When You Have to Stay Low Carb Forever
Strategies for People With Diabetes
Low Carbing to Control Blood Sugar is Different From Low Carbing to Lose Weight
People who adopt a low carb diet to lose weight tend to start out with great enthusiasm, adapt extreme dieting strategies, swear they will never eat another piece of bread or french fry for the rest of their lives, lose some weight, stall out, burn out, and slink back to their old diets, where they gain back all the weight they lost and more.
This is not a surprise. People on any diet, including low calorie and low fat, do the same thing. The body is very resistant to weight loss and deeply buried instincts in our brains do everything they can to maintain our weights, no matter how unhealthy they might be.
But while this pattern of dieting may be tolerable for those who are dieting to shed a few pounds before their class reunion, it spells disaster for those who must change their diet in order to prevent the high blood sugars that result in amputation, blindness, kidney failure and heart attack death.
Low carbing for diabetes means low carbing for life, long after the thrill has worn off of eating that runny brie and steak. Despite the hype in the diet books, it is not easy, simple, and fun. I know only a handful of people who have been able to sustain a low carb lifestyle for more than five years. And that is after years of online participation in low carb groups.
What you'll find below is what I've found works for me. I've been low carbing to control blood sugar for more than five years and have gone through the whole cycle, from enthusiasm, to boredom, to burnout, to saying "To hell with it, we've all got to die some time!" to starting all over again determined to avoid the mistakes that sent me round the bend the first time. It is from that background that I offer the following suggestions with the hope that they might be of use to other people with diabetes who are embarking on the same path.
Don't Create "Forbidden Foods"!
If you are one of those people who could live happily on Purina People Chow, you can skip what follows. But if food has been important to you, and if you have hitherto had a long and emotionally satisfying relationship with food, or if, like me, baking from scratch was one of your favorite ways to show love and express creativity, low carbing will mean that a whole lot of what you've been eating (and baking) up until now is suddenly, completely, off limits.
Most people deal with this in the enthusiasm of the first weeks or months of low carbing by coming up with new recipes, finding new, delicious and healthy things they can substitute for old, high carb standards, and appreciating how low carbing curbs their hunger and makes food much more manageable. This is good and is why long term low carbing is possible. But our old favorite foods do not go away that easily.
If you decide that some food you have been eating and enjoying all your life will never cross your lips for the rest of your life, it is almost 100% guaranteed that you'll end up pigging out on that food at some time in the future, hating yourself, and even beginning a binge that can throw you completely off the diet for months.
It might not happen the first month you are dieting, or even the first year. It took me three years of low carbing to get to where I crashed off my stringent low carb diet. But it happens, and since getting back into a low carb lifestyle a year ago I've put a lot of time into finding a way of doing a low carb diabetic diet in a way that would avoid the buildup those feelings of deprivation that eventually lead to long periods of unwise eating.
Do the Diet Straight for a Month or Two Before You Try Off-Plan Goodies
You will need to cut carbs way down for a month or two to get your blood sugar under control. You'll also need a long stint of pure low carb eating to learn how to eat this way at home, in the workplace, at restaurants, and when visiting.
If you attempt to add in off-plan foods before you are solidly on-plan you may never really get into the swing of the low carb diet and may not get to where your body learns to enjoy lower carb foods.
But after you've gotten the hang of the low carb diet, and after you've gotten your blood sugar under control, nothing horrible will happen if you make room for a small portion of some high carb treat every now and then.
Adding Off-Plan Foods to the Plan
If you've avoided bread for a couple months, the humble roll in that restaurant bread basket may start to call out to you with an irresistible siren song. If you give in and eat it, with each bite you may find yourself feeling as if you are doing something incredibly sinful--the way you might have felt if you had eaten a whole box of chocolates in the past.
That feeling is the sign that you're heading for trouble. You've created a "forbidden fruit" and sooner or later it's going to get you. You may find yourself thinking about that roll, craving another, sneaking off to eat one where nobody knows you, or, alternatively, declaring you will never again eat a roll ever--and then ruining the holiday for yourself when you go to Aunt Glenda's on Thanksgiving and have to turn away from those wonderful rolls of hers you've eaten every year of your life.
It is far better to make a bit of room in your diet for high carb treats so that they don't build up a charge. If you do this, you'll find that they almost never taste as good as you remembered, and you'll be able to leave them behind without turning them into an object of obsession.
Just knowing that you can eat some specific off-plan food at some future time, when it is scheduled, makes it that much easier to say, "No thanks" to it and maintain your healthy blood sugar the rest of the time.
How Often Can You Eat Off-Plan?
How often you have an off-plan food depends a lot on your dietary goals, how high your blood sugar is before you eat carbs, and whether you are willing to exercise after a carb-up. Whatever I eat, I try to keep my blood sugar below 120 mg/dl at 2 hours after any meal.
Forty minutes of cardiovascular exercise will burn off a lot of extra carbs, so if I have to eat something seriously carby, I try to do it before I head for the gym or else I keep the portion small enough that my blood sugar does not go over 140 mg/dl at one hour.
If you're trying to lose weight, you may have to keep off plan treats few and far between. When I was actively losing weight I ate one off-plan meal about once every two weeks.
Once I reached my weight loss goal I loosened up a bit but I've found it best to cycle between weeks of eating a strict very low carb diet, and then a week of eating slightly more carbs--but at this point I almost never eat anything that would cause my blood sugar to be over 120 mg/dl at 2 hours after a meal because doing so makes me feel rotten.
Throw Away the Vocabulary of Self-Destructive Dieting
When you eat something with carbs in it, it is not a "cheat." Cheating is what you do when faced with an authority figure--your 9th grade math teacher or the IRS. But you are the one in control of what you eat. So when you eat something that is off-plan, you should stop thinking of it as "getting away with something" and treat it instead as something you've decided to do--for a reason that should be clear to you while you do it.
If you keep eating things that were not what you had intended, rather than beating yourself up it's time to reconsider your food plan and figure out why it isn't working. Are you having trouble finding low carb foods in restaurants? Maybe it's time to bring your lunch along to work for a while, or to find new place to dine. Are you bored with what you have been eating? Google the alt.support.diet.low-carb newsgroup for recipes. Does your spouse keep bringing home carby foods you end up eating? Maybe you didn't explain why you are eating this way clearly enough. Or maybe you are eating too much protein and it is causing bad breath.
Keep the vocabulary of sin and guilt for the confessional. You're going to eat a lot of things in the years to come that mess up your blood sugar. But if you are kind to yourself and dust yourself off after you mess up and keep going, you may very well end up healthier than many people who do not have diabetes because you'll be doing the best you can to preserve your health day after day after day.
Know What You've Eaten and What It Did
Track How Many Grams You Ate
I find it a lot easier to stick to any food plan when I track my food intake using diet software (I use LifeForm ) because that way I avoid "carb creep" and keep in touch with what I'm actually eating. When I tracked my food intake over a period of many months of maintaining my weight loss, I found that my average daily carbs stayed around 60 grams a day (after deducting fiber) though the daily amounts varied from 40 to 122 grams (with very few days at the higher level.) By having a record of what I ate, I could usually explain any blood sugar rises.
Most importantly, when I tracked my intake this way, when I saw a blood sugar rise that did not map down to what I'd eaten in the past couple days, I was able to identify medications that were having a negative or positive effect on my blood sugar and I was also able to see my body fighting off viruses I did not yet know I'd caught. (Before you get a cold, your blood sugar will go up!)
Use Your Meter
If I eat something that is going to raise my blood sugar, I make sure I use my meter to test. It keeps me honest. There's nothing like seeing 210 mg/dl right there on your meter when you "only had a little bite" of Aunt Sadie's pecan pie to take the appeal out of doing it again! Test whenever you have any food with carbs in it. Some of them will have a much higher impact on your blood sugar than you expect. One of the worst blood sugars I've seen this past year came after eating 1/4 of a cantaloupe! I also test my fasting blood sugar every couple days. If it starts creeping up, it's either a sign that I've gotten too lax with my after dinner snacking or else it points to some problem with a new medication.
Use Portion Control
One dinner roll is only about 20 grams. Half a roll will fit into most low carb plans without causing much damage. One ounce of whole wheat bread is also not likely to be too damaging to your blood sugar, but a six ounce sub roll is!
If you are yearning for a chocolate chip cookie, measure off a one ounce serving and toss the rest away. A typical coffee house chocolate chip cookie weighs six or seven ounces and may contain over 100 grams of carbohydrate. A small piece of that cookie--one ounce--can give you the taste of the cookie without sending your blood sugar up to 300 mg/dl. By the same token, if you crave some real pizza eat only a portion of the crust of one slice, then just eat the toppings of the rest. Think of the "free samples" they give out in supermarkets and keep your serving to that size if you have to eat something off plan. And always count the carbs so that you know what you are doing to yourself!
Know Your Limits
I've learned the hard way I can't eat half a blueberry muffin, so I don't even try portion control for that particular food. I know it's trouble and I know that I will eventually eat one. That's just how it is, so every blue moon or so I eat a blueberry muffin, experience the miserable high blood sugars that follow, and remember why I don't eat muffins every day anymore. What I don't do is fool myself that I can buy a muffin and only eat half. Everyone has a few foods that fall into this category. Treat them with caution!
Eat Off-Plan Foods Out of the House
I've learned the hard way that if a big box of something I like that is full of carbs is in the fridge, bad things are going to happen. So I eat my off-plan foods away from home. I eat my muffins or cookies at a coffee house. I have a slice of pizza at a pizzeria. I don't buy a box of muffins or a whole pizza and bring them home.
Getting this strategy to work requires that your whole family understand what's at stake. It took me a couple years of harping on what "complications" means, but by now, my family understands that if my blood sugar is too high, I'm damaging my body. They want to keep me around for a while, so they understand that there are some foods that can't be brought into the house--ever.
When other family members want to have treats at home, they are kind enough to buy things I don't like. For example, if someone wants Ben & Jerry's they buy the Chunky Monkey flavor that I find revolting, not the New York Fudge. By the same token, I don't buy the kids the brands of cookies I can't resist. There are plenty of others that they like fine, that don't tempt me at all.
My whole family's health and fitness have improved after five years of having no potatoes, bread, or rice served with homemade meals. They can eat them elsewhere or cook them themselves. I do buy bread but, again, not my very favorite kind. Over the years they have come to understand that no one is doing themselves a favor scarfing down 300 grams of fast acting carbohydrate every day--particularly not people with a family history of diabetes and heart disease!
Medications Can Help
I'm not a big fan of medications because I've learned the hard way that drug companies lie about side effects and some of them are permanent and can ruin your life. But I have found it very helpful to keep a supply of Precose (Acarbose) handy for those times when I'm going to go over my 15 grams per meal limit. This prescription drug blunts the ensuing blood sugar spike so that when I do overdo it, I don't murder what's left of my beta cells. What's nice about Precose is that if you use it for more than a few meals, you start developing digestive symptoms that quickly remind you of why you don't want to live on the stuff.
Be Aware of Rising Insulin Resistance
After a long stint of low carbing, I suddenly started gaining weight and feeling rotten while my fasting blood sugar started to rise. A visit to an excellent endocrinologist who tested my C-peptide levels revealed that my insulin production was much higher than it should be for the level of carbohydrate I was eating. She put me on Metformin which stopped the weight gain cold, dropped my triglycerides, and allowed me to eat at a slightly higher carb level. Coincidentally, I discovered that Dr. Bernstein's new edition of "Dr. Bernstein's Diabetes Solution" recommends Metformin as an appropriate drug for patients on a low carb diet whose blood sugars are still not completely controlled. It isn't a cure by any means, just one more tool you can use to keep blood sugars under control. Even with this drug, I still have to watch my carb intake, however it appears to be lowering my insulin resistance.
So there it is: give yourself some room to be human, keep aware of what you are eating and what it does to your blood sugar, keep focussed on maintaining your blood sugar control at truly safe levels. Good control can keep you alive for a long, long, time--so it's worth working out a long-term way of eating you can live with!
http://www.geocities.com/jenny_the_bean/diab-diet.htm 
When You Have To Stay Low Carb Forever: Strategies for People With Diabetes 
Gracias!
