The Low-Carb Diabetes Solution Cookbook (5 page)

Your body knows that high blood sugar is dangerous. If your blood sugar is elevated, so is your insulin, because your body is trying like heck to get rid of that sugar. This means that your body will always burn glucose before it gets around to burning fat for fuel. (This is how so many people got the mistaken idea that glucose is the primary fuel of the body.)

If you've been giving your body carbohydrate every few hours—cereal for breakfast, a doughnut on break, fries with your lunch, etc.—your body rarely gets around to burning fat. According to an article in the
Journal of Lipid Research
, insulin signals your body to reduce production of the enzyme needed to release fat from cells to be burned. Since you rarely use it, you make less of the stuff.

So when you stop eating carbs, your body may be confused for a few days—you're not giving it glucose, and it's having trouble releasing fat. You may be tired, achy, or have trouble concentrating. Do not panic. Do not give up. If you quit a two-pack-a-day cigarette habit and felt bad for a few days, would you assume it meant that giving up smoking was a bad idea? Same thing here. Your body
will
step up production of the enzymes needed to burn fat for fuel.

The
American Journal of Physiology
tells us that high insulin levels signal the kidneys to hang on to sodium, and with it water, even to the point of causing high blood pressure. When you go low carb and your insulin levels drop, your kidneys get the signal to let that sodium go, along with the water it holds. This is why most people drop several pounds of water weight in the first few days, and high blood pressure comes down quickly.

Because of this, it is possible to wind up with dehydration and low sodium levels, especially as you'll also be cutting out most high-sodium processed food. The symptoms of dehydration include light-headedness, fatigue, headaches, muscle aches, and possibly cramps.

It's easy to prevent this. Don't hesitate to use salt in cooking and at the table, and if you feel weak, dizzy, or achy, add a cup or two of bouillon or heavily salted broth per day. The salt and water in the bouillon will replace some of the salt and water that you have lost, and you'll feel better in just 10 minutes.

And remember: You cannot exercise your way out of a lousy diet.

Knowing this, it is no surprise that triglyceride levels drop, often precipitously, on a low-carbohydrate diet.

A 2014 study at Tulane University in New Orleans compared a low-carbohydrate diet with a low-fat diet in a yearlong trial. The low-carb dieters were to eat 40 grams or fewer of carbohydrate per day, while the low-fat dieters were told to get 30 percent or less of their calories from fat. What happened?

The low-carbohydrate group had greater improvements in HDL cholesterol and triglyceride levels, and in the ratio of total cholesterol to HDL. Their estimated ten-year heart disease risk declined.

But these were nonobese, nondiabetic subjects. What about people who are already ill?

A 2007 study of a ketogenic diet—very low carbohydrate and high fat—looked at the effects on both obese yet healthy subjects and obese subjects with high blood sugar. After fifty-six weeks, the study showed that total cholesterol, LDL, and triglycerides all showed a “significant decrease,” while HDL increased significantly. The researchers noted that these changes were actually more significant in subjects who started with high blood glucose.

The kicker? There were also reductions in blood sugar, along with body weight and body mass index.

But the implications are far wider. Low-carb, high-fat ketogenic diets, first used medically for diabetes control in 1797 by John Rollo, a Scottish military surgeon, and for seizure control in the early twentieth century, are showing promise for treating many health problems.

•
A study published in 2011 in the scientific journal
PLOS One
looked at the effects of a ketogenic diet on diabetic nephropathy—the most common cause of kidney failure—in diabetic mice. The result? Two months on a ketogenic diet actually reversed kidney damage. This has hitherto been virtually unheard of.

•
In August 2013, the
Clinical Journal of the American Society of Nephrology
published the results of a small human trial, again showing an improvement in kidney function in people with type 2 diabetes with nephropathy after twelve weeks on a ketogenic diet.

•
In 2012, in the journal
Nutrition
, Richard D. Feinman, M.D., and Eugene Fine, M.D., published groundbreaking work regarding the effectiveness of such diets in inhibiting cancer growth by reducing insulin signaling.

•
A 2014 article in
BioMed Research International
states: “[The] ketogenic diet is recognized as an effective treatment for pharmacoresistant epilepsy but emerging data suggests that ketogenic diets could be also useful in amyotrophic lateral sclerosis, Alzheimer, Parkinson's disease, and some mitochondriopathies [disorders of the mitochondria, the energy-producing power-houses of the cells].”

•
A 2014 article in the
Journal of Child Neurology
looked at the power of ketogenic diets to reduce pain, finding a long-term reduction in pain in rats. The article states that “many types of pain and painful or progressive conditions involve chronic inflammation” and “several mechanistic threads support the hypothesis that a ketogenic diet will reduce inflammation.” Because inflammation is implicated in many illnesses, from heart disease to cancer, this is exciting news.

•
In 2005,
Nutrition & Metabolism
published an article regarding a pilot study of a ketogenic diet for treatment of polycystic ovarian syndrome (PCOS), the leading cause of female infertility. The study found that the diet not only caused “significant” weight loss but also improved hormone balance and lowered fasting insulin.

•
In a 2010 interview for the Cureality blog, Michael Fox, M.D., a reproductive endocrinologist specializing in fertility problems, states, “We now recommend the VLCD [very low-carbohydrate diet] to all fertility patients and their spouses. The pregnancy rates do seem much better overall, as well as seeing a reduction in miscarriage rates.”

I
t's all well and good to tell you to eat 20 grams or fewer of carbohydrate per day. But what does that mean? What can you eat?

First, divide up those carbs: You're shooting for 5 grams per meal, plus 5 grams in a snack. Do not eat all 20 grams at one meal. Five grams will barely budge your blood sugar. Twenty all together will probably raise it.

Eat at least three meals per day. Feeling full helps you resist the junk food that crosses your path and prevents you from stressing your body, which can cause an adrenaline release that can raise your blood sugar.

The heart of your diet will be meat, fish, poultry, eggs, cheese, nonstarchy vegetables, and natural fats—those that come along with your protein foods, such as the fat on steaks or the skin on chicken, plus butter, olive oil, coconut oil, peanut oil, lard, tallow, chicken fat, and the like. Let's dolly in for a close-up.

•
These processed meats: Breakfast sausage, bacon, pepperoni, hot dogs, many cold cuts, and ham. These generally have a small quantity of sugar added. Read the labels and choose those with the lowest sugar content. There are hot dogs with 1 gram of carbohydrate and hot dogs with 4 grams of carbohydrate (same thing with ham). Choose the lowest carb brands you can find.

•
Poultry: Chicken, turkey, duck, Cornish game hen, or any other fowl. Again, if you have a hunter in the family, feel free to eat any game bird.

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Fish and shellfish: Any fish, including tuna, salmon, catfish, cod, flounder, sole, red snapper, mahimahi, bass, and trout, as well as shrimp,
scallops, crab, and lobster. Clams, oysters, and mussels have some naturally occurring carbohydrate in them, so choose them only occasionally.

•
Eggs: Whole eggs are permitted without restriction. Eat the yolks!

You will add to these core foods a couple of moderate portions of salad greens and/or nonstarchy vegetables per day.

Your choice of greens includes, but is not limited to: Arugula, bok choy, cabbage (all varieties), chard, chives, endive, greens (all varieties including beet, collards, mustard, and turnip), kale, lettuce (all var-ieties), parsley, spinach, radicchio, radishes, scallions, and watercress. If it is a leaf, you can eat it.

Nonstarchy vegetables include: Artichokes, asparagus, broccoli, Brussels sprouts, cauliflower, celery, cucumber, eggplant, green beans (string beans), jicama, leeks, mushrooms, okra, onions, peppers, pumpkin, shallots, snow peas, sprouts (bean and alfalfa), sugar-snap peas, summer squash, tomatoes, rhubarb, wax beans, zucchini.

Quantities of vegetables will vary a bit, since they contain differing quantities of carbohydrate. The recipes in this book take this into account. If you're simply making a salad, figure on 1 cup of loosely packed leaves; if you're having sautéed, roasted, or steamed vegetables, figure
1
/
2
to 1 cup of nonstarchy vegetables.

All fats and oils, even butter, are allowed. Olive oil and peanut oil are especially healthy oils and are encouraged in cooking. Natural fats that come with your food are allowed, along with coconut oil and lard (avoid hydrogenated lard).

Avoid margarine and other hydrogenated oils. It is best to minimize soy, corn, canola, and safflower oils. For salad dressings, use oil and vinegar, blue cheese, ranch, Caesar, or Italian. Avoid “lite” dressings, as these commonly have more carbohydrate. Chopped eggs, bacon, and grated cheese may also be included in salads.

Fats, in general, are important because they add flavor and make you feel full. Do not attempt to follow a low-fat diet!

It's common for people to refer to low-carbohydrate diets as “high protein,” but you are actually shooting for a low-carbohydrate/moderate-protein /high-fat diet. Fat should be what makes up the calories you've subtracted by cutting carbo-hydrates. Understand that natural fats are not just “not bad,” they're healthful. Eat the fat on your steaks and chops, egg yolks, and poultry skin. Feel free to eat delicious, fatty meats such as rib-eye steaks, spareribs, bacon, and duck. Fry or scramble your eggs in butter or bacon grease, sauté or roast your vegetables with plenty of fat, and be generous with olive oil on your salads.

If you choose one of the lower fat recipes in this book—one calling for, say, boneless, skinless chicken breast or a lean white fish—pair it with a higher-fat side dish.

•
Avocado: Up to one-half Hass avocado (the little pebbly-skinned black ones) per day. This is the one exception to the only-5-grams-at-a-time rule. Half a Hass avocado will have about 7 grams of
carbohydrate, but they are so healthful—loaded with good fats, fiber, and potassium—and so satisfying, that we encourage you to eat them.

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Cheese: Up to 4 ounces (115 g) per day of cheeses such as Swiss, Cheddar, Brie, Camembert, blue cheese, mozzarella, and Gruyère. Also cream cheese and goat cheeses. Check the carbohydrate counts.

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Cream: Up to 3 tablespoons (45 ml) per day of heavy cream or sour cream.

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Mayonnaise

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Olives: Black or green, up to 10 per day.

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Pickles: Dill or sugar-free, up to 2 per day.

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Soy sauce: Up to 2 tablespoons (28 ml) a day.

After the second week you may add up to 1 ounce (28 g) per day of walnuts, pecans, Brazil nuts, pine nuts, or macadamias.

Allowable seasonings include:

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All individual spices and herbs

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Spice blends that contain no sugar; a dismaying number of them do, so read the labels.

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Horseradish: Read the labels and choose one with no sugar.

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Lemon and lime juice

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Mustard: Dijon, spicy brown, or yellow mustard. (No honey mustard, and check the labels on other mustards.)

Do not use ketchup (although eating 1 or 2 tablespoons (15 to 28 g) of Heinz Reduced Sugar Ketchup per day is allowed), steak sauce, barbecue sauce, or cocktail sauce.

Food may be baked, boiled, stir-fried, sautéed, roasted, fried (with no flour, breading, or cornmeal), grilled, or microwaved.

As mentioned, some people become dehydrated in the first few weeks of eating low carb and need extra sodium. Unless directed otherwise by your physician, you can have bouillon or broth with extra salt stirred in up to twice a day as needed during the first few weeks of the diet to minimize headache or fatigue. If you're tired, achy, or dizzy, this is the first thing to try.

Starches are complex carbohydrates that break down into sugars. Avoid: Grains (even whole grains), rice, cereals, flour and flour-containing items, cornstarch, breads, pastas, muffins, bagels, crackers, starchy vegetables such as legumes (pinto, lima, black beans, etc.), carrots, parsnips, corn, peas, potatoes, french fries, and potato chips etc.

Check the labels of liquid medications, cough syrups, cough drops, and other over-the-counter medications that may contain sugar. Most pharmacies carry “diabetic cough syrup” and cold-and-flu relief products in capsule, rather than liquid, form.

Avoid products that are labeled “Great for Low-Carb Diets!” and ignore “net carb counts.” It's astonishing the garbage food processors try to rationalize.

Become an obsessive label reader. It is often bewildering the places sugar sneaks in. I once made the mistake of buying canned clams without reading the label, only to notice later they had added sugar. Who put sugar in the clams?

However, if a food is not on the HEAL Protocol, it is out. Completely out.

On low-calorie diets, people are always making deals—“I'll skip 300 calories at lunch so I can have cake at the party later.” This kind of deal does not work. No matter what healthy food you skip, that cake is going to jack your blood sugar through the roof. You'll be knocked out of ketosis—hunger renewed, back to addiction and craving—and it will take you the better part of a week to get back in the happy biochemical state where your hunger and cravings are suppressed and your blood sugar is rock-steady.

Just accept it: There is no way to play games with this nutritional protocol. There is no cheating. The word “cheat” implies that you'll get away with something, and you never will. Your body will know.

However, if you do deviate from your plan, get right back on the wagon with the next meal or snack. Do not decide, “I blew it at lunch, I may as well go ahead and have ice cream.” Remember, every excess glucose molecule does damage. Ask yourself: If you stumbled on the top step, would you throw yourself down the stairs?

Ask yourself: If you quit a two-pack-a-day cigarette habit, would you expect to be able to have just a couple on the weekend? If an alcoholic friend sobered up, would you tell him he was too rigid, and he should be able to have a glass or two of wine at a holiday dinner?

You're overcoming a serious, dangerous health issue, as deadly as smoking or alcoholism. Ignore those who would make light of it. It's not their feet, eyes, or kidneys at risk.

The most basic HEAL meal is an animal protein food—meat, poultry, fish, or eggs—cooked without added carbohydrate and paired with a nonstarchy vegetable. For instance:

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Broiled steak with sautéed mushrooms

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Roast chicken with asparagus and lemon butter

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Grilled salmon fillet with a green salad

But there are recipes in this book for meat, poultry, fish, or eggs combined with vegetables or seasonings that add as much as 5 grams of carbohydrate. Those you will have to eat solo. There are also recipes that have fewer than 5 grams. We are confident that you can add, and combine—or not combine—these dishes to wind up with 5 grams per meal.

It's pretty simple. With the personal motto “I feed people, therefore I am,” I have devised many menus that have allowed me to stick to my plan while making guests happy. The trick is to serve the starch separately. Look at those menus above. You can add baked potatoes to the steak with sautéed mushrooms, brown rice to the roast chicken with asparagus and lemon butter, or a few ears of grilled sweet corn along with the salmon. One word of advice: Don't choose your favorites. If you find rice boring but french fries irresistible, serve rice.

Look out for mixed dishes. If the family wants pasta, don't serve lasagna. Instead, make bread crumb–free meatballs, spaghetti, and no-sugar-added sauce, plus a salad with Italian vinaigrette. The family has spaghetti and meatballs and you have meatballs and a bit of sauce, with plenty of Parmesan cheese and salad on the side.

Do share your favorite low-carb dishes with your loved ones. Remember that your children share your DNA, and with it your risk of developing diabetes. The more you can encourage them to enjoy a healthy sugar-and-starch-free diet, the healthier they will be later in life. Some of the happiest emails I get are from parents telling me their children love my recipes.

Next Step recipes include ingredients that are not allowed in the early intervention stage of your recovery from diabetes. Usually they are ingredients that include some sugar—Worcestershire sauce, for instance—or fruit products, such as no-sugar-added preserves. These ingredients are used judiciously, of course, keeping within our 5-gram carb limit.