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.

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. 

——————————————————————————————————
Follow Dr Sukol on Twitter: www.twitter.com/RoxanneSukolMD
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

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!
——————————————————————————————————————–
Follow Dr Sukol on Twitter: www.twitter.com/RoxanneSukolMD
Follow Dr. Sukol on Facebook at Roxanne Breines Sukol.
Follow Your Health is on Your Plate on Facebook.

Even though today is the first of May, I woke up to 40 degrees and rain rain rain.  I’m glad that I went for a very long walk yesterday morning, when the sun was shining.  It’s true that the temperatures yesterday were a bit on the brisk side for the end of April, but I didn’t care.  I loved the sun shining on my face.

Sunshine makes it extra good, but it’s not a must-have when it comes to my walk.  I have a new strategy that I’m calling “get it while the gettin’s good.”  If it’s not pouring out, I’m going for a walk.  I have a raincoat.  I have rainboots.  I have a hat. So from now on I’m keeping my rain gear together, ready to go, hanging on the coat
tree by the door.  Farmers do it; and so can I.  When I was a little girl, we played outside in all kinds of weather.

I remember that when my now 24-year-old daughter was a child, she loved being outside in the rain.  From our living room window, I could see her outside on the driveway, stamping hard, over and over, in the puddles, for the sheer delight of feeling the water rise up around her and catch her inside a fleeting fountain.

I’ve noticed that they don’t cancel baseball games when there’s a threat of rain.  They start on schedule, and they play, and they keep on playing even when the water starts to drip off the fronts of the players’ baseball caps.  It’s only when the water starts to come down in sheets too heavy for the pitcher to see through that they finally call a delay.  A delay is really another way of saying that the field needs to be covered while they wait for the rain to let up enough to get back to it.  So I’ve decided that it’s time to take a page from professional baseball’s rule book.  If it’s not pouring, I’m going for a walk.  Rain makes a beautiful high-pitched rushing sound when you listen for it.

Now here’s the thing.  If the sun is shining, I’m still gonna get it while the gettin’s good.  No waiting ’til later in the afternoon after I’ve written my post.  No more finishing my cup of tea first, and one more row on the scarf I’m knitting.  When I see that the sun is shining, I am outside!  You hafta take advantage of the opportunity
when it comes.  You hafta strike when the iron is hot.  Opportunity favors the prepared.  Yea, all that stuff.  This is northeast Ohio, and the sun is not something to be taken for granted around here.

————————————————–

Now, to switch topics, a few months ago someone I work with decided to buy some cupcakes and bring them into the office.  Very nice — I think.  I’m sure she had the best intentions.  But this is a good example of the fact that we are going to have to take responsibility for what we put into our mouths, because if we don’t, no one else will.  I grabbed the mind-boggling ingredient list, and have been holding on to it to share with you:

Sugar, water, partially hydrogenated vegetable oil (soybean, palm, cottonseed, or canola), mono & diglycerides, TBHQ (preservative), enriched wheat flour, bleached flour.  Contains 2% or less of high fructose corn syrup, dextrose, glycerin, egg white slids, nonfat milk, soy flour, calcium acetate, sodium probaking powder, sodium pyrophosphate, sodium aluminum phosphate, calcium phosphate, cornstarch, modified food starch (corn, tapioca, wheat), salt, corn flour, propylene glcol, mono & diesters of fatty acids, agar, soy lecithin, polysorbate 60, guar gum, xanthan gum, invert sugar, natural and artificial flavor, maltodextrin, sodium stearoyl lactylate, glycerol esters, sorbic acid, citric acid, sodium benzoate, phosphoric acid, malic acid, microcrystalline cellulose, titanium dioxide, carrageenan, tragacan, hydrated silica, sorbitol, propylene glycol, confectioner’s glaze, cocoa processed with alkali, pectin, turmeric, hydroxyl methylcellulose, chocolate liquor, natural tocopherol, sodium stearate, caramel color, coconut oil, artificial colors (red 1, 3, 40; yellow 5, 6; blue 1,2), corn oil, sorbitan, mono and tristearate, egg yolk.

Holy mackerel, is this for real?!  Yes indeed, that was the actual list.  Have a cupcake?  No thank you, I think I’ll pass today.  Instead, I think I’ll go for a walk, head for the grocery store, and buy the ingredients to make some cupcakes.