I just found out that Jimmy Moore is posting the conversation we had last month tomorrow on his Living La Vida Low Carb show. You'll find the podcast here:
http://www.thelivinlowcarbshow.com/shownotes/
If you have any questions after you hear it, feel free to post them here.
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31 comments:
Thanks for the heads-up, Jenny! I'll make sure to download the podcast.*
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* Confession: I pretty much download ALL of Jimmy's podcasts, but I'm very pleased to see that you have made one with him.
This had to be the most helpful podcast for diabetes yet. Easy to follow, and good clear advise. Thanks so much
Bev, Thanks for your very kind words. I'm so glad you found it useful!
Jenny, your website, (safely bookmarked for a couple of weeks now), is packed full of the stuff I need. That's where I found a link to your podcast today. You were fascinating and informative. I'm new to this disease and have so much to learn. Thank you for making this important information accessible. You have done more to help me than I can express.
I thought your podcast was very helpful for diabetics. I like your common sense moderate approach. As you say the important thing is getting blood sugars down, and not necessarily eating extremely low carb. I thought it was good that you made the point about insulin not being a bad thing, since people often do need it. I was interested in your background and how it helped you to sort out the the information on diabetes. It can be hard to sort out the meaningful information from the junk for me at times.
Excellent podcast. I am so glad that Jimmy finally interviewed you. It was also fun hearing your voice. You packed so much good info in you interview just like you do in your book, blog and website. Thanks for all the work.
What you said about high postprandial blood sugars causing heart disease really hits home. I started having problems with blockages in my coronary arteries in my mid 50's and ended up with bypass. Interesting is that in my 20's I had an abnormal OGTT but was told it was only "suspicious" but did not have diabetes. In my 50's my OGTT spiked to 200 but was still told this was "OK" because fasting was "normal". Wonder how much damage was done from all the high postprandial sugars?
Following your advice, my blood sugars are now in a good range and no more spikes. Thanks again.
Very interesting about a small portion of diabetics having damaged dietary fat metabolism. I didn't know that.
My mom listened to the first half-hour of the podcast and agreed with everything you said. She's 81, t2 diabetic, eats VLC, and her energy is flagging. However, even a mouthful of high-carb food sends her BG way up. Any suggestions, besides finding an endocrinologist?
Thanks for the podcast Jenny! I was afraid to go up in carbs altho Im "kicking at the traces" Im so afraid Ill end up gaining all my weight back. So it seems some but maybe not all!? Hopefully! Thanks again. Im on Atkins forum and send people your way when they come in diabetic and looking for help! Karen
I know this is OT, but have you reconsidered your approach and opinion of Victoza? My MD put me on this and it has been nothing short of amazing in helping my stay low carb, and get my numbers down, as well as losing weight. I do dislike big Pharma in general, but in this case they may have just gotten it right. This is far superior to Byetta in my experience, less nausea and far better at helping to regulate the glucagon dumps that were causing me to get high AM readings no matter how I did or didn't eat. I'm seeing 80's and 90's at wake up since I went on this with my Metformin. You may want to revisit your original opinion and complete lack of coverage of this on your meds page.
Lori,
Is your mom taking Metformin? Metformin allowed me to raise my carb intake just enough to avoid that VCLD exhaustion. Family doctors can prescribe it and it is a cheap generic.
Other than that, low doses of insulin would allow her to eat slightly more carbs, and in my case, adding insulin to my regimen felt like I was a dried out plant that had been watered. I really needed it.
But that may require prescriptions (for the needles, Regular Human insulin is available without one most places in the US) and more importantly--a lot of reading to understand how to use it. Dr. Bernstein's book is a good place to start, and a very low dose would allow her to add enough carb to push herself over that ketogenic boundary where the exhaustion can kick in.
Karen, If you watch your calories and add carbs very slowly so that your body has a chance to adapt you should be fine. That's actually what the old Atkins diet book told people to do but few people ever did it slowly.
If you get hungry, KNOW that you're hungry and don't feed that hunger, and stabilize at that carb level for a while until you aren't getting hungry.
You will gain that water weight as you go over the ketogenic diet, but it is just water in your liver and muscles (in the form of stored glycogen) and once it is fully refilled your weight should stay constant unless you eat more calories than you need. The trick is to remember that if you've lost a lot of weight, the number of calories you need to maintain your weight WILL be a lot less than it was when you were heavy.
NightSapper, Reports like yours, if I hear more of them will cause me to reconsider my current opinion about Victoza. But when a brand new drug comes out I have to rely on the prescribing information and what it says. What I've published about Victoza comes straight from the prescribing information. The thing about Byetta is that it has been out long enough that the real side effects have become clearer.
It was because I heard so many enthusiastic reports about its effect that I did change my attitude towards Byetta, though only for the one person in three for whom it has a useful--sometimes very useful--effect.
Since Byetta has a longer track record, it is probably a good idea for most people to wait--as is the case with any new drug, so that other people get to be the guinea pigs who discover the real effect and the real side effects.
Jenny, thanks for the response; I read it to my mom. (She doesn't have a computer; I called her last night and set the phone by the computer speaker so she could hear your podcast.) She has Bernstein's book; however, since her GP won't prescribe metformin (?) and she had some bad kidney function readings, she'll see if she can get a referral to an endocrinologist.
She's good about diet since high blood sugar levels make her feel like crap, and she's never hungry.
Lori,
Compromised kidney function is a counter-indication for metformin. It might be helpful to see an endo, ideally a young one who is more aware of the impact of low carbing on blood sugar. The first one I saw looked at my A1c and pretty much said "WTF are you doing here". He didn't understand that I was only eating 30 g of carb a day to get those numbers. With the next one, I carbed up before a blood test and there was no such problem.
Your podcast was wonderful.
The question that nags at me is, now that I'm manipulating my blood sugar numbers through carb restricting, do they reflect my health or my diet. I keep reading that restricting carbs lowers blood sugar, but doesn't affect insulin resistance, which is the real problem.
I have the same wonderings about heart markers: if I eat like Ornish, my LDL will drop right away, or if I eat low carb my HDL goes up and my trigs ggo down, but am I really measuring changes in my health or in my breakfast?
So, how do I know my lower blood sugar numbers are actuallyprobably lowering my risk of getting diabetes or heart disease? Thanks.
Peter, I don't think the case has been proven that links insulin resistance to complications. If it were, people with Type 1 who are highly sensitive to insulin wouldn't have virtually the same complication profile as insulin resistant people with Type 2.
The reverse is also true. There are people who are highly insulin resistant but who keep their blood sugars normal and don't develop complications.
Read up some more about the relationship of lipids (LDL, etc) and heart disease and you'll find it is the particle size of the LDL not the total count that seems to be relevant. "Low" LDL where the LDL is made of very small particles is toxic, and besides, the standard lab test calculates LDL and doesn't measure it, so it can be wrong. There is a lot more on this subject posted on Dr. William Davis' Heart Scan Blog. Though he goes a bit overboard blaming all human ills on wheat, he is a cardiologist and has a very good grasp on how lipids and other factors affect heart disease.
Jenny, thanks for your answer on metformin. I passed that on to my mom, and she found out the same thing last night reading your book. (She's had your book and Bernstein's for a long time, but she's not much of a reader.)
Young doctors--yes, and old lawyers.
I listened to the podcast and felt validated when you said you had tendon damage as a diabetic complication. I have been saying that my tendons have been damaged by long periods of high blood sugars and that I'm okay (but limping) when my sugars are normal but cannot walk when my sugars are high because the pain flares up in my tendons.
Every time I have said such things, though, I have been pooh-poohed and told that the only thing wrong with my tendons is that I am overweight and they are overstressed. I'm sure the weight doesn't help, but my weight doesn't change when my blood sugar goes up!
Hearing you (who are NOT overweight) say that you have tendon problems as a result of diabetes made me want to cheer -- not because of your suffering, of course! But because SOMEONE finally said what I've been saying all along!
I have problems with other tendons, but the ones in my feet are the worst (probably because they have to take on the biggest tasks, with my weight being high.)
So thank you for validating this "kook" in her suspicions about what diabetes has done to my body.
Sparrow Rose,
I've run into the same incredulity from doctors about the connection between my tendon problems and blood sugar, but it is well documented.
This page has some references:http://www.phlaunt.com/diabetes/16162241.php
Dr. Bernstein also has a paper about diabetic complications it on his web site. http://www.diabetes-book.com/cms/templates/beez/pdf/bernstein.pdf in which he lists carpal tunnel syndrome, frozen shoulder, and Iliotibial Band/Tensor Fascia Lata (ITB/TFL) Syndrome which causes back pain.
Thank you, Jenny! You have such great information!
If it weren't for people like you, I'd probably be blind or dead by now. I had to beg my clinic for mealtime insulin -- 2000mg of metformin didn't budge my A1c, Lantus budged it a little but my postprandials were 250-300 and stayed up there for hours! Once I fasted for two full days before it started to come back down.
So...my pharmacist told me I needed to see "the best diabetes specialist in town." I made an appointment with him (went to see him on Thursday) and the first thing he said was that he wanted to take me off insulin and put me on Byetta instead. I think I got deer-in-headlight eyes when he said he wanted to take away my insulin! Since I started insulin is the first time in years I don't feel so sick and exhausted. I'm not interested in lizard spit; let me keep my insulin.
So then he said he wanted me to have an A1c of 7 because "that's a normal A1c." Normal? On whose planet?
After talking for a while, I convinced him to at least see if my pancreas is making any insulin before he tries to take me off my exogenous insulin. So now I'm waiting for the results of a c-peptide test. Either way, though, I'm not going to let him take me off the insulin. He said I don't need it. Ummm... if I don't need it, how come I was having 250-300 blood sugars on a 20g/day low carb diet? Yeah, that's what *I* thought. *shakes head.*
And this is "the best diabetes specialist in town." Makes me glad I normally go to a crappy low-income clinic where my PCP is a nurse practitioner who admits she's no specialist and is willing to listen to me (and give me humalog when I beg for it. (and write it in my charts as if it were her great idea that she convinced me of. heh.))
Again, thanks for all the great information. You are saving my life. And my eyes. And my legs. And my heart. You deserve an award for what you do.
Hi, Jenny! I just found your website yesterday and listened to the Podcast this evening. I have been low carbing for over two years (Atkins), but have been unable to sustain my weight loss. All I have to do is look at food and I gain weight.
I decided the other day to start testing my blood sugar for the first time, and I'm trying to learn what my numbers mean. My morning fasting blood sugar is around 86 and my 1-hour postprandial is around 112 after eating a breakfast of only eggs and bacon - only 1.5 carbs.
I have searched your website, and I cannot find if it is normal to have blood sugar go up that much after eating virtually no carbs.
Last night, I did something I rarely do - I had 65 grams of carbs in the form of ice cream for the first time since testing, just to see what would happen. My 1-hour postprandial went up 90 points - from 86 to 176. I tested my sister, too, and her blood sugar went up 2 points - from 84 to 86.
This seems extreme, especially with my rapid weight gains from day to day, even while eating very low carb. Should I be concerned? My nutritionist friend said that as long as it is not over 200 and accompanied by frequent urination, thirst and weight loss, it is not a problem. Should I be seeking medical help?
Thank you!
Rebecca,
Those numbers are a bit higher than normal,, though when you have been low carbing, you will usually see a higher reading when you carb up suddenly than you would if you increased carbs gradually over a week or two. That's because your body has downregulated some enzymes etc and needs a few days up upregulate them to digest carbs.
It's possible that you've run into the thyroid slowing that afflicts many long term low carbers which won't show up on TSH tests.
If you can find a doctor who is supportive, trying metformin with a raised carb intake (another 10-15 grams per meal) might straighten that out and get weight loss moving again. But you should expect your A1c test which most doctors use now to sort out blood sugar to be normal given your low carbing. Even explaining that you have been eating very low carb might not help, because few doctors know that cutting carbs dramatically will normalize sugars.
Thanks, Jenny! I have had a full panel of thyroid tests, including TSH, Free T3, Free T4 and Reverse T3, and I DO have low thyroid and it is getting worse.
I also did an A1C last week, and it was 5.1.
I am seeing my bio-identical hormone doctor in two days, and I would like her to run some additional tests (CRP, homosysteine, fasting insulin, etc.) and I would like her to prescribe glucose testing strips and Metformin for me. Could you suggest a link that I could give her to help her understand why I might need the Metformin - possibly something succinct from your own site? Thanks again!
Rebecca
Rebecca,
A 5.1% A1c is so normal you won't be able to justify strips. They are very expensive and insurers won't cover them without a relevant diagnosis which you won't have.
The thyroid issue is probably why you are gaining and that needs to be addressed with thyroid hormone supplementation first.
Try raising your carbs to closer to 100 g a day total, over a few weeks. Once you are in an non-ketogenic state you'll remove some of the stress from your thyroid. Count calories and you should be fine. A carb level of 100 g a day is the level at which many long term low carb dieters report they maintain best (self-included.)
If your blood sugar rises into the pre-diabetic range when you raise your carb intake you could would have a better case for strips and metformin, but the numbers you report sound so very normal you probably are fine re blood sugar and just need to get the thyroid straightened out.
Thanks again! Just for the record, I have been on bio-identical thyroid replacement for over two years (sometimes Armour and sometimes compounded), and my thyroid keeps getting worse.
I would love to increase carbs, but the trouble is that I have chosen not to eat grains or legumes, and unless I eat three pounds of veggies per day or a lot of fruit, it is hard to get those numbers up. Also, I am a small woman, only 5'3", like you, and if I eat more, I gain weight.
The thought strikes me that I should go back to high carb eating (with the grains, sugar, etc.) just long enough to get my blood sugar into unhealthy ranges, get diagnosed, then go back to a lower carb way of eating. I have no doubt that if I ate that way, my blood sugar would go up right away.
Is that a bad plan? Would I have myself by doing this short term just to get a diagnosis?
Rebecca
It sounds to me like you need to see a very good endocrinologist to find out why your thyroid keeps getting worse. Have you seen one associated with a major regional hospital associated with a medical school?
Thyroid will worsen blood sugars that would otherwise be normal and what you posted was very close to normal for someone low carbing.
Jenny, no, I have not seen an endocrinologist. I have seen regular doctors that do not even know that TSH alone tells you nothing, and I have seen hormone doctors who promise weight loss with balanced hormones that never materializes.
My body fat today is close to 37%. The average over this past 2.5 years has been 35.5%, with the low at 31.4% (for only very brief periods of time) to as high as 44.8%.
My experience with doctors in general is that they do not think there is anything wrong. One doctor told me, "It's normal for women your age to be fat."
My other experience with doctors is that they want to prescribe harmful or ineffective drugs (read: Synthroid), because that is what they are taught in medical school and by Big Pharma. I thought that going to a progressive anti-aging doctor would be my answer, but I have not been helped there, either.
I am really at a point of desperation. I cannot live in the real world, I cannot eat in a restaurant, I cannot go to family functions, if I eat what other people eat, I gain 5 pounds overnight while the other people maintain their weight, or even lose weight, and I am not exaggerating.
Many people will say to just eat whole foods to satiety, but when I do that, I literally gain 10 pounds and 4% body fat within a matter of a couple of days.
There has got to be something wrong, and I feel like I am spinning in circles, trying to find an answer. Everyone says they have the answer, and I try everything, but nothing works for me for more than a week or two, and then it all reverts back to high body fat.
I really don't know where to turn.
Chances are if you are gaining weight that fast, it is glycogen refilling. Have you read THIS? The scales' body fat percentages aren't reliable for that.
You really do need to see a good endocrinologist. One who practices out of a major regional hospital would be best if you can find one. They tend to be better educated than the ones who practice out of smaller community hospitals.
Unfortunately, as you are learning, fad alternative health stuff only works if you have simple health problems. For complex ones you need to find a good doctor. They exist, but you may have to try a few to find one.
Have you had a scan of your thyroid to make sure nothing is growing in it? That would be a good place to start. But DO find an endocrinologist who specializes in thyroid issues. They do exist and I have friends who have found them very helpful.
I will take your advice and see an endocrinologist.
I do want to mention that when I have had drastic weight gains from eating one high carb meal, it has taken me months to take it back off, and it takes me months and months sometimes to get to my lowest weights.
My waist-to-hip ratio is on a steady incline for the past two years:
http://tinyurl.com/3lo745l
I do not use a body fat scale. I use an online calculator that is based on average body measurements, and I have had those numbers corroborated by DXA and Bod Pod tests.
I know that there can be water weight gains, but not ones that take months to get rid of even when you are eating right. Even averaging my scale weight over seven days, which should average out normal water weight fluctuations and glycogen reloads, shows that I cannot lose weight without taking drastic measures, such as extreme low calorie. Before you ask, no, I do not do that all the time, but when I have been gaining body fat steadily for a year and a half at a time, I have resorted to it. I have done this probably only three times in the past 2.5 years, and then only for a week or so and then go back to a normal range of calories.
Thank you again for your help. I understand that you do not have the answer for me. Maybe seeing an endocrinologist will be my answer.
Rebecca,
Have you had any thyroid antibody tests done? Anti-TPO and TgAb are the tests. Positive results to either of these indicates an auto-immune attack on your thyroid gland. Also, persevere when seeking an endocrinologist; IME, one has to sort through those, too. ;-(
Also, have you considered potatoes, yams/sweet potatoes, and winter squashes for non-grain/non-legume carb sources? Ethnic markets and some supermarkets in more diverse urban areas might carry taro (taro is a starchy corm, not a tuber or root), which are small and as easy to prepare as a potato - you can find more taro information online). Jerusalem artichokes are another source for non-grain, non-legume carbs, though the fermentable fiber can create a lot of gas, so proceed v-e-r-y slowly if you try those. If you are avoiding grains because of gluten and lectins, white rice is a carb source that is easy to prepare in small portions.
Thanks, No Grain! Those are all really good suggestions. I remember trying spaghetti squash for the first time recently and really liking it, but did not have it again because it was a little high on carbs. In an effort to raise carbs, that would be a good choice, along with the other squashes.
I have to be so careful with the starchier veggies, because my husband has Metabolic Syndrome and the doc said no starches at all. But as long as we can now test our blood sugars, we can find out if they actually cause him a problem or not. We did his A1C last week for the first time, too, and his was 5.5, plus he has had high blood sugar that has only recently started coming down and is now consistently below 95 or so.
I'm thinking about yams, too. Thanks again!
And when I see the endo, I will ask about those two tests.
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