Updated handout--More evidence based

Some Surprising But True Facts....
Cutting calories in your diet by decreasing starches and sugars, without adjusting meat, dairy and healthy vegetables and fruits in your diet will raise good cholesterol, lower triglycerides, lower blood pressure, improve blood sugars, and loose weight instead of just cutting calories by cutting fat.



It will be helpful to understand how your food choices can either partially or completely reverse or at least slow down your diabetes or metabolic syndrome—or your diet make them get worse.

1. Knowing that foods are made of different macronutrients: carbohydrates, fats, and proteins.
2. Knowing how the macronutrients affect your blood sugar and then insulin levels. Carbohydrates raise blood sugar and require more insulin to control the blood sugar rise than proteins, and fats do not stimulate insulin or raise blood sugar at all.
3. Knowing the negative effects of too much insulin include the inability to lose stored fat, storing more fat, and possibly an increase in hunger.
4. The problem may be how quickly (and by how much) the carbohydrates we eat raise blood sugar (and thus insulin), called the glycemic index. White rice, potatoes and bread have higher glycemic indexes than brown rice, sweet potatoes and whole grain bread.

No diet will be effective if you are eating too many calories. The reasons why lower carbohydrate diets have been more effective for weight loss and improvements in blood sugar and triglycerides versus similar low fat diets with high carbohydrate contents are an area of much research and the findings are still controversial. I am not necessarily proponent of the Atkins diet, and a fish and plant based Mediterranean diet with 30-45% of calories from carbohydrates may be ideal. I believe though that the most effective diet should be followed when we are trying to reverse obesity and the complications of diabetes and the metabolic syndrome. Lower carbohydrate diets compared to lower fat diets have lead to greater weight loss that is both quicker and sustained for up to two years in studies.

The effect of a lower carbohydrate diet on your cholesterol, or lipids (triglycerides, HDL, and LDL) is complex and surprising to most people. Low carbohydrate diets are usually not any higher in fats than most peoples usual diet. Fat includes saturated fats, monounsaturated, and polyunsaturated fats (depending if you eat mammal or fish protein, nut/avocado intake, and your choice of oils). By decreasing the amount of carbohydrates, your triglycerides will go down, your HDL will increase, and the LDL cholesterol may go up or down. The measured volume of the LDL may increase, but if it does it will be less dense (more buoyant and fluffier, and less likely to lead to artery blockages) with fewer overall number of LDL particles—even if you eat saturated fats.

In many studies, having a low HDL and high triglycerides predicts heart disease much more than a high LDL or total cholesterol level. For many years it has been known that a low carbohydrate diet will improve triglycerides and HDL, but most dieticians and physicians have been reluctant to recommend this dietary change. American Heat Association and Department of Agriculture recommendations have not yet incorporated dietary advice that focus on improvements in HDL or triglycerides. The traditional USDA Food Pyramid has stressed increasing grain and other carbohydrate consumption. This may have been healthy advice if calories were kept stable and saturated fat intake decreased, but Americans have ate the same amount of protein and fat and added approximately 200 calories a day to their diets from carbohydrates. In a years time, this excess calorie intake could add up to 20 lbs in weight. The reasons for not recommending a moderation in our carbohydrate intake likely have more to do with academic culture, and government agricultural policies than an honest interpretation of the science of nutrition, in my opinion and that of many others.

In summary: You should avoid sugars (table sugar and high fructose corn syrup) and refined carbohydrates (rice, bread, and pasta) and fruits and vegetables which are high in carbohydrates or sugar with very little fiber (like potatoes, grapes and watermelons). Decrease your carbohydrates more if you are not losing weight or reaching your blood sugar goals. You must not intentionally overeat or eat when you are not hungry. It is harmful to your health to eat both a high fat and high carbohydrate diet, so be sure you have not taken my advice to mean increasing fats without decreasing carbohydrates. After you have reached your weight loss goal and/or are instructed to cut the doses or stop some of your diabetes medications or insulin, you can add back more healthier, unrefined carbohydrates (like recommended in the South Beach Diet books). You can be sure you are not reversing the helpful metabolism changes you have made by making sure you do not gain weight and checking your blood sugar to be sure it is remaining under control.

WARNINGS FOR DIABETICS:

If you have diabetes and are on insulin or a sulfonylurea, you should know and recognize the symptoms of hypoglycemia (low blood sugar). The pills which stimulate the pancreas to release insulin even with a normal blood sugar are called sulfonylureas (glipizide, glyburide, and glimepiride/Amaryl and metglitinides (repaglinide/Prandin and neglitinide/Starlix). If you are on one of these medications or insulin, your should seek specific advice regarding your risk of developing hypoglycemia and an action plan to prevent it or modify your medications (at times decreasing doses by up to 50% or more depending on your current diet and diabetic controll) before decreasing carbohydrate intake significantly.

If you have diabetes and are on insulin or a sulfonylurea, you should keep your carbohydrates between 50 and 100 grams a day, at least. You should have one small serving of carbohydrates with each meal (one slice of bread, ½ cup of cereal, ½ cup rice, or ½ a medium potato) to be sure you get enough this amount of carbohydrates in addition to the carbohydrates you get in a healthy selection of non-starchy vegetables and less-sweet fruits.

If you are following one of the popular diet books like the Atkins Diet or South Beach Diet, you should begin the programs in the second phase and avoid the extremely low carbohydrate first phases, called “Induction” in the Atkins diet and begin in the “Ongoing Weight Loss” second phase. Your should begin in “Phase 2” of the South Beach diet.

The fist phases of the Atkins or South Beach Diets diet recommend less than 20 grams of carbohydrates a day and would lead to dangerous and unpredictable insulin reactions or hypoglycemic reactions if you are treated with insulin or a sulfonylurea.

Foods can be eating and things you should be doing:

Meat, Eggs, and Tofu Chicken, beef, pork, turkey, venison etc. are all acceptable meats. Eggs that are home raised or vegetarian fed/omega 3 enriched eggs are more beneficial. Only a 15% of people will develop an increase in cholesterol from eating eggs, and even 3 eggs a day, everyday, only raised their LDL by 10-15 mg/dL Fish—any fish is fine, but wild caught and fattier fish may be more beneficial Tofu can be a meat substitute. I like to buy extra firm tofu, press it between two plates to drain the water, and then marinate before cooking. Oils, Fats, and allowed treats Olive oil is probably preferable to canola oil―Avoid most other vegetable oils. Avoid margarines and trans fats. Some baked goods or pancakes made with almond or coconut flour and eggs Nuts― Avoid salty or sweetened varieties because they will stimulate appetite and overeating. Dark chocolate. Butter and cream and other dairy fats can be used in moderation. Cheese—cheeses are fine in moderation

Vegetables green beans, asparagus, broccoli, cauliflower, cabbage, onions, tomatoes, avocados, squash, zucchini, carrots, all kinds of lettuce, etc. Raw carrots and celery are very convenient snacks. Avocados are a very good source of monounsaturated fat. Basically any vegetable except potatoes or corn Fruits Berries are very healthy fruits, high in fiber and nutrients. Blueberries are especially plentiful in the Willamette Valley and can be frozen. Try and eat sweet fruits with less fiber when they are in season or you are more active, generally in the summer. Peaches, plums, grapes, etc. Apples can be eaten anytime of the year and are very filling. Time and water Take the time to enjoy your your food and split your servings into two if you find yourself overeating despite good choices. Drink plenty of water between and with meals. 64 ounces a day is adequate. Supplements Fish oil for most people Vitamin D supplements for most people (1000 to 2000 units a day) A one-a-day multivitamin for most people Calcium supplements for some people

Foods you should try to avoid and things to read:

Group One Foods Generally avoid for maximal metabolic and weight loss benefits. When you do eat them, choose whole grains. Bread―whole grain preferred Pasta―whole wheat preferred Rice―brown or wild rice preferred Potatoes―sweet potatoes are preferable Cereals, hot or cold—choose the highest fiber cereal or old fashioned less processed oatmeal Corn―I consider it nutritionally a starch, not a vegetable. Full sugar/corn syrup sodas, fruit juices, and energy drinks Beer―it is very high in carbohydrates Group Two Foods Avoid if possible―only as very special treats Most desserts, cookies, candy, pancakes, ice cream, and baked goods—in moderation, for obvious reasons Chips, crackers, pretzels, cereals bars—most foods in pre-packaged bags or boxes contain corn syrup or other carbohydrates as the main source of calories. Milk—It contains a lot of carbohydrates and many people drink to excess. Cream or half and half in coffee is fine. Sugary fruit without much fiber―for example watermelons, canned fruit, juices, bananas, and grapes. Group Three Foods Eat in moderation Yogurt—Yogurt is relatively high in carbohydrates compared to fat and protein. Beans― have a significant amount of carbohydrates, but also provide fiber and some protein.

Beginner Books The South Beach Diet, by Anthony Agatston, MD New Atkins for a New You, by Eric Westman, MD Primal Blueprint, by Mark Sisson In Defense of Food, by Michael Pollan Advanced Books Good Calories, Bad Calories, by Gary Taubes. Dr. Bernstein's Diabetes Solution, by Richard K. Bernstein, MD Beginner Web Sites/Blogs www.goodcaloriesgoodinsulin.com my blog www.marksdailyapple.com www.phlaunt.com/diabetes www.phlaunt.com/lowcarb www.low-carbchef.com recipes http://tinyurl.com/veganlowcarb Vegan Low Carber More Advanced Web Sites/Blogs http://tinyurl.com/NYT-Gary-Taubes-Article New York Times Magazine article by Gary Taubes summarizing much of Good Calories, Bad Calories http://tinyurl.com/Rebuttal-of-Gary-Taubes Low fat biased rebuttal of this article by Center for Science in the Public Interest (Nutrition Action) wholehealthsource.blogspot.com www.paleonu.com Paleolithic Nutrition http://tinyurl.com/CarbohydrateRestriction Journal article entitled: Dietary carbohydrate restriction in type 2 diabetes mellitus and metabolic syndrome: time for a critical appraisal My Personal Experience I knew I had to lose weight to avoid diabetes, which runs very strongly in my family. I have cut the carbohydrate calories down in my diet with remarkable improvements. My weight has decreased 30 pounds and I am easily maintaining this. My blood sugar went from 118 to 105. My hemoglobin A1c decreased from 5.8 to 5.3 (a drop of 15 blood sugar points on average). These improvements were in spite of stopping metformin (Glucophage) a medicine which would lower my blood sugar even further. My triglycerides decreased to 135 from 204, my HDL increased to 52 from 46, and my LDL increased to 109 from 74