The Low-Carb Diabetes Solution Cookbook (2 page)

W
elcome to this book, and to the HEAL family. We're sorry that your health has driven you to search for a solution, but we're glad to have you with us. You're in the right place.

HEAL Diabetes & Medical Weight Loss Clinics have a simple mission: to teach “Healthier Eating and Living,” and by doing so, restore people to health. Eric C. Westman, M.D., M.H.S., our founder and president, and Jacqueline A. Eberstein, R.N., a medical advisor, have, between them, taught thousands of people with diabetes to not merely control the progression of their disease, but to put it into total remission.

Me? I write low-carbohydrate cookbooks. I have eaten a low-carbohydrate diet for twenty years now. I was never diagnosed with diabetes, but have had a doctor, looking at my charts, say that I would surely be diabetic by now had I not changed my diet in 1995.

I know Dr. Westman and Jackie Eberstein because of my longtime involvement with the low-carb community. When Dr. Westman told me he was starting a chain of diabetes treatment centers, with the goal of teaching people to eat a low-carbohydrate diet, I knew I had to be involved. They deal with the medical part and have vetted everything I say here. I'm the one who can help you figure out the question “What do I eat now?” I promise, the answer to that question is varied, delicious, and satisfying.

Type 1, or juvenile-onset diabetes, is due to failure of the insulin-secreting beta cells in the pancreas. People with type 1 diabetes simply lack insulin. According to the American Diabetes Association (ADA) website, only 5 percent of people with diabetes have this form of the disease.

In type 2 diabetes, the pancreas makes insulin, but the insulin receptors, or the “doors” on the cells that insulin should open, are not working properly
to move sugar out of the bloodstream, a condition called insulin resistance. Blood sugar levels start rising. The beta cells secrete more and more insulin, trying to force the faulty insulin receptors to respond. Eventually, the beta cells start to fail, producing less and less insulin, and blood sugar rises inexorably.

It is type 2 diabetes that has been increasing at a frightening rate all over the world.

What does this mean for the lives of these people?

•
The National Institutes of Health (NIH) states that 60 to 70 percent of those with diabetes even-tually suffer diabetic neuropathy, a degenerative condition of the nerves that causes numbness, tingling, and/or pain in the extremities. It can also cause muscle wasting, indigestion, nausea, vomiting, diarrhea, constipation, dizziness on standing, problems with urination, and erectile dysfunction.

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The American Podiatric Medical Association estimates that between 15 and 24 percent of people with diabetes develop ulcerated wounds on their feet.

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Diabetes is a major cause of amputations, often due to those ulcerated wounds. According to the CDC's
2014 National Diabetes Statistics Report
, seventy-three thousand people with diabetes had a limb amputated in 2010. Sixty percent of amputations in people over age twenty are due to diabetes.

•
According to the National Eye Institute, 40 to 45 percent of those with diabetes develop diabetic retinopathy, the most common cause of new blindness in adults. The condition doubles the average person's risk of glaucoma and increases the risk of cataracts even more dramatically (two to five times the usual).

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The CDC's report also states that in 2011, because of diabetes, nearly fifty thousand people began treatment for kidney failure and more than a quarter of a million were living on dialysis or with a kidney transplant.

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Seventy-one percent of people with diabetes over the age of twenty-one have high blood pressure. People with diabetes have nearly double the risk of heart attack and one-and-a-half times the risk of stroke as those who do not have the disease.

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Diabetes increases susceptibility to other illnesses and can worsen their prognoses. For example, the CDC tells us that people with diabetes are more likely to die from pneumonia or influenza than people who do not have diabetes.

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The CDC's Diabetes Fact Sheet for 2011 tells us that people sixty or older with diabetes are two to three times more likely than those who do not have diabetes to report an inability to walk one-quarter of a mile, climb stairs, or do housework compared with people without diabetes in the same age group.

•
The CDC also states that people with diabetes are twice as likely to have depression (which can complicate diabetes management) than people without diabetes. Interestingly, depression also appears to predispose sufferers to diabetes.

•
According to the National Academy on an Aging Society, “The life expectancy of people with diabetes averages 15 years less than that of people without diabetes.” That's nearly a 20 percent reduction in life span. The CDC concludes, “Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.”

Does this scare you? It should. Elevated blood sugar rots your body from the inside out, doing massive, global damage to both your body and your quality of life.

To add insult to genuine, crippling injury, diabetes threatens to bankrupt us. The rapidly escalating cost of medical care is among the greatest burdens facing the United States, and a frightening part of that cost is attributable to diabetes. In 2013, the journal
Diabetes Care
stated, “The total estimated cost of diagnosed diabetes in 2012 is $245 billion, including $176 billion in direct medical costs and $69 billion in reduced productivity.”

What does that look like on an individual level?
Diabetes Care
breaks it down: “People with diagnosed diabetes incur average medical expend-itures of about $13,700 per year, of which about $7,900 is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.”

I'm sure you can think of more agreeable things to do with your money.

Overindulgence was harder before modern agriculture, grocery stores, fast-food joints, convenience stores, and omnipresent soda machines. As indulgences of the rich became the staples of the middle class and then the impoverished, this disease of the affluent crossed cultural lines and is now ravaging the poor, who subsist on starches and sugar because they are cheap.

Yes, genetics appear to be involved as well; some people are more susceptible than others. But if genetics were the driving factor, diabetes would not have exploded, both here and worldwide. Genetics simply don't change that quickly. Diet has.

In 1977, led by Senator George McGovern, the federal government issued its first dietary guidelines, recommending that all Americans reduce fat —especially saturated fat—and cholesterol intake. Those guidelines also recommended an increase in starch intake. Suddenly, Americans “knew” that a healthy diet was based on grains, and that meat, butter, and eggs were the causes of heart disease.

We listened. According to the USDA's Economic Research Service, between 1970 and 1993, annual per capita grain consumption increased by an average of 54 pounds (24.5 kg), added sugars by 23 pounds (10.5 kg), fruit by 48 pounds (21.5 kg), and vegetables by a remarkable 61 pounds (27.5 kg). Simultaneously, egg consumption dropped by 76 per person per year, and milk consumption by 7 gallons (3.75 L) per year.

With low-fat, low-cholesterol diets being the new word in health, people with diabetes, at high risk of heart disease, were told to reduce fat and load up on “healthy whole grains.”

Unfortunately, the saturated fat and cholesterol hypothesis of heart disease was wrong. In 2010, a meta-analysis appeared in the
American Journal of Clinical Nutrition
. It looked at twenty-one studies regarding the effects of saturated fat on heart disease and found “no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [coronary heart disease] or CVD [cardiovascular disease].”

Despite numerous articles debunking the dan-gers of saturated fat and cholesterol in the past decade—heck, the story made the cover of
Time
magazine in 2014—Americans are still being told to limit saturated fats and cholesterol and load up on starches. The USDA 2010 Dietary Guidelines for Americans recommend that adults get 45 to 65 percent of their calories from carbohydrates. Assuming a 2,000-calorie-per-day diet, that would be anywhere from 225 to 325 grams of carbohydrate per day. One hopes this will be amended in the guidelines due out by the end of 2015.

That's for ostensibly healthy people. What about diabetics, people with broken carbohydrate metabolisms? Unfortunately, many dietitians follow the old advice and recommend a carb-heavy diet for people with diabetes. Too many people trying to manage diabetes are still being told to eat carbs and use medication to “cover” the resultant blood sugar spikes.

Although the ADA has recently said that there is no one ideal diabetic diet, at the time of publication, the organization recommends starting at 45 to 60 grams of carbohydrate per meal. That's up to three times the carbohydrate we recommend in an entire day—and the ADA is also suggesting another 15 to 20 grams of carbohydrate in each snack. Whole grains appear among the group's list of “Diabetic Super Foods.”

The ADA also continues to warn against saturated fats, saying, “To cut risk of heart disease and stroke, look at saturated and trans fats. Look for products with the lowest amount of saturated and trans fats per serving.” (We agree with this advice about trans fats.)

The National Institutes of Health, at the time of publication, still recommends that people with diabetes eat six to ten servings of starches per day and two to four fruits, depending on body size and activity. The agency still recommends limiting meat and eggs to just 4 to 7 ounces (115 to 200 g) per day, and still shows the Food Pyramid, long since abandoned by the USDA, with the foundation still resting on starches. The NIH states: “Eat some starches at each meal. Eating starches is healthy for everyone, including people with diabetes.” It does not elaborate.

The NIH recommendations lump fats in with sugars as foods to be carefully limited. What is said specifically about sweets? “Sweets can be high in carbohydrate and fat. Some contain saturated fats, trans fats, and cholesterol that increase your risk of heart disease.” Saturated fats, not carbohydrates, are still the official bogeyman.

While pushing starches, the NIH recommends, “Eat fewer fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try pretzels, fat-free popcorn, baked tortilla chips or potato chips, baked potatoes, or low-fat muffins.”

Yet fat does not raise your blood sugar. Carbohydrates do. The commonly recommended “diabetic diet” depends on medication, usually in
increasing doses. Even then, it generally does not create normal blood sugar, and the “control” achieved still leads too often to crippling, even life-threatening, complications.

What is truly normal blood sugar? Diabetes Education Online, a resource from the University of California, San Francisco, tells us that “overnight and between meals, the normal, non-diabetic blood sugar ranges between 60 and 100 mg/dL [3.3 and 5.5 mmol/L] and 140 mg/dL [7.8 mmol/L] or less after meals and snacks.”

Yet the target blood sugar ranges for people with diabetes listed by both the Joslin Diabetes Center and the American Diabetes Association go as high as 130 mg/dL (7.2 mmol/L) for fasting blood sugar, and up to 180 mg/dL (10 mmol/L) after meals or snacks. It is these levels that lead to widespread damage in people with “controlled” diabetes.

There is a depressing assumption in the medical community that people with diabetes will inevitably end up with at least some complications. This is because they do. The illnesses listed earlier are occurring in people with diabetes treated according to current guidelines. One frightening example: The National Institute of Diabetes and Digestive and Kidney Diseases states, “Even when diabetes is controlled, the disease can lead to CKD [chronic kidney disease] and kidney failure.” That's a frightening definition of “controlled,” because—and be clear on this—these debilitating, life-altering repercussions are expected in people with diabetes who are being treated according to the current standards.

Richard K. Bernstein, M.D., a physician with type 1 diabetes and a longtime advocate of carbohydrate restriction for glucose control, nailed it when he said, “The ADA (American Diabetes Association) has repeatedly advocated by their blood sugar and A1c guidelines that DIABETICS ARE NOT ENTITLED TO THE SAME BLOOD SUGARS AS NON-DIABETICS [Bernstein's emphasis] and thus should be destined to suffer the morbidity and mortality caused by high blood sugars. They ensure this sad outcome by advocating high carbohydrate diets and industrial doses of medication to cover the carbs and thereby cause both very high and very low (not normal) blood sugars.”