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Saturday, April 25, 2009

Are Carbs Really Necessary?

I wrote about the The Diabetes Diet Wars and the continuing controversy over low-fat versus low-carbohydrate late last year. Although I do not consider myself to be following a low carbohydrate way of eating I certainly eat less carbs than I did pre-diagnosis and a lot less than the average type 2 diabetic in a Western country.

I spend the first couple of hours each day reading and posting on several diabetes forums. Daily I see newly diagnosed type 2s reporting the advice they have received from dieticians, diabetes educators or doctors. Far too often that advice is to eat to a formula. The formula is usually 45 to 60 grams of carbohydrate at each of the three main daily meals and 15 grams for snacks. That gives 180 to 225 grams of carbohydrate daily as a minimum level. I have discussed the problems inherent in that advice in several previous posts. However, when I, or others, suggest to new people that they could benefit from eating less carbs we find they have been told horror stories of the dangers of inadequate carbohydrate input.

The most common warning is the need to eat a minimum of 130 grams of carbohydrate per day or the brain will lack sufficient energy to function, but there are others such as the dangers of fatigue from lack of energy or just the generalised warning "but your body NEEDS carbs!"

This is just one of many examples: What Should I Eat? New ADA Guidelines Can Help
"ADA does not recommend a specific mix of carbohydrates, fats, and protein. Rather, it refers people to the guidelines of the Institute of Medicine. These recommend that healthy adults get 45 to 65 percent of their calories from carbohydrates, 20 to 35 percent from fats, and 10 to 35 percent from protein.
ADA discourages low-carb diets (diets that limit carbohydrate to fewer than 130 grams per day). Carbohydrates are major sources of fiber, vitamins, minerals, and phytochemicals (health-promoting chemicals in plants). People who overly restrict carbohydrates can miss out on these benefits as well as the good flavors of carbohydrate foods".

Despite statements like that, whether or not carbohydrates are essential is still a matter of differing opinions. Far too many health authorities accept that "carbohydrates are a necessary dietary component" is a given fact that needs no support. I can only offer my own opinion, supported by reading, personal experience and discussions with many people on the web and the net.

Carbohydrates are not essential to energy or cognition. Before I go on, I want to stress that although I eat carbohydrates myself my point is that I don't need carbohydrates for good health.

To meet our energy and cognition needs there is nothing that carbohydrates provide that can not be provided by protein or fat via gluconeogenesis, aided by glycogen storage in the liver and muscles. The oft-repeated need for a minimum intake of 130gms of carb per day for brain energy is nonsense. Ask a traditional Inuit. Or read Vilhjalmur Stefansson's story.

The issue is confused by the other factors mentioned in that ADA quote: fibre, vitamins, minerals, and phytochemicals. That is correct, the body needs all those and other micronutrients and flavonoids for good health. Some of those things, especially fibre, are available in most abundance in starchy foods like grains and root vegetables, so people tend to presume that is the best way to get them. Unfortunately it's not necessarily the best and certainly not the only way, it's just a convenient way. Adequate fibre is available in other, non-starchy vegetables; fibre is also readily available as a supplement in natural forms such as psyllium husk. The same logic applies to fruits; flavonoids, vitamins and other micronutrients are available from other vegetable sources with less effect on blood glucose levels. Again, note that I eat fruit, but with care and in small portions. Not because I have to but because I choose to.

There is no doubt that carbs provide quick energy. There is definitely a use for higher carbohydrate input before exercise or heavy activity for an athlete or a worker in a highly active job. But for the rest of us that does not usually apply. I have no energy problems in the mornings despite a simple breakfast that never exceeds 10gms carb; nor do I have energy problems after lunch despite rarely having eaten more than 25 gms total by that time.

Many people lead long, productive and healthy lives on ultra-low-carb diets. It may not be the way you would choose, but you only need to drop in on the Bernstein forum to meet a lot of people who do.

Personally I choose a middle ground. I used my meter to find, over time, how much I needed to reduce carbs at different meals to meet my blood glucose goals. But within those limits I include a significant level of carbs (by my standards) to add variety and flavour. My main focus is blood glucose control; for the micronutrients I consciously try for maximum variety in my vegetable input to try to cover the field.

To me carbohydrates are not essential, they are a luxury food that I treat similar to chocolate or scotch. Nice to eat and beneficial in moderation, but with specific limits which I should not exceed.

But, of course, if you believe the experts my brain will die before dinner from the lack of carbs. I had dire warnings from the dieticians seven years ago that one day I would hear a little voice in the back of my mind...

"I'm afraid. I'm afraid, Alan. Alan, my mind is going. I can feel it. I can feel it. My mind is going. There is no question about it. I can feel it. I can feel it. I can feel it. I'm a... fraid. Alan, please eat more carbs..."

I'm still waiting for that little voice (apologies to HAL 9000)

Cheers, Alan
Everything in Moderation - Except Laughter

Friday, April 17, 2009

Test, Test, Test

The best advice I received from any source, professional or otherwise, since I was diagnosed with type 2 diabetes was written by a lady named Jennifer. I first met her in cyber-space posting on the alt.support.diabetes usenet group where she regularly greeted newly diagnosed people with the advice I repeat below. It appeared as Jennifer's Information for the Newly Diagnosed on the a.s.d. home page and has now been repeated on many other web-sites. Some years ago she graciously gave me permission to spread it far and wide. I have been doing that ever since by providing a link to that a.s.d page.

The web-master made some improvements to the site which I just noticed today so I will be revising the link wherever it appears in earlier blog posts. It occurred to me that this may happen again, so I have decided to repeat Jennifer's original advice here in full so that it will always be available for me to reference.

Jennifer's Information for the Newly Diagnosed

"Sounds like you're planning a move to take control of your diabetes... good for you.

There is so much to absorb... you don't have to rush into anything. Begin by using your best weapon in this war, your meter. You won't keel over today, you have time to experiment, test, learn, test and figure out just how your body and this disease are getting along. The most important thing you can do to learn about yourself and diabetes is test test test.

The single biggest question a diabetic has to answer is: What do I eat?

Unfortunately, the answer is pretty confusing. What confounds us all is the fact that different diabetics can get great results on wildly different food plans. Some of us here achieve great blood glucose control eating a high complex carbohydrate diet. Others find that anything over 75 - 100g of carbs a day is too much. Still others are somewhere in between.

At the beginning all of us felt frustrated. We wanted to be handed THE way to eat, to ensure our continued health. But we all learned that there is no one way. Each of us had to find our own path, using the experience of those that went before, but still having to discover for ourselves how OUR bodies and this disease were coexisting. Ask questions, but remember each of us discovered on our own what works best for us. You can use our experiences as jumping off points, but eventually you'll work up a successful plan that is yours alone.

What you are looking to discover is how different foods affect you. As I'm sure you've read, carbohydrates (sugars, wheat, rice... the things our Grandmas called "starches") raise blood sugars the most rapidly. Protein and fat do raise them, but not as high and much more slowly... so if you're a T2, generally the insulin your body still makes may take care of the rise.

You might want to try some experiments.

First: Eat whatever you've been currently eating... but write it all down.

Test yourself at the following times:

Upon waking (fasting)
1 hour after each meal
2 hours after each meal
At bedtime

That means 8 x each day. What you will discover by this is how long after a meal your highest reading comes... and how fast you return to "normal". Also, you may see that a meal that included bread, fruit or other carbs gives you a higher reading.

Then for the next few days, try to curb your carbs. Eliminate breads, cereals, rice, beans, any wheat products, potato, corn, fruit... get all your carbs from veggies. Test at the same schedule above.

If you try this for a few days, you may find some pretty good readings. It's worth a few days to discover. Eventually you can slowly add back carbs until you see them affecting your meter. The thing about this disease... though we share much in common and we need to follow certain guidelines... in the end, each of our bodies dictate our treatment and our success.

The closer we get to non-diabetic numbers, the greater chance we have of avoiding horrible complications. The key here is AIM... I know that everyone is at a different point in their disease... and it is progressive. But, if we aim for the best numbers and do our best, we give ourselves the best shot at heath we've got. That's all we can do.

Here's my opinion on what numbers to aim for, they are non-diabetic numbers.

Fasting............................Under 110
One hour after meals.......under 140
Two hours after meals.....under 120

or for those in the mmol parts of the world:

Fasting............................Under 6
One hour after meals......Under 8
Two hours after meals....Under 6.5

Recent studies have indicated that the most important numbers are your "after meal" numbers. They may be the most indicative of future complications, especially heart problems.

Listen to your doctor, but you are the leader of your diabetic care team. While his /her advice is learned, it is not absolute. You will end up knowing much more about your body and how it's handling diabetes than your doctor will. Your meter is your best weapon.

Just remember, we're not in a race or a competition with anyone but ourselves... Play around with your food plan... TEST TEST TEST. Learn what foods cause spikes, what foods cause cravings... Use your body as a science experiment.

You'll read about a lot of different ways people use to control their diabetes... Many are diametrically opposed. After awhile you'll learn that there is no one size fits all around here. Take some time to experiment and you'll soon discover the plan that works for you.

Best of luck!

As an engineer, when I read that, it made sense immediately. So simple, yet so powerful. And it has certainly worked for me. Thanks again Jennifer.

Post-script. I've been musing on Jenny's comment below and decided to add this.

I used Jennifer's wonderful advice to gain control of my numbers fairly quickly. Once I understood it I did not mess about and I used a lot of test strips in those early days. I fairly rapidly achieved the goals she set and I realised that I could do better. At the time, despite their poor advice on carbs and goals the ADA recommended something that stuck in my mind "Keeping your blood sugar (glucose) as close to normal as possible helps you feel better and reduces the risk of long-term complications of diabetes." That sounded logical to me so eventually I changed Jennifer's goals for myself to my present ones of:

Fasting............................Under 100
One hour after meals.......under 126
Two hours after meals.....under 100

or for those in the mmol parts of the world:
Fasting...........................Under 5.5
One hour after meals......Under 7.0
Two hours after meals....Under 5.5

Cheers, Alan
Everything in Moderation - Except Laughter.