Now that you have the essentials of what you should eat and what you should avoid, it’s time to take you through the steps of customizing a meal plan that will get you on your way to blood sugar normalization.
If you found yourself thinking as you went through the No-No foods section of the prior chapter that all of this information goes against conventional thinking—you’re right. No doubt as you embark upon a meal and treatment plan to normalize your blood sugars, well-meaning but ill-informed friends and relatives will urge you to try more “fun” foods, or to eat less fat and more “complex” carbohydrates. I suggest that you read Appendix A, which provides some possible explanations as to why conventional wisdom may have taken a wrong turn.
If you use blood sugar–lowering medications such as insulin or oral agents, the first rule of meal planning is don’t change your diet unless your physician first reviews the new meal plan and reduces your medications accordingly. Most diabetics who begin our low-carbohydrate diet show an immediate and dramatic drop in postprandial blood sugar levels, as compared to blood sugars on their prior, high-carbohydrate diets. If at the same time your medications are not appropriately reduced, your blood sugars can drop to dangerously low levels.
The initial meal plan should be geared toward blood sugar control, and also toward keeping you content with what you eat. So with those things in mind, if I were to sit down with you to “negotiate” your meal plan, I would need to have before me a GLUCOGRAF data sheet (see Chapter 5) showing blood sugar profiles and blood sugar–lowering medications (if any) taken during the preceding week or two. I also would ask for a list of what and when you eat on a typical day. This information would give me an idea of what you like to eat and what effect particular doses of blood sugar–lowering medications have on your blood sugars. I also must know your current weight and about any other factors—such as delayed stomach-emptying and medications for other ailments—that might affect your blood sugar. In negotiating the meal plan, I’d try wherever possible to incorporate foods you like.
We will discuss weight reduction in Chapter 12. Changes for this purpose can be made after observing the effects of the initial diet for a month or so.
If you’ve tried dieting to lose weight or to control your blood sugar, you may have found that simply cutting back on calories according to preprinted tables or fixed calculations can be frustrating and can even have the opposite effect. Say you have a supper that’s too small to satisfy you. Later you’re so hungry you feel you must have a snack. If you’re like most people, your snack will likely be snack food, a bowl of cereal, or some fruit—that is, something loaded with carbohydrate—so you end up with high blood sugars and more calories than you would have consumed if you’d started with a sensible meal. My experience is that it’s always best to start with a plan that allows you to get up from the table feeling comfortable but not stuffed.
If you’ve ever followed the old ADA “exchange” system for preparing diabetic meal plans, you’ll find that keeping track of grams of carbohydrate and ounces of protein food (we always estimate carbohydrate in grams and protein food in ounces) requires considerably less effort. Not only is it easier than the exchange approach, it’s also more effective, because it places the focus on the nutrients that actually affect blood sugar.
Since all of my patients bring me glucose profiles, over the years it has not been very difficult to develop guidelines for carbohydrate consumption that make blood sugar control relatively easy without causing too great a feeling of deprivation, even for those trying to lose weight.
My basic approach in negotiating a meal plan is that I first set carbohydrate amounts for each meal. Then I ask my patients to tell me how many ounces of protein we should add to make them feel satisfied. (I actually show them plastic samples of protein foods of various sizes, to help them estimate amounts.) For example, I usually advise adult patients to restrict their carbohydrate intake to no more than 6 grams of slow-acting carbohydrate at breakfast, 12 grams at lunch, and 12 grams at supper.* Few people would be willing to eat less than these amounts of carbohydrate. (Lower carbohydrate amounts apply to small children.) There is no such thing as an essential carbohydrate for normal development, despite what the popular press might have you believe, but there most certainly are essential amino acids (protein) and essential fatty acids. As mentioned in Chapter 9, the main reason I don’t suggest that you avoid all carbohydrate is that there are many constituents of vegetables—such as vitamins and minerals, but also many other nonvitamin chemicals (phytochemicals)—that are only recently becoming understood but that are nonetheless crucial to diet and cannot be obtained through conventional vitamin supplements. This is particularly true for whole-plant and leaf varieties. Folic acid—so called because it is derived from foliage—is essential to all manner of development, but strictly speaking is neither vitamin nor mineral.
Ideally, your blood sugar should be the same after eating as it was before. If blood sugar increases by more than 10 mg/dl after a meal, even if it eventually drops to your target value, either the meal content should be changed or blood sugar–lowering medications should be used before you eat. Contrary to ADA guidelines, it has recently been shown that postprandial, or after-meal, blood sugars are more likely than fasting blood sugars to cause cardiovascular damage.
Distinctions are often made between “complex” and “simple” carbohydrates, with foods such as multigrain breads or pasta touted as “full of complex carbohydrates.” This is essentially a meaningless distinction, if not a foolish one. There are fast-acting carbohydrates—starches and sugars that break down rapidly and have a consequent rapid effect on blood sugars—and there are slow-acting carbohydrates. Generally, slow-acting carbohydrate comes from whole-plant vegetables (and others listed here). They are predominantly indigestible fiber accompanied by some small amount of digestible carbohydrate and vitamins, minerals, and other compounds, but have relatively little effect on blood sugars.
The foods in the following list are slow-acting carbohydrate foods. These can constitute the building blocks of the carbohydrate portion of each meal. Of course you needn’t limit your foods to these—many other such building blocks can be created. Read labels on packaged foods, consult nutrition tables for carbohydrate values of foods you like, check your blood sugars, and find out which foods work for you.*
Equivalent in blood sugar effect to approximately 6 grams of carbohydrate per serving
6 Worthington Stripples or Morningstar Farms Breakfast Strips (meatless soy bacon) (also contains 1 ounce protein)
3 Morningstar Farms Breakfast Links (meatless soy sausage) (also contains 2 ounces protein)
2 GG Scandinavian Bran Crispbreads
1½ Wasa Crisp’n Light 7 Grain crackerbreads
7-ounce container Fage whole-milk yogurt (also contains 2½ ounces protein)
4½ ounces Brown Cow Farm or Stonyfield Farm whole-milk unflavored yogurt (8 ounces contains 11 grams carbohydrate and 2 ounces protein)
1 cup mixed salad with oil-and-vinegar (not balsamic) dressing
cup cooked whole slow-acting carbohydrate vegetable (or ¼ cup mashed or ½ cup sliced or diced) from list here
1 serving sugar-free Jell-O brand pudding made with water or with water and 1 tablespoon cream
½ small avocado (3 ounces)
Equivalent in blood sugar effect to approximately 12 grams of carbohydrate per serving
1 cup mixed salad with oil-and-vinegar (not balsamic) dressing, plus cup cooked whole vegetables (or ¼ cup mashed or ½ cup sliced or diced) from list here
8 ounces Brown Cow Farm or Stonyfield Farm whole-milk unflavored yogurt (contains 11 grams carbohydrate and 2 ounces protein)
These lists slightly exaggerate the carbohydrate content of salad and cooked vegetables, but because of their bulk and the Chinese restaurant effect, the net effect upon blood sugar is approximately equivalent to the amounts of carbohydrate shown. To this slow-acting carbohydrate, we’d add an amount of protein that, in your initial opinion, would allow you to leave the table feeling comfortable but not stuffed.
As with carbohydrate, it is necessary to keep the size of the protein portion at a particular meal constant from one day to the next, so if you eat 6 ounces at lunch one day, you should have 6 ounces at lunch the next. This is especially important if you’re taking blood sugar–lowering medications. If you’re using tables of food values and need to convert grams of protein to ounces of a protein food, keep in mind that for these meal plans, 6 grams of protein is the equivalent of 1 ounce of an uncooked protein food. To estimate by eye, a portion the size of a deck of playing cards weighs about 3 ounces (red meats weigh about 3.7 ounces because of their greater density).
In order to maintain muscle mass, most physically active people should consume at least 1–1.2 grams of protein per kilogram of ideal body weight.* Athletes will require considerably more, as will growing children. A recent study reported that the average American adult eats about 1.5 grams of protein per 1 kilogram of body weight daily, in spite of the usual sedentary lifestyle.
Protein foods with virtually no carbohydrate (unless added in processing)
Beef, lamb, veal
Chicken, turkey, duck
Eggs
Most cold cuts (bologna, salami, et cetera)
Fish and shellfish (fresh or canned)
Most frankfurters
Pork (ham, chops, bacon, et cetera)
Most sausages
Protein foods with a small amount of carbohydrate (1 gram carbohydrate per ounce of protein)
Cheeses (other than cottage cheese and feta cheese); the gram of carbohydrate per ounce found in most cheeses should usually be included when computing the carbohydrate portion of a meal
Soy products (up to 6 grams carbohydrate per ounce of protein—check Nutrition Facts label on package)
Veggie burgers
Tofu
Meatless bacon
Meatless sausage
Other soy substitutes (for fish, chicken, et cetera)
If you have a rare disorder called familial dyslipidemia, where dietary fat actually can increase LDL, restrictions on certain types of dietary fats contained in some protein foods may be appropriate.
Unfermented soy foods contain small amounts of phytoestrogens—female sex hormones. Amounts consumed should therefore be limited, especially for children.
Meals need not follow a rigidly fixed time schedule, provided, in most cases, that you do not begin eating within 4 hours of the end of the prior meal. This is so the effect of the first meal upon blood sugar won’t significantly overlap that of the next meal. For those who inject insulin before meals, it’s very important that meals be separated by at least 5 hours if you want to correct elevated blood sugars before eating (see Chapter 19, “Intensive Insulin Regimens”). This is also ideally but not always true of snacks covered by insulin.
Snacks are permitted for some diabetics but certainly not required. The carbohydrate content of snacks may in some cases duplicate but should not exceed that allocated for lunch or supper. So if you ate lunch at noon, you might tolerate a snack that didn’t exceed 6 grams of carbohydrate at about 4 P.M. You would then eat supper at about 8 P.M. Snacks are discussed in greater detail later in the chapter.
If you do not take insulin, you need not be restricted to only three daily meals if you prefer four or more low-carbohydrate meals on a regular basis. The timing, again, should ideally be at least 4 hours after the end of the prior meal or snack. For most type 2 diabetics, it may be easier to control blood sugar, with or without medication, after eating several smaller meals than after eating only one or two large meals.
Remember that there are no diabetes-related prohibitions on coffee and tea, either plain or with limited cream (not milk) and/or tablet (not powdered, except for pure stevia) sweeteners.*
Now, let’s attempt to translate our guidelines into some practical examples.
With or without blood sugar–lowering medications it is usually more difficult to prevent a blood sugar rise after breakfast than after other meals. Therefore, for the reasons discussed under “The Dawn Phenomenon” (here), I usually suggest half as much carbohydrate at breakfast as at other meals. Your body will probably not respond as well to either the insulin it makes or to injected insulin for about 3 hours after you get up in the morning because of the dawn phenomenon.
It is wise to eat breakfast every day, especially if you’re overweight. In my experience, most obese people have a history of either skipping or eating very little breakfast. They then become hungry later in the day and overeat. Nevertheless, for most of us, any meal can be skipped without adverse outcomes, provided, of course, that insulin or any other blood sugar–lowering medication taken specifically to cover that meal is also skipped.
A typical breakfast on our meal plan would include up to 6 grams of carbohydrate and an amount of protein to be determined initially by you. There are numerous possible sources of appetizing ideas for the carbohydrate portion of your breakfast. The best place to start is with what you currently eat, as long as it’s not on the No-No list (here). You can also sample recipes from Part Three or from my book The Diabetes Diet. You can experiment with foods in “So What’s Left to Eat?” (here). There are many soybean products, such as the foods mentioned here and here. Despite restrictions, with a little creativity you can find any number of satisfying things to have for breakfast.
Suppose that, like many of my new patients, you’ve been eating for breakfast a bagel loaded with cream cheese and 2 cups of coffee with skim milk and Sweet’n Low powdered sweetener (totaling about 40 grams of rapid-acting carbohydrate altogether). As we negotiate, I might propose that you substitute other sweeteners for the Sweet’n Low and 1 ounce WestSoy soymilk (0.5 gram carbohydrate) for the skim milk in each cup of coffee (or use cream). Then I’d recommend that instead of a bagel you eat a Wasa Crisp’n Light 7 Grain crackerbread (2 grams carbohydrate) with 1 ounce of cream cheese (1 gram carbohydrate plus 1 ounce protein). This adds up to about 4 grams of carbohydrate. Finally, I’d suggest that you add a protein food to your meal to make up for the calories and “filling power” that disappeared with the bagel.
Let’s say you decide you’ll eat eggs for breakfast (or egg whites or Egg Beaters, although for most of us on a low-carbohydrate regimen, neither of these is necessary for cholesterol control). I’d ask how many eggs it would take to make you feel satisfied after giving up the bagel. You might want to make a vegetable omelet instead of eating one of the carbohydrate foods mentioned above. If you’re unnecessarily afraid of egg yolks, you might use organic eggs or egg whites. If you find egg whites bland, you could add spices, soy or Tabasco sauce, some mushrooms, a small amount of onion or cheese, chili powder, or even cinnamon with pure stevia to enhance the taste. One of my current personal favorites for flavoring is a “chili sauce” made from Better Than Bouillon Chili Base. This packs a nice chili punch with very little carbohydrate (according to the label, 1 gram of carbohydrate per 2 teaspoons), and works quite well on eggs or other foods, depending on your taste. (I like to make chili burgers with it—which you could certainly have for breakfast.) This product, a kind of mushy paste, comes in a small glass jar and is available at most supermarkets or from Superior Quality Foods, 2355 E. Francis St., Ontario, CA 91761, (800) 300-4210, www.superiortouch.com.
Some years ago, I tried to help my patients who felt they had to have cold cereal include a small amount in their breakfast meal plan, but blood glucose profiles showed consistently that this just didn’t work. Grain products, with the exception of the bran products I’ve mentioned, contain too much fast-acting carbohydrate to allow us to keep blood sugar under control, and so we’ve had to eliminate breakfast cereals entirely. An alternative might be GG Scandinavian FiberSprinkle.
The good news is that there are lots of other tasty, filling things to eat.
If you don’t want eggs, you might try some smoked fish, tuna fish, or even a hamburger. I have one patient who eats two hot dogs for breakfast—her favorite food. The quantity of fish or hamburger would be up to you, but it would have to be kept constant from one day to the next. You can either weigh the protein portion on a food scale or estimate it by eye. The rule of thumb is, again, that a portion of poultry or fish the size of a standard deck of playing cards will weigh about 3 ounces (3.7 ounces for red meat). One egg has the approximate protein content of 1 ounce of meat, poultry, or fish plus up to 0.6 gram of carbohydrate (which we usually ignore).
You can take any of the foods in the 6 grams of carbohydrate list here and add protein to them (cheese, eggs, et cetera) to make a satisfying breakfast. You can have less than 6 grams of carbohydrate or even no carbohydrate, provided the amount is unchanged from day to day.
Follow the same guidelines for lunch as for breakfast, with the exception that the slow-acting carbohydrate content may be doubled, up to 12 grams.
Say, for example, that you and your friends go to lunch every day at the “greasy spoon” around the corner from work and are served only sandwiches. You might try discarding the bread and eating the filling—meat, turkey, cheese, or other protein food—with a knife and fork. (If you choose cheese, remember to count 1 gram carbohydrate per ounce.) You could also order a hamburger without the bun. And instead of ketchup, you could use mustard, soy sauce, or other carbohydrate-free condiments. You then might add 1
cups of cooked whole vegetables from the list here (12 grams carbohydrate) or 2 cups of salad with vinegar-and-oil dressing, not balsamic (12 grams carbohydrate), to round out your meal.
If you want to create a lunch menu from scratch, use your food value books to look up foods that interest you. If you like sandwiches, one double cheese puff as described later in this chapter under the “Snacks” heading will be about the size of a large slice of bread. The cheese puffs are sturdy enough that you can make a sandwich from two of them. Just make sure to account for the protein and carbohydrate in the cheese.
The following building blocks may be helpful in giving you a start.
For the protein portion, one of the following
A small can of tuna fish contains 3 ounces by weight in the United States. If you’re packing your lunch, these can be quite convenient if you like tuna. The next larger size can contains 5 ounces. The tastiest canned tuna I’ve tried is made by Progresso, packed in olive oil.
4 standard slices of packaged pasteurized process American cheese (process cheddar in the U.K.) weigh about 2 ounces. They will contain about 3 ounces of protein and 3 grams of carbohydrate.
1 cups cooked whole vegetables (from the list here).
2 cups mixed green salad, with 1 slice tomato and vinegar-and-oil (not balsamic) dressing. Sprinkling bacon or soy bacon bits or grated cheese will have negligible additional blood sugar effect.
1½ cups salad, as above, but with 3 tablespoons commercial salad dressing (other than simple vinegar-and-oil) containing 1 gram carbohydrate per tablespoon. Check the label.
You might decide that 2 cups of salad with vinegar-and-oil dressing is fine for the carbohydrate portion of your lunch. You then should decide how much protein must be added to keep you satisfied. One person might be happy with a 3-ounce can of tuna fish, but another might require 2 large chicken drumsticks or a packet of lunch meat weighing 6 ounces. For dessert, you might want some cheese (in the European tradition) or perhaps some sugar-free Jell-O brand gelatin (if it contains no maltodextrin) covered with 2 tablespoons of heavy cream. You might consider some of the desserts described in Part Three or in The Diabetes Diet. The possible combinations are endless; just use your food value books or read labels for estimating protein and carbohydrate. Some people, after having routinely eaten the same thing for years, discover that their new meal plan opens up culinary possibilities they never knew existed. Our patients, as well as our readers, are always looking for recipes, so if you come up with a recipe that you think is particularly good, please feel free to share it on the website for this book, www.diabetes-book.com. Choose the “Recipes” link and follow the directions for submission. The simple recipe format used in Part Three must be followed precisely for it to be acceptable.
Supper should follow essentially the same approach as lunch. There is, however, one significant difference that will especially apply to those who are affected by delayed stomach-emptying (gastroparesis) and take insulin. As we’ve discussed briefly, this condition can cause unpredictable shifts in blood sugar levels because food doesn’t always pass into the intestines at the same rate from meal to meal. The difficulty with supper is that you can end up with unpredictably high or low blood sugars while you are sleeping and unable to monitor and correct them. Sustained exposure to high blood sugars while sleeping—even if they are normalized during the day—can lead to long-term diabetic complications. For certain affected people, a viable approach to this problem is to facilitate stomach-emptying by replacing salads with cooked vegetables (from our list) that are low in insoluble fiber and reducing protein content. For these people, the amount of protein at supper would be less than that eaten at lunch—just the opposite of what has become customary for most Americans. A more complete analysis of this problem appears in Chapter 22.
If you like cooked vegetables (from our list) for supper, remember that most can be interchanged with salads as near equivalents— cup of cooked whole vegetables (or ¼ cup mashed or ½ cup sliced or diced) and 1 cup of salad each have the blood sugar effect of about 6 grams of carbohydrate.
If you like wine with dinner, choose a very dry variety and limit yourself to one 3-ounce glass (see here). As noted here, one “lite” beer may actually turn out to have no effect upon your blood sugar. Still, don’t drink more than one if you take insulin or use one of the oral agents that stimulate insulin secretion (sulfonylureas; remember that our program prohibits use of these agents).
For many people with diabetes, snacks should be neither mandatory nor forbidden. They do, however, pose a problem for people who take rapid-acting insulin before meals. Snacks should be a convenience, to relieve hunger if meals are delayed or spaced too far apart for comfort. If your diabetes is severe enough to warrant the use of rapid-acting blood sugar–lowering medication before meals, such medication may also be necessary before snacks.
The carbohydrate limit of 6 grams during the first few hours after arising and 12 grams thereafter that applies to meals also applies to snacks. Be sure that your prior meal has been fully digested before your snack starts (this usually means waiting 4–5 hours). This is so that the effects upon blood sugar will not add to one another. You needn’t worry, however, if the snack is so sparse (say, a bit of toasted nori) as to have negligible effects on blood sugar. Sugar-free Jell-O brand gelatin (without maltodextrin) can be consumed pretty much whenever you like, provided you don’t stuff yourself. As a rule, snacks limited to small amounts of protein will have less effect upon blood sugar than those containing carbohydrate. Thus 2–3 ounces of cheese or cold cuts might be reasonable snacks for some people.
Among my patients, a common favorite snack, which has a negligible amount of carbohydrate, is homemade microwave cheese puffs. They’re simple and convenient to make. Get some freezer paper from the grocery—not waxed paper. It has a dull side and a shiny side. Place a slice of American cheese (process cheddar in the U.K.) on the shiny side of a piece of the freezer paper, then pop it into the microwave for 1–2 minutes, depending on how powerful your microwave is. The cheese will bubble up and puff quite nicely, but let it cool a little before attempting to remove it from the paper. Cooling can be accelerated by putting it into the freezer for 30 seconds.
Two slices side by side in the microwave will melt together to make a double cheese puff. Two of these are suitable for a sandwich. I have put mayonnaise on one and mustard on the other and ham or turkey and cheese in between. Cheese puffs can also be substituted for toast at breakfast.
If you’re being treated with only longer-acting blood sugar–-lowering agents, the question of random or even preplanned snacking is best answered by experimentation using blood sugar measurements.
Although your blood sugars will respond best if you adhere to our restrictions on carbohydrate, you’ll find that you have considerable leeway when it comes to planning the amount of protein for each meal, provided that you don’t have gastroparesis or another digestive disorder and inject insulin. At the initial meal-planning session with your physician or other health care provider, you may estimate that you will require perhaps 6 ounces of protein to satisfy your appetite at lunch. When you actually try eating such a lunch, you may conclude that this amount of protein is either too much or too little for your satisfaction. This can readily be changed, provided that you first advise your health care provider, so that dosage of any blood sugar–lowering medication you take may be adjusted accordingly. Once a comfortable amount of protein has been established for a meal, it should not change from day to day but, like the carbohydrate, be held constant. The predictability of blood sugar levels under this regimen depends, in part, upon the predictability of your eating pattern.
Many patients ask me if they can juggle carbohydrate or protein from one meal to another, keeping the totals for the day constant. Such an approach doesn’t work, for reasons that should be obvious by now, and can be downright dangerous if you’re taking medications that lower blood sugar. Some patients who visit me for the first time after reading this book have totally ignored this very important point and have found it impossible to achieve stable blood sugars.
Some people who follow my dietary guidelines consume considerable amounts of fiber. Slow-acting carbohydrate foods that are especially high in fiber include salads, broccoli, cauliflower, bran, and soybean products. Fiber binds dietary calcium in the gut, causing a reduction of calcium absorption and potential depletion of bone mineral, which contains 99.5 percent of our calcium reserves. The phosphorus present in proteins also may bind calcium slightly. Since I discourage the use of milk and certain milk products (except cheese, yogurt, and cream), which are good sources of dietary calcium, the potential for bone mineral depletion may indeed be real. This is a special problem for women, who tend to lose bone mass at an increased rate after menopause. Since recent research targets calcium supplements as a risk factor for arterial disease, I recommend increased consumption of calcium-rich foods such as cheese, whole-milk yogurt, and cream. For women it also makes sense to build up calcium stores earlier in life, and to offset high-fiber and high-protein diets with extra calcium. This is most important for growing teenagers. Vitamin D replacement to bring blood levels to 50–80 mg/ml will make this more effective, as vitamin D aids calcium uptake by bone.
Calcium also facilitates weight loss by slightly elevating your metabolic rate, but that doesn’t mean that the more you take, the more weight you’ll lose. Nor does it mean that if you are in the minority of diabetics who are trying to gain weight you should avoid calcium.
Sedentary and thin people lose more bone calcium over a lifetime than do physically active people. Exercise builds bone just as it builds muscle.
The guidelines set forth in this chapter should be adequate for you to create your own meal plan, but I don’t want to leave you with any uncertainty as to how it is done. I have, therefore, listed below 3 days’ worth of breakfasts, lunches, and suppers to give you an idea of how I do it. These meals should serve as a starting point. You may want to overhaul them entirely to reflect your favorite foods. If, for example, you prefer canned salmon to frankfurters, just substitute a small can (3 ounces) of salmon for the two 1.7-ounce frankfurters in the lunch of Day One.
The carbohydrate content of each meal reflects our 6-12-12 guidelines. If you’re going to maintain normal blood sugars, then whatever amounts of carbohydrate you use must remain rigid. (Small children should theoretically consume less, but this may pose problems of compliance.) That said, exceeding or diminishing carbohydrate allocations by 1–2 grams per meal for adults will not make a great difference in your blood sugars—remember the Laws of Small Numbers. Aside from these constraints, you are otherwise limited only by your imagination. The protein content of meals, on the other hand, is completely up to you, provided that you don’t take insulin and have a digestive disorder. For the following examples, I’ve arbitrarily assumed certain amounts of protein that may be too much or too little to satisfy your desires; you will want to experiment to determine your own preferences. Remember, however, that protein, like carbohydrate, should be kept constant from one day to the next for any given meal.
Let’s assume that you’ve negotiated a meal plan, and the amounts of assigned carbohydrate and amounts of protein that you think will satisfy you are as follows:
| Breakfast: | 6 grams carbohydrate, 3 ounces protein |
| Lunch: | 12 grams carbohydrate, 4 ounces protein |
| Supper: | 12 grams carbohydrate, 5 ounces protein |
Note that none of the nine meals that follow adds up precisely to these guidelines for total carbohydrate and protein, yet all of them are quite close and thus acceptable. Note also that I usually don’t list beverages. This is simply because most acceptable beverages contain neither carbohydrate nor protein and may therefore be ignored in our computations. Remember, however, that every tablespoon of cream for your coffee or tea contains about 0.4 grams of carbohydrate.
I haven’t made the protein and carbohydrate exactly equal for a given meal from one day to the next. That will be your job when you make your selections.
Day One
| Breakfast | Carbohydrate (grams) | Protein (ounces) |
| Mushroom Omelet with Bacon (here) | 3.1 | 2.8 |
| 1 Wasa Crisp’n Light 7 Grain crackerbread with butter | 4.0 | 0.1 |
| TOTAL | 7.1 | 2.9 |
| Lunch | ||
| Green Cabbage Coleslaw with Lemon Zest (here), 1 serving | 5.8 | — |
| 1 GG Scandinavian Bran Crispbread with mustard or butter | 3.0 | 0.2 |
| 2 frankfurters | 3.0 | 3.4 |
| TOTAL | 11.8 | 3.6 |
| Supper | ||
| cup mixed salad with oil, vinegar, and spices |
4.0 | — |
| 2 tablespoons crumbled blue cheese on salad | 0.4 | 0.7 |
| Pan-Fried Swordfish with Ginger Scallion Butter (here) | 7.6 | 4.8 |
| TOTAL | 12.0 | 5.5 |
Day Two
| Breakfast | Carbohydrate (grams) | Protein (ounces) |
| Pancakes (here) | 7.0 | 1.4 |
| 2 sausage patties, 1 ounce each | 0.6 | 2.0 |
| TOTAL | 7.6 | 3.4 |
| Lunch | ||
| 2 cups salad with vinegar-and-oil dressing, sprinkled with grated cheese | 12.0 | — |
| 1 small can tuna (3 ounces) mixed with 1 tablespoon each mayonnaise and chopped celery | 0.3 | 3.1 |
| 1 slice American cheese (place on top of tuna and heat in microwave for tuna melt) | 0.67 | 0.67 |
| 12-ounce bottle “lite” beer | Assume 0 | Assume 0* |
| TOTAL | 12.97 | 3.772 |
| Supper | ||
| Quiche Lorraine (here), ¾ serving | 9.2 | 2.7 |
| Chocolate Soufflé (here) | 2.9 | 1.8 |
| TOTAL | 12.1 | 4.5 |
* Unless your blood sugars prove otherwise.
Day Three
| Breakfast | Carbohydrate (grams) | Protein (ounces) |
| 2 ounces smoked Nova Scotia salmon | — | 2.0 |
| 2 Wasa Crisp’n Light 7 Grain crackerbreads | 4.0 | 0.1 |
| 2 cheese puffs (here) | 1.3 | 1.3 |
| TOTAL | 5.3 | 3.4 |
| Lunch | ||
| Avocado Spread (here), 1 serving | 6.6 | 0.4 |
| ½ red or green bell pepper, cut into strips | 3.8 | — |
| 3½ ounces hamburger meat | — | 3.5 |
| 1 tablespoon Bac-Os brand soy bacon bits (knead into hamburger before cooking) | 2.0 | 0.5 |
| TOTAL | 12.4 | 4.4 |
| Supper | ||
| 1 medium artichoke, boiled, served with melted butter | 12.4 | 0.5 |
| 4½ ounces any meat, fish, or poultry, cooked as you like | — | 4.5 |
| TOTAL | 12.4 | 5.0 |
To any one of these meals you could add as a dessert a serving of sugar-free Jell-O brand gelatin (without maltodextrin), which would not appreciably affect your carbohydrate allocations. Again, you are limited only by your imagination, and there are countless different meals you could create that add up to no more than 6 or 12 grams of carbohydrate and 3, 4, 5, or more ounces of protein.
I will personally answer questions from readers for one hour every month. This free service is available by visiting www.askdrbernstein.net.