By Beth Klos, R.D., L.D.N.
Oh no. I just found out I have high cholesterol and diabetes. Worse yet, my spouse just told my relatives.
At family dinner the advice starts flowing: "Put down that shrimp!" "Don't eat carrots. They're loaded with sugar!" "You're not still eating eggs are you?" "Don't drink soda. Here, have this natural juice instead. It's better for you."
What should I eat? Will carrots really hurt me?
Help is on the way. Read on to find out which healthy foods have gotten undeserved bad reputations and deserve to be back on your plate, and how to avoid being deceived by one sugary drink with a squeaky clean reputation.
Even for people with elevated cholesterol, these small, tasty shellfish add panache to a healthy diet. Therapeutic Lifestyle Changes (TLC) guidelines from the National Cholesterol Education Program allow 200 milligrams of cholesterol daily. So there's room to eat shrimp. Three ounces of shrimp (about the size of a typical computer mouse) has 166 milligrams of cholesterol. The TLC guidelines recommend having shrimp occasionally. Vegetarians who eat fish and shellfish can eat shrimp more often, as long as they're within this daily cholesterol limit. That's because they normally eat few, if any, foods containing cholesterol (meat, eggs, cheese).
This small crustacean has many benefits in spite of its slightly high cholesterol content. Shrimp is very low in saturated fat, a key type of unhealthy fat that can drive up your LDL or "bad" cholesterol. Shrimp is even lower in saturated fat than white chicken without the skin, which has 0.9 grams in three ounces. The amount in shrimp is slight, with just 0.2 grams in three ounces. Grilled, baked and steamed shrimp or shrimp cooked in a small amount of heart-healthy oil (not battered or deep-fried) are healthy choices. In addition, shrimp are low in calories, rich in protein and contain a significant amount of selenium. So to those who beat up on shrimp: Pick on someone your own size.
This myth comes from a misinterpretation of the glycemic index. This is a relatively new way of measuring exactly how quickly or slowly carbohydrates (sugars and starch) are digested. The sugar in carrots is like a race car. It gets digested quickly compared with other foods. That's why carrots have a high glycemic index. Yet carrots have very small amounts of sugar. A whole pound of boiled carrots contains only about three teaspoons of sugar. So although the sugar in carrots moves into the blood stream very quickly, the amount is relatively insignificant when it is eaten in typical amounts. This information is of more interest to scientists, not someone selecting a vegetable to serve at dinner.
A more refined concept called "glycemic load" takes both the speed at which the sugar moves into the bloodstream and the quantity of sugar into account. This information is more practical, because low glycemic-load foods have health benefits. Carrots have a very low glycemic load. In short, carrots are a wonderful, healthy vegetable, rich in fiber and beta carotene and low in calories. Like other vegetables, filling up to half of your plate twice a day is a great choice for most people, including many people with diabetes. Include other vegetables for variation and a broad range of nutrients.
True, one egg yolk has 185 milligrams of cholesterol, less than a day's supply according to the TLC guidelines. However, even the TLC guidelines allow two egg yolks per week. The humble egg has numerous redeeming qualities. The yolk contains less than 2 grams of saturated fat, the main culprit in driving up the LDL or "bad" cholesterol. The white and the yolk both contain high quality protein, which supports healing. Enhanced eggs are now available that contain omega-3 fatty acids, for extra nutritional value. Therefore, even if your cholesterol is high, two eggs per week is safe. Another option is egg substitute — egg whites with added ingredients to substitute for the flavor and texture of the missing yolks. Since egg substitutes do not contain cholesterol, they can be eaten more often. They are ideal for those who like to have scrambled eggs every morning.
This myth probably got its start when fruit punches became popular. Fruit punch typically has even more sugar than fruit juice. However, 100% fruit juice is still high in sugar. In fact, you may be shocked to find out that natural fruit juices usually have about as much sugar as soda, or even more. The sugar content is so high because fruit juice is made by straining out the liquid portion of fruit, so the sugar is concentrated. And in liquid form, the sugar can be digested more quickly. According to one reference, a typical orange yields 2.9 ounces of juice. So, a 16 ounce bottle of orange juice would contain the sugar extracted from over 5 pieces of fruit — almost nine teaspoons of sugar. In the process of making juice smooth and palatable, most of the naturally-occurring fiber ends up in the trash. Surprisingly, even juice with pulp does not contain fiber. This kind of fiber is helpful for weight loss, blood sugar control and lowering cholesterol.
People with diabetes who test their blood glucose after having "natural" juice are often shocked to find it has skyrocketed. Orange juice has twice the glycemic load as an orange. The bottom line is that it is much healthier to eat two to four medium-sized pieces of fruit a day and choose low-calorie beverages or refreshing iced water. If you choose to drink juice at all, limit it to four ounces — a small juice glass.
In conclusion, carrots in healthy portions will not overload your sugar intake. On the other hand, innocent looking "natural" juice will spike your blood glucose levels and possibly your weight, especially in medium to large amounts. For egg yolks and shrimp, it's not all-or-nothing. Moderation rather than elimination is a reasonable strategy.
Beth Klos, RD, LDN, is a Senior Nutritionist at Brigham and Women's Hospital. She completed her undergraduate degree at University of Rhode Island and her dietetic internship at Brigham and Women's Hospital. She enjoys providing nutrition counseling to her patients and teaching counseling to Brigham and Women Hospital's Dietetic Interns.