by Meghana Kumar, MD

Sugar Free Assortment, 17.75 oz bag | Russell Stover

You’ve seen the aisles of enticing desserts aimed for people with diabetes in the grocery store – puddings, chocolate bars, cookies. Can you really indulge in these products guilt free?

These sweets tend to be sweetened with artificial sweeteners, like Splenda, Stevia, and aspartame. Artificial sweeteners have been linked with obesity, appetite stimulation, and glucose intolerance as well, though not nearly to the same extend as regular sugar. They can also cause bloating, diarrhea, and abdominal pain, especially when consumed in excess.

Remember that sugar-free doesn’t necessarily mean carbohydrate-free – it often simply means that the product contains no added sugar. In other words, carbohydrates come in more forms than refined white sugar. A sugar-free vanilla pudding (Jello single-serve cup) still has 10 grams of carbs, stemming from the dairy contents. While better than the 25 grams in a regular pudding, it may still impact your blood sugar and certainly is not a license to eat without inhibition. One Voortman’s sugar-free chocolate chip cookie contains 14 grams of carbohydrates (coming from flour), but no added sugars. This distinction is especially important for people who need to count and dose insulin for carbohydrates precisely.

Calorie and saturated fat content often do not differ significantly between sugar-free chocolate and regular desserts. For example, a chocolate bar still has fat and calories from milk and cocoa butter. So keep in mind that, carbs aside, there are usually healthier choices than highly processed sugar-free snacks – fresh fruits, a scoop of cottage cheese, carrot sticks and hummus, etc.

Some people may find moderation with regular desserts to be a more satisfying and equally healthy choice. For instance, 2 pieces of Hershey’s Dark Chocolate Nuggets with almonds have 10 grams of carbs, whereas 3 pieces of Hershey’s sugar-free Special Dark chocolates have 13 grams of carbs. If you can stop yourself at one or two pieces, then the former may be a preferable option.  

In short, don’t just rely on advertising (the people who design food packaging are savvy!) – look at the nutritional labels and make the decision for yourself about whether a food item is a healthy choice or not.

Meghana Kumar, MD

What Should I Look for When Buying Whole Grains? - The New York Times
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In many cuisines, white rice is a staple of the dinner table – but one cup of cooked white rice has almost 50 grams of carbohydrates! This can put someone with diabetes in a tough position when it comes to reconciling sitting down to a family meal with their health needs. Here are some healthy alternatives to white rice that won’t force you to compromise on flavor.

First some terminology:

A carbohydrate (carb for short) is a molecule that is broken down to sugar for use as energy in the body.

Net carbs represent the total carbs in a food item minus fiber (which is not digested and therefore does not impact blood glucose). Net carbs are comprised of simple and complex carbs. Simple carbs are quick to digest whereas complex carbs (which are made of longer chains of molecules) take longer to digest. Complex carbs do not spike blood sugar as dramatically or rapidly and provide energy for a longer duration. Therefore, complex carbs are considered a superior option for diabetics.

Low carb substitutes:

  1. Vegetable rice – You can make this yourself in seconds using a food processor or buy it ready-made. Any vegetable can be riced if you get creative – sweet potatoes, cabbage, cauliflower, broccoli, etc.  1 cup of cauliflower rice = 4 grams of total carbs, 2 grams of net carbs.
  2. Shirataki rice – Made from konnyaku flour, this rice can have a distinct odor and texture but is a great addition to a ketogenic diet. Look online for tips to make shirataki rice palatable. 1 cup = 5 grams of carbs, 0 grams of net carbs.

Moderate to high carb substitutes:

Brown rice, quinoa, couscous, barley, bulghur, buckwheat, farro, freekeh, and other grains are all still relatively high in starch, containing 30-50 grams of total carbohydrates per cup. But don’t write these options off completely! They also contain higher amounts of fiber and protein than white rice. They have varying amounts of important minerals like iron, selenium, and calcium. Most importantly, the carbohydrates they do contain are complex. These characteristics help carbohydrates to be absorbed and digested more slowly, allow you to stay full for longer with a smaller quantity of food, and are ultimately far better than white rice for your blood sugars.

Next time you go to the grocery store, we encourage you to step out of your comfort zone and try something new. The varieties are endless – if you don’t like brown rice, try brown jasmine or basmati rice. If not white quinoa, see if red quinoa is more up your alley. Happy eating!

Meghana Kumar, MD

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Thyroid hormone replacement is the mainstay of treatment for hypothyroidism, whether the hypothyroidism is caused by radiation, surgery, or Hashimoto’s disease (autoimmune destruction of the thyroid gland). The goal is to replace the body’s production of thyroid hormone in the most physiologic way possible. However, a quick internet search will reveal an overwhelming number of options for thyroid hormone replacement. In this article, we will break down the different brands of thyroid hormone available in the US and things to consider before selecting a formulation.

A normal thyroid gland produces 80% T4 (inactive thyroid hormone) and 20% T3 (active thyroid hormone). Various organs have enzymes which convert T4 to T3, which then mediates all the functions of thyroid hormone, from sleep to digestion to temperature regulation.

T4-only formulations:

Generic – Levothyroxine

Brand name – Synthroid, Levoxyl, Euthyrox, Unithroid, Tirosint

These medications are usually the first-line treatment offered. It is important to stay on the same brand or advise your doctor if you are prescribed a different brand than before. Different brands even at the same dose may have slightly different contents.

All these medications are comparable in effectiveness. Tirosint is notable because it comes in a gel capsule or solution form, which can help with medication absorption. Some patients may experience more stable thyroid levels upon switching from generic to brand name hormone.

T3 and T4 combination formulations:

Thyroid extract medications: Armour, NP Thyroid, Nature-Thyroid, WP Thyroid, Westhroid

Synthetic: Cytomel/Liothyronine (T3) plus one of the T4 medications listed above.

Most doctors are reluctant to prescribe thyroid extract medications (which are made from dried and powdered pig thyroid glands) because they do not simulate the normal human thyroid production closely. They tend to contain high concentrations of T3 which can cause highly variable levels and symptoms.  Prescribing T3 and T4 as separate pills allows the doctor to control the ratios of each.

A T3-only medication regimen is generally not prescribed.

There are a number of factors that go into selection of a thyroid hormone replacement. Your endocrinologist can talk to you further about which medication is the best choice for you, and why.