Some time ago it came time for us to replace our 300-foot-long driveway, so we hired some able-bodied cement guys.  They put a date on the calendar for the following spring, and we waited patiently until the next May came around.  When it did, they showed up one day and ripped out the old driveway, fully intending, of course, to replace it in the days ahead.  Alas, as my grandmother used to say, “Menschen tracht und Gott lacht.” That means people plan and God laughs.

I could start a long explanation here about how the original driveway’s footprint veered unexpectedly close to a property line, but I would prefer not to go into it.  So let’s just say there were technical difficulties.

And that is how I found myself parking out on the street for the better part of three months, while we gathered the necessary information, and then waited through the dog days of summer, to allow the city to make the ruling that would allow us, finally, to replace, in August, our exceedingly long driveway.

Although I often find things amusing that other people might not, this was not one of them.  In retrospect, keeping the wheelbarrow parked by the street for groceries and the like now seems pretty funny.  But it did not feel very amusing at the time.

But here’s something that did interest me:  Within a couple of weeks, my pants were fitting a little more loosely.  Now as you’ve certainly already discerned, we have a very long driveway, at least in comparison to all the other homes on our suburban street.  But it’s not like we’re set back a mile or anything.  Even still, just being required to walk that extra 300 feet 2-4 times a day more than previously was obviously enough to make a difference in my physique.  [Not a word I usually use when speaking about myself.]  Believe you me, it wasn’t much more than that either, because I made it my business to be very efficient about the number of trips I had to make to get out to my car that summer!

I believe that I may have written on this theme before.  It goes by other names, such as “the excellent is the enemy of the good,” or “every little bit helps,” or “every little bit counts,” or “you don’t have to do everything right, just pick the first right thing,” or “whatever you do, please just stop drinking soda/pop,” or “can I talk you into eating a high-protein breakfast instead of that candy they call breakfast cereal?” or “what do we have to do to get kids walking or riding bikes to school again?,” and so on.  Just pick one thing — it’s a great way to start.

No one was more surprised than me to discover that just a few more steps a day made a real, measurable difference in how my clothing fit.  So if you’re not up to walking 10,000 steps a day, I can understand.  But try answering this:  how many steps can you take?  More importantly, how many steps can you add to your current usual daily number?  Can you add 300?  600?  That works for me.  And it will work for you.  Promise.

In each of the past three weeks, I have been delighted to find garlic
scapes in the weekly box of produce I receive from the CSA
(community-supported agriculture) I joined this year.  Because those firm,
green, curly-cues of flavor come only once a year, and then they’re
gone, this is the time to enjoy them!  As I’ve said before about
belonging to a CSA, I appreciate the zucchini, onions, and tomatoes, but
I adore the kohlrabi, Swiss chard, chamomile (jam it into a small mug
and pour boiling water over it) and the things whose names I learned
only recently.  Like garlic scapes.

You may be one of those people who is asking right now, “What exactly are garlic scapes?” Here is what I’ve learned:

Garlic and its Allium family relatives (leeks, chives, scallions,
onions) begin their underground lives as soft bulbs. As garlic bulbs
harden, a shoot rises up and curls above the ground.  This shoot,or
flower stalk, is called the scape, and I read that it appears only on
the finest hardneck varieties of garlic.  If left unattended, the scape
eventually straightens, hardens and turns the opaque white/beige color
of a garlic peel.  That’s the status of several garlic scapes in my
garden currently.  Oh well, better luck next year.  As the scape absorbs
its share of energy from the plant, it also prevents the garlic bulb
from growing large and fragrant.  So farmers harvest the scape in full
curl, before it straightens, when it is still tender and delicious.

Here are a few ideas for what to do with garlic scapes.  You can 1)
grill them like asparagus; 2) chop them up and add them to eggs,
vegetables, salad, rice, pasta or a stir-fry; 3) cut them to green bean
size, saute them in butter and salt for 6-8 minutes, and add a teaspoon
of balsamic vinegar the last minute of cooking; or 4) make garlic scape
pesto.  Toss pieces of 4-8 raw garlic scapes into a food processor.  Add
grated parmesan cheese and walnuts, toasted if you’d like.  Use pumpkin
seeds if you don’t eat nuts.  Pour in 1/4 cup olive oil, 2 tablespoons
lemon juice, some salt and pepper, and give it a spin —> voila,
garlic scape pesto!  Spread pesto on toast, add it to pasta, or place a
tablespoonful in a little ramekin with a raw egg (cracked open, no
shell).  Bake in the toaster oven at 350 for 10-12 minutes.  The flavor
of this simple recipe is so heavenly that if you make it for breakfast,
it will put a glow on the rest of your day.

Yesterday I fried a full bunch each of approximately 10 garlic scapes
and 10 scallions in some olive oil until they were starting to turn a
bit brown around the edges.  I added a bunch of kale [rinsed, leaves
sliced from the rib, and then sliced again into thin strips].  My co-cook
stirred it around a bit until all the leaves were bright green and
shiny.  We sprinkled in some hot curry powder for flavor, just two
shakes, plus a few generous shakes each of salt and pepper.  Then we
poured in 10 scrambled eggs, put the cover on the frying pan, and turned
down the heat.  The first time I checked, the eggs were still wet, but
when I checked it again in after about 15-18 total minutes of cooking, it looked perfect.  I
turned off the heat and left it to sit a few minutes to absorb the kale
liquid, and then served it in slices, straight from the pan.  Leftovers went into the refrigerator to be eaten later, cold.

I’m captivated by the mythical plant creation that Barbara Kingsolver
calls the “vegetannual.”  Kingsolver’s vegetannual is what a single
plant would look like if that single plant were a representation of the
entire cycle of germination, growth, and ripening through which a garden travels from early
spring to the end of the growing season.  It’s real life, producing
all food in its proper season, in its own time.  Like all gifts from
the garden, garlic scapes have their own season, so get some now if you
have the chance.

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.