A couple of weeks ago I was introduced to an unusually determined local businessman with type 2 diabetes. We joined a mutual friend for lunch together in a local restaurant known for 1) being accommodating, and 2) their great salads with lots of fresh ingredients. What makes this guy so interesting is the fact that he decided, on the week of his diagnosis, more than 10 years ago, that he was going to keep his blood sugars under control exclusively through diet.

He said that if he finds himself at a party or dinner or some other celebration with absolutely nothing he can eat, he says “I just ate” or “I’m getting over a little bug” or something similar. When he arrives home, he eats nutritious choices that he knows won’t spike his blood sugar. He told me how much it bothered him when he went to a benefit for diabetes once and all they served was soda and doughnuts. He withdrew his support for that organization.

If you’re one of the many people whose doctor’s sole advise has been to “go lose some weight and get some exercise” then here’s something you may find a bit more helpful. You can do what my new friend does: check your blood sugars 90 minutes after you eat. My new friend keeps his sugars on track by checking them up to eight times a day. I am pretty sure that he would check them twice that many times if that’s what it took to keep them in the normal range. That’s what I mean by determined.

This man knew more about the effect of food on blood sugar than any other individual I have met, patient or physician. He certainly knew more than I do. No one can trick him, because he knows. He knows exactly how much oatmeal will spike his blood sugars, to the teaspoon. He’s checked it over and over, and that’s that. He knows how to construct a salad will satisfy his appetite without having to pay the dreaded price of high sugars, and so he digs in with relish. He knows that there is essentially no safe amount of mac ‘n’ cheese for him. He knows. I was able to share one bit of information of which he was not aware. He didn’t realize that he could increase the amount of nutritious fats in his diet without compromising his blood sugar control. I recommended olive oil on his salads, a few slices of avocado, a sprinkle or two of sunflower seeds, some almonds, and so forth.

Yes, he’s been offered medications on many occasions, and even insulin, especially in the beginning, when he showed up with a blood sugar near 500. But that’s not his style. This guy has a long reputation of delivering on his professional promises, but I would say that the one he made to himself has been the most important of all.

What drives him? Apparently he grew up in the company of family members with diabetes, and saw for himself, firsthand, the gruesome consequences of uncontrolled blood sugars. This is what he told me: “There is no food in the world that I’d exchange for my feet or my kidneys.” Okay, I get it. He’s right, the stakes are really high.

Remember that it’s not diabetes that’s the problem; it’s uncontrolled blood sugars. If you figure out how to keep your sugars normal, no matter what they call it and no matter how you do it, you’ll keep your risk of complications low, low, low. Once you figure out how to keep your sugars normal, then you are winning.

Once in a while, maybe if you aren’t feeling 100%, the only thing that seems appealing is a bowl of grains. Maybe it’s oats, or maybe it’s millet, or maybe bulgur. Then again you might feel like eating rice. You can take your pick.

Maybe you’ve lost your taste for spice and sour, in which case it’s nice to go for something sweet. It definitely feels good on your tongue when you can’t taste or smell anything. Not to mention if your tongue is sore. A drizzle of maple syrup might do the trick, or a heaping spoonful of stewed fruit, or maybe both.

Whether you eat a vegetarian, omnivore, plant-based, Mediterranean, or even Atkins or Paleo diet, once in a great while a bowl of grains is the thing. Atkins and Paleo? Are you kidding me? Well, actually, no. Sometimes you have to trust your body, and if that’s the only thing you want, then grain is what it’s gonna be. Quinoa and buckwheat are relatively high in protein, by the way. And buckwheat, also called kasha, contains no wheat, if you’re interested in that kind of thing.

For cooking times for all kinds of grains, visit delectable planet.

I’ve been thinking about knife skills, not just what they are, but why they are. If you take a cooking class, the chef starts by teaching knife skills, so they must be important, right? But why?

Last week I learned, in passing conversation, that cutting foods into smaller pieces increases the amount of moisture available for tasting. Moisture turns out to be a vehicle that carries flavor molecules into your taste buds. So the more moisture, the more flavor. And that explains the appeal of my dad’s chopped salad; the relatively small pieces of lettuce, tomato, onion and other ingredients markedly increase the amount of flavor (and mixing of flavors!) released with every bite.

How does Chef Ira create that magic? With his knife.

So I watched a whole bunch of youtube videos on knife skills. I learned all about weight and balance, about chopping and dicing, and about protecting my fingers by making them into the shape of a spider that crawls backward along the celery stalk while the knife rocks back and forth to form uniform, bite-size pieces. I learned to peel half an onion in 1 second flat, to tell the stem from the root, and then to use that root to keep the onion together as I slice and dice.

I watched a few videos about mincing garlic. Henceforth, I will mince garlic in an imaginary quarter-circle area. Then, when the bits of garlic begin to stray from the 90 proscribed degrees of intention, I will use the back of the knife to draw them back together. At least I’ll try.

Why, then, are knife skills so valuable? Because we use them to increase flavor. Have you ever tasted something so good that you put down your fork and sat still, concentrating on the flavor and allowing it to run over your tongue, fill your mouth, satisfy your soul? On those happy occasions when this happens, I never find myself searching the kitchen cupboard afterward for a little bite of something extra. I am already thoroughly satisfied. Knife skills are everything.

“To see what is in front of one’s nose needs a constant struggle.”  George Orwell

Lately I’ve been thinking about the four major stripped carbohydrates as each having its own century or two. In my mind, corn starch/syrup belongs to the 20th century, rice to the 19th, wheat to the 18th, and sugar to the 17th (and 16th) centuries. One foodstuff at a time, humans figured out how to strip away the germ and the fibrous outer coat to increase shelf life, marketability, and profitability. I have nothing against capitalism, by the way, just not at the expense of our health. I am a physician, dedicated to preserving the health of my patients and my community.

Is it possible that we simply tipped the balance, previously straining, but not exceeding, our abilities to tolerate increasing amounts of stripped carb over several centuries, until we reached the 20th century and the amounts in our food supply skyrocketed with the introduction of high-fructose corn syrup? Perhaps. I do think that most of us can tolerate a small amount of stripped carb now and then. Especially if we are active.

Today I want to focus on sugar, the first product humans figured out how to strip. The sugar industry obtains its raw materials from three major sources: dates, beets, and sugar cane. Each of these is high in fiber; that’s how it’s found in nature. What must it have been like when, for the first time, large amounts of sugar began to be manufactured and distributed? Yes, small amounts were being produced in pockets of communities scattered around the world, but there had been nothing like it before, at least not in industrial doses. Previously, recipes for sweets would have used honey, or maple syrup, or mashed dates. Applesauce also comes to mind, or other mashed fruits. Small amounts, restricted to certain times of the year. But the concentrated sweetness of sugar revolutionized the way people cooked, ate their meals, drank their tea.

Turning to what I call “sweet n pink, sweet n blue, sweet n yellow,” and so on, I am concerned about the food industry’s heavy marketing of these alternative “artificial sweeteners.” If you’ve decided that sugar isn’t good for you, the food industry has a variety of alternatives at the ready, and it markets strenuously the message that artificial sweeteners are a great way to get your “sweet fix” without having to pay a price, metabolically speaking.

Yet, there is now research showing that more than two diet sodas per week were associated with an increased prevalence of diabetes and stroke. In one particular study, depression appeared actually to be caused by diet sodas in excess of four daily. We don’t have sufficient evidence yet to prove causality for diabetes and stroke, but I’m not going to stand in the middle of the highway waiting to find out.

Other recently published research showed a 20% rise in insulin levels on consuming sucralose, marketed as a splendid alternative to sugar. High insulin levels are the underlying cause of so many chronic diseases, including diabetes, hypertension, high cholesterol, obesity, arthritis, gall stones, fatty liver, and more. What else raises insulin levels? Stripped carbs, like white flour, white rice, corn syrup, corn starch, and, of course, sugar. Sweet n white?

Fish don’t know about the water in which they swim; it’s their world. Birds don’t see the air in which they fly; it’s simply their world. All over the world, humans are surrounded by a diet consisting of enormous amounts of items that we did not evolve to eat. Though we ourselves no longer see it, I’m absolutely certain that George and Martha Washington’s grandparents would have more than a few questions were they to find themselves, tomorrow, in the “food court” at my local mall.

So I ask you to consider: Was sugar the first artificial sweetener?