Spaghetti Squash Recipes

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

The yellow spaghetti squash is at the top. It’s related to pumpkins and zucchini.

Spaghetti squash is a classic low-carb vegetable. If you’ve never tried it, you should. As vegetables go, it’s one of the largest, heaviest, and most interesting to prepare. Easy, too. The spaghetti squash season is autumn and winter in the northern hemisphere. Purchasing in spring and summer may be iffy.

It’s hard to give up pasta. Many diabetics who don’t notice that their blood sugar levels spike too high when they eat pasta. What’s too high? In general, I’d say over 150 mg/dl (8.33 mmol/l) measured one hour after a meal, or over 130 mg/dl (7.22 mmol/l) two hours after the meal.

Other experts disagree and propose other numbers.

An alternative to spaghetti pasta that shouldn’t raise blood glucose levels as high is the aforementioned spaghetti squash. It’s all about the carbohydrates. A cup of cooked spaghetti squash has 10 g of carb; a cup of cooked spaghetti has 43 g. The fiber grams are about the same. Numbers are from FitDay.com.

In my part of the world, supermarket spaghetti squashes weigh between two and five pounds. We cooked a three-pounder (1.4 kg) that yielded five cups; a five-pounder (2.3 kg) gave us 12 cups. A serving size is one, maybe two cups. What you don’t eat immediately stays fresh in the refrigerator for at least several days. Re-heat by microwaving or stir-frying.

Like pasta and potatoes, the squash by itself is bland. It’s a great substrate for sauces or seasonings.

You can fit spaghetti squash into both the Ketogenic Mediterranean Diet and Low-Carb Mediterranean Diet.

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

Raw squash cut in half lengthwise

Here’s how we cook it at the Parker Compound. Preheat the oven to 375º F 0r 190º C. Very carefully slice the squash in half lengthwise. Spoon out and discard the guts (seeds and membranes like a pumpkin; it even smells like a pumpkin). Put the halves flat-side down in a pan, then add a half inch (1.3 cm) of water to the pan. Cover with foil and bake until the outer shell (rind) is fairly easily pierced with a paring knife. This will be about 45 minutes for a two-pound squash (0.9 kg); 90 minutes for a four-plus pounder (2.3+ kg). Then turn them over, re-cover with foil, and cook 15 minutes more, until very tender. Remove from the oven and allow them to cool for a few minutes. Then use a fork to pull the strands away from the rind.

Other cooks simplify the process and just place the squash halves flat-side down on a baking sheet and cook for 30-60 minutes. Some leave the seeds in while cooking and spoon them out just before the stranding step.

Now what?

You got options.

Our first experiment was with l0w-carb spaghetti sauce.

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

Low-carb spaghetti

Next we took three cups squash (710 ml) and mixed in 2 tbsp (30 ml) extra virgin olive oil, 2.5 tbsp (37 ml) chopped parsley, 1/2 tsp (2.5 ml) minced fresh garlic, 1/2 tsp (2.5 ml) salt, and 1/8 tsp (0.6 ml) black pepper.

low-carb diet, diabetic diet, paleobetic diet

Seasoned with parsley, olive oil, garlic, salt, pepper

Finally, we took a cup (240 ml) of the squash and added minced celery (4 inches or 10 cm of stalk), 3 minced black olives, 5/8 oz (18 g) of minced sweet (bell) pepper, 1/2 clove of minced garlic, salt (a dash), and pepper to taste.

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

Seasoned with sweet peppers, black olives, garlic, celery, and salt

These last two options I consider side dishes. By the way, they taste good either cold or warm. They would go well with a number of entrees, such as steak or salmon.

I’ve read that this squash is good with pesto, or just with salt and butter.

Nutrition facts from FitDay.com:

One cup of cooked spaghetti squash has 75 calories (I’ve seen 42 elsewhere), 10 g of carbohydrate, 2 g of fiber, 8 g of digestible carb, 4 g of fat (predominantly MUFA), minimal protein, and a fair amount of vitamins A, niacin, B6, and C. Plus 8% of your RDA for manganese.

Steve Parker, M.D.

 

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Low-Carb Spaghetti Sauce

paleobetic diet, low-carb  spaghetti sauce

Spaghetti squash in the background

We eat a lot of spaghetti sauce at the Parker Compound. We make enough for leftovers at subsequent meals. Many folks with diabetes get unacceptable blood sugar spikes when they eat typical wheat-based spaghetti or other pastas. Avoid that with a spaghetti substitute called spaghetti squash (click for the recipe and nutritional analysis).

This recipe uses Truvia, a sweetener that’s a combination of stevia and erythritol. If you don’t have any, don’t fret: you have options.

Stevia is supposedly “natural.” I don’t know where erythritol, a sugar alcohol, comes from. The purpose of a sweetener is to counteract the tartness or bitterness of the tomatoes. Honey would probably serve this purpose, but I’ve never tried it in this recipe. If you use the honey or table sugar option below, it will increase the digestible carb count in each cup by three grams. Whatever your favorite non-caloric sweetener, use the equivalent of two tablespoons of table sugar (sucrose).

Ingredients:

1 lb (454 g) sweet Italian sausage, removed from casing

3/4 lb (340 g kg) lean ground beef (lean = up to 10% fat by weight)

1/2 cup (118 ml) onion, minced

2 cloves garlic, crushed

1 can crushed tomatoes (28 oz or 793 g)

2 cans tomato paste (total of 12 oz or 340 g)

2 cans tomato sauce (total of 16 oz or 454 g)

1/2 cup water (118 ml)

2 tsp (10 ml) Truvia (combo of stevia and erythritol; optional substitutes are table sugar  (2 tbsp or 30 ml) or honey (1.5 tbsp or 22 ml), or leave out sweetener

1.5 tsp (7.4 ml) dried basil leaves

1/2 tsp (2.5 ml) fennel seeds

1 tsp (5 ml) Italian seasoning

1/4 tbsp (3.7 ml) salt

1/4 tsp (1.2 ml) ground black pepper

4 tbsp (60 ml) fresh parsley, chopped

Instructions:

Put the sausage, ground beef, onion, and garlic in a pan and cook over medium heat until well browned. Drain off the excess liquid fat if that’s your preference (not mine). You’ll probably have to transfer that mix to a pot, then add all remaining ingredients and simmer on low heat for two or three hours. You may find the flavor even better tomorrow. If it gets too thick, just add water.

To avoid carbohydrate toxicity—high blood sugar—eat this over spaghetti squash rather than pasta. I’ll have a post on cooking spaghetti squash soon. Small or inactive folks may find a half cup of sauce over one cup of cooked squash is a reasonable serving (about 250 calories). I prefer to double those portions, making it a whole meal.

Sometimes I just eat this sauce straight. But I’m weird. A cup of sauce with some veggies or fruit is a meal for me. If you have other uses for spaghetti sauce other than over spaghetti squash or grain products, please share in the Comments.

Number of Servings: 9 (1-cup each)

Nutritional Analysis: (assumes you retained all fat)

55% fat

23% carbohydrate

22% protein

345 calories

21 g carbohydrate

4 g fiber

17 g digestible carbohydrate

985 mg sodium

1,117 mg potassium

Prominent features: Rich in vitamin B12, iron, copper, niacin, sodium, and selenium

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Dining Out and Obesity: Related?

No need to dine out if you have one of the four "Low-Carbing Among Friends" cookbooks

No need to dine out if you have one of the four “Low-Carbing Among Friends” cookbooks

The U.S. trend of increasing overweight and obesity started about 1970. I wonder if eating away from home is related to the trend. I found a USDA report with pertinent data from 1977 to 1995. It also has interesting info on snacking and total calories consumed. Some quotes:

“We define home and away-from-home foods based on where the foods are obtained, not where they are eaten. Food at home consists of foods purchased at a retail store, such as a grocery store, a convenience store, or a supermarket. Food away from home consists of foods obtained at various places other than retail stores (mainly food-service establishments).”

***

“Over the past two decades, the number of meals consumed has remained fairly stable at 2.6 to 2.7 per day. However, snacking has increased, from less than once a day in 1987-88 to 1.6 times per day in 1995. The increased popularity in dining out is evident as the proportion of meals away from home increased from 16 percent in 1977-78 to 29 percent in 1995, and the proportion of snacks away from home rose from 17 percent in 1977-78 to 22 percent in 1995. Overall, eating occasions (meals and snacks) away from home increased by more than two-thirds over the past two decades, from 16 percent of all eating occasions in 1977-78 to 27 percent in 1995.”

***

“Average caloric intake declined from 1,876 calories per person per day in 1977-78 to 1,807 calories per person per day in 1987-88, then rose steadily to 2,043 calories per person per day in 1995.”

***

“These numbers suggest that, when eating out, people either eat more or eat higher-calorie foods or both.”

Parker here. I’m well aware that these data points don’t prove that increased eating-out, increased snacking,  and increased total calorie consumption have caused our overweight and obesity problem. But they sure make you wonder, don’t they? None of these factors was on a recent list of potential causes of obesity.

If accurate, the increased calories alone could be the cause. Fast-food and other restaurants do all they possibly can to satisfy your cravings and earn your repeat business.

If you struggle with overweight, why not cut down on snacking and eating meals away from home?

Steve Parker, M.D.

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Low-Fat Diet Loses to Mediterranean Diet in Heart Disease Prevention

The American Journal of Medicine has an article entitled “Diets to Prevent Coronary Heart Disease 1957- 2013: What Have We Learned?” The authors conclude:

The Mediterranean-style diet, with a focus on vegetables, fruit, fish, whole grains and olive oil, has proven to reduce cardiovascular events to a degree greater than low fat diets, and equal to or greater than the benefit observed in statin trials.

The only bone I’ll pick with that quote today is that folks with diabetes and prediabetes often have unacceptable blood sugar spikes when they eat whole grains. That’s one reason I designed the Low-Carb Mediterranean Diet.

Steve Parker, M.D.

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New ADA Criteria for Diagnosis of Gestational Diabetes

You can't tell if she has gestational diabetes just by looking

You can’t tell if she has gestational diabetes just by looking

Gestational diabetes occurs in 5% of pregnancies in the U.S., affecting more than 240,000 births annually. Compared to caucasians, gestational diabetes mellitus (GDM) occurs more often in blacks, native Americans, Asians, and Latinos.

So What’s the Big Deal?

Numerous problems are associated with GDM, for both the mother and the baby:

  • dangerously high blood pressure (preeclampsia)
  • excessive amount of amniotic fluid (the baby in the uterus floats in this fluid)
  • delivery requiring an operation
  • early or premature delivery
  • death of the baby
  • birth trauma, such as broken bones or nerve injury
  • metabolic problems in the baby (low blood sugar, for example)
  • abnormally large baby (macrosomia, a major problem)

How Is Gestational Diabetes Diagnosed?

All pregnancies are characterized by some degree of insulin resistance and high insulin levels: they are necessary for the baby.  Nevertheless, healthy pregnant women run blood sugars 20% lower than when they are not pregnant.

Most women should undergo a screening test for gestational diabetes around the 24th to 28th week of pregnancy.  Screen earlier if undiagnosed type 2 diabetes is suspected or if risk factors for diabetes are present.  The American Diabetes Association (2014 guidelines) recommends either one of two screening tests.

  • “One-step test.” It’s a morning oral glucose tolerance test after at least eight hours of fasting. Fasting blood sugar is tested then he woman drinks 75 grams oral of glucose.  Blood sugar is tested again one and two hours later.  This blood sample is obtained by a needle in a vein, not by finger prick.  Gestational diabetes is diagnosed if any of the following apply: 1) fasting glucose is 92 mg/dl (5.1 mmol/l) or higher, 2) 0ne-hour level is 180 mg/dl (10.0 mmol/l) or higher, or 3) two-hour level is 153 mg/dl (8.5 mmol/l) or higher.
  • “Two-step test.” This is a nonfasting test with only one needle-stick. The woman drinks 50 grams of glucose; plasma glucose is tested one hour later. But if it’s over 140 mg/dl (10.0 mmol/l), that’s a flunk and a three-hour 100-gram oral glucose tolerance test in the fasting state must be done (step two). Gestational diabetes is present if the three-hour glucose is 140 mg/dl (7.8 mmol/l) or higher. Other experts say the diagnosis requires two or more of the following:
    • fasting blood sugar > 95 mg/dl (5.3 mmol/l)
    • 1-hour blood sugar > 180 mg/dl (10 mmol/l)
    • 2-hour blood sugar > 155 mg/dl (8.6 mmol/l)
    • 3-hour blood sugar > 140 mg/dl (7.8 mmol/l)

You’ll find that various expert panels have proposed different criteria for the diagnosis. The National Institutes of Health in the U.S. published their consensus statement in 2013.

There’s no need for the screening test if a random blood sugar is over 200 mg/dl (11.1 mmol/l) or a fasting sugar is over 126 mg/dl (7 mmol/l): those numbers already define diabetes, assuming they are confirmed with a second high reading.  A random blood sugar over 200 mg/dl (11.1 mmol/l) should probably be repeated for confirmation.  Gestational diabetes can be diagnosed at the first prenatal visit if fasting blood sugar is 92 or over mg/dl (5.1 mmol/l or over) but under 126 mg/dl (7 mmol/l), or if hemoglobin A1c at the first prenatal visit is 6.5% or greater.

Women with diabetes in the first trimester have overt diabetes, not gestational diabetes.

Steve Parker, M.D.

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Narrowing Down Your Choice of Diabetes Drugs

Conquer Diabetes and Prediabetes

Metformin is the most-recommended drug for type 2 diabetes

We now have 12 classes of drugs for the treatment of diabetes. How does your doctor choose which ones to use?

It’s easy for type 1 diabetes: insulin. Type 2’s have more options.

Earlier this year I reviewed the American Diabetes Association’s Standards of Medical Care in Diabetes – 2014. A type 2 treatment algorithm therein mentions only six of the 12 classes. This gives you an idea of expert consensus on which drugs to use. The classes are biquanides (metformin), sulfonylureas, thiazolidinediones, DPP-4 inhibitors, GLP-1 agonists, and insulins. This is one reason you don’t see much use of bromocriptine and colesevelam.

The American Association of Clinical Endocrinologists also has a type 2 diabetes treatment algorithm, published in 2013. It also addresses prediabetes and overweight/obesity. You’ll see some of the other classes mentioned. You may find it confusing because of abbreviations.

Believe it or not, most doctors want to do what’s right for our patients. We want positive results that reduce suffering and death. Does Big Pharma influence the production of guidelines and individual physician drug choices? If I had to guess, I’d say yes. But I don’t have the resources to investigate that in any depth. I know without a doubt that if I recommend a drug and the patient has a bad outcome, it helps me win the malpractice lawsuit if I’ve recommended a guideline-approved drug. Other docs know that, and it’s one of many factors that influence drug choice. We also consider cost (if you bring it up), convenience, patient preference, what our local colleagues are doing, what other illnesses the patient has, potential adverse drug effects, etc. Click here for a summary of the various drug classes.

We don’t know the long-term adverse effects of many of these drugs. That’s why I favor doing as much as reasonably possible with lifestyle modification, such as diet and exercise, before stacking up multiple drugs. If you need drugs, and most with diabetes do, lifestyle modification can help you minimize drug use.

Steve Parker, M.D.

PS: My Conquer Diabetes and Prediabetes book is now available on Kindle and other digital formats.

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QOTD: Mark Rippetoe on Below-Parallel Squats

The below-parallel squat is the best exercise in the entire catalog for whole-body strength, power, balance, coordination, bone density, joint integrity, and mental toughness — good things to develop if you don’t have them.

—Mark Rippetoe

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