DrKnows Healthy Eating 7-18-2015

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Confidential ProprietaryInformation
Scot J. Richardson, M.D.
salubriti.com, LLC ®
DrKnows.com ®
July 18, 2015
© Copyright 2015. All rights reserved.
DrKnows Guide to Healthy Eating
Overview to Healthy Eating
For most people, meals and food represent two of life’s greatest pleasures and
necessities. Meanwhile, poor food choices can pose serious, negative consequences to
one’s health. If you are considering changing your diet, you may have come to the
realization that your current eating habits are adversely affecting your health. Better
yet, you may be starting to address healthy eating early on in life and have decided that
you want to be proactive about protecting and maintaining your health.
As a physician who has counseled tens of thousands of patients about appropriate
dietary choices, I believe that our culture needs to move away from the strategy of
“going on a diet.” The concept of dieting is fraught with problems because a weight loss
“diet” is only a temporary fix to a greater problem. In general, many people unwittingly
follow a pattern of “yo-yo” dieting, losing and regaining weight, and often gaining back
more weight after each diet. I encourage you to completely eliminate the strategy of the
temporary diet. Regardless of your health and dietary goals, I encourage you to make a
lifestyle change – to permanently change your dietary and exercise habits and change
the role food has in your life. While dining can bring enjoyment to our lives,
intellectually we should think of food as fuel for our bodies. Would you prefer to put
sugar in your car or premium gasoline? That may sound like a silly question, but the
point is that most of us make sure that our vehicle is running on the correct fuel so why
wouldn’t we do the same with our bodies?
When using the term diet, I am not suggesting temporarily limiting and narrowing food
selection to reduce weight, but rather I am recommending developing an appropriate,
health-oriented selection of food and beverages. Multiple factors affect a person’s
weight, ranging from food intake, exercise, genetics, behavior, medications, hormonal
factors, and medical illness. For most people, the most important factor that determines
weight is the balance between calorie intake and calories consumed.
Think of it simply as follows:
calorie intake > calorie consumption = weight gain
calorie intake < calorie consumption = weight loss
calorie intake = calorie consumptions = weight neutral
If you are having difficulty maintaining a healthy body weight – whether you are
overweight or underweight – you should consult your physician. Abnormal body weight
can result from many different health conditions, and your healthcare provider may
evaluate you for low thyroid function (hypothyroidism), overactive thyroid
(hyperthyroidism), diabetes mellitus, sleep apnea, among many other diseases.

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#DrKnowsCares
Author: Scot Richardson, M.D.
Body Mass Index
Currently, physicians monitor a person’s body mass index (BMI) in addition to their
weight as two of many vital signs that reflect on overall health and fitness. A person’s
weight refers to the heaviness of their body. In physics, the weight of an object defines
the amount of force that gravity exerts on the total mass of the object. A person who is
180 pounds and standing 5’10” has a normal weight and body mass index. In contrast, a
person weighing 180 pounds and standing 5’2” by definition has an obese weight and
elevated body mass index.
Calculating the Body Mass Index (BMI) 1 :
The body mass index is calculated as a person’s weight in kilograms (kg) divided by the
square of their height in meters (m2 ).
Formula: weight (kg) ÷ [height (m)]2 = BMI
For example: 80 (kg) ÷ [ 1.83 (m)]2 = 23.88
Tocalculate the body mass index in pounds and inches, multiply by a conversion factor
of 703 as follows:
Formula: weight (lbs) ÷ [ height (in)]2 × 703 = BMI
For example: 176 (lbs) ÷ [ 72 (in)]2 × 703 = 23.87
While the body mass index is not a direct measurement of a person’s total body fat
percentage, the BMI does correlate with other more direct measurements of body fat,
such as skinfold thickness measurements and other measures.2 An elevated BMI is a
measure of the fatness of a person’s body and strongly correlates with some metabolic
diseases, such as diabetes mellitus, cardiovascular disease3 , the metabolic syndrome,
and other medical conditions.4

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How is the Body Mass Index Interpreted for Adults?
For all adults over the age of 20 years, the BMI is interpreted using “weight status
categories.” The same four “weight status categories” are applied to men and women of
all ages and body types.
BMI Weight Status
Below 18.5 Underweight
Between 18.5 and 24.9 Healthy Weight or Normal Weight
Between 25.0 and 29.9 Overweight
30.0 and Above Obese
The DrKnows height and weight chart is your reference toassist you in determining
your goal healthy body mass index and weight.
Height Under Weight Healthy Weight Overweight Obese
4’10” Less than 91 lbs. 91 to 118 lbs. 119 to142 lbs. 143 to 186 lbs.
4’11” Less than 94 lbs. 94 to 123 lbs. 124 to 147 lbs. 148 to 193 lbs.
5’0” Less than 97 lbs. 97 to 127 lbs. 128 to 152 lbs. 153 to199 lbs.
5’1” Less than 100 lbs. 100 to131 lbs. 132 to 157 lbs. 158 to 206 lbs.
5’4” Less than 110 lbs. 110 to144 lbs. 145 to173 lbs. 174 to 227 lbs.

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BMI Less than 19 19 to 24 25 to 29 30 to 39
#DrKnowsCares
What factors cause weight gain and obesity?
Factors that may cause weight gain include:
 Unhealthy diet
 Sedentary lifestyle/inactivity
 Medical Conditions
 Genetics/Family history of obesity
 Lifestyle
 Culture
 Age
 Socioeconomic factors
 Insufficient sleep
 Sleep disorders
 Medications
 Smoking cessation/quitting tobacco
Diseases that may cause weight gain include :
 Hypothyroidism (underactive thyroid)
 Diabetes mellitus (hyperglycemia)
 Cushing’s syndrome (adrenal dysfunction with high cortisol levels)
 Smoking cessation/quitting tobacco
 Depression and mood disorders
 Stress
 Sleep apnea
 Renal failure
 Congestive heart failure

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 Prader-Willi syndrome
Medications that may cause weight gain:
 anticonvulsant/anti-seizure medications
o valproic acid (Depakote, Depakene)
o pregabalin (Lyrica)
o carbamazepine (Tegretol)
o gabapentin (Neurontin)
 corticosteroids
o prednisone (Rayos, Sterapred)
o dexamethasone (Decadron, Baycadron, DexPak, Intensol)
o methylprednisolone (Medrol, Medrol Dosepak)
o hydrocortisone (Anusol-HC)
 atypical antipsychotic medications
o olanzapine (Zyprexa)
o risperidone (Risperdal)
o clozaril (Clozapine)
o quetiapine (Seroquel)
 some antidepressants
o tricyclic antidepressants such as amitriptyline (Elavil) and nortriptyline
(Pamelor)
o paroxetine (Paxil)
o mirtazapine (Remeron)
o sertraline (Zoloft)
 antihistamines
o cetirizine (Zyrtec)
o fexofenadine (Allegra)
 beta-blocker antihypertensive (high blood pressure) medications
o propranolol (Inderal, Innopran)
o metoprolol (Toprol, Lopressor)
o atenolol (Tenormin)
 calcium channel blocker antihypertensive medications
o amlodipine (Norvasc)
 alpha-2 adrenergic agonist antihypertensive medication
o clonidine (Catapres)
 thiazolidinedione diabetes medications
o pioglitazone (Actos)
o rosiglitazone (Avandia)
 sulfonylurea diabetes medications
o glimepiride (Amaryl)
o glipizide (Glucotrol)
o glyburide (Diabeta)
 insulin for diabetes

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o insulin (Novolog, Lantus, Humalog)
 lithium (Lithobid)
Medications that may cause weight gain:
Generic Name of
Medication
Brand Name of
Medication
Drug Class or
Purpose
Likelihood of Causing
Weight Gain
valproic acid Depakote,
Depakene
Seizures, Migraines,
Mood Stabilizer
carbamazepine Tegretol Seizures, Migraines,
Mood Stabilizer
pregablin Lyrica Polyneuropathy,
Seizures, Pain
gabapentin Neurontin Polyneuropathy,
Seizures, Pain
olanzapine Zyprexa Antipsychotic, Mood
Stabilizer
quetiapine Seroquel Antipsychotic, Mood
Stabilizer
risperidone Risperdal Antipsychotic, Mood
Stabilizer
clozaril Clozapine Antipsychotic, Mood
Stabilizer
prednisone Rayos, Sterapred Corticosteroid, Anti-
inflammatory
dexamethasone Decadron, DexPak
Intensol, others
Corticosteroid, Anti-
inflammatory
methylprednisolone Medrol, Medrol
Dosepak
inflammatory
hydrocortisone Anusol-HC, various
others
inflammatory
lithium Lithobid Bipolar Disorder,
Mood Stabilizer
amitriptyline Elavil Tricyclic
Antidepressant
nortriptyline Pamelor Tricyclic
Antidepressant
paroxetine Paxil Selective Serotonin
Reuptake Inhibitor
sertraline Zoloft Selective Serotonin
Reuptake Inhibitor

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While certain medications may cause weight gain, if you are concerned that you may be
experiencing an adverse reaction to any medication, it is very important that you consult
your physician before discontinuing or altering the dose of any medication. While the
medications listed in this article may cause weight gain, it is important to evaluate the
overall risks, benefits, and alternatives of treatment with any medication as to how it
may affect your overall health. Keep in mind that the key phrase is “may cause” because
some of these medications are only slightly more likely than placebo to cause weight
gain. Also, you should work with your healthcare provider to ensure that you have
considered and eliminated all other plausible causes for weight gain and that you are
following a healthy program of diet and regular exercise.
mirtazapine Remeron Antidepressant
Medication
propranolol Inderal, InnoPran Beta-blocker
Antihypertensive
atenolol Tenormin Beta-blocker
Antihypertensive
metoprolol Toprol, Lopressor Beta-blocker
Antihypertensive
amlodipine Norvasc Calcium channel
Antihypertensive
clonidine Catapres Alpha-2 adrenergic
Antihypertensive
pioglitazone Actos Thiazolidinedione
Diabetes Medication
rosiglitazone Avandia Thiazolidinedione
Diabetes Medication
insulin Novolog, Lantus,
Humalog
IDDM Diabetes
Medication
glimepiride Amaryl Sulfonylurea
Diabetes Medication
glyburide Diabeta Sulfonylurea
Diabetes Medication
glipizide Glucotrol Sulfonylurea
Diabetes Medication
fexofenadine Allegra Antihistamine, H1
Histamine antagonist
cetirizine Zyrtec Antihistamine, H1
Histamine antagonist

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#DrKnowsCares
Treatment of Obesity and Strategies for Losing Weight
Whether you are coping with high cholesterol, high blood pressure, elevated blood
sugar, diabetes mellitus, or being overweight, many of the same basic nutritional and
exercise strategies will help you reach your goal of healthier living. The first challenge is
to identify and acknowledge that there is a health problem. The next step involves
creating a plan for overcoming your medical condition. This plan should involve
medical nutrition therapy (MNT). Work with your physician and a registered dietician
to develop detailed plan that meets your preferences and focuses on your specific needs.
The following are suggested strategies for achieving and maintaining your ideal body
weight and personal health – all suggestions that should become part of your MNT.
People around the world are constantly seeking the next original and exciting diet fad,
but ultimately successful weight loss programs universally focus on reducing calorie
intake and increasing calorie consumption. Before embarking on any substantial
changes in your diet or exercise, DrKnows encourages you to consult with your own
healthcare provider.
Educate yourself about food and healthy eating
Reduce calories, increase calorie consumption
Plan your meals
Eat regularly
Measure your food portions
Use smaller plates and bowls
Create a varied, balanced diet
Don’t eat before bedtime
Exercise regularly
Moderation
Eat until satiated not stuffed
Eat more slowly
Sufficient, good quality sleep

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Review the packaging on all foods you prepare and eat
Count your daily carbohydrate, fat, cholesterol, and protein intake
Monitor your weight
Maintain and food and weight journal
Eat foods with a low glycemic index (GI)
Eat plenty of vegetables
Eat whole grains
Drink plenty of water
Avoid empty calories
Skip the trans fats
Limit saturated fats
Reduce cholesterol intake to less than 300 mg per day
Limit sodium intake to less than 2300 mg per day
Eat healthy carbohydrates
Eat heart-healthy fish
Eat foods rich in fiber
Eat “good” monounsaturated and polyunsaturated fates
Reward successful weight loss, but not with food
Set goals for healthy eating and weight loss
Dine at home
Moderation
While you can continue to savor many of the foods you love, it is important to embrace
moderation. Eat those favorite recipes in smaller quantities and less often, and you will
be taking one giant step towards healthier living.
Eat More Slowly
For decades, dieticians have encouraged us to eat more slowly. As you dine, your
stomach needs time to digest your meal, and your brain needs time to register that you
have eaten. Rushing and eating quickly may result in over-eating. Chew your food
slowly and completely, and savor each bite. By pacing your meals, your brain will have
time to register that you are full. With fewer calories taken in, your body will have fewer
calories to burn.
Avoid Empty Calories
One of the quickest and most efficient opportunities to eat healthier and to lose weight is
by eliminating “empty calories” during the day. One of the best examples of empty
calories are beverages such as soft drinks, juice, sweetened iced tea, or alcohol
containing beverages. While these drinks may taste good, a simple glass of water would
be equally effective in quenching one’s thirst. Condiments are another common source

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of “empty calories.” Cutting back on ketchup, mayonnaise, and salsa can eliminate a
significant chunk of calories each day.
Before embarking on any substantial changes in your diet or exercise, DrKnows
encourages you to consult with your own healthcare provider.
#DrKnowsCares
The patient’s body mass index (BMI) is above normal parameters. The patient and healthcare
provider reviewed the patient's elevated body mass index (BMI), including discussing the risks
of a high BMI, and a follow-up plan was developed. Patient education and counseling were
provided, including the option of counseling with a dietician/nutritionist, dietary supplements,
weight-loss programs, exercise, and surgical options. Treatment to lower the BMI was discussed
in detail, including creating a plan, establishing support, behavior modifications such as a diet
rich in lean meat, vegetables, whole grains, fresh fruit in moderation, and low-fat foods. Further,
the physician discouraged soda, fruit juice and energy drinks and emphasized the importance of
regular aerobic exercise and appropriate weight loss. Pharmacologic interventions may include
topiramate and phentermine, according to patient need and tolerance. Surgical options have also
been addressed, including but not limited to, lap band surgery and gastric bypass surgery.

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What Factors Cause Weight Loss and Unhealthy, Low Body Weight?
For some people, maintaining a healthy, ideal body weight can be very difficult, and
some patients experience lack of appetite (called anorexia) and severe weight loss.
Being underweight and malnourished can be as serious - often more dangerous - than
being obese. Patients who are emaciated (gaunt, wasted away) or cachectic (severe
wasting often associated with cancer or chronic infectious disease) are often
malnourished and at risk for various types of medical complications.
In most modern, western countries in which poverty and dysentery are not chronic
public health crises, the principal cause of low body mass index (BMI of less than 19) is
some type of underlying medical condition. For patients experiencing rapid,
unexplained weight loss, the first priority should be eliminating more aggressive, life-
threatening diseases such as cancer and tuberculosis. In other instances, patients lose
weight as a result of poor p.o. (oral) intake caused by impaired swallowing (dysphagia),
pain with swallowing (odynophagia), or problems chewing as may be seen in idiopathic
Parkinson’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), and
myasthenia gravis. Others may have impaired gastrointestinal absorption resulting
from infectious disease, celiac disease, prior surgery, or malfunctioning digestive
processes. Patients with dementia often experience diminished appetite and may
literally forget to eat. In contrast, patients with eating disorders engage in various
extreme behaviors dedicated toward losing weight. Additionally, some patients
experience a loss of weight due to muscle wasting (atrophy), particularly patients with
amyotrophic lateral sclerosis (ALS). Finally, a handful of medications may reduce
appetite, cause nausea, or increase metabolism, resulting in unintended weight loss.

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What factors lead to anorexia, weight loss, and low body mass index?
Factors that may cause weight loss include:
 Unhealthy diet
 Excessive exercise
 Medical Conditions
 Genetics/Family history
 Lifestyle
 Culture
 Age
 Socioeconomic factors
 Medications
 Tobacco abuse
What medical conditions can cause weight loss, anorexia, and low body
mass index?
Diseases that may cause weight loss:
 Cancer
 Tuberculosis
 Dementia and Alzheimer’s disease
 Parkinson’s disease
 Amyotrophic lateral sclerosis (Lou Gherig’s disease)
 Hyperthyroidism
 Depression
 Stress
 Gastrointestinal diseases
 Eating disorders
o Anorexia nervosa
o Bulimia nervosa
 Gastric bypass surgery
 Diseases that affect chewing or swallowing
Which drugs or medications can cause weight loss, anorexia, and low body
mass index?
Medications that may cause intended or unintended weight loss include:
 Appetite suppressing/anorexic medications
o phentermine (Fastin)

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 Seizure, migraine, and appetite suppressing medications
o topiramate (Topamax)
o zonisamide (Zonegran)
 Amphetamine stimulant medications
o dextroamphetamine saccharate, amphetamine aspartate (Adderall)
o methylphenidate (Ritalin)
o dextromethylphendiate (Focalin)
 Antidepressant medications
o venlafaxine (Effexor)
o bupropion (Wellbutrin)
o duloxetine (Cymbalta)
 Acetylcholinesterase inhibitors for memory loss and dementia
o donepezil (Aricept)
o donepezil/memantine (Namzaric)
o rivastigmine (Exelon)
o galantamine (Razadyne)
 Dopamine agonists for idiopathic Parkinson’s disease and restless leg syndrome
o pramipexole (Mirapex)
o ropinirole (Requip)
o rotigotine (Neupro)
 Levodopa for idiopathic Parkinson’s disease and restless leg syndrome
o carbidopa/levodopa/entacapone (Stalevo)
o carbidopa/levodopa (Sinemet, Parcopa)
 Chemotherapeutic medications
o Too many to mention
 Immunomodulatory medications for multiple sclerosis
o dimethyl fumarate (Tecfidera)
Medications that may cause weight loss and anorexia:
Generic Name of
Medication
Brand Name of
Medication
Drug Class or Purpose Likelihood of Causing
Weight Loss
phentermine Fastin Appetite Suppressing
Anorexic Medications
topiramate Topamax Anti-Seizure, Migraine
Appetite Suppressing
zonisamide Zonegran Anti-Seizure
Medication
dextroamphetamine
saccharate
Adderall Amphetamine
stimulant medications
amphetamine
aspartate
Adderall Amphetamine

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While certain medications may cause weight loss, if you are concerned that you may be
experiencing an adverse reaction to any medication, it is very important that you consult
your physician before discontinuing or altering the dose of any medication. While the
medications listed in this article may cause weight loss, it is important to evaluate the
overall risks, benefits, and alternatives of treatment with any medication as to how it
may affect your overall health. Keep in mind that the key phrase is “may cause” because
some of these medications are only slightly more likely than placebo to cause weight
loss. Also, you should work with your healthcare provider to ensure that you have
methylphenidate Ritalin Amphetamine
dextromethylphendiate Focalin Amphetamine
venlafaxine Effexor Antidepressant
medications
bupropion Wellbutrin Antidepressant
medications
duloxetine Cymbalta Antidepressant
medications
donepezil Aricept Acetylcholinesterase
inhibitors
donepezil/memantine Namzaric Acetylcholinesterase
inhibitors
rivastigmine Exelon Acetylcholinesterase
inhibitors
galantamine Razadyne Acetylcholinesterase
inhibitors
pramipexole Mirapex Dopamine agonists for
Parkinson’s disease
ropinirole Requip Dopamine agonists for
rotigotine Neupro Dopamine agonists for
carbidopa/levodopa/
entacapone
Stalevo Levodopa for
carbidopa/levodopa Sinemet, Parcopa Levodopa for
dimethyl fumarate Tecfidera Immunomodulatory
agent for M.S.
chemotherapeutic
medications
Multiple different
medications
Treatment of Cancer

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considered and eliminated all other plausible causes for weight loss and that you are
following a healthy program of diet and regular exercise.
#DrKnowsCares
Treatment of Low weight, Low Body Mass Index, and Anorexia
The following are suggested strategies for achieving and maintaining your ideal body
weight and personal health. For patients with a low body weight and low body mass
index, the most important steps towards better health is increasing total calorie intake
but also correcting any underlying medical condition. If your weight is dangerously low,
you should work closely with a team of healthcare providers, including your physician
and a dietician/nutritionist to develop a nutrition plan. For patients suffering from
severe weight loss, malnutrition, and impaired swallowing, in some instances a feeding
tube, such as a gastrostomy tube, may be necessary toensure adequate calorie intake.

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In more extreme cases, total parenteral nutrition (TPN) may become a life-saving
measure. Patients suffering from malnutrition should be tested for deficiencies of
essential vitamins and nutrients, and these deficiencies should be corrected when
appropriate.
Generally, our body mass index is determined by the balance of calorie intake and
calories consumed. For those suffering from low BMI and malnutrition, it might seem
logical to reduce exercise in order to reduce fuel consumption. However, exercise is still
important because the goal is to build up healthy muscle tissue and bone rather than to
just store a lot of body fat.
Increase calories ingested
Plan your meals
Eat regularly
Create a varied, balanced diet
Don’t eat before bedtime
Exercise regularly
Eat more slowly
Sufficient, good quality sleep
Make your diet and meals a priority, and plan your menu for the week. For patients
experiencing poor appetite (anorexia) or trouble swallowing (dysphagia), packing a lot
of calories into a small quantity of food can be essential to restoring healthy body
weight. Dietary supplements such as Ensure, Boost, and Scandishake are full of
calories, vitamins and nutrients. For diabetics needing to be cautious with carbohydrate
intake, Glucerna may be a more appropriate option. Many patients prefer to chill these
dietary supplements to improve the experience, and some mix in ice cream or yogurt for
enhanced taste and caloric value.
Before embarking on any substantial changes in your diet or exercise, DrKnows
encourages you to consult with your own healthcare provider.
#DrKnowsCares

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Low Carbohydrate Diet
If you have been diagnosed with high blood sugar (hyperglycemia) or diabetes mellitus,
your doctor has likely recommended that you begin following a low carbohydrate diet.
In addition to following the general strategies listed in the DrKnows Guide to
Healthy Eating, you will need to become familiar with the types of foods that contain
carbohydrates and what your goals should be for total carbohydrate intake each day.
Simply stated, the term carbohydrates – commonly called “carbs” - refers toa large
group of organic compounds that occur in foods and living tissues, including sugars,
starch, and cellulose. Most people with hyperglycemia and diabetes mellitus understand
that they need to reduce their sugar intake, but many do not realize that they also need
to reduce their dietary intake of complex sugars, specifically starches (complex
carbohydrates).
When preparing and eating meals, you should begin reviewing the packaging on all of
the food you purchase and consume. With regards to the packaged food you purchase,
the term “total carbohydrate” includes all three types of carbohydrates (sugars,
starches/complex carbohydrates, and fiber/cellulose). Tobe successful in your quest for
better health, you should begin “carb counting” to keep track of your daily carbohydrate
intake, and work toward not exceeding a daily total carbohydrate intake.
Types of Carbohydrates
There are three basic categories of carbohydrates, including:
1. Sugars (glucose, sucrose, fructose, lactose)
2. Starches (often called complex carbohydrates)
1. Fiber (cellulose – the carbohydrate in plant food)
Sugars
When most people think of lowering their blood sugar or treating diabetes, they focus on
lowering the simple sugars. Sugars are sometimes called “simple sugars” or “fast-acting
carbohydrates” because they are much less complicated molecules compared to complex
carbohydrates (starches) and cellulose (fiber). As simpler molecules, our bodies are able
to digest and metabolize sugars more quickly than the two other types of carbohydrates.

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The simple sugars come from two basic sources:
1. Naturally occurring sugar
a. Milk products – this naturally occurring sugar is called lactose
b. Fruit – typically fruits contain between 40% and 55% fructose with the
remaining sugar being glucose
2. Added sugar
a. Table sugar – called sucrose, most table sugar is 50% fructose and 50%
glucose
Most of the sugar in the world comes from one of two sources: sugar cane and sugar
beets. In both cases, 99.95 percent of the sugar extracted is sucrose.
When reading packaging nutritional information, the chemical name for all simple
sugars has the ending “-ose.” You should also know that dextrose is another term for
glucose, and levulose is another word for fructose. In total, the common simple sugars
include: glucose (dextrose), fructose (levulose), sucrose (combination of fructose and
glucose), lactose, and maltose.
In terms of health benefits, there is no real benefit to the naturally occurring fructose
and glucose in fruit products in comparison to the added or processed sucrose sold as
table sugar or added to canned fruit products. The naturally occurring sugar in fruit and
table sugar both contain a similar combination of fructose and glucose. Consequently,
neither form of sugar is healthier for our bodies. The enzyme amylase begins to digest
and metabolize the simple sugar glucose within the human stomach, requiring the
release of insulin into the blood stream for glucose to be completely metabolized. The
fact the glucose requires insulin for metabolism is one of the basic reasons doctors
monitor blood glucose levels in diabetics who either do not produce enough insulin or
who have become resistant to their own insulin. In contrast to glucose, the simple sugar
fructose is metabolized in the liver, and fructose does not require insulin for
metabolism.
Types of simple sugars
Starches or Complex Carbohydrates
The starches, or complex carbohydrates, are an oft forgotten component of the total
carbohydrate intake that is part of our daily diet.
Foods that contain starches include:
1. Grains such as oats, barley, and rice

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2. Vegetables including potatoes, corn, peas, and lima beans
3. Other beans and peas including split peas, black-eyed peas, kidney beans, pinto
beans, lentils
In the North American diet, many foods and beverages are made from grains. Some of
the most common carbohydrates in our diets originate from foods such as pasta, bread,
and crackers. Keep in mind that alcohol contains sugars generated from oats and
barely. Grains consist of three different parts: (1) bran, (2) germ, and (3) endosperm.
The outer husk of the grain is called the bran, and of the three different components of
grain, the bran contains the most B vitamins, minerals, and fiber. The middle germ
layer contains vitamin E and fatty acids, while the innermost layer is called the
endosperm. The endosperm consists primarily of starch.
Many people have heard that whole grain foods are healthier than refined grains.
Refined grains are processed such that they contain only the carbohydrate containing
endosperm, but the nutrient rich bran and germ layers have been removed from the end
product. Consequently, refined grains will have fewer B vitamins, vitamin E, essential
fatty acids, minerals, fiber, and other nutrients compared to the whole grains. Whole
grains include all three parts of grain and therefore are more nutritious than refined
grains.
Fiber or Cellulose
When most of us imagine eating carbs, we do not consider fiber to be an important
carbohydrate in our diets. Fiber comes from cellulose in plants, and cellulose is the
building block of plant matter found in fruits, nuts, vegetables, legumes, and whole
grains. Cellulose comes exclusively from plants (fruits and vegetables) and is not found
in animal products. This cellulose is the indigestible portion of plant food, so why is
dietary fiber important? Fiber plays an essential role in the digestive process, helping us
to feel full without over-eating and bulking up stool for more regular, healthy bowel
movements. Most Americans consume only half of the recommended daily intake of
fiber.

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Type of Carbohydrate Source of Carbohydrate
Sugar/Glucose Fruit
Sugar/Fructose Fruit
Sugar/Lactose Milk, Milk Products
Sugar/Sucrose Table Sugar
Sugar Brown Sugar
Sugar Molasses
Sugar Honey
Sugar Beet Sugar
Sugar Cane Sugar
Sugar Confectioner’s
Sugar/Powdered Sugar
Sugar Maple Syrup
Sugar High-fructose corn
syrup
Sugar Agave nectar
Sugar Sugar cane syrup
Starch/Carbohydrate Pasta
Starch/Carbohydrate Bread
Starch/Carbohydrate Crackers
Starch/Carbohydrate White Rice
Starch/Carbohydrate Brown Rice
Starch/Carbohydrate Wild Rice
Starch/Carbohydrate Potatoes
Starch/Carbohydrate Sweet Potatoes
Starch/Carbohydrate Yams
Starch/Carbohydrate Peas
Starch/Carbohydrate Split Peas
Starch/Carbohydrate Black Eyed Peas
Starch/Carbohydrate Pinto Beans
Starch/Carbohydrate Kidney Beans
Starch/Carbohydrate Lima Beans
Starch/Carbohydrate Corn
Starch/Carbohydrate Oats
Starch/Carbohydrate Barley
Starch/Carbohydrate Alcohol
Fiber/Cellulose Whole wheat
Fiber/Cellulose Oats
Fiber/Cellulose Whole Grain Cereal
Fiber/Cellulose Whole Grain Pastas
Fiber/Cellulose Black Beans
Fiber/Cellulose Kidney Beans
Fiber/Cellulose Pinto Beans
Fiber/Cellulose Garbanzo/Chick Peas
Fiber/Cellulose White Beans
Fiber/Cellulose Lentils

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Fiber/Cellulose Fruits with edible skin
Fiber/Cellulose Fruits with edible seeds
Fiber/Cellulose Vegetables with skin
Fiber/Cellulose Peanuts
Fiber/Cellulose Walnuts
Fiber/Cellulose Almonds

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Carbohydrate Goals for a Healthy, Low Carb Diet
During the past ten or fifteen years, dietary recommendations for diabetes have changed
substantially. However, healthy eating remains one of the pillars of managing
hyperglycemia, prediabetes, and diabetes mellitus. Your physician may refer toa low
carbohydrate diet or diabetes diet as medical nutrition therapy (MNT), underscoring the
importance of dietary changes and healthy eating in managing hyperglycemia. While
the older diets of the 1980s and 1990s focused on restricting calories, medical nutrition
therapy (MNT) emphasizes developing a healthy eating plan that is low in fat and
calories while being rich in nutrients. The MNT centers on eating fruits, vegetables, and
whole grains. Alternatively, your healthcare provider may encourage you to eat foods
with a low glycemic index (GI). A food’s glycemic index refers tohow that particular
food ranks compared to other foods in its effect on the blood glucose level when
compared to a standard food.
Twoof the principal goals of a medical nutrition plan are to lower blood sugar and lower
body mass index (BMI). To develop a more specific diet that addresses your personal
preferences and needs, consider scheduling an appointment with a licensed dietician.
Overall your MNT should include the following recommended foods:
Healthy Carbohydrates: Get the most out of your calories. Eat foods containing
healthy carbohydrates that are high in fiber and low in sugars (simple carbohydrates)
and low in starches (complex carbohydrates). Examples of healthy carbohydrates
include vegetables, fruits, legumes (peas, beans, lentils), whole grains, and low-fat dairy
products. Preferred fruits include those with an edible skin (apples, blueberries, pears,
peaches) and those with digestible seeds (strawberries, blackberries, raspberries).
Remember that our bodies digest simple sugars and complex carbohydrates down into
glucose, and these foods will elevate your blood sugar.
Foods Rich in Fiber: Tomaintain good health, it is recommended that adults ingest
between 25 grams and 30 grams of fiber each day. Dietary fiber from fruits, vegetables,
legumes, nuts, and whole wheat is preferred over fiber from supplements. Keep in mind

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that excellent sources of fiber contain at least 5 grams of fiber per serving, and good
sources of fiber contain between 2.5 grams and 4.9 grams of fiber per serving. If you do
the math, you should be eating somewhere between five and twelve servings of fiber per
day.
Eat Healthier Sources of Fat: Avoid saturated fats, and limit your intake of fats in
general because fats are packed with calories. Foods containing monounsaturated fats
and polyunsaturated fats are preferred. Examples of these foods include walnuts,
pecans, macadamia nuts, almonds, avocados, olives, olive oil, peanut oil, and canola.
Get Protein from Hearth Healthy Fish: Omega-3 fatty acids, found in some fish,
promote heart health by lowering triglycerides. Rather than eating red meats which
contain a lot of fat, eat at least two servings of heart-healthy fish each week. The
preferred types of fish include: salmon, mackerel, tuna, sardines, and blue fish. Halibut,
cod, and tuna are lower in saturated fat than most poultry and red meat. However,
eating fried fish will add back a lot of fat and calories to your diet. Avoid eating
excessive amounts of fish that may contain high levels of mercury.
Continuing to develop your medical nutrition therapy, focus on eating foods with a low
glycemic index (GI).
The following is a list of some foods offering a low GI:
Dark, green, leafy vegetables
Kale
Collard greens
Spinach
Legumes
Lentils
Peas
Split peas
Black eyed peas
Pinto beans
Kidney beans
Lima beans
Navy beans
Black beans
Berries
Blueberries
Strawberries
Blackberries
Raspberries
Citrus Fruits
Oranges

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July 18, 2015
Lemons
Grapefruit
Limes
Sweet Potatoes
Tomatoes
Heart Healthy Fish
Salmon
Tuna
Blue Fish
Mackerel
Sardines
Nuts
Almonds
Walnuts
Pecans
Peanuts
Macadamia Nuts
Flax seeds
Whole Grains
Oatmeal
Barley
Low-fat or Fat-free Milk Products
Low-fat milk
Low-fat or fat-free yogurt
Just as it is important to know what types of foods to eat, you should also be aware of
the many types of foods to avoid.
Cholesterol: Most of us are aware that high blood cholesterol levels place us at risk for
heart disease, stroke, and other cardiovascular complications. Keep your total
cholesterol intake under 300 milligrams per day. Common sources of cholesterol
include red meat, other high-fat animal proteins, high-fat dairy products, egg yolks,
shellfish, avocados, liver, and meat from other organs.
Saturated Fats: Like cholesterol, saturated fats a found in abundance in red meat,
other animal proteins, high-fat dairy products, bacon, and processed meats including

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July 18, 2015
salami, sausage, and hot dogs. Goal saturated fat intake should be under 7 percent of
the total daily calories.
Trans Fats: Trans fats have very deleterious effects on weight and health. Trans fats
are found in shortening, stick margarines, processed snacks, and some baked goods.
Most dieticians and health experts recommend avoiding trans fats completely.
Sodium: Ideally, you should try tokeep your total sodium intake under 2300 grams
per day. However, do not completely eliminate sodium from your diet. During the
normal course of a day, through sweating and eliminating waste products, our bodies
also lose sodium. Toprevent dizziness from low blood pressure and to ensure normal
cellular function, it is important to replace this sodium in our diets every day.
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July 18, 2015
Low Cholesterol Diet
Sources
1http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/
2Freedman, D.S., Horlick, M. & Berenson, G.S., 2013. A comparison ofthe Slaughter skinfold-thickness
equations and BMI in predicting body fatness and cardiovascular disease risk factor levels in
children. Am. J. Clin. Nutr., 98(6), pp.1417–24.
3Steinberger, J. et al., 2005. Comparison ofbody fatness measurements by BMI and skinfolds vs dual
energy X-ray absorptiometry and their relation to cardiovascularrisk factors in adolescents. Int. J. Obes.,
29(11), pp.1346–1352.
4Willett, K. et al., 2006. Comparison ofbioelectrical impedance and BMI in predicting obesity-related
medical conditions.Obes. (Silver Spring), 14(3), pp.480–490.
http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/understanding-carbohydrates/types-of-
carbohydrates.html

DrKnows Healthy Eating 7-18-2015

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