Diabetes advice going low-carb

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The American Diabetes Association (ADA) has long advised a high carbohydrate diet which seems counterintuitive given diabetes is a condition of high blood sugar and carbohydrates more than any other nutrient cause blood sugar to rise. 

In response to the ADA’s stance, many of us who live with and write about diabetes complain about such advice, and personally follow low-carb diets. As do I. 

I used to scratch my head wondering why the ADA would so tirelessly recommend eating a lot of carbs until I read sufficient literature that they feared people were eating too much fat and fat caused heart attacks (not my belief), the greatest cause of death for people with type 2 diabetes. Thus, they wanted people to give up their fat and thinking there was no other way, they pushed them to eat more carbs.

This too kind of stuns me as I eat a low carb diet and haven’t replaced carb with more fat, I just eat sensibly – a bit of steel cut oatmeal most mornings with nuts, seeds, a few berries and Greek plain yogurt, other days cottage cheese, eggs or a protein shake. For lunch a salad with veg and grilled chicken and for dinner fish and veg mostly and snack on a bit of cheese, handful of nuts, piece of dark chocolate. 

So, I’m glad to see in the last several months the ADA finally seems to be coming ’round to advising PWDs lower their carb intake, and it’s making its way into the general advice on diabetes management. 

In today’s DiabetesInControl is one such article. Here are the highlights: 

  • Dietary carbohydrate restriction has the greatest effect on decreasing blood glucose levels.
  • During the epidemic of obesity and type 2 diabetes, caloric increases have been due almost entirely to increased carbohydrates.
  • Benefits of dietary carbohydrate restriction do not require weight loss.
  • Studies show that carbohydrate restriction is the best intervention for weight loss.
  • Adherence to a low-carb diet in people with type 2 diabetics is at least as good as adherence to any other dietary interventions and is frequently significantly better.
  • Replacement of carbohydrate with protein is generally beneficial.
  • Dietary total and saturated fat do not correlate with risk of cardiovascular disease.
  • Plasma saturated fatty acids are controlled by dietary carbohydrates more than dietary lipids.
  • The best predictor of microvascular and to a lesser extent, macrovascular complications in patients with type 2 diabetes, is glycemic control (HbA1c).
  • Dietary carbohydrate restriction is the most effective method of reducing serum triglycerides and increasing HDL.
  • Patients with type 2 diabetes on carbohydrate restricted diets reduce and frequently eliminate medication and type 1 diabetics require less insulin.
  • Intensive glucose lowering by dietary carbohydrate restriction has no side effects comparable to the effects of intensive pharmacologic treatment.

Full article here.

The Big Fat Surprise uncovers a big fat lie: fat is not the enemy

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I’ve long thought our reverence for a low and no fat diet has failed us. Just look around. Ever since the US government began pushing more carbs and less fat, and food manufacturers all but wiped full fat products off the shelf, as a nation we’ve grown fatter than ever.

Now, The Big Fat Surprise uncovers 9 years worth of investigation by its journalist author, Nina Teicholz, tracing how one man – Ancel Keys – convinced food experts, scientists, researchers the government and the American public that saturated fat was the devil – and changed our diet. 

Keys massaged much of his research to fit his notion that fat and red meat was our downfall. Study after study was faulty and wrongfully reported. Keys also liked being the persuasive savior and his charisma filled a room until all were convinced.  

I am two-thirds of the way through the book so I can’t tell you if we will find at the end the Big Truth, but I do believe sugar and carbs have increased our waistline, not fat, and the sooner we drop those containers of skim milk and no fat fruit yogurt and add some eggs, red meat and cheese back into our diet, the better off we’ll be. 

Unfortunately as pointed out in the book, the studies that contradict the merit of low-fat eating, you don’t read or hear about. Because they fly in the face of 30 years of our adopted “wisdom” they never get published. And, I know from marketing, if you hear something often enough you think it’s true whether it is or not.  

Here are a few snippets from the Wall Street Journal review:

In the great morality play of modern diet, the angels, we have been told by a host of experts, favor egg-white omelets and skimmed milk, while the devil gorges on red meat cooked in butter. For 50 years we have been warned to fight the good fight on dietary fats if we want to stay healthy. In “The Big Fat Surprise,” as one might guess from the title, Nina Teicholz plays the devil’s advocate—convincingly.

when skeptics, including the National Academies of Science, weighed in on Keys’s impoverished data, and on related claims that multiplied over the succeeding years, the media attacked the skeptics, heedless of statistical reasoning. Meanwhile, the food industry—apart from the protesting cattle and dairy lobbies—happily ministered to the new dietary wisdom. Government agencies weighed in with dietary guidelines that emphasized carbs and vegetables and warned that red meat was something one could only risk eating a few times a month. And when this miserable diet, shorn of taste, wearied its adherents, as it so often did, the pharmaceutical industry stepped in, offering drugs to lower cholesterol.

Read the book and judge for yourself.

How’s your carb-counting?

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The great CDE, founder of Integrated Diabetes Services and author Gary Scheiner, and his fellow CDE and Director of Lifestyle and Nutrition, Jenny Smith, conducted a Carb Quiz in May.

Below is part of the interview they conducted with three outstanding “carb-counters,” that may give you a few ideas to make counting carbs easier.

Of course I no longer call it carb-counting, but carb-guessing. And I’m sure we can all relate to that!

For more carb-guessing advice, click here.

What are some of the tools you’ve used over the years to count carbs?

 Stephanie: I’m using measuring cups and a food scale at home to be as accurate as possible.  At  times I am tempted to just pour a cup of milk without using a measuring cup, but then I think about how well controlled my BG is because I do measure and this helps me continue to use tools.

Lisa: I started by using measuring cups and a food scale.  After a few years I learned about “carb factors” and this has been most helpful for more precise counting for the portions I want to eat.  I use carb factors a lot for fruits and vegetables.   I find when I use measuring tools at home it trains my eye to be aware of what a particular portion looks like and how much carb it may contain – it’s so helpful when I don’t have a label to read.  When I’m eating out at a restaurant I look up information online or I use my Calorie King book as a reference.

Stephen:  There was a learning curve –some foods don’t “look” like they would have sugar!  I had to remember there was carb in milk!  I downloaded Gary’s book – Think Like a Pancreas and read it in one night and realized I needed help.  I use Calorie King and I look up glycemic index as well as information when I’m going to go out to eat.  I do use measuring cups and labels, as well as the estimation tricks I’ve learned from working with Integrated Diabetes Services.  I’m the primary cook at home so it’s easier to count when you know what has gone into a dish you’ve prepared.

What has worked the best for you to ensure accuracy?

S: Measuring is my best tool.  I feel measuring at home has helped me count carbs more accurately when I don’t have a label or the measuring tools to use – such as in the College dining hall.  I have learned to eyeball a portion of carb when eating out by weighing fruits and other carbs at home. I also tend to look info up before going out so I have a more specific count than a simple guess, especially if it is a restaurant that I’ve never been to before.

L: I use eyeball portions when I have to “guess”. I often refer to the size of a tennis ball because I know about how much this is as a measured portion and then I can more accurately account for the carbs when I have to guess.  My best time saving trick at home is to use a measured ladle for soups/casseroles (½ cup per ladle), and I use drinking glasses with a line that equates to a specific portion (pouring up to this line on the glass is equal to 1 cup).

Stephen: I feel the best trick is to trust my gut feeling. Calorie King may say “this is 15g carb”, but then I’ll consider my past experience with the food and what the response was on my CGM. I may adjust up or down by 2-5g based on previous experience.  The use of measuring cups and labels are also major players in ensuring I learn how to count – it helps when I have to guess something that may not have a label.

Do you take into account fiber/glycemic index/glycemic load?

S: I do consider fiber – I subtract it all off the carb count. If it is a lower glycemic index food, I may deduct a bit off the suggested bolus.

L: I don’t use anything scientific, but I keep these things in mind when meal planning and counting carbs to evaluate the effect after meals.

Stephen:  I do consider fiber – I subtract all of it off of the carb count. But, I also take into account the kind of food it is or the glycemic index of the food– sometimes I only subtract ½ the fiber count (I use this for things like granola bars because of all the added sugar, I’ve found that I really can’t subtract all the fiber noted).

Do you feel the use of “smart” pump features helps you cover your meals better?

S: I haven’t been using square/dual bolus (no one has really taught me what to use them for) – but I do use the temporary basal feature for my lacrosse practice as well as running.  I feel it’s the accuracy in counting carbs that makes the major difference in post meal control.

L:  I like to use these when grazing or when eating out at a buffet – I don’t think I use this often enough and when I look back at my pump records, I see I could probably use it for more foods/meals. It’s a question I should ask my nurse educator about so I can use this more effectively.  Since I do a good job with precise carb counting already, I assume proper use of the combo bolus would improve my BGs even more!

Stephen: I have no experience with the smart features on the pump, but I would assume that it’s accuracy in counting as well as portion estimation that makes the most difference.

Do you have any words of wisdom to help everyone become a king or queen of carb counting?

S:  “When you are home and you have access to scales/measuring cups – use them frequently. This will help you with more precise guess-timation when you are out and don’t have your tools or a label available.”

L: “Take classes or ask to take them. You might think you are good at counting carbs and there isn’t anything new you’ll learn, but there is always something new. Every class seems to teach me something I didn’t know before, even as good as I think I am at counting!”

Stephen: “Measure your portions when you have the tools available, and learn how to estimate these when you are away from your measuring tools”

My best advice – routine. If you eat the same basic foods most of the time, you’ll get to know how they affect your blood sugar.

And, if you can, eat a low carb diet. Then, for the most part, your blood sugars won’t be bouncing all over the place! Or as they say, “riding the roller coaster.”

Bronx, New York where diabetes thrives in a food desert

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Saturday I gave the A1C Champion program in the Bronx. The Bronx is one of the five boroughs of New York City. The one also where diabetes has the highest concentration, largely because it is the poorest.

I was speaking at a storefront church converted from an ordinary building. Bishop David was jamming as the afternoon’s DJ. There were about ten or twelve small folding tables in front of the church on the sidewalk where people could pick up some information about diabetes. A hot buffet table was set up where the hosts were ladling out a relatively healthy lunch – chicken, rice, beans, veggies, corn.   

Before my talk, I walked around the neighborhood. I wanted to see where you could shop for something to eat and what you would find. Certainly, I’m sure, there are supermarkets not far, but within the few blocks I walked, there were several “bodegas.” Little delis like this one above where you could run in and find food – sort of. 

This is what was on offer: sandwiches on big white bready rolls and packaged snack foods everywhere, it took up 95% of the store: candy bars, chips, bakery goods and sugary soda and juices. They covered the store from top to bottom. In one store, one lone bottom shelf held a few onions and potatoes. Those were the only fresh vegetables in the store, no fruit. In another store, I saw only rotting bananas as fresh foods go. And this food desert – the Bronx – is only a subway ride from where I live.

We keep saying people need to eat healthy; yet how are we helping them to do so? I also don’t have to tell you if it costs $1 to buy an apple and $1 to buy a Big Mac, where’s the incentive for people to spend their hard-earned cash on a piece of fruit?

It saddened me to see what I read about in article after article. The food deserts in America. Those poor neighborhoods where there is no fresh food available and fast food brothels line the landscape – McDonalds, Burger King, Kentucky Fried Chicken, Taco Bell. Places that seduce us with sugary, fatty, salty foods and low prices. 

Obesity and diabetes are not merely about individual responsibility – they are also about infrastructure, what the government subsidizes, safe neighborhoods with places to play. It is about getting healthier foods into poorer neighborhoods and helping people do the right thing for their diabetes. 

Yet, it also gladdened me to find the 20 people I spoke to were engaged, curious, thirsty for information and many were eating better than their parents. They shared their strategies from a one day a month “cheat day,” to sautéing fish with plenty of lemon and herbs instead of frying, replacing half the juice in a glass with seltzer and sneaking ten minute walks into the day.

The city councilman above gave a talk just before I went on and let people know how important it is to get exercise and about the parks he’s been building in the Bronx. His eyes were bright and clear as he greeted me and his passion for improving his community and helping people, was earnest. 

Saturday I traveled to a place so close to my home, yet so far from my world. But I also became a bridge for people to take a step from being under the thumb of this disease and its burdens to doing a little better. Riding home on the subway afterward, I was full from the adventure and my heart was light.

Two new diabetes food books worth chewing on



Not food in the sense of recipes and cooking, but food in the sense of how to eat healthy. This Spring I had the pleasure, along with several other women, to contribute to Amy Mercer’s new book, The Smart Woman’s Guide to Eating Right with Diabetes: What Will Work.

This is a great read if you’re still trying to figure out how to eat sensibly and not give up everything you love – and who among us isn’t to some degree? Amy shares her own struggle and successes with food and invites about 10 of us fellow smart, successful women with diabetes to share what we do so that we manage to control our blood sugar, and manage our carbs, while still eating things we love. Not only will you get tips, but I guarantee you will feel you have a community of women to hang out with while yore reading and a cheering squad who get “it”.

This is also an exceptional book for health care providers to get, and share, a real-life picture of what actually works for patients, rather than just dispense the standard dietary guidelines.

Two weeks ago I read Ginger Vieira’s new book, Emotional Eating with Diabetes: Your guide to creating a positive relationship with food. Ginger is not only an amazing diabetes videographer, power-lifter and writer, but she’s also a health coach. So when Ginger talks about ‘emotional eating’ she knows of what she speaks.

The book is big in size, yet short in pages. Just the right length to cover just the essential, most important topics regarding eating: both the difficulties and hardships, the battling and fighting food, and how to be more successful with an eating plan and staying positive. 

Ginger’s topics include: Habits that lead to overeating, Over-treating lows, (boy, don’t I remember early on eating everything in sight from pie to toast and jam, cookies and fruit, all at the same time, to get my blood sugar up!), Using food to stuff emotions and then coming into the light to develop a more positive relationship with food. 

Psychologist, Dr. Bill Polonsky writes the forward and there are several worksheets in the book, for as any good coach does, Ginger asks you to do the work. You’ll also get Ginger’s insightful questions to help you, and her mantra, which I love, which is that we are all a work in progress. 


Reduce Your After Breakfast Blood Sugar 40%

If you haven’t heard there’s some new news about reducing those after breakfast spikes in your blood sugar if you have type 2 diabetes.

Based on research that showed a reduction in blood sugar after the second meal of the day (lunch for most of us), it was hypothesized that high blood sugar after breakfast could also be reduced if there were a pre-breakfast snack, in a sense making breakfast the second meal of the day.

Researchers studied 10 men and women who controlled their diabetes with diet or diet and metformin and gave them a high-protein, low-carb snack before breakfast. Measuring blood sugars the results showed a lower rise in plasma glucose (blood sugar) after breakfast. 

Researchers say they are still searching for the perfect pre-breakfast snack and the perfect time lapse in-between the snack and breakfast. Plus further studies need to be done to see whether a high-protein, low-carb snack before breakfast improves A1cs, but for now it seems worth a try. Why not conduct your own experiment?

For more details check out “How to Reduce After Breakfast Blood Sugars 40%” in DiabetesInControl.com.

Food Is Medicine appears on HuffPost


chicken on saladI posted another version of my beef with food – that food is medicine – on The Huffington Post. 

It appears as a lead story today.  

A loyal fan already wrote me,

What an inspiring article to read first thing in the morning – thank you for your latest Huffington Post piece on healthy eating.  

Great tips in there – and makes me glad I have a fridge full of fresh produce waiting for me at home for tonight’s episode of Top Chef (a weakness of mine).”

It also occurs to me maybe I should let you know one of my little secrets for health. 

I not only have a medicine cabinet in my bathroom, but I also have one in my kitchen. 

It doesn’t have a mirror on it, although to be frank that would be a great incentive to eat healthy, wouldn’t it?. But it does have these big shiny silvery doors. 

I’m sure having a medicine cabinet in my kitchen is not particular to New York City. You probably have one too.

And just to show you I’m a woman of my word that food is medicine, I’ve put up a picture of what you’ll find in my kitchen medicine cabinet most days. 

Come to think of it there’s probably more medicine in my kitchen medicine cabinet than in my bathroom medicine cabinet. 

I like to think that’s a good thing.

A sobering obesity report

Last week it hit all the news wires that obesity in children and adults has not only not abated, but grown ever bigger, greater, huger, wider. 

Childhood obesity has tripled since 1980 and most schools don’t meet the local FDA requirements for planned menus. 23 states have increased in obesity with Mississippi, Alabama, Tennessee and West Virginia topping the list. Colorado and Vermont are our thinnest states, the year-round active outdoor culture sighted as a major reason.

But I have another thought why people in this country are fat beside the usual culprits — stress, status, poverty, availability of food, super-sizing, processing and illiteracy. It first came to me while in Europe and I am reminded every time I return: Food there has so much more flavor. In Holland, for instance, tomatoes drip down your arm with their sweetness and even the lowly brussels sprout comes packed with layers of chewy deliciousness. Largely across Western Europe food is grown in richer, less fallow soil, on farms only miles from where it is then sold, only days or minutes after it is picked. Freshness is a flavor all its own. Farming is a prideful occupation and the higher price of food funds higher quality growing conditions.  

I say that if our food had more flavor, we’d be satisfied with less. We could put down our forks when we should, and feel fed. Think about it. If what you ate was flavorful, delicious, nutritious and wholesome, granted, if that was a rare treat you might over eat, but if that was the character of most of your meals, I believe you’d reach your level of satisfaction and feel satiated with smaller portions. In contrast here in America, I believe an unspoken reason why a great majority of people overeat is because, like on a treasure hunt they are foraging for flavor which never comes. And, there’s a hope that if they keep eating, eventually taste and satisfaction will arrive. 

Whether it’s two thin slices of tangy cheese on a that-morning-baked yummy crunchy seeded roll or a light as air soul-satisfying four-forkful sliver of pastry ordered for the table or peas shot through pod to pod with green, earthy deliciousness, less food on your plate is actually much more satisfying when it actually has taste. Food as nature intended.

A Taste of Mississippi Livin’

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I just returned from spending a week in Mississippi. It was a great trip: relaxing, lots of laughs, I’ve learned a few new great expressions and have come away with a much better understanding of why diabetes is an epidemic in America–to a great degree it’s the ubiquitous fry up.

I was touring Mississippi with three  girlfriends. A kind of “Ya Ya Sisterhood” on insulin. When my New York friends asked before I left, “Why on earth are you going to Mississippi?,” I told them, “Because I can.” I have always wanted to see part of the South with a Southerner. One of our Ya Yas grew up in Mississippi, so that was it: four diabetic women in a car soaking up the local life, comparing blood sugars every few hours, noticing how differently we all react to food and exercise, and in-between being charmed by the South’s hospitality and shocked, by how difficult it is to find healthy food. I didn’t realize, but Mississippi has been ranked “fattest state” for three consecutive years.

Now hearing “Yes, maam,” repeatedly is admittedly some compensation for the lack of health-friendly food. Trust me, you will never hear it in New York. And my favorite new expression, “Bless your heart…” I’ve learned is extremely useful when you’re bad-mouthing someone but want to maintain a polite demeanor. And, yes, the pleasantries unrolled like an unfurling flag, and this troupe of women were lovingly and graciously hosted to lunches and toured through town after town. Tana, a fabulous cook, whipped up an incredible melange: cream of spring soup, shrimp Louie, southern mayonnaise biscuits with home-grown herbed butter and chocolate pots ‘specially for this Yankee, and actually welcomed me with my own signboard, boa and special guest, Marilyn Monroe.

While I didn’t know (or care) what we would do in Mississippi, other than soak up local life, I found our tours revolved around visiting university campuses and churches. Initially, I kept looking for downtown and charming stores to poke my head into, being the New Yorker that I am, and it took me the first several days to realize depressed downtowns were not where life was any longer. It was on college campuses and at church. 

I experienced my first Baptist service, complete with a children’s choir, baptisms in what looked like the bell tower, singing, singing, singing and your requisite fervent preacher. Walking through a Presbyterian church, we lucked into hearing an amazing organist, and left with his CD gifted to us. We toured several antebellum houses learning about the history of the families that owned them and plantation life. Admittedly, when I walked into anyone’s house afterward I expected a tour. 

I was introduced to the very funny and bawdy series of books, The Sweet Potato Queens by Jackson, Mississippi author, Jill Conner Browne. Our Tennessee gal-pal, Ann, read passages to us in her rich Southern drawl, with tears of laughter streaming down her cheeks, as we drove past tractors and catfish ponds. I ate one of the best meals ever at J. Broussard in Colombus, pecan-crusted catfish and a nutty buddy (you figure it out!). I sampled thirty different types of pecans (peecaaahhns) in a pecan (peecaaaahhn) store in Indianola, which was all of three streets long but seemed to be experiencing rush hour traffic while we were there. 

The friends and family of my native Mississipian asked me what I found surprising about Misissippi and I told them. It’s much more rural and green than I expected…people are very friendly and welcoming…many have been to New York — and love New York.. everyone goes to church, and the food, outside of a few truly fabulous restaurants, is growing our increasing population of diabetics. 

I, in fact, had a very earnest conversation about this with the President of Jones college in Laurel, Mississippi, Jesse Smith. Jesse Smith is a sort of President Obama–young and vital and making tremendous changes to the university to expand students’ potential and opportunities, and that includes healthier meals on campus. But throughout our trip my companions and I had to work really hard to eat healthy. Fried in Mississippi is a food group: fried chicken, fried steak, fried green tomatoes, fried pickles, fried okra, fried crawfish and on and on. If it was edible, it was fried. Then of course there are the staples: biscuits n’ gravy, chicken n’ dumplings, overcooked vegetables in lard and sweet tea, 1/2 cup of sugar in 1/2 a gallon of tea. 

My eyes were open widest looking at the aisles in the little superettes at each gas station where we stopped. Aisle upon aisle of chips, crackers, fried pork rinds, soda, fried meats, and, perturbingly nothing else. Except in one, which harbored a stand of books. “Bible Cure for Diabetes” intrigued me enough to buy it but also made me think: Would we really need a bible cure for diabetes if there were more fruits and salads available?

So what will I remember from my trip? Outstretched hands and open hearts and the knowledge that all the segments I hear on the morning news about healthier food choices aren’t going to happen where it’s so hard to find them. As Dr. Smith explained to me, there was a time when the livelihood of Mississippi was based on people working the land. That required a lot of calories and a lot were burned off in their labor. Today, however, few people labor in the fields, yet the foods have not changed. Further, education about food and its consequence on health doesn’t seem to have reached many people, including the young people I saw working in the gas station superettes. 

On the last day of our trip we talked about how much opportunity there is to bring education to areas like this where it’s so vitally needed: A grass roots movement to teach people about the benefits of healthy eating like Governor Mike Huckabee is doing for Arkansas. So if anyone wants some wise women to consult on this, please do let me know, and, really, bless your heart.

A day without halvah is like a day without sunshine

UnknownHalvah, Tahini-based sweet

Yesterday I had a friend over for lunch. A friend who grew up in Mississippi, lives in Texas, and with whom I’m touring for a week in late April her home state. I thought since she will shortly introduce me to hush puppies, cheese grits, biscuits n’ gravy and chicken fried steak, oh, my god… (And yes, we are both diabetic and will have to test, test, test and walk a lot), I thought I’d introduce her to one of my favorite sweets that I was sure she’d never come across–halvah. Have you?

Like the 1979 advertising campaign,You Don’t Have To Be Jewish To Love Levy’s Jewish Rye” you don’t have to be Jewish to love halvah, but if you’re not, nor of middle-eastern descent, you may never have tasted it. 

Halvah is a sweet that has a texture as described by my Mississippi friend, this way, “Boy, that just melts in your mouth!” It comes in vanilla, chocolate, plain and/or with nuts. My personal preference is marble with nuts. The common ingredients are: tahini (sesame seed paste), sugar or honey, water and sesame oil. 

The Shocking Nutrition Facts:

1 bar (8 oz)

Total Fat: 66 g

Saturated Fat: 11g (the “unhealthy” fat)

Polyunsaturated Fat: 30 

Monounsaturated Fat: 21 g

Total Carbohydrate: 128 g

Dietary Fiber: 10 g

Protein: 23 g

Mind you to eat one bar for me would be unconscionable. You can also find low fat, low sugar halvah in some specialty stores, but it’s not easy to find and frankly, it doesn’t taste half as good. I say eat the real thing in small portions. I buy it at a middle eastern shop where it’s sold in chunks off a huge mound, think of a big wheel of cheese. My eating directions: Cut a small sliver (very thin slice, likely half an ounce), pop into mouth and savor. Cut one more sliver and repeat. Wrap halvah and put back into the refrigerator before you eat the whole thing.

When my friend’s step-daughter came to pick her up, she knew what halvah was and went right for it. So of course I packed it up for them to take with them on their trip home. But, I just happen to have bought another package yesterday.