Pizza with Minimal Carbs

This is something I make myself; use it as ideas to base your own variations on.

Ingredients

Pastry:
Bread flour
yeast
Topping base :
Napoli Sauce
Shredded Mozzarella cheese; purists can use sliced real mozzarella - but shredded is fine for pizza in my opinion.
Grated Parmesan Cheese.

Suggested Toppings

Any or all, in small quantities:

shredded ham or bacon (pre-cook slightly and drain on kitchen paper if you want minimal fat)
pineapple pieces (for the non-diabetic spouse)
sliced mushrooms
sliced capsicum (bell pepper)
chopped olives
anchovies
sliced onion
sliced tomato
whatever is your favourite
Pastry for four medium or eight individual pizzas.

Methods

Base Preparation

Use your favourite bread recipe and make up the standard amount for one loaf, based on 500gm (just over 1 lb) of flour. I usually use a wholemeal flour with added bran and psyllium husk, but use your own.

Let it get to the stage of final rising. I don't use a machine - if you do, don't let it cook! Then pound it down and divide into eight equal portions.

Shape into balls, cover in cling wrap, and freeze for future use.

Pizza for two

Thaw two dough balls and allow to rise until doubled in size.

Take one ball, punch it down, knead a little (I know it's small) and then roll with a rolling pin or similar into a circle. Keep rolling and stretching until you have a thin circle about 8"-10" (20-25 cm) diameter. Spray your tray with olive or canola oil and spread the pastry on it. I know it looks awfully thin; let it sit for at least half an hour in a warm place to rise a little and get a little thicker. It will rise further in cooking. My wife hates anchovies and olives and I can't eat pineapple, which is why I make two 8" pizzas. Of course, you could combine the two dough balls to make a bigger single pizza and share.

Next time I take a picture - I'll clean up a bit more - at least you know it's real:-)

In the meantime, prepare or thaw a cup of Napoli Sauce, prepare your toppings and warm the oven to 200c (390 F). When the pastry is ready, spread the napoli sauce over it. Sprinkle or arrange your toppings on the pizza, finally spread liberally with the mozzarella and sprinkle with the grated parmesan.

Bake for about 15 minutes, checking after 10.

Nutrition details:

For the base only, per dough ball based on "Kitchen Collection" wholemeal bread mix:
Energy 600 kj
Protein 6 gm
Fat Total 2gm, incl .25 gm saturated.
Carbohydrate total 23 gm, including 2 gm sugars.
Dietary Fibre 4 gm (separate, British system).
Sodium 250 mg.
Add fat/protein/carbs for your topping.

Bon Appetit

Cheers, Alan

Thanksgiving and other Feasts

I have a friend named Jennifer. She's more than a friend - her Test,test,test advice changed my life. Consequently I promote it to every newby I meet.

Jennifer also realises that we are human as well as being diabetic; many of us have problems at holiday and feast times, feeling left out and restricted. She posted this today on alt.support.diabetes. We don't have Thanksgiving in Australia, but the same philosophy would apply for us on Christmas Day.

Re-posted with permission; also see her following comments from an earlier post on a special dietary ingredient called "Birthday Cake".

The Holidaze

I've been thinking about the upcoming season of joy, love and food.

With the holidays coming up, give yourself permission to be human.There is a lot of great food that will be out there soon. Don't try to steel yourself against all of it. You most likely won't be able to, and then you'll have guilt on top of it.

Choose your times. And then enjoy a piece of cake. A dollop of mashed potato. That holiday cookie that only shows up once a year. Make it your CHOICE, not a moment of weakness that will haunt you. That way you'll be able to enjoy it so much more, AND not fall into the "well I messed up, might as well eat the plateful".

The other side is all the family you're likely to be around this season. Some may decide that they know what you should or shouldn't be eating. They'll announce loudly, "Sara can't have that, she has the diabetes". Exhausting. Or they'll push food on you "Oh come on, it's the holidays, you can have a taste". More exhausting.

Whatever you decide to eat or not eat, the most important thing is that YOU control it. If you choose to have some pumpkin pie, make it your conscious decision. Not a mindless "What the hell" or a forced "NO"through gritted teeth. You decide. Only you.

When it comes to food and diabetes, I discovered that I had to change "Can't" to "Don't" in my thinking. I "can't" eat that cookie... means "Poor me, someone or something is not allowing me to eat that cookie". I have no choice. It's beyond my control (which also means that sometimes if I do eat that cookie, then it's a "cheat" and there is the ensuing guilt and shame for being a bad diabetic).

I "don't" eat cookies... means that I have made a choice, it's not something that's part of my life. I am in control (which also means that sometimes if I do eat cookies, I have just decided at that moment to make a different choice... no guilt, it's just my decision at that moment).

A bonus to this way of thinking and talking is when you are out and about and someone offers you something you would rather not eat at the moment,"don't" works better than "can't" to get them to understand.

If you tell them you can't have ice cream, they will tell you can...that just a little won't hurt. If you tell them you don't eat ice cream...what are they going to say? Yes you do? And if they say, "well you used to"... you can always say "I don't anymore". ; )

Hang in and Happy Holidaze!!

Jennifer

Birthday Cake

IMPORTANT ANNOUNCEMENT!!!
Modern research has determined that "Birthday Cake", ie: A highly decorated sweet flour/fat/sugar based dessert, generally festooned with YOUR name, has NO CALORIES, NO CARBS, AND NO FAT.

Shocking? Sure.

But it appears, the joy felt once a year when we eat a piece of this comestible surrounded by our loved ones immediately dissipates all CALORIES, CARBS AND FAT!

There are a few important caveats:

1. It must be YOUR birthday.
2. You must only have ONE birthday a year.
3. Cake must be consumed AFTER appropriate musical accompaniment ("Happy Birthday" or "For He/She's a Jolly Good Fellow/Person" or the like).
4. Candles, while low carb, low calorie and low fat must NOT be consumed... especially when lit.
5. BEWARE! Foods consumed before and after cake maintain their original carb, fat and calorie count.

This has been brought to you as a public service announcement.

Jennifer

Yes, the "Ice Cream AND Cake" variable was addressed in the study.

Should "Ice Cream AND Cake" be consumed, as separate items, each will release HALF of it's calories, carbs and fats. So an option would be to only eat the HALF that is now CCF-FREE. Determining which half is now CCF-FREE is easy... it's the half closest to you.

As for an "Ice Cream Cake" ie: Baskin Robbins/Haggan Daz/Carvel... normal sized slices fall under the original CCF-FREE study and can be consumed with pleasure.

Hope that clears it up.

Jennifer

It certainly does - thanks Jennifer:-)

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

Napoli Sauce

My apologies to anyone of Italian extraction - I know it's not like Momma used to make.

I cook this sauce up in bulk, then use it in various other recipes like Spaghetti Bolognese, Stuffed Mushrooms, Minimal-Carb Pizzas etc. I'll post recipes for those later. I also like it as a low-carb sugar-free alternative to ketchup on steak, hamburgers and other cooked meats.

It will keep for a few days in the fridge, but I mostly freeze it in two ways. About half of a bulk lot I freeze as ice cubes which I then transfer to an old ice-cream container in the freezer for ready use. Then I can defrost the number necessary without waste, as I often cook for one. The remainder I freeze in larger 1 or 2 cup serves in plastic containers for use as needed. I always have a thawed one in the fridge for ready use as a ketchup or sauce.

All of my recipes are very flexible. In this case vary ingredients, particularly herbs, to your own taste. However, it's best to follow the recipe with a small test try first.

Base Ingredients

1 can (about 400g or 14 oz) peeled tomatoes, or fresh equivalent.
1 medium onion, chopped
1/4 cup tomato paste (optional)
1 clove of garlic, minced
olive oil
1 teaspoon of dried basil or a few chopped leaves. If you like other herbs such as oregano, thyme etc, just adjust to your taste, but basil is basic to the recipe.
cracked black pepper to taste
salt to taste

Method

Sweat the chopped onion in a large pot over medium heat until translucent but not brown. Use a little olive oil to prevent sticking to the pot.

Add the minced garlic and cook until also translucent.

Chop the tomatoes and add to the pot with their juice. For large quantities drain the liquid into the onion mix and use a processor for the solids in batches. Or, if you have a stick blender, blend it in the pot - it doesn't need to be a puree, I prefer some texture; it will also break down further as it cooks.

Add the basil/herbs and bring to a slow covered simmer. Allow to simmer as long as possible, but at least an hour, until the tomato breaks down and the onion seems to almost disappear.

Check and stir occasionally to prevent sticking; add a little water if the mixture gets too thick.
When the sauce is cooked it should be thickish but still liquid and pourable. Adjust seasoning near the end.

For a richer, thicker sauce add the tomato paste towards the finish and cook while stirring until it is cooked in. If you add it too early you will need to watch more closely for sticking.

For bulk cooking

I just multiply; usually I cook about six cans worth. How much you cook depends on the size of your saucepan/cooker and storage/freezing facilities. As you increase the quantity you may need to adjust the onion, garlic and basil quantities down a little in proportion.

Up-date May 1 2009
Nutrition Table. This is approximate and will vary a little. The total fat content is from the olive oil.

Per cup of Napoli Sauce
Calories......................140
Protein..................2.5 gm
Total Fat..................7 gm
Sat. Fat ....................1 gm
Mono. Fat................5 gm
Poly Fat....................1 gm
Carbohydrate.........18 gm
Fiber.....................9.5 gm

Bon Appetit

Cheers, Alan, T2, Australia
Everything in Moderation - Except laughter

xita's Story

One of the forums I read daily at the moment is the ADA Adult's Type 2 Message Board. I was late arriving there, as I disagree quite strongly with the ADA dietary guidelines (see Diabetes Authorities and Diet ); so I was pleasantly surprised to see that my preconceptions were wrong. Just a different group of diabetics struggling to gain control. Of course, most had not heard of Test,test,test so I've tried since my arrival to remedy that. Politely, as they are moderated, but regularly and often:-)

Today "xita" - a person I had never heard of before, posted her story. There are so many parallels with my own path on this journey it was eerie reading it - but I'll let her tell it herself.

First, she (I'm guessing from the name) wrote:

I have been diagnosed with diabetes since March. When I was diagnosed my A1c was 10.4 I finally had another test and my new A1c is 5.1 I am so happy I needed to tell someone. I have followed this and other boards for information. I am not sure I would've been able to do it without the internet. When I started this journey nearly 8 months ago I weighed 256 pounds. I am now 193. It's been unbelieveable since I never thought this was possible. I had given up hope on losing weight and here I am still losing weight. I will go back to the doctor in December to see what she has to say as far as medicines are concerned. Currently I take 1000 mg of Metformin twice a day. I've mostly low-carbed it. I eat my meter as they say. It was really hard at first but now I really don't struggle much with my food. I've learned to love vegetables! Anyway, thanks for letting me share my story.

When others answered with congratulations, this was her answer:

Thanks a lot to everyone! I find celebrating milestones keeps one motivated.To answer your question Morris, I'll try to be brief in explaining some of the things I've been doing. At first, I was depressed and didn't know what to do. It took a full month to begin seeing some real results. I felt frustrated because it seemed like nothing I did was bringing my numbers down. That first week was especially hard because I got a meter but I had to wait a week till I had some classes on diabetes.

Kaiser set me up with three classes. They really helped me a lot but so did my research. There are some things that I learned at Kaiser that really helped me with my diet. I learned about portion sizes and that I should always aim for half my plate to be vegetables. They also taught me which foods were carbohydrate and which ones weren't. They told me which vegetables were high in carb and should be measured. This is their suggestion on how to eat right. I scanned that sheet and put it online for people. One of the suggestions I liked also was balancing the protein, fat and carb. I always try to balance my meal. I made some edits to this food chart. This is the bible I followed at first. I added peas and pasta to that chart as well as coloring the carbs pink. I also suggested having no more than 2 of the carbs during a meal.Another thing I learned at kaiser was to eat every 4-5 hours and if I didn't that's when I should snack. I also snack when I am hungry but I try to have good snacks (a piece of fruit before exercise, nuts whenever).However, that wasn't bringing me down completely.

Then came the internet and I found Jennifer's Advice.

I started measuring after everything, starting with breakfast because it is the most important meal since we are all more insulin resistant during that time. It was depressing because I didn't know what I could eat, everything seemed to spike me to nearly 200. Once I got it down, I started testing at 1 hour after breakfast and found that I was still spiking too high. I concentrated on not spiking above 140 at 1 hour. I realized that I could only have about 11 grams of carbohydrate in the morning. I went from having a big bowl of cereal to 3/4 of a cup.

At first it was very depressing and I felt like I wasn't eating anything. I had to go buy a small bowl so I wouldn't notice the difference. I also found that Kellog's Protein + cereal was the lowest carb around and it was tasty. I now vary it with some low carb atkins bars. I have protein in the form of either a string cheese or egg beaters. I also have calcium in the morning with some low carb Chocolate Almond Milk. Once I controlled that breakfast number, it seemed like the other numbers worked themselves out easier.

With practice I learned that I can rarely consume more than 20 grams of carbohydrate a meal. BTW, I do not count vegetables (excluding peas and corn and starches) as carb. I eat plenty of vegetables at lunch and dinner. I just can't manage to work them into breakfast much. It was really hard at first but I started finding it easier and easier to do. I don't crave certain things anymore and I never eat things that I can't find nutritional value to. Things I haven't eaten in months: chips, candy, pizza, donuts, cake. I try to treat myself with low carb fudge bars, low carb ice cream, and that low carb cheesecake from The Cheesecake Factory (Steve's Low Carb Cafe in the la area also has low carb cheesecake). Some things also don't seem to spike me, home made pancakes (2 small ones).

I also learned to measure, I measure everything that might spike me, at first I couldn't touch black beans and I used to love them. Now, I can eat 1/3 of a cup without problem. And the thing is you get used to the portion size. I used to cry at the thought of eating so little but now a cup seems HUGE to me. And I believe that now that I have a better diet I am a lot less hungry and I eat a whole lot less.

I didn't set out to lose weight, I set out to control my sugar. It's miraculous but the weight just started coming off. One month I lost 10 pounds, some weekends it seemed like I was losing 5. I have now settled down and I am not losing as fast. I lose probably 5 pounds a month. I keep having to set diff goals because I keep meeting them. I wanted an A1c of 5 and I got it!! I wanted to lose 20 pounds, then 30, then 40, then I wanted to be under 200. Now I have a goal of being solidly under 190 by the end of December. I would like to be in the 170s by next summer. I don't want to push it.

Anyway, the keys to weight loss for me I believe have been, portion control, tons of vegetables, NEVER eating more than the serving size of anything (read the labels). I also do not eat fast food with any regularity, I try to eat home cooked meals as much as possible. I haven't been too much concerned with fat, I eat meat every day, I eat cheese. I just eat small portions.

Lastly, exercise, this is the area that I need to get better at. At first and for 5 months, I was doing exercise 3-4 times a week. It was hard to go more often than that. Since the summer, one reason or another has kept me from going regularly. I haven't really been exercising since July. I try to be active in my daily life. I am now motivated to hit the gym again this week since I am out of excuses and newly motivated by my great A1c!

Ok, this was not a brief response at all, hee.

I just want to share with you all and if anyone gets anything out of this, it will make me very happy. My own non-diabetic brother has lost 40 pounds, he was also morbidly obese. My mother has lost 10 pounds as well. Another benefit is that I believe I have prolonged my father's life. He's a diabetic and we didn't realize how badly he was off. Once I learned, I taught him and my mother how to cook for him. He was suffering from neuropathy in his feet and his hands were quickly going as well. He now feels better than he has in a long time, his feet don't feel like they're burning all the time. He went from an A1c of 12.4 to 6.4.

Note: xita later added: "My cholesterol was also borderline high according to my doctor, but I chose not to take medicine and thanks to my low carb dieting, it's now at 160, 93 LDL, 54 HDL, and triglycerides at 64. It used to be 183,112 LDL, 45 HDL, and the triglycerides at 127", now to continue:

My paternal grandmother died recently, she suffered from diabetes but lived into her nineties. My father's brother and sister also have diabetes. My own sister went through gestational diabetes.I have no doubt that my weight and my genes got me where I am. I am 34 years old, suffering from diabetes for god knows how long. I was in denial since I peed a lot and was morbidly obese.

I didn't realize how many in my father's family were diabetic. Still, I am glad I found out because diabetes changed my life for the better. I am healthier than I have been in 17 years. When I looked at bad food, I'd tell myself do you want that more than you want your foot? I would always choose my foot. I don't find that I need that motivation anymore, as much. The difference for me is completely mental. It's not about what I shouldn't eat, it's about what I can't eat. I want to live as well as possible for as long as possible.

xita

Beef Burgundy

In all of my recipes the quantities are extremely flexible and subject to what happens to be in the fridge and pantry. I sometimes use precise measurements such as a "slurp", or a "smidgin" or a "grating". Use your imagination, if it doesn't work I feed next door's pooch and order in Pizza (and only eat one slice:-)

Every recipe is a base, add what you like that you think will work. For example, I often add copious quantities of mushrooms, or carrot, or celery to this one, depending on what's in the larder.

Ingredients

1kg (2 ½ lb) Stewing steak - any cheap cut of beef. Of course, the cheaper the cut, the longer you cook it.
125 gm (1/4 lb) Bacon.
One medium onion.
2 cloves garlic.
1 or 2 tablespoons plain flour (or 1 teaspoon guar gum).
Black pepper.
Nutmeg.
Salt.
Olive oil
One bottle of red wine.

Chop the bacon roughly, slice the onion into rings and crush the garlic.

Saute the bacon, onion and garlic over moderate heat in a tablespoon of the oil in a heavy skillet until the onion is transparent, then set it aside temporarily. If you are trying to lose weight and the fat worries you, drain it on kitchen paper.

Remove as much fat and gristle as possible from the beef. Roughly cut it into chunks, about 2 cm (3/4") cubes. Add a little more oil to the skillet and quickly fry the beef over high heat in small batches until browned and sealed, but not cooked. Set the meat aside in a casserole dish that has an appropriate cover.

Return the bacon, onion and garlic to the skillet and mix in a tablespoon of flour. Stir while cooking lightly, brown but do not burn. Guar gum can be used as a carb-free thickener – but needs practice to get the quantity and method right, about a level teaspoon in this recipe. I prefer flour in this recipe, as the flavour seems better and the tablespoon is spread across six serves. Flour also seems to combine better with the wine.

Add a large glass of red wine and stir while cooking until the sauce thickens. If the sauce is too thick, add a little more wine or water until the consistency is thick but pourable and not gluey. If it's too thin, add a little flour to a little water, stir the lumps out, and add it to the sauce. Add freshly ground black pepper, a good grating of nutmeg and a little salt to taste.

Add the sauce to the meat in the casserole dish, cover and place in a slow (170c, 340F) oven for an hour (or longer if a cheap cut was used). Check and stir, cook for another half-hour, then turn the oven off but leave it in for another half-hour.

The cook is entitled to drink some of the remaining wine while awaiting completion of the cooking process. Of course, you may drink the rest at dinner.

Serve as it is, or with brown or basmati rice if you can handle the carbs. Serves 4 - 8, depending on serve size and accompaniments. I turn it into lots of small breakfasts, by freezing small individual serves.

Nutrition count based on six serves using flour for thickener:

Calories 474
Protein 28 gm
Total fat 36 gm
Sat 14 gm
Mono 17 gm
Poly 3 gm
Carbohydrates 6 gm
Fibre 0.7 gm
Cholesterol 106 mg

When To Test After Meals

When we first received our brand new blood glucose meter the majority of us were told by our doctor or qualified diabetes educators to test twice daily - before breakfast, also known as "fasting" and before the evening meal. Some, not many, of us were also told to test occasionally two hours after meals.

The "us" I speak of are the thousands of newly diagnosed type 2's I've met in cyberspace over the past four years. Over that time, in three diabetes usenet newsgroups, eight Yahoo diabetes newsgroups and a couple of others via the web, I have yet to meet a single newby who was told by their doctor to test one hour after every meal or snack. In fact I've only recently met a few who were advised to test one hour after any meal at all.

So, why do I recommend that we should? Well, I must admit - it wasn't my idea; I learnt it from Jennifer and her Test, Test, Test advice. I also learnt from Derek Paice and his e-book Diabetes and Diet

Any test is wasted if it neither informs nor confirms some information. The tests prescribed by your medics are designed to help them analyse your progress, to assist in their decisions for your treatment - but they do very little to help you personally manage your diabetes. The doctor wants to see your "static" numbers, not the ones that might be very high or low as a result of the carbs you ate, or ignored, at your last meal.

And that's why I add those one-hour post-prandial (after-eating) tests - they help me directly. They are the "dynamic" numbers that showed the direct effect of the food I ate and the exercise I did. I call them one-hour, but the real term should be "peak" or maximum "spike"; mine is one-hour but you'll have to find your own.

I don't think the timing of the spike is as important as it's peak level and duration.

Think about it logically. Why would a spike of 10(180) affect you any differently if it occurred at 30, 60, 90 or 120 minutes? It's duration would be a factor - but post-prandial timing of the actual peak should be irrelevant. It still got to that peak, no matter when it occurred.

So, I learned to find my peak. That is slightly different, but reasonably predictable, with different foods and meal mixtures. Drinks, like OJ, spike me very quickly within 30 minutes and drop just as quickly. Which is why some people use them as hypo treatment. Starchy carbs, without much fat, will spike me in 30-45 minutes. But add fat - and it's about 60 minutes. A normal meal combining moderate fat, protein and low GI carbs leads to a peak at 45-75 minutes for me, and so on. That's why I settled on using the 1hr post-prandial test as my guide, but I occasionally do a 30 minute one if the food was low-fat and high-GI.

As to whether a brief spike causes damage - not enough research has been done. There appears to also be a possibility that spikes have a damaging effect at lower thresholds for type 2 than type 1, partly from anecdotal discussions I've followed over the past four years and partly from the slight differences in results in studies like the DCCT and UKPDS. Let's face it - only type 2 have beta cells to lose anyway. Therefore I am swayed by the reports here, on Jenny's excellent web-page; there is enough evidence to convince me that staying under 8(140) is worth the effort - no matter when it occurs: Blood Sugar Levels and Organ Damage (lottadata.wixsite.com)

Of course, I tend to always aim a little tighter, so these days I set the level at 7(126) for my one-hour post-prandial maximum. What you do is up to you.

Cheers, Alan

Everything in Moderation - Except Laughter.

Yoghurt

Yoghurt is an interesting food, with many benefits. For diabetics it is one of those foods where testing after you eat the first few times is essential because the carb content on the label doesn't give a true idea of the carb effect. Something changes when the acidophilus bacillae convert the milk to yoghurt and much of the lactose becomes lactic acid. I'm not a chemist - check it on the web for an explanation. But it means that you can often eat it at times when other foods will spike you, and it can become a satisfying and tempting dessert with the right flavourings.

I make up my own from basics. I only learnt this last year; it’s so simple I don’t know why I never did it before. Maybe because I didn’t eat the stuff until I learned to like it since diagnosis. I started eating yoghurt shortly before I started on metformin, following a tip by somebody who said it helped reduce the usual GI problems. Whether it did, I can't say, but I had none of those problems and developed a liking for the stuff.

My method may not be perfect – it’s just what I developed for myself.

I make up about three litres (a little less than a gallon) of milk using powder. I mix full-cream powder with skim in equal parts to get a 2% fat result. I use a slightly richer mix than the packet directions. I heat that until it is significantly warmer than body temperature, but not so hot I can’t sip it. I think it’s supposed to be about 55C(130F) but that’s my way of testing:-)

I use a plastic container which allows me to use the microwave for heating the milk. I take a cup of the hot milk and stir in about a ¼ cup of commercial yoghurt. Then I add that back to the milk and stir it in. I buy a local greek yoghurt as the starter – but any live yoghurt will do. The starter can have subtle effects on the flavour. The quantity doesn’t really matter as it will spread throughout the milk. The only difference a larger quantity seems to make is the speed of “setting”.

Then I cover the mix and store it overnight in an insulated pack. In the morning, like magic – yoghurt. Some people like it as it is; I prefer to strain about half of it through cloth and mix the strained portion with the unstrained for a rich, creamy yoghurt. Then I transfer it to jars and keep it in the fridge.

I use some plain in various ways: cooking, a base for spice marinades, mixed with mayo etc; or I add berries (blueberry, strawberry, fresh or frozen) or fruits (chopped – mango, apple – a little goes a long way) or flavourings (vanilla, instant coffee etc) and splenda to eat direct from the jar.

I reserve ¼ cup of that yoghurt to be the starter for the next one; about every three or four times I buy a new starter to refresh the process.

Bon Appetit, Alan

Everything in Moderation - Except Laughter.

Teeth, Gums, Diabetes and Death

First, the personal background.

I was first diagnosed with periodontal disease just before I left the RAAF 22 years ago. I had the same cleaning routine, every three months for a year, with the service paying. I didn't continue after that, because everything seemed good.

Nobody had mentioned that it is an incurable disease, at least while you still have teeth. Of course, if you don’t treat it that isn’t forever.

Over the next ten years, I had some minor dental work, but no serious problems. Then, quite suddenly, I got a major infection and abscess and was told that I needed treatment by the periodontist again. That was the first time I was told that it was an incurable disease, and that I should have been getting regular periodontal cleaning treatment ever since the first diagnosis.

Over the next five years, under an excellent periodontist in Melbourne, I managed to retain most of my teeth (lost four) and had several flare-ups. One of those I ignored for a few days because I was travelling; that one nearly killed me when it got out of control and I was treated just in time. I now carry Amoxycillin when I travel, just in case.

Now for the good news. At the time I was diagnosed with diabetes in 2002 I was seeing my new and also excellent periodontist on the Gold Coast every three months. He commented that I had improved significantly after a year of no smoking. But the improvement a year later when I had reduced my A1c and gained some control over my BGs was even better.

I now only attend every four months, and on two of those appointments I now only see the dental hygienist because I've improved too much to justify the periodontist's time.

Now – the serious bit for other diabetics.

Below I’ll list some links for those that want to read further, but I’ll summarise briefly here. I haven’t read all of the hundreds of papers – but skimming through the conclusions there is a gradual trend to general agreement on the following:

The bad news:

Periodontal disease and diabetes mellitus is a two-way relationship. Poor control of either degrades control of the other. See Periodontitis and diabetes interrelationships
That paper concludes with a quite unexpected additional possibility:
"Thus, there is potential for periodontitis to exacerbate diabetes-induced hyperlipidemia, immune cell alterations, and diminished tissue repair capacity. It may also be possible for chronic periodontitis to induce diabetes." Induce diabetes? Further research should be done there.

Postscript January 2009. See Diabetes and Dental health for more comment on causality.

Mortality (that word has a sense of finality) is significantly increased in diabetics with Periodontal Disease. http://care.diabetesjournals.org/cgi/reprint/28/1/27

The good news:

The two-way relationship can work in your favour. Improved control of Periodontal disease can assist with glycemic control and vice-versa. See http://www.medscape.com/medline/abstract/16584339

So - look after your pearly whites, folks. We all get lazy at times, as my periodontist is quick to remind me, but as a diabetic bad teeth and gums can literally be the death of us.

Cheers, Alan,

Everything in Moderation - Except Laughter.

If you are interested in further reading, this is a link to over 100 papers listed in PubMed:
http://tinyurl.com/y92tbs
And a similar link for medline (with some duplications)
http://tinyurl.com/t69s8

A post-script, posted 5th October 2010

A friend of mine, who is a Type 1 diabetic in the UK, just posted this report of a dental problem. Although not directly related to periodontitis I thought it may reinforce the need for dental health and also includes some sound advice on what to do if you ever have the same extraction need.

Here is Patrick's post, slightly edited:

I've had one very rotten wisdom tooth taken out and I'm a complete WIMP when it comes to dentists, that's why I hadn't been in years and is also why I've had the problems I've had.

Anyhooo I'm sure there's a few of you out there who are as nervous as me so here's a link to a very good site.

http://www.dentalfearcentral.org

There is a wealth of info for scaredy cats and also a list of NICE friendly dentists.

My thread is here http://www.dentalfearcentral.org/forum/showthread.php?t=13006

Now I'm aware there's more than a few food gurus in here, I'm not and never will be one of them so if you're one of those lazy low maintenance T1 like me then I hope the following is of some use.

Bearing in mind we're at a higher risk of dry sockets, we are more prone to infection and we take longer to heal I think stuff like this is worth paying attention to.

1. Follow your dentists advice on post tooth removal care.

Do NOT smoke. ( diabetics shouldn't anyway but I know some of us do)
Do NOT drink alcohol
DO rinse with warm salt water after each meal ( half teaspoon of salt per glass of warm water)
DO buy some Corsodryl and use that to rinse the salt taste away
DO drink lots of water
DO brush carefully but avoid the gum where the tooth was - the salt rinse and Corsodryl will see to that.

The longer you can stomach a liquid diet ( tomato soup for me as it has no bits in it) the better then you don't run the risk of getting food stuck in the gum.

Be aware that if you're used to a high carb diet, switching to just soup is going to present liquid problems at the other end

Breakfast has been either microwaved scrambled eggs mixed with sliced hot dog sausages. Or one crumbled weetabix mixed with half a sliced banana ( sliced into quarter of the round slices) and full fat milk but wait till it goes all soft before you eat it. I switched to egg on the basis that it tends to bind the gut up - a good thing when all you've really had in there is soup

Lunch has been soup mixed with more sliced hot dog sausages and buttered bread, the butter helps to keep the bread in one piece so you can keep it away from the gum.

Evening meal - more soup. bread and sausage.

I have also invested in low fat yoghurt for between meals to ensure there's plenty of good bacteria kicking around - this seems to have really sped up the healing process.

All the above foods do NOT fall to bits in your mouth and therefore do not get stuck in the gum as it heals - avoid rice and nutty breads etc for this reason.

Two things are going to happen, firstly you're going to lose any excess weight you had and secondly you're going to hate the taste of soup I'm ok with the latter on the basis of the former!

Lastly and for a rare few this will help. I'm T1 diabetic so the reduction in carb means a massive reduction in insulin requirements, be aware that Ibuprofen / Neurofen will remove your low blood sugar physical warning signs. Test more frequently and if like me, you're on a basal / bolus DAFNE system, you'll really need to work out what you're going to do with insulin.

Remember no two T1 diabetics are the same but my basal insulin was split 18u and 18u morning and evening. At the moment due to diet changes, i'm running 12u morning and 8u evening - this also due to the weight loss which makes you less insulin resistant.

Before you go in for the tooth out, please bear in mind you may not want to eat for up to 24 hours - to do that safely as a diabetic you need to ensure you reduce your basal insulin BEFORE you have the tooth out. Also ensure you eat a good meal before going in so that your blood sugar can be kept high enough to be safe. 24 hours of running a little higher than normal won't kill you. Knowing what I know now, I'd have changed over to this diet a week or so before the tooth came out so that I was better prepared for it.

Lastly and I can't stress this enough, I haven't needed any painkillers since the day the tooth came out - I've had no swelling at all and on day 5 it looks like my appetite has returned. I have lost approximately 1.5 stone in a little under a month ( I cut out coffee and tea with sugar, chocolate of any kind, ALL wine etc ) and I think I've got another 2 or 3 weeks of this diet to go so I'm guessing another half stone will drop off. I've gone from a 35" waist down to a 32" waist. [note for US readers. One stone is 14 pounds.]

The point I'm getting at is simply that losing middle body fat is a GOOD thing, I just didn't expect to have this many positive side effects after having something done I was very very nervous about. All of a sudden I'm hitting the exercise bike on Monday with a figure worth fighting for

So if you're out there and nervous, you can't be any more than I was and I'm fine, as is my diabetes control which has been almost perfect for the entire period.

Cheers

Patrick

Cheers, Alan

Diabetes Authorities and Diet

What follows is a copy of a letter I wrote a couple of years ago to the Editor of Conquest, the Diabetes Australia (DA) quarterly magazine. Since then, nothing has changed - so I'll repeat it as sent. Because my opinion hasn't changed either. For accuracy, I will note that I have added 1000mg metformin daily since writing the letter, so I can no longer claim to "take no diabetes medications". But that doesn't change the thrust of my argument.

To be clear, I think that both DA and the American Diabetes Association are marvellous, worthy organisations doing sterling work for diabetics in both countries. My only disagreement is specifically to do with their dietary and testing guidelines. The dietary advice and guidelines promoted by DA is effectively a rubber-stamp of that issued by the ADA; so the same comments apply to both.

I never received a reply.

I am eternally grateful for the work the pioneers at Diabetes Australia did in helping us get the NDSS and the support system that we now have. The organisation continues to do a great job. But I have a basic difficulty with the logic of the dietary advice recommended by your dieticians.

I see their advice like this:

1. Dieticians advise high complex carbohydrate consumption, apparently for heart, kidney and vascular health;
2. High complex carbohydrate consumption causes high blood glucose levels;
3. High blood glucose levels cause diabetic complications such as retinopathy, neuropathy, nephropathy and heart disease;
4. DA dieticians therefore recommend balancing the high complex carbohydrate consumption with medication or insulin to control blood glucose levels.

This advice appears to be in line with the recommendations of overseas organisations such as the American Diabetes Association (ADA).

Specific examples can be found on the DA web-site at http://www.diabetesaustralia.com.au/multilingualdiabetes/healthpros/FoodNut/healthy.htm [Edit 13th August 2008. This link no longer works; the new page on DA is significantly better, although still not great. You will find it at Carbohydrate ]
or the ADA web-site at http://www.diabetes.org/nutrition-and-recipes/nutrition/starches.jsp [Sadly, this link still works in August 2008]
[Both links no longer work in 2010 - excellent!]

My difficulty in understanding this is because no-one seems to be investigating the alternative approaches. I don't mean herbs and supplements, just a better diet for diabetics, together with exercise, to enable minimal medication.

To me, the most obvious alternative is to search for a diet for the diabetic which provides adequate nutrition for good health but does not cause high blood glucose levels. If such a diet is possible it would minimise the need for medication, particularly for type 2, with side
benefits for overall health and health costs. I can attest that it is possible; I've done it, as have many others. However, when diabetics write to give examples, such as K ...... in the Autumn issue, they are dismissed and told that their improvement must be because of exercise, or weight loss, or some other factor.

The method I followed, as a type 2, was simple. I started with a standard, sensible diet to lose weight. Then, as I followed that diet, I tested everything I ate one hour and two hours after I ate it. If I consistently found that something led to high blood glucose, I changed it. Sometimes I changed the food, sometimes the quantity, sometimes the timing, but always the aim was to minimise "spikes". Gradually I found I was eating significantly less carbohydrates, a little more protein and a little more "good" oils. And I did a little "lazy man's" exercise along the way. I also gradually reduced the high level of initial testing as results became predictable.

After attaining a degree of control over my blood glucose, I now progressively review my diet to ensure there are no missing nutritional requirements and to further improve lipids etc. At diagnosis in 2002 my HbA1c was 8.2, now it's 5.9 and I take no diabetes medications. It's a long time since I've seen a "spike" over 8, rarely over 7.5. The improvements continued long after I reached my target weight. And my heart, blood pressure, lipids, kidneys and so on are also in good shape.

Why do your dieticians continue to promote high carbohydrate consumption? What is it I'm missing, apart from complications?

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Cheesy Guacamole Dip

Ingredients

Chopped ingredients are to the texture you like - I like some lumps and crunchy bits, but if you don't then chop them finely.

1 ripe avocado
¼ cup finely chopped celery
¼ cup chopped onion
¼ cup chopped red capsicum (bell pepper)
1 chopped hot chili pepper (to your taste, or chili flakes)
½ minced clove of garlic
30g chopped cheddar cheese
30g light philadelphia or ricotta or cottage cheese
2 teaspoons grated parmesan
a large squeeze of lemon or lime juice - essential to longer life in the fridge.
1/2 tsp minced/grated ginger (optional)
salt and pepper to taste
All ingredients are extremely approximate and dependant on what's in the fridge.

Peel avocado, mix all dry ingredients and then add the lemon juice. Adjust dryness with olive or peanut oil if necessary until a smooth paste is obtained.

If using a food processor, add the solid vegetable ingredients last and process briefly to retain some texture.

Serve with slices of carrot, celery or similar for dipping. Thin low-fat crackers may be OK depending on your carb requirements.

Carbs, fat etc - low in carbs subject to whether you use crackers for dipping, fat depends on proportions of full-fat and low-fat cheeses. Check your own BG at one hour, mine is usually good after this.

Use it to fill the "gotta have something" gap between meals.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Hearty Vegetable Soup

The advantage of this recipe is that it is simple, totally flexible, and after it is done, creates 10-12 large (320ml) serves of soup from ¾ hour’s preparation and an hour’s simmering. After cooking and cooling I store the results in single-serve containers in the freezer. This would be my lunch three or four days a week; straight from the freezer via the microwave.

I have given an example of the ingredients in the pot I made yesterday. However, it is totally flexible. Use your favourite veges and seasonal veges. The only proviso is that you try to include slightly more watery or green veges than root veges. That gives a wider mix of vitamins and flavours and reduces the carbs. The carb count below is based on my choices in the list below.

OK, the method:
Half-fill two large pots with water and bring to the boil; reduce to a simmer. I use a two-litre (roughly half-gallon) pot for my "blender pot" and one twice that size for my "main pot".

Blender pot preparation

Add a can of tomatoes and bring to the simmer. As you later prepare vegetables, scrub them first and then put any peels, celery tops, carrot ends, cabbage cores etc into the blender pot. I waste nothing edible.

A tip for those cooking for fussy eaters like children or spouses. Put all of the veges they "won’t eat" in the blender pot. My good lady is blissfully unaware that there is broccoli (her most detested vegetable) in our soup. But never let them see the contents of that pot until you have reached that stage where it is a puree.

Main pot preparation

Add a bone – ham, leftover roast joint, whatever, to the main pot to become part of the stock base. If you don’t like the meat scraps becoming part of the soup do that separately in advance and strain the liquid into the main pot. Whenever we have a lamb or pork roast, or buy a new ham for freezing chunks, the next free afternoon is the soup-making time. Or just add a few stock cubes. Then add two or three tablespoons of pearl barley and bring to the simmer.

Roughly chop or dice as preferred:

One medium to small onion
½ a capsicum (bell pepper)
one large carrot
one medium to large potato
a few stalks of celery
one large cup of cabbage
one large cup of broccoli chunks – including the stem.

Add the neatest chunks/pieces to the main pot, all peels and scrappy bits to the blender pot.

Crush a couple of cloves of garlic and add to the blender pot.
Ensure there is adequate water in both pots to let them simmer safely for at least an hour. Check and stir occasionally, top up the water if necessary, but allow space in the main pot for the two to be combined at the finish. The hour is needed both for the barley to fully cook and the bone to add it’s flavour.

Remove the blender pot from the heat. When it’s cool enough to use your stick blender, blend to a puree and add it to the main pot after removing the bone from that pot. Add seasoning and herbs to taste.

If you prefer a thicker, less chunky soup, use the stick blender to achieve your desired consistency. If you like it thinner, add some boiling water and let it simmer again for a few minutes. Adjust seasoning (salt and pepper) to taste.

When it has cooled sufficiently fill single-serve individual freezer containers and store for future use. When you want a quick and simple lunch, decant the container into a soup bowl (I run it under a tap to loosen it) and zap it in the microwave. If you take lunch to work – heat it in the morning and take a thermos.

The nutrition count is roughly as follows, dividing into ten large serves:
Calories: 56
Protein: 2gms
Total Fat: 0.25gm (plus the fat on your stock bone)
Carbs: 12.5gms (mainly depends on the root veges proportion)
Fibre: 2.65 gms

A couple of vitamins and minerals stand out in the count. One serve provides the following RDAs for these:
Vitamin A: 50%
Vitamin C: 50%
Folacin: 13%
Potassium: 16%
And significant percentages of lots of lesser known vitamins and minerals.

Bon Appetit,

Cheers, Alan
Everything in Moderation, except Laughter

Stir-Fry and Salad Mix

So, you've got a few more vegetables in the fridge - what to do with them? Steamed veges can get fairly boring fairly quickly. And please don't boil them to a mush - apart from having no texture many of the good vitamins will disappear down the drain.

I developed this idea as a way of always having something ready in the fridge for a quick salad or a stir-fry with minimal preparation at cooking or meal preparation time. I don't have a vast range of recipes - but most of my small repertoire are ones I make up in bulk when time is available so that meal time can be quick and easy.

Basic Mix:

One medium onion cut in eighths (halve it, quarter the halves)
1 cup coarsely chopped cabbage (any type)
1 diced carrot
1 cup Yellow Capsicum (bell pepper)
A few stalks of chopped celery

Options. Add all or any of these, but at least four different things. Measurements, unless stated otherwise, are between a half-cup and a cup. Corn and beans are subject to your post-meal BGs, but as it's spread across multiple serves you'll find there will be little effect. Chop or dice as appropriate:

Red or Green Capsicum (bell pepper)
Cauliflower florettes
Broccoli Florettes
Green Peas
Green (string) beans
Snow (snap) peas
½ cup sweet corn kernels
½ cup cooked kidney beans
assorted cooked other beans
Raw asparagus
Bok Choi
Scallions or eschallottes
Leeks

And anything else I may have forgotten that you like or that is in season in your district. I've found that some veges, such as broccoli, asparagus, fresh peas or green beans can stay fresher and be slightly less "raw" if blanched briefly before slicing (drop in boiling water for a couple of minutes - but not sufficient to cook - then plunge into cold water to prevent further cooking).

After preparation, cover and store in the fridge. It should keep fresh and crisp for several days. See later posts on what to do with it for stir-fry, or simply add your favourite dressing to it for a quick salad. Use a cup or two per person as a serve. You can also add things like lettuce, tomato, avocado, diced cheddar at serving time for a salad, but don't put them in the mix for storage because they will not keep in the mix. Add cold cuts or ham for protein at serving time. Or tofu if you must :-)



My simple salad dressing:
Mix, in a small bottle with a cap, two or three tbsp extra virgin olive oil, one tbsp balsamic vinegar, one tbsp white vinegar, a small chopped clove of garlic, a touch of hot chili, some chopped garden herbs to taste (basil, thyme, rosemary, mint whatever); shake and add lightly to the salad. It will keep for a long time in the fridge, let it warm up to room temperature before using so that the oil will become liquid again.

Cheers, Alan

Everything in Moderation - Except Laughter.

Vegetables

Before diagnosis, my idea of "vegetables" was anything not animal or mineral - I didn't separate starches and other veges like others do. And my list of veges in my diet was very small: potatoes, peas, corn, iceberg lettuce, carrots, tomatoes, silverbeet(chard), our pumpkin(squash), an occasional onion and baked beans. That was pretty much all we bought and ate as veges. When invited to dinner at someone else's place, I would sample whatever was on the plate as a courteous guest - but most of it stayed on the plate if it wasn't on that list.

After diagnosis, I was told to lose weight and designed my own diet. I found that I needed a "filler" - something with bulk but minimum calories. I discovered braised cabbage and learned to like it with a dash of chopped bacon.

As time went on I started testing (see Test, Review, Adjust) and found that most of my list became a problem: potatoes, corn, carrots (when cooked) and baked beans became dangerous foods for me and I had to find others.

It is amazing what you can learn to like when you finally realise that your life may depend on it.

What focussed my mind wasn't the possible loss of life - but the possible loss of my sight. Negative motivation - maybe; but it sure worked for me. And the more I read, the more I learned that there were side benefits to many of those veges - particularly for the eyes



I just looked in my pantry and at the "crisper" of fresh veges and fruit in my fridge. If you had told me four years ago that I would be buying the following at my grocer's I'd have said you had rocks in your head. But I do - and as I bought each for the first time I researched recipes on ways to make them palatable; gradually I then found that I liked them no matter which way I cooked or prepared them; it was all in my mind. I am not recommending this as a list for anyone - it just happens to be what I have at this moment:

Avocado
Asparagus
Capsicum(bell pepper), red, green ,yellow
Broccoli
Cauliflower
Carrots
Sweet Potato
Onion, ordinary
Lettuce
Tomatoes
Olives
Onion, Red
Garlic
Ginger Root
Cabbage, ordinary
Cabbage, chinese
Cabbage, red
Silverbeet (Swiss Chard)
Celery
Brussels sprouts
Potato
Kidney beans
Psyllium
And some fruits, used with care:
Strawberries (fresh)
Blueberries (frozen)
Pears
Limes
Apples
Oranges

In my garden there are veges in season, hot chili peppers and herbs - thyme, basil, rosemary, oregano, sage, lavender and mint. In "drygoods" I have lentils, brown rice, barley, psyllium, guar gum, flax seed, kidney beans, cornflour etc. And a large range of spices. I've probably missed some - but I think you get the picture. You do what you wish; I added each thing individually over time, and had to experiment a bit.

But, to repeat myself, it's amazing what you can learn to like once you accept that your life depends on it.

Cooking as a Survival Skill

Over the four years that I’ve spent reading and posting on the various diabetes forums I’ve noticed that people seem to fall into one of three categories:
Those who cook for themselves, and enjoy doing it; those who cannot cook and survive on someone else’s cooking at home or in a restaurant – or eat pre-packaged or ready-made foods; and those who can cook but don’t enjoy it and only do it when they have no alternative.

My research after diagnosis led me to two unsurprising revelations for an obese T2. I needed to lose a lot of weight and I needed to control my blood glucose. Of course, there are other factors, but those two were paramount.

It is a never-ending task, but I believe it was much easier for me to achieve reasonable weight and control because I am a person who enjoys cooking. It allows me to be the one who controls what goes into the recipe by type and quantity, to control the size of portions, and to experiment by testing the results.

I can only imagine the stress it places on a relationship when the diabetic is trying to tactfully tell the cook that the new dish or dessert that they made with love is either too many carbs or so full of Splenda it tastes horrible – and that the real problem is the flour, not the sugar anyway. Or that they now need five meals or snacks a day, and so on. A major chronic condition places enough stress on relationships without that.

There is also a continual search by non-cooks for "safe" pre-prepared foods in the supermarket, "low-carb" this and "sugar-free" that, or "safe" fast foods and restaurant foods. Some people are forced to eat out, by work or local social requirement; and fast or pre-prepared foods are convenient. But there is no doubt in my mind that the easiest way to control your own diet is to be the person who creates the menu and cooks the dishes on it.

Basic home cooking is not that difficult. One reason I've included recipes here is to show that. All of my recipes are simple and pretty basic with reasonably short lists of the sort of ingredients found in most homes.

Practice, experiment, and don't get upset if you have an inedible failure. That's why you cooked extra the time before so there was something in the freezer for a quick zap in the microwave.

Bon appetit.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter