Lifestyle Medicine Clinic Duke University Medical Center

"No Sugar, No Starch" Diet

Getting Started
This diet is about providing your body with the nutrition it needs Eliminating the food that your body does not require
Nutritionally empty carbohydrates.

For effective weight loss keep total grams of carbohydrate below 20.

Your diet is to be made up exclusively of foods and beverages from the following pages If the food is packaged, check the label for carbohydrate count for your meal
2 grams or less for meat and dairy products, 5 grams or less for vegetables.

All food may be cooked in a microwave oven, baked, boiled, stir-fried, sauted, roasted, fried (with no flour, breading, or cornmeal), or grilled.

When You Are Hungry, Eat Your Choice Of The Following Foods
Meat
Beef (including hamburger and steak) Pork, ham (unglazed), bacon, Lamb, veal, or other meats. For processed meats (sausage, pepperoni, hot dogs), check the label Carbohydrate count should be about 1 gram per serving (preferably organic and nitrate free).

Poultry
Chicken Turkey Duck Any other fowl

Fish and Shellfish

Any fish, including Tuna Salmon Catfish Bass Trout Shrimp Scallops Crab Lobster (Avoid farmed seafood, there are too many toxins in them).

Eggs
Whole eggs are permitted without restrictions

REMEMBER
You do not have to avoid the fat that comes with the above foods. You do not have to limit quantities deliberately, but you should stop eating when you feel full.

Foods That Must Be Eaten Every Day

Salad Greens
2 cups a day minimum
Arugula Bok choy Cabbage (all varieties) Chard Chives Endive Greens (all varieties, including beet, collards, mustard, and turnip) Kale Lettuce (all varieties) Parsley Spinach Radicchio Radishes Scallions (spring onion) Watercress (If it is a leaf, you may eat it.)

Fibrous Vegetables: includes

Artichokes (globe or French only not Jerusalem) Asparagus Black Soybeans Broccoli Brussels sprouts Bamboo shoots

 Bean sprouts Cauliflower Celery Celeriac (celery root) Chayote Cucumber Edamame beans Eggplant (aubergine) Fennel Green beans (string beans) Jicama Mushrooms Okra Pepper Pumpkin Rhubarb Rutabaga (swede) Snow peas Sprouts (bean and alfalfa) Sugar snap peas Summer squash Tomatoes Turnip Wax beans Zucchini (courgette)

Bouillon
2 cups daily - as needed for sodium replenishment. Clear broth (consomm) is strongly recommended, unless you are on a sodium-restricted diet for hypertension or heart failure. Use these particularly when you start. Helps avoid headaches and fatigue as your body adjusts to your new diet.

Foods Allowed In Limited Quantities

Cheese
Up to 4 ounces a day. Includes hard, aged cheeses such as Swiss and Cheddar, Brie, Camembert blue, mozzarella, Gruyere, cream cheese, goat cheeses. Avoid processed cheeses, such as Velveeta. Check the label; carbohydrate count should be less than 1 gram per serving.

Cream
Up to 4 tablespoons a day. Includes heavy, light, or sour cream Not half and half

Mayonnaise
Up to 4 tablespoons a day. Duke's and Hellmann's are low-carb. Check the labels of other brands.

Fatty Vegetables
Olives (Black or Green):
Up to 6 a day.

Avocado:
Up to 1/2 of a fruit a day.

Condiments
Lemon/Lime Juice:
Up to 4 teaspoonfuls a day.

Soy Sauces:
Up to 4 tablespoons a day. Kikkoman is a low carb brand. Check the labels of other brands.

Pickles
Dill or Sugar-Free: Up to 2 servings a day. Mt. Olive makes sugar-free pickles. Check the labels for carbohydrates and serving size.

Snacks
Pork rinds/skins Pepperoni slices Ham Beef Turkey Other meat roll-ups Deviled eggs

THE PRIMARY RESTRICTION: CARBOHYDRATES

On this diet, no sugars (simple carbohydrates) and no starches (complex carbohydrates) are eaten. The only carbohydrates encouraged are the nutritionally dense, fiber-rich vegetables listed.

Sugars: Simple carbohydrate

Avoid anything containing:
White sugar Brown sugar Honey Maple syrup Molasses Corn syrup Beer (contains barley malt) Milk (contains lactose) Flavored yogurts (usually have a lot of sugar) Fruit juice Fruit

Starches: complex carbohydrate

Avoid these kinds of foods:
Grains (even "whole" grains), Rice Cereals Flour Cornstarch

 Breads Pastas Muffins Bagels Crackers Beans and legumes (pinto, lima, black beans, peas etc) Most Root vegetables particularly carrots, parsnips, corn, potatoes, French fries, potato chips

SWEETENERS AND DESSERTS

If you feel the need to eat or drink something sweet, you should select the most sensible alternative sweetener(s) available. Available alternative sweeteners are:
Splenda (sucralose), Nutra-sweet (aspartame), Truvia (stevia/erythritol blend), Sweet N Low (saccharin).

SUGAR ALCOHOL SWEETENERS

Avoid food with these particular sugar alcohols
Sorbitol Maltitol

FATS AND OILS

All fats and oils, even butter, are allowed. Some oils are better for cooking Coconut oil, butter, or lard is recommended for cooking as these are most stable at high temperatures Olive oil is recommended for cold dressings. Avoid margarine and other hydrogenated oils that contain trans fats they are not healthy. For salad dressings, the ideal dressing is a homemade oil-and-vinegar dressing, with lemon juice and spices as needed. Blue-cheese, ranch, Caesar, and Italian are also acceptable if the label says 1 to 2 grams of carbohydrate per serving or less. Avoid lite dressings, because these commonly have more carbohydrate.

Chopped eggs, bacon, and/or grated cheese may also be included in salads as a fat source
Natural unprocessed fats, in general, are important to include, because they taste good and make you feel full. You are therefore permitted the fat or skin that is served with the meat or poultry that you eat, as long as there is no breading on the skin. Do not attempt to follow a low-fat diet!

BEVERAGES
Drink as much as you would like of the allowed beverages, do not force fluids beyond your capacity. The best beverage is water. Essence-flavored seltzers (zero carbs) and bottled spring and mineral waters are also good choices.

Caffeinated Beverages
Some people find that their caffeine intake interferes with their weight loss and blood sugar control. You may could consume a maximum of one of the following
3 cups of coffee (black, or with artificial sweetener and/or cream) 6 cups tea (black, or with artificial sweetener and/or cream), 3 caffeinated diet sodas per day.

For example:
2 cups of coffee + 2 cups of tea or 1 cup of coffee, 1 soda and 2 cups of tea.

Alcohol
At first, avoid alcohol consumption on this diet. At a later point in time, as weight loss and dietary patterns become well established, alcohol in moderate quantities,
Low carbohydrate alcohol (spirits/hard liquor) may be added back into the diet.

Quantities
Eat when you are hungry; stop when you are full. The diet works best on a "demand feeding" basisthat is, eat whenever you are hungry; try not to eat more than what will satisfy you. Learn to listen to your body. A low-carbohydrate diet has a natural appetite-reduction effect to ease you into the consumption of smaller and smaller quantities comfortably. Do not eat everything on your plate just because it's there. On the other hand, don't go hungry! You are not counting calories. Enjoy losing weight comfortably, without hunger or cravings. It is recommended that if you are hungry you start your day with a nutritious low-carbohydrate meal. Note that many medications and nutritional supplements need to be taken with food at each meal, or three times per day.

IMPORTANT TIPS AND REMINDERS

The following items are NOT on the diet:
Sugar Bread Cereal Flour-containing items Fruits, juices Honey Whole or skimmed milk Yogurt Canned soups Dairy substitutes Ketchup Sweet condiments and relishes

Avoid These Common Mistakes

Beware of "fat-free" or "lite" diet products, and foods containing "hidden" sugars and starches (such as coleslaw or sugar-free cookies and cakes). Check the labels of liquid medications, cough syrups, cough drops, and or other over-the-counter medications that may contain sugar. Avoid products that are labeled "Great for Low-Carb Diets!"

Search the USDA food nutrient database online to find information about foods not listed above.

LOW-CARB MENU PLANNING

What does a low-carbohydrate menu look like? You can plan your daily menu by using the following as a guide:

Breakfast
Meat or other protein source (usually eggs) Fat source this may already be in your protein; for example, bacon and eggs have fat in them. But if your protein source is "lean," add some fat in the form of butter, cream (in coffee) or cheese. Low-carbohydrate vegetable (if desired)this can be in omelet or a breakfast quiche.

Lunch
Meat or other protein source Fat source - If your protein is "lean," add some fat, in the form of butter, salad dressing, cheese, cream, or avocado. 1 to 1 cups of salad greens or cooked greens to 1 cup of vegetables

Snack
Low-carbohydrate snack that has protein and/or fat.

Dinner
Meat or other protein source Fat sourceif your protein is "lean," add some fat in the butter, salad dressing, cheese, cream, or avocado. 1 to 1 cups of salad greens or cooked greens to 1 cup of vegetables

A Sample Day May Look Like This

Breakfast
Bacon or sausage Eggs

Lunch
Grilled chicken on top of salad greens and other vegetables, with bacon, chopped eggs, and salad dressing

Snack
Pepperoni slices and a cheese stick

Dinner
Burger patty or steak Green salad with other acceptable vegetables and salad dressing Green beans with butter

Reading a Low-Carb Label

Start by checking the nutrition facts. Look at serving size, total carbohydrate, and fiber. Use total carbohydrate content only. You may subtract fiber from total carbohydrate to get the "effective or net carb count."
For example, if there are 7 grams of carbohydrate and 3 grams of fiber, the difference yields 4 grams of effective carbohydrates. That means the effective carbohydrate count is 4 grams per serving.

Reading a Low-carb Label (cont)

No need to worry - at this point - about calories or fat. Effective carbohydrate count of vegetables should be 5 grams or less. Effective carbohydrate count of meat or condiments should be 1 gram or less. Also check the ingredient list. Avoid foods that have any form of sugar or starch listed in the first 5 ingredients.

Sugar by any other name is still sugar!

All of these are forms of sugar:
Sucrose Dextrose Fructose Maltose Lactose Glucose Honey Agave syrup High-fructose corn syrup Maple syrup Brown-rice syrup Molasses Evaporated cane juice Cane juice Fruit-juice concentrate Corn sweetener Invert syrup Partially inverted sugar malt dextrin