Dietitian-Approved Breakfasts For Diabetics

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I had an interesting back-and-forth debate on Twitter yesterday with a doctor who took offense to my previous post, tweeting that it’s NOT dietitians who are going after Tim Noakes, and that I’d needlessly insulted an entire profession of hardworking folks.

I pointed that I’d blamed – in plain English – the dietitians in South Africa, not the entire profession. As for whether dietitians are behind the Noakes witch-hunt, Marika Sboros (who’s done more reporting on the trial than anyone I’m aware of) weighed in that one:

Quite right, Tom. The number is shockingly high – dietitians in practice and academia – involved directly and indirectly and all heavily conflicted.

And again:

HPCSA went for Tim Noakes at behest and whim of dietitians and still going. Number of dietitians in practice and academia involved directly and indirectly is mind-boggling.

As for the profession of hardworking folks, I replied that their professional organizations are heavily funded and influenced by the makers of industrial foods (a fact anyone can check), and that one of those hardworking professionals had my diabetic father-in-law eating pancakes with syrup for breakfast … but no butter, because butter is bad for the heart, ya see.

The doctor replied that now I was impugning an entire profession because of bad advice from one dietitian.

Well, at least he agreed it’s bad advice. I replied that it’s very typical advice: you need to eat those carbs for energy even if you’re a diabetic (exactly what the dietitian told Chareva’s father, in fact), then handle the glucose spike with more insulin. I pointed out that the hardworking professional who had him eating pancakes and syrup for breakfast was the staff dietitian at the hospital where he was recovering from surgery. Very unlikely she’d gone rogue.

No, no, no, that’s not typical advice from a hardworking professional dietitian, the doctor insisted over and over. He demanded I provide citations to prove that it is. So replied with this quote from the Dear Dietitian column I mentioned in a previous post:

There is no need to remove carbs from your diet… Anyone who has diabetes should be able to consume 12 to 15 servings of carbohydrate foods each day while maintaining healthy blood glucose levels.

And I cut and pasted this quote directly from our friends at the Academy of Nutrition and Dietetics (whose president encourages members to report “disruptors” who offer alternative advice):

If you have diabetes, a healthy daily eating plan includes: starchy foods including breads, cereals, pasta, rice, other whole grains and starchy vegetables such as beans, corn and peas.

The doctor offered this reply:

You think grains = pancakes? Damn… no wonder your logic is so weak. And that means you have no evidence that this was typical advice. As I thought.

Hmmm, I’m pretty sure pancakes are made from grains. And while the Academy of Nutrition and Dietetics didn’t mention pancakes specifically in that quote, I can’t see any reason dietitians who are trained to serve starchy foods including breads, cereals, pasta, rice and other whole grains to diabetics would object to pancakes. In fact, I’d bet dollars to donuts (and you can keep the donuts) that plenty of dietitian-approved hospital meals served to diabetics include pancakes.

So out of curiosity, I went looking for hospital menus online. I found three that include both advice for diabetics and menu offerings. And remember, hospital meals are approved by registered dietitians, not just some schmuck in the cafeteria.

Here’s part of the advice for diabetics offered by Northwestern Memorial Hospital:

Starch: Include 2 to 3 servings per meal, or 6-11 servings per day.
Fruits: Include 1 with each meal, or 2 to 4 per day.

Two or three servings of starch per meal. Got it. And here’s one of the offerings on the menu that’s labeled as a single serving of starch:

1 waffle or pancake

And here’s an entry from Other Sugars and Starches, and again labeled as one serving:

1 Tbsp sugar/syrup

Yup, a dietitian could give a diabetic pancakes or waffles with syrup for breakfast and be within the official guidelines – designed by dietitians, of course.

Here’s the advice for diabetics from UAB hospital in Alabama:

Your menu includes the number of carbohydrate (carb) servings in brackets to help manage your blood sugar levels. One carb {1} equals 15 grams of carbohydrates. This number is based on a portion size, which has been adjusted for your diet restriction. The average diabetic diet includes three to five carbohydrates per meal.

So the average meal for diabetics (designed by a hardworking professional dietitian) includes 45 to 75 grams of carbohydrate. Awesome. And here are some items from the menu, with the number of carb servings in brackets.

Buttermilk Pancakes {2}
French Toast {2}
Cheerios {1}
Blueberry Muffin {2}
Bagel {2}

Yup, those sure look like ideal foods for diabetics to me. Heck, at five carb servings per meal, your diabetic relative could order the pancakes and the blueberry muffin and still be within the guidelines developed by one of those hardworking professionals. But let’s not forget dessert:

Angel Food Cake {1}

And now for the punchline: the buttermilk pancakes, Cheerios, bagel and angel food cake all have the “heart-healthy” symbol next to them on the menu. That’s what the typical hardworking, professional dietitian believes: low-fat = heart-healthy. So my diabetic father-in-law was served pancakes in a hospital … but no butter. That would be bad for his heart.

By the way, syrup is listed on that menu as condiment, but there’s no number in brackets indicating to count it as a serving of carbs.

And finally, we turn to the dietitian-approved menu at Good Samaritan Hospital – which reminds patients to talk to a staff dietitian about their needs. The hospital offers a Cardiac Diet, which it describes as a “heart-healthy diet” featuring low-fat, low-cholesterol, and low-sodium foods. It also offers a Diabetes Diet designed to control blood sugar … which it defines as not exceeding four servings of carbohydrate per meal.

Here are some foods on the breakfast menu and the number of servings of carbohydrate:

Fresh Breads (1)
Freshly Baked Blueberry Muffins (2)
French Toast (2)
Buttermilk Pancakes (2)

The menu says the pancakes can be served with sugar-free or maple syrup, but doesn’t give a carb-count figure for the maple syrup. Poking around the menu, I saw that bread, cream of wheat, macaroni and cheese, vanilla soy milk, granola and fruit, and of course angel food cake are all listed as “heart-healthy” — for diabetics.

So yes, I’m going to maintain that it’s quite typical for those hardworking, professional dietitians to serve pancakes with syrup to diabetic patients.

Someone, perhaps Milton Friedman, once explained that people are either foolish or wise, and either diligent or lazy. That creates four combinations. The people who most benefit the rest of us are wise and diligent. People who are lazy (whether wise or foolish) generally don’t have much effect on the rest of us. But people who are both foolish and diligent cause a lot of trouble.

I wish a whole lot of those hardworking, professional dietitians would be less hardworking. Or better yet, wise up.

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134 thoughts on “Dietitian-Approved Breakfasts For Diabetics

  1. Kathy Sollien

    Long story short, my stay in the cardiac ICU after a stent in my LAD was told I could not get a black cup of coffee. After all, “I was in the cardiac unit”. They could get me instant decaf if I wanted. Was then served a breakfast of french toast with fake syrup, orange juice, low fat milk, cereal, margarine and that decaf coffee. I had my husband go down to the Dunkin Donuts located inside the hospital to get me real coffee and an egg and sausage sandwich. I ate without the bread.
    A year later at a different hospital (both well known, teaching hospitals) and my second stent – another long story – again, could not get a black cup of coffee. Was served a full sized coke, crackers and peanut butter before my dinner of some kind of meat with gravy, mashed potatoes and a roll plus a fruit cup of sorts. My terrific nurse helped me to order an appropriate breakfast with real coffee for the next morning. This hospital also had a Dunkin Donuts outside their own cafeteria.
    I told the dietitian and the cardiologist that until they started practicing what they preach as well as to stop sending such conflicting messages that they were loosing a lot of credibility.
    I stay healthy with a LCHF diet and specific supplements of my choosing and research. I refused all statins, beta blockers and now off all blood thinners.
    I tell people to question everything……..

    Reply
  2. Kathy Sollien

    Long story short, my stay in the cardiac ICU after a stent in my LAD was told I could not get a black cup of coffee. After all, “I was in the cardiac unit”. They could get me instant decaf if I wanted. Was then served a breakfast of french toast with fake syrup, orange juice, low fat milk, cereal, margarine and that decaf coffee. I had my husband go down to the Dunkin Donuts located inside the hospital to get me real coffee and an egg and sausage sandwich. I ate without the bread.
    A year later at a different hospital (both well known, teaching hospitals) and my second stent – another long story – again, could not get a black cup of coffee. Was served a full sized coke, crackers and peanut butter before my dinner of some kind of meat with gravy, mashed potatoes and a roll plus a fruit cup of sorts. My terrific nurse helped me to order an appropriate breakfast with real coffee for the next morning. This hospital also had a Dunkin Donuts outside their own cafeteria.
    I told the dietitian and the cardiologist that until they started practicing what they preach as well as to stop sending such conflicting messages that they were loosing a lot of credibility.
    I stay healthy with a LCHF diet and specific supplements of my choosing and research. I refused all statins, beta blockers and now off all blood thinners.
    I tell people to question everything……..

    Reply

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