Don’t manage diabetes

Diabetes is reversible. That’s the exciting conclusion of a study I’m leading at Indiana University Health.

Two hundred and sixty-two patients with type-2 diabetes recently completed one year of a clinical trial examining the impact of a low-carbohydrate diet, which limits foods such as grains and pasta while boosting consumption of healthy fats such as avocados and butter. The diet didn’t restrict calories.

Using smartphone technology, health coaches worked with participants while physicians monitored and adjusted medications.

A control group of 87 patients with diabetes received the American Diabetes Association standard nutritional treatment.

A full 94 percent of patients on the low-carb intervention have been able to reduce or eliminate their need for insulin. For six in 10 patients, average blood sugar levels fell so low that, technically, they had reversed their diabetes.

These findings are promising for treating one of America’s deadliest, most expensive diseases.

Diabetes is a public health emergency. Thirty million Americans suffer from diabetes. The illness is the nation’s seventh leading killer, with serious side effects such as heart disease, kidney damage, limb amputation and blindness. Last year, diabetes cost the country approximately $327 billion in medical bills and lost productivity.

Despite this staggering cost, health experts have focused on managing the disease rather than reversing it. When patients consult the ADA website, they learn that “there is no cure for type 2 diabetes, but it can be managed.”

“Management” usually involves costly medications. Medical expenditures for people with diabetes total about $13,700 per year—double the figure for people without the disease.

Bariatric surgery, the procedure that helps people lose weight by stapling, binding or removing part of the stomach, has even become a “first line” treatment for obese individuals with diabetes. This procedure was once seen as a last resort, as it costs approximately $26,000 and one in six patients experiences complications. Yet in 2016, the ADA led 45 international diabetes organizations to begin recommending the surgery as standard treatment.

That’s misguided. Plenty of research—including our own—shows that dietary adjustments can curb diabetes. A 2017 study from University of California San Francisco found that 60 percent of diabetic patients put on a very low-carb diet were able to stop common medications for their condition at one year. A 2008 study found that 95 percent of patients on a low-carb diet either cut back on diabetes medications or stopped taking them entirely.

With conventional treatment regimens, according to a study in Diabetes Care, only 0.1 percent of patients achieve complete remission.

Nutrition-centric treatment was once the standard. In the 20th century, people with diabetes were told to avoid foods high in carbohydrates. That treatment fell from favor with the commercialization of insulin. Employing insulin, patients could again consume carbohydrates, and when the U.S. government launched its low-fat, high-carbohydrate advice via the dietary guidelines in 1980, those with diabetes fell in line with everyday Americans, eating bread and pasta with gusto.

Critics worry that low-carb diets are too difficult. But in our study, 83 percent of patients stayed with it. With individualized support, changing a grocery list is far less daunting than a lifetime of dependency on costly medications.

Sarah Hallberg, DO, MS, is the medical director and founder of the Medically Supervised Weight Loss Program at Indiana University Health and an adjunct professor at Indiana University’s School of Medicine.

Need to make it clear. That’s 30 net carbs per day which is sometimes written as NC in recipes. When reading recipes or nutrition labels on foods, subtract the fiber/dietary fiber grams from the carb grams to get the net carbs. Fiber is just flushed through your system so doesn’t count for anything.

Yeah, you’re going to have to give up cereal and apples.

Fruit is limited to berries. That 25 carb apple has about 4 grams of fiber so it’s 21 net carbs. Still too high but just showing you things aren’t as bad as you first thought.

Instead of a sandwich with bread, try a lettuce leaf wrap.

There are many recipes for lc “breads” but you’ll have to experiment to see which works for you. Some have an eggy flavor so I tweek the portions so it isn’t so eggy. “Oopsies” or “Revolution” is usually in the title for decent recipes. Most call for cream cheese and eggs which turn out ok when you just have to have a sandwich but don’t expect them to be like a slice of white/wheat bread. Most are formed into hamburger bun shapes since that’s the easiest because they’re made individually rather than a sliceable loaf. I don’t crave bread so haven’t made it in a while but do a search for Cleochatra’s Best Ever Revol-oopsie Rolls. Thinking that’s the one we like and it’s like 1 net carb so can’t go wrong!

I fashioned a square form for a square piece of sandwich bread. Take on old plastic milk carton and cut four strips 1/2” by 5” (I think that’s the measurements). Cut a slot in each end about 1/4” from the ends. Stand up the four pieces to form a square and secure them into the slots (like putting together cardboard furniture or a balsam wood toy plane). Spoon out the bread batter into it. Of course, remove it as plastic doesn’t bake.

There are many lc recipes for pancakes and sweet muffins but watch the carbs as some are higher than what you want.

A savory muffin is an easy way to use up leftovers for a quick grab breakfast or snack. General idea here: http://www.genaw.com/lowcarb/tuna_muffins.html or http://www.genaw.com/lowcarb/tasty_chicken_muffins.html . Another quick use for little bits of leftovers is a quiche. If there’s a man in your life, call them meat pies because men don’t eat quiche.

There are lc cracker recipes that are really great. Very artisan-y with different seeds, nuts and herbs.

Slice up lc crepes for noodles in your soup. Sure, it’s more time consuming than just dumping in some dried noodles but pasta is a no-no. Do a search (at Linda’s site I posted) for Nancy’s Easy Chunky Chicken and Vegetable Soup for the recipe. Those crepes/noodles can be used to bake any wrapped crepe you wish. Very versatile.

There are also many pizza crust recipes. Not exactly like your favorite local pizza place but they’re lc friendly. Most call for cheese and eggs but some use cauliflower.

Make friends with cauliflower. It is way more versatile than you ever thought. Fantastic substitute for mashed potatoes. Makes a great potato salad, hash browns, and “rice”. Yes, it’s not just for veggie sticks.

You want dessert? There are plenty of recipes but watch the carb counts and know you can’t eat the thing. Lots of lc cheese cakes. For cheese cakes, I use greek yogurt or drain your own lc plain regular yogurt because it cuts the calories of cream cheese.

Pumpkin is lc so make a lc pumpkin pie without the crust or a pumpkin bake (loaf/cake). Super secret taste sensation is to eat bacon with a pumpkin dessert! My, oh, my.

Peanut butter fudge is good but pricy on the carb count.

Of course, there is always sugar free jello and pudding boxes. Note - let those sit overnight before eating so the bitter taste goes away. Don’t know what it is with the bitter taste but if you have a dessert that contains a large amount of lc sweetener (Splenda), it sometimes gets bitter but it magically disappears the next day. I love lemon curd and made some for a cheesecake and absolutely couldn’t take the bitterness and thought I’d ruined it but poof! it was wonderful the next day.

About the only weird ingredient I’ve had to buy (unless you count flax seed meal as weird) is xantham gum. But Bob’s Red Meal makes both and can be found at Walmart and larger grocery stores. Xantham gum is a powder that is used as a thickener for gravy and sauce. You only need a teeny little pinch so it lasts FOREVER. I store mine in the freezer and it’s been there for a decade. Note - you will get it on your fingers and when you wash it off it goes all slimy. Again, just a teeny pinch or your sauce will get slimy, too. Or don’t add so much liquid to your gravy and sauce and let it reduce.

Oooh, the best recent recipe I’ve found is for chicken. Think it was titled chicken nuggets online somewhere but it’s not nuggets so forget that. Three ingredients! No seasoning needed. Get raw chicken tenders or slice up 2-3 chicken breasts to tender sizes. Wrap each in raw bacon (obviously smaller chicken pieces use a half piece of bacon). Bake or cook in an ungreased skillet until done. Remove meat from the skillet. In the bacon grease in the skillet, melt in a couple ounces of cream cheese which will turn into a sauce for the chicken pieces. That’s it. Done. Practically zero carbs but count as 1 carb for an entire serving just to stay honest.

You can substitute cream, sour cream or lc greek yogurt (lowest count I’ve found is 7 carb/cup) for the cream cheese. Greek yogurt (or drain regular plain yogurt in a paper towel lined colander a few hours) is a great substitute for higher calorie cream cheese and sour cream. I’ve made my own homemade yogurt for years but that is another topic.

I’ve rattle on, but just wanted you to know that going on a low carb diet is far from torture. There’s lots you can eat. And for many high carb foods, there are substitutes. Here’s Linda’s grocery list - http://www.genaw.com/lowcarb/low_carb_shopping_list.html

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