Blood Sugar 101

​A Diabetes Diet Is Different From and Easier Than a Weight Loss Diet

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Weight Loss Diets Usually Fail but Diabetes Diets Can't Afford To Fail.

Did your heart sink when you learned that the best way to control diabetes was with "diet?" Of course it did. Almost everyone diagnosed with Type 2 diabetes has a long history of trying to diet off weight and failing miserably. If you believe that your health depends on even more dieting, it is easy to give up hope.

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But it turns out that a diabetes diet is very different from a weight loss diet of the sort you can see illustrated in the photo above. The point of a diabetes diet is not to lose weight. The point of a diabetes diet is to bring your very high post-meal blood sugars down into the normal range. You can eat as much food as you want on a diabetes diet, as long as the food you eat is food that doesn't raise your blood sugar.

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What comes as a surprise, however, is that many people with Type 2 diabetes find that when the adopt an effective diet that lowers blood sugar, they lose weight, sometimes a lot of weight.

 

One reason for this is because high blood sugars make us more insulin resistant than we would otherwise be, which promotes weight gain. But there's another reason why diabetes diets can help you lose weight without trying: when you flatten out your blood sugar after meals, you eliminate the overwhelming hunger that often goes along with blood sugars that surge very high. When you aren't starving all the time, losing weight is a lot easier. But that's just a nice plus. You can eat a totally successful diabetes diet that gives you back your health without losing a pound.

 

The Diabetes Diet is All About Carbohydrates

It's the carbohydrates you eat that raise your blood sugar, the starches and sugars of all types. No other nutrient raises blood sugar to any significant amount, especially not the fats. So if you cut back on those starches and sugars, your blood sugar will come down. It's that simple. Solid research has proven that it is not eating fats that raise cholesterol, either. It turns out the the most damaging kind of blood fat is triglyceride, and guess what raises triglycerides? Eating carbohydrates! So while it is true that eating fats along with high levels of carbohydrates is very unhealthy, the less carbohydrate you eat, the more fat you can eat safely.

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How Many Grams of Carbs Should You Eat? As Many as Allow You to Reach Your Blood Sugar Targets

When people think about adopting a lower carb diet, their first question is almost always, "How many grams of carbs can I eat at each meal?" Most of the diet books will answer that question with a hard and fast number. Atkins, for example, tells you to start out with 20 grams a day. Protein Power, a healthier low carb diet than Atkins, starts you at 30 grams. And Dr. Bernstein suggests you eat no more than 6 grams for breakfast and snacks and 12 grams at lunch and dinner.

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Adopting these very low carbohydrate limits will control your blood sugar very nicely. But the carbohydrate levels prescribed by those authors are extremely restrictive. This is a problem because all the large studies of low carb dieters followed for more than a year shows that very few, including those who had excellent results during their first months on the diet, are able stick to it for more than a year.

 

Even worse, the research studies discussed at length in my book, Diet 101 showed that when people stop eating at those very low, ketogenic diet levels, they often end up with worse cholesterol and other health measures because eating a ketogenic diet has accustomed them to eating very high levels of fat which are very unhealthy when consumed with even 150 grams of carbohydrate a day. Since people with Type 2 diabetes need to find a diet that will control their blood sugar for the next twenty, thirty or forty years the emphasis needs to be not on finding a "perfect" diet, but on finding one they can stick to, without heroic efforts, for decades to come.

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That's why I'm going to ask you to throw away all those diet books and try a new approach to restricting carbs.

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Try the strategy used by the people who used to hang out on the alt.support-diabetes newsgroup and call themselves The 5% Club, because using their strategy brought their A1c test results into the 5% range which doctors consider normal.

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You'll find this simple technique described here: How to Lower Your Blood Sugar

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How to Discover the Best Diabetes Diet for You

The key to this strategy is to use your blood sugar meter to test what happens to your blood sugar after each meal you eat. This lets you figure out how many grams of carbs you can eat and still meet a healthy blood sugar target.

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You will start out by measuring your blood sugar one and two hours after each meal. Write down what you ate and observe what it did to your blood sugar. If a meal allows you to reach your blood sugar targets at those times, test it again once or twice at a later time, just to make sure that your good numbers weren't just a result of slow digestion. Pasta and Pizza are two foods that are notorious for causing later than normal blood sugar spikes. Many "sugar free" products will also cause a delayed blood sugar spike, often one as high as what you would have seen with foods containing table sugar.

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If you end up too high after a meal, the next time you eat it, cut back on the portion size of the starchy and sugary foods in that meal and test again. For example, make your sandwich with one piece of bread, not two. Eat only a bit of the crust on a piece of pizza. Substitute a serving of polenta with 16 g of carbs per 2 oz cooked serving for one of pasta with its 42 grams. Try a less sugary salad dressing. Eat a delicious square of premium chocolate (6 grams) in place of that chocolate cupcake (24-50 g of carbs ) Do this until you can hit your targets.

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You'll find suggestions for foods that won't raise your blood sugar here:

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What Can You Eat When You Are Cutting Carbs?

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What you're doing here is creating what Australian Diabetes activist Alan Shanley calls a low spike diet rather than a low carb diet.

 

Everyone's Effective Diabetes Diet Will Be Different

It isn't particularly helpful to ask someone else how many grams of carbs they eat for their diabetes diet, because individual have such varying differences in how much carbohydrate they can tolerate. Your body size, muscle mass, age, gender and how well your metabolism works all affect how much carbohydrate you can eat without seeing a damaging blood sugar spike.The more you weigh or the more muscle you have, the less each gram of carbohydrate you eat will raise your blood sugar. Because of this, men can usually eat more carbohydrates and still reach their targets than can women

 

In addition, a lot depends on how damaged your beta cells are. Reducing carbohydrates will always lower blood sugar, but if enough beta cells have died off you may still need help in lowering your blood sugar to normal levels.

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How to Learn How Much Carbohydrate is in Your Food

To make this system work, you must learn how many grams of carbohydrate are in the meals you eat, first so you can figure out which foods to cut back on, and later, when you've found meals that don't raise your blood sugar over your blood sugar targets, so you can put together other meals with the same amount of carbohydrate, which should also work well.

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The best way to learn how many grams of carbohydrates are in the different foods you eat is to read food labels carefully, invest in a nutritional guide like The Complete Book of Food Counts, or google "carbs in [Your Food Here}." This will bring you to a seleciton of "online calculators or mobile apps like Fitday.com or My Fitness Pal. Mobile apps can also be very helpful--as long as you have a realistic idea of how big the portion sizes are of the foods you are actually eating.

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Learn about Portion Sizes

This brings up an important point: You can't estimate how much carbohydrate there is in the food on your plate unless you know what the "one serving" size is that is listed on a label, a book, or in software looks like on that plate.

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The best way to do this is to invest in an electronic food scale and to weigh your foods for a few weeks until you get the hang of estimating portion size. You can get a good food scale at a gourmet kitchen shop for $25 to $40 dollars.

 

A food scale may be the best nutritional investment you'll ever make. Once you start using your scale, you will find that the muffin you bought at the coffee shop weighs 8 ounces, which is four times the 2 ounces that most food databases define as "one serving" of muffin. When you read that a mythical 2 ounce portion of muffin contains 27 grams of carbohydrate you will realize why that 8 ounce coffee shop muffin with its 108 grams of carbohydrates sends your blood sugar into the psycho zone.

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With ice cream, when you weigh your ice cream on a food scale, you'll quickly see that the "one portion" listed on the package turns out to be only a few teaspoons' worth. That bowl you've been considering as one portion of ice cream weighs in as four servings or 72 grams of carbohydrate and 600 calories--which explains its damaging effect on both your blood sugar and your waistline.

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This may sound like a lot of work, and when you first start, it is. But after you do it for a few weeks you'll find you have memorized the carbohydrate gram counts and the portion sizes for many of the foods you usually eat. Once you have tested your blood after eating your usual meals with their usual portion sizes, you won't have to test after eating those meals.

 

When Eating Away from Home

The biggest challenge you'll encounter as you start learning what you can eat will be eating away from home. You aren't going to be able to weigh restaurant foods. You can't look up the nutritional values for food at any restaurant that cooks things from scratch, and though many chains do post the calorie and carb counts of their offerings, they often do this without listing portion sizes.

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This makes it a very good idea to avoid starchy or sugary restaurant foods until you have gotten the hang of eating to control your blood sugar. Then cautiously test restaurant foods that seem like they ought to work using your trusty blood sugar meter. You may often see surprising readings after eating foods that you wouldn't expect to raise your blood sugar. Soups may be more starchy than bread, due to thickeners. Eggs may have been extended with added flour-based fillers. Fast food "meats" and "cheeses" often have been stretched with the addition of starchy fillers, too.

 

Don't Trust Nutrition Data Provided by Restaurants.

When television stations went out and had chain restaurant food tested at a lab in 2008, they learned that the calorie and fat counts were significantly understated. Some foods had as much as 40% more calories per portion than the menu claimed. The TV stations were defining "diet" as low fat/low calorie and didn't report on carbs, but you can be sure they were higher too.

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Diabetes in Control: Don’t Depend on Restaurant 'Diet' Menus

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Fat and Carbs Eaten Together May Digest Slowly

Foods with a lot of fat in them take longer to digest than those without a lot of fat. This is why pizza and ice cream often give deceptively good readings on your meter. If you test a meal and see a reading that is too good to be true, be sure you test at 3 or four hours after eating.

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The Truth About Pasta

Pasta was long recommended to people with diabetes as a food that would not raise blood sugar and you will still see it starring in many cookbooks and magazines intended for people with diabetes.

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However, if you test pasta 4 or 5 hours after eating, you may get an unpleasant surprise. This is true with the so-called "low carb" pastas, too. These foods give you excellent readings at one and two hours because they are resistant to digestion so they don't turn into glucose right away. But five hours later, they do break down into glucose and when they do, the 42-52 grams of carbohydrates found in each 2 ounce serving of dry pasta will hit your blood stream with a nasty wallop. (Not to mention that you almost need a microscope to see a 2 ounce portion of pasta once it has been cooked. Most people's idea of a portion of pasta is closer to 6 ounces--and 156 grams of carbohydrate!)

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If you have pasta for dinner and don't see a peak 3 hours later, be sure to check your fasting blood sugar the next morning. You may see the blood sugar rise there, too.

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Sugar Alcohol and "Sugar Free" Foods

The sugar alcohol used in so-called "sugar free" foods can also show up in your blood sugar an hour or two after you'd expect to see them, especially the maltitol used in "sugar-free" candy. At least half of the sugar in maltitol does turn into glucose in your blood stream and it can raise your blood sugar, but the rise is delayed so you may miss it on testing. So if a "sugar free" food seems to be kind to your blood sugar, try testing it an hour or two after your first tests. Erythritol is the one sugar alcohol that usually does not show up in your blood sugar.

 

Dealing with Limited Blood Testing Supplies

In in ideal world, we'd all have all the testing supplies we needed to control our blood sugar, but in real life blood sugar test strips are very expensive and many insurers sharply limit the number of strips people with Type 2 diabetes can get each month.

Here are some strategies that can help you if your access to strips is limited.

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• If you only have 50 strips to get you through a month, plan out what you are going to test ahead of time. Pick one of your favorite meals, and test at 1 hour after eating the first time you eat it and 2 hours after eating the second. Do this with a couple different meals and see if there's a pattern as to when you see the highest reading--whether it is at one hour or two. Then choose another meal and test it at the time when you saw the highest reading in the earlier meal. If you ever get a surprisingly low reading, try testing an hour later or earlier, to make sure you aren't missing the peak.

• Make the goal of your testing be learning how many grams of carbs you can tolerate in one meal. If you learn that 30 grams is your upper limit, use software and your scale to find portions of other foods that will also clock in at 30 grams or less. Test one or two of these, and if you see the result you expect, you don't have to test every time you eat these foods again.

• Walmart sells a cheap and effective blood sugar meter with strips that cost one half as much as other vendors. Some drug stores also sell store brand meters with cheaper strips. If you need more strips, consider the money you pay for another 100 strips an investment in your health. It's far better to spend that money now, than to spend it on expensive doctor bills caused by complications you don't need to develop!

• Many insurance plans will give you more strips if your doctor says they are medically necessary. At your first appointment after you have dropped your blood sugar significantly with your dietary changes, tell your doctor that you need more strips to maintain your great improvement. Though classic Medicare limits strips to only 30 a month for people who are not using insulin, many Medicare Advantage Plans will also allow you more strips if your doctor prescribes them.

 

Keep the Focus on Achieving Your Blood Sugar Goals

By testing after meals, you'll learn how many grams of carbohydrate your own, unique, body can handle. And more importantly, you'll also be able to decide if you are going to be able to control through diet alone, of whether it is time to talk to your doctor about supplementing dietary control with drugs.

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Many people are so excited to learn that they can achieve normal blood sugars by cutting way back on carbohydrates that they become zealots for low carb dieting. I've been there and I've done that. But it's important not to get too carried away with a "Carbs are Evil" mentality which makes it a matter of religious zeal never to let evil carbs cross your lips again.

 

Like all conversions this one tends to fade out in time and when it does the backsliding that follows can be very hard on your health. As we said at the start of this chapter, your ultimate goal is to keep hitting your blood sugar targets for the rest of your life. So the safest approach is to get the most blood sugar benefit you can out of restricting carbohydrates, but to only restrict them to a level you can maintain year in and year out. If the level you can maintain is not low enough, it's time to add safe diabetes drugs like metformin, repaglinide, or insulin to your regimen.

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It is best to treat dietary carb restriction as a strategy--one of many--which you use in combination with other strategies including medications if needed, can give you normal blood sugars, rather than the One and Only True Way. If you can be flexible and find more than one tool to help you meet your blood sugar targets, you are more likely to be able to maintain those excellent blood sugars for years to come.

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