Recipe: Frozen Fruit Smoothie #2

 

Similar to an Icee, but healthier for you

Similar to an Icee, but healthier for you

Try this for dessert instead of calorie-laden items like pie, cake, cookies, and ice cream. Unlike this smoothie, those aren’t very nutrient-dense, either. Since I provide the nutritional analysis below, you can easily incorporate this into most diabetic diets, such as the Paleobetic Diet. Most diabetics need to limit their carbohydrate consumption. Twelve fl oz of this smoothie has almost 40 digestible carb grams, so you may need to reduce the serving size or eat few other carbohydrates with your meal.

At the Parker Compound, we mix this in a Vitamix. Other devices may work, but I’m not familiar with them.

It's all here

It’s all here

Ingredients

1 cup (240 ml) frozen raspberries

1/2 cup (120 ml) frozen blueberries

1 cup (240 ml) frozen strawberries

1 frozen banana (7 inches or 18 cm), cut into 3–4 pieces

1 tbsp (13 g) chia seeds

1 handful (1/2 ounce?) raw kale

2.5 cups (590 ml) water

1 cup (240 ml) ice cubes

Instructions

First item into the Vitamix is the water, then banana, all berries, chia seeds, then top off with the ice. Start mixing on variable speed 1 then slowly increase spin rate to 10, for a total mix of 45–60 seconds. Soon after you get started you’ll probably have to use the “plunger” a few times to un-clump the top items.

Loaded and ready to spin

Loaded and ready to spin

Depending on your batch of fruits, this drink may not be as sweet as you like. You could easily sweeten it up with your favorite artificial non-caloric sweetener. I used 1.5 tsp (7.5 ml) of Truvia to good effect, just thrown in with every thing else before or after the primary mix. Or you could use table sugar, about 4 tsp (20 ml), instead of the Truvia. Most of us eat too much sugar. If you go the sugar route, you’ll increase the calories per serving by 15, and increase carbohydrate grams by 4 per serving.

My able assistant wields the plunger

My able assistant wields the plunger

Number of Servings: 3.5 servings of 12 fl oz (350 ml) each

Advanced Mediterranean Diet boxes: 2 and 1/2 fruits

Nutritional Analysis per Serving:

7% fat

90% carbohydrate

3% protein

190 calories

46 g carbohydrate

7 g fiber

39 g digestible carbohydrate

5 mg sodium

290 mg potassium

Prominent features: Rich in vitamin C, fair amount of fiber, homeopathic amounts of sodium

Steve Parker, M.D.

PS: I credit my wife with this recipe.

 

Fruit Smoothie #1

 

A 12 fl oz serving

A 12 fl oz serving

My wife began experimenting with smoothies last year after seeing a Vitamix demonstration at Costco. Most Americans should probably eat more fruit; smoothies are one way to do that. Today’s recipe is one she concocted. Note the trendy chia seeds and kale. Smoothies are a great substitute for junk food desserts.

We’re using a Vitamix mixer. Other devices may be able to get the job done. The mixing speeds our device range from one to 10. (Tip for a competitor: make one that goes to 11.) We love our Vitamix and have no regrets about the purchase, although it was expensive (over $500 USD). It is hard to hear anything else when it’s running at top speed.

Since I provide nutritional analysis below, most diabetics can fit this smoothie into their diets without guessing the carb grams. Twelve fl oz or 350 ml provides 32 digestible carb grams. Most diabetics should probably reduce the serving size by a third, down to 8 fl oz (240 ml) and 11 digestible carb grams.

One potential advantage of blending these fruits is that one fruit may provide nutrients that the others lack

One potential advantage of blending these fruits is that one fruit may provide nutrients that the others lack

Ingredients

1 cup (240 ml) grapes, green seedless

1 mandarin orange, peeled, halved

1 banana (7 inches or 18 cm), peeled, cut into 3–4 pieces

1 pear, medium-size, cored, quartered (ok to leave peel on)

1/2 tbsp (7 g) chia seeds

1 cup (50 g) raw kale

Instructions

First put the water in the Vitamix, then grapes, pear, orange, banana, chia seeds, kale, and finally ice. Ice is always last. Then blend on variable speed 1 and gradually go up to high level (10). Total spin time is about 45 seconds.

Full speed ahead!

Full speed ahead!

Number of Servings: 2.5 consisting of 12 fl oz (350 ml) each.

Advanced Mediterranean Diet boxes: 2 fruits

Nutritional Analysis per Serving:

7% fat

88% carbohydrate

5% protein

160 calories

38 g carbohydrate

6 g fiber

32 g digestible carbohydrate

15 mg sodium

520 mg potassium

Prominent features: Good source of vitamin C, fair amount of fiber, miniscule sodium.

Steve Parker, M.D.

 

 

More Evidence That Modern Diets Are Bad For Our Teeth

Australian Aborigine in Swamp Darwin

Australian Aborigine in Swamp Darwin

Phys.org has an article on dental changes associated with the transition from hunter-gatherer cultures to less mobile agricultural ones. The transition occured 10,000 to 12,000 years ago at the end of the Paleolithic period. Some quotes:

“Our findings show that the hunter gatherer populations have an almost “perfect harmony” between their lower jaws and teeth,” he explains. “But this harmony begins to fade when you examine the lower jaws and teeth of the earliest farmers”.

*   *   *

The diet of the hunter-gatherer was based on “hard” foods like wild uncooked vegetables and meat, while the staple diet of the sedentary farmer is based on “soft” cooked or processed foods like cereals and legumes. With soft cooked foods there is less of a requirement for chewing which in turn lessens the size of the jaws but without a corresponding reduction in the dimensions of the teeth, there is no adequate space in the jaws and this often results in malocclusion and dental crowding.

You can read the original research report in PLOS One.

Steve Parker, M.D.

h/t Diet Doctor Eenfeldt

This bedrock metate was used by Indians (aka Native Americans) for grinding maize, acorns, and other foods

This bedrock metate was used by Indians (aka Native Americans) for grinding maize, acorns, and other foods. Rainwater fills this 4-inch deep rounded depression in granite about 10 miles from my house.

Are Your Computers Giving You E-mentia?

Thinking about it...

Exercise your brain

I saw a patient at the hospital a couple years ago who had been brought in by ambulance after suffering some trauma (not to his brain). He couldn’t call any friends or relatives to let them know what was going on because he didn’t have his cellphone. His phone had all his contact numbers so he had no reason to memorize any. Would you be in the same boat?

DailyMail has an interesting article on whether our use of technology is making us dumber. If we turn over mental tasks like navigation and math to computers, do our brains waste away? Will we be seeing more and earlier cases of age-related dementia? E-mentia?

This is worth keeping an eye on.

Steve Parker, M.D.

PS: The five other members of my household all have cellphones. The only number I’ve memorized is my wife’s.

Is Estrogen Poisoning the Cause of the Obesity Epidemic?

Eating too much tofu?

Too much tofu?

James P. Grantham and Maciej Henneberg of the School of Medical Sciences (University of Adelaide, Adelaide, Australia) suggest that estrogen-like compounds in the environment are causing obesity. Read about their hypothesis in PLOS One. I don’t know if they’re right, but their idea deserves consideration.

A couple estrogen-like substances they mention are in soy and polyvinyl chloride (PVC). We ingest these xenoestrogens. I had not been aware that soy consumption is positively linked to obesity.

The authors don’t instill confidence by using weak references such as #22.

I didn’t see the trendy “endocrine disruptors” moniker in the article.

Read the whole enchilada.

Steve Parker, M.D.

Family Physician Robert Oh Attacked His Prediabetes With Low-Carb Paleo Diet

Robb Wolf’s version of the paleo diet plus stopping his statin drug was just the ticket for Robert Oh, M.D., to cure his prediabetes, or at least put it into remission. Dr. Oh couldn’t blame genetics, physical inactivity, or obesity for his prediabetes. He was very active with CrossFit and had a healthy BMI of 23 at the time of his diagnosis. everydayHEALTH has the story. A quote by Dr. Oh:

Since I was already doing everything in terms of fitness, I began to experiment with my nutrition. Being a CrossFit fanatic, I heard about the low-carb Paleo diet, which is popular in the CrossFit community. Based on gut instinct alone, I took the 30-day challenge described in Robb Wolf’s book The Paleo Solution. Even though I started at 150 lbs. on my 5’7” frame, at the end of 30 days, I had lost eight pounds of body fat and felt great. Most importantly, my hemoglobin A1C, a marker of glucose control, dropped back to normal.

We’ve known for a few years that statin drugs are linked to type 2 diabetes in some way. Is it possible that Dr. Oh’s prediabetes cure stems simply from his discontinuation of the statin? Yes. I’ve not seen any studies to tell us whether statin-associated diabetes is reversible, nor how quickly.

Steve Parker, M.D.

Why Do Diabetics Resist the Paleo Diet?

Dr. Ernie Garcia (MD) posted a passionate essay about his difficulty getting his patients with diabetes to follow a carbohydrate-restricted Paleolithic diet. He makes a good case for carbohydrate addiction. A few quotes:

Today I saw a lady at my office. Fairly typical middle-aged, over weight female with poorly controlled diabetes. She recently started on an insulin pump but her glucose control is no better at all. I had a suspicion why, and again started to question the details of what she eats. Of course, she eats carb after carb after carb. Whole wheat this, and low fat that. She has tried to cut the carbs in the past, and actually had pretty decent success, but quickly falls back into your carbilicious ways. Why? Why go back when a change in diet shows clear improvement in her sugars?

*   *   *

What do addicts do? They generally know what they do is bad for them, and they have periods of clarity where they do better. Eventually though, the pull of their drug of choice draws them back in. Or, they slip up and use just a little and BAM…right back to square one. They feel shame for their addiction, people look down upon them for it, and they wish so badly they could make a permanent change, but they always fall back into old habits. Now, imagine a heroin addict who is advised to control the addition by sticking with “moderation” because of course, everything is good in moderation right?

Another issue that type 2 diabetics have is that they’ve been eating copious carbohydrates for over 40 years. It’s hard to break any habit with that type of longevity. It doesn’t help that they’re immersed in a carb-centric culture.

RTWT.

Steve Parker, M.D.

 

Ever Heard “No Carbs, No Cavities”?

I didn’t think so. None of my dentists ever uttered those words. Conflict of interests, maybe? And the worst carbohydrates for your teeth seem to be sugars.

173 Years of U.S. Sugar Consumption

(Thanks to Dr. Stephan Guyenet and Jeremy Landen for this sugar consumption graph.)

MNT on September 16, 2014, published an article about the very prominent role of sugars as a cause of cavities, aka dental caries. This idea deserves much wider dissemination.

I’ve written before about the carbohydrate connection to dental health and chronic systemic disease. Furthermore, sugar-sweetened beverages are linked to 200,000 yearly worldwide deaths

Investigators at University College London and the London School of Hygiene & Tropical Medicine think the World Health Organization’s recommendation of a maximum of 10% total daily calories from “free sugar” should be reduced to 3%, with 5% (25 grams) as a fall-back position.

Six teaspoons of granulated table sugar (sucrose) is 25 grams. That should be enough daily sugar for anyone, right? But it’s incredibly easy to exceed that limit due to subtly hidden sugars in multiple foods, especially commercially prepared foods that you wouldn’t expect contain sugar. Chances are, for instance, that you have in your house store-bought sausage, salad dressings, and various condiments with added sugars such as high fructose corn syrup. Sugar’s a flavor enhancer.

tooth structure, paleo diet, caries, enamel

Cross-section of a tooth

The aforementioned “free sugar” are defined as any monosaccharides and disaccharides that a consumer, cook, or food manufacturer adds to foods. In the U.S., we just call these “added sugars” instead of free sugars. From the MNT article, “Sugars that are naturally present in honey, syrup, and fruit juices are also classed as free sugars.” Sugar in the whole fruit you eat is not counted as free or added sugar.

The London researchers found that—in children at least—moving from consuming almost no sugar to 5% of total daily calories doubled the rate of tooth decay. This rose with every incremental increase in sugar intake.

From the MNT article:

“Tooth decay is a serious problem worldwide and reducing sugar intake makes a huge difference,” says study author Aubrey Sheiham, of the Department of Epidemiology & Public Health at University College London. “Data from Japan were particularly revealing, as the population had no access to sugar during or shortly after the Second World War. We found that decay was hugely reduced during this time, but then increased as they began to import sugar again.”

I’m convinced. How about you?

Steve Parker, M.D.

What About Vegetarian Diets for Diabetes?

low-carb diet, spaghetti squash, paleobetic diet, diabetic diet

The spaghetti squash at top is related to pumpkins and zucchini

I was surprised to learn that well-known diabetes writer David Mendosa (Type 2 DM) has switched from a very low-carb diet to a low-carb vegetarian diet, eating no more than 50 grams/day of carbohydrate. Why?

For me the issue is that I don’t want to be responsible for harming sentient beings as much as I can avoid it while still following a healthy diet.

I can respect that. I’m sure he’s monitoring the effects of the diet on his blood sugars and weight. Probably his blood lipids, too.

It sounds like all David had to do was drop fish from his prior diet. He still eats eggs (whites only?), cheese, and full-fat yogurt, so I’d call him a lacto-ovo-vegetarian.

If you’re already convinced that the Paleolithic diet is the best one for people with diabetes, read no further.

What Is a Vegetarian Diet?

From UpToDate.com:

Vegetarian diets vary considerably depending on the degree of dietary restrictions. According to the strictest definition, a vegetarian diet consists primarily of cereals, fruits, vegetables, legumes, and nuts; animal foods, including milk, dairy products, and eggs generally are excluded. Several less restrictive vegetarian diets may include eggs and dairy products. Some vegetarian diets may be grouped as follows:

●Macrobiotic — Vegetables, fruits, legumes, and seaweeds are included in the diet, while whole grains, especially brown rice, are also emphasized. Locally-grown fruits are recommended. Animal foods limited to white meat or white-meat fish may be included in the diet once or twice a week.
●Semi-vegetarian — Meat occasionally is included in the diet. Some people who follow such a diet may not eat red meat but may eat fish and perhaps chicken.
●Lacto-ovovegetarian — Eggs, milk, and milk products (lacto = dairy; ovo = eggs) are included, but no meat is consumed.
●Lactovegetarian — Milk and milk products are included in the diet, but no eggs or meat are consumed.
●Vegan — All animal products, including eggs, milk, and milk products, are excluded from the diet. Some vegans do not use honey and may refrain from using animal products such as leather or wool. They also may avoid foods that are processed or not organically grown.

A 2012 poll in the U.S. estimated that 7% of adults eat at least one meal a week that does not include meat, fish or poultry, 4% do not eat meat, fish, or poultry, and 1–2% do not eat meat, fish, poultry, dairy products, or eggs. Roughly 5% of individuals in the UK, Germany, and Australia describe themselves as vegetarian.

Switching to the paleo diet often leads to increased vegetable and fruit consumption

A low-carb diet can still have plenty of vegetables

Are Vegetarian Diets Safe?

Vegetarians need to be careful to get enough high-quality protein, iron, vitamin B12, vitamin D, and perhaps calcium. B12 comes only from animal products, as far as I know. You can make vitamin D by exposing your skin to sufficient sunlight. Some vegetarians will need to consult a dietitian to ensure adequate nutrition. (BTW, all my comment about vegetarian diets apply to adults only—I don’t treat children, so I’m not up-to-date on their nutritional needs.)

I’ve written about vegetarian diets for diabetes before: here and here. Dr. Michael Greger couldn’t convince Dr. Harriet Hall (or me) that we should avoid eating all animal products.

The Grashow Question

Someone claiming to be Charles Grashow left a comment on one of my blogs recently:

As I’ve posted before, this [vegetarian macrobiotic diet] took Insulin Dependent T2D [patients] OFF MEDS within 21 days!

Seems much better – but then again this diet is vegan not paleo!

http://www.hoajonline.com/internalmedicine/2052-6954/2/3
Ma-Pi 2 macrobiotic diet intervention during 21 days in adults with type 2 diabetes mellitus, Ghana 2011

http://www.nutritionandmetabolism.com/content/11/1/39
The effect of the macrobiotic Ma-Pi 2 diet vs. the recommended diet in the management of type 2 diabetes: the randomized controlled MADIAB trial

http://www.hindawi.com/journals/jnme/2012/856342/
Medium- and Short-Term Interventions with Ma-Pi 2 Macrobiotic Diet in Type 2 Diabetic Adults of Bauta, Havana

SO – my question is this. Why do you not recommend this type of diet instead? Or does it not fit into your paradigm?

I responded:

Charles, that macrobiotic Ma-Pi 2 diet looks like it has significant potential. I quickly scanned your first link only. For those not familiar with the diet, here’s a description form your first link:

“Vegetarian Ma-Pi 2 macrobiotic diet, designed especially by Mario Pianesi for treating diabetic patients. Total volume of the Ma-Pi 2 diet consisted of 40-50% whole grains (rice, millet and barley), 35-40% vegetables (carrots, savoy cabbage, cabbage, chicory, onions, red radish, parsley), and 8% legumes (adzuki beans, chickpeas, lentils, black beans). As a complement we used gomasio (roasted ground sesame seeds with unrefined sea salt), fermented products (miso, tamari, umeboshi) and seaweeds (kombu, wakame, nori). Bancha tea (theine-free green tea) was the main liquid diet.”

“The assayed Ma-Pi 2 diet is lower in energy than the traditional one recommended for diabetic patients, but safe, with adequate satiating effect due to the high fiber content, adequate in protein (12% of the total energy), with an acceptable amino acid score, low in fat (15% of the total energy), and high in complex carbohydrates (73%). The diet has a high antioxidant capacity and a high content of bioactive compounds with recognized functional properties (Table 2). Foods were elaborated by culinary macrobiotic specialists from UPM, Italy, and offered at the hospital during breakfast, lunch, dinner and snacks. Unfortunately, the variety of vegetables was restricted because of limited availability.”

I wonder if that would be deficient in vitamin B12.

It looks like it would be worth a try for a type 2 diabetic under medical supervision (risk of hypoglycemia). I’d like to try a few meals with those ingredients, some of which I’ve never heard of, prepared by someone who knows what they’re doing. Unless I missed it in the link, it might be hard for the average person to replicate that study diet. If I understood correctly, the study participants stayed in a hospital for three weeks and meals were prepared for them.

I don’t have time to hit the other links right now.

-Steve

My Current Stance on Vegetarian Diets For Diabetes

I say “current stance” because I’ll change my mind based on scientific evidence as it becomes available.

I’m not convinced that any of the vegetarian diets is clearly superior to the other available “diabetic diets” in terms of quality of life, longevity, and avoidance of diabetes complications.

We have some evidence that some vegetarian diets may help control diabetic blood sugars and help reduce the need for diabetes medications, at least short-term.

If my diabetic patients want to try a vegetarian diet, I have no objections as long as these criteria are met:

  • it’s a well-designed diet that provides adequate nutrition (which may require a dietitian consultation)
  • blood sugars, hemoglobin A1c, body weight, and blood lipids are monitored periodically
  • the patient is able and willing to self-monitor blood sugars fairly frequently
  • physician oversight, especially for those taking diabetes drugs

Vegetarian diets can be very high in carbohydrate content, which potentially could wreck blood sugar control. If that happens, consider a vegetarian diet with fewer starches and sugars.

Steve Parker, M.D.

Do Sugar Substitutes Cause Overweight and T2 Diabetes?

We don’t know with certainty yet. But a recent study suggests that non-caloric artificial sweeteners do indeed cause overweight and type 2 diabetes in at least some folks. The study at hand is very small, so I wouldn’t bet the farm on it. I’m not changing any of my recommendations at this point.

exercise for weight loss and management, dumbbells

Too many diet sodas?

 

The proposed mechanism for adverse metabolic effects of sugar substitutes is that they alter the mix of germs that live in our intestines. That alteration in turn causes  the overweight and obesity. See MedPageToday for the complicated details. The first part of the article is about mice; humans are at the end.

Some quotes:

“Our results from short- and long-term human non-caloric sweetener consumer cohorts suggest that human individuals feature a personalized response to non-caloric sweeteners, possibly stemming from differences in their microbiota composition and function,” the researchers wrote.

The researchers further suggested that these individualized nutritional responses may be driven by personalized functional differences in the micro biome [intestinal germs or bacteria].

***

Diabetes researcher Robert Rizza, MD, of the Mayo Clinic in Rochester, Minn., who was not involved with the research, called the findings “fascinating.”

He noted that earlier research suggests people who eat large amounts of artificial sweeteners have higher incidences of obesity and diabetes. The new research, he said, suggests there may be a causal link.

“This was a very thorough and carefully done study, and I think the message to people who use artificial sweeteners is they need to use them in moderation,” he said. “Drinking 17 diet sodas a day is probably a bad idea, but one or two may be OK.”

I won’t argue with that last sentence! (Unless you have phenylketonuria and want to use aspartame.)

Finally, be aware that several clinical studies show no linkage between human consumption of non-caloric artificial sweeteners and overweight, obesity, and T2 diabetes.

Steve Parker, M.D.