Focus on Diabetes

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Since 2008, the American Diabetes Association has acknowledged the value of using a low carb approach when treating people with diabetes.  While the ADA once had a minimum number of recommended carbohydrates for diabetic clients, they now have recognized the need for a more individualized approach for each client.  What works for one client may not work for another.  In their 2013 position statement on Medical Nutrition Therapy, the ADA states:

“Evidence suggests that there is not an ideal percentage of calories from carbohydrate, protein and fat for all people with diabetes; therefore, macro-nutrient distribution should be based on individualized assessment of current eating patterns, preferences and metabolic goals.”  Those metabolic goals should include: optimal blood glucose control, improvement in cardiovascular health, and, if possible, weight loss.

The ADA further states:

“Monitoring carbohydrate intake, whether by carbohydrate counting or experienced based estimation, remains a key strategy in achieving glycemic control.”

“Monitoring carbohydrate intake remains a key strategy in achieving glycemic control.”

In other words, managing those foods that raise blood glucose the most, carbohydrates, will lead to the best possible glycemic control.

Studies show that for many, a low carb approach is more effective than a low fat approach in terms of weight loss, greater blood sugar control, and improved cardiovascular health, especially when combined with a whole food approach.

The ADA acknowledges:

“Published studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels indicated improved markers of glycemic control and insulin sensitivity with lower carbohydrate intakes.”

“Studies comparing lower levels of carbohydrate intake to higher carbohydrate intake levels revealed improvements in serum lipid / lipoprotein measures, including improved triglycerides, VLDL triglyceride, VLDL cholesterol, total cholesterol and HDL cholesterol with lower carbohydrate intakes.”

“Lowering total fat intake did not consistently improve glycemic control or CVD risk factors.”

Therefore, since lowering fat intake did not improve cardiovascular risk factors, but lowering carbohydrate intake did, doesn’t it make sense to encourage this approach?

If you have tried other dietary approaches to controlling your diabetes, and felt they were not effective, the low carb-whole food approach may be beneficial for you.

In the past 5 years, I have made this an area of intense research for myself, reading dozens and dozens of nutritional books, pouring over hundreds of nutritional studies and listening to numerous expert lectures. In the process, I have used myself as a human nutritional “guinea pig,” testing these nutritional theories out on myself.  I have very much in common with many other people with Type 2 diabetes, and those with metabolic disorders, not to mention a strong genetic pre-disposition to Type 2.

After a lifetime of low-fat, high-carb living, I was obese, pre-diabetic, had uncontrolled hypertension and dyslipidemia.  I followed the food pyramid and ate lots of whole grains and low fat carbohydrates…and VERY little fat.

Here I was…

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My Stats

Weight: 251 lbs

A1c 6.3%

HDL 40

LDL 125

Trig 241

Health Conditions:

Pre-diabetes,

Uncontrolled hypertension (on medication)

Dyslipidemia,

Reflux (on medication)

Chronic insommnia

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This is me after about one year of adhering to a low carb way of living…

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My Stats

Weight: 171 lbs

A1c 5.0%

HDL 53

LDL 98

Trig 61

Health Conditions:

None

Medications:

None

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How Did I Accomplish This?

By eliminating these foods…

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And eating plenty of these foods…

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CLINICAL STUDIES

Examining this study published in the New England Journal of Medicine in 2008 shows that a low carb diet resulted in:

Greater weight loss
Increased “good” cholesterol
Decreased “bad” cholesterol
Lower triglycerides
Lower Insulin
Improved C-Reactive Protein

versus a low fat diet.  This is true even though low carb diets include greater amounts of dietary cholesterol and saturated fat, in foods such eggs, butter and coconut oil, which are actually heart healthy (as you will soon discover.)

This was a two year study, considered to be a long term nutritional study, of 322 moderately obese subjects with a mean age of 52 years old.

NEJM 359-3, July 17, 2008

Study Terms and Conditions
Low Fat Group

Followed the American Heart Association current guidelines
1500 kcal restriction for women
1800 kcal restriction for men
Less than 30% of total calories from fat
Less than 10% from saturated fat

Participants were counseled to consume:
Low fat grains, vegetables, fruit, other grains and legumes.

Participants were counseled to limit:
Fats, sweets and high-fat snacks

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Study Terms and Conditions
Low Carb Group

Followed the Atkins Diet
No calorie restriction
20g of carbs per day for two months
120g per day thereafter
No limitations on fat, including saturated fat

Participants were counseled to consume:
Both animal and plant sources of saturated fat

Participants were counseled to limit:
Carbohydrates, trans fats

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FINDINGS

The low carb diet caused greater weight loss than the low fat diet…

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The low carb diet caused greater reduction in insulin levels than the low fat diet…

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The low carb diet caused greater increase in beneficial HDL cholesterol than the low fat diet…

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The low carb diet caused greater decrease in LDL than the low fat diet…

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The low carb diet caused greater decrease in triglycerides than a low fat diet…

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The low carb diet caused greater improvement in C-Reactive Protein than a low fat diet.

(C-Reactive Protein is a marker of inflammation and can be used as an indication of cardiovascular health.)

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WOW!!!

Here is a similar study, Funded by the National Institutes of Health and published in the Annals of Internal Medicine, September 2, 2014. It compared a low fat diet to a low carb diet for weight loss and cardiovascular risk. It was a one year trial involving 148 men and women. Here were the terms for each group…

Study Terms and Conditions
Low Fat Group

Follow the American Heart Association current guidelines
No restrictions on calories
Less than 30% of total calories from fat
Less than 7% from saturated fat

Participants were counseled NOT to change their physical activity.

Participants were counseled to consume:
Vegetables, fruits, grains, starches

Participants were counseled to limit:
Fats in general

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Study Terms and Conditions
Low Carb Group

No calorie restriction
More than 40% of calories from fat
Twice the saturated fat as recommended by the American Heart Association
40g of carbs per day

Participants were counseled NOT to change their physical activity

Participants were counseled to consume:
Fats: butter, eggs, cheese, olive oil, nuts
Meats: red meat, fish, poultry

Participants were counseled to limit:
Carbohydrates in general

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FINDINGS

Weight loss

The low carb group had greater weight loss

Fat Mass

The low carb group lost greater body fat.

The low fat group actually lost more lean muscle than body fat.

HDL

The low carb group had greater increase in HDL.

Triglycerides

The low carb group had the greatest reduction in triglycerides.

LDL*

No change in LDL for either group

Framingham Risk Scores

The low carb group lowered their Framingham Risk Scores. The Framingham Risk Score calculates the likelihood of a heart attack in the next 10 years.

The low fat group did NOT improve their scores.

The study concluded with these words: “The low carbohydrate diet was more effective for weight loss and cardiovascular risk factor reduction that the low fat diet. Restricting carbohydrate may be an option for person seeking to lose weight and reduce cardiovascular risk factors.”

Further Quotes From the Study

*“One important predictor of heart disease that the study did not assess was the relative size and number of LDL particles in the bloodstream. Two peoples can have the same overall LDL concentration, but very different levels of risk depending on whether they have a lot of small, dense LDL particles or a small number of large, fluffy particles,” states Dr. Allan Sniderman, Professor of Cardiology at McGill University in Montreal.

“Eating refined carbohydrates tends to raise the overall number of LDL particles and shift them toward the small, dense variety, which contributes to atherosclerosis. Saturated fat tends to make LDL particles large, more buoyant, and less likely to clog arteries, at least when carbohydrate intake is not high. Small, dense LDL is typically found in heart patients and in people who have high triglycerides, central obesity and other aspects of so-called metabolic syndrome,” states Dr. Ronald M. Krauss, Director of Atherosclerosis Research at Children’s Hospital Oakland Research Institute and former Chairman of the American Heart Association’s Dietary Guidelines Committee.

“The research suggests that health authorities should pivot away from fat restriction and encourage people to eat fewer processed foods, particularly those with refined carbohydrates,” states Dariush Mozaffarian, Dean of the Friedman School of Nutrition Science and Policy at Tufts University.

What Happens on a High Carb (Low Fat) Diet?

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Effects of a Diet High in Carbohydrates:

High carb intake increases blood sugar
Increased blood sugar causes insulin response
Fat burning stops
Fat storage increases

This is happening even though your dietary fat intake is low. It is carbohydrates that cause increased body fat, NOT consumption of fat.

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What Happens on a Low Carb (High Fat) Diet?

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Effects of a Diet Low in Carbohydrates:

Low carb intake creates normal blood sugar
Normal blood sugar lowers insulin response
Fat burning increases
Stored fat is burned

This is happening even though your dietary fat intake is higher. It is carbohydrates that cause increased body fat, NOT consumption of fat.

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Weight Loss, Blood Glucose, Insulin and Carbohydrates

CarbEffect

Weight loss and gain is governed predominantly by hormones, insulin being one of the master hormones involved. When insulin is present in abundance, it is very difficult to lose weight. Insulin’s presence tells the body to stop burning stored fat, and also signals the body to store excess incoming carbohydrates as fat. One logical way to stop this action is to consume the foods that do not require large amounts of insulin to process.  This also helps regulate blood glucose levels.

The food that requires the greatest amount of insulin to process in the diet is carbohydrates. Carbohydrates cause blood glucose to rise sharply, which causes the body to make insulin to lower the blood sugar once again. The only logical way to reduce insulin in the body is to reduce those foods that cause the need for insulin, that’s right, reduce carbohydrates.  This is the primary way to promote weight loss and improve blood glucose control.

“Fed Vs Fasted”

Another practice that can lead to increased insulin levels is eating frequently. We have often been told to “eat small meals all day long” to “keep our metabolism going. This is extremely bad advice. Not to mention that no studies prove this to be true.

Our body has two “states” in regards to food intake: a “fed” state (when we have recently eaten), and a “fasted” state (when we have not eaten in some time, such as when sleeping). When we spend too much time in the “fed” state, insulin levels stay elevated for too long. Spending more time in the “fasted” state can lead to reduced insulin levels and promote weight loss. To achieve this, eat no more than 2-3 meals per day, no closer than 4-5 hours apart to allow yourself to return to a “fasted” state between meals. Avoid eating within 2 hours of bedtime to allow for a sufficient evening fast. (This is why breakfast has it’s name…the meal that “breaks our fast.”)

*Images courtesy of http://www.burnfatnotsugar.com

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Reducing Carbohydrates With Diabetes Just Makes Sense!

Barbara Gower, PhD., Professor and Vice-Chair for Research in the UAB Department of Nutrition Sciences, stated that, “Diabetes is a disease of CARBOHYDRATE INTOLERANCE.  Reducing carbohydrates is the obvious treatment.  It was the standard approach before insulin was discovered and is, in fact, practiced with good results in many institutions.  The resistance of government and private health agencies is very hard to understand.”

Richard David Feinman, PhD., Professor of Cell Biology at SUNY Downstate Medical Center, states: “The low-fat paradigm, which held things back, is virtually dead as a major biological idea.  Diabetes is too serious a disease for us to try to save face by holding onto ideas that fail.”

Gower added that, “For many people with Type 2 diabetes, low-carbohydrate diets are a real cure.  They no longer need drugs.  They no longer have symptoms.  Their blood glucose is normal, and they generally lose weight.”

Some plans being suggested to diabetics have upwards of 240g of carbohydrates daily (4 exchanges per meal for 3 meals, 2 exchanges per snack, for 2 snacks).  Normal sugar in the blood represents approximately ONE TEASPOON (or 4g) of sugar.  So, 240g of carbohydrates is equal to nearly 60 TEASPOONS of sugar.

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This EVEN applies to “complex” carbohydrates!

“We all know that sugar is bad, but we mistakenly believe complex carbohydrates are healthy and we need to eat them in abundance.  BUT what if I told you that “complex carbohydrates” and “whole grains” are just glucose molecules hooked together in a long chain.  The digestive tract breaks it down into glucose…also known as sugar.  So a “complex carb” diet and a “sugary” diet are pretty much the same thing.” – Maria Emmerich, Expert in Nutrition and Exercise Physiology, Author of “Keto Adapted”

Image result for image maria emmerich simple carbohydrates vs complex carbohydrates

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What is the Glycemic Index and Why Does It Matter To Me?

The glycemic index is a measure of how quickly certain foods containing carbohydrates will raise your blood sugar. You will see things like green leafy vegetables at the bottom of the list, and things like rice and bread towards the top. For reference, table sugar ranks at about 62. I often encourage ones to eat low glycemic foods. The problem is that the general definition of “low glycemic” are foods that have a glycemic index of 55 or lower. I believe this needs to be redefined. If table sugar is 62, that means that foods that will raise your blood sugar almost as high as table sugar, are considered “low glycemic.” Low glycemic SHOULD mean foods that have very little blood sugar impact.

We have been told again and again that we should replace our white bread with whole wheat bread, our processed oatmeal with steel cut oatmeal, etc. But in reality, ALL of these foods cause far too much spike in our blood sugar levels. In fact, a new study published in the Journal of the American Medical Association, December 17, 2014, compared higher glycemic items (GI=65) to their lower glycemic counterparts (GI=40), and found NO benefit in replacing these higher glycemic foods with their lower glycemic counterparts. Why? They ALL cause significant blood sugar spike. Dr. Davis, author of Wheat Belly, uses a great illustration by saying that just because low tar cigarettes may be less bad than regular cigarettes, doesn’t mean that lots of low tar cigarettes are good for your health. In other words, less bad doesn’t equal good. The JAMA study proved this. Even if you still believe that wheat bread is less bad than white, it doesn’t mean it is good for you. Do you want to be truly healthy? Or just a little less unhealthy…

So when I personally recommend lower glycemic foods, I am specifically talking about foods that are VERY low on the chart, those that will cause VERY little blood sugar spike. These include, mostly, your non-starchy vegetables. If you really desire to have fruits, choose those lowest on the chart, like berries. Of course, your proteins and healthy fats are so low glycemic, that they are not typically listed on the charts.

The following charts help you understand why it is so important to chose items that have a low glycemic impact. When you eat foods that cause blood sugar spikes, you also create an insulin response to match. Remember, once insulin responds, your body stops burning its own fat, and goes into fat storage mode. Because you’ve created a sugar-insulin roller coaster, you will become hungry again sooner and will crave higher carbohydrate foods. By living a life of glycemic control, you avoid these complications.

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For Information Specific to Different Types of Diabetes, Click Below:

For Those with Pre-Diabetes, Read These Two Articles Below

Insulin Resistance

Pre-Diabetes

For Those with Type 2 Diabetes, Read These Two Articles Below

Insulin Resistance

Type 2 Diabetes

For Those with Type 1 Diabetes, Read This Article Below

Type 1 Diabetes

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So, let’s see how a low carb, whole food approach can help both Type 1 and Type 2’s.

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What is a “Whole Food” Approach?

A whole-food approach focuses on eliminating processed foods, excess sugar, and processed carbohydrates, as well as trans fats and industrial man-made fats, the REAL unhealthy fats.  This is what a low carb, whole food pyramid looks like: (image courtesy of http://www.edify.net.au)

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Frequently Asked Questions

Isn’t a low carb diet high in protein and fat?

A low carb diet is not typically a high protein diet (unless more protein is needed, such as for children, pregnant women, athletes, etc) nor is it a high fat diet, for most people. While protein and fat are obviously increased, the focus mainly is on reducing the quantity and improving the quality of carbohydrates. Fat and protein needs vary for every person and are individualized according to a person’s weight and health goals.

If I restrict carbs, won’t I be missing out on essential nutrients?

The type of carbs being consumed by most people (bread, cereal, pasta, cake, cookies, chips, popcorn, etc) have no nutritional value.  Any nutrients in these highly processed foods are typically added artificially and are of poor quality.  You will not be missing out ANYTHING nutritionally by avoiding these foods.  You will be eating plenty of whole food sources of carbohydrates which will provide all the nutrients you will need.

Will I get enough fiber?

Absolutely!  Once again, a low carbohydrate, whole food way of living will provide you with all the nutrients your body needs, including fiber.  Fiber will be obtained from many healthy, fibrous plant sources of carbohydrates.

Won’t eating fat make me fat?

It has been believed that fat makes you fat because a gram of fat contains 9 calories, whereas a gram of protein or carbohydrate contains 4 calories. While fat itself has more calories, it is also more satiating and typically self limiting. Where a person is very likely to overeat carbs, this is unlikely with fats. People on low carb diets generally eat less often because they are not feeding the demands of highs and lows with their blood sugar levels. But even when eating more calories, low carb diets cause greater fat burning and weight loss, regardless of calories.  Most low carbers do not strictly count calories.

A calorie is not a calorie…

While we are on the subject, lets dispel the myth of calories in / calories out.  We’ve all heard it…”as long as you burn more calories than you take in, you will lose weight.” Unfortunately, it doesn’t work like that. Calories are NOT created equal. Common sense tells us that 100 calories of broccoli is NOT the same as 100 calories of cake. Broccoli will NOT cause insulin spike and fat storage…cake will. Plain and simple. If you don’t believe me, eat your entire amount of daily calories in broccoli for a week. The next week, eat the same amount of calories in cake…see what happens!

Won’t fat and cholesterol clog my arteries and cause heart disease?

Both saturated fat and cholesterol are essential in our diet. A review of earlier studies done in the 1950’s, that led to the original recommendations to cut saturated fat and cholesterol from the diet, have long since been found to be totally misinterpreted and misrepresented. Although studies have been published for the past 20 years showing no connection between dietary cholesterol and saturated fat with heart disease, the myth persists. Let’s look at just a few of those studies…

Cholesterol Intake and Plasma Cholesterol: An Update
December 16, 1997

“The misconception that dietary cholesterol determines blood cholesterol is held by many consumers in spite of evidence to the contrary. Many studies reported over the last two years have shown that dietary cholesterol is not a significant factor in an individual’s plasma cholesterol level or cardiovascular disease risk.”

http://www.ncbi.nlm.nih.gov/pubmed/9430080

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Meta-Analysis of Prospective Cohort Studies Evaluating the Association of Saturated Fats with Cardiovascular Disease
March 9, 2010

“A reduction in dietary saturated fat has generally been thought to improve cardiovascular health. The objective of this meta-analysis was to summarize the evidence related to the association of dietary saturated fat with risk for coronary heart disease (CHD), stroke and cardiovascular disease (CVD). During a 5-23 year follow up of 347,747 subjects, intake of saturated fat was NOT associated with an increased risk for CHD, stroke or CVD.

http://www.ncbi.nlm.nih.gov/pubmed/20071648

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Saturated Fat, Carbohydrates and Cardiovascular Disease
September 6, 2011

“Replacing dietary saturated fat with carbohydrates, notably those with a high glycemic index, is associated with an increase in CVD risk”

http://www.ncbi.nlm.gov/pubmed/21978979

This study shows that when we replace fats in the diet with high glycemic carbohydrates, as one would do on a low fat diet, our cardiovascular risk is INCREASED.

(images courtesy of http://www.drperlmutter.com)

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Rethinking Dietary Cholesterol
March 15, 2012

PURPOSE OF REVIEW: The perceived notion that dietary cholesterol is associated with increased risk for coronary heart disease (CHD) has led to dietary recommendations of no more than 300mg/day for healthy populations in the USA. This study will review the current dietary restriction regarding cholesterol while it presents some beneficial effects of eggs (an icon for dietary cholesterol) in healthy individuals.

RECENT FINDINGS: the European countries, Australia, Canada, New Zealand, Korea and India among others do not have an upper limit for cholesterol in their dietary guidelines. Further, existing epidemiological data have clearly demonstrated that dietary cholesterol is not correlated with increased risk for CHD.

SUMMARY: The lines of evidence coming from current epidemiological studies and from clinical interventions support the notion that the recommendations limiting dietary cholesterol should be reconsidered.”

http://www.ncbi.nlm.nih.gov/pubmed/22037012

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Revisiting Dietary Cholesterol Recommendations:
Does the Evidence Support a Limit of 300 mg Per Day?
November 12, 2010

“The perceived association between dietary cholesterol and risk for coronary heart disease (CHD) has resulted in recommendations of no more than 300 mg/day for healthy persons in the United States. These dietary recommendations proposed in the 1960s had little scientific evidence. In contrast, European countries, Asian countries, and Canada do not have an upper limit for dietary cholesterol. Further, current epidemiologic data have clearly demonstrated that increasing concentrations of dietary cholesterol are NOT correlated with increased risk for CHD.

Clinical studies have shown that…dietary cholesterol increases high-density lipoprotein (HDL) cholesterol. More importantly, dietary cholesterol reduces circulating levels of small, dense LDL particles, a well-defined risk factor for CHD. This article presents recent evidence documenting the lack of effect of dietary cholesterol on CHD risk, suggesting that guidelines for dietary cholesterol should be revisited.”

http://www.ncbi.nlm.nih.gov/pubmed/20683785

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Additional studies for consideration:

http://www.ncbi.nlm.nih.gov/pubmed/22208554
http://www.ncbi.nlm.nih.gov/pubmed/18203890
http://www.ncbi.nlm.nih.gov/pubmed/18289377
http://www.ncbi.nlm.nih.gov/pubmed/11023005
http://www.ncbi.nlm.nih.gov/pubmed/11078235

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Why Do I Need Cholesterol?

“Cholesterol is essential for our bodies to function. Without cholesterol, you would die. In fact, the majority of the cholesterol in our blood comes from our own bodies making it. I don’t think that a lot of people understand this concept. People mistakenly think they get most of their cholesterol from their food and that is not true. Cholesterol is used to make hormones like estrogen and testosterone, is transported to the adrenal gland to aid in hormone synthesis, repairs nerves and makes bile for fat digestion, it is a structural component of our cells, it synthesizes vitamin D. It plays such a crucial role in our body that we genuinely need it. If our levels of cholesterol are too low, that can play a negative role in our health too, as a telltale sign of autoimmune disease or even cancer.” Cassie Bjork, Registered Dietician, as quoted in the book Cholesterol Clarity

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Are There Any Benefits to Saturated Fat?

“Saturated fat plays many vital roles in our body chemistry. They make up at least 50% of the cell membranes. They are what create our cell’s necessary stability. They play a vital role in the health of our bones. They allow calcium to be effectively incorporated into the skeletal structure. They guard the liver from alcohol and other toxins, such as Tylenol. They improve the immune system. Saturated fats have antimicrobial properties, which protect us against harmful microorganisms in the digestive tract.” Maria Emmerich, Expert in Nutrition and Exercise Physiology, specializing in the study brain chemical transmitters, as quoted in the book Keto Adapted.

So if cholesterol and fat are so important, why are we shunning them?

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With overwhelming evidence exonerating saturated fat, Time Magazine was prompted to post this article in their June 2014 issue:

“Eat Butter: Scientists Labeled Fat the Enemy.  Why They Were Wrong.”

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So what does that mean for us? It means that dietary fat and cholesterol can take their rightful place back in a balanced diet as they once had. No more opting for low fat margarine over butter. No more egg-white omelets.  Let’s see how to combine a low carb lifestyle with a whole food approach for weight loss, optimal blood glucose control and total wellness.

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EAT THESE FOODS FREELY

Non-starchy vegetables: preferably green leafy ones.

Eat non-starchy vegetables at every meal.

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EAT THESE FOODS FREELY
(BUT NOT EXCESSIVELY IF NEEDING TO LOSE WEIGHT)

Healthy fats: coconut oil, butter (no substitutes), avocados, olive oil, fatty fish (like salmon), high fat nuts (like macadamias).  While we can eat these foods freely, that does not mean excessively.  Use these foods to compliment and flavor foods.

Eat healthy fats at every meal.

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EAT THESE FOODS FREELY

Whole Eggs: with the yolks, preferably pasture raised.

Feel free to eat eggs daily (unless allergic).

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Water: drink a minimum of 2 liters of water daily, but preferably more

(unless on a medically prescribed fluid restriction.)

Aim for 1/2 your body weight in ounces per day.

(Example: weight 150 lbs = 75 oz of water)

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EAT THESE FOODS MODERATELY

Meats: beef, pork, lamb, venison, poultry, seafood

(Choose fresh meat.  Avoid processed meat as much as possible.)

A typical recommendation is a “palm-sized” portion at meals.

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EAT THESE FOODS MODERATELY

Dairy: full fat cheese, cream (no low fat dairy)

(Avoid processed cheese-like substances, ie. Velveeta)

(Exception: milk – see below)

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EAT THESE FOODS MODERATELY

Nuts: it is very easy to overeat nuts.  Watch portion sizes.

(Macadamias, pecans and almonds are great choices.  Nut flours are acceptable.)

(Cashews are higher in carbs.  Peanuts are not nuts)

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EAT THESE FOODS MODERATELY

Fruit: no more than 1 small serving of low glycemic fruit daily (preferably berries).

Eat only if well tolerated with your blood sugar.

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PREFERABLY AVOID THESE FOODS

Starches

Starches are vegetables, such as potatoes and tubers, carrots and peas (peas are technically a legume – see below), and other root vegetables (those that grow below ground).  Although having some beneficial nutrients, starches are not an ideal choice for people with diabetes.  If you choose to eat these foods, do so in very limited quantity.  I would recommending avoiding these foods if your blood glucose is not well regulated.

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PREFERABLY AVOID THESE FOODS

Legumes

Legumes include beans, peas and lentils.  Although they have some beneficial proteins, they are high in carbohydrates and contain some anti-nutrient properties (which prevent you from absorbing nutrients) and can cause digestion / gut-related problems. If you choose to eat these foods, do so in very limited quantity.  I would recommending avoiding these foods if your blood glucose is not well regulated.  If you are on a plant based diet and use legumes for protein sources, I would highly suggest researching appropriate preparation methods (soaking and sprouting) to minimize gut inflammation.

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PREFERABLY AVOID THESE FOODS

Milk and Milk Products

Milk (and milk products like yogurt) are high in sugar.  Although lactose is a natural “sugar”, your body does not really know the difference.  Milk and sweetened yogurts will cause a quick spike in blood glucose.  If you do drink milk, it should NOT be low fat / fat free.  These often contain undesirable additives to improve texture and flavor to the milk after the fat has been removed.  In addition, vitamin D, a fat soluble vitamin in the milk, CANNOT be absorbed without fat.  Therefore, drink full-fat milk, preferably a less processed milk that contains the cream at the top.  When it comes to yogurt, low fat / non-fat ALWAYS means MORE SUGAR.

Although having some beneficial nutrients, this type of dairy is not an ideal choice for people with diabetes.  If you choose to consume these foods, do so in very limited quantity.  I would recommending avoiding milk and sweetened yogurt  (If you like yogurt, go for full fat, plain, Greek yogurt.)  I have chosen to avoid milk altogether.  There is absolutely NO nutritional need for it.

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ELIMINATE THESE FOODS

Grains

It would be ideal to eliminate ALL GRAINS from your diet, especially products derived from wheat and corn.  Avoid processed grain products (WHEAT OR WHITE) including, but not limited to: bread and pasta, as well as all corn products, including, but not limited to: corn chips, corn tortillas, corn meal, grits and corn itself.  Other grains to avoid include: rice, oats, barley, rye, etc.

I STRONGLY discourage ALL grains.  I have chosen to be completely grain free.  There is absolutely NO nutritional need for them.

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ELIMINATE THESE FOODS
ANYTHING MADE WITH FLOUR AND SUGAR.

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ELIMINATE THESE FOODS

Low Fat and Fat Free Products

Low fat = more sugar!

If you choose to use some processed products, choose the full-fat version.

Avoid oils high in Omega 6 polyunsaturated oil, like vegetable, corn, soy and canola oils, as well as seed oils.  Avoid TRANS FATS!!!  Avoid all butter substitutes. All of these are HIGHLY inflammatory and have been shown to increase cardiovascular risk.

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ELIMINATE THESE FOODS

Sweet Drinks

ABSOLUTELY avoid ALL sweet drinks, including soda, sweet tea, lemonade and juice.  NEVER DRINK YOUR CARBS!!  Diet drinks are not a good alternative either!  Studies have shown that they can contribute to weight gain and pose other dangers to your health.  It would be best to drink only water, (and coffee / unsweetened teas if you prefer).

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ELIMINATE THESE FOODS

Processed / Fast Foods

ABSOLUTELY avoid all processed convenience foods and fast foods, especially foods containing HIGH FRUCTOSE CORN SYRUP AND TRANS FAT.

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THE GOOD NEW IS THIS: BEING LOW CARB DOESN’T MEAN MISSING OUT ON EVERYTHING YOU LOVE.  ALMOST ALL OF THE FOODS ON THE “ELIMINATE” LIST CAN BE MADE LOW CARB BY SUBSTITUTING A FEW INGREDIENTS.  LOOK AT THE END OF THIS PAGE TO FIND LINKS TO HELPFUL LOW CARB COOKING WEBSITES.

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How Many Grams of Carbs Should I Eat?

Unfortunately, there is no “one-size-fits-all” answer to this question. Everybody has differing levels of tolerance with carbs. It also depends on your level of physical activity and metabolism. But It has been the thinking in the medical community for decades that your body requires 130g of carbohydrates per day to maintain brain function.  This is NOT true.  Your brain needs GLUCOSE, not CARBOHYDRATES.  Your body is fully able to produce all of the glucose it needs for healthy brain function.  There is no such thing as an essential carbohydrate.  But this doesn’t mean that I recommend NO carbs.  NO carbs means NO vegetables.  I certainly don’t agree with that.

Many have found an average of 50g per day to be safe and effective.  If you are physically fit, active and have normal weight, you may be able to tolerate slightly more carbohydrates than this.  If you are not physically active, are overweight, have hypertension or dyslipidemia (cholesterol issues), you may need to reduce your carbohydrates further.  This low carb approach has been used successfully for decades, even with less carbs than recommended above.

*Note: keep in mind that lowering your carb intake may affect the level of diabetic medications needed. Many have eliminated the need for some of their medications. In the meantime, continuing on the same medication regimen may cause you to experience low blood sugar levels. Reduce your carbs slowly and work closely with your healthcare team. Test your blood glucose frequently and advise your primary healthcare professional if you feel your medications need to be adjusted. This may be the same for medications you are taking for your blood pressure.

Quantity vs Quality

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If you only think about watching the NUMBER of carbs you eat, you are missing half the point. If you are going to be reducing a source of potential nutrients, then focusing on the QUALITY of carbs is important. Say for instance, you chose to eat 50g of carbs per day, but you chose to “spend” them on bread and pasta. What are you missing? A HUGE source of nutrients you could have received from better quality carbohydrates. Choose the most nutrient dense carbs you can find.  Quality carbs are usually those found in nature, those which derive much of their carb content from fiber and those which have very little effect on blood sugar.  For me, good quality carbs are predominantly non-starchy vegetables, but also nuts and nut butters (in moderation), certain types of full fat dairy and some low sugar fruit (if you can tolerate it).  For those needing to improve blood sugar control, focusing on carb quality is extremely important, as poor quality carbs typically raise blood sugar significantly.  So focus on both QUANTITY and QUALITY for optimal health.

Controlling Your Blood Sugar

As mentioned, every person with diabetes is different in their ability to tolerate carbohydrates.  The ONLY way for you to know your level of carbohydrate tolerance is to test your blood glucose frequently with a blood glucose meter.

You can get these without a prescription, inexpensively, at most major retail drug stores.  I suggest the following: for a week, test at 1 and 2 hours after every meal.  See how foods are affecting your blood glucose.  If your food choices raise your blood glucose only minimally above normal fasting range, then consider this a “safe food.”  Make a list of these safe foods and enjoy them.  But, if you have a significant blood glucose spike from your food choices, just know that your body cannot process these foods efficiently.  High blood glucose is at the root of almost all chronic disease.  Continuing to consume food that will require medication in order to keep blood sugar controlled will make you at greater risk for almost every major chronic disease (heart disease, strokes, kidney disease, Alzheimer’s and dementia, neurological damage, blindness, erectile dysfunction and amputations).  NO FOOD IS WORTH MEDICATION and the side effects that come with them.  (This does not apply to those with Type 1 who REQUIRE insulin at all times.  However, following the same principles allows most Type 1’s to significantly reduce their insulin needs.)

Read my article “Eat To Your Meter” HERE

Remember…..

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What Is NORMAL Blood Sugar?

How do I define NORMAL blood glucose?  “Diabetics are entitled to the same normal blood sugars as non-diabetics.” – Dr. Richard Bernstein (a Type 1 diabetic himself for about 60 years).

Please read my post “Diabetic Normal” Blood Sugar is NOT Normal Blood Sugar” HERE

These are generally accepted guidelines for non-diabetics:

Fasting Blood Glucose 70-90 (preferably mid 80’s at the highest)

Post-Meal <110

These goals can be achieved by many of those with diabetes when focusing on lifestyle management, versus medical management only.  I have helped many, including myself, to achieve these “non-diabetic” goals.  These goals are quite different than the goals set by most diabetes organizations for people with diabetes.  But their goals WILL NOT protect you from the long-term complications of diabetes.  And they will not lead to a high quality of life RIGHT NOW.  Remember, this book is about optimal blood glucose control.  Not just about following the current guidelines and having your diabetes worsen year after year.  Many are able to halt or reverse their disease process with the above guidelines.

What Else Do I Need to Be Healthy?

If you are currently sedentary, begin an exercise program by starting out walking 10 minutes once or twice daily. Just start moving. Work up to 1/2 hour of vigorous exercise daily in which you profusely sweat. Don’t worry about special equipment, just move.

Once you have the energy, try interval walking. Studies show greater benefit with interval exercises versus steady paced exercises. How do you perform interval walking? Warm up with a slow to moderate pace for 3-5 minutes. Then begin interval walking (1-2 minutes of power walking followed by 1-2 minutes of recovery. Then repeat, for a total of 15-20 minutes.  Progressively make your speed walking interval longer and your recovery interval shorter.) Cool down for 3-5 minutes. Later, when you have even more energy, add higher intensity interval training, and/ or strength training. Building muscle aids in fat burning and improves overall health.

Going to a gym is not necessary. Good health is 85% diet and 15% exercise. Remember, you CANNOT exercise your way out of a bad diet, and exercise is NOT a weight loss solution. Exercise is ONLY effective when paired with healthy eating. So, 1/2 hour daily is just fine. If you can do more, by all means do so. But set this as a minimum goal.

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Benefits of Exercise

So if exercise is not the answer to weight loss, why do it? There are some AMAZING health benefits to exercise. Courtesy of Dr. Mark Hyman, author of “Blood Sugar Solution,” here are some…

  • “It makes your cells and muscles more sensitive to insulin so that you don’t need as much. Less insulin = less belly fat.
  • It reduces the stress hormone cortisol. Too much cortisol and you become insulin resistant and store belly fat. Too much cortisol also makes you crave sugar and carbs and seek comfort food.
  • If you do interval training (going fast, then slow), you can speed up your metabolism and burn more calories all day long, even while you sleep.
  • Strength training builds muscle, and muscle burns seven times as many calories as fat.
  • Exercise improves memory, learning and concentration.
  • Vigorous exercise is a better anti-depressant than Prozac.
  • Exercise protects your heart and reduces your risk of heart attack and stroke.
  • Exercise reduces inflammation (the cause of almost every disease of aging).
  • Exercise boosts detoxification of environmental chemicals.
  • Exercise balances hormones and reduces breast and other common cancers.
  • Exercise improves sexual function.”

Quite impressive, need I say more? 😉

What Else Do I Need To Be Healthy?

Get preferably 8 hours (but no less than 7) of sleep per night. Sleep deprivation causes weight gain and is detrimental to your health. No eating within 2 hours of bedtime. To improve sleep quality, avoid exercise and the use of electronic devices within two hours of bedtime.

Hydrate first thing in the morning, about 16 oz or 500 mL upon waking.

Practice stress reduction. This reduces hormones that interfere with weight loss and good health. Stretching exercises can be used for both stress reduction and as an exercise warm up and cool down.

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