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)
• Onions, except in small amounts
• Packaged creamed spinach containing flour
• 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
• 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
• Breakfast cereal
• Pancakes and waffles
• Bread, crackers, and other flour products
• 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):
bell peppers (green and red only, no yellow) (cooked or raw)
bok choy (Chinese cabbage)
celery root (celeriac)
hearts of palm
patty pan squash
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.
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.”
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  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.
HOW DO PEOPLE REACT TO THE NEW DIET?
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.