Jane has been in the Clinical Nutrition field for decades. I don’t know her personally but we’ve exchanged a few emails lately. She graciously gave me permission to post her comments here. Anything in brackets below is what I added for clarification. Without further ado, here’s Jane:
I like to put fruits and vegetables in their proper categories. For example, avocados, tomatoes, olives, pumpkin, squash and peppers are all fruits.
As I said earlier, I discovered through observation in the early 80’s that diabetics could not eat fruit by itself, though fruit was always recommended as a stand-alone snack by the Am. Diabetic (and Dietetic) Assoc. You recommended that starchy vegs/fruits should be eaten with a protein or nuts, which is so invaluable to people, in general, diabetic or not.
In your general rec’s, there are 10 CHO’s [carbohydrate grams] AM, and Lunch/Dinner with 20 CHO’s [grams]. I’ve found that most people do better with equal amounts of protein at every meal. You mentioned later that if one is exercising, then increase the B’fast CHO’s, which I agree with. But, for the most part, I think people burn off the CHO’s during the day, no matter what they are doing. Plus, most people eat the next meal (after b’fast) within 4 hrs, whereas lunch and dinner are usually spaced more at 5 – 6 hrs. I think CHO’s should be highest at breakfast for most diabetics, as long as it is balanced with enough protein. Proteins at the next two meals could be higher. I disagree with fruits being eaten at dinner, as I think this spikes the BG for the next morning fasting. The type and amount is, of course, key.
Diet sodas. None! I believe that the sweet taste of any artificial sweetener will provoke some kind of response in the brain/body. There are mixed studies as far as insulin response, but French researchers performed a 14 yr study which showed an association between diet soda intake and Type 2 Diabetes. If your patients drank 2 sodas/day, that’s 14 per week…….too many!! I’m not a purist, by any means, but to be on the safe side, I’d stick with Paleo here……..no artificial anything.
Hypoglycemia. Again, I’m not in the ADA camp on this one either. I do believe in emergencies, (below 60 mg/dl [3.3 mmol/l]) the diabetic must ingest glucose, but only about 10 gms is usually needed, for the most part, if the BG is not too low. (Under 45 mg/dl [2.5 mmol/l], then 20 gms is warranted.) If between 60 – 70, I’d do a combo of protein and sugar. (1/2 cup OJ [120 ml orange juice] with 4 almonds or 3 glucose tabs with 4 almonds.) I’ve witnessed diabetics sucking on hard candies too many times per week, which does bring up the glucose, but to the detriment of hormonal balance. I try to prevent this yo-yoing syndrome that goes on…..it can’t be good long-term.
You advised to check BG [blood glucose] 4 – 6 times per day before meals and at bedtime. I think two of those should be 2 hr. post-prandials, which may give them better control overall.
Your meal ideas use too much of the same foods, like onions and tomatoes. Cruciferous vegetable are all over the place, which may be detrimental to those with Hypothyroidism. I’d include different vegetables at every meal to give the diabetic more option ideas.
Thank you, Jane!
Regarding 10 grams of digestible carbohydrate at breakfast and 20 g at lunch and dinner (evening meal): This is in deference to the dawn phenomenon, in which blood sugars tend to run higher between 6 and 9 am, roughly. I need to do some research to see how commonly this occurs. Adding carbs on top of dawn phenomenon may not be a great idea. I believe this is why Dr. Bernstein’s Diabetes Solution provides fewer carbs for breakfast than for lunch and dinner. If you don’t experience dawn phenomenon, it wouldn’t matter if you ate 20 or 30 g of digestible carb for breakfast.
I’ve asked for feedback on the Paleobetic Diet, hoping to make it better in future versions. If you give me comments via email, rest assured I will never publish them anywhere without your permission.
I’m keen to review this book. I have varying thoughts on cruceiferous vegetables and hypothyroidism, as well. I don’t agree with Jane and the perceived goitrogens in these foods should not permit someone with low thyriod to avoid them. Thanks for sharing team!
Because I have witnessed elevated TSH levels decrease with avoidance of soy and a reduction (not elimination ) in cruciferous intake, I do believe that this may allow for a better uptake of iodine. When eaten, cook the vegetables well. As far as the Dawn phenomenon is concerned, the body begins to increase cortisol and catecholamine levels which works against insulin response. The reason I recommended more protein and less CHO’s at night is to hopefully avoid this phenomenon altogether, thus the higher CHO at breakfast and higher protein intake at lunch and dinner.