Why the Diabetes Diet Is Superior
The Diabetes Diet : Dr. Bernstein's Low-Carbohydrate Solution
by Richard K. Bernstein, M.D.
enotalone.com
(Page 3 of 3)
It's arguable whether any of the low-carbohydrate diets in the bookstores today is ideal for nondiabetics. But I can say that none of them is ideal for diabetics. Most of them depend heavily on the glycemic index, which is a subjective rather than objective evaluation of the speed of the action of carbohydrate on blood sugar. What does that mean? Sugars and starches are all carbohydrate. The body breaks them down at different rates; for example, 10 grams of glucose is going to affect your blood sugar considerably more rapidly than 10 grams of carbohydrate in spinach. The glycemic index (which we will discuss in greater detail in Chapter 3) attempts to rank most common foods by this speed - and thus the rapidity of the subsequent requirement for insulin (either made by the body or injected). The glycemic index, for reasons we'll get into later, is at best flawed and misleading. Many foods that I advise you to avoid are perfectly acceptable on mainstream low-carb diets that use it as a guide.
The Diabetes Diet works better than typical low-carb regimens for other reasons as well. The first is that, within the guidelines, you eat what you want and like to eat, but there are no "treat days." Many low-carbohydrate diet plans ignore the reality that much of overweight and obesity is directly related to carbohydrate addiction and constant snack ing. This may be because many dietitians and diet doctors really don't understand carbohydrate addiction, although the mechanism has been well documented (see page 135). Treat days are a little like having a smoker go all week without a cigarette and then saying, "Go ahead and have a cigarette on Saturday." My experience with my patients has demonstrated over and over that for people with a history of overeating "treats," it's much simpler just to give up the treats than to have the self-discipline to eat only one small portion of sweets or starches on a treat day. I have also found that when most people give up fast-acting carbohydrate, their desire to snack, indeed, their need to snack, goes away too. And, of course, treat days and the resultant high blood sugars make no sense for diabetics.
The second notable difference between the structure of this diet and others is that there are no "phases" here. The amounts of carbohydrate that you ought to eat will remain essentially constant for life. For purposes of weight loss, or if you significantly increase or decrease your physical activity, protein amounts can be adjusted, but that's about it. In that respect, this diet is much simpler to follow.
In most of the low-carb diets I know of, you begin on a highly restricted regimen and then, just as you start to lose weight nicely, you change your diet. You start to reintroduce into your meal plan foods that tend to be high in fastacting or concentrated carbohydrate. These diets often add the caveat that after phase one you will stop losing weight or slow your weight loss but you can stay on phase one for a longer period of time if you want to lose more.
There are a number of problems with this kind of phasing. A significant one is that if your weight loss is too fast - for instance, if you starve yourself - you're likely to get on the yo-yo diet roller coaster. Why? Your body can't make glucose from fat, so if you're starving yourself, your quickweight- loss diet may reduce your stores of protein (after your body converts some to glucose) in addition to fat. Your protein stores are principally your muscle mass. If you lose 10 pounds, you may lose 5 pounds of muscle in addition to 5 pounds of fat. If and when you gain back 10 pounds (or more) - which is likely because you're starving - what you gain back will be mostly fat. You'll end up worse off than when you started.
Another result is that you will have decreased your sensitivity to insulin, because our ratio of fat to muscle mass is one of the main factors affecting insulin sensitivity. Decreased sensitivity to insulin, also called insulin resistance, means there will be more of this fat-building hormone in your bloodstream.
From the perspective of a diabetic, phasing makes achieving normalized blood sugars considerably more diffi- cult, in part because you will likely need to make several adjustments to your medications. Medications for diabetes, in particular injectable insulin, must be carefully fine-tuned. We'll talk about this a little more in the next chapter. Just as important is the issue of carbohydrate addiction. Most low-carb diets might as well add the caveat that after phase one, you're going to quit the diet because suddenly you're back to the same old stuff that got you into trouble in the first place.
My college classmate became obese after years of poor diet, which included carbohydrate addiction and a lot of snacking. Then, several years ago, he went on a lowcarbohydrate diet and lost about 45 pounds over the course of a relatively short period. He looked great, felt great, had a whole new outlook and a whole new wardrobe. Then one evening he was at a party and "just had one" cracker. No problem, he thought. But it was the same as if he'd been a smoker who'd stopped and then just had one cigarette. It was impossible to stop at just one, and his diet never recovered.
He gained back the weight he lost in almost no time. The consequence? He's in much poorer health than he was, and his lipid profile is back in the unhealthy range. His new wardrobe, his newfound health and energy, his whole new outlook - all of that is out the window.
The restricted phase of these diets also plays into the not very healthy view of diet as a continuum between sin and virtue. The fast-food chain Subway ran an ad campaign that exemplified this, with an actor doing something "sinful" but excusing it by saying, "It's okay, I had Subway for lunch." (Subway sandwiches, by the way, have no place in this diet, not even their new "low-carb" sandwiches - unless you throw away the bread.)
Gluttony is one of the seven deadly sins, and from that frame of reference, the tendency is to look at abstinence as virtue and at indulgence as vice. The phasing of diets (and the treats) creates an unfortunate dynamic of deprivation and reward. Get through boot camp, so to speak, and then you can relax. Just lose that 20 pounds so you can fit into your wedding dress or tuxedo and look good for the pictures, then gorge yourself on the honeymoon, because you've got a mate and don't have to look your very best anymore. This is not healthy thinking and not healthy dieting. My aim is not to deprive you or starve you. The "reward" for the "virtue" of this diet is a healthy weight and overall health and longevity. In the end, you'll find it far more satisfying than the so-called yo-yo effect that phased diets regularly cause.
Finally, many people seem to equate low carbohydrate with high protein. That may be true of some diets, but not of this one. As noted previously, amounts of protein can be adjusted to suit individual needs, but I do not subscribe to the myth that as long as you aren't eating fast-acting carbohydrate there is no need to limit protein intake. A certain amount of protein does get converted to blood sugars by the body, and that will raise insulin levels and build fat. (Still, if you're going to overeat or binge, a 42-ounce steak is not as likely to lead to incessant snacking as a 42-ounce bag of corn chips.)
The idea here is to put yourself on a single regimen and then just stay with it. I provide guidelines, and the diet doesn't change much except in what you select to eat. Then depending on how rapidly you lose weight (or don't), and on any lifestyle changes (pregnancy, training for a marathon, or an injury that interrupts your regular exercise, for example), the amount of protein you consume may be changed. In that respect, there could hardly be a more reliable, simpler diet.
The wonderful recipes in this book have been created by a chef and restaurateur whose son is a type 1 diabetic. You could live off these innovative and creative dishes forever, but I encourage you to eat what you like and enjoy your eating within the guidelines. We have gourmet dishes that will have your friends or your mother-in-law asking for the recipe. We also have fast breakfasts for when you're on the go. So use the guidelines and the tools provided, and be healthy, feel great, and live long.
Copyright © 2005 by Richard K. Bernstein, M.D.
About the Author
Recognized as one of the world's foremost experts on diabetes, Richard K. Bernstein, M.D., F.A.C.E., is author of Diabetes Type II and Diabetes: The Glucograf Method for Normalizing Blood Sugar. His private practice in Mamaroneck, New York is solely devoted to diabetes and prediabetic conditions, including obesity. |
