Diabetes Triage

[sirdle]

Hello Jeff,

I successfully dropped my weight 65 pounds in 18 months by following your 'triage' guidelines.

1. no smoking
2. moderate alcohol (< 30 g/d)
3. exercise 30 per day, 5-6 times per week
4. aim for a healthy BMI (now at 23.9 and falling, down from 32.6)
5. reduce calorie density to around 550 calories per pound.

I don't have a sweet tooth or suffer from cravings.

For me, the problem was always one of logistics. I never liked getting up early and making breakfast or preparing a lunch; it was always much easier to buy something to eat (usually candy) at 7-Eleven on the way to work. The change from 7-Eleven to eating oatmeal each morning and baking sweet potatoes and preparing a humongous salad a couple times a week was an exercise in creating new habits to replace old ones.

To that end, your triage guidelines help tremendously. Every couple of weeks I would choose a new behaviour to change and work on it diligently until I felt comfortable with the change and then move on to the next change.

My wife has been diagnosed with diabetes. She is working on changing her habits, too. But this will take time.

She has #1 and #2 covered. She is working hard on #3. #4 is okay... just. We need help with #5.

Do you have any sort of triage guidelines specifically for diabetes, i.e., what is the most important goal to nail first? No animal protein? Reduced fat intake? No added sugars? Or are the guidelines the same as the MWL plan, and you really need to adapt all of the behaviours before you will see a noticeable change?

Our long-range plan is to follow the guidelines in "The Real Dirty Dozen: The 12 Deadliest Lifestyle Factors"... but for this to work (for us) we need to create new habits and we can't do this all at once.

Cheers,

====================

Edited to add additional links to Diabetes-related threads and resources:

• Dr Barnard's Diabetes Recommendations (and Jeff Novick's response)
• Didn't pass the gestational diabetes screening - updated!
• Effect of 'grazing' on Blood Sugar
• Jeff, Which McDougall Program for Pre-Diabetic?
• Twitchy blood sugar
• A Simple Nutritious & Affordable Plan (SNAP)
• Quick Recipes (with Pictures)
• The Healthy Eating Placemat: A Visual Guide to Healthy Eating
• McDougall's Maximum Weiht Loss Guidelines

[JeffN]

Hello Jeff,

I successfully dropped my weight 65 pounds in 18 months by following your 'triage' guidelines.

1. no smoking
2. moderate alcohol (< 30 g/d)
3. exercise 30 per day, 5-6 times per week
4. aim for a healthy BMI (now at 24.4 and falling, down from 31.1)
5. reduce calorie density to around 550 calories per pound.

I don't have a sweet tooth or suffer from cravings.

For me, the problem was always one of logistics. I never liked getting up early and making breakfast or preparing a lunch; it was always much easier to buy something to eat (usually candy) at 7-Eleven on the way to work. The change from 7-Eleven to eating oatmeal each morning and baking sweet potatoes and preparing a humongous salad a couple times a week was an exercise in creating new habits to replace old ones.

To that end, your triage guidelines help tremendously. Every couple of weeks I would choose a new behaviour to change and work on it diligently until I felt comfortable with the change and then move on to the next change.

Thanks.

I love your story and hearing about the changes you have made and how you have gone about it. And that you and doing this together with you wife. Keep supporting it each other and remember, people move forward at different speeds.

This is a way of life, not a diet.

Baby steps work only if they are the right steps. Otherwise, we end up just spinning our wheels, getting no where, getting frustrated and often quitting.

Just too clarify the recommended alcohol from me is 0. If you choose to drink, I think you should stay to 1/2 the recommended minimum as even light drinking can be problematic. The accepted guidelines are to high.

In regard to diet, it is to follow a healthy diet (which they define differently then me) as I recommend in this forum. That calorie density number you cite is a reference range based on my clinical experience and the existing evidence and is for those looking to lose or maintain weight. They are just a guide that must be adjusted to the individual. I really don't want people to change numbers though but to get the food right and let the numbers fall into place.

Do you have any sort of triage guidelines specifically for diabetes, i.e., what is the most important goal to nail first? No animal protein? Reduced fat intake? No added sugars? Or are the guidelines the same as the MWL plan, and you really need to adapt all of the behaviours before you will see a noticeable change?

It depends where you are at, what you are doing and what needs to be improved.

I think the Healthy Eating Placemat is an excellent goal to strive for and basically covers anything. It is why I created it. If it helps, my SNAP meals, meet all the main plate requirements of the placemat all in one quick cooling meal. You just have to add in, Start with Soup or salad, and finish with fruit (if desired). And, have some as simple as oatmeal and berries for breakfast.

By following the placemat you will be...

- lowering the calorie density, which will help to lose weight which is so important in regard to diabetes and overall health
- increasing the fiber, which will increase satiety, help manage lipids and blood sugar and increase digestive health
- decreasing any extra fat and saturated fat in the diet, which lowers calorie density, improves lipids and blood sugar, etc.

Keeping up the exercise and if possible increasing to the upper range of the 150-300 min/week at a moderate pace, will also help. You don't need to do anything extreme.

Of course, keeping your home completely safe and healthy so there is no temptation. Also, managing any social outings and any travel by planning ahead and being proactive to make sure you are successful.

It sounds like you have a really intelligent and sound approach to this, are making great progress and just need to keep going.

If you get to where you need more specific or detailed recommendations personalized to you or your wife's personal journey, you could always book a 20 minutes call, though I doubt you need one.

In Health
Jeff

[sirdle]

Jeff,

Thank you very much for your response.

I love your story and hearing about the changes you have made and how you have gone about it. And that you and doing this together with you wife. Keep supporting it each other and remember, people move forward at different speeds.

Thank you. I am very lucky to have my wife on this journey with me.

This 'way of life' feels very natural to me. I'm not sure how to explain this... When I was in elementary school I was overweight. As I entered Junior High I started cycling competitively and I lost weight and became healthy. It seemed I could eat anything and still remain healthy and slim. For the past 20 years, however, I have worked at a desk job and have lead a sedentary life. Every year I have tried to lose weight and improve my health. Some years I was more successful than others, but in the end I always ended up back where I started.

Over the past 18 months I have gradually come to realize that exercise, while important, is not the magic key to health I thought it was. Reading your thread on how much exercise is enough made me realize that I must choose a life-long diet that will allow me to maintain my weight without intense exercise. If I don't, then every time I am sick... everytime I go on vacation... everytime I am facing a deadline at work... I will gain weight (and this is what has happened over the years).

I still exercise, but I don't depend on it compensate for a poor diet. Instead I modified my diet... and everything 'clicked'. I don't feel any drive to revert to the way I was before. I still fail from time to time, but almost always due to lack of planning. I pick myself up and focus more conscientiously on my short- and long-range plans.

As you say, "This is a way of life, not a diet."

"Baby steps work only if they are the right steps..."

We do understand this. I know what works for me. We are discovering what works for my wife.

For example, when I started, my biggest obstacle was food prep. Instead of waking up late and grabbing a bite at 7-Eleven, I needed to wake up at 4:00 AM, eat breakfast, make my lunch, and get in a workout. I started with store-bought processed oatmeal with tons of added sugar for breakfast and ham and cheese sandwiches for lunch. I chose ham and cheese sandwiches because they were very quick to make, they travelled well, and the ham and cheese would keep for a long time in the refrigerator without spoiling. After my workout, I ate a bag of edamame and downed a protein shake. I knew that my nutrition had not improved much, but I was getting up early and making my lunch (which, half the time I forgot to take anyway). This was an essential first step.

I had to buy storage containers and a lunch box for my sandwiches... pans and microwavable dishes for my breakfasts and dinners. In retrospect, these were minor details, but at the time they seemed daunting.

Once I had the habit of getting up early, eating breakfast, and making a lunch, I gradually started substituting foods with better choices. The cheese became pickles and peperoncinis... the bread became a whole grain bread with no added oil and very little sugar... the processed oatmeal with tons of added sugar became oats with frozen blueberries... the edamame became an apple... the protein shake became water... and finally the sandwiches became sweet potatoes or pasta primavera and a salad without dressing.

Right now my diet is around 8-10% fat, 10-12% protein. Around 1,500 mg of sodium, 700 mg calcium, 2:1 ratio of omega-6:omega-3. 95% of my food is fruits, vegetables, starchy vegetable, grains and legumes. Total calories are just shy of 2,000 per day and my weight has dropped from 245 to 175. I am very happy and I feel like I can easily eat this way the rest of my life.

My wife has different obstacles from me. She loves her fat (salad dressing, butter, avocado, olives, cheese, cream, tofu) and it is hard for her to give up. She has eliminated meat, cheese, and added butter. She still takes 1 tablespoon of cream with her tea in the morning, and she still uses a full-fat salad dressing (though not as much). She still purchases many of her meals on-the-go (but is making better food choices).

We understand about calorie density and what our long-range goal should be. My hope in asking for a 'Diabetes Triage' was that you would respond along the lines of:

1. Eliminate meat
2. Exercise
3. Eliminate dairy
4. Eliminate added sugars

... i.e., a list of three or four dietary goals that would achieve the greatest result with the least amount of change to help us avoid "spinning our wheels, getting no where, getting frustrated and often quitting."

I thought I had read all of your posts about diabetes. Turns out I hadn't read any of them (I must have searched for McDougall's posts, instead). I've remedied that oversight.

If I may paraphrase...

At the risk of putting words in your mouth, it seems like you are saying: "Improving your health in the face of diabetes involves a 'pattern of eating' not simply the elimination or addition of a few select foods. Get the principles right and the rest will follow." (I understand that this is a public forum and you can not offer personalized advice. I may take you up on your offer to consult... but first I have more reading to do )

"Just too clarify the recommended alcohol from me is 0."

No problem. We've got this covered. I haven't had any drinks in over 30 years and my wife drinks 1-3 glasses of wine a year.

"It sounds like you have a really intelligent and sound approach to this, are making great progress and just need to keep going."

Thank you.

Note: I have edited my first post, above, to include links to threads that were the most useful to me. I would like to quote the passages that I found especially helpful, below, but it occurred to me that you might not want those quotes taken out of context and you might prefer that I just post the links.

Cheers,

[JeffN]

At the risk of putting words in your mouth, it seems like you are saying: "Improving your health in the face of diabetes involves a 'pattern of eating' not simply the elimination or addition of a few select foods. Get the principles right and the rest will follow."

You go it, 100%.

You can fine tune later, once your well on your way, if needed.

Note: I have edited my first post, above, to include links to threads that were the most useful to me. I would like to quote the passages that I found especially helpful, below, but it occurred to me that you might not want those quotes taken out of context and you might prefer that I just post the links.

I appreciate you adding the links as it adds value to the thread. You are also welcome to include your favorite quotes and if I feel the need to clarify anything, I will

In Health
Jeff

[sirdle]

Hello Jeff,

Finally getting around to adding the quotes...

Dr Barnard's diabetes recommendations (and Jeff Novick's response)

-Follow an unrefined, unprocessed, high carbohydrate, lower fat, very high fiber, and plant based diet for weight loss and for better health. Such a diet is based on fresh fruits, fresh vegetables, “intact” whole grains, starchy vegetables and legumes. It is not only very healthy; it is also very effective for weight loss, diabetes and heart disease. It is low in calorie density so you can fill up without overeating and not worry about being hungry. In addition, it is very high in nutrient density, so you will be optimizing your nutrient intake at the same time.

-Do not be afraid of carbohydrates but understand that all carbohydrates are NOT EQUAL. Forget the GI/GL [glycemic index/glycemic load] or whether they are complex or simple. That is all too complex. Instead, choose carbohydrates that are intact, unrefined and unprocessed. Period. Choose whole kernel corn over corn flakes or corn chips. Choose brown rice over white rice or rice crackers.

-Aim for a fiber intake of at least 50 grams a day from whole foods. If it makes it easier, focus on getting at least 17 grams of fiber at each meal, based on 3 meals a day. If you follow the diet recommended above, this will be easy.

-While increasing fiber, focus on the foods that tend to be higher in soluble fiber for improved blood sugar, insulin sensitivity and lipid levels. These foods are beans, yams [sweet potatoes], oats, barley and berries. These foods are easy to remember by using the acronym BYOB & B. (We give new meaning to life’s acronyms!) (Beans are the best for this)

-Do not be misled by diets, food choices, or packaged products that are recommended for weight loss, diabetes, heart disease and/or cancer based on the glycemic index or the glycemic load. The GI and the GL is not only extremely confusing, but they are also misleading and have little if any benefit to you. It is much simpler to just choose foods based on the principles I described above.

I will add in...

- be active for at least 45-60 minutes, 5-6 days a week.

At the last center I worked, in 10 years I saw over 15K people with about 2/3 to 3/4s of them with diabetes. About 80% on average, were able to get off their medications in about 2 weeks.

Note: energy density of some common foods (cal/lb).

Food ED
----------- ----
Peanuts 2556
Table Sugar 1756
Popcorn 1734
Honey 1380
White bread 1330
Pizza 1217
Ice cream 912

Brown rice 508
Baked potato 422
Bananas 404
Oatmeal 286

didn't pass the gestational diabetes screening - updated!

The key issues in insulin resistance are:
1. activity
2. naturally occurring high fiber foods
3. minimal to no refined/processed foods
4. weight
5. belly fat
6. dietary fat.

GI is not a relevant issue. Unrefined, unprocessed, high fiber, low calorie dense, high nutrient dense, high satiety "intact' whole foods is, regardless of what their GI or GL is.

Effect of 'grazing' on Blood Sugar

Eat when hungry until you are comfortably full. Do not over-stuff, and do not starve yourself. And always choose the healthiest foods.

For a diabetic, I would recommend they stay as much away from any refined processed foods (including whole grain ones) until they get their blood sugars under control. I would also include "smoothies" in this category as blended foods impact satiety, insulin and blood sugar negatively more so than whole foods.

I also only recommend checking your blood sugar twice a day, three times maximum. Once upon awakening, and the second time in the afternoon, about 3 hours minimum after "finishing" your lunch. The third time, if desired would be three hours after finishing dinner, before bed.

Also, both fasting blood sugar and A1c are important.

In addition, regular daily physical activity like brisk walking for 30-60 minutes is very important in helping control diabetes.

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As mentioned in my above post, if someone was trying to control their blood sugars, I would not recommend them to mechanically grind their food up in a blender, especially any fruit, starchy vegetables, or intact whole grains. I would recommend they only consume them in their whole natural form, untill their blood sugars were under control.

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The closer a food is to its whole natural state, and the less ground (or blended) it is, the better it is, especially for a diabetic. Grinding/blending breaks down fibers, release sugars, & increases surface area. Sometimes, the influence of one meal is not seen to the next meal or later.

A well known (but different) example of this is fat. For most people it will "appear" to lower blood sugar in the immediate meal, but raises it in the following meals.

Jeff, Which McDougall Program for Pre-Diabetic?

In your opinion, which McDougall dietary program is the best for me to recommend to someone really motivated and ready to make lifestyle changes and prevent progression of the condition, and who wants to avoid getting on meds and wants to avoid a Doctor recommended 'stomach band'.

Hi Clary

The best program is the one they will do!

In all sincerity, they will all work. However, I would recommend the MWL program for several reasons.

1) it will produce the best results the quickest (which is a real motivating force for many people)

2) it provides enough variety of foods, recipes and meals that they won't feel deprived.

3) if they "fall short" of the program, they are still on the regular McDougall program.

4) it eliminates all the "processed" foods made from flours, which can be very helpful for a diabetic.

5) it eliminates most all calorie dense foods, which can also help with diabetes and will help weight issues and avoid the "band."

They will also need to be active for at least 30 minutes, most days (5-6) at the equivalent of a brisk walk.

If they were to make a 30-day commitment, they would see incredible results and feel more inspired and motivated. In addition, they should start seeing results in as little as the first week.

If they are at a point where the MD is recommending medication and/or a stomach band, then this is an important time, and an important decision. I wish them the best and applaud your efforts to help them.

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... but for best results with your blood sugars, I would still dramatically reduce and/or eliminate all flour products.

twitchy blood sugar

I have posted the data here already, on several studies on programs like this showing that about 70% of those on oral medications can get off of their medications and stay that way and about 40% of those on insulin can get off their insulin with normal blood sugars and stay that way in about 3-4 weeks.. These studies have 3 and 5 year follow ups. In addition, programs like this have been shown to reverse metabolic syndrome in around 50% of the patients in just 14 days. However, these are with strict adherence and those who are more insulin resistant may take slightly longer. Over the last 10 years, I have worked with literally thousands of diabetics and have seen them all dramatically improve (many are part of the above studies) over time to where their blood sugars are normal and/or they have reduced or completely eliminated their need for medications.

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In addition, losing any excess weight if you have any, increasing daily activity to make sure you are getting in at least 30-60 minutes a day, making sure you get in at least 35 to 50 grams of fiber each day, with at least 12-16 at each meal, and focusing on unprocessed unrefined whole natural foods that are low in calorie density, would be very important.

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The Maximum Weight Loss program is based on calorie density and not only the best for weight loss but also the best approach for diabetics. You eliminate all processed/refined grains and also focus on foods in their natural state, which are lower in calorie density. This way, you will be able to fill up on much more food, for less calories, not go hungry and also increase the amount of soluble fiber. Focus on Beans, Oats, Yams, Barley that are not refined or processed.

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My recommendation is, if you want, is to do the MWL program 100% for at least 30-90 days. (Rye Krips, and other highly processed foods, would not be on the list.) As you seem to be more sensitive, focus more on veggies and raw foods with your meals. Track your blood sugars twice a day, as I outlined, stay active, and then we can see your A1c after 3 months. To further help, you may want to download the CRON-O-Meter and input all your food for this time. This would be more important to me, than your frequent post meal monitoring.

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In regard to the more calorie dense foods, I would be somewhat cautious of overdoing the the whole grain processed foods (like breads, bagels, crackers, dry cereals), if you are insulin resistant, as the processing of these foods does reduce the effectiveness of the fiber somewhat, and creates more surface area, so they can be digested and absorbed quicker and "may" effect (or interfere with) your IR. Same with the foods that are more calorie dense and higher in fat (nuts, seeds, avocados). Fat can interfere with IR also.

So, the best choice may be to consume more of the intact whole grains, legumes (great for IR), starchy veggies, roots, and tubers and combinations of them.

McDougall's Maximum Weiht Loss Guidelines

Program outlined in the MWL book, page 60.
1. Eliminate All Animal Foods
2. Eliminate All Oils
3. Eliminate All High Fat Plant Foods: Nuts, Nut Butters, Seeds, Seed Butters, Avocados, Coconut, & Olives.
4. Eliminate All Flour Products
5. Eat Whole Grains and Potatoes
6. Eat Legumes
7. Make Green & Yellow Vegetables One-Half to One-Third of your meal
8. Eat Uncooked Foods
9. Restrict Fresh Fruit to No More Than Two Servings a Day, and Avoid Dried Fruit, Fruit Puree, and Fruit Juice
10. Use Simple Sugar Sparingly

Guidelines for Healthy Eating in MWL book, page 67.
1. Eat until you’re satisfied
2. Graze
3. Allow time for digestion
4. Chew foods thoroughly
5. Restrict variety

Weight-Losing Reasons To Exercise. MWL book, page 100.
1. Exercise burns calories
2. Calories continue to burn after exercise
3. Exercise counteracts plateaus
4. Exercise suppresses appetite
5. Exercise reduces insulin
6. Exercise protects and increases muscle mass

Exercise you can live with. MWL book, page 106-107

Aerobics: The best kind of exercise. Walking, running, cycling, & swimming are not only enjoyable but highly efficient ways to lose weight.

Benefits of weight training:
Build a stronger body
Build a shapelier body
Strengthen ligaments
Improve bone density
Help prevent musculoskeletal injury
Elevate metabolism
Increase stamina
Elevate blood levels of HDL cholesterol

Your New Daily Exercise Plan: MWL Book Page 109
1. Get up half an hour earlier each day, or skip a TV program to do a specific exercise.
2. Make exercise a part of each day.
3. Choose an activity that you have always enjoyed and do it at least four times per week.
4. Sometimes purchasing equipment helps to motivate…
5. Invest in a membership in a YMCA, YWCA, or health and fitness club
6. Ask a friend to become your exercise partner
7. Go dancing, a great aerobic (and romantic) exercise
8. Join a walking or hiking club.
9. Check with your local adult-education program for exercise programs.
10. Keep an exercise journal.

Establishing a healthy way of life from page 127 of the MWL book.
Step 1. Be Goal-Oriented
Step 2. Acknowledge Your Willingness to Pay the Price
Step 3. Educate Yourself, Become an Expert
Step 4. Visualize Yourself as Healthy
Step 5. Make a Commitment: It’s Magic
Step 6. Ensure That Your Environment Supports Your Goals
Step 7. Alter Your Coping Mechanisms
Step 8. Join A Support Group
Step 9. Reward Yourself
Step 10. Keep It Simple

The Real Dirty Dozen: The 12 Deadliest Lifestyle Factors

The Real Dirty Dozen: The 12 Deadliest Dietary & Lifestyle Factors & What You Can Do About Them.

1. Smoking (including 2’nd & 3’rd hand smoke)
2. Excess Calories/Body Weight
3. Inadequate Diet (fruits, vegetables, intact starches)
4. Alcohol
5. Inactivity/Sedentary Lifestyle
6. Added Sodium/Salt
7. Saturated fat
8. Dietary Cholesterol
9. Added Sugars/Caloric Sweeteners
10. Added Fats/Oils
11. Refined Flours/Grains
12. Hydrogenated/Trans Fats

And one more...

13. Illicit Drugs & Prescription Drugs


What you can do...

1. Smoking (including 2’nd & 3’rd hand smoke)
- Don't smoke. If you smoke, quit. Avoid 2’nd & 3’rd hand smoke.

2. Excess Calories/Body Weight
- Maintain a healthy weight with a BMI of 18.5 to 24.9 (a BMI of 18.5-22 may be optimal), and a waist circumference of <35 for women and < 40 for men, and a waist to height ratio of < .50

3. Inadequate Diet (fruits, vegetables, intact starches, fiber-rich foods)
- Eat a diet based predominately on a variety of minimally processed whole plant foods (fruits, vegetables, starchy vegetables, roots/tubers, intact whole grains and beans).

4. Alcohol
- Don't drink. If you drink and it is a problem, quit. If you do drink, limit the intake to occasional light drinking (<1 drink/day & <4 drinks/week).

5. Inactivity/Sedentary Lifestyle
- 150 to 300 minutes per week of moderate activity (or 75 to 150 minutes of vigorous activity) that includes aerobic and resistance exercise. The inclusion of some balance, flexibility work is also recommended.

6. Excess Added Sodium/Salt (3)
- Keep total sodium from all sources to <1500 mg/day. No added salt/sodium is optimal.

7. Excess Saturated Fat (1) (3)
- Keep saturated fat to <7% of total calories; <5% is optimal.

8. Dietary Cholesterol (1)
- Keep total cholesterol to < ~25 mg/day. None is optimal.

9. Added Sugars/Caloric Sweeteners (2) (3)
- Keep added sugars/sweeteners (including fruit juice and natural sweeteners) to <5% of total calories. None is optimal.

10. Added Fat/Oils (2) (3)
- Keep added fats/oils to <4% of calories. None is optimal.

11. Refined Flours/Grains (2) (3)
- Less than 5% of calories. None is optimal.

12. Hydrogenated/Trans Fats (3)
- Avoid these.

13. Illicit Drugs and Prescription Drugs
- Avoid illicit drugs. Avoid prescription drugs except for short-term use when unavoidable. There are exceptions where Rx drug are often necessary, sometimes for life (insulin, thyroid, etc). In these situations, make sure the benefits clearly outweigh the risks and that you are informed and aware of the risks.

(1) While these are found in several places, that are mostly a marker for animal product consumption. Limit animal products to no more than 5% of calories, regardless of saturated fat and cholesterol. None is optimal.

(2) The total intake of added sugars, added fats/oils, refined flours, animal products, etc., if included, should not exceed 10% of calories on any given day. None is optimal.

(3) While these are found in several places, a large percentage of them comes from intake of Overly Processed foods, which should be avoided.

A Simple Nutritious & Affordable Plan (SNAP)

Quick Recipes (with Pictures)

The Healthy Eating Placemat: A Visual Guide to Healthy Eating

The Five Pillars of Healthy Eating
"A Common Sense Approach To Nutrition"

1) Plant-Centered - Center your plate and your diet predominately around plant foods (fruits, vegetables, starchy vegetables, roots/tubers, intact whole grains, and legumes (beans, peas & lentils).

2) Minimally Processed - Enjoy foods as close to "as grown in nature" with minimal processing that does not detract from the nutritional value and/or add in any harmful components.

3) Calorie Dilute - Follow the principles of calorie density choosing foods that are calorie adequate, satiating and nutrient sufficient.

4) Low S-O-S - Avoid/minimize the use of added Salts/sodium, Oils/Fats and Sugars/sweeteners

5) Variety - Consume a variety of foods in each of the recommended food groups.

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The Principles of Calorie Density: A Common Sense Approach to Sound Nutrition
Jeff Novick, MS, RD

The Principles of Calorie Density

1) Hunger & Satiety - Whenever hungry, eat until you are comfortably full. Don't starve and don't stuff yourself.

2) Sequence Your Meals - Start all meals with a salad, soup and/or fruit. By starting with the foods that are lowest in calorie density, you begin to fill up for fewer calories.

3) Don't Drink Your Calories - Avoid liquid calories. Eat/chew your calories, don't drink or liquefy them. Liquids have little if any satiety so they do not fill you up as much as solid foods of equal calories.

4) Dilution is the Solution (the 50/50 guideline) - Dilute Out High Calorie Dense Foods/Meals - Dilute the calorie density of your meals by filling 1/2 your plate (by visual volume) with intact whole grains, starchy vegetables and/or legumes and the other half with non-starchy vegetables and/or fruit.

5) Be Aware of the Impact of Vegetables vs Fat/Oil - Non-starchy vegetables are the lowest in calorie density while fat and oil are the highest. Therefore, adding non-starchy vegetables to any dish will always lower the overall calorie density of a meal while adding fat and oil will always raise the overall calorie density of a meal.

6) Limit High Calorie Dense Foods - Limit (or avoid) foods that are higher in calorie density. These include dried fruit, high fat plant foods (nuts, seeds, avocados), processed whole grains (breads, bagels, crackers, dry cereal, tortilla's, popcorn, etc). If you use them, incorporate them into meals that are made up of low calorie dense foods and think of them as a condiment to the meal. For example, add a few slices of avocado added to a large salad, or a few walnuts or raisins added in a bowl of oatmeal and fruit.

In addition, include about 30-60 minutes of activity a day (including some aerobic, resistance and flexibility exercise), aim for a BMI of around 18.5-22 and get enough sleep, rest, relaxation, recreation, fresh air, pure water, etc and enjoy life!

Cheers,

[sirdle]

Hello Jeff,

I would never tell my wife what to eat; she is very intelligent and is perfectly capable of making her own decisions.

However, I have often asked if I could talk about this journey I'm on -- where I'm going and why -- as a means of sharing those things which are important to me.

When my wife was diagnosed with diabetes, she was gutted. Her doctor was very pressed for time that day and didn't explain her blood results or counsel her; he just prescribed medicine. (By looking at her blood results and searching online, we could tell the medicine was for diabetes, high blood pressure and high cholesterol.) She was very discouraged by the bleak glimpse into her future: a future of daily blood sugar measurements and ineffective medicine.

I bit my tongue and waited to see what she would do.

One day she asked me for help... she asked if I would be her coach.

We've had many long talks. (She would rather talk to me than read forum posts or watch videos.) We talked about the posts that I linked to above... we talked about how overcoming these diseases requires a change in thinking... and a change in living.

In the end, she decided not to take any of the prescribed medicine; she decided to wait two months and see what she could achieve through diet and lifestyle changes. She has lost weight, but she is still discouraged. She is, perhaps, 60% compliant (too much food eaten out). She is struggling, but she is committed toward long-term success.

Last week she had blood and urine tests in preparation for a follow up appointment with her doctor (which she has been dreading).

Today she received a phone message from her doctor:

Just wanted to touch base with you and let you know I'm totally impressed with your dramatic improvement in your cholesterol and glucose (sugar) levels. Whatever you are doing, please keep up the good work and I look forward to seeing you when you come in for your exam. Again, keep doing it... that's a very impressive improvement.

So, I want to thank you, Jeff, for all the hard work you've done and continue to do. You're an inspiration and although I'm sure there are many days when you feel like you're butting your head against the wall, your words... your thoughts... your compassion... filter down sometimes have very profound consequences.

Cheers,