My Life with Diabetes: Well Beyond Half a Century and Counting

Dr. Richard Bernstein

The following is the story that changed mylife and entire perspective around diabetes–this is the story that made me realize there actually is a solution.  This disease is not a dead end of progressive nature where eyes have to be lost, limbs numbed or amputated, and life turned into something less then it should be.  Read this and if solving diabetes if of interest get his book .

This is republished from Dr. Berstein’s website and can read there by clicking here.

Read more My Life with Diabetes: Well Beyond Half a Century and Counting

Steven’s Success Story

Dr Katharine Morrison explains how her son’s type 1 diabetes led her to question accepted dietary advice and adopt a low-carb, high-fat approach.

Summary: 12 year old, Male, Type 1 diabetic

This article was originaly published in Pulse-i out of the UK, Issue: 16 November 2006, Section: Clinical.  A link to the full article (requires registration) can be found at the end of the article.

Read more Steven’s Success Story

How To: Follow a Low Carbohydrate Diet

This section is for everyone. No skipping!



Overview

Dr. Annika’s Diet

Meal Suggestions for Dr. Annika’s Diet

How to Follow the Life Without Bread Diet 

How many carbs and calories do alcoholic drinks have?

How to eat out in a restaurant?

Helpful low carb books

Myths about low carbohydrate diets

Overview

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

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, palmoil 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

Breakfast options:

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 recipies 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.

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.

This low carbohydrate diet is very suitable for anyone who wishes to lose weight.

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.

 

HOW TO FOLLOW THE “LIFE WITHOUT BREAD” DIET

This diet is quite similar to the carbohydrate exchange method that was used for many years by diabetics.

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 Annika’s diet. The basic diet 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.

Breakfast
3 egg omlette with onion and peppers
half a grapefruit one unit
Coffee with cream

Lunch
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

Evening meal
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.

 

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 fo 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.

Bistro

  • 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.

BBQ

  • 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.

Chinese

  • 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.

French

  • 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.

Indian Restaurants

  • Tandoori chicken or lamb.
  • Chicken, beef or lamb curry.
  • Chicken tikki or chicken masala.
  • Tossed green salad, tomato and cucumber salad, spinach, mushrooms.
  • Vegetable accomaniments are often good choices. Try cauliflower instead of rice with a meat curry.
  • Avoid breads and potato dishes.

Italian Restaurants

  • 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

Japanese

  • 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.

Mexican

  • Chicken or steak fahitas but miss out the tortilla. You can have the guacamole, sour cream and vegetables.
  • Meat and salad.

Pizza

  • 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.

For other Low Carb books that are recommended by our members ,please Click Here or check out the books recommended on D-solve .

 

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.

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.

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. Many studies show more weight loss on low carb diets than on high carb diets with the same number of calories.  Also more of the weight lost on low carb diets comes from fat. Better blood biochemistry occurs too. Lowering 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.


Quick Quiz:
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?
a Sashimi.
b Miso soup.
c Beef Teryaki
d Sushi.

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. Ther 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.

Reference Info:
Dr Annika Dalqhist 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!

Whenever you are ready you may all now proceed to the  How To: Exercise section.

How To: Lose Weight and Keep it Off

This section gives many tips on how to reduce and maintain a weight that you are happy with.

If you are happy with your weight you may wish to skip this section and move onto the How To: Follow a Low Carbohydrate Diet section.


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.

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 through better compliance than low fat/ calorie counting diets. Lack of hunger is a main advantage. For diabetics or people with metabolic syndrome there are 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.


Quick Quiz

A useful strategy to control your weight is...

Correct
Incorrect

You should eat...

Correct
Incorrect

A useful strategy to help you eat less is to...

Correct
Incorrect

Reference Info:
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.


Where to Go Next?
Now please continue onto the How To: Learn About Metabolic Syndrome