Diabetes Mine - the all things diabetes blog

Suddenly Celiac

Back in 2003, when I was diagnosed, nobody seemed to know anything much about the connection between Type 1 diabetes and celiac disease.  Or at least it wasn't mainstream, certainly not for my doctors at the time.  Celiac is of course and intolerance to gluten, a composite of proteins contained in wheat, rye and barley.  Having it therefore means eating no foods that contain those grains.  Picture that!

But my point was that suddenly, I seem to see the topic of diabetes & celiac popping up all over.  I was amazed to find an article in this month's edition of Diabetes Forecast, called "A Tricky Diagnosis: Why You Should Learn About Celiac Disease" that explains the classic and atypical versions of this disorder:

* Classic = nasty gastrointestinal (GI) problems when you eat gluten

* Atypical = mild or no GI symptoms, but a skin rash (dermatitis herpatiformis - yikes) that can appear on your face, elbows, knees or tush

The article notes that the latter may in fact be the more common presentation. And they cleverly note: "Because grains find their way into all kinds of products, always read labels on foods, over-the-counter medicines, and supplements. Ask your doctor about the ingredients in prescribed medicines."

Well yes, I had to learn all of this the hard way.  Like when we stopped at the drug store for some allergy pills, and later my lip swelled up like a ubangi.  That was a nice look at Disneyland, I'll tell you.

If you are in this boat, see this nice new Boston Globe piece about how to find gluten-free products. If you're in Europe, it might cheer you to know that a new 2,230-meter factory has just been opened in Wales to pump out gluten-free goods.  In Seattle, "Gluten-Free Girl" Shauna James is doing great things with rice and corn pastas. Personally, I prefer Quinoa. It's not so heavy and dry.  But if you happen to have diabetes as well as celiac, you will REALLY want to watch the pasta, anyway; it's carb-noxious.

Here's a list of research on the connection between celiac and diabetes, including one study indicating that the disorder was discovered in 12.3% of children with Type 1 diabetes.  New research on "the double life of proteins" may help scientists understand this all better.

Meanwhile, you are not alone.  Mark your calendar for May 28, when DiabetesTalkFest will be hosting a chat with Catherine Oddenino, editor of "A Gluten-Free Guide."  This woman knows what she's talking about, because she's not only an expert in gluten-free gourmet, but she also manages her Type 1 diabetes with an insulin pump.

"Mystery Carbs" Question of the Day

We like to think we've got a handle on this carb-counting thing.  But the truth is, most of us have very little clue -- not least because nutrition labels on packaged products are so darn confusing. One of our beta testers over at the new community recently posted this query:

When I'm counting carbs I often read the "category" of carbs that are in the food I'm eating (i.e. Dietary Fiber, Sugar, Other Carbohydrates, etc.). I have noticed that often they don't quite add up to the Total Carbohydrate amount.

Maybe this is a stupid question with an obvious answer but:

Does anyone know what these "mystery carbs" are or where they come from?

Not a stupid question at all. I couldn't answer it off-hand.  Why are we consuming more carbs than appears necessary or possible based on the corresponding food data?  For some insight, I turned to local San Francisco nutrition expert Norae Ferrara.  Of course, nothing is simple with diabetes.  The answer was much more than I bargained for. Here's what this food whiz had to say:

Label reading can be tricky because the original purpose which is to provide accurate, useful, information is also clouded by marketing strategies of most companies who may add more information than is required, or practice "rounding" of values to emphasize or de-emphasize certain components.

 

To further explain:

 

Definition of Carbohydrates

Carbohydrates are made up of: 1) Complex Carbohydrates, 2) Simple sugars (or sugar), and 3) Dietary fiber (sometimes separated into soluble and insoluble on the label)

 

Required Labeling of Carbohydrates in the US:

United States Federal Law requires that companies state on the nutrition facts label the total grams of carbohydrates, dietary fiber, and sugars. This makes listing the content of complex carbohydrates as optional, which in most cases, will make up for the difference between total carbohydrate, and the sum of dietary fiber and sugars.

 

A truly complete label for a breakfast cereal might look like this (remember, each time a component is listed as a subgroup--underneath and indented to the right--it means that it is included in the total listed above):

 

Total Carbohydrate 24g

      Dietary Fiber 3g

        Soluble Fiber 1g

        Insoluble Fiber 2g

      Sugars 10g

      Other Carbohydrate 11g

 

While the more common food label will list only what is required, for example the same product might also be listed as:

 

Total Carbohydrate 24g

      Dietary Fiber 3g

      Sugars 10g

 

Rounding:
Companies may choose to round up or down to the nearest .5g. They may choose to round .3g fiber up to .5g, or just call it "less than 1g", when it is a desired component, or they may choose to round .3g sugar to 0g, for example, when the component is not highly desirable.

 

That sounds pretty sneaky to me.  Might be OK for enticing dieters to eat their products, but a veritable nightmare for anyone attempting to dose insulin based on that information.  No wonder I manage to make frequent "mistakes" even when I'm eating neatly labeled foods.  I know what you're thinking: don't trust the packaging, learn to estimate carbs yourself -- within a fraction of .5g.  Correct.  Great strategy.  But it seems like that could take a lifetime, and a lot patience that I do not possess.   *Sigh*
   

Teaching Patients to Carb-Count

I always find it fascinating to have a window into diabetes "from the other side" -- i.e. what doctors and healthcare providers are doing and talking about.  Something that caught my eye in the latest issue of the AADE's journal, The Diabetes Educator: a new 10-step guide to teaching carbohydrate counting, called (oh so cleverly!) C-O-U-N-T C-A-R-B-S.

It's apparently a program to help nurses teach diabetes patients diet tactics with more confidence, which is "shown to produce better behavioral outcomes that the didactic strategies commonly used in hospitals at present."  Well, that sounds good.

Staff nurses are first encouraged to explore each patient's "individual medical and motivational factors."   Right, no one size fits all!

Then -- after a number of other preliminaries -- they are encouraged to implement the following steps, based on Gray's evidence-based teaching strategy.  Here are the 10 steps in shorthand:

1) Create a typical meal. The nurse is supposed to talk through the details of an ordinary meal the patient eats on a regular basis, including sauces, condiments, and beverages.

2) Offer information.  Here the nurse defines carbohydrate, and explains which foods from the previous step contain them.

3) Use food lists and labels.  A quick lesson in reading food packaging labels, including paying close attention to Serving Size, and the idea of 15-carb "units." 

4) Now it's {the patient's} turn.  The patient is next asked to try to estimate the total carb value of their typical meal in Step 1.

5) Take time.  I quote: "Answer questions and provide clarification and performance feedback. (This step could last several days for many of us :)

6) Compare patient choices to written dietitian recommendations. The nurse is encouraged to be constructive and focus on the positive.  (As in, "I see you enjoy your tortilla chips...")

7) Adjust meal. Talk about ways to alter meal choices based on dietitian recommendations.  Here's where the nurse can use "visualization" for portion sizes, etc.  I'm guessing they mean those plastic chicken legs and such.

8) Recalculate, record, reinforce. (Sound like a contest entry?) The patient gets to recalculate their initial meal as a sample entry in a food diary.  The nurse demonstrates how to record BG readings and insulin doses.  Learning is reinforced using "case scenarios."

9) Bolus. I guess they're actually practicing eating the meal at this point, 'cause the nurse is supposed to assist with administering an appropriate bolus.

10) Support learning.  The nurse is supposed to provide resources for the patient to consult later on, like web sites, support groups, and customized food lists based on the patient's preferences. (Man, I need a list like that!)

So, my question is... how did you learn to carb-count?  Did the person who taught you use anything like the method above?  If you're like me, do you sort of "have it down" now and yet still feel like you're just eeking by most of the time?

Protein, Carbs, Whatever...

Sometimes you just don't know what spikes your blood sugar.  So you've been a "good diabetic" and gone low-carb and high protein all week long, and you're STILL running over 180 too much of the time?  Aaack!

As I was complaining about this lately, a number of commenters jumped in to point out that some of the protein we eat gets converted to glucose as well.  Turns out this is correct, but with a number of caveats, that make it unlikely to be the cause of an SUS (sudden unexplained {blood glucose} surge).

In particular:

* protein can convert to carbs in your system through a process called called gluconeogenesis. This takes place in your liver, and to a smaller extent, in your kidneys, I've read.  But this process is generally kicked off only in extreme cases of glucose debt, such as during fasting, starvation, or intense, prolonged exercise (none of those would be me)

* according to blogger/diet expert Jimmy Moore, people on extreme low-carb diets do experience BG spikes for just this reason.  "If protein is consumed in excess of energy needs, then some of that extra glucose that is created by the liver through the breakdown of protein can indeed lead to the same kind of spike in blood sugar as eating a slice of white bread or white sugar would," he tells me.

* but it takes much more protein (in terms of grams) to raise your blood sugar than it does carbs. I really don't eat THAT much protein, in terms of pure volume of food...

* and if you eat protein along with carbs (as I typically do), the GI impact of those carbs is reduced by the slower-absorbing protein.  So why should I spike so much after just a few mostly-protein meals?

* sometimes the fat's at fault. "For example, if you ate pizza the previous night.  The fat causes a delayed rise in glucose that could last until the next day, yes," my co-author Dr. Jackson tells me.  That seems like an awfully long lag time!

OK, so I get it: "A high-fat diet, in the absence of carbohydrates, typically results in weight loss. Yet your blood glucose does not drop too low, because your liver continues to convert some of the dietary protein into glucose."  But since my diet is not consistently low-carb/high fat, and I'm bolusing painstakingly what feels like 14x/day, what is UP with the highs?  I know I should be more consistent with my meals, but what's a busy and active PWD to do out in the Real World?

Some sensible advice: 

"Opt for a healthy ratio of 30% protein, 15% fat, and 55% complex carbohydrates."  Because too much protein may affect your kidneys.  (Authorities claim there is simply not enough information about the long-term effects of a high-protein diet.)

Man, all this data is creating some diet anxiety over here.  As usual, Dr. J had a nice way of bringing the whole discussion down to Earth: "Just think about it in a food sense, think about meals with a little bit of each type of food.  You eat the calories, your body makes glucose, and that's the energy you run on."

"Yes," I replied.  "That sounds simple -- if I just didn't need to dose for every gram of carb!!"

Meet Ranae Whitmore: "Heartgirl" Who Transformed Her Life

Attention, please: This lady knows how it's done.  If you don't think you can lose weight, get healthy, and turn your life around, read this...

I met Ranae Whitmore at the recent Health 2.0 conference.  She was there because she is an example of the most amazing Health 2.0 success story you can imagine.  In the last 20 months, this 52-year-old Red Cross employee from Iowa managed to transform herself from morbidly obese and dejected to a healthy weight and healthy attitude using an array of online tools and communities.  She's lost 140 pounds and is well on her way to losing the last 30 she wants off, plus she's now dedicated herself to helping others find the connection to Web-based tools, support and friendship that made the difference in her life.

Ranae, a most sweet and intelligent lady, talked with me at length about her epiphany and where it's leading her:

DM) Where you always heavy, or how did you get to that extreme place?

When I was younger, I weighed more than the other kids.  I got teased about it, so then it becomes kind of a self-fulfilling prophecy.  After I had my daughter (who's now 31), a lot more weight came on.  In hindsight, there were a lot of emotional issues I wasn't dealing with.  I was just eating them.  As I 'didn't deal,' my weight eventually came up to 330 pounds. I'm 5'6".

DM) Did you just not realize...?

Oh, I knew. I came from a medical background -- I used to run the front-office of a doctor's practice -- so I knew all the risks.  I knew I could get diabetes, heart disease, and much more. I even developed asthma symptoms, which the doctors said were not related to my weight, but they were.  I just couldn't get myself to do what I needed to do.

I wasn't very mobile.  Taking the stairs was a major project. Imagine picking up another human being and carrying them around with you all the time.  That's what I was essentially doing.

DM) Was that the impetus to take charge and make a change?

No. It took the kindness of a stranger.  At the time I was working for Maytag, which was going through a difficult merger with Whirlpool.  I was working with this gentleman in another state over email and phone calls.  He really validated my work, and me as a person.  He stood up for me when things got tough.  He made me see myself through his eyes.  And I thought, "If a stranger can show me this integrity and caring, I should do that for myself, too.  It's time to start taking care of me."

To this day, I haven't met the man in person, but he changed my life.

DM) So how did you get involved with all the websites?

Actually, it started with email.  I created an email network of friends and supporters.  Then I started searching for calorie counting sites, recipe sites, exercise sites, and the like.  At one point, after I'd already lost 110 pounds, I hit a bad place.  I'd started binging and purging.  I knew I couldn't go back, but I also felt powerless to go forward.  The old behaviors started popping up, but I just couldn't return to that place.  One day I just started searching for "support," or something like that, and I stumbled into DailyStrength.org.  It was the best decision I've ever made.

DM) Wait, you mean you lost all that weight even before discovering the community sites for support?  How did you do it?

I'd tried all the diet programs; I knew all the right things to do, just like most people who are extremely overweight.  But it finally became really clear to me that what you eat minus what you expend equals your body size.  It's simple physics.

I bought a scale and started weighing and measuring everything. I cut out the junk food and focused on fruits, vegetables, whole grains, and lean meats. Heavy on the protein, which helps you feel full longer.  I put signs on my cupboards that said, "STOP: are you REALLY hungry?"  A lot of times I wasn't. Eating was just an emotional outlet. I'd just grab something and throw it in my mouth.

I stared writing down everything I ate -- boy, that was eye-opening!  And I researched restaurants online before we went out, so I knew what I could order. (I always ask for a box right away and put half the portion out of sight before I start.)

For exercise, I started with walking, which is easiest, and then I used home aerobics videos. Later I finally got over my fear of being so fat -- of having people make fun -- and I joined a gym. I started using the treadmill and weights.  I figured if they wanted to laugh at what I was doing, taking care of myself, then let them laugh.

DM) So you hit this crisis point, and then you found the Social Media sites?

I'd say the support community is crucial. They helped me through that rough spot, and they've kept me motivated and going even on the worst days, when I want to pull my hair out.

A group of us got together and started organizing weight-loss challenges.  For that we used Yahoo Groups and a site called SquareSpace, where we could post goals and our daily progress. For the first one I was a team captain.  We had five teams of 10-11 people each, from all over the country.  I also met a new friend who lives in London, and we talk almost every day now.

The latest weight-loss challenge was leading up to Valentine's Day. We got a group together and used Skype for our calls about organizing the challenge.  That was also about 50-60 people. We use DailyStrength a lot, where I'm known as "Heartgirl."  The anonymity was important, since at the time I didn't feel like broadcasting my problems to the entire world.

DM) So what does life look like for you going forward?

I'm now at 193 lbs, and my goal is 174.  I used several height-weight charts to figure out my ideal weight.  I'd like to reach out and help others change their lives this way, too.  This is an issue that hits people across the board -- young, old, big, small, different backgrounds.  But you have to feel that you are worth it, that you are valuable.  It's also so important to be in contact with other people who can validate your issues and cheer you on.  That's what I'd like to do with my life.

NOTE: See Ranae in the Glamour blog this month (!)  She does not have the 'betes, btw, but is thinking of starting her own weight-loss blog, and getting involved in online communities in some more formal way.  Got questions for her?  Or ideas?  Please feel free to post them below.

Eat Your Greens

They keep telling us we should eat lots of veggies and fruit.  Obviously, veggies are better -- if you don't want to spike your blood sugar, that is (D'OH).  Well, I don't eat nearly as many servings of greens per day as I ought to.  And don't pretend you do, either. 

So what are our options then?  Disguise the stuff?  No, I mean like the celebs do, hiding them inside other foods that seem more appealing?  Maybe.  Or maybe try liquidating the stuff into a smoothie with a little zing.  Here's a recipe that some very health-conscious friends passed on:

Mainly spinach (3/4) then add the following:
One apple (cut it up before you put it in the blender or it’s a disaster)
Tablespoon of raw chopped ginger
Parsley (usually lots)
Cucumber (half of a hot house or English cucumber)
Lemon Juice (use half a lemon and squeeze it in)
Celery (not much of this or it’s difficult to blend)
Bell Peppers (totally optional, they say -- personally I can't digest the suckers)

Blend until smooth on high – It’s best if the veggies are cold...
"The apple, ginger and lemon really make it taste great," my friends claimed.

Here's me attempting to make the stuff:

Ingredients - check!

Stuff into blender - check!  (Wow, that's full)

Produce extremely green drink - check!

Drink despite the disgusted looks on children's faces, and despite husband's remark that it looks like some Frog [Byproduct] - check!

Really, it wasn't half bad after all.

I wanted to note that I also tried Mollyjade's suggested vegetable dip, made by mixing peanut butter, soy sauce, chili sauce, and garlic powder.  Chili-flavored peanut butter.  Strange.  A little like you'd imagine the "PB Special" at El Torito Mexican restaurant.  In other words, the jury's still out on that one -- especially since my BG level shot up after I presumably under-dosed for this concoction.  But worth a try just the same.  I think I'll spring it on my next Book Club meeting at our place, just to test whether it motivates people to eat their raw greens  :)

Food: the Final Frontier

Last weekend we were hiking with some friends -- former colleagues actually, who haven't seen us in a long time.  Hoping to make it a "diabetes-free day," I tried to give the woman an ultra-quick synopsis of what I'm doing these days. 

"A diabetes blog?  So you write about diet? "

"Well no, hardly ever, actually."

"What?  It's not about food?  I would have thought that would have been the central theme," she said.

Eggads...  well, it isn't.  And of course, it is. 

If it weren't for the complex make-up of stinkin' food, and the fact that we can't live without the stuff, this disease wouldn't be half so hard to manage. 

I'm no certified dietitian, so I have no business telling anybody what they should eat. 

But tips?  Personal experiences?  Well sure, I guess I could delve into those a lot more.  I've been lucky that I'm not trying to lose weight in the last few years, but even weight maintenance has become a major challenge since hitting the Big 4-0. 

A few things I've learned / discovered of late:

* Oatmeal is not the anti-Christ.  Sorry for the term, but I kind of thought delicious, lumpy, carb-packed oatmeal was the devil's work for diabetics.  I have discovered that Quaker's regular quick-cooking oats, along with several brands of instant oatmeal, are far less carby than you'd imagine.  And yummy and filling too.  Some people even lose weight on this stuff.  Hallelujah!

* I'm trying to skip the cheese and munch on veggies and dip instead for snacks of late.  I finally seem to have found a dip that's both tasty AND low-carb AND low-fat. Anyone tried Trader Joe's Cilantro & Chive Yogurt Dip yet?  Yum.

* Mark's Daily Apple runs a series called "Healthy Tastes Great!" that has awesome tips and recipes, with lots of snarky asides.  Just my style!  I'm not sure I've ever mentioned that I love to cook.  I friend recently recommended the Silver Palate cookbooks.  You can get some of their recipes online HERE.

* Like many of you, I've got this peanut butter addiction.  I try to avoid it, but with 3 kids in the house, that's tough.  Of course, some people will tell you it's the ultimate low-carb snack.  But lo and behold, those carbs add up.  And it's @#$! high-fat, too.  Low-carb King Jimmy Moore recommends "Naturally More" peanut butter -- with fewer carbs, less fat, and more fiber and protein than the regular stuff.  Oooh, I so need to try this!

What else is new on the diabetes-friendly food front?  Care to share your favorite sites or snacks?

[Editor's Note: Keep it real, please; commercial product solicitations will be promptly removed]

Straight Talk on Diet from a Blog Authority

Anyone here read the Diet-Blog?  I am normally VERY skeptical of web sites covering anything-diet, I must say, but this one is not only extremely popular, but quite level-headed as well.  Lots and lots of valuable info on new foods, diet plans, fitness issues, lose-weight-fast scams, body image, diet pills, fast food, and more.  In short, everything you could ever want to know about all that.

I caught up with editor Jim Foster recently for a "brain dump" over here at DiabetesMine.com.  Jim claims he's not an expert -- rather just an "Average Joe" trying to stay reasonably fit and healthy -- who calls on the collective knowledge of his editorial team.  Still, he's garnered quite some kudos for his work at the Diet-Blog, "filtering the best of diet news and advice — and combining it with real-world application and opinion."  Have a look at what he has to say:

Jim, how would you describe your overall "diet philosophy"?

Nutrition is individualistic. What works for me may not work for you. As a simple rule of thumb, I believe we should favor whole foods over highly processed foods.  We have weight problems because we eat too much -- but in our defense -- we are surrounded by an abundant food supply mostly comprised of foods that are very easy to overeat!

Give us a sense of your approach to carbs: good carbs, bad carbs, low carbs, no carbs?

Carbohydrate-based foods are cheap. Next time your are eating at a "large-portioned" restaurant -- look at what fills your plate. Highly refined carbs are easy to overeat and often lack the satiety of certain fats and proteins. Recent data has shown that sweetened soft drinks contribute 10% of all calories in the American diet.

So, having said this, I feel we tend to eat too many refined carbs and sugars. However, nutritional advice for the last few decades has focused exclusively on fat. Someone forgot to mention that we also need to moderate carbohydrate intake.

As for heavily restricting carbs, I believe there is a place for it in certain situations. And rather than being a target for derision -- a controlled-carb approach needs to be offered as an option -- particularly to those with any blood sugar issues.

I have my own experiences with this: I struggled with hypoglycemia for years. A nutritionist advised that I needed to be snacking and grazing more throughout the day. The suggested snacks were all carbohydrate-based foods. My symptoms persisted until I began to include a strong protein component in my snacks. Now the glucose wasn't hitting my body in a rush, and it helped to balance out the wild blood sugar swings.

The "eatwell plate" you featured from the UK food authorities seems to recommend a very large proportion of carbs. Are you on board with that?

I'm not out to antagonize public health authorities - however I feel we as consumers don't need any encouragement to eat more carbs. If anything we need more education on the different kinds of carbohydrates - and the impact on satiety.

Do you have a party line on exercise?  Which type and how much is best?

Again -- whatever works for you. I believe exercise is essential for good physical and mental health, although I suspect at times we tend to overstate the effect of exercise on weight loss.  We also tend to focus on a narrow style of exercising (think 60 minutes on a treadmill, or a "bodybuilder-type" workout consisting of 3 sets of 8-10 reps performed slowly). There is an astonishing variation of exercise technique out there. Mixing it up a little can help keep the boredom away. See HERE.

The Diet-Blog claims to sort out the "big fat lies" in food/fitness marketing from the good stuff.  What is your method for evaluating new products and diet plans?

I don't know about sorting out the big fat lies… :-) but there is plenty of murky misinformation out there.  The advertising budget of a single food manufacturer probably impacts more people than any well-meaning government or NGO initiative.  As consumers we need to constantly challenge the beliefs that we have about food and weight.  In terms of products and diets, myself and the other writers just try to present both the pros and cons and leave it up to the reader to discuss and decide. That's why blogging is such a great platform for these sorts of issues.  It's an ongoing conversation. Many times I or one of the writers have made a misstep with one of our posts, and the readers will quickly put it right by chiming in with their point-of-view in the comments section.

You talk a lot about body image on the blog. What's your basic philosophy on that?

Turn on the TV: what sort of people do you see?  Mostly very thin ones. Look at the statistics: what do you see?  Over 65% of Americans are overweight.  We have a strange paradox at work here. Popular culture is obsessed with being slim and yet most of us are anything but.  That would imply that there are an awful lot of people who feel they fail to live up to the kind of physical image that society prescribes.

When self-esteem plunges we become victim to all kinds of dangerous behaviors, from semi-starvation diets to dodgy diet pills. The more we focus on trying to look a certain way, the less satisfied we become.

I advocate pursuit of wholeness and health. Constantly chasing the ever-changing standards of physical beauty is a no-win situation. Let's go after a strong, healthy, and functional body instead -- you never know -- you may find that a side-effect of that goal is a body that you can look at in the mirror without shame.

Is guilt a big issue?  Do your readers share their struggles?

Some of the comments that hit the blog from young women are very sobering indeed. There is a powerful culture of self-hate out there, particularly among teens.  Then there is the obsession with food. Whenever we follow a regimented eating plan, guilt and obsession are never far away. Rather than seeing some comfort foods as evil, find a way to incorporate those foods into our (overall healthy) diet -- typically by eating small portions very slowly.

If you could only recommend one or two books to help people with diabetes eat right, which would it be?

So many books -- so little time! A few favorites: Brian Wansink's Mindless Eating and Michael Pollan's The Omnivore's Dilemma. I know these aren't specifically about diabetes, but they address some of the issues we have with modern food consumption.

Thank you, Jim, for this good sober reality check.

Low-Carb Favorites, from the Devotees

So this whole low-carb thing about diabetes is driving me crazy.

As I said myself recently, when struggling to control your blood sugar, the more carbs, the more struggle.

But I also don't believe that complete abstinence is the answer (like "just say no" isn't really the answer for birth control, right?)  Carbohydrates are part of life, and part of a healthy diet, too, in moderation.  I just wish there were more -- and more satisfying -- low-carb (LC) choices to make the whole carb restriction thing a bit easier.

So in desperation, I turned to Atkins / ultra-low-carb devotees for advice.  I wrote to Jimmy Moore of the leading LC blog Livin' La Vida Low-Carb, with this query:

Since most diabetics seem to struggle with restricting carbs and figuring out what in the heck they can eat, I need your help. Could you share your TOP 20 FAVORITE LOW-CARB MEALS & SNACKS with me to share with my readers?

What we're looking for are some viable meal/snack options that really keep a person satisfied -- some actual dishes you can prepare for a dinner or a lunch meal, or something you can order in a real live restaurant.

Jimmy posted the query on his discussion board, and whala, we got a whole mess of suggestions! I'm not sure they added up to exactly 20; I lost count (speaks for my carb-counting skills, ay?).  Here's a rough synopsis, in no particular order:

Fave Low-Carb MEALS:

*  Chicken Marsala
"Thin sliced chicken dredged in parm cheese and pan fried in butter and garlic.  A splash of real marsala wine for flavor (do not drink the rest of the bottle). Serve with sauteed sliced mushrooms and a gorgeous salad." 

* Chopped shrimp (the frozen stuff will do) on a bed of lettuce with a dollop of mayo and hard boiled egg slices

* Green bean casserole, mashed cauliflower, meatloaf, turkey burgers, unbreaded fried wings, baked chicken breasts, baked fish

* Fauxtatoes, buffalo wings,  low carb pizza (not for the gluten-free, of course)

* Sea scallops wrapped in bacon, skewered on the BBQ

* Steak on the grill with "loaded broccoli": broccoli with a bit of sour cream, a touch of butter, real bacon bits, chopped onion, and shredded cheese (apparently kills those potato cravings)

* Spaghetti squash, instead of pasta

* "Lettuce sandwiches": wrap your sandwich fixins in lettuce leaves

* Salad, salad, salad: taco salad, chicken salad, egg salad, tuna salad, Caesars salad with chicken or shrimp, spinach-strawberry salad, lemon-tarragon salad, and so on

Fave Low-Carb SNACKS:

* Steamed shrimp

* Turkey Kielbasa (good as an entree, too)

* Pepperoni chips

* Yogurt cup with a few chopped berries and walnuts

* Cauliflower "Popcorn" (comes complete with an oh-so-cute instructional video on YouTube HERE)

* Celery sticks with flavored cream cheese

* Deviled eggs, avocado-filled eggs, boiled eggs mashed with wasabi powder

*  Salad, salad, salad: chicken salad, tuna salad, shrimp salad, etc., etc.

Thanks so much for the suggestions, Guys!  But I also see my problem right there; I am sick to death of skinless chicken, eggs, and salad, salad, salad. I can't stand cauliflower. Steak and pepperoni are too fatty for my poor sensitive stomach to take very often... whine, whine, whine... I know. 

Honestly, the enthusiasm of Jimmy's followers alone kind of re-kindled my motivation to slash the carbs.  And it's sure nice to know there's a whole community out there to fall back on whenever you feel you might be "losing it."  Time to start surfing the low-carb recipe circuit again :)  Need a place to start?  Go see Linda.

Breakfast Cereal: A Case Study in Bad PR

Oh joy, I just received an emailed press release from a major PR agency that represents Kellogg's cereals, announcing that a new study confirms: "People Who Eat a Daily Cereal Breakfast Maintain a Healthier Weight."  And what do you know?  This study (published in the Nutrition Bulletin, June 2007) was sponsored by the Kellogg Company itself!

With all the current discussion on best-practices and proper etiquette for healthcare PR, where the f*** have these people been?!

First off, study BS: the results announcement claims that "people who eat cereal for breakfast regularly tend to have a lower body mass index (BMI) and are less likely to be overweight than those who do not eat cereal for breakfast regularly."

BUT, if you look at the Nutrition Bulletin summary of this study, you can't figure out what they are actually comparing.  Were the adults not eating cereal having a daily Java Chip Frappuccino and Starbucks scone for breakfast?  Were the children in the control group eating Krispy Kremes?

Come on!  Hasn't the attempt to paint breakfast cereal as a diet food already been pounded to death? (with the exception of the real whole-grain stuff, of course).

I know the low-carb crowd agrees when I say it's dangerous to tout breakfast cereals as a wonder-food, as their average sugar content tends to be sky-high.

And then to go and email this "breaking news" to diabetes bloggers just really takes the cake!

The press release I received tells me:

"For a healthy start to each day, the Special K Breakfast(TM) – a serving of Special K® cereal, 1/2 cup skim milk, fruit and black coffee – comes in at fewer than 250 calories.  To mix things up throughout the week, choose one serving from of any of the Special K varieties..."  Mind you, these include Special K Red Berries, Special K Vanilla Almond, and Special K Chocolatey Delight -- which contains only 1g of fiber and 25g carb per 3/4 cup.

As a (trying-not-to-be-bitter) PWD who has had to all but give up yummy breakfast cereals due to those uncontrolloable BG spikes they cause, I'm just a little ticked off here.  Lesson learned: think before you email, especially if your job is PR for a cereal company.

Taste Sensations

I'm always reminding PR people that this ain't your typical "diabetic Web site": I don't post weight-loss tips or recipes.  I'm not looking for the low-carb "magic bullet."  But OK, there are some food items that are of special interest to PWDs like me.  Here are a few of them that I've tried (or especially liked) lately:

* The new all-natural sweetener called Sweet Simplicity. The samples the company offered finally arrived, and I must say, it lives up to its name.  What's particularly nice is the subtlety of the sweetness.  I was surprised at how big the individual packets are.  You know how you can never use an entire packet of Equal or Splenda or SweetNLow because you would absolutely gag at the over-the-top penetrant artificial sweetness of it?  Well, Sweet Simplicity is not like that.  It has a very light sweetness that I can only describe as tasting "natural."  Thumbs up.

* Diet Ocean Spray. Discovered this recently to my delight, as I do miss fruit juice so.  Two flavors: Diet Orange Citrus (8g carbs per 12oz) and Diet Cranberry (3g carbs per 8oz).  Orange Citrus I found too artificially sweet (see above), but they still get an A for effort.  Cranberry, on the other hand, was quite tart.  My kids hated the aftertaste.  I rather liked it, thank goodness.  I'm not sure I could stand another exclusive season of Crystal Light Pink Lemonade.

* FAGE Yogurt, which a reader recommended a while back. I've been clearing the shelves at Trader Joe's ever since.  It has a very plain, "Greek yogurt" taste and can be combined nicely with low-sugar jam for flavor fun.  But even better, FAGE qualifies in my mind as a Super Food: One 7oz container of the 2% milk fat variety provides just 8g of carbs, but a whopping 17g of protein!  Thumbs Up. (And this is the front-runner for Best Reader Tip of the Year so far).

* Equal Flavor For Water.  Have you seen these yet?  Little packets of powder you dump into your water bottle to add a (no-sugar, no-carb) kick of mandarin orange, lemon lime, or black cherry flavor.  I'm not a lemon-lime fan myself, so I stuck to the other two.  Not bad, really.  They kind of made the water taste like candy, though, so I personally wouldn't use this stuff for water when I'm working out.  Too fruit-liciously sweet.  But for a treat, say at the movies when everyone else is guzzling sweet drinks and gobbling up theater candy, I'd be right there with my EFFW (Equal Flavor For Water).  Good idea for a little change of beverage scenery, I think.

Beating the Angst of Eating with Diabetes

Hope Warshaw is a leading expert on diabetes and nutrition, with nearly 25 years of expertise as a nutrition consultant, diabetes educator, spokesperson, and author.  Her best-selling books published by the American Diabetes Association include: Diabetes Meal Planning Made Easy; Diabetes Food and Nutrition Bible; The Complete Guide to Carb Counting; and the Guide to Healthy Restaurant Eating.

DiabetesMine.com (aka Yours Truly) recently caught up with Warshaw for a down-to-Earth chat about the “angst” experienced by people with diabetes in particular about following a healthy eating plan.

DM) It’s hard to know what to eat with diabetes.  What is the first thing you’d tell a person newly diagnosed with pre-diabetes or type 2 diabetes about eating?

HW) More than likely a person with pre-diabetes or type 2 diabetes has some weight to trim off. Therefore, I want to help them find some easy ways to accomplish this goal. One of the first things I talk about is not what people eat, but what they drink. Are you downing a Caramel Macchiato every day? Are you guzzling Gatorade? People can drink 1,000 calories in beverages through the course of the day without realizing it, so that’s an A-Number-1 priority.

People can have weight melting off them just by changing what they drink.

DM) There are lots of reasons why changing your food habits can be difficult. What do you see as the biggest hurdle for people with diabetes?

HW) Unfortunately, there’s lots of misinformation out there. Fad diets can mislead people. And eating habits and food choices in America today aren't exactly what you’d call healthy. So, trying to eat healthy can at times make you feel like you are a fish swimming upstream. That’s not easy to keep doing, particularly when the reward of good health might be many years away.

There’s also a clear distinction between people with type 1 and people with type 2 diabetes.  My book “Diabetes Meal Planning Made Easy” is directed straight to the many people with pre- or type 2 who have access to pathetically little information, nutrition guidance, and support. If there’s one thing confirmed in the large multi-center trials like DCCT, DPP and the like, it’s that people can make changes if they have the knowledge and support they need over time. Unfortunately, that’s not the way we practice medicine and chronic care today. 

For type 1 diabetes, I don’t think most people are taking insulin in the way that maximally helps them. There’s a lot of fine-tuning, for example of insulin pump features, that people often don’t get enough education about. So for them, it’s less about food and more about insulin management.

DM) So meal planning isn’t for everyone?

HW) I would never say that. A healthy eating plan is important for everyone with diabetes, pre- type 1 or type 2. There is no doubt today that eating healthy day after day and year after year can help a person stay healthier with diabetes, and also prevent myriad other related and unrelated health problems. The “but” is that as a dietitian I have learned to be realistic with the people I co