Hello there. I am Dr Katharine Morrison . I am a General Practitioner in Ayrshire, Scotland and I want to help you improve your health through better management your blood sugars. No matter what your age and the stage of any weight problem, pre-diabetes or diabetes you, or the person you care for has, this course can help.
This low carb diabetic course has been compiled by myself with the generous help of other diabetics, their carers and interested doctors and researchers. It takes a lot of nerve to do something very different from what a diabetic specialist or dietician tells you.
My son developed type one diabetes at the age of 12. I am absolutely determined that he will have the same chance to enjoy a full and long life as his non-diabetic brother. Fortunately many other people have the same aims for their relatives, friends and for themselves. We have joined resources on Dr Richard Bernstein’s forum (read more about Dr Bernstein’s approach here) and many other sites to help you have normal sugars and prevent and reverse diabetic complications.
The things you will need to know about how to improve your blood sugars will be different for each one of you. Although personal coaching at your diabetes clinic occurs, there are often gaps in what would make that important difference to you. On this course you will have all the advantages of the many tips and clearly set out steps to improvement that have been directly tested by other people with diabetes. As you go through the course you will quickly realize that a reduced carbohydrate diet is highly recommended for you. This is key to stabilising and then normalising blood sugars. In turn, this can reduce hunger if your aim is to lose body fat or improve metabolic control if you suffer from any of the glucose metabolism disorders.
Low carb diets for diabetics are not yet mainstream in the NHS but will be soon. The weight of scientific evidence for this way of eating is overwhelming. Whether your diabetes team is enthusiastic and supportive, still getting up to speed, or still mired in denial and avoidance, you can help yourself by going through this course.
The main groups of people who will benefit from the information here are:
- Overweight people and those who have the added problems associated with Metabolic Syndrome.
- Type two insulin resistant diabetics and older type one diabetics who have now developed a degree of insulin resistance.
- Insulin dependent diabetics both juvenile and those with maturity onset diabetes who now need insulin.
Women with polycystic ovary syndrome or who have gestational diabetes.
- Carers of any of these people including their friends, families and doctors whether in primary care or in hospitals.
Please remember that this is an online internet course and that while the information given is correct to the best of my knowledge at the time of posting advances in medical knowledge can change rapidly.
You should therefore be aware that this information is given in good faith. Any advice should not be accepted uncritically or without proper regard to likely future effects. Please remember that I and anyone who sends back a reply to any comments or queries does not and cannot really know you personally. There is no way that the information or advice can cover all individual differences or eventualities. You will still need to seek information from your usual health care providers. You are free to print out any information here to give to them. This could help them make better decisions about your medical care. (Please see our Warning and Disclaimer)
Do not start to change anything you do about your diet or diabetes till you have completed the entire course. This is particularly important for insulin users and those on medication that could lower blood sugar. You may however find that starting to record what you eat and then counting up the relevant carbohydrates once you know how will be a very helpful step right away.
Each section starts with a description of who would be likely to get benefit from reading the material and those that may want to skip the section. For each group we will direct you to the next section that you are likely to find of interest.
After the information is given you will find a quick quiz. Have you got it? The aim of this is to reinforce important points.
Work to your own speed when going through the course. Work section by section until the end.
As you go you will find may internet sites that can help. Don’t spend too long on these sites during your first run through the course!
Once you have completed your first run through the course you can think about what is going on with you:
- What type and stage of pre-diabetes or diabetes do you have?
- Where do you come in regarding your blood sugar control in the How To: “Eat to Meter” section?
- Where would you really like to be?
- What tips sounded right for you?
- How motivated are you to make the necessary changes?
- Do you need any more help or information? (This is when a second run through the internet resources can really make a difference.)
You will then be in a position to plan any changes you would like. A good long second run through the sections that emphasise procedures will help here.
All your changes should be made in well thought out, planned and gradual steps. You may need help from your usual diabetes support team at this stage.
Joining a forum such as Dr Bernstein’s Diabetes Forum or the UK based Diabetes Support Forum can make an amazing difference. In both there are a core of dedicated low carbing diabetics here who have done it all themselves. And they are happy to help you.
What you need to know about Vitamin D
Many people live in areas where they can get vitamin D from the sun. But I live in Scotland and we certainly don’t get enough of it here. Even when you do live in a sunny place, you may be stuck in a building or in a car most of the day. You will no doubt have to cover up with clothes, and may use additional creams to protect you from the sun.
Almost every week a new study comes out confirming the benefits of vitamin D. What I want to discuss with you is, why is this vitamin so important for diabetics? If you do decide to use it, and can’t rely on sun exposure, what can you do to raise your levels?
In our typical modern diets, many substances are inflammatory to the body. Refined dietary carbohydrate, high blood sugars, too much omega six vegetable oil, too much insulin. This is not an exhaustive list.
In a nutshell vitamin D is a hormone that improves cell function in almost every part of the body. It has an anti inflammatory effect on almost all body tissues. This means that some of the damage that happens to diabetics due to excessive inflammation can be reduced if vitamin D levels can be optimised. Excessive inflammation is responsible for more arteriosclerosis, cancers and immune system problems in people with diabetes.
Optimal levels of blood vitamin d are 160 in the UK and 60 in the USA.
In my town in Scotland I have found 15 patients who had undetectable levels of vitamin D. Most people had levels around 20(UK). Below 50 (UK) and you are at risk of secondary hyperparathyroidism. I have found one severe case of this. When you have very low vitamin D levels you are not able to absorb calcium from the food in your gut. Your blood levels fall and your parathyroid tells your bone to give up its calcium. Your bones get thinner and yet your blood levels are still low. You may get cramps in your muscles and it can affect all muscle function including your heart.
Only those people I tested who took cod liver oil regularly had non deficient levels. But a level of 50, while sparing your bones, is not optimal. If you get above 160, your mental functioning, coordination, bone strength, immune system all improve.
You can improve psoriasis, gingivitis, flu, improve insulin sensitivity, reverse arteriosclerosis, greatly reduce your chances of getting multiple sclerosis, cancers and improve your survival rate if you do get cancer. Some cancers are particularly associated with high blood sugars and high insulin. Breast and prostate cancer incidence are reduced at optimal levels of vitamin D. Prostate cancer survival time is doubled at optimal vitamin D levels. Bowel cancer rates are four times more frequent at low compared to optimal vitamin D levels.
Let me go now into more specifics about benefits to diabetics. Pregnancy first. Vitamin supplementation improved the outcome of pregnancy. There were fewer low birth weight children, and the survival rate improved. Schizophrenia and Multiple Sclerosis are related to lack of sunshine in the first trimester of pregnancy.
In Norway, mothers who gave their children any form of vitamin D supplementation in the first year of life had fourteen times less type one diabetes develop in those children over the first 14 years of life.
Diabetics are prone to gingivitis and gingivitis causes heart disease. You can reduce this with vitamin D supplementation.
Flu can result in ketoacidosis for a type one diabetic. You can greatly cut down the chances. Vitamin D supplementation in some populations has been found to be more effective than the flu jag.
Vitamin D helps reduce and even reverse arteriosclerosis. This is something that diabetics are prone to. Dr William Davis in the USA advises a low carb diet, vitamin D, Magnesium, resistance exercise and omega three fatty acids. He scans people’s hearts before and after and can demonstrate resolution of calcified arterial plaques.
We can’t all flit to the Canary Islands or Florida, so how do you get vitamin D? What dose is right?
The cheapest source I have found is from amazon.co.uk. The dose recommended for most adults is Vitamin D3 5,000 iu a day. This costs £15 for a year’s supply of the brand Healthy Origins at this level of supplementation and postage is included. In the USA iherb has the same product for $15.
For those who live in the UK, If you are not on the internet you can phone or write to The Vitamin Service, Leigh on Sea, England. They charge about £36 for a years supply of Bio D Mulsion Forte. The dose is based on your weight. For every 30 pounds body weight you need 1,000iu of vitamin d 3 a day.
Vitamin D3 can be prescribed on the NHS but the dose is much lower. There is also a formulation with calcium in it. This may be fine for bone disease prevention but it is too low for optimizing blood levels. If you tried you would end up with a gross over dosage of calcium. Whatever supplement of Vit D3 you take blood levels should be monitored after three months of use so you can adjust your intake accordingly.
For a very good overview of the benefits of vitamin D supplementation please visit you tube and type in vitamin D3. There are a series of lectures from Davis University California explaining its use in diabetes, heart disease, cancer and chronic illnesses of many kinds.
Quiz: Which of these options is NOT correct?
- Optimising your vitamin D level can improve:
- Your gum health.
- Your insulin sensitivity.
- Your hair growth.
- Your risk of developing certain cancers.
- Your dose of vitamin D should:
- Usually be around 1,000 iu for every 30 pounds body weight.
- Be discontinued during the summer.
- Be checked with a blood test after 3 months.
- Be adjusted so that you are in the optimal range.
Answers: 1. 4 is not correct. As far as I know there is no effect on this aspect of your health. 2. 3 is not correct. Many of us don’t get enough sun exposure in the summer and sun tan creams block absorption of vitamin D3 too.
So, what do you eat?
Restricting carbs on a vegan diet by Emily Jost
For: those who follow or are thinking of following a vegan diet.
I have had type 1 diabetes for over 25 years, aged 11 at diagnosis, and for almost 20 of those have followed a vegan diet. Having been a vegetarian since the age of 5, I decided to cut out eggs and dairy too when I realised that these industries were the same as the ones producing meat, and that dairy cows and even “free range” chickens generally have short and miserable lives.
I have been reading with interest about the benefits of a reduced carb diet to people with Type 1 diabetes for a few months, but always thought that it would be very difficult to do while avoiding animal products. I love food and worried that my choices would be too seriously limited. But about 6 weeks ago I decided to try it, and as a 2 week experiment, cut my daily carb total from about 150g to 90g. I found it not only easy, but enjoyable and have since cut down further to 75g-90g per day, and have noticed less BG spikes and obviously reduced insulin needs (although no weight loss as yet). I am toying with cutting down to 60g per day, but am not quite there yet.
So, what do I eat?
Salads, low-carb vegetables, nuts and seeds form a large part of my diet. I also eat a lot of pulses and sprouted pulses and seeds. The carb value of pulses is one of the reasons that further carb restrictions could be difficult: I am not prepared to cut down on these, as they provide protein, fibre and lots of vitamins and mineral, plus they are slowly absorbed, so unlikely to cause a spike if bloused for correctly. Delicious dressings are essential for salads – olive oil plus lemon juice or balsamic vinegar, mustard, garlic, herbs – the possibilities are endless.
Nuts and seeds
A great source of protein and many other nutrients, nuts are also filling and make an ideal ingredient as well as a snack. Home-made nut loafs and rissoles are great, and they can be sprinkled on soya yogurt or added to salads – most are especially great toasted. Different types of nuts have different carb values, so do need to be checked and counted.
Seeds like sunflower, sesame and pumpkin are good sources of calcium, as well as being delicious. Dry-toasted in a frying pan, or with added soy sauce, they are great on soup, salad or to provide a crunchy topping to bakes etc. Sesame seed pulp (tahini) is a fantastic ingredient for sauces, dressings and dips, being high in fat and calcium.
Sprouted seeds and pulses
Sunflower, alfalfa, rocket and radish seeds can be sprouted, as can chickpeas, green lentils and mung beans. These make a very nutritious addition to any salad and are delicious. It’s worth buying a sprouter as the sprouts end up being very cheap compared to ready-sprouted ones.
Note: most of these products require a trip to the wholefood or healthfood shop, although supermarkets usually sell some basics like soya milk and cream, plain soya yogurt and tofu.
In addition to nuts, seeds and pulses for protein, I also use meat substitutes, usually made from soya protein and wheat gluten. Many veggie sausages and burgers are quite high carb; I am a big fan of Redwood’s Vegi Deli range that includes sausages, schnitzels, chorizo-style chunks. Some are nicer than others, but the range is so wide that there should be something to suit all tastes. Personally I don’t like anything that tastes too meaty – but for some people this is exactly what they are after. Most of these products are both low carb and high protein. A couple of examples:
23.9g protein per 100g
4.9g CHO per 100g
23.5g protein per 100g
16.5g CHO per 100g
22.8g protein per 100g
4.6g CHO per 100g
Tofu is also another excellent source of protein and very low carbs, and is an extremely versatile ingredient. Quite bland on its own, when flavoured with herbs/spices/garlic/sesame oil/mustard/wasabi/miso/paprika etc and fried it is delicious. It can be sliced, diced, scrambled, mashed…and some manufacturers make already-interesting tofu infused with basil or sun dried tomato (yum) or it also comes smoked.
Taifun tofu wieners & other sausages. These are the king of all vegetarian sausages, made from tofu and divine, either raw or cooked. Chop and add to a salad, chop and fry and add to a soup or stew, fry or steam them whole and eat with a mash and gravy. Expensive but worth it!
This is another soya bean product, made from fermented, whole soya beans. It can be added to stir fries and other dishes as a good protein source with an interesting texture. I always think it tastes like stir-fried apple crumble (ie a bit wrong) but it does add another choice to the animal-free diet.
Wheat protein used as a meat substitute – it can be bought plain or from Oriental shops in tins in the form of mock duck. Use in place of duck or other meat in many different dishes.
Cruelty-free low carb “dairy”
Dairy replacements are plentiful nowadays. Soya milk is low carb, but also worth noting that it’s low protein too, as is soya yogurt. Both can be used in the same way as dairy milk. Soya cream is also a useful ingredient and quite lovely on fresh strawberries. Watch out for the types that can be whipped, though, as these are sweetened and therefore higher carb.
Soya “cheeses” have improved in recent years and there is a place for all of them in the vegan diet. Here is a quick review of what’s on offer:
A powdered parmesan style product for sprinkling on soups etc. Also adds a convincing cheesy flavour to sauces, pestos etc.
Scheese (Bute Islands Foods)
A range of hard “cheeses” with very strong flavours. They do not melt, and although the flavours are good, the texture is not like dairy cheese. Probably better for cooking.
Comes in a super-melting style, in 3 flavours – it really does melt beautifully, but the flavours are quite subtle. The non super-melting types have better flavours but don’t melt! They also have higher carb content.
Individually wrapped “cheese” slices – these are like processed cheese and melt very well, but are quite bland in flavour.
Toffutti Cream Cheese
Delicious high-fat cream cheese, comes plain or flavoured with herbs etc.
Toffutti Sour Supreme
A sour cream substitute with many sweet and savoury applications.
Gram flour is a very useful ingredient. Recently I’ve made courgette fritters using gram flour, and “pizzas” with a gram flour pancake base – fabulous and easy! I haven’t yet worked out the carb contents of these, but suffered no BG spike after eating them. No Egg is an egg replacer which is useful in recipes where eggs are used for binding only – you can’t make an omelette with it! There are a few egg-free mayonnaises on the market. My favourite is Plamil, which comes in a few flavoured varieties.
Luckily for me I don’t have a very sweet tooth, so I am happy pudding-wise to eat berries with soya yogurt or cream, and good dark (70% cocoa +) chocolate. See below for a stunning chocolate mousse recipe.
Some Typical Day menus
- Plain soya yogurt with vanilla essence, 2 spoonfuls of Lizzi’s low-GL granola, roasted hazelnuts, pumpkin seeds, sunflower seeds & cacao nibs. Occasionally adding some berries or ½ grapefruit. 20 – 25g CHO.
- 2 small pieces sourdough toast with avocado or vegan cheese plus a glass of soya yogurt/hazelnut milk lassi. 25 – 30g CHO.
- McCann’s instant oat bran – made according to the instructions, but with soya milk, has only 10g CHO per serving, so is an excellent alternative to porridge. I have it with roasted hazelnuts and plain soya yogurt.
- Soup – eg. lentil & vegetables, white bean and spinach, watercress and bean. 20 – 25g CHO.
- 1 Vegi deli schnitzel, hoummous, sprouted alfalfa & sunflower seeds, sun-dried tomatoes, avocado. 20 – 25g CHO.
- Any leftovers of the previous evening’s meal!
- Celeriac (or white bean or swede) mash, 2 vegi deli sausages, red wine & onion gravy, steamed broccoli. 20 – 25g CHO.
- Gram flour pancake with creamy mushroom topping; green salad with olives. 20 – 25g CHO (I think).
- Braised tofu with tahini, stir-fried greens with garlic, spicy celeriac chips. 15 – 20g CHO (I think).
I am not prepared to forgo occasional meals out and am accept having a higher carb meal than usual at these times. However, by not having breads, rice, noodles, potato etc I find it’s still possible to enjoy a meal out at many restaurants while keeping the carb count down.
I still eat out at the same places I did as a vegan on a higher carb diet. Indian & South Indian: curries, dahls and vegetable side dishes (without potato) and have found many starters are relatively low carb, especially the lentil based ones. I’ll also allow myself a poppadum on the side. Turkish: I love a mezze which is mostly salads and pulses of many kinds. Vietnamese or Thai: lots of tofu and veg dishes. Tapas: vegetable and lentil or bean dishes. I think I would possibly go hungry in an Italian restaurant, an English pub or greasy spoon…
Many non-vegan vegetarian and even omnivorous recipes can be easily adapted using the replacements mentioned above. I’m not going to give recipes for such obvious things as nut loaf (which can be delicious and made low – carb), or basics like lentil or bean soup. However, I will give a few recent discoveries and unusual favourites I’ve developed over the years.
I am a creative and intuitive cook – I don’t measure things, and if I ever follow a recipe I always adapt it anyway, so I give you these as guidelines – apologies for the lack of precision, and also apologies for the lack of carb values. They will hopefully give you some ideas, though, for reduced carb vegan deliciousness.
Braised tahini tofu
Slice a block of tofu in half to make two “steaks”. Use either smoked or plain.
Make a marinade of the following ingredients:
Tahini, sesame oil, chopped fresh coriander, soy sauce, the juice of a lime, a teaspoon of sugar or apricot jam, chilli flakes, minced garlic and/or shallots. Beat together to make a smooth paste.
Put the tofu in a baking dish and score with a knife. Smear with the paste so that it’s completely coated.
Bake in a moderate oven for about 30 minutes. The paste becomes an amazing crispy shell, with the soft and succulent tofu inside. This is one of my favourite dishes ever – invented by my sister and adapted by me.
Grate some courgettes into a bowl.
Add garlic, chilli or any other spices as desired (Thai curry paste, curry powder, fresh herbs etc.) and salt and pepper.
Sprinkle in some gram flour and stir. Keep adding and stirring until you have a batter that’s not too runny. Heat some oil in a non-stick frying pan and when it’s hot, add spoonfuls of courgette mixture. Allow to crisp then turn over and fry on the other side. Serve with a soya yogurt raita and salad. (I had this last night and worked out that 3 fritters adds up to about 15g CHO).
Gram flour pizza
Make a batter from gram flour, water, salt and olive oil. Whisk so that it’s a pancake batter texture. Heat some oil in a small non-stick frying pan – like for pancakes, a very thin coating is all you need. Get it nice and hot, then reduce to low. Use a ladle to spoon in some batter so that it fills the pan. When it comes away easily from the sides, turn over and cook the other side. Place on a baking sheet.
Make a topping from fried onions, peppers and courgettes, roasted tomatoes, olives, pesto, basil, mushrooms – whatever veg you fancy. Add some sliced vegan sausage or chorizo- style chunks. Spread over the pizza base and heat through for 10 minutes. If adding a meltable vegan cheese, only add this for the last 5 minutes.
Gram flour pancake with creamy mushroom topping
Make a pancake as above.
For the topping, cook some mushrooms with garlic, salt and pepper in some olive oil or vegan margarine, until soft. Reduce to get rid of most of the liquid coming out of the mushrooms. Add a good dollop of toffutti cream cheese, some plain soya yogurt and some parmazano. Spread over the gram flour pancake and enjoy with a green salad.
Chick pea burgers
Drain and rinse a tin of chickpeas, and place in a bowl. Add some tahini, lemon juice, chopped coriander and garlic and salt and mash together with a potato masher. Form into burgers and fry.
Peel the celeriac and cut into chips (or whatever shape you like). Put some olive oil in a roasting tin and heat slightly over a hob. Add salt, pepper, chilli flakes, coriander seeds, paprika or thyme and oregano. Toss the celeriac in the oil so that they are coated and roast in a medium- hot oven for approx 30 – 40 minutes. They don’t have to be spiced, but this is how I like them. They possibly could be deep fried, but I don’t think they’d be as nice.
Celeriac Rosti (this recipe comes from my sister Charlotte)
Peel the celeriac. Grate in a food processor or by hand. Dry slightly on kitchen paper, then stir in some No-Egg. Potato rosti relies on the starch in the potato to bind it, so celeriac needs the extra help. Season.
Heat some oil in a heavy-bottomed or non-stick frying pan. Get it quite hot then reduce. Form a ball of grated celeriac in your hands then add to the pan. Press the celeriac down hard with a spatula. Fry until crispy then turn over, and fry the other side.
Melt some good dark chocolate in a bowl over a pan of hot water. In a bowl whisk some toffutti sour supreme with some soya cream. Add the melted chocolate and stir. Add flavours as desired: white rum, lime juice and zest, chilli, orange zest and orange oil, brandy, coffee… Place in individual cups or glasses and refrigerate to set before serving. I like serving this in tea cups with saucers.
For everyone: Basic Low Carb Diets
Most of the diets that I have chosen to discuss have three main structures:
1. Restriction in type or amounts of certain foods or both.
2. Carbohydrate counting which is important for metabolic control.
3. Calorie counting which can be important if additional weight loss or gain is needed.
In the metabolic syndrome part I will particularly discuss Dr Annika Dalquhist’s diet and Drs Allen and Lutz “Life without bread” diet. Anna’s is food type restriction diet and Allen and Lutz’s diet is an easy “block” method of carb counting.
In the type two – insulin resistance – diabetes section I will discuss the Atkins diet and the “Eat to meter method.” These both give you suggestions on outcomes and you manipulate your diet to achieve them. More advanced carb counting skills are needed for both methods.
In the type one – insulin dependence- diabetes section I will discuss Dr Richard Bernstein’s diet and Dr Lois Jovanovich’s diet. Both these doctors have type one diabetes themselves. Dr Bernstein is at the strict end of the scale and Dr Jovanovich’s diet is at the more liberal end. By understanding both concepts I hope you can find an eating plan that suits you.
All the dietary plans are suitable for all ranges of glucose metabolism disorders. What will be important is how much you need to control your blood sugars, how much weight you want to lose, how good your carb counting skills are and how much carbohydrate you feel you “must have.”
Dr Annika’s Diet
This low carbohydrate diet is very suitable for anyone who wishes to lose weight. It contains basic information that everyone should read.
It is an eat this but don’t eat that sort of diet so almost no carb counting is required for most people. Just follow the rules.
If you are on any medication or insulin to lower your blood sugar, for instance if you have type one or two diabetes, you must reduce the carbohydrate in your diet gradually and do more frequent checks on your blood sugar. This diet very effectively reduces your blood sugar and to balance this you will need to have a progressive reduction in your medications and insulin. There are specific modules about meal/insulin matching later in the course.
- Carbohydrates are food items that contain sugar and starch.
- Dairy products contain fat and variable amounts of carbohydrate and protein.
- You may eat full cream milk, yoghurt, feta cheese, cottage cheese, creme fraiche, cream cheese, butter and mayonnaise.
- Avoid low fat, lite, or sugar added products.
- Meat contains protein with variable amounts of fat.
- Eat beef, pork, lamb, chicken, fish and shellfish. You don’t need to remove the fat.
- When eating ham, sausage and other processed meats be aware that they often contain sugar and starch as binding and fillers. Choose items that are not more than 5g carbohydrate in 100g of the item.
- Eggs are great. High protein and low in fat and carbs.
- Herbs, spices, stock, salt, pepper and low carbohydrate sauces will help your food taste pleasant and exciting.
- Most vegetables, olives and linseed are good.
- Cold pressed oils can be used for dressing and cooking. Olive, rapeseed, linseed, coconut, palm oil and macadamia nut oils are good. Avoid commercial vegetable oils as they contain partially hydrogenated and trans fats.
- Unless you eat a lot of fatty fish such as sardines, trout, salmon and herring you may benefit from an omega 3 oil supplement.
Foods to limit or avoid:
- Potato and potato products such as chips and crisps.
- Rice and rice products.
- Corn and corn products eg cornflakes.
- Grain based products eg pasta, bread, biscuits, breakfast cereals and porridge.
- Sweets, cakes, pastries, non diet fizzy drinks and fruit juice and cordials.
- All sugar and sugary products.
- Margarines and processed oils contribute to cardiovascular problems, diabetes, weight gain, cancer and allergies.
- Oils with a high omega 6 content eg corn oil, sunflower oil, soya oil, peanut oil.
You may be crying when you read this list but I promise you that you can soon get into the way of making much lower carb and healthier versions of many baked goods and desserts.
Many people have been brought up on potatoes and bread and find it particularly hard to let go. Reduce them gradually. Not too gradually!
You may eat a little of these foods:
- Beans, lentils, nuts, sunflower seeds.
- Fresh fruit.
- Chocolate with a high cocoa content such as over 60%.
Avoid dried fruits and fruit juices as there is too much sugar in them.
When you are trying to lose weight the legumes, fruit and chocolate may stall your weight loss. Could you give them up for a while ?
What about alcohol? It also can add to the calories and more importantly can affect your judgement on portion sizes and will power. Beer in particular contains maltose which is a very fast acting carbohydrate. Dry red and white wines are somewhat healthier for you. But only in small quantities.
MEAL SUGGESTIONS FOR DR ANNIKA’S DIET
- Yoghurt with 1-2 tablespoons of linseed or sunflower seeds. Add wheat bran if you are prone to constipation.
- Eggs, sausage, bacon, ham, black pudding, mushroom, tomato.
- Omelettes with meat/fish/vegetables
- Low carb baking eg cheesecakes, muffins with double cream and small quantities of fruit as desired.
- Coffee or tea with cream or milk.
Lunch and supper options:
- Mainly meat/fish/eggs/cheese based dishes with vegetables or salad vegetables such as celery and avocado.
- Avoid low fat products. Many stews, soups and gratin dishes are naturally low in carbohydrate. You can adjust most recipes to give a much lower carbohydrate alternative.
- Cooked cauliflower especially with cream, cheese and seasoning makes a great substitute for potatoes.
- Grated cabbage and carrot with an oil and vinegar dressing makes a good base for a salad.
- Quick snacks to tide you over till the next meal are cheese slices, ham, sausage, yoghurt, nuts, olives or boiled eggs.
- Crisp breads can be loaded with butter, cheese, ham and other toppings.
At a buffet load up with the high protein and fat items and leave the carbohydrates alone.
Fruit does raise the blood sugar so avoid or take a lot less of the higher sugar tropical types such as bananas and grapes and eat moderate portions of the temperate grown fruits such as apples and pears.
If you do eat a high carbohydrate meal you are likely to feel hungry or get another carb craving after about an hour or two when the high blood sugar starts to drop. Just take a low carb snack at this point. This will help your sugar and insulin levels get on an even keel again.
Low carb diets work because you don’t experience a raise in blood sugar after eating. You avoid the pancreas releasing excess insulin which lowers your blood sugar making you feel hungry again. The fat also blunts the blood sugar and insulin spikes. The protein also fills you up for longer.
Insulin is a major fat storage hormone. It converts the carbohydrate you eat into fat.
Your body can make enough glucose and energy for essential processes all by itself from the protein and fat in your food. Your muscles and brain work just fine with a mixture of ketones and bodily produced glucose. This steady production of sugar in the body is called gluconeogenesis and it can occur in the liver, kidneys and intestinal tract. Reliance on mainly fat and protein for energy mean that you don’t need to load your body with fast sugar releasing carbs that raise and lower your blood sugar and insulin levels causing unhealthy metabolic effects.
HOW TO FOLLOW THE “LIFE WITHOUT BREAD” DIET
The advantage of this diet is that it gives more flexibility over what foods you can eat. You limit your carbohydrates by a simple exchange system.
This diet is quite similar to the carbohydrate exchange method that was used for many years by diabetics. In the UK 10g exchange units are used. In Europe 12g and in the USA 15g. The exchange system was used because it was thought to be easier to learn than carb counting. In my opinion it is much better to simply count the total carbohydrate. We will be using precise carb counting measurements for insulin management later on and I think the exchange system isn’t quite up to the job. This is what they suggest however.
The authors, Dr Christian Allen and Dr Wolfgang Lutz have counted out units worth 12g of carb each for most food groups. They suggest that for most people eating six x 12g of carbohydate a day will give around 70g of carb a day which is palatable and helps weight loss, diabetes control and other autoimmune illnesses.
For people over 45 or heart or autoimmune problems they suggest starting at 9 x 12g a day and slowly reducing to 5 or 6 such portions. (60-70g carb a day).
This method gives a bit more flexibility over what foods you can eat compared to Dr Annika’s diet. The basic diet is free intake of fish, meat, eggs, cheese, dairy products, non- starchy vegetables, moderate intake of nuts and alcohol remains the same.
All carbohydrate containing foods such as grain products and potatoes, sweetened foods, sweet and dried fruits must be accounted for.
For the full list of foods see their book, “Life Without Bread.”
For illustration purposes I will list a typical day that you may have on this diet.
3 egg omelette with onion and peppers
half a grapefruit one unit
Coffee with cream
Cold roast chicken
lettuce, one medium tomato, half an avocado 1.2 units
1/4 cup of rice (before cooking and seasoning) 3 units
Tea with small amount of milk
Peppered steak with cream sauce and mushrooms one unit
Slices of Danish blue cheese and brie with celery
Two glasses of wine 0.8 units
The trick is to fill up on a wide variety meat and fats and reserve your carbohydrates to give a bit of variety to your meals. Instead of basing your meals on the same old bread, potatoes, rice and breakfast cereals base them around meats/fish/eggs and cheese and non- starchy vegetables.
For a lot of people it is harder to eat low carb away from home and if this true for you allocate more of your allowance to these meals and make the effort to cook delicious low carb meals at home.
Another look at the Atkins diet
What? Did I hear this right? Surely everyone in the developed world knows how to do Atkins? They all think they do! That’s for sure.
The easy way to do the Atkins diet is to buy one of Dr Robert Atkins books and do it.
The book I would particularly recommend is Atkins for Life the Next Level.
This is a simple introduction to low- carbing and it covers all the basics you should know about. The book discusses the research information, the relative importance of protein, fat and carbohydrate in the diet and gives you various meal plans and recipes that you can incorporate into various total daily carb plans.
What I like about it is its versatility between carb plans from 20-120g of carb a day. Compared to the Zone diet it is more versatile about the amount of carb that may suit you and compared to the South Beach diet there is no unnecessary restriction on saturated fat.
When you do a traditional Atkins diet you start at 20g of carb a day and gradually increase your carbs as far as you can till your weight loss levels out. For many people who simply need to lose weight and who are not on any medication that could affect their blood sugar this is usually fine.
For anyone who is on insulin or blood sugar lowering medication such as sulphonureas which includes gliclazide or metaglinides this would not be such a good idea. In fact such a drastic reduction could be dangerous.
But the Atkins diet has in my opinion still a great deal to offer. For those people who have pre-existing heart disease or are otherwise at greater than average cardiac risk, or who are on medication or who perhaps are getting on a bit – over 45 – for instance why not do Atkins in REVERSE?
What I am proposing is to take things nice and slow. If you have any glucose metabolism problem you are going to have to restrict your carb intake for the good of your long term health sooner or later. You have to face this sometime.
From my discussions about how to measure the carbohydrates you eat you can surely find some way that suits you to find out how much carb you are currently consuming.
Whatever this is you need to start here.
Start wherever you are and start to cut down.
Week on week. Day by day. Meal by meal. Carb by carb.
If you are over 120g a day that is okay. If you are already on say 90g a day that is okay too. Simply look at the weight loss and blood sugar goals you want to achieve for your future health and start right away.
Many people will get what they need at the higher ends of the Atkins range such as those following the Zone or perhaps Dr Lois Jovanovich’s guidelines at about 120g of carb a day.
Some will want to drop their carbs further such as those people who are following the Drs Eades Protein Power plan or the diet advocated by Dr Allen and Dr Lutz or Dr Jorgen Vestig-Nielsen or Barry Groves at around 70g a day.
Others will not get to what they want until they get to Dr Bernstein’s diet of between 30-42g of carb per day.
- How healthy are you now?
- What specific health concerns do you have?
- What do you want to achieve?
- What amount of carb restriction is likely to be necessary to achieve this?
- I would suggest that you start at 120g a day and work your way down.
- How slowly must you go down for safety?
- How slowly must you go down to avoid a relapse into old patterns?
HOW MANY CARBS AND CALORIES DO ALCOHOLIC DRINKS HAVE?
For non- insulin users alcoholic drinks are just a matter of carbs and calories to worry about. For insulin users however the issue of delayed hypoglycaemia needs to be understood. For diabetics of both types one and two anything more than light or very modest alcohol drinking is not compatible with good control and safety. Many people have no idea what drinks contain and this list aims to give you relevant information on that point.
Beer one pint 13g carb 170 calories
Lager 500mls bottle 7.5g carb 146 cals
Stout 275 mls bottle 11g 100 cals
Cider dry one pint 15g 207 cals
Cider sweet one pint 25g 242 cals
Cider vintage strong one pint 42g 580 cals
Dry wine (red or white) 125mls trace carbs 85 cals (some say allow 5-10g)
Sweet sherry 50mls 3.5 carbs 70cals
champagne 125mls 2g 95 cals
Any spirit 25mls trace carbs 60cals
Bacardi Breezer 275mls 20g 170 cals
Soft drink 120mls 14g 50 cals
Tonic water 120mls 12g 45 cals
Gin and Tonic 245mls 16g 170 cals
Diet drinks and water have no carbs and no cals.
HOW TO EAT OUT IN A RESTAURANT
Doctors Mike and Mary Dan Eades are the authors of “Protein Power.” This has an excellent section on eating in international restaurants both the dos and the don’ts. It also gives clear scientific reasons for low carbing and the advantageous effects of this diet on the metabolic syndrome. There is also a good recipe section.
Here are a selection of what you can eat in restaurants.
Drink a single glass of wine as 5g
Drink mainly diet drinks, water, tea and coffee without sugar.
Dessert can be berries and double unsweetened cream, fresh fruit salad or cheese.
- Grilled meat fish or fowl, green salad, blue cheese or vinaigrette dressing.
- Eat vegetables instead of potatoes, pasta or rice. No bread or crackers.
- Chefs or Caesar salad but no croutons.
- Quiche but don’t eat the crust.
- Tomato stuffed with chicken, tuna, crab or cottage cheese.
- Beef, pork, chicken, dry ribs, tossed salad, devilled eggs.
Fast Food Burger Restaurants
- Eat the fillings of grilled chicken, burgers including cheese and bacon. No buns or chips.
- Chicken salad but miss out the croutons.
- Hot and sour soup
- Beef or chicken kebabs
- Beef, chicken, pork, prawn dishes with broccoli or assorted Chinese vegetables. No noodles, rice, or pancakes.
- Dry ribs. Avoid sweet sauces.
- Clear soups
- Green salads
- Beef, pork with butter or peppercorn sauce.
- Roast lamb, duck or other poultry.
- Grilled or poached fish.
- Mixed vegetables.
- Avoid sauces thickened with flour.
- Tandoori chicken or lamb.
- Chicken, beef or lamb curry.
- Chicken tikka or chicken masala.
- Tossed green salad, tomato and cucumber salad, spinach, mushrooms.
- Vegetable accompaniments are often good choices. Try cauliflower instead of rice with a meat curry.
- Avoid breads and potato dishes.
- Cured meats and melon
- Chicken or veal, grilled fish, pork. Avoid breaded items.
- Salad and vegetables instead of pasta, risotto or bread.
- Steak Diane.
- Veal in cream sauce.
- Cheese and a few grapes or apple slices for dessert
- Sushi but under eat the rice or order sashimi which has none.
- Miso soup.
- Terriyaki chicken, beef, fish, prawn. No tempura as it is battered.
- Chicken or steak fahitas but miss out the tortilla. You can have the guacamole, sour cream and vegetables.
- Meat and salad.
- Pizza toppings only.
- Buffalo wings with the sour cream rather than BBQ sauce.
- No pasta, bread dishes or ice cream.
HELPFUL LOW CARB BOOKS
Atkins for Life: The Complete Controlled Carb Program for Permanent Weight Loss and Good Health. Very good clear book for long term low carbers. Atkins is the standard text on which many other low carb diets are variants. This is the most flexible regarding what fat and what carb you can eat.
Dr. Atkins’ New Diet Revolution, New and Revised Edition. The orange paperback. You can probably borrow someone’s. In every workplace or club someone has done Atkins or knows someone who has.
Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes. More tailored to the type 2 diabetic.
Protein Power: The High-Protein/Low Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health-in Just Weeks! by Drs Mike and Mary Eades has been recommended by diabetics.
The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution. A companion to Dr Bernstein’s Diabetes Solution.
I find it hard to choose between Atkins for Life and Protein Power as a basic book for people with metabolic syndrome but due to a better cooking section and clearer reasoning of the scientific evidence in Protein Power I recommend the Eades book if you are only going to buy yourself one book on the subject.
MYTHS ABOUT LOW CARB DIETS
“Living the low carb life.” by Jonney Bowden gives lots of reference material throughout his book. One thing that always comes up when you tell your friends that you are going to go on a low carb diet are what I call the “Oh. Buts” Here are some of the commoner myths regarding low carb diets as explained by Jonney Bowden.
Myth One. Low carb diets induce ketosis, a dangerous metabolic state.
Dietary ketosis is not the same as diabetic ketoacidosis. The ketosis of a low carb diet is also not the same as the ketosis of starvation. Many studies have demonstrated the safety of ketogenic diets even for children. Dietary ketosis is due to a relative lack of carbohydrate so the body increases its fat burning. The ketones are a by-product of this which get excreted by the body. Diabetic ketoacidosis is a relative lack of insulin which causes the liver to secrete sugar and the body to burn fat. The ketones are much higher in amount than in dietary ketosis.
Myth Two. Low carb diets cause calcium loss, bone loss and osteoporosis.
Higher protein intakes do not cause bone loss or osteoporosis especially in the presence of adequate mineral intakes. In fact lower protein diets are associated with more bone loss.
Myth Three. High protein diets cause damage to kidneys.
Higher protein diets do not cause any damage whatsoever to healthy kidneys.
Low carb diets have been successfully used to prolong the time to dialysis in diabetic patients with kidney failure.
Myth Four. The only reason you lose weight on a low carb diet is because it is low in calories.
Calories count but so do hormones. Low carb diets produce a more effective weight loss than high carb/low fat diets. They are easier to stick to due to reduced hunger. Also more of the weight lost on low carb diets comes from body fat rather than muscle. Better blood biochemistry occurs too. Lowering dietary fat intake is not the only answer to obesity.
Myth Five: Low carb diets increase the risk of heart disease.
Low carb diets do not increase the risk of heart disease and in fact they improve blood lipid profiles.
Reference: Scientific evidence for the erroneous myths have been gathered and presented in a paper by Anssi H. Manninen. High Protein Weight Loss Diets and Purported Adverse Effects. Where is the Evidence? Sports Nutrition Review Journal. 1 (1): 45-51, 2004. (www.sportsnutritionsociety.org)
Manninen works at the Dept of Physiology, Faculty of Medicine, University of Olulu, Finland.
1. Low carb diets…
a Cause ketosis which is a dangerous metabolic state.
b Lead to calcium loss so causing osteoporosis.
c Increase your risk of heart disease by adverse effects on blood lipids.
d Reduce the risk of heart disease by helpful effects on blood lipids and blood sugar.
2. In a Chinese restaurant the best single choice would be..
a Crispy duck with pancakes.
b Chicken chow mein.
c Prawns cashew nuts and assorted Chinese vegetables.
d Pork in batter with sweet and sour sauce.
3. In a French restaurant you could eat three of these. Which one is off the menu for you?
a Confit de canard.
b Chicken with peppercorn sauce.
c Sole meuniere.
d Crepes flamed with apple brandy.
4. In an Italian restaurant which one of these would you not consider eating?
a Risotto milanese.
b Melon with procuttio.
c Cheese and a few grapes and apple slices.
d Steak Diane.
5. In a Japanese Restaurant you could choose from three of these. Which one would you not eat?
b Miso soup.
c Beef Teryaki
6. A good choice of vegetable to have with your meal could be one of these…
a Fat free pureed carrots.
b Green beans with butter and slivered almonds.
c Mashed potato with cream and butter.
d Baked parsnips.
7. A drink could be chosen from one of these…
a Bacardi breezer.
b Coffee with cream.
c Red wine.
d Gin and slimline tonic.
Have you got it?
1. D is correct. The others are common myths about low carb diets.
2. C is correct. The rest have a lot of starch included and the sweet and sour sauce is also very high in sugar.
3. ABC are good choices. The small amount of breading on the fish is not a concern as long as the vegetable choices are low carb.
4. BCD are good choices. The risotto is mainly rice and picking out a few mushrooms or bits of seafood to eat from these dishes is rarely worth the effort.
5. ABC are good choices. Sushi has a rice base. You would need to eat the fish toppings only to avoid this which makes this a very expensive meal. Sashimi is simply the raw fish without the rice.
6. B is correct. The rest are cooked starchy vegetables that will have your blood sugars soaring.
7. BCD are suitable. Mineral waters are also a good choice. Many pre-mixed alcoholic drinks are heavily laden with sugar.
Dr Annika Dalquhist is a Swedish doctor who has had her low carbing blog made into a book. She has enthusiastically approved of my efforts to spread the word about what works with obesity and diabetes and has provided a translation for those of you who don’t understand Swedish. Thank you Annika.
Where to Next?
I reckon many of you are now desperate to head off to your favourite restaurant to try out your new skills in meal choices. But it’s not all about eating on this course!
For those who have some weight to lose
How motivated are you to achieve a healthy weight and stay there?
Is it something that you have tried to do before and not reached a weight you were happy with? Perhaps you did become slim again but somehow the weight gradually returned?
Here are some tips from fellow health minded people to give you some inspiration and help.
- Have a clear picture in your head of how much worse you will look and feel if you keep on your current habits for the next year, five years or ten years.
- Have a clear picture in your mind of what benefits you will have when you are a healthy weight or even a little slimmer than you are right now. How will you feel? How will you behave differently?
- List the foods that you eat a lot of, that you know you can’t resist, and that you know are stopping you losing body fat. If you really cannot resist them perhaps it is best to decide not to buy them and not to eat them at all.
- Keep an accurate food and drink diary.
- Plan to eat or have a snack every 4 hours or so to prevent you overeating when you are hungriest.
- What activities can you do to relieve stress and boredom? List the sorts of things you can do indoors and outdoors, in company and alone that you are going to do instead of eating to deal with emotions.
- Cut back on your portions. Measure them.
- Stop eating when you are not hungry any more. Not when the plate is empty.
- Eat a good breakfast. High protein is best as it fills you up for much longer than carbohydrates. What sorts of high protein breakfast items are you going to stock up on to get your day off to a good start?
- Avoid anything other than small portions of sugar and starch. They can be very addictive for some people.
- Eat real food. Avoid the processed package meals that have lots of unhealthy fats, sugars and chemicals added.
- Have a high protein or fibre afternoon snack to prevent you gorging at your evening meal.
- Eat your evening meal early enough that you have time to digest it before bed. You will be less hungry with an earlier evening meal too.
- Carry a small high protein snack with you. Boiled eggs? Cheese triangles? These are more filling than a Danish pastry and will keep you out of trouble.
- Eat enough protein at your main meals to stop you becoming ravenous before the next meal.
- Shop for food on a full stomach. Your impulse buys are likely to be less.
- At a buffet fill a small plate once.
- If you have an indulgence get back on track right away. Not Monday and not tomorrow.
- How can you reward yourself without using food?
- Foods that fill you up include seafood, eggs, meats and high calcium dairy foods.
- Eat meals that contain a fixed amount of calories or have a fixed portion size.
- Think about how you are cooking your food. Fried food and dressings can easily add a lot of calories.
- Stick to your good habits once you are at a weight you are happy with.
- Wear attractive neat fitting clothes.
- Don’t allow yourself to go more than 5 pounds over your goal weight.
- Exercise every day if you can and at least three times a week.
- Think ahead about what healthy foods you need to buy so you don’t run out.
- Weigh yourself or put on a particular close fitting outfit (eg trousers) once a week. You need to know when you are going off track.
Cutting calories one way or another is usually needed to lose weight. A typical weight loss programme for a woman will be 1,200 kilocals and day and 1,800 for maintenance. The type of food won’t change just the higher quantity you can allow yourself when you have stabilised at a weight you are happy with. The beauty of a low carbohydrate plan is that you tend to eat lower calories without even measuring them.
Look at the internet, books and speak to your friends about what works for them before deciding which plan to commit to. What sort of programme would suit you best?
Exercise during and after weight loss.
Change aspects of your life that have been making you unhappy. This can help your mood considerably.
Develop other interests in your life that don’t involve food and drink.
Low carbohydrate diets tend to cause more weight loss as they are easier to stick to compared to low fat/ calorie counting diets. Lack of hunger is a main advantage. For diabetics or people with metabolic syndrome there are other benefits such as more predictable blood sugar control, lower blood pressure and healthier lipid patterns.
Some kinds of diet work better for different people. Do your research and once you decide on a plan stick to it consistently for best results.
1. A useful strategy to control your weight is…
a Write down everything you eat.
b Write down how miserable you feel feeling fat.
c Write your will.
d Write to Santa Claus.
2. You should eat…
a Only when you are hungry.
b Regularly around every 4-6 hours during the day.
c Everything that is on your plate.
d Everything that is in your fridge.
3. A useful strategy to help you eat less is to…
a Miss out breakfast when you are not hungry anyway.
b Divert yourself while you eat by reading or watching television to keep your mind off the food.
c Stop cravings by eating just a little bit of the food so it has less power over you.
d Measure out your portions.
Have you got it?
1 a Keep a food diary. Many people lose track of what they really are eating and doing this simple thing improves success. For those who are going onto the low carbohydrate diet sections knowing this accurately is essential for success.
Writing about how miserable you feel will just make you feel more miserable. Not what you want I’m sure.
2 b Regular eating makes it less likely for you to binge when hunger overtakes your best laid plans.
3 d Measuring portions helps. Portion sizes have increased to around double what they were about 20 years ago. Most people will just eat it if it is on their plate without realising that it is more than usual or whether they are still hungry or not.
Breakfast eaters tend to be thinner than breakfast missers.
As for cravings it is very hard to stop once you have started.
Dr Stephen Gullo’s book The Thin Commandments: The Ten No-Fail Strategies for Permanent Weight Loss discusses the common emotional and behavioural patterns that determine how successful we are likely to be in sticking to a food plan for weight loss and weight maintenance.
I have summarised some of his more important tips in this section. If you want to understand more about how your brain could work better FOR you instead of AGAINST you when it comes to dieting, this book is a good start.
For everyone: exercise basics
There is no getting around this section. The only skipping I want to see here is something you do repetitively with a rope!
If you are not used to exercise:
Gentle walking building up to 30 minutes every day.
Gentle weight training starting with very light weights or rubber bands.
Gentle yoga or stretching
Chair based exercises. In the UK there are many exercise dvds available. a great range of videos. If you buy in bulk it can be worth the shipment charge.
Why not see if you can join a pensioners keep fit class at your local hall? If you are not a pensioner explain that you are extremely unfit and would appreciate a gentle introduction to fitness.
ANYONE WITH MORE THAN BACKGROUND RETINOPATHY WHO HAS NEW VESSELS NEEDS TO SEEK ADVICE ON EXERCISE. Any jarring activity such as jogging or trampolining could rupture the delicate blood vessels and cause a bleed into the eye. Upside down postures in yoga and serious weight training must not be done.
If you are somewhat used to exercise:
Interval / Circuit training.
Aerobics / Fitness / Dance classes building from 15-60 minutes.
Video tapes and dvds. These cost almost nothing at car boot sales and charity shops.
Why not join a gym or regular class? You will get expert tuition. Weight machines tend to be safer than free weights for novices.
THOSE WITH CARDIOVASCULAR IMPAIRMENT OR AUTONOMIC OR PERIPHERAL NEUROPATHY NEED EXERCISE ADVICE. Unaccustomed exercise that raises your heart rate could be risky. Shoes must be well fitting and suitable for the task.
If you are trying to lose weight, exercising after meals can work well. If you are using insulin you don’t need to eat extra food and cutting back on insulin promotes the loss of body fat.
Physical activity can make muscle cells more sensitive to insulin for many hours after activity eg 12-24 hours for vigorous and prolonged activity say at a school sports day or a strenuous hill walk.
Certain exercises have little or no impact on blood sugars eg light weights with frequent repetitions.
Other exercises can produce a short term bood sugar rise:
Heavy weight lifting with low repetitions.
Sports with bursts of activity eg golf, running, swimming and rowing, sprinting.
Sports where you are being judged eg gymnastics.
Sports when winning is the primary objective eg football.
For insulin users
Measures you can take to offset hypoglycaemia after exercise include:
Exercising at the same time every day and with similar intensity and duration. You can learn how to adjust insulin for this daily event much easier that if it is done sporadically.
Lowering the basal insulin at night if you are on a pump or on Lantus or Levemir at bedtime.
Have an extra snack.
Reduce any meal boluses or correction boluses at bedtime.
If you have high blood sugars and not enough insulin available, you can tip yourself into Diabetic Ketoacidosis by more exercise.
As long as you have sufficient basal insulin however light exercise that does not stress you can be a helpful way to get your blood sugar down. This tip is especially helpful for people on fixed insulin doses who are not in a position to give a correction bolus.
You can see that matching up food and insulin to sports can be a tricky business. Unfortunately advice from exercise physiologists does not appear to be available in the UK in the way it is for diabetics in the US.
Joining an internet forum for diabetic exercisers may be the most pragmatic approach to getting advice on this if you are particularly sporty or competitive.
Runsweet is one such site. A problem is that it seems to be very keen on high carb diets.
If you are a fitness fanatic
Keep doing what you are doing.
Add in any missing components to your regime such as stretching, relaxation, balance, aerobics or weights / toning.
Type ones may need detailed advice about their insulin regimes especially at competitive level. This one to one work is not available on the NHS but would be well worth having. www.diabetes-exercise.org is the home page of the Diabetes, Exercise and Sport Association. (USA)
Why not buy Gary Scheiner’s book, Think Like a Pancreas: A Practical Guide to Managing Diabetes with Insulin It is a good start and he says he will answer questions online. He is a type one pumping exercise physiologist.
Sheri Colberg has written a book,The Diabetic Athlete. Sheri has also recently completed a series of articles about getting fit at the internet site www.diabetesincontrol.com They are geared towards those of us who are simply not sure where to start and are a very helpful introduction to exercise and fitness. They may be in the archive section.
John Walsh and Ruth Roberts book, Pumping Insulin: Everything You Need For Success On A Smart Insulin Pump has a detailed section on how to modify diet, basals and boluses for certain activities, intensities and durations. It could be adapted by those on a multi dose injection regime.
If you are working very hard physically you may wish to consider switching to an insulin pump because the basal levels can be altered with considerably more finesse than with one or two basal injections a day. This can help a great deal with the post exercise delayed hypoglycaemia problem.
If you are not working to any extent physically you may wish to consider looking at the types of exercise that could suit you in the metabolic section. If you are working out a little and feel you could handle a little more there is information for you too.
Exercise Tips for Kids of all ages
Spike and Bo Loy have edited a book of tips from diabetic kids called, “478 Tips for Kids with Diabetes.” This is published by the ADA. Here are some things their young contributors would like everyone to think about when it comes to exercise.
- Always tell your teacher, team mates and class mates that you have diabetes and give them information about how to recognise and handle emergencies such as low blood sugar or vomiting.
- Carry a bottle of water with you.
- If you feel low come out of the activity, consider testing, eat a snack, then return.
- Test frequently to see how your body reacts to different patterns of exercise.
- Test before you start. If you are low or normal have a small snack to prevent a drop later on.
- While you are active you may want to drink diluted gatorade or lucozade as you go along.
- If you get over heated blood sugars can drop fast.
- Because insulin absorption soars in hot water don’t inject right before you get in a hot tub or bath.
- When you go swimming disconnect your pump and put a cap on the infusion site.
When you take your pump off keep it in a cool place.
- You may want to give yourself a lower temporary basal rate to avoid low blood sugars after exercise.
- Many pumps are waterproof but none of them float. If they are lost they cost !
- Watersports need more vigilance than others.
Never swim alone.
- Eat before you go.
- Consider putting a little tube of hypostop gel/icing in your trunk pocket.
- Come back every hour to test, eat and drink.
If you are pumping you may need to come back for more insulin.
- Consider lowering your short acting insulin before heavy exercise.
- If you have forgotten your hypo kit at an exercise session sprint as fast as you can in 30 second bursts towards the end of the session to stop you going low.
- If you are skiing, keep the insulin pump next to your body to prevent the insulin from freezing. Keep your meter warm too or the batteries won’t work.
- Being at high altitude lowers blood sugar.
- The deeper and colder the water, the more carbs you burn when you are diving.
If you leave food on the beach make sure animals cannot get into the cooler and eat it. Test 30 minutes and right before exercise to see if your blood sugars are tending to rise or drop.
1. Three of these exercise regimes are harmful to diabetics with proliferative retinopathy. One is okay. Which one?
d Heavy weight training.
2. Three of these exercise regimes are suitable if you are very unfit. Which ones?
a Circuit training.
b Tai chi.
c Gentle stretching.
d Chair based workouts.
3. Three measures type ones can take to offset night time hypoglycaemia after exercise include…
a Eat more at bedtime after prolonged strenuous exercise.
b Lower the basal insulin at night after prolonged strenuous exercise.
c Decrease the meal or correction boluses at bedtime.
d Avoid any exercise as it makes blood sugar control too difficult.
Have you got it?
1. ACD are jarring activities and weight training additionally raises pressure in the eyeball. These factors can cause the delicate new vessels present in proliferative retinopathy to rupture. The bleeding into the eye can often cause visual loss. Stick to walking, swimming and static exercise bikes if you have proliferative retinopathy. By the way, skipping is out too!
2. BCD are fine. Circuit training is really for people who are pretty fit already. You are aiming to gradually improve your fitness levels.
3. ABC can all be appropriate. The whole issue of adjusting food and insulin to your exercise regime can be very tricky indeed. Physical activity to improve your cardiovascular fitness, strength, flexibility and mood will however help you on the long term and can be a great source of pleasure.
It’s back to Home Economics 101 for your lessons: Cook and Bake the Low Carb Way.
Even if you’ve never boiled an egg your life, the quality of food you will soon be able to serve to yourself your family and friends will greatly improve when you’ve taken the plunge.
There are two ways of cooking and baking the low carb way.
By far the easiest way is simply to use ingredients that are naturally low in total carbohydrate and in glycaemic index and cook the way you usually do. For example many meat, fish, poultry and egg dishes can be made just the same as usual and served with plenty of low starch vegetables and butter or olive oil instead of rice, pastry, pasta, bread or potatoes.
The more tricky way is to substitute lower carb ingredients for the higher glycaemic, high carb items such as sugar, flour, potatoes, rice and bread. This tends to be a lot more expensive and there is often some compromise regarding the texture and flavour of these dishes.
Learning how to cook and bake low carb well is a pleasure not only for the cook but for those who get to eat the end result. You need not give up old favourites entirely. You simply enjoy them in a different way. Some dishes will freeze well and can be made in bulk so you are not so tied to the kitchen.
LOOKING AT INGREDIENTS: CARBOHYDRATE
What carbs raise your blood sugar very little and what ones raise it rapidly and a lot?
I have listed some of the commoner ingredients which Dr Atkins has listed according to how generous or restricted you should be with them.
FOODS TO EAT REGULARLY
Asparagus, green beans, bok choy, broccoli, brussels sprouts, butter beans, cabbage, cauliflower, celery, chard, collards, cucumber, aubergine, fennel, lettuce, mushrooms, okra, onion, mangetout, snow peas, peppers, radishes, rutabaga, saukerkraut, spinach, sprouts, courgettes, tomato, water chestnuts.
Almonds, brazil nuts, coconut, hazelnuts, macadamias, pecans, pine nuts, pistachios, pumpkin seeds, sesame seeds, sunflower seeds, walnuts.
Chickpeas, hummus, kidney beans, lentils, lentil soup, minestrone soup, peas dried or split, soybeans, unsweetened soy milk, tofu.
Apple, blackberries, blueberries, cherries, cranberries, grapefruit, unsweetened grapefruit juice, oranges, peach, pear, plum, raspberries, strawberries, tangerine.
All bran, cooked barley, low carb bread and muffins, low carb pasta, old fashioned oatmeal, wheat bran.
EAT IN MODERATION (infrequently or in small portions)
Carrots, green peas, mashed pumpkin, butternut squash, tomato juice, tomato soup.
Whole milk, unsweetened yoghurt.
Cashew nuts, peanuts.
Black eyed beans.
Apricots, grapes, kiwifruit, mango, melon, papaya, pineapple.
Bran flakes, 100% wholegrain bread, pumpernickel bread, rye bread, sourdough, buckwheat, bulgur, whole wheat couscous, egg fettucine, melba toast, no sugar added muesli, pasta, popcorn, raisin bran, brown rice, taco shell.
EAT VERY SPARINGLY (these are the “bad guys”)
Sweet corn, parsnips, pea soup, potato
Full fat ice cream with sugar
Apple juice, bananas, cranberry juice, tinned fruit cocktail, grape juice, orange juice, prunes, raisins.
White bread, wholewheat supermarket brand breads, cornflakes, couscous, semolina, crackers, croissants, pita bread, pizza, pretzels, most breakfast cereals, all white rice, shredded wheat.
WHAT FATS SHOULD I USE ?
Use lard, butter and macadamia nut oil in preference to refined vegetable cooking oil and margarine for frying and in baked goods.
Use extra virgin olive oil, unrefined flax oil, hazelnut oil, walnut oil and macadamia nut oil for dressing salads.
Use grapeseed oil and canola oil for cooking at higher temperatures but stir fry instead when you can.
WHAT PROTEIN SHOULD I USE?
Free range meat, poultry, fish and eggs are best as they usually contain healthier fats and have less hormones and antibiotics added.
Cold and cured meats may contain added sugar and preservatives that are not beneficial.
Lightly grill meats and fish and avoid getting them black.
Partly cook your barbeque meats in the oven to minimise the black on the outside and raw on the inside health risks.
Use marinades to tenderise meat. Marinades with reduced levels of oil can reduce flaming that burns the meat. Trimming fatty meat can reduce this too.
If you eat about the palm of your hand size minus the fingers of lean protein three times a day you are having about the right amount for you.
HOW DO I SUCCESSFULLY SUBSTITUTE INGREDIENTS?
Some things lend themselves to substitution better than others.
Grate cauliflower and then gently fry it to simulate fried rice or steam it briefly to simulate boiled rice.
Steam or boil the cauliflower for at least 7 minutes till it is tender and then mash with butter and cream. You can add grated cheese or fried shallots or finely cut onions to taste. This can also be used to top cottage pie and moussaka.
Low carb pasta can be purchased in certain specialist stores. It usually has a high gluten content. It seems to become high glycaemic again when it is overcooked or reheated so just cook lightly and once.
Spaghetti squash can be baked and then used in pasta dishes to mimic spaghetti.
Instead of using flour to thicken sauces use cream instead of milk for white sauces. Very small quantities of xanthan powder can also be used to thicken sauces.
For a traditional loaf which is low in carbs you could make Graeme’s version which is on our home page. For a microwave bread which is faster to prepare see the recipe section at our sister site www.diabetes-normalsugars.com. Mandy, a fellow “Bernie” has spent a lot of time perfecting this recipe (requires login) and has some variants you may wish to try.
Instead of using flour use ground almonds and instead of sugar use a substitute.
Instead of flour use such items as flaxseed meal, whey protein powder, soya flour, ground almonds.
These are very easy to low carb because the texture depends on the fat rather than the sugar. They can have no base or a low carb pastry base can be made. Sharron Long’s recipe in Low Carb Meals on the Go is my favourite.
Dark chocolate is a very versatile and healthy ingredient when a high cocoa content, 70% or above , version is used.
Cakes and Shortcrust Pastry
Such items as courgettes, almonds, ground hazelnuts, soya flour and whey protein powder are used in various combinations as flour substitutes.
Because of oxidative damage caused by an excess of omega six vegetable oils and margarines it is better to use unsalted butter, lard and macadamia nut oil for many baked goods. Hydrogenated fats have the advantage of being cheaper and they produce lighter textured baked goods with a longer shelf life. On the long run though we are aiming at not only improving your blood sugars but also your general health. As hydrogenated vegetable fat consumption is related to higher obesity, diabetes, heart disease and cancer risks it is better to avoid them. As my friend Rosie puts it, “If bacteria are smart enough to know not to eat hydrogenated fats I’m certainly not going to either.” Baked goods may be heavier than you would like as a result. Beating egg whites separately till they peak and then adding them in to the cake mix is a technique that can help.
If you have a favourite family recipe that you can’t de carb successfully it is often possible to compromise and use half the high glycaemic flour or sugar and substitute the rest. It is the texture that is more commonly affected than the taste by going full low carb.
All of the sugar substitutes are more expensive than sugar. There is not the same caramelisation and texture benefits or the range of sugar substitute types. To mimic brown sugar you can add a small quantity eg a teaspoon of black treacle or black strap mollasses to eg a carrot, passion cake or gingerbread recipe along with the sugar substitute.
To mimic white granulated sugar I have found the best one to be Steviva Blend. Others are Z sweet and Truvia. Using ¼ of a cup of splenda and ½ a cup of xylitol is a good baking substitute for sugar. The xylitol granules don’t melt easily so it needs to be cooked for best results.
To mimic icing sugar I have found Splenda to be the best. This is also more available and cheaper than Steviva Blend. I find this sweeter than sugar and would recommend you use about half a cup or half the weight of the amount of granulated sugar you would normally use in a recipe.
I packet of sucralose (eg Splenda) = 2 teaspoons sugar in bulk but = 4 teaspoons in sugar of sweetness.
24 packets of sucralose (eg Splenda) = one cup splenda = 2 cups in sweetness
Use half the usual bulk of sugar that you would normally use when using Splenda for your first go. You can increase or decrease the amount according to taste at your next baking session.
Two tablespoons of Stevia Plus = one cup sugar
One cup of Steviva Blend = one cup sugar
One and a half tablespoons of Sweet and Slender = one cup of sugar
These are my personal selection of books that I cook from regularly.
500 Low-Carb Recipes Dana Carpender
500 More Low-Carb Recipes Dana Carpender
The Low-Carb Gourmet Karen Barnaby
Low Carb Italian Cooking Francis Anthony
Low-carb Vegetarian Celia Brooks Brown
The Illustrated Atkins New Diet Cookbook Robert Atkins
Extreme Lo-Carb Meals On The Go Sharron Long
Low Carb Sinfully Delicious Desserts Victor Kline
George Stella’s Livin’ Low Carb George Stella
Eating Stella Style George Stella
INTERNET LOW CARB COOKING SITES
I have listed some helpful sites for you in the metabolic section. My favourite is:
The Bernies have been experimenting for years and have a very varied selection of recipies for you.
There is no quiz for this section. I hope you now know that almost anything can be lower carbed with a bit of effort. As Dr Atkin’s was fond of saying. “This is not a deprivation diet.”
Much of this section is from Atkins for Life.
External Web Sites
This is a collection of websites that may help you to improve your low carb know how, cookery skills, exercise routine and knowledge about glucose metabolism disorders and diabetes.
For those with Glucose metabolism disorders and diabetes
www.diabetes-normalsugars.com *meet the Bernies at the forum*
For everyone: Low carb cooking
www.carb-lite.au.com * my favourite*
www.recipegoldmine.com *go to low carb recipies on list*
Especially for insulin users: Carb counting
For everyone: Exercise
www.amazon.co.uk *dvd rental and books*
www.diabetes.ca/files/Riddell-Final.pdf * for type ones*
For those with diabetes: Blogs
For everyone: Basic Low Carb Diets