This is very good - just mixed up a large glass full (minus the flaxseed).  And, that's my question, do you use finely ground flax seed?  I also tossed in a fist-full of blueberries - should be able to tolerate them well; I just had a very intense resistance training session

I'd love to see more recipes for some ideas.  I disagree with those who wrote in on the earlier post, characterizing smoothies as "not real food."  I'm a big fan for time-challenged mornings and post-workout nourishment.

Bill

I can't believe you passed up a perfectly good opportunity to embed a cheesy 80's Reese's commercial in this post.

http://www.youtube.com/watch?v=DJLDF6qZUX0

Anon--

Yes, I used a finely-ground flaxseed.

The berries are a great idea, provided quantity is small.

Just a cautionary note -

Sucralose/Splenda can have severe reactions.

I seem to respond/react to things severely.  Sucralose has caused both allergic reaction (swollen mucus membranes) and severe migraine for me.  In fact, as a frequent migraine sufferer (tho much less now that i've removed gluten and sulfites), the migraine i got from sucralose was by far the worst i've ever had.  

Personally, i am of the belief that if it effects me so strongly, it is probably not good for anyone, but the damage it does is much less pronounced in other people.

I stick to stevia for a no-calorie sweetener.

http://jstevens.wordpress.com/2008/02/20/how-sucralose-aka-splenda-is-made-and-why-you-want-to-avoid-it/

"How Sucralose (aka Splenda) Is Made And Why You Want To Avoid It

...I wanted to comment on Splenda.  Splenda, also known as sucralose, was created accidentally when some chemists were trying to produce an insecticide.  Here is the process by which they produce the formula sold in stores:

“1.  Sucrose is tritylated with trityl chloride in the presence of dimethylformamide and 4-methylmorpholine, and the tritylated sucrose is then acetylated with acetic anhydride.

2.  The resulting sucrose molecule TRISPA is chlorinated with hydrogen chlorine in the presence of tolulene.

3.  The resulting 4-PAS is heated in the presence of methyl isobutyl ketone and acetic acid.

4.  The resulting 6-PAS is chlorinated with thionyl chloride in the presence of toluene and benzyltriethylammonium chloride.

5.  The resulting TOSPA is treated with methanol in the presence of sodium methoxide to produce sucralose.”  (Note that methanol, wood alcohol aka paint remover,  is one of the questionable ingredients in aspartame.)

In addition, the bags and packets of Splenda commercially available are not pure sucralose.  They also contain bulking agents.  All artificial sweeteners use bulking agents.  Do you know what they use?  Sugar.  Dextrose, sucrose, and maltodextrin.  (Maltodextrin is corn syrup solids composed primarily from fructose and glucose in a starch form.)   All sweetener packets are at least 96 percent sugar.  Splenda is 99% sugar.

The packets are labelled calorie free as a result of manipulating a loophole in the food labeling laws.  The product can be described as sugar free if a serving contains less than 5 grams of sugar, and calorie free if a serving is less than 5 calories.  So they set the serving size on bags at .5 grams  and the packets contain a serving of 1 gram.  A one gram packet contains 4 calories.   This can be confirmed on the manufacturer’s website in the FAQ section:  â€œLike many no and low calorie sweeteners, each serving of SPLENDA® No Calorie Sweetener contains a very small amount of common food ingredients, e.g., dextrose and/or maltodextrin, for volume. Because the amount of these ingredients is so small, SPLENDA® No Calorie Sweetener still has an insignificant calorie value per serving and meets FDA’s standards for “no calorie” sweeteners. “

To make matters worse, when sucralose was shown to not raise blood sugars, it was the pure substance that was tested, not the mixture that is sold to the public.  Dextrose, sucrose, and/or maltodextrin are definitely going to raise a diabetic’s blood sugar.  There is also a great deal of evidence that artificial sweeteners actually cause an increase in appetite, causing people who consume them to take in more calories than they would otherwise.

Stevia, on the other hand, lowers blood sugar, making it a much better choice.  If you have tried stevia in the past and did not like the flavor, you might want to try another brand. ..."

If your looking for a more nutritious "sweetner" you should try adding half a cup of coconut water. Delicious!

Ps. I love your blog. Keep up the great work!

Tapioca starch in the almond milk, but not enough to hurt you.

I enjoy your blog. You have a good thread about the hazards of hyperglycemia.
However, this recipe is not one I would recommend to patients attempting to reverse metabolic syndrome, T2D, or IR.
Their main concern is the inflammation caused by the above listed disorders. The omega 6 content of the peanut butter, sunflower seed, and to an extent, almond butter would exacerbate the inflammation mitigated by the hyperglycemia.
In addition, sugar alcohols (xylitol, erythritol) tend to cause GI upset (gas, diarrhea). Also the hazards of Sucralose are intuitively obvious....it contains chlorine molecules....commonly found in many household cleaners, and of course used in WWI as a pulmonary choking agent.
I would only use macadamia nuts/nut butter, and Stevia to sweeten.
Dr. John

Thanks, Dr. John.

I hear you on the sucralose issue. I've actually been having positive experiences with stevia, xylitol, and erythritol. The important thing is that people have some good choices nowadays, unlike 20 years ago when we had saccharine . . . period.

There is no question that mannitol and sorbitol have greater potential for both GI distress (diarrhea) as well as increases in blood glucose, so these are clearly on the no-no list (unless you need a quick laxative).

Sucralose is not metabolized.  Most of it is excreted unchanged in the feces.  A small percentage is absorbed and excreted unchanged in urine.  

Sodium in food is more of a concern for a person who experiences migraine headaches.  Over-activity of muscles activated by the Trigeminal nerve due to airway resistance secondary to water retention is a greater concern.  Various factors are present both anatomically and physiologically in people who experience migraine.  The only way to determine if sucralose is actually the cause of a migraine is to consume sucralose on its own.

What concerns me is what happens to the sucralose in the environment.  The addition of a chlorine atom, (not a molecule, Dr. John) results in a molecule which cannot be metabolized by bacteria.  If environmental degradation is possible, then sucralose excreted by human beings is not an issue.  But if it persists in the environment, then it is a pollutant.

I am practically a fruitarian, so much of what I like would be off limits.
Is there an article here on what IS recommended?

Yes, atoms, not molecules...ie. precisely 3 atoms of chlorine/molecule of sucrose...

An interesting thing about this selective halogenation of sucrose, is the fact that sucralose (being 600 times as sweet as sucrose), increases the HbA1c numbers in my patients. This demonstrates a lessening of diabetic control. Thus, hemoglobin gets glycated and fasting blood sugar increases....with the attendant hyperglycemia issues as mentioned, and this excellent blog site.

For this reason I do not recommend sucralose for diabetics nor anyone wanting to keep blood sugar levels within normal limits. The current cost and future costs for diabetes will cripple our healthcare structure. Here are ADA numbers:

$174 billion: Total costs of diagnosed diabetes in the United States in 2007
$116 billion for direct medical costs
$58 billion for indirect costs (disability, work loss, premature mortality)

Dr. John

Dr. John, is it possible that other factors contribute to higher H1ac levels in your type 2 diabetic patients?  

Since sucrolose is not metabolically active and does not act as a laxative, then there could be other endocrinological and neurological reasons for higher glucose levels.

Here's an abstract on sucralose and Type 2 diabetes:

Grotz VL, Henry RR, McGill JB, Prince MJ, Shamoon H, Trout JR, Pi-Sunyer FX. Lack of effect of sucralose on glucose homeostasis in subjects with type 2 diabetes. J Am Diet Assoc. 2003 Dec;103(12):1607-12.

OBJECTIVE: To investigate the effect of 3-months' daily administration of high doses of sucralose, a non-nutritive sweetener, on glycemic control in subjects with type 2 diabetes. DESIGN: A multicenter, double-blind, placebo-controlled, randomized study, consisting of a 6-week screening phase, a 13-week test phase, and a 4-week follow-up phase. SUBJECTS/SETTING: Subjects with type 2 diabetes (age range 31 to 70 years) entered the test phase of this study; 128 subjects completed the study. The subjects were recruited from 5 medical centers across the United States and were, on average, obese. INTERVENTION: Subjects were randomly assigned to receive either placebo (cellulose) capsules (n=69) or 667 mg encapsulated sucralose (n=67) daily for the 13-week test phase. All subjects blindly received placebo capsules during the last 4 weeks of the screening phase and for the entire 4-week follow-up phase. MAIN OUTCOME MEASURES: Glycated hemoglobin (HbA1c), fasting plasma glucose, and fasting serum C-peptide were measured approximately every 2 weeks to evaluate blood glucose homeostasis. Data were analyzed by analysis of variance using repeated measures. RESULTS: There were no significant differences between the sucralose and placebo groups in HbA1c, fasting plasma glucose, or fasting serum C-peptide changes from baseline. There were no clinically meaningful differences between the groups in any safety measure. CONCLUSIONS: This study demonstrated that, similar to cellulose, sucralose consumption for 3 months at doses of 7.5 mg/kg/day, which is approximately three times the estimated maximum intake, had no effect on glucose homeostasis in individuals with type 2 diabetes. Additionally, this study showed that sucralose was as well-tolerated by the study subjects as was the placebo.

PMID: 14647086 [PubMed - indexed for MEDLINE]

Now, I can understand how sugar alcohols taken in large quantities might have some effect on blood sugar because they are laxative and increase gut motility and cause discofort or pain, both of which will spike blood sugar values. the liver dumps glucose into the bloodstream when the body is under stress like this.  And of course, the pancreas reacts very sluggishly to endogenous glucose.

I think type 2 diabetics should have routine sleep study screening to determine whether breathing issues during sleep may be upramping the sympathetic nervous system and causing high sugar levels during sleep. We can't just help these people improve their life quality by looking at only one parameter.

They need otolaryngological evaluation for anything from deviated nasal septa to chronic allergies, enlarged adenoids and tonsils.  The size of their jaws, how they function and tongue posture also factors in.

Not to mention, anyone with pulmonary issues would have increased effort on breathing...asthma, pulmonary hypertension etc.  The existance of chronic pain and anxiety conditions also influence how the body produces its own glucose.  

Patient's require a multi-disciplinary workup to determine the multiple factors that result in the development of type 2 diabetes.  It's not merely diet because these people have an awfully hard time changing their diets without having other problems addressed.

Excellent! Dr. Davis, you have had many posts of what not to eat but very few on what we should eat. Taking something out of our diet means we have to replace it with something. This post seems to be in the right spirit. I am going to try this soon. Now if only you can post a similar substitute for Keva Juice's Oreo Speedwagon smoothie! Yes, I know they are hazardous to your health but they are wickedly good!

-- Boris

I'm not totally convinced why sucralose, a chloro-carbon, similar to DDT and PCBs, would elevate the HgA1c levels. My guess would be a neurological response to an ingested poison. Sucralose does kill intestinal beneficial bacteria...lactobacillus, bifidobacteria, and bacteroides...of varying amounts of 37-67%...and the enteric nervous system would react by elevating cortisol/adrenaline/glucagon: while at the same time not delaying gastric emptying.
Body perception is stress....glycation of RBCs result, with CVD and sudden cardiac death.

Studies that use diabetic, and obese subjects in the assessment of A1c elevation are biased from the start. These individuals have already lost glycemic control and as a result would not have normal A1c levels to begin with...let alone studying their response 13 weeks later.

McNeil Nutritionals, maker of SPLENDA® Brand products, stated it has provided the American Diabetes Association (ADA) with a sponsorship to support the Association's efforts to fund research, information and advocacy programs on behalf of people with diabetes.
And McNeil Nuts. are owned by Johnson and Johnson, who are large contributors to the ADA...the journal of the previously listed biased study showing the sucralose doesn't affect A1c levels...in spite of the fact in clinical results showing the opposite.

Anything, sucrose or sucralose, that elevates A1c levels is cardio-lethal...and is best avoided.

Dr. D,
Do you use regular coconut milk or the lite? Does it make a difference, except calorically?

Thanks!

Jeanne

I am allergic to the artificial sweeteners. Thought I could tolerate sucralose but it just took a little time for a reaction. My mouth and throat became inflamed and I had sore bumps all over the inside of my throat and back of my mouth after about a week.

I don't like stevia or the other natural no calorie sweeteners either...they just don't taste sweet to me or have odd flavors.

But I found something.  It is not calorie free, but it has low glycemic index and tastes just like sugar.  It is "Organic Blue Agave". What are a few calories in exchange for some actual taste.

I bought it at Costco.

""Organic Blue Agave". What are a few calories in exchange for some actual taste."

High fructose corn syrup (HFCS) is about 55% fructose and cause inflammation, insulin resistance, and elevates triglycerides.  Agave syrup is often 70% or higher (possibly as high as 90%) fructose!  Marketing scam...

It's about time SOMEBODY started telling the truth about the heart disease "plumbing" racket!

What kind of carbs are we talking about exactly though? Is there a difference between carbs in fruits and vegetables vs breads? And what should I replace them with?
(not looking for an argument, I would  just like to know).

-Thanks.

I wonder what the rationale is for the Diabetes Association's recommendation to eat a lot of carbs.
Right or wrong, there must be some logic to it.

Jon,

I think you'll find this site and TYP focuses on cutting out the carbs most responsible for inflammation.  This includes getting rid of wheat and sugars.  Read this site for an evening or two and you'll quickly find out what to avoid.  The topics on the left column contain a wealth of information.

I cut out all grains and sugars and limit my fruits to mostly berries (too much sugar in most everything else).  I eat meat, lots of vegetables, nuts, seeds, eggs, and some berries.  You'll get all that your body needs from those sources.  Ditch the bread; you don't need it.

Dr. Davis,

My older brother was recently diagnosed with Type II diabetes. I sent him many of your links but he tells me the classes he goes to, put on by the doctor, tell him he can eat 75 cabs per meal as you talk about in your recent post.

The cabs include bread, oatmeal, and even chocolate. Any advice on how else I can get it through his thick skull he should not be eating this junk? I love him and want him around for many years.

Thank you.

The paleo people will tell you to drop the carbs and replace those calories with more fat, especially saturated fat.

Of all the carbs breads/grains are the worst and then fruits so keep those to a minimum if not total elimination (small amounts of berries are ok).

I was just signing in to address the same question as Jon. Actually to put in my 2-cents worth:  When you say drop all carbohydrates, surely you mean all high glycemic carbs - the high starch carbs like wheat and other grains (breads, cereals, even gluten-free grains), potatoes, white rice, plus moderate those carbs that are very high in sugars like carrots, onions, corn, the list goes on.  I find it confusing, and other readers may also, for you to say cut out all carbs. For if that is the case, what do we eat?
I've been reading your blog for some time and find it to be most helpful, but this is the one area in which I wish you would be more specific.
Thanks for being there. The world needs you.

Same here. I had great success in my cholesterol numbers and weight as a result of lowering my carb intake to ~70g per day. I don't eat grains and prefer to get my carbs via colorful fruits and veggies.

I exercise a lot now too.

When you mean cutting carbs, what kind and to how much are you recommending?

Thanks for the post. I did not know the mechanism for small LDL being formed or for their getting into arteries before reading this entry.

IMO, common sense would dictate keeping the better more nutrient dense carbs and limiting the less nutrient dense and starchy carbs.  So stick to mainly vegetables as your carb source - that's how I like to do it.

Hi, Jon--

Vegetables are, of course, desirable foods. Some fruit.

Beyond this, the sensitivity to carbohydrates is best judged individually with at least a HbA1c or, even better, a one-hour postprandial glucose.

Anon--

The most persuasive tool is to get your brother to check occasional 1-hour postprandial glucoses.

These high values can be downright hair-raising.

By the way, I will start a series of Heart Scan Blog posts called "What to eat" to clarity the confusion.

This is also already posted in exhaustive detail in Special Reports on the Track Your Plaque website.

I'd like to know where lentils, chickpeas and beans sit.
When I've tested I get very little BG spike after eating them

Indeed, very good advice Dr. Davis.

It is worth noting that low fasting triglycerides, especially below 70 mg/dl, are a marker for large-buoyant LDL particles:

http://healthcorrelator.blogspot.com/2010/04/low-fasting-triglycerides-marker-for.html

Dr. Davis, How can we tell which of these is the main problem?

1.  Wheat.  The cultures that eat rice or corn and beans don't seem to have much heart disease or diabetes.

2. Refined carbohydrates.  The cultures that don't have many of the diseases of civilization don't have Cheerios, etc.

3. Carbs in general.  All carbs seem to raise our post-prandial
glucose levels.

4. Sugar and it's variants.  Increasingly sugar seems to be linked with health problems.

Hi Ned Kock
I have read your article, and I'd like to know how much exercise is considered excessive.