Bread and Fruit or not?

[tdstiayw]

Hello. I'm new to the site.

My doctor said that I am borderline Type 2. He gave a simple diet to follow: no bread, no fruits, lots of veg, and lean meats and fish. Dairy is also OK.

He also sent me to a dietitian. She put me on a diet w/ quite a few carbs and fruits. I'm confused. With the doc's diet I lost weigh immediately. With her's I began gaining weight.

What do I do?

[jenb]

Sounds like the dietician subscribes to the American Diabetes Association dietary guidelines and your doctor does not.

If you read the posts here you'll find that (generally) this group agrees with your doc. Cut out the starchy, bready carbs like rice, potatoes, corn, most grains etc.and load up on yummy low carb veggies. Dairy products are good, but watch for carbs in low fat versions. As for fruit, I think most people will agree that it's great in limited quantities, especially berries. You can test to see which fruits and in what quantity have the least impact on your blood sugar by eating some and testing you BG an hour later. If your glucose level rises excessivily, either reduce the quantity or eliminate that particular fruit from your diet.

In my opinion, if you think you've been advised to include too many carbs in your diet, follow your gut instinct and cut back. With diabetes you'll find you feel better if you take the reigns, learn all you can about how various foods affect you, and make the adjustments that make sense to you ;). Never forget that you're in charge!

Jen

[tdstiayw]

Sounds like the dietician subscribes to the American Diabetes Association dietary guidelines and your doctor does not.

If you read the posts here you'll find that (generally) this group agrees with your doc. Cut out the starchy, bready carbs like rice, potatoes, corn, most grains etc.and load up on yummy low carb veggies. Dairy products are good, but watch for carbs in low fat versions. As for fruit, I think most people will agree that it's great in limited quantities, especially berries. You can test to see which fruits and in what quantity have the least impact on your blood sugar by eating some and testing you BG an hour later. If your glucose level rises excessivily, either reduce the quantity or eliminate that particular fruit from your diet.

In my opinion, if you think you've been advised to include too many carbs in your diet, follow your gut instinct and cut back. With diabetes you'll find you feel better if you take the reigns, learn all you can about how various foods affect you, and make the adjustments that make sense to you ;). Never forget that you're in charge!

Jen
Thanks for the great advice. It's very encouraging to have a forum like this one.

[mazea]

Nutritionists often recommend carbohydrate low fat diets which make it impossible to lose weight/gain weight. I've heard a few stories like yours. My nutritionist gave me the opposite problem- I couldn't stop losing weight because I was eating 165g carbs a day and eating low fat foods(under 15g). 3 months later after this diet, I had lost 3 kg and was underweight so I decided to ignore much of the advice.

It's not the type of carbs you eat so much as the amount of carbs (carbs especially in my opninion) and fat you eat that put on weight.

High GI foods like sugar put put your blood sugar up the same amount as low GI foods like milk, but hi GI foods put your blood sugar up faster. It is better for diabetics to put blood sugar up slower. Banannas are very low GI and great for diabetics to eat.

I cheat:) . I can have sugar without a spike if I have 15g fat with it because fat makes the carbs absorb slower. I can have bread as long as I have a slice of 5g fat cheese with it.

Apart from recommending a second opinion from a nutritionist and informing them that you are having problems with weight, have you tried carb counting?

[tdstiayw]

Nutritionists often recommend carbohydrate low fat diets which make it impossible to lose weight/gain weight. I've heard a few stories like yours. My nutritionist gave me the opposite problem- I couldn't stop losing weight because I was eating 165g carbs a day and eating low fat foods(under 15g). 3 months later after this diet, I had lost 3 kg and was underweight so I decided to ignore much of the advice.

It's not the type of carbs you eat so much as the amount of carbs (carbs especially in my opninion) and fat you eat that put on weight.

High GI foods like sugar put put your blood sugar up the same amount as low GI foods like milk, but hi GI foods put your blood sugar up faster. It is better for diabetics to put blood sugar up slower. Banannas are very low GI and great for diabetics to eat.

I cheat:) . I can have sugar without a spike if I have 15g fat with it because fat makes the carbs absorb slower. I can have bread as long as I have a slice of 5g fat cheese with it.

Apart from recommending a second opinion from a nutritionist and informing them that you are having problems with weight, have you tried carb counting?
The dietitian has me on 105 grams of carbs a day, plus 2 fruits of my choice. Add to that unlimited vegetables.

Haven't figured out how many calories that is total. I'm supposed to be on 1800 cals a day.

In any case, I find it a harder diet to follow than my doctor's advice.

The doc said that sugar from carbs is my problem. If I can limit those, then my blood sugar re-enters the normal range.

I'm going to go see the doc and see what he thinks. He was adamant about cutting out bread, starch, etc. Truncal obesity is a problem also. Thankfully everything else about my health is A1.

(I'm a male in my mid thirties and overweight with a desk job. I do manage around 7000 steps a day and walk 30-45 mins a day as well.)

[sumi]

Hi td, welcome
As you can see already, diabetes is very individual. Some people eat more carbs, some less. If what your doctor suggests feels right for you, you are losing weight and your bgs are improving, it sounds like you have it made!

[mazea]

Some vegetables have carbs in them. Potatoes has 15g carbs per 70g potato. Corn has carbs too. A piece of fruit roughly 15g carbs per orange or apple or small bannana. So your 'other' carbs could add up to 60g a day very quickly.

[jps]

In talking with a few dietitians in my line of work, they all seem to subscribe to the ADA guidelines for diabetics. My PERSONAL OPINION is that it is waaaaaay too carb heavy. In fact, with my first counseling with one, she was impressed with how quickly I normalized my sugars. She saw the log and saw that the overwhelming majority of the diet was fats and proteins. And of the 60g of carbs I did allow daily, they were of the low GI variety carbs. That meant no bread, no pasta, no peas, no corn, no potatoes, no rice. Then she chimes in that I need to add alot more grain and potato to my diet.

That's when we got into an argument about what I was going to eat. I simply would not follow her plan at all, I figured my own was working for me, that her thinking was ADA based and "outdated".

I think it's more of a matter of what works for you individually. I decided to go somewhat extreme at first (lower than 60g carb per day) and figured I could modify it after a few months if it was too forgiving or not forgiving enough. Turns out it was just right and I've since been able to increase the carbs a bit after a lot of weight loss via the low carb route.

[Ronin]

Tdstiayw, et al.,

Dietary advice is all over the place, and they have differnt goals. Clearly your MD wants you to reduce your carb intake, the dietician wants you to eat a "healthy" diet. The proper diet for you will be somewhere in-between the two.

What I've learned is that the timing and placement of carbs, as well as the type of carbs makes a juge difference. Keep in mind that I'm one of the Pre-D's so my pancreas does work (albeit at the low end of the normal scale) and I exercise a lot so I do burn carbs efficiently.

I have studied and determined the windows where I can eat moderate GI carbs without causing dramatic spikes in BG levels. For me that is within and hour before or after a bicycle/tandem ride. (Note the "or" -- that is an or, not "and") Sometimes if I know I'll be doing a very long ride, I'll carb-up prior to the ride but I usually go for the post ride carb boost.

The key to this is testing yourself often with a log that will (eventually) show you the coorelation between what you eat and do and your BG levels.

Finally, diet alone isn't going to help. You must, and I mean must, get active as in "exercise" -- doing some physical activityt that you like daily if possible that gets you breathing harder than normal, makes you sweat a bit, and builds muscle tissue. This also drives weight loss and strangely enough, allows you to consume more carbs.

[jenb]

Some vegetables have carbs in them. Potatoes has 15g carbs per 70g potato. Corn has carbs too. A piece of fruit roughly 15g carbs per orange or apple or small bannana. So your 'other' carbs could add up to 60g a day very quickly.

Just to clarify....all vegetables, fruits, grains and some dairy products contain carbohydrate. For diabetics, the challenge is to find the carb sources that cause the minimal need for insulin. Generally that means reducing your intake of sources of starchy and/or sugary carbs and concentrating on the higher fiber, lower glycemic index cohort.

Jen

[foxl]

Well it is an oversimplifaction, and some times you should eat even the higher-carb things -- like bananas, in smalle portions.

But for the most part, I kind of do follow that rule.

[sanflan]

Bread is especially hard for me, it sends my blood sugar way up. I have better luck eating apples.... that is just me. You can test and see how you respond. I have adopted the philosophy that if God made it you can eat it, but if man made it beware.

My son, who is type 1, said he never met a dietician who was thin. This might be an exageration, but I have never met a dietician who didn't believe in low fat, high carb. I would follow my doctors advice if I were you, he knows how hard it is to control this disease.

[xMenace]

There's many more plusses to your doctor's plan than your dietician's. In my opinion reducing or eliminating grains is a must. I feel fruit has too many benefits to eliminate completely. You can find more sugar friendly fruits like berries and apples (YMMV). (?) are assertions I can't find absolute proof for [to my satisfaction].

Doc
- lose weight
- lower triglycerides
- lower VLDLs
- lower CHD risk (?)
- lower BP
- lower BG
- lower overall cancer risk(?)
- lower risk of complications(?)

Dietician
- more energy (?)
- better mental performance (?)
- lower bowel cancer (?)

[jenb]

Well it is an oversimplifaction, and some times you should eat even the higher-carb things -- like bananas, in smalle portions.

Ha, no kidding! There is so much to talk about on this topic that we could write volumes on it, no? Hopefully I covered eating things like bananas (and bread too) by saying that we need to minimize the amount in our diets, not eliminate these foods. I love a good starchy carb as much as the next guy (or gal):D.

Jen

[tdstiayw]

Thank you all, once again, for the great advice.

My doc is getting back to me in a day or two with his thoughts on the dietitian's diet plan. Until then, I am splitting the difference between the two diets and watching what I eat.

Any thoughts on multivitamins or on PGX?
Polyglycoplex - Wikipedia, the free encyclopedia (http://en.wikipedia.org/wiki/Polyglycoplex)

I take a multivitamin everyday but no other supplements. I also drink whey protein isolate once or twice a day.

Any experience with high quality whey?

[mazea]

All vegetables do contain gross carbs in the forum of fibre, But many vegetables do not the have net carbs, which are the carbs that put your blood sugar up. I can eat as many Carrots, peas broccoli and pumpkin as I want and my blood sugar won't budge. In fact I had insulin once for pumpkin soup counting the carbs and ended up having a severe hypo because all the carbs were empty fibre carbs which don't put blood sugar up(in some diabetics anyway).
Although this is different for everyone. Different diabetics react to foods differently. I have heard that some diabetics react differently to carrots than others. You are best to do your own tests. Good luck with your diet anyway.

[tbach]

After my heart attacks and stent implant at age 62, I was told that I had to exercise, adopt low fat diet and lose weight . . . my life depended on it. Over 18 months, I shed 65 pounds - 10 inches from my waist. That was due to lots of exercise - 12-20 hours per week, and careful low fat diet - under 20% fat (as little saturated as possible), 30% protein and 50% carbs.

It was working for me, but my fasting blood glucose levels were still over 100. When I asked my doctor, he said to keep exercising - I was doing okay. Over the past couple of years I developed a pattern of almost comatose sleepiness mid-afternoon and early evening. Cardiologist had no idea/regular doctor had no idea/even the new endo I finally found (mainly to assist in testosterone replacement therapy program) could not address my afternoon "crashes." He did tell me that with my past blood test history, my age, low testosterone and sleep apnea, it was quite likely that I was insulin resistant. He started me on 1000mg of MetforminER and sent me home. After a few shocked responses from diabetes forums, from other medical people in my life and from my daughter, who is diabetic and controlled with diet and oral meds, I finally called my endo back and requested a glucometer and testing supplies.

Surprise, surprise. Frequent testing revealed that my glucose was still pretty high 2 hours after meals . . . and higher than it should be almost every afternoon (high 150's, 160's)!!! Cowabunga! I'm lucky - taking some high glycemic foods out of my daily diet - like raisins, white bread, potatoes, pretzels (and the list is growing, thanks to continued testing) - has brought my waking level <100, post exercise <90, mid-afternoon and after meals 100-110. I'm still tired in the afternoon - I am very active - but I'm no longer pseudo-comatose. By the way, it was a forum member who brought my attention to the fact that sleepiness/exhaustion is often one of the signs of a glucose "spike."

So if I were to clock in on the low fat/low carb controversy, my experience is that low fat diet is essential to healthy weight loss (especially if you have high cholesterol and/or coronary problems), but only by severly limiting high glycemic foods am I able to keep blood glucose at healthy levels. This is especially important to me because current thought connects glucose spikes with inflamation, which aggravates coronary disease.

And I agree that you have to find your own path through this new territory - our bodies are different and respond differently. Our job is to discover what works and stay the course.

[tdstiayw]

I am coming to realize how individual diabetes is.

The doc agreed with me and said that I should emphasize to the dietitian that the main idea is to control blood sugar (in my case). Weight loss is a desirable side effect but it is not our primary focus. He also thought the carb intake was a bit high...

Looks like I still have more to learn.

[matingara]

So if I were to clock in on the low fat/low carb controversy, my experience is that low fat diet is essential to healthy weight loss (especially if you have high cholesterol and/or coronary problems),

this may be true for you.

but the only way i have been able to control my bgls AND my cholesterol AND my triglycerides is by adopting a Low Carb diet where i do not even worry about the amounts of fat and protein that i eat.

:)

-- Joel.

[fgummett]

...Over 18 months, I shed 65 pounds - 10 inches from my waist. That was due to lots of exercise - 12-20 hours per week, and careful low fat diet - under 20% fat (as little saturated as possible), 30% protein and 50% carbs.

It was working for me, but my fasting blood glucose levels were still over 100. ... Over the past couple of years I developed a pattern of almost comatose sleepiness mid-afternoon and early evening. ...

Surprise, surprise. Frequent testing revealed that my glucose was still pretty high 2 hours after meals . . . and higher than it should be almost every afternoon (high 150's, 160's)!!! Cowabunga! I'm lucky - taking some high glycemic foods out of my daily diet - like raisins, white bread, potatoes, pretzels (and the list is growing, thanks to continued testing) - has brought my waking level <100, post exercise <90, mid-afternoon and after meals 100-110. I'm still tired in the afternoon - I am very active - but I'm no longer pseudo-comatose.

Couple of suggestions: by increasing exercise AND changing diet you cannot say which of these was most instrumental in your weight loss.

Many of us have also experienced afternoon/evening sleepiness with high BGs but especially associated with high-carb food.

Fat is an important nutrient and energy source... we need it to survive. I also have greater weight loss, less hunger and improved cholesterol/lipids when eating a higher proportion of fat -- including saturated.

[GayleM]

Hello. I'm new to the site.

My doctor said that I am borderline Type 2. He gave a simple diet to follow: no bread, no fruits, lots of veg, and lean meats and fish. Dairy is also OK.

He also sent me to a dietitian. She put me on a diet w/ quite a few carbs and fruits. I'm confused. With the doc's diet I lost weigh immediately. With her's I began gaining weight.

What do I do?

You have been given a gift! The opportunity to take control of you BG before it takes control of you :-)

Being diagnosed "pre-diabetic" is a like being half pregnant, really. If you are "pre" your body is already NOT processing glucose normally and may never do so again. So my best advice is to pop over to T2 boards and consider yourself as diabetic. If you control your food choices as such you will go a long way to giving yourself more energy, better health and control over increasing complications. If you don't do anything at all, well...you know the story...chance of blindness, losing limbs or toes, heart problems, painful nerve problems...not good.

1. The first thing I did was research like crazy on my own to learn what is normal as those are the ranges I want to achieve and maintain. Get your numbers from your Doc if you don't have them already. What was your fasting BG number? Did they do an oral glucose tolerance test and what were those numbers? Did they do an A1C test and what were those numbers?

Conservatively, here's what's "normal" in those ranges:

morning fasting = 70-100
2 hrs after a meal = 70-145
any other random reading outside of the above times= 70-125

A1C numbers:
Percent: equals average glucose:
5% 100
6% 135
7% 170
8% 205

If you didn't get an A1C test, ask your Doc for one. Or you can also buy a home test at WalMart for $9. This will tell you what your average BG has been over the last 3 months. The goal is to get in the 5% club.

2. TEST!!! You need to get a monitor and strips to test your BG to see how your body reacts to different foods to know what will and won't work for you as far as food goes. Everyone is different and this is where docs & diaticians really fall short in their advice, generally. If your doc has prescribed you as "pre" he probably won't write a perscription for a monitor and strips, nor will your insurance company then pay for them. WalMart has the cheapest I've found - ReliOne monitor is $9 and 100 test strips are around $40.

Now, this is where many differ from what Docs ask for as far as the timing of testing...but it is critical for you to find your "peak" time after eating to know how much certain foods and carb totals affect you. To find your peak, for a few days test before each meal, then 45 min., 1 hour, 90 minutes. Keep track of the numbers on a spreadsheet along with a precise list of every morsel you take along with it's carb content. (and if you need to lose weight, record calories too)
Keeping those "normal" ranges listed above in mind, most diabetics want to keep their spike after eating to less than 30 or 40.

3. Keep track! Once you find your peak after eating a meal, keep track for a month of your fasting, after breakfast, after lunch & after dinner numbers. Try different foods and see how you react to them. Portion control is VERY important. Record the exact amounts you eat. Generally speaking, most of us try to keep around 20-30 carbs per meal and two snacks of 15 carbs or so. If you are very active pysically you will probably need more carbs at meals, but 45 is typically a top number. You may also find through your testing that you can tolerate carbs better at night than in the morning or for lunch. It's very common for carbs in the morning to be intolerable without spiking your BG to beyond normal limits.
THe goal is to keep from getting those very high spikes...that is a sign that your pancreas isn't handling the food well and it stresses your body.

Forget sugar content. Sugar is a carb and you only need to count the carb content because it already includes the sugar.

Using the "1 fruit + 1 carb" kind of diet that dieticians typically give us doesn't help your condition to any great extend. As you'll find, fruits can differ greatly in their carb content from one to another. And if you need to keep your carbs at 30 per meal to keep your BG from rising out of normal bounds, I sure as heck want to know exactly the amount of carbs I'm eating! "One diet fits all" doesn't work with us. If you need to lose weight, use one of the calorie/nutrition sites that are on the net to plan your menus. A typical total for a couple pounds a week (with daily work outs) is 1500 calories and 100 to 120 carbs a day. Go too low on your carbs and you go in to ketosis, which is unhealthy for you.

4. Exercise big time!! This and losing weight (if you need to) are two things that - along with controlling carbs you eat - may delay a type 2 diagnosis for years or enable you to avoid it all together. We're not talking a leisurely walk here, you want to do at least 30 minutes a day of something that produces a little hugging & puffing :-)

5. Keep testing periodically even after you find your peak, seem to have it under control and know what foods you can and can't eat. THe body can change its mind fast and suddenly your numbers can soar with foods that once were ok to eat.

Some general thoughts:
1. READ NUTRITION LABELS! Watch out for that "dairy is okay!" Much of it is NOT. Dairy products have lactose, and generally anything ending is "ose" is sugar. One cup of milk has 12 carbs in it!!! If you are on 30 per meal, that uses up alot fast. Cheese is low carb, but high fat. So while there are some low carb choices in the dairy family, the fat content can be scary and if you have cholesteral problems that has to be considered.

Fruit is a tough one as most have huge amounts of carbs, so learn what works for you through testing and looking up carb content. The only fruits I've found I can eat without spiking big time is a small apple, some cantelope or blueberries. Fruit contains fructose...remember the "ose" rule :-)

2. BE HONEST WITH YOURSELF. Measure what you eat, pay attention to the portions shown on the nutrition labels and record them accurately. THat is the only way you'll learn what you can and can't eat.

Alot of stuff to read and do, I know, but this is your chance to stem the tide!! It will become second nature to you and you will be armed to take control of your own well-being.

Good luck!

[GayleM]

this may be true for you.

but the only way i have been able to control my bgls AND my cholesterol AND my triglycerides is by adopting a Low Carb diet where i do not even worry about the amounts of fat and protein that i eat.

:)

-- Joel.

I envy you! Ignoring fat content doesn't work for me...I only could get my chol & tri under control with watching my fat intake. Recent studies have shown much of our ability to control cholesteral is pure genetics - and I'm on the wrong side of that track! :(

[tdstiayw]

I envy you! Ignoring fat content doesn't work for me...I only could get my chol & tri under control with watching my fat intake. Recent studies have shown much of our ability to control cholesteral is pure genetics - and I'm on the wrong side of that track! :(
Thank you, once again, for the great advice. Things seem OK for now. I'm going to get checked out again shortly.

[soso]

Hi tdstiayw

You could always conduct your own study.... do the docs diet for a month.. record everything.. including how you feel..
then do the dieticians for a month ..ditto....

I suspect that eventually you will find something between the 2 that satisfies you and is good for your body.. although I would be prepared to bet on a heavy shift toward your doc's advice...

[moereiss]

Gayle M,
Thank you for your most informative post. I've printed it out and will reference it often. Through much advise from this forum I have found that the ADA recommendation for total carbs per day on a 1000 cal. plan is 130 carbs. and is not the right fit for my body. I will begin more testing to find my "peak" after each meal. My DR only has me test each morning for FBG. Thank you again for helping me learn & regulate what to eat and what not to eat!