Tag Archives: Conquer Diabetes and Prediabetes

Long-Term Severe Carbohydrate Restriction Is Possible!

I got an email a few days ago from a blog reader, J.H. (I won’t give his name because I didn’t ask permission to publish his letter):

Dr. Parker — I’m a 65 year old male who has battled insulin resistance and pre-diabetes for many years. About 15 months ago I started pursuing a very low carb (20 grams per day) ketogenic diet, and my health has improved significantly. I’ve lost about 35 lbs (down from 265), and I have not found it difficult at all to stay on this regimen. You mentioned in an article (https://diabeticmediterraneandiet.com/ketogenic-mediterranean-diet/) that you don’t believe people can stay with it for more than 6 months and that most people can only last about two weeks. With all due respect, hogwash! I was fortunate enough to become a patient of Eric Westman at Duke, and he does an excellent job of teaching the ketogenic diet to his patients. Any overweight person should give it great consideration, and it’s just not that hard to follow.

Best regards, J.H.

My response was: “Congrats on a job well done! I wish all my patients had your discipline and commitment.”

I have great respect for Dr. Westman. He’s the c0-author of The New Atkins for a New You. I reviewed it in 2010. No clinical studies have compared the effectiveness of Dr. Westman’s diet to my Ketogenic Mediterranean Diet, which attempts to lasso the health benefits of the time-honored traditional Mediterranean diet while helping folks lose weight. The Ketogenic Mediterranean Diet is a key component of Conquer Diabetes and Prediabetes.

Steve Parker, M.D.

PS: You don’t have to know what ketogenic means to benefit from ketosis.

PPS: I have a non-diabetic version of the Ketogenic Mediterranean Diet for otherwise healthy folks who just need to lose a boatload of weight.

low-carb mediterranean diet

Front cover of book

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Please Help Keep This Blog Alive

You need a break. Enjoy.

I pay $3 to $12 to license many of the photos and diagrams here. I won’t steal someone else’s intellectual property.

Have you noticed how some blogs just fizzle out? No new posts for a year, then they’re gone?

One reason is that it costs money to maintain them. For instance, I pay WordPress $30/year to keep them from posting advertisements that would interfere with your reading pleasure. I also turn down many offers from marketers who will pay me for access to my audience.

The biggest “cost” of the blog is my time that it takes to write posts.

Steven P. Parker, M.D.

Steven P. Parker, M.D., in 2016

I hope you find my writing worthwhile and interesting. You’ll find information here, at no cost, that should improve your health and longevity. What’s that worth?

If you’d like to support the blog, the best way is to buy one of my books, or recommend one to your friends or relatives. The second best way is to post a review of the book at Amazon.com. Even a brief one. My books are at Amazon.com, Smashwords, and wherever fine books are sold.

I’d be grateful for your support. Your continued readership is also encouraging to me.

Steve Parker, M.D.

PS: I’m based in the U.S. but have lots of readers from the U.K., Australia, Canada, New Zealand, India, and Germany. I’m not sure how easy it is to get one of my paper books in those countries. Ebooks from Smashwords should be widely available.

 

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How to Eat Low-Carb at Fast-Food Joints

Laura Dolson tells you how over at About.com. For example:

Occasionally, you’ll see salads with other protein, but chicken is the mainstay of fast-food meal salads. Tips: 1. Skip the croutons, tortilla strips, and similar additions. 2. Be very careful about sugars in the dressing. 3) For best nutrition, look for salads with a mixture of greens, and a variety of vegetables. 4) Make sure the chicken is grilled, not “crispy fried”, or other chicken with breading.

On the Advanced Mediterranean Diet for non-diabetics, you have the option of:

  1. Traditional portion- and calorie-controlled eating, or
  2. Low-carb eating with the worlds’ first Low-Carb Mediterranean Diet

If you’ve read Conquer Diabetes and Prediabetes, you’re already familiar with #2.

Steve Parker, M.D.

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Meal Plans For “Conquer Diabetes and Prediabetes”

For both types 1 and type 2 diabetes, carbohydrate restriction is a great way to help control blood sugars and minimize the toxicity and expense of drug therapy. Here are some low-carb recipes from my book, Conquer Diabetes and Prediabetes.

These are Hass or California avocados (the other common one in the U.S is the Florida avocado)

These are Hass or California avocados (the other common one in the U.S is the Florida avocado)

Breakfast:  Steak and Avocado

4 oz (110 g) raw steak

1 California avocado, peeled, seeded, and sliced (136 g)

½ tbsp (7 ml) olive oil (optional)

salt and pepper

1 tbsp (15 ml) vinaigrette (see below) or commercial Italian dressing (regular, not low-fat, with less than 2 g of carb per tbsp or 15 ml)

Cook the steak over medium heat, adding half a tbsp (7 ml) olive oil at the start if desired. Salt and pepper to taste. Peel and slice a California avocado. Dress avocado with homemade vinaigrette or commercial Italian dressing. Salt and pepper to taste. Digestible carb grams: 4.

AMD VINAIGRETTE

Try this on salads, fresh vegetables, or as a marinade for chicken, fish, or beef. If using as a marinade, keep the entree/marinade combo in the refrigerator for 4–24 hours. Seasoned vinaigrettes taste even better if you let them sit for several hours after preparation. This recipe was in my first book, The Advanced Mediterranean Diet; hence, “AMD vinaigrette.”

Ingredients

1 clove (3 g) garlic

juice from ½ lemon (23 g or ml)

a third of a cup (78 ml) oil olive

2 tbsp (8 g) fresh parsley

½ tsp (2.5 ml)) salt

½ tsp (2.5 ml) yellow mustard

½ tsp (1.2 ml) paprika

2 tbsp (30 ml) red wine vinegar

Preparation

In a bowl, combine all ingredients and whisk together. Alternatively, you can put all ingredients in a jar with a lid and shake vigorously. Let sit at room temperature for an hour, for flavors to meld. Then refrigerate. It should “keep” for at least 5 days in refrigerator. Shake before using. Servings per batch: 3.

Nutrient Analysis:

Recipe makes 3 servings (2 tbsp or 30 ml per serving). Each serving has 220 calories, 2 g digestible carb, almost no fiber, negligible protein, 24 g fat. 3% of calories are from carbohydrate, 97% from fat.

Lunch:  Aguacate Cucumber Salad

5 oz (140 g) cucumber, peeled and sliced into rounds

1 California avocado, peeled, seeded, and sliced (136 g)

2 tbsp (30 ml) AMD vinaigrette (see above) or commercial Italian dressing described below

salt and pepper

dash of lime or lemon juice (optional)

1 oz walnuts

Mix the cucumber and avocado in a bowl with the AMD vinaigrette or commercial Italian dressing (regular, not low-fat, with 3 g or fewer carbs per 2 tbsp or 30 ml). Salt and pepper to taste. For extra zing, add a dash of lemon or lime juice. Enjoy the walnuts on the side now, or mid-afternoon as a snack. Digestible carb grams: 10.

Dinner:  Bacon Shrimp Salad

2 slices (15 g) pork bacon, cured, cooked (or substitute 2 tbsp (30 ml) commercial real bacon bits)

2 tbsp (30 ml) AMD vinaigrette (see above) or commercial Italian dressing as below

½ packet of tabletop Splenda

4 oz (110 g) fresh baby spinach

4 oz (110 g) cooked shrimp (Consider commercial pre-cooked, peeled shrimp to save time)

6 oz (180 ml) dry white wine

Cook two bacon slices over medium heat, then crumble or cut in to tiny pieces (or substitute commercial real bacon bits). Add a half packet of Splenda to the AMD vinaigrette or commercial Italian dressing (regular, not low-fat, with 3 g or fewer carbs per 2 tbsp or 30 ml), then mix. On a bed of fresh baby spinach, place the cooked shrimp, then top with bacon pieces and vinaigrette. Enjoy with 6 oz dry white wine. Digestible carb grams: 9.

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Yet Another Study Links Long Life Span to the Mediterranean Diet

…by Johns Hopkins researchers.

Six thousand Americans were followed over eight years, with attention to heart disease and death. Significantly lower death rates were seen in nonsmokers, and those maintaining a healthy weight, exercising regularly, and eating the Mediterranean diet. The more adherence to those healthy factors, the lower the risk of death

h/t Lyle J. Dennis, M.D.

Reminder: Conquer Diabetes and Prediabetes is now available on Kindle and other ebook formats. That’s where you’ll find the full Low-Carb Mediterranean Diet.

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Meal Plans For “Conquer Diabetes and Prediabetes”

For both types 1 and type 2 diabetes, carbohydrate restriction is a great way to help control blood sugars and minimize the toxicity and expense of drug therapy. Here are some low-carb recipes from my book, Conquer Diabetes and Prediabetes.

Breakfast:  Brats and Tomatoes

6 oz (170 g) tomato, sliced

2 tbsp (30 ml) AMD vinaigrette (see below) or commercial Italian dressing (regular, not low-fat, with 3 g or fewer carbs per 2 tbsp or 30 ml)

salt and pepper

2 pre-cooked bratwursts (about 2.3 oz or 65 g each)

6 tsp (30 ml) mustard (optional)

Dress the tomato slices with the vinaigrette, plus salt and pepper to taste. Heat 2 pre-cooked bratwursts as instructed on package. Use mustard on the brats if desired. Digestible carb grams: 8.

AMD VINAIGRETTE

Try this on salads, fresh vegetables, or as a marinade for chicken, fish, or beef. If using as a marinade, keep the entree/marinade combo in the refrigerator for 4–24 hours. Seasoned vinaigrettes taste even better if you let them sit for several hours after preparation. This recipe was in my first book, The Advanced Mediterranean Diet; hence, “AMD vinaigrette.”

Ingredients

1 clove (3 g) garlic

juice from ½ lemon (23 g or ml)

a third of a cup (78 ml) oil olive

2 tbsp (8 g) fresh parsley

½ tsp (2.5 ml)) salt

½ tsp (2.5 ml) yellow mustard

½ tsp (1.2 ml) paprika

2 tbsp (30 ml) red wine vinegar

Preparation

In a bowl, combine all ingredients and whisk together. Alternatively, you can put all ingredients in a jar with a lid and shake vigorously. Let sit at room temperature for an hour, for flavors to meld. Then refrigerate. It should “keep” for at least 5 days in refrigerator. Shake before using. Servings per batch: 3.

Nutrient Analysis:

Recipe makes 3 servings (2 tbsp or 30 ml per serving). Each serving has 220 calories, 2 g digestible carb, almost no fiber, negligible protein, 24 g fat. 3% of calories are from carbohydrate, 97% from fat.

Lunch:  Easy Tuna Plus Pecans

5-oz can (140 g) of albacore tuna

2 tbsp (30 ml) Miracle Whip Salad Dressing (or real, high-fat mayonnaise)

1 tsp (5 ml) lemon or lime juice

1 oz (28 g) pecan halves

Drain the liquid off the can of tuna then place tuna in a bowl. Add Miracle Whip Salad Dressing and lemon or lime juice. Mix thoroughly and enjoy. Eat 1 oz of pecan halves around mealtime or later as a snack. If you want to simplify this, forget the Miracle Whip and lemon; just use 1 oz (28 g) of commercial tartar sauce that derives at least 80% of calories from fat and has less than 3 g of carb per 2 tbsp or 30 ml. Digestible carb grams: 5.

Dinner:  Ham Salad

2 oz (60 g) cooked ham, cut in to small cubes

1 oz (28 g) celery, sliced and diced

1 oz (28 g) seedless grapes (about 4 grapes), cut into small chunks

1 oz (28 g) walnuts, coarsely crumbled

4 oz (110 g) romaine lettuce

3 tbsp AMD vinaigrette or commercial Italian, French, or ranch dressing having 2 or fewer grams of carb per 2 tbsp or 30 ml)

Lay out a bed of lettuce then sprinkle these on top: ham, celery, grapes, walnuts. Finish construction with AMD vinaigrette or commercial dressing. You’re done. Alternatively, substitute cooked chicken or steak for ham. With chicken, apple may work better than grapes. If having a glass of wine (6 fl oz or 180 ml) with meal, delete the grapes or the carb count will be too high. Digestible carb grams: 10.

(When commercial dressing is used, the digestible carb count is closer to 13 than 10 g.)

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E-mail Interview With a Low-Carb Friendly Dietitian

Conquer Diabetes and Prediabetes, Steve Parker MD

Brain food that won’t spike blood sugars

I received an email from a registered dietitian (FS) in May, 2013. She had some reasonable questions for me and I thought you might be interested in my answers. Here’s her email first:

So funny that you happened to comment on my blog post today because I’d already planned to email you. I’m writing an article on low-carbohydrate diets for Diabetes Self Management magazine and was hoping to ask you a few questions about your experience treating your patients with the Diabetic Mediterranean and Ketogenic diets. We could do it via e-mail if you like. What I’d really like to know is how many of your patients were/are successful in sticking to the diet long term and what type of feedback you’ve received from them, along with any other information you feel is pertinent. Also, what carb range to you recommend for your diabetic patients?

My response:

Dear F,

First, let me explain a little about my medical practice. I’m a full-time hospitalist, meaning I treat adult patients only in the hospital setting. Nearly all of my patients come in through the emergency department. I treat a great variety of problems, like pneumonia, heart failure, cellulitis, pancreatitis, urinary tract infections, headaches, strokes, GI tract bleeding, cholecystitis, altered mental status, out of control diabetes, etc. My training is in Internal Medicine.

By the way, I work in Scottsdale, Arizona, which is a fairly sophisticated and affluent community. My two hospitals employ some dietitians who receptive to very-low-carb eating.

As it turns out, 30% of my hospitalized patients happen to have diabetes, at least 95% of which is type 2. This is typical for non-pediatric hospitalists. Nearly all of these diabetics have an established diagnosis of diabetes and a relationship with an outpatient doctor who is treating it. I usually ask them, “Are you on any special diet, or do you pretty much eat whatever you want?” Half of them say “nothing special; I eat what I want”! Three out of 10 respond that they “avoid sweets and desserts” or something similar. One or two of every 10 report they make a strong effort to reduce carb consumption below the usual American level (250-300 g/day). No more than five of every 100 has ever heard of Dr. Richard Bernstein’s Diabetes Solution. (I consider Dr. B the founder and leader of the modern carbohydrate-restricted diabetes diet movement.) No more than one of every 100 follows Dr. Bernstein’s or a similar very-low-carb or ketogenic diet.

Once these patients leave the hospital, I cannot follow them in a clinic setting. I wish I could. I see many of them in the hospital only once, which is not much time to develop a trusting relationship. Perhaps surprisingly, I don’t often do a “hard sell” for a low-carb diet, even though that’s what I’d follow if I had diabetes of either type. People have to be ready to make a change in hard-wired eating behavior, like an alcoholic is ready to quit drinking only when he’s hit “rock bottom.” For someone with diabetes, that rock bottom point is typically at the time of initial diagnosis or when a major complication hits (such as neuropathy, kidney impairment, or retinopathy). They’re more receptive to change then. All of my hospitalized diabetics get a business card referring them to my Low-Carb Mediterranean Diet website (Diabetic Mediterranean Diet).

Since I have no outpatient clinic, I have no way of knowing how many of them adopt a low-carb way of eating. I do get unsolicited emails from diabetics who have adopted the Low-Carb Mediterranean Diet or Ketogenic Mediterranean Diet, and they report satisfying results with weight management and glucose control. Problem is, as mentioned, I don’t know the denominator. Not once in two years has anyone ever contacted me to report they were harmed by the diets or that they didn’t help at all with glucose control.

I’m convinced you can get good nutrition eating low-carb and very-low-carb. By “low-carb,” I mean under 130 g/day, and “very-low-carb” is under 50 or so. An added benefit for diabetics is that they may be able to avoid the cost and toxicity of some diabetes drugs. We have no long-term toxicity data on most of our diabetes drugs. (Insulin and metform are safe long-term.)

Whether a diabetic goes with Dr. Bernstein’s, my Low-Carb Mediterranean Diet, or Dr. Atkins’ Diabetes Revolution, I think they’re going to be better off over the long run compared to eating a typical “diabetic” diet that has 200+ grams of net carbs. Of course, I have no hard proof. We may never have it. Of those who choose LCMD, I have no data on how many of them actually follow it long-term. Hey, I finally answered one of your questions!

If one of my diabetics prefers to eat Bernstein or Atkins-style over my program, I have no problem with that at all. (The Atkins program recommends some nutritional supplements that I’m not convinced are necessary or even minimally helpful.)

How many diabetics stick with a carb-restricted diet (e.g., under 130 g/day) long-term, more than 2-3 months? My guesstimate is only two or three out of ten. The problem is that we live in a highly carb-centric culture: temptation abounds, we form firm dietary habits in childhood, carbs are cheap, and, frankly, many taste very good.

Incidentally, I don’t have diabetes but I strive to keep my digestible (or net) carbs in the range of 60 to 80 grams/day. The carb restriction helps me control my weight, and I’m seeing some preliminary evidence that it may help with prevention of dementia and mild cognitive impairment.

The long-term carbohydrate intake range I recommend for diabetics is 60-80 g of net or digestible carb daily. Twenty or 30 g/day (a la Bernstein or my Ketogenic Mediterranean Diet) can help overweight diabetics lose the excess fat a little quicker and easier. But 30 d/day over the long run is extremely difficult for all but the most highly motivated. If I had type 1 diabetes, I’d give 30 g/day a serious try, like Dr. Bernstein. Competitive endurance athletes may need more than 100 g/day. Some mild type 2’s may be able to adequately handle over 80 g/day depending on degree of residual pancreas beta cell function. It bothers me to see a type 2 diabetic taking 4-5 diabetes drugs just so they can control diabetes while eating a high-carb diet (e.g., over 200 g/day). Again, we don’t know the long-term effects of most of these drugs.

I’m sorry for being so long-winded! I hope this helps. Email me soon if you have more questions and I’ll respond w/in 24h. Or call me at xxx-xxx-xxxx. Please keep up the good work. In turn, I’ll keep doing my little part to turn around this carb-centric culture. At least until the science dictates otherwise.

Sincerely,

-Steve

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