Let’s
just say that you’re not diabetic and, of course, you want to keep it that way.
But then let’s say that one (or both) of your parents is
diabetic.  Plus you have a brother, and your mom says
the doctor just told him that his blood sugars were a little
too high, and he’s pre-diabetic.  Now you’re
wondering if it’s inevitable that it’s going to happen to you, too.
It’s not.

If
you read last week’s post, you may recall that I recommend to people
in the situation I just described that they get themselves a glucometer.  One of
the best ways to prevent diabetes in people at high risk (and everyone
else, for that matter) is to check your own blood sugars after you eat
and figure out for yourself which foods and situations keep your blood
sugars from recovering normally.

You can get a glucometer, a
machine for measuring your blood sugar, at the drugstore without a
prescription.  Or you can ask your doctor for a prescription, and
perhaps decrease the cost a bit that way.  If you’re only planning to try it once
or twice, you can even ask your brother, or a friend, if you
can borrow theirs for an experiment.

The
next time you’re not sure whether something you ate made your blood sugars spike, check them about 60 to 90 minutes after you’re done eating.  If your
sugars aren’t back in the normal range, say 80-120, that meal (or
snack) had too much carbohydrate for your body to cope with.  Maybe it
was too much refined carbohydrate (white flour and sugar), or maybe it
was too much carbohydrate, period.  Or maybe there wasn’t that much of
any one single thing, but when you added up everything together, that
was too much.

So how can you keep your blood sugars from spiking a little too high for a little too long?  Here are a few ideas:

#1
Don’t make your insulin do all the work of getting your blood sugar
into the cells!  Make your muscles do their share — run around, play,
toss a ball, get some exercise!

#2  Eat something that you absorb slowly before you
eat something that you absorb fast.  There are three things that we
absorb slowly — protein, fat and fiber.  There are two things that we
absorb quickly — sugar and white (stripped) flour.  I can think of two
benefits to eating something absorbed slowly first.  The first is that the
protein, fat or fiber mixes in your stomach with the sugar and/or white
flour, and decreases its absorption.  The second is that your stomach
is fuller to start with, so you eat more of the “slow-absorb stuff” and
less of the “quick-absorb stuff” to begin with.

#3  Eat
something highly acidic before you eat something sweet.  I have some
ideas about why this works, but to be honest I have not seen any
research on it.  It’s one of those old wives tales that really seems to
work.  The idea would be to drink a glass of water with a teaspoon
of cider vinegar mixed in before you eat your meal.  Try eating the
identical meal on two different occasions, at the same time of day, in
as similar a circumstance as you can arrange.  Change only one
variable:  one time have a glass of water and vinegar first, and another time have the identical meal without.  Don’t forget to check your blood sugars 90 minutes after you eat, both times.
Then send me your results.

#4
Save refined carbohydrates for later in the day, when you aren’t so
insulin resistant.  We are all naturally most insulin resistant when we wake
up in the morning.  As the day goes by we become less resistant and more insulin
sensitive.  So if you really enjoy oatmeal but you discover that it spikes your
blood sugar, try it for dinner with something that increases the meal’s
protein content, like some nuts.  You could actually stir some peanut butter into the oatmeal instead, if you’d like.

#5  Choose carbohydrates that
come with the fiber attached instead of eating ones that have had the
fiber stripped away.  Whole grains instead of stripped, refined grains.  Oranges instead of orange juice.  Dates instead of sugar.  And so on.

#6  Drink water or iced tea instead of soda pop.  Enough said.

#7
Load up your plate with fruits and vegetables, and leave room for one
brownie, instead of two, or three, or four.  Notice that in nature you
don’t normally find carbohydrate without the fiber attached.  With very few exceptions, refined
carbohydrate is a recent human invention, and it
is one of the major causes of the obesity and diabetes
epidemic.

#8  Drink a glass of milk before you head on over to
your friend’s house to hang out and eat snacks.  This gets back to filling your belly with protein
before you eat refined carbohydrate.  And fat, if you drink 2% or whole
milk.

#9  Eat a handful of peanuts before you leave for a party.  Peanuts are rich in protein, fat, and fiber, a three-in-one
winner all around!  If you are allergic to peanuts, try almonds, walnuts, sunflower seeds or pumpkin seeds.

#10  See #1.  The more we move, the more we will
protect our blood sugars.  Think big.  See if you can organize a group
at work to walk together at lunchtime.  Find out what it would take to
put in sidewalks in your town.  A community garden.  Maybe you can talk your family into a weekly ball game after Sunday dinner.

Don’t take
my word for it.  Compare your blood sugar with and without these kinds
of interventions, and see what you get.  Figure out which kinds of
changes work best for you, and stick with them.  Teach them to your
friends, your siblings, and your parents.  Diabetes is not inevitable,
and pre-diabetes is reversible.  You can get yourself off the road to diabetes.

As a doc, it’s easy enough for me to think I understand a disease state, and then to write a prescription for a medication to be taken two or three times daily.  I can spend hours and hours studying that problem.  I can even talk with patients who have been diagnosed with that illness, and learn how it has changed their lives.  But all it takes is to have a member of my own family diagnosed with asthma for me to really understand what it means to have that disease.  It’s completely different, like understanding from the inside out.

Diabetes has been a little like that for me.  I learned a ton in medical school.  But in the end, my friend Dee has taught me more about diabetes than anyone else.  She became an expert because she had to: she was diagnosed with it when she was 9.  Dee is a type 1 diabetic, which means that her pancreas doesn’t make any insulin at all.  All the insulin that she uses comes from outside, via a pump or a needle.

Dee is absolutely expert at keeping her blood sugars normal.  I wish everyone’s blood sugars were as good as hers.  Over the years and decades since her diagnosis, she has come to be able to predict with virtual certainty which foods cause her blood sugars to spike, and which ones don’t.  But she doesn’t leave anything to chance.  There’s no guesswork here.  She uses her glucometer to check her sugars all day long, before meals, after meals, before she takes a walk, or a drive, or a nap.

Dee is not into self-deprivation.  She loves ice cream, cookies, and cake like everybody else.  She just uses them like medicine, to keep her blood sugars normal.  Once, when her blood sugar was low, I saw her eat a quarter of one of those gargantuan chocolate chip cookies from a fancy bakery.  It was definitely an adequate single serving.  It’s just that I never saw anyone actually break one of those giant cookies into quarters.  Halves, yes.  Quarters, no.  Not until Dee did it.  But it worked, and her sugars normalized shortly.  She put away the rest of the cookie for another time.

Of course, you should know that she never creates low blood sugars on purpose to give herself an excuse to eat a treat.  She doesn’t create opportunities for treats.  But when her blood sugars drop, she treats them with treats.  Also, if she exercises more on any given day, she will lower her insulin dose to keep her blood sugar from dropping too low.  Keeping her sugars normal requires her to constantly juggle a lot of variables, but the truth is that it’s become second nature to her.

There’s a place in her diet for candy, too.  But she doesn’t just load up on it whenever she feels like it.  She carries individually-wrapped jelly beans and uses them as “medicine” when her blood sugars are dropping.  She told me once that each jelly bean raises her blood sugar about 6 points.  So 5 jelly beans will increase her sugar from 50 to 80, as long as she’s sitting still.  If she’s walking, her blood sugars become a moving target and it’s harder to get them back up into a normal range.  So we’ve sat on a bench or a curb for a few minutes more than a few times, waiting for things to stabilize.

She also has a deal with her family:  It’s fine to have ice cream any time you want — you just have to be willing to walk to the ice cream store to get it.  She’s happy to go with you!  Of course, she gets the sugar-free ice cream.  But if you don’t feel like walking, then no ice cream.  You have to earn it.  This might seem drastic, or it might sound like the sanest approach to treats that you’ve ever heard.  Before you decide which, remember that Dee’s blood sugars are perfectly normal.  You should also know that everyone in her family is slender and active.

I look at type 1 diabetes like a “canary in the mine.”  Long ago, miners would carry caged canaries down into the tunnels with them.  If poisonous gases (like methane and carbon monoxide) leaked into the mine-shaft, the canaries, more sensitive to the stress of the poison, would be affected (and die) before the miners began to experience difficulty breathing.  The miners would then, theoretically at least, have time to escape.

We can use what Dee has learned to keep our own blood sugars normal right now.  We don’t have to wait until we start running out of insulin and we get diagnosed with type 2 diabetes.  We can take a page from Dee’s healthy approach to blood sugar management to keep our own blood sugars in the normal range right now.  Here is what I have learned from Dee:

#1 Don’t feel guilty every time you feel like having a treat.  Just make yourself “earn” it.  That’s why it’s called a treat.

#2 Give each of your kids another jelly bean every time they pass one more block the next time you go on a family hike.  Walk to the ice cream store.

#3 One serving is a slice of cake, or a cup of ice cream, or two small-medium cookies.  One serving is enough.

#4 Ready for more drastic measures?  Got two diabetic parents?  Buy a glucometer and check your own blood sugar 60-90 minutes after you eat.  If your sugar hasn’t returned to the normal range (80-120), think back to what you ate, and see if you can figure out why.  Over time, you will get better and better at predicting which particular item(s) caused your blood sugars to spike, and preventing it from happening the next time.  [More on this next week.]

What I am trying to get across is that this is how to keep your blood sugars normal.  Why wait?

I am pleased to report that this past week, Michelle Obama, Agriculture Secretary Tom Vilsack, and Surgeon General Dr. Regina Benjamin unveiled “MyPlate” to replace the ancient food pyramid.  With rates of obesity and diabetes climbing, the pyramid clearly wasn’t working.  Everyone, me included, is hoping that the plate will fare better. 

What do I like about MyPlate?  For one thing, half the plate is fruits and vegetables.  One half of the plate is composed of produce!  So half of our meal is supposed to be made up of fruits and vegetables!  That’s a huge improvement in the recommendations.  Fruits and vegetables are jam-packed with all kinds of vitamins and minerals, phytonutrients, color, flavor, and fiber, which happens to be filling.  

MyPlate is the first step in a three-part program designed to get us to 1) eat more fruits and vegetables, 2) bring our portion sizes into a more realistic size, and 3) drink water instead of sugared beverages.  

What else do I like?  I like that no one is asking you to weigh all your food anymore.  That’s not really realistic for most of us.  What else?  A pyramid that touts grain as the foundation for health was not a solution to the diabetes and obesity epidemics.  Thank goodness we’re done with it.

Now I’ve heard my share of cynics calling it the Gluten, Trans Fat, Beef, Cheese, and Corn Syrup Plate.  To them I say:  So eat gluten-free.  Avoid all processed foods.  Eat grass-fed beef and dairy when you can, and avoid them otherwise if you are so inclined.  I, for one, am inclined.  That reminds me, I stopped at Jeni’s, the new premium ice cream shoppe in Chagrin Falls, last night.  The line was OUT THE DOOR!  I tasted the Meyer lemon, salted caramel, milk chocolate, and Ugandan vanilla flavors, and am looking forward to making my way through the rest of their menu, one flavor at a time.  All their cream comes from pastured Brown Swiss, Guernsey, Friesian and Jersey cows at the Snowville Creamery in nearby Pomeroy, Ohio.  If I want, I can go there to see the cows.  

With regard to trans fats and corn syrup, I continue to believe that a significant portion of our twin diabetes and obesity epidemic will go away with the disappearance of manufactured calories from our diets.  

If I could make one correction to MyPlate, I’d call the upper right-hand quadrant “Whole Grains.”  I would definitely not call it chips, which are a windfall for the food industry but a disaster for healthful eating.  Nevertheless, I would say that MyPlate makes it easier to understand how to eat better, and it’s a long way in the right direction from a pyramid that offered up grains, and refined ones at that, as a basis for a healthy diet.
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Last fall, I took a lunchtime walk in Larchmere, and passed Felice’s Urban Cafe.  It looked so nice on the outside, in a beautiful old Craftsman-style house with a huge front porch and a hand-painted sign, in a section of town that has been trying to become regentrified for 15 years at least.  Last night I finally had the chance to go.  Felice’s did not disappoint.  

We arrived in Larchmere as evening fell, and walked on the path alongside the house to a partially enclosed, outdoor patio behind the restaurant to await our friends.  Right away I knew I’d come to the right place.  How?  The restaurant’s owners had planted a large garden right alongside the house!  Many empty beds were covered in mulch, and paths of stepping stones were set between the beds to keep gardeners’ feet from compressing the rich dirt.  

Except for the beautiful stone paths, the garden doesn’t look like much right now, but pretty soon tiny green stalks will begin to poke their little heads up from the dirt.  By late summer there will be an abundance of fresh vegetables and herbs!!  I expect that the menu will begin to include loads of mixed greens from the restaurant garden any time now.  

The website metromix.com described Felice’s cuisine as “Mediterranean-inspired in a homey atmosphere.”  Okay, whatever.  What captured me was that everything was made from scratch and the chef uses tons of local ingredients.  That’s what I want no matter where I go.  I don’t remember what everyone ordered because I was so interested in my own plate that I didn’t think to look around.  The food was wonderful.  

Here’s what I had:  My appetizer consisted of a beautiful pottery cup filled with small chickpeas sauteed until dry and then sprinkled with crystals of sea salt.  They were an exquisite accompaniment to the glass of prosecco I was drinking.

My entree was grilled polenta (my favorite!), served on a bed of wild mushrooms and slivers of sauteed onion, and topped with a flavorful sauce of red pepper and ground almonds.  It was a little bit sweet from the onions, red pepper and corn meal.  It was a little bit earthy from the mushrooms.  It was a little bit salty, and nutty.  It had a little bit of a bite, so there was probably some hot pepper, maybe jalapeno or chipotle, in there, too.  Every bite was a little bit wonderful.

Today, in response to my question about what he ordered, Eddie reminded me that he had eaten an appetizer of four perfect asparagus spears, crisp and scrumptious, and then a fresh, green salad, and then salmon tacos, which looked to be homemade and came adorned with jalapeno peppers and limes.  He ate every last crumb.  I do remember having taken a quick glance at his plate last night when it arrived, and I can only say that his dinner looked really tasty.  

We finished our meals with cups of fragrant coffee and rich cream.  The company was fun, the food was divine, and I was so happy. 

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If you’ve been wondering what I mean when I say that my goal is to help
readers understand the difference between real food and manufactured
calories, then today’s post is for you.

When you make a choice
about what to eat, the question is, “Is this really food, or is it
an invention of the 20th century, i.e., manufactured calories?” 
Sometimes things in life can be divided into black and white, like the
coin toss at the start of a football game.  But sometimes it’s not that
simple.  Occasionally a coin lands on its side.  Between black and
white you find a spectrum of grays.  That’s what I want to talk about
today.  

When you talk about the difference between real food
and manufactured calories, you’re talking about a spectrum of items. 
To show you what I mean, today we’re going to talk about corn.

Corn,
like lots of other real food, originates in the earth, and you can eat
it straight off the cob.  As soon as corn is picked, the sugars in the
kernels begin to be converted to starches, which do not taste as sweet
to our palates.  So I’m not one bit surprised to hear from a friend
that he has fond memories of having eaten uncooked, fresh-picked sweet
corn when he worked on a collective farm years ago.  I’m sure that the
raw foodists would approve.  

One step removed, but still
“real,” as far as I’m concerned, is the same corn, purchased a few days
later from the supermarket, and boiled for a couple of minutes until
bright yellow.  Maybe it’s eaten as is, or maybe the kernels are sliced
off to make Heather’s Snazzy Salsa
or something else equally delicious.  Maybe those kernels are
flash-frozen or canned for consumption some months later.  It still
looks and tastes like corn as we know it, and it’s definitely corn, as
most any 5-year-old can tell you.  Little by little though, we are
moving farther and farther away from the date and place that corn was
picked.

Some of that corn is set aside and completely dried. 
It’s going to be crushed to become corn meal, or flour.  Some of that
corn meal will be made from whole corn kernels, and will retain the
germ and the outer covering.  Some will be “defatted” or “degermed,”
and have its fiber removed.  This process will result in a substantial
decrease in the nutritional value of the corn meal.  In order not to
cause nutritional deficiencies in the large numbers of people who will
consume this kind of corn meal, certain nutrients will be returned in a
process called “enrichment.”  Of course, the corn meal would not have
required enrichment if it had not been stripped in the first place. 
But that’s a conversation for another time.  Anyway, enriched corn meal
is bound, in extraordinarily large quantities, for commercial bakeries, and fast
food and snack food manufacturers all over the globe.  

Corn
meal is used to make corn muffins, corn bread, corn dogs, and other
corn-based products.  An essential ingredient in fast-food
establishments, it is dusted on the top and bottom of hamburger buns to
provide that extra touch of authenticity.  Or something.   And some
corn meal goes to the manufacture of corn chips, which I would venture
to call the mother of all manufactured calories.  Now we have moved pretty far away from the corn that was picked on that long-ago summer day.

[The
whole-grain corn meal, manufactured in comparatively miniscule amounts,
will end up in specialty stores, farmers markets, and the growing
organic food industry.]

Somewhere along the way, an additional
manufacturing stream will be diverted to generate high-fructose corn
syrup, which (since it is much cheaper than sugar) has extraordinary
value as an sweetener in the manufacture of edible products.  Corn syrup solids figure into this equation, too, though I’m not sure where.  I see it frequently on ingredient lists.  I don’t know anyone who keeps a bottle of it in their kitchen.  That’s a sign that we’re no longer in the realm of real food.

So
which products are real food, and which are manufactured calories?  And
which ones should we be eating, and which should we avoid?  

I’m not going to tell you that you can’t eat any corn chips at all.  It’s not like a handful of corn chips is going to
knock out your immune system or anything.  A little bit of enriched
corn meal isn’t going to give you a heart attack, or diabetes.  We can
all handle a little bit of this stuff.  Again, the problem is that
we’re drowning in it.  And that’s a huge problem, really. 

The more processed or manufactured the
item, the more “predigested” it is.  The more predigested, the easier it is to absorb.  And the easier it is to absorb, the more insulin we waste. 

So here are my recommendations: 
Eat more fresh corn and less canned corn.  Not that
canned corn is “bad.”  Just that fresh is better.  Frozen is almost as good, since fresh corn is frozen when it’s relatively newly picked.  Eat more whole-grain
corn meal and less “refined” corn meal.  Or don’t eat any refined corn
meal at all.  Unless of course you’re a guest visiting at someone else’s
house.  I’m a big believer in being
a gracious guest. 

I want everyone to eat
fewer chips and more real corn.  Not because I want you to eat
more corn, but because I want you to eat more real food and less manufactured calories.  Especially corn chips, which have little if any redeeming nutritional value.  Actually, if you need some help
kicking your corn chips habit once and for all, all you have to do is
read David Sedaris’s description of how his mother’s misshapen toenails
resembled the Fritos at the bottom of the bag.  That should do it!
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