help with insulin sensitivity, thus improve sound sleep.
  5. Clean your room. Not in a mom-like suggestion but clear the clutter. A messy, cluttered space can clutter your mind and distract you from falling asleep faster.
  6. Assess your caffeine intake. If you are reliant on caffeine to keep you going – cut back. The first week of cutting back on caffeine will be hard, but then it will become manageable.
  7. Get in bed earlier and aim for 8-9 hours of sleep. Sleep can be the secret weapon for better digestion and weight loss. When we trim our sleep we become insulin resistant, we crave sugar and our hunger hormone (leptin) is deregulated. Guess what? Bedtimes are not just for kids. You now have a bedtime.
  8. Take magnesium before bed, or natural calm magnesium (this is a brand). I highly recommend and provide Standard Process supplements to clients – if interested you are welcome to email me with inquiries.
  9. Have a notebook next to your bed – if your mind is running about a project, a to-do, an upcoming event, make note of it and shut your mind off.
  10. Take 3 deep breaths, let your stress of the day go, say in your head or out loud something you are thankful for, close your eyes and fall sleep.

As for carbohydrate choices, I do not give all foods my blessing. I think there are better choices than others including:

  • Vegetables: Starchy tubers (sweet potatoes, japanese sweet potatoes, yams, tarot, jerusalem artichoke, cassava, and bamboo) and winter squash such as pumpkin and butternut squash.
  • Fruit (berries, cherries and bananas)


De Castro JM. Macronutrient relationships with meal patterns and mood in the spontaneous feeding behavior of humans. Physiol Behav. 1987;39(5):561-9.

Brinkworth GD, Buckley JD, Noakes M, Clifton PM, Wilson CJ. Long-term effects of a very low-carbohydrate diet and a low-fat diet on mood and cognitive function. Arch Intern Med. 2009 Nov 9;169(20):1873-80.


Type 1 Diabetes Paired With a Paleo Diet

I have three main purposes for my website and one is to help educate consumers on the connection between nutrition and health, secondly to describe the philosophy of my counseling services to potential patients to distinguish it from other dietitians/nutritionists and thirdly, to act as a portal for people with type 1 diabetes and those interested in the care for type 1 diabetes to connect, communicate and learn.

That said, I am honored to share the experiences from Keith R. Runyan, MD, a physician in Florida, about his journey with type 1 diabetes.

So often I can write how the paleo diet has changed my life (diabetes), yet, when I see another fellow T1 experiencing similar things, I am inspired to share the story with my audience. Thank you Dr Runyan for allowing me to post this information and keep up the great work with your diabetes and helping your patients.

Dr. Runyan’s story goes something like this…

In medical school, I learned a tremendous amount of information about anatomy, histology, embryology, physiology, biochemistry, cell biology, and genetics, as well as most of the pathologic conditions that affect mankind.  Interestingly, the topic of how nutrition influences or causes disease was lacking.  Of course, we learned about vitamin, mineral, fatty acid, and protein deficiencies and their clinical presentations, but the idea that a diet which deviates from that on which humans evolved to thrive can cause numerous major chronic diseases was not covered or adequately emphasized.  So, over most of the past 20 years, I have been treating these diseases with medications and advice to see a dietitian, thinking that the dietician would be dispensing correct information about what my patients should be eating.

In 1996, I gradually became ill with weight loss initially, then later fatigue, polyuria (excessive urination), polydipsia (excessive thirst), and diarrhea.  Through the powers of denial, of which mine were strong, I was able to ignore these symptoms and continue working.  Even though my wife, other physicians, and nurses noticed the weight loss, I continued to believe the problem would go away on its own.  Eventually, in 1998, having lost 40 lbs. from my originally normal body weight, I could no longer deny I had a problem.  I saw a physician and had some tests run.  My blood sugar was 489 mg/dL, and obviously I had diabetes mellitus, type 1 in my case.  I started on insulin that same day with resolution over the next 2 weeks of the fatigue, polyuria, and polydipsia, but the diarrhea which turned out to be caused by diabetic autonomic neuropathy involving the intestinal tract would take another two and a half years to resolve.  With treatment of the diabetes with insulin and improved blood sugar control came the onset of severe and diffuse peripheral neuropathy with pain and numbness over most of my body.  I could not decide which was worse, the whole body pain or the diarrhea up to 20 times per day.  Fortunately, I did not have eye, vascular, or kidney involvement and that remains the case today.  The neuropathic pain gradually resolved over the next year, and the neuropathic numbness gradually went away after 2-3 years.  But, I did want to discuss the difficulty I had with controlling blood sugars while following the recommendations of the ADA (American Diabetes Association).  Ever since I was diagnosed with type 1 diabetes mellitus in 1998, the ADA has recommended a low fat diet in line with the dietary fat-heart disease hypothesis since heart and vascular disease is the most common cause of death of the diabetic patient.  Specifically, a dietary intake of 50 – 60% of calories from carbohydrates (carbs) has been recommended, some of which may be simple sugars.  In theory, I thought this seemed plausible, since the ADA recommended counting carbohydrate grams in the diet to be balanced with insulin, in my case, or other diabetes medications (for those with type 2 diabetes).  However, after 2 years of weighing my food or otherwise calculating the grams of carbohydrates eaten with each meal, there was no significant improvement in blood sugar control and no improvement in the number or severity of hypoglycemic episodes (low blood sugars).  So, I abandoned the carb counting and just tried to keep the intake of carbs constant with each meal.  At some point along this journey, I heard about the book “Dr Richard Bernstein’s Diabetes Solution”.  I did not read the book at the time, but found out about the “drastic” reduction in carbohydrates in the diet as the main feature of his approach.  The thought of giving up so many foods that I liked did not appeal to me.  I thought the fluctuations in blood sugar, hypoglycemic episodes, and my HgbA1c values of 5.6 to 6.9% were an inevitable part of having diabetes.  In addition, I assumed that if his approach was scientifically based and clinically effective, that the medical authorities (including the ADA – American Diabetes Association) would have also embraced this approach.  But the fact that they did not, added to my reluctance.  Well, I should have looked into that more at the time and actually read his book.  In 2008, the ADA for the first time acknowledged the use of a low carbohydrate approach for the purpose of weight loss in diabetics for up to one year, based on a recent study published in the medical literature.  They did not, and have not, embraced the low carbohydrate diet for all diabetics long term.

In 2007, my wife trained for and did her first triathlon.  I watched her first triathlon race and saw how she and so many others appeared to enjoy it.  I had not exercised on any regular basis since high school and since I had a chronic disease that might be helped with exercise, I decided to give triathlon a try.  I enjoyed the exercise and having a goal to work toward gave me the motivation I needed.  After a few years of increasing the distance of the triathlon events, I contemplated doing the full ironman distance triathlon.  I started looking into how to keep my body fueled and blood sugars near normal for the 12+ hours it might take me to do such a race particularly since sugar is the primary, if not sole, fuel used by athletes during a long distance triathlon.  This is what motivated me to discover the dietary change that I am currently enjoying.

In 2011, I reexamined my diet and studied the Paleo Diet (Loren Cordain, PhD), the low carbohydrate ketogenic diet for diabetes (Richard Bernstein, MD), and the low carbohydrate ketogenic diet for athletes (Stephen Phinney, MD, PhD, Jeff Volek, PhD, RD and Eric Westman, MD).  I have combined portions of both of these diets for myself.  The essence of the low carbohydrate ketogenic approach for diabetes is as follows.  Diabetes is a disease of carbohydrate intolerance.  Carbohydrates in the diet are not essential to the diet, only protein and fat are essential.  Near elimination of carbohydrates from the diet will maximally improve diabetes control, reduce insulin doses needed to control blood sugars in type 1 or insulin dependent type 2 diabetes, and in the case of pre-diabetes or early type 2 diabetes can normalize blood sugars without medications.  See Athletes page for more details.

I transitioned to this low carbohydrate ketogenic diet to address both of my issues, namely diabetes control and fueling endurance exercise with excellent results.  My blood sugars are better controlled and hypoglycemia is quite unusual.  I have had several blood sugar readings in the range of 46 to 60 mg/dl without any symptoms of hypoglycemia.  Readings this low prior to the ketogenic diet would have caused symptoms of hypoglycemia.  On the ketogenic diet, however, these symptoms are absent presumably due to the use of ketones by the body and brain.  I am able to exercise with no apparent loss of energy or power while consuming relatively little sugar during exercise to prevent hypoglycemia.  I measure my blood sugar while exercising usually every 60 – 90 mins or if I feel my blood sugar might be low.  My blood tests have improved in the typical pattern seen on a ketogenic diet. Triglycerides decreased from an average of 76 to 65 mg/dL, HDL cholesterol increased from an average of 61 to 90 mg/dL, the triglyceride/HDL ratio decreased from 1.31 to 0.72, the calculated LDL cholesterol increased from an average of 103 to 162 mg/dL.  The hsCRP (high sensitivity C-reactive protein, a marker of inflammation) decreased from 3.2 to 0.7 mg/L.  Of note, in my case, exercise did not result in a significant change in any of these lipid values, nor did niaspan or pravastatin (taken during different time frames).  The niaspan was discontinued 16 months prior to and the pravastatin was discontinued 4.5 months prior to these latest results.  Seeing that this diet actually worked for me and the scientifically proven health benefits of a well formulated low carbohydrate diet for treatment of obesity and numerous chronic diseases, I decided to add nutritional therapy to my medical practice.  In addition to review of books and literature, I am using the resources of the ASBP (American Society of Bariatric Physicians) in preparation for the board certification examination in obesity medicine (by the American Board of Obesity Medicine) in Nov. 2012.

What Does Dr Runyan Eat?
1.  Macronutrient Composition
Protein – about 0.7 grams protein per pound of body weight per day, currently 163 lbs X 0.7 = 114 grams per day.  This is close to what I ate prior to starting a ketogenic low carb diet.  This is in the range recommended for athletes (0.6 to 1.0 grams per pound of body weight per day).  I chose the lower end of this recommended range for two reasons.  First, I am doing endurance exercise rather than body building exercise and therefore need less protein.  Second, too much protein in the diet can interfere with maintaining nutritional ketosis since protein in excess of the body’s needs for production of enzymes, hormones, structural components, etc. can be converted to glucose which in turn would require more injected insulin and suppress fat burning and ketone production.  The protein in my diet comes from grass-fed beef, lamb, and pork (which is higher in omega-3 fatty acids than grain-fed), range-fed chicken, omega-3 enriched eggs (currently not range-fed), cheese (extra sharp cheddar, feta, and cream cheese primarily), fish (primarily wild caught Alaska salmon, but other varieties as well) and shrimp, plain Greek yogurt (10% milk fat), and nuts (primarily macadamia and pistachio).

Carbohydrates – about 40 – 50 grams carbohydrate per day.  I aim for about 30 – 40 grams from my diet, and during long exercise sessions (> 2 hrs) which generally occurs 2 days/week, I may take up to 24 grams of carbohydrate per hour while exercising to prevent hypoglycemia.  Carbohydrates in my diet come from vegetables (kale, collard greens, yellow squash, zucchini squash, brussels sprouts, lettuce, etc), and the small amount of carbohydrates contained in cheese, yogurt, nuts, cream, and 2 tbls lemon juice for salads.  I avoid all grains and foods made from grains, fruits (except tomato and avocado), potatoes, and legumes.  I take sugar (glucose) only to treat hypoglycemia or prevent it during exercise.

Fats – about 230 grams fat per day (about 100 grams saturated fat, 100 grams monounsaturated fat, 30 grams polyunsaturated fat, 6600 mg of omega-3 fatty acids, omega-6/omega-3 ratio of 3.6 to 1, and 600 mg of cholesterol).  Fat in my diet primarily comes from meat, tallow, eggs, fish, cheese, nuts, butter, heavy whipping cream, coconut oil, olives and olive oil.

Totals Calories = (114 grams protein x 4) + (45 grams carbohydrate x 4) + (230 grams fat x 9) = 2700 calories.  From a caloric perspective, 17% of calories come from protein, 7% from carbohydrates, and 76% from fat.

2.  Micronutrient Composition
I used the USDA nutrition data tables primarily to calculate the micronutrient content of my diet.  Using the Recommended Dietary Intake (RDI) values for my sex and age, I compared them to my daily intake.  My diet met or exceeded the RDI values.

3.  Fiber
My daily dietary fiber intake is about 18 grams/day, which is less than the recommended 30 grams/day.  This recommended figure is based on the belief that dietary fiber will prevent colon cancer.  I believe that colon cancer is not causally related to dietary fiber, but more related to a carbohydrate predominate diet since colon cancer is one of the many diseases of Western civilization.

In summary, I have combined most of the tenets from the Paleo Diet as outlined by Loren Cordain, PhD (except for the use of some dairy products, inclusion of more fat, exclusion of fruit) with a ketogenic low carbohydrate approach as detailed by Richard Bernstein, MD which I believe is optimal for those with diabetes.  This lifestyle has resulted in the best control of my diabetes to date and has the potential to minimize the many complications of diabetes.

Keith R. Runyan, MD
6499 38th Ave N., Suite C-1
St. Petersburg, FL   33706
Phone (727)345-3908


See You Later Hypertension

Last fortnight I was asked to participate in an online interview (article originally published on: about natural ways to manage high blood pressure. Not only was this request interesting but it is a topic that needs more coverage. High blood pressure, or hypertension, is a silent killer. I hate to be so blunt but there is no way around it – one in four adults (US data) have hypertension. Untreated hypertension can get ugly causing kidney damage, stroke, heart disease, dementia and more. However, with most things related to health, you can turn it around for the better. If hypertension is something you deal with personally, consider the below to incorporate with your daily routine. As always, if you need some help, feel free to contact me.

  • What supplements/foods do you recommend people with high blood pressure try, to help lower their blood pressure?

Before advising someone on what to eat and what to supplement with, I first need to understand if there is anything else going on with their health, such as diabetes, kidney disease, etc. I also want to know what medication they are taking.

Generally speaking though, I advise eating a moderately high protein and fat diet, with moderately low (less than 150 grams per day) carbohydrates. Carbohydrates should be mainly sourced from vegetables, legumes/lentils, tubers and fruit.

Important foods to consider are those rich in potassium (bananas, avocado, herbs, cocoa, nuts, and tomatoes), magnesium (pumpkin, squash, cocoa, nuts, fish), vitamin C (citrus fruits, broccoli, bell peppers, cauliflower, cabbage, celery) and vitamin E (almonds, herbs, olives), omega 3 fatty acids (fatty fish like salmon or sardines) and flavonols (red wine, grapes, cocoa). Do you see a trend? I am a believer in dark chocolate/cocoa nibs and consume cocoa in one shape or another daily.

However, more important than knowing what to eat is knowing foods to cut back on, including foods high in fructose and processed foods (chips, deli meat, bread, pastries, cookies, desserts, etc).

Fructose, simply put, is a type of sugar. It is under a lot of scrutiny causing detrimental things to our health including hypertension. While the jury is still out, there is a true consensus that fructose does more harm than good. The important take away is to know what foods are high in fructose i.e. candies/lollies, cold breakfast cereals, desserts such as ice cream, cake, muffins, salad dressing, breads, pizza,crackers, canned fruit and juices with added sweeteners and more.

My recommended supplements include high-quality fish oil, a strong probiotic, magnesium twice a day, Himalayan sea salt and CoQ10. Food always comes first.

  • What are your thoughts on salt and high blood pressure? Should we be limiting salt intake or is the salt thing all blown out of proportion?

You may be surprised to hear that I do not stress salt restrictions. Processed foods should certainly get more vigilance in this space. I think overall sodium claims are blown out of proportion and certainly, I strongly advise the use of Himalayan sea salt. Overall, individuals need to self-assess how salt makes them feel. If the consumption of salt makes someone retain fluid or make their heart palpitate/speed up, then a reduced salt intake should be implemented. However, I think there are far more important actions to take than demonizing salt. Focus should zero in on stress levels, adequate sleep, exercise, eating whole foods (this does not include whole grains) and maintaining a healthy weight.

  • Not necessarily specific to high blood pressure, but what are your top 5 healthiest foods we should all be trying to eat more of, and why?

Grassfed/free range meat – protein is essential and free range meat, ideally, beef, has an optimal fatty acid ratio, up to 6 times more omega 3’s compared to the grocery store variety. Certainly, omega-3 fatty acids play a vital role in every cell and system in our bodies. Beyond the nutrient profile grassfed/free range beef offers, it is a great tool for optimal health. It is satiating, protective against cancer and cardiovascular disease, has low insulinogenic properties and more.

Coconut – whether it is coconut oil, flour, cream or milk, I welcome it all. I consume this functional food daily, reaping one of the thousands of benefits it offers. In traditional medicine, coconut is used to treat a wide variety of health problems and it is so versatile to use. I make pancakes from coconut flour and milk, I cook with coconut oil, especially with eggs and coconut cream is delicious with berries.

Pumpkin – is loaded with healthy starches and it is absolutely delicious. Pumpkin is nutrient-rich, easy to make and can satisfy a sweet or savory craving. I have learned to cook pumpkin in a variety of fashions from pumpkin soup (with coconut milk and cinnamon), roasted pumpkin salad (with pine nuts, spinach, feta and homemade balsamic dressing) to pumpkin porridge (mixing puree pumpkin with eggs, nuts, and raisins).  Pumpkin can also serve as a dessert by garnishing it with spices and honey.

Free range eggs – they are one of few foods that naturally contain vitamin D and are far superior to caged eggs when it comes to nutrient content. They are rich in vitamin A and E and omega 3 fatty acids, among many other important vitamins and minerals.

Fermented foods – I am all about gut health and a happy gut, makes a good immune system. Fermented foods such as sauerkraut, kefir, kimchi, etc provide probiotics to our intestines. There are plenty of benefits to adding probiotics to our bodies, including protection from colon cancerrelief from lactose intolerance and diarrheareduction in cavities, and more. Improved digestion means more nutrients, vitamins, and minerals are absorbed, making you an overall healthier being.

Cheers to you and good health,





Dear Food Diary – 3/12/11 – Christmas BBQ Party…

Today, Saturday, I am prepping for a gathering of friends to celebrate Christmas. Let’s see how I behaved at the BBQ, keeping in mind these few goals:

1. Avoid all dairy and grains
2. Drink plenty of water and do not over eat on anything
3. Avoid all dairy

Breakfast: 9AM
Long black
I was not hungry when I first woke up so I waited an hour or so. I also had rubbish sleep last night, so I will be interested in how my cravings run today.
Protein, Coconut oil smoothie
Fish Oil
Allergy meds

Exercise: I have graduated from my walks and am back in the gym! Do not get me wrong, I love walking the parks but I am beyond ready to get my heart rate up and to life some weights.
11AM: Kettlebell workout – wow, I am out of shape.

12noon: met Schmidtty at the market and picked up some wild barramundi for tonight’s barbie! Enjoyed some preservative free sausage samples.

Lunch: 1:35PM
1/2 banana and nutbutter
Ham, deli

Exercise: 4 mile walk with friend

Snack: 4PM
Blueberries and Glutamine fortified jelly (Jell-O)

Party begins 6PM
Grazed in sweet potato chips, sliced pears and apples, hard boiled egg, wine and some tuna-like dip (gfree no doubt)

Dinner: 8PM
Wild barramundi
Salad, Greek-like

Bites of my husband flourless chocolate cake (to.die.for.)

My Diabetic Motive

It is almost my birthday and looking back on my 27th year of age – a heck of a lot has happened. Good and bad.

The Good: Moved twice. First from Chicago to Ohio, starting a new role at Abbott Nutrition as a sales rep, and then again in January, relocating to Australia with my now husband. If not obvious enough with the last statement, I got married! I have flown around the world twice. I have started a new job in a new industry and have acquired more friends than I could have ever dreamed. I finally tried duck, snorkeled through the Great Barrier Reef and became an Aunt.

The Bad: With big life events, there is stress and with stress, there are ups and down in blood sugar control. Along with last year’s event there were many time zone changes. Flying also has a tole on my blood sugar control, especially when I am changing to such drastic time changes. And lastly and most recently, I was in an accident and on the mend of a broken jaw. Broken jaw means eating softer and different food, which again means a challenge on my glucose control.

Bottom line: I would not trade this last year for anything. I have AMAZING memories, I have grown and changed for the better, and married my best friend. But I have one of the worse A1C% I have ever had. I must and am doing something about it and I want to make my goals public. Why? As a type 1 diabetic, sensitive to dairy, caffeine, birth control and legumes, potentially nuts too, I have a tough case. But I will succeed. I am determined. Can any of you relate?

For the next 3 months I am going to eat strictly paleo and re-do some of my labs. This is my main goal because when I avoid grains, legumes, dairy, white potato, corn and sugar, I have a much smaller margin of error in controlling my blood sugar.

I have chosen 3 months because this will allow for enough time to see change in my A1C%. Red blood cells turnover ~ every 3-4 months and closer to the 4 months when eating a low carbohydrate diet.

Wish me luck and I intend to blog many days of what I eat. I will admit I get to have a gluten free peanut butter banana sandwich on my birthday and for Christmas. Food is medicine but it is also one of life’s greatest pleasures.

Cheers to you and good health!

My Healing Potion

If there is anything I had learned in my role at Abbott Nutrition as a Sales Rep it is nutrition is power in the healing process and the earlier the implementation the better.

I bring this topic up because last Saturday I broke my jaw; in quite a few places actually and it is by far the most painful process I have been through. But focusing on the positives…

As I was prepping for surgery there were hours and hours of fasting but when I was not fasting, I ensured I consumed the best nutrients I could. And that lead to my husband running home and making my specialty smoothie and foregoing the “Diabetic Sustain.”

I just want to rant, if I could, the Diabetic drink had High Fructose Corn Syrup (HFCS) as the second ingredient! One, that ingredient is poison and two, HFCS could be the most harmful thing to my blood sugars. And they put DIABETIC on the label. What is wrong with these manufactures? I truely believe they use HFCS because it is a cheap and easy ingredient and the makers really do not focus on the patient or care about the outcomes. As my Aussie friends would say, “That is rubbish.”

So what did I drink? I had and continue to have a high calorie, low carbohydrate (so my blood sugars can be well controlled) and high fat smoothie. And of course it is a smoothie so it is nice and easy to consume. But besides the macronutrients, I have zeroed in on good food sources allowing me to heal as quickly as possible.

Healing Potion Smoothie:

3/4 cup spinach

2 scoops of whey protein

1 to 1 1/2 cup of coconut milk


1 spoonful of natural peanut butter

2 pinches of chia seeds

Depending on my appetite and the lapse of time it has been since I had eaten, I will add some frozen banana or frozen berries.

Have you ever been in a pinch and could not chew food? What did you brew up? I welcome all tips and comments.

Cheers to you and good health!

Diabetes and Dr Bernstein’s Diet Recommendations

I admit I have an obsession with diet books. Not because I want to try the latest fad to drop a few but because as a dietitian I want to see and learn what an author’s thoughts are on a perfect diet. The latest diet book I’ve dove into is, “The Dukan Diet,” and it was painful to churn through each page. This diet has helped many people but some of the thought process and advice is backwards.  However, I will not dwell on this.

An exceptional diet, especially for people with diabetes, is Dr Bernstein’s. You can read his book online by clicking here. The diet is no walk in the park, take a look at what is allowed and what is not. Yikes – but if it can make someone feel better, live a longer and healthy life, it is well worth embracing.  The content below is pulled from his book and some content is abbreviated.

No-No’s in a Nutshell

Sweets and Sweeteners

• Powdered sweeteners (other than stevia)
• Candies, especially so-called sugar-free types
• Honey and fructose
• Most “diet” and “sugar-free” foods
• Desserts (except Jell-O gelatin without maltodextrin—no more than ½ cup per serving) and pastries: cakes, cookies, pies, tarts, et cetera
• Foods containing, as a significant ingredient, products whose names end in -ol or -ose (dextrose, glucose, lactose, mannitol, mannose, sorbitol, sucrose, xylitol, xylose, et cetera), except cellulose; also, corn syrup, molasses, maltodextrin, et cetera

Sweet or Starchy Vegetables
• Beans: chili beans, chickpeas, lima beans, lentils, sweet peas, et cetera (string beans, snow peas, and bell and chili peppers, which are mostly cellulose, are okay, as are limited amounts of many soybean products)
• Beets
• Carrots
• Corn
• Onions, except in small amounts
• Packaged creamed spinach containing flour
• Parsnips
• Potatoes
• Cooked tomatoes, tomato paste, tomato sauce, and raw tomatoes except in small amounts
• Winter squash

Fruit and Juices
• All fruits (except avocados)
• All juices (including tomato and vegetable juices— except for some people, in a Bloody Mary)

Certain Dairy Products
• Milk
• Sweetened and low-fat yogurts
• Cottage cheese (except in very small amounts)
• Powdered milk substitutes and coffee lighteners
• Canned milk concentrate

Grains and Grain Products
• Wheat, rye, barley, corn, and lesser-known, “alternative” grains, such as kasha, quinoa, and sorghum
• White, brown, wild rice, or rice cakes
• Pasta
• Breakfast cereal
• Pancakes and waffles
• Bread, crackers, and other flour products

Prepared Foods
• Most commercially prepared soups
• Most packaged “health foods”
• Snack foods (virtually anything that comes wrapped in cellophane, including nuts)
• Balsamic vinegar (compared to wine vinegar, white vinegar, or cider vinegar, balsamic contains considerable sugar)

Most vegetables, other than those listed in the No-No section, are acceptable.
Acceptable vegetables include asparagus, avocado, broccoli, brussels sprouts, cabbage and sauerkraut, cauliflower, eggplant, onions (in small amounts), peppers (any color except yellow), mushrooms, spinach, string beans, summer squash, and zucchini.

As a rule of thumb, ? cup of diced or sliced cooked vegetable,¼ cup mashed cooked vegetable, or 1 cup of mixed salad acts upon blood sugar as if it contains about 6 grams of carbohydrate. Remember that cooked vegetables tend to raise blood sugar more rapidly than raw vegetables because the heat makes them more digestible and converts some of the cellulose to sugar. Generally, more cooked vegetables by weight will occupy less volume in a measuring cup, so ? cup cooked spinach will weigh considerably more than ? cup uncooked. On your self-measurements, note how your favorite vegetables affect your blood sugar. Raw vegetables can present digestive problems to people with gastroparesis.

Of the following vegetables, each acts upon blood sugar as if it contains about 6 grams of carbohydrate in ? cup (all cooked except as noted):

artichoke hearts
bamboo shoots
beet greens
bell peppers (green and red only, no yellow) (cooked or raw)
bok choy (Chinese cabbage)
brussels sprouts
celery root (celeriac)
collard greens
daikon radish
dandelion greens
hearts of palm
mustard greens
patty pan squash
snow peas
spaghetti squash
string beans
summer squash
turnip greens
water chestnuts
zucchini flowers

In addition to the above, you should keep the following in mind:
• Onions are high in carbohydrate and should only be used in small amounts for flavoring—small amounts of chives or shallots can pack a lot of flavor.
• One-half small avocado contains about 6 grams of carbohydrate.
• One cup mixed green salad without carrots and with a single slice of tomato or onion has about the same impact on blood sugars as 6 grams of carbohydrate.
• One-quarter cup mashed pumpkin contains about 6 grams of carbohydrate. My own opinion is that without some flavoring, pumpkin tastes about as appetizing as Kleenex. Therefore I flavor it with much stevia and spice (cinnamon) and warm it to make it a bit like pumpkin pie filling. (For other vegetables from this list, such as turnips, assume that ¼ cup of the mashed product contains 6 grams of carbohydrate.)

Meat, Fish, Fowl, Seafood, and Eggs

These are usually the major sources of calories in the meal plans of my patients. The popular press is currently down on meat and eggs, but my personal observations and recent research implicate carbohydrates rather than dietary fat in the heart disease and abnormal blood lipid profiles of diabetics and even of nondiabetics. If you are frightened of these foods, you can restrict them, but depriving yourself will be unlikely to buy you anything.

Egg yolks, by the way, are a major source of the nutrient lutein, which is beneficial to the retina of the eye. Organic eggs contain large amounts of omega-3 fatty acids, which are good for your arteries.

Tofu, and Soybean Substitutes for Bacon, Sausage, Hamburger, Fish, Chicken, and Steak

About half the calories in these products come from benevolent vegetable fats, and the balance from varying amounts of protein and slow-acting carbohydrate. They are easy to cook in a skillet or microwave. Protein and carbohydrate content should be read from the labels and counted in your meal plan. Their principal value is for people who are vegetarian or want to avoid red meat. Health food stores stock many of these products.

Certain Commercially Prepared and Homemade Soups

Although most commercial and homemade soups contain large amounts of simple sugars, you can learn how to buy or prepare lowor zero-carbohydrate soups. Many but not all packaged bouillon preparations have no added sugar and only small amounts of carbohydrate. Check the labels or use the Clinistix/Diastix test, observing the special technique described on page 136. Plain consommé or broth in some restaurants may be prepared without sugar. Again, check with Clinistix/Diastix.

Homemade soups, cooked without vegetables, can be made very tasty if they are concentrated. You can achieve this by barely covering the meat or chicken with water while cooking, rather than filling the entire pot with water, as is the customary procedure. Alternatively, let the stock cook down (reduce) so you get a more concentrated, flavorful soup. You can also use herbs and spices, all of which have negligible amounts of carbohydrates, to enhance flavor. See “Mustard, Pepper, Salt, Spices, Herbs,” below. Clam broth (not chowder) is usually very low in carbohydrate.

In the United States you can also buy clam juices (not Clamato), which contain only about 2 grams of carbohydrate in 3 fluid ounces. Campbell’s canned beef bouillon and consommé contain only 1 gram carbohydrate per serving. College Inn brand canned chicken broth contains no carbohydrate.Most bouillon cubes are also low in carbohydrate; read the labels.

Cheese, Butter, Margarine, and Cream

Most cheeses (other than cottage cheese) contain approximately equal amounts of protein and fat and small amounts of carbohydrate. For people who want (unwisely) to avoid animal fats, there are some special soybean cheeses (not very tasty). There’s also hemp cheese, which I know nothing about. Cheese is an excellent source of calcium. Every ounce of whole milk cheese contains approximately 1 gram carbohydrate, except cottage cheese, which contains more. Generally speaking, where dairy products are concerned, the lower the fat, the higher the sugar lactose, with skim milk cheeses containing the most lactose and the least fat, and butter containing no lactose and the most fat.

Neither butter nor magarine in my experience will affect your blood sugar significantly, and they shouldn’t be a problem as far as weight is concerned if you’re not consuming a lot of carbohydrate along with them. One tablespoon of cream has only 0.5 gram carbohydrate—it would take 8 tablespoons to raise my blood sugar 20 mg/dl.


Although personally I don’t enjoy yogurt, many of my patients feel they cannot survive without it. For our purposes the plain whole milk yogurt, unflavored, unsweetened, and without fruit, is a reasonable food. A full 8-ounce container of plain, Erivan brand, unflavored whole milk yogurt contains only 11 grams of carbohydrate and 2 ounces of protein. You can even throw in some chopped vegetables and not exceed the 12 grams of carbohydrate limit we suggest for lunch. Do not use nonfat yogurt. The carbohydrate goes up to 17 grams per 8-ounce container.

Yogurt can be flavored with cinnamon, with Da Vinci brand syrups, with baking flavor extracts, or with the powder from sugar-free Jell-O brand gelatin (if the package doesn’t list maltodextrin as an ingredient) without affecting the carbohydrate content. It can be sweetened with stevia liquid or powder or with Equal or Splenda tablets that have been dissolved in a small amount of hot water. Erivan brand yogurt is available at health food stores throughout the United States. If you read labels, you may find brands similarly low in carbohydrate in your supermarket; two such brands are Stonyfield Farm and Brown Cow Farm.


There are many soy products that can be used in our diet plan, and soymilk is no exception. It’s a satisfactory lightener for coffee and tea, and one of my patients adds a small amount to diet sodas. Others drink it as a beverage, either straight or with added flavoring such as those mentioned for yogurt. Personally, I find the taste too bland to drink without flavoring, and I much prefer cream diluted with water.

When used in small amounts (up to 2 tablespoons/1 ounce), soymilk need not be figured into the meal plan. It will curdle if you put it into very hot drinks.

Soybean Flour

If you or someone in your home is willing to try baking with soybean flour, you will find a neat solution to the pastry restriction. One ounce of full-fat soybean flour (about ¼ cup) contains about 7.5 grams of slow-acting carbohydrate. You could make chicken pies, tuna pies, and even sugar-free Jell-O pies or pumpkin pies. Just remember to include the carbohydrate and protein contents in your meal plan.

Soybean flour usually must be blended with egg to form a batter suitable for breads, cakes, and the like. Creating a blend that works requires either experience or experimentation. Some recipes using soy flour appear in Part Three, “Your Diabetic Cookbook.”

Bran Crackers

Of the dozens of different crackers that I have seen in health food stores and supermarkets, I have found only three brands that are truly low in carbohydrate.
• G/G Scandinavian Bran Crispbread, produced by G. Gundersen Larvik A/S, Larvik, Norway (distributed in the United States by Cel-Ent, Inc., Box 1173, Beaufort, SC 29901, phone [843] 525- 1437). Each 9-gram slice contains about 3 grams of digestible carbohydrate. If this product is not available locally, you can order it directly from the importer. One case contains thirty 4- ounce packages. They are also available from Trotta’s Pharmacy (877) 987-6882.
• Bran-a-Crisp, produced by Saetre A/S, N1411, Kolbotn, Norway (distributed in the United States by Interbrands, Inc., 3300 N.E. 164th Street, FF3, Ridgefield,WA 98642). Each 8.3-gram cracker contains about 4 grams of digestible carbohydrate. Bran-a-Crisp may be ordered directly from Interbrands, Inc., by phone or e-mail if you cannot find it locally. Phone (877) 679-3552; e-mail: [email protected] A number ofWeb sites sell these crackers— just search for Bran-a-Crisp if you want to order that way, or order from Trotta’s Pharmacy.
• Wasa Fiber Rye. These crackers are available in most supermarkets in the United States and in some other countries. One cracker contains about 5 grams of digestible carbohydrate. Many of my patients feel that this is the tastiest of these three products. Although some people eat these without a spread, to me they taste like cardboard.

My preference is to enjoy them with chive-flavored cream cheese or butter. Crumbling two G/G crispbreads into a bowl and covering them with cream or cream diluted with water can create bran cracker cereal. Add some Equal or Splenda tablets (dissolved in a bit of hot water) or some liquid stevia sweetener and perhaps a baking flavor extract (banana flavor, butter flavor, et cetera), or one of the Da Vinci syrups.

If eaten in excessive amounts, bran crackers can cause diarrhea. They should be eaten with liquid. They are not recommended for people with gastroparesis (delayed stomach-emptying), since the bran fibers can form a plug that blocks the outlet of the stomach. The carbohydrate in these crackers is very slow to raise blood sugar. They are great for people who need a substitute for toast at breakfast.

Low-Carbohydrate Salad Dressings

Most salad dressings are loaded with sugars and other carbohydrates. The ideal dressing for someone who desires normal blood sugars would therefore be oil and vinegar, perhaps with added spices, mustard, and followed by grated cheese or even real or soy bacon bits. There are now available some commercial salad dressings with only 1 gram carbohydrate per 2-tablespoon serving. This is low enough that such a product can be worked into our meal plans. Be careful with mayonnaise. Most brands are labeled “carbohydrate—0 grams,” but may contain up to 0.4 grams per tablespoon. This is not a lot, but it adds up if you eat large amounts. Some imitation mayonnaise product shave 5 grams of carbohydrate per 2-tablespoon serving.


Although all nuts contain carbohydrate (as well as protein and fat), they usually raise blood sugar slowly and can in small amounts be worked into meal plans. As with most other foods, you will want to look up your favorite nuts in one of the books listed in Chapter 3 in order to obtain their carbohydrate content. By way of example, 10 pistachio nuts (small, not jumbo) contain only 1 gram carbohydrate, while 10 cashew nuts contain 5 grams of carbohydrate. Although a few nuts may contain little carbohydrate, the catch is in the word “few.” Very few of us can eat only a few nuts. In fact, I don’t have a single patient who can count out a preplanned number of nuts, eat them, and then stop. So unless you have unusual will power, beware. Just avoid them altogether. Also beware of peanut butter, another deceptive addiction. One tablespoon of natural, unsweetened peanut butter contains 3 grams of carbohydrate, and will raise my blood sugar 15 mg/dl. Imagine, however, the effect on blood sugar of downing 10 tablespoons.

Sugar-Free Jell-O Brand Gelatin

This is one of the few foods that in reasonable amounts will have no effect upon blood sugar if you get the kind that is indeed sugar-free. I have been informed by some of my patients and found it to be true that in some areas “sugar-free” actually contains some maltodextrin, which is a mixture of sugars and will raise your blood sugar. The ready-to-eat variety in plastic cups does not thus far contain maltodextrin— or at least that which I’ve found on my grocery’s shelves.


Most of my patients initially feel somewhat deprived, but also grateful because they feel more alert and healthier. I fall into this category myself. My mouth waters whenever I pass a bakery shop and sniff the aroma of fresh bread, but I am also grateful simply to be alive and sniffing.


Carbs: the secret to slim

Recent studies suggest that a high carbohydrate diet can be effective for losing weight and even outperforms a high protein diet for cutting body fat and lowering cholesterol and blood sugar.

In the post-Atkins era, this might seem like strange advice: Eat carbohydrates to help you stay lean. But according to a study of 4,451 healthy Canadians, those whose diets contained the most carbohydrate had the lowest risk of being overweight or obese.

For the past decade, the debate over the best diet to maintain a healthy weight has been centred around carbohydrates. The late physician and cardiologist Robert Atkins won over many dieters to his high-protein, low-carbohydrate plan which, over the short term, produces greater weight-loss results than a diet high in carbohydrates.

But the long term is what counts when it comes to maintaining a healthy weight and studies have determined there’s no difference between the diets and amount of weight lost after one year.
In fact, recent studies suggest that a high carbohydrate diet is indeed effective for losing weight and outperforms a high protein diet when it comes to losing body fat and lowering cholesterol and blood sugar.

The current study, published in the July issue of the Journal of the American Dietetic Association, assessed the diets and body weights of 4,451 healthy Canadians aged 18 years and older. The likelihood of being overweight or obese declined steadily as carbohydrate intake increased.

Compared to people whose diets provided the least carbohydrate (36 per cent of calories), those who consumed the most (64 per cent of calories) had a 40 per cent lower risk of being overweight or obese.

Overweight and obesity was defined as having a body mass index (BMI) of 25 or greater. (BMI is calculated as your weight in kilograms divided by the square of your height in meters. For adults, a BMI of 25 or more signals overweight; 30 more indicates obesity.) A higher carbohydrate diet was protective from overweight and obesity among older and younger participants, men and women, and people who never smoked.

A diet that is high in carbs such as whole grains, legumes, fruits and vegetables is also naturally low in fat and high in fibre. Fibre-rich foods add volume to meals, helping you feel full on fewer calories.

In the study, participants with the highest carbohydrate intake had a lower intake of calories, protein, total fat and saturated fat than the lower carbohydrate eaters. They also consumed almost double the fibre and more fruits and vegetables that those with the lowest carbohydrate intake.

Earlier research has also revealed that a high carbohydrate diet is good for the waistline. A 2008 study found that the Mediterranean diet – high in whole grains, fruit and vegetables – was as effective as the low carbohydrate diet at shedding pounds over a two-year period. What’s more, among people with diabetes, this high carbohydrate diet did a better job at reducing blood sugar and insulin levels.

However, not all carbohydrates are good for you. Mounting evidence suggests that diets based on low glycemic index (GI) carbohydrates are better for weight control and health.

The GI is a scale that ranks carbohydrate-rich foods by how quickly they are digested and raise blood sugar compared to pure glucose. Foods that are ranked high on the GI scale are fast acting – they’re digested quickly and, as a result, cause large rises in blood sugar and insulin, the hormone that removes sugar from the blood and stores it in cells. Examples include white bread, whole-wheat bread, baked potatoes, refined breakfast cereals, instant oatmeal, cereal bars, raisins, ripe bananas, carrots, honey and sugar.

Foods with a low GI release sugar more slowly into the bloodstream and don’t produce an outpouring of insulin. Examples include grainy breads with seeds, steel cut oats, 100 per cent bran cereals, oat bran, brown rice, sweet potatoes, pasta, apples, citrus fruit, grapes, pears, legumes, nuts, milk, yogurt and soymilk.

In a recent study of 129 overweight adults assigned to one of four diets that differed in the amount of carbohydrate and glycemic index found that while all diets promoted weight loss, only the high carb, low glycemic index diet resulted in a greater loss of body fat and a reduction of LDL (bad) cholesterol.

It’s thought that a diet based on high glycemic carbohydrates is less effective at promoting weight loss because the large spikes in blood sugar and insulin it causes can trigger hunger and inhibit the breakdown of body fat.

To help reduce the risk of excess weight gain, diabetes and heart disease, 40 to 65 per cent of your daily calories should come from carbohydrate rich foods such as whole grains, fruit, vegetables and legumes. The following strategies can help you increase your intake of healthy carbs – and manage your weight.

Go for whole grain
Choose 100 per cent whole grain breads, brown rice, whole wheat pasta, quinoa and breakfast cereals made from whole grains. Read ingredient lists; choose foods that list a whole grain as the first ingredient.

Choose fibre-rich carbs
Include 21 to 38 grams of dietary fibre in your daily diet. Men and women aged 19 to 50 need 38 and 25 grams of fibre each day, respectively. Older women require 21 grams; older men need 30 grams.

Choose breads that provide at least 2 grams of fibre per slice and breakfast cereals with at least 5 grams of fibre per serving. Mix ½ cup (125 ml) of 100-per-cent bran cereal with other cereals to boost your fibre intake.

Add legumes and lentils to soups, salads and pasta. Snack on fruit, dried fruit, nuts or plain popcorn instead of refined, low fibre snacks such as pretzels, cereal bars, and white crackers.

Choose low glycemic
In general, whole grains, bran cereals, legumes, fruits and vegetables have a low glycemic index. Include at least one low GI food per meal, or base two of your meals on low GI choices.
Instead of creamy dressings, use salad dressings made from vinegar or lemon juice – the acidity will result in a further reduction in the GI of your meal. Choose fruits that are more acidic (e.g. oranges, grapefruit, cherries, strawberries, green apples) as these have a low GI.

Practice portion control
Regardless of the type of carbohydrate you eat, managing portion size is key to weight control. If you are trying to lose weight, keep portions of cooked grains and pasta to 1 to 1.5 cups (250 to 375 ml) – or fill only one-quarter of your plate with starchy foods. To judge your portion size at home, measure your food for a few days.
Choose two slices of whole grain bread instead of one large bagel (worth 4 to 5 slices of bread).

Limit refined sugars
Curb your intake of candy, chocolate, soft drinks, fruit drinks, desserts and other sweets. The World Health Organization recommends limiting added sugars to no more than 10 per cent of daily calories. If you follow a 2,000-calorie diet, this translates to a daily maximum of 48 grams (12 teaspoons worth) of added sugars.

Reference click here

Have a healthy and fit day!

Pass the Finish Line

When you’re engaging in exercise beyond your usual activity level — such as a charity bike ride, mini-marathon or fun run — don’t forget to refuel your body during the event.

Your body can store only about an hour’s worth of carbohydrates, so if you want to finish the race without being pulled over the finish line, eat or drink carbohydrates along the way, such as a sports drink or energy bar.

After any especially long workout, you need to restore your energy. A small high-carbohydrate, moderate-protein and low-fat meal is best. Bring along some fruit, low-fat yogurt and whole-wheat crackers or bread for after you cross the finish line.

Produced by ADA’s Public Relations Team

Have a healthy and fit day!