A huge, long-term UK study appears to show that for people with Type 2 Diabetes injecting insulin raises the risk of both cancer and heart disease.
The study is:
Mortality and Other Important Diabetes-Related Outcomes With Insulin vs Other Antihyperglycemic Therapies in Type 2 Diabetes
Craig J. Currie et al. The Journal of Clinical Endocrinology & Metabolism February 1, 2013 vol. 98 no. 2 668-677
The study examined the records of 84,622 people with Type 2 Diabetes treated with 5 different drug combinations. It concludes: " In people with T2DM, exogenous insulin therapy was associated with an increased risk of diabetes-related complications, cancer, and all-cause mortality."
This conclusion is likely to lead insurance companies and physicians to deny insulin to people with Type 2 diabetes. This is tragic and very ill advised.
That is because what this study shows is a correlation between insulin use and heart disease and cancer, not causation. In fact, these results are easily explained when you understand that insulin use in people with Type 2 Diabetes in UK is a marker for long-term exposure to very high, uncontrolled blood sugars, and conclude that it is the high blood sugars, not the insulin causing the increase in mortality.
Indeed, the way that insulin is prescribed in the UK makes it so that patients aren't given insulin until they have had extremely high blood sugars for many years, and when insulin finally is prescribed it is done so in a way that does not bring blood sugars down to safe, physiologically normal levels.
So it isn't the insulin that is to blame here, it is the high blood sugars, which a great deal of research has shown cause all the classic diabetic complications as well as heart disease and cancer.
Let's look a bit more closely at how Type 2 Diabetes is treated in the UK where this study was conducted. Because the UK has a National Health Service, patients and to some extent doctors are not given choices about what treatment to use for Type 2 Diabetes. Treatment is based on the use of a rigid set of guidelines that links the treatment to long term blood sugar level. The guidelines consider 7.0% a safe and healthy blood sugar level for people with Type 2 diabetes. So no interventions occur when blood sugars are that high, though we know that level is high enough to produce all the classic diabetic complications. (You can read about the research connecting complications to blood sugar levels HERE and HERE.
At diagnosis, with A1c over 7.0%, patients in the UK are told to change their lifestyle--to exercise and eat the low fat/high carb diets that do little to lower blood sugar. Only if their A1cs continue to climb well above 7.5% are they put on oral drugs.
As we know, studies presented in the prescribing information included with diabetic oral drugs show that none of these oral drugs lower A1c more than about .5%. (I.e. from 8.5% to 8.0%.) Patients are left on these drugs, with their A1cs in the 7-9% range for years.
Only when A1cs climb much higher are patients prescribed insulin. Unfortunately, they are not prescribed the basal/bolus insulin regimens that make it possible to get normal, physiological blood sugars. Instead, they are given only enough insulin to lower fasting blood sugars to a level that will produce A1cs in the 7-7.5% range. This basal insulin does nothing to lower the post meal blood sugar spikes that research suggests cause heart disease and promote cancer. (You can learn more about the right way to use insulin for Type 2 diabetes HERE.)
When basal insulin isn't enough, most patients are given the worst form of insulin, the 70/30 mix which combines fast and slow-acting insulin in a way that makes it impossible to cover meals tightly without risking hypos. Patients are forced to eat high carb meals to avoid hypos with this nasty insulin blend and are unlikely to be able to lower A1c below or even to 7.0%.
Insulin under this regimen is dosed by the health professional who issues a simple guideline. As a result patients must eat a lot of carbohydrate to avoid hyping. This way of using insulin is like driving with one foot on the accelerator and one on the brake.
So patients "on insulin" at best end up with A1cs between 7.0 and 8.0%, and this occurs only after years of exposure to the much higher blood sugars that almost certainly explain the depressing rates of heart attack and cancer seen in this study.
The outcomes of patients using insulin who use it properly are much better. But using insulin safely to normalize blood sugars require education and a lot of careful observation and adjustment of doses. It can't be done with one appointment but takes time and training. Most if not all family physicians do not understand the proper dosing of insulin. Many don't even know there is such a thing, as they refer their patients with Type 1 Diabetes to endocrinologists. (And sadly, not all endocrinologists are familiar with how to dose insulin properly, especially not those trained before the mid 1990s.)
Used properly, the right combination of basal insulin to lower fasting blood sugars and fast-acting insulin to cover the carbohydrates in meals can make it possible to get A1cs in the 5% to low 6% range and avoid the classic diabetic complications.
To be fair to the researchers who publishsed this study, they concluded at the end of the report, "Differences in baseline characteristics between treatment groups should be considered when interpreting these results." But because they don't spell out what those differences are--that it means that the people on insulin are those with the very worst blood sugars who have lived with these very bad blood sugars for years and whose insulin did not really reverse them--this statement is very likely to be ignored.
Instead, because most U.S. physicians in general practice--the people who treat most people with Type 2 Diabetes--have almost no familiarity with the research explaining how blood sugar causes complications, this study is likely to result in fewer people with Type 2 Diabetes being given access to insulin when they need it.
Drug company marketers will use this result to pressure doctors to prescribe more of the dangerous, heavily marketed and very expensive DPP-4 inhibitors
like Januvia and Onglyza (which also cause cancer)
and the GLP-1 analogs like Byetta and Victoza (the latter of which as been linked to Thyroid cancer.) Neither class of drugs lower blood sugar in people whose beta cells aren't able to secrete insulin or have been killed by very high blood sugars. These are the very people who need insulin the most.
So if doctors use this result to deny patients insulin it will, in fact, raise the number of heart attacks and cancers over time. But it will save insurers money to deny people insulin, so expect to see this happening
February 21, 2013
Another Dangerously Misinterpreted Study: Insulin Doesn't Raise Cancer & Heart Disese Risk--High Blood Sugars Do
December 10, 2012
Research Posted on The BS101 FB Page Since September
It's time to collect and post all the substantive, research-related posts that have been posted on the Blood Sugar 101 Facebook Page.
As you can see there is the usual mix of disturbing findings about environmental pollutants, bad diet advice, dangerous prescription drugs, mistaken medical policy, and the benefits of lowering blood sugar by cutting back on carbohydrates.
I have put red arrows (==>) next to a few studies that have immediate, serious health implications for people with diabetes.
I continue to be less than thrilled with FB, but since so many people use it I've concluded it is a pretty good way to reach people who would otherwise never find this blog.
====
Study: After weight loss, Roux-en-Y causes dramatic post-meal blood sugar spikes. Banding makes no difference in blood sugar. Stats argue against either being a "cure" for diabetes, doesn't it.
See this chart:
http://www.jci.org/articles/view/64895/figure/4
From this article http://www.jci.org/articles/view/64895
=====
Ketones may why calorie restriction leads to life extension. So don't starve yourself, cut back on carbs.
http://www.sciencedaily.com/releases/2012/12/121206142025.htm
=====
Apparently, free speech extends to drug reps lying about prescription drugs. We're all screwed.
http://www.reuters.com/article/2012/12/04/us-offlabel-conviction-idUSBRE8B21DC20121204
=====
"Countries that use high fructose corn syrup in their food supply have a 20% greater prevalence of type 2 diabetes compared with countries that do not" Study says.
http://americannewsreport.com/high-fructose-corn-syrup-blamed-for-worldwide-diabetes-epidemic-8816853
=====
Dangerous concentrations of PCBs are found in many women's blood. They are known to promote diabetes.
http://www.sciencedaily.com/releases/2012/11/121128143944.htm
=====
You'll find lots of low carb holiday treats including cookies and other desserts here that you can indulge in without spiking your blood sugar.
http://www.tudiabetes.org/group/lowcarbrecipeswap/forum/topics/holiday-foods?commentId=583967%3AComment%3A2487538
=====
Flame retardants are hormone disrupters that promote obesity. You can't avoid them if you own upholstered furniture.
http://www.sfgate.com/health/article/Chemicals-in-furniture-hard-to-avoid-4072857.php
=====
What a shocker: The Wash Post notices that drug companies have polluted high impact medical research studies.
http://www.thedailybeast.com/cheats/2012/11/25/bias-may-taint-big-pharma-research.html
=====
A mouse study finds the specific cancer gene that is silenced when dietary carbs are restricted.
http://www.sciencedaily.com/releases/2012/11/121115133152.htm
=====
PCBs which concentrate in body fat (and therefore in the fat of the meat we eat) not only cause diabetes, they lead to infertility. This is a serious issue for people eating low carb diets, alas. Organic meat may be better, but the pervasiveness of these toxins in our environment makes them difficult to avoid with husbandry practices, as the animals still have to breath polluted air and drink polluted water.
http://www.sciencedaily.com/releases/2012/11/121114084027.htm
=====
A UK study concludes that screening for diabetes doesn't prevent bad outcomes. No one draws the obvious conclusion--UK treatment for diabetes sucks. Which it does.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61422-6/abstract
=====
BPA slows thyroid in pregnant animals and their offspring.
http://www.sciencedaily.com/releases/2012/11/121114083226.htm
=====
==> The EU has approved dapagliflozin which will be sold as Forxiga. This drug blocks absorption of glucose in the kidney, so you lower blood sugar by peeing away glucose. The FDA did NOT approve it because of possible liver damage and signals of breast and bladder cancer. Do NOT take this new drug until it has been on the market for at least 5 years and we know a bit more about what it really does.
http://medcitynews.com/2012/11/eu-approves-bristol-astra-diabetes-drug-forxiga-after-fda-rejection-due-to-cancer-risk/
=====
Arsenic, DDE, dioxin and pesticides all are strongly associated with both diabetes and obesity. It's NOT personal choices damaging our children.
http://www.sciencedaily.com/releases/2012/11/121113134928.htm
=====
==> FDA committee approved very long lasting basal insulin. But it isn't better than Lantus/Levemir and the 70/30 mix makes it impossible to cover post-meal spikes safely.
http://www.healio.com/endocrinology/diabetes/news/online/%7B61213728-C9A3-46E8-AD49-0010CE03911E%7D/Insulin-degludec-degludecaspart-receive-FDA-committee-approval-in-8-4-vote
=====
More evidence that sulfonylureas are worse for the heart than metformin. There is a well-understood reason why this should be true. They are discussed HERE
http://www.sciencedaily.com/releases/2012/11/121107122453.htm
=====
Doctors really are biased against fat people. If you thought your doctor was dissing you, it wasn't paranoia.
http://www.sciencedaily.com/releases/2012/11/121107200036.htm
====
==> Low vitamin D levels correlate to longevity in this new study. Perhaps because high levels often result in calcium in arteries.
http://www.sciencedaily.com/releases/2012/11/121105130355.htm
=====
==> If you have heart disease and diabetes don't let a cardiologist rush you into stenting, the way this NEJM editorial explains they will. A major long-term study found coronary artery bypass produces much better results in people with diabetes than stenting.
http://www.nejm.org/doi/full/10.1056/NEJMe1212278
=====
Another study proves that soy is useless against menopausal symptoms. Since it also promotes autoimmune attack by promoting leaky gut, wise women avoid soy.
http://www.sciencedaily.com/releases/2012/11/121101110633.htm
=====
The radical weight loss surgeries can lead to significant bone loss.
http://www.sciencedaily.com/releases/2012/11/121102115342.htm
=====
==> If you have any signs of early diabetic kidney disease Pradaxa could be very dangerous. The FDA is being defensive since it approved it. Doctors are rarely aware of the fine print about who should NOT get a new, heavily marketed drug.
http://www.nytimes.com/2012/11/03/business/a-rising-anti-stroke-drug-is-tied-to-risk-of-bleeding-deaths.html
=====
Cochrane Review: Cranberry juice for Urinary Tract Infections is a myth promoted by people funded by the cranberry industry. It's extremely high in sugar and terrible for blood sugar. High blood sugar promotes UTIs.
http://summaries.cochrane.org/CD001321/cranberries-for-preventing-urinary-tract-infections
=====
Losing weight using a low fat/high carb diet that raises blood sugar won't reduce heart disease. Duh. It isn't the weight. Note the supposed experts never ask, "What diet?" But just assume "diet" doesn't work. The "experts" cited are drawing huge sums as they are on the payroll of drug companies as "consultants" and other weaselly terms meant to hide the fact that they are drug pitchmen.
http://www.washingtonpost.com/national/health-science/moderate-weight-loss-alone-doesnt-lower-heart-disease-risk-in-diabetics-study-shows/2012/10/19/89cee7cc-1a22-11e2-aa6f-3b636fecb829_story.html
=====
Ex- top insurance exec (at a company I used to write software for) reveals how insurers deceitfully manipulate data to make it look like people are uninsured by choice.
http://www.publicintegrity.org/2012/10/15/11413/opinion-myths-healthy-uninsured
=====
The Sweetarts sold at drug store and convenience store counters have shrunk. The new nutritional info shows they are no longer 2 grams each. Now they are 1.6 grams. Important to know if you use them to correct lows.
=====
Doctors finally admit that lowering post-meal blood sugars is ALL you need to do to avoid heart attack. But they also want to link it to DPP-4 inhibitors, ignoring the cancer and immune system risks. If you can lower your post-meal blood sugar without these dangerous drugs, do it.
http://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/{3d16eba1-1568-4b2d-8e92-b516391831f7}/dpp-iv-inhibitors-appear-to-reduce-cv-risk-in-type-2-diabetes-
====
It took 6.5 years to "decades" before the benefits of tight control became obvious in the landmark diabetes studies. Lowering A1c DOES help. If you wait another decade until ignorant doctors finally admit lowering your A1c 5% range using SAFE technique WILL significantly lower the rates of all complications, it may be too late for you as the higher blood sugars associated with 7% A1cs will have damaged and destroyed your organs.
http://www.nejm.org/doi/full/10.1056/NEJMp1208169
=====
BD is announcing a new Ultra-Fine needle that is supposedly even thinner than their previous ones. My experience with the short ultra-fines is that they are painless. The new ones should be even better. Note, however, that contrary to what you may be told, many of us find we can get several days worth of injections from one pen needle before it starts to blunt.
http://www.bd.com/us/diabetes/page.aspx?cat=7002&id=7409
====
Almost all rice contains the inorganic form of arsenic that’s known to cause bladder, lung and skin cancers. And to destroy pancreas' ability to secrete insulin, too.
http://www.washingtonpost.com/business/economy/fda-working-on-plan-to-limit-arsenic-levels-in-rice/2012/09/18/3238a578-0133-11e2-b257-e1c2b3548a4a_story.html
As you can see there is the usual mix of disturbing findings about environmental pollutants, bad diet advice, dangerous prescription drugs, mistaken medical policy, and the benefits of lowering blood sugar by cutting back on carbohydrates.
I have put red arrows (==>) next to a few studies that have immediate, serious health implications for people with diabetes.
I continue to be less than thrilled with FB, but since so many people use it I've concluded it is a pretty good way to reach people who would otherwise never find this blog.
====
Study: After weight loss, Roux-en-Y causes dramatic post-meal blood sugar spikes. Banding makes no difference in blood sugar. Stats argue against either being a "cure" for diabetes, doesn't it.
See this chart:
http://www.jci.org/articles/view/64895/figure/4
From this article http://www.jci.org/articles/view/64895
=====
Ketones may why calorie restriction leads to life extension. So don't starve yourself, cut back on carbs.
http://www.sciencedaily.com/releases/2012/12/121206142025.htm
=====
Apparently, free speech extends to drug reps lying about prescription drugs. We're all screwed.
http://www.reuters.com/article/2012/12/04/us-offlabel-conviction-idUSBRE8B21DC20121204
=====
"Countries that use high fructose corn syrup in their food supply have a 20% greater prevalence of type 2 diabetes compared with countries that do not" Study says.
http://americannewsreport.com/high-fructose-corn-syrup-blamed-for-worldwide-diabetes-epidemic-8816853
=====
Dangerous concentrations of PCBs are found in many women's blood. They are known to promote diabetes.
http://www.sciencedaily.com/releases/2012/11/121128143944.htm
=====
You'll find lots of low carb holiday treats including cookies and other desserts here that you can indulge in without spiking your blood sugar.
http://www.tudiabetes.org/group/lowcarbrecipeswap/forum/topics/holiday-foods?commentId=583967%3AComment%3A2487538
=====
Flame retardants are hormone disrupters that promote obesity. You can't avoid them if you own upholstered furniture.
http://www.sfgate.com/health/article/Chemicals-in-furniture-hard-to-avoid-4072857.php
=====
What a shocker: The Wash Post notices that drug companies have polluted high impact medical research studies.
http://www.thedailybeast.com/cheats/2012/11/25/bias-may-taint-big-pharma-research.html
=====
A mouse study finds the specific cancer gene that is silenced when dietary carbs are restricted.
http://www.sciencedaily.com/releases/2012/11/121115133152.htm
=====
PCBs which concentrate in body fat (and therefore in the fat of the meat we eat) not only cause diabetes, they lead to infertility. This is a serious issue for people eating low carb diets, alas. Organic meat may be better, but the pervasiveness of these toxins in our environment makes them difficult to avoid with husbandry practices, as the animals still have to breath polluted air and drink polluted water.
http://www.sciencedaily.com/releases/2012/11/121114084027.htm
=====
A UK study concludes that screening for diabetes doesn't prevent bad outcomes. No one draws the obvious conclusion--UK treatment for diabetes sucks. Which it does.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61422-6/abstract
=====
BPA slows thyroid in pregnant animals and their offspring.
http://www.sciencedaily.com/releases/2012/11/121114083226.htm
=====
==> The EU has approved dapagliflozin which will be sold as Forxiga. This drug blocks absorption of glucose in the kidney, so you lower blood sugar by peeing away glucose. The FDA did NOT approve it because of possible liver damage and signals of breast and bladder cancer. Do NOT take this new drug until it has been on the market for at least 5 years and we know a bit more about what it really does.
http://medcitynews.com/2012/11/eu-approves-bristol-astra-diabetes-drug-forxiga-after-fda-rejection-due-to-cancer-risk/
=====
Arsenic, DDE, dioxin and pesticides all are strongly associated with both diabetes and obesity. It's NOT personal choices damaging our children.
http://www.sciencedaily.com/releases/2012/11/121113134928.htm
=====
==> FDA committee approved very long lasting basal insulin. But it isn't better than Lantus/Levemir and the 70/30 mix makes it impossible to cover post-meal spikes safely.
http://www.healio.com/endocrinology/diabetes/news/online/%7B61213728-C9A3-46E8-AD49-0010CE03911E%7D/Insulin-degludec-degludecaspart-receive-FDA-committee-approval-in-8-4-vote
=====
More evidence that sulfonylureas are worse for the heart than metformin. There is a well-understood reason why this should be true. They are discussed HERE
http://www.sciencedaily.com/releases/2012/11/121107122453.htm
=====
Doctors really are biased against fat people. If you thought your doctor was dissing you, it wasn't paranoia.
http://www.sciencedaily.com/releases/2012/11/121107200036.htm
====
==> Low vitamin D levels correlate to longevity in this new study. Perhaps because high levels often result in calcium in arteries.
http://www.sciencedaily.com/releases/2012/11/121105130355.htm
=====
==> If you have heart disease and diabetes don't let a cardiologist rush you into stenting, the way this NEJM editorial explains they will. A major long-term study found coronary artery bypass produces much better results in people with diabetes than stenting.
http://www.nejm.org/doi/full/10.1056/NEJMe1212278
=====
Another study proves that soy is useless against menopausal symptoms. Since it also promotes autoimmune attack by promoting leaky gut, wise women avoid soy.
http://www.sciencedaily.com/releases/2012/11/121101110633.htm
=====
The radical weight loss surgeries can lead to significant bone loss.
http://www.sciencedaily.com/releases/2012/11/121102115342.htm
=====
==> If you have any signs of early diabetic kidney disease Pradaxa could be very dangerous. The FDA is being defensive since it approved it. Doctors are rarely aware of the fine print about who should NOT get a new, heavily marketed drug.
http://www.nytimes.com/2012/11/03/business/a-rising-anti-stroke-drug-is-tied-to-risk-of-bleeding-deaths.html
=====
Cochrane Review: Cranberry juice for Urinary Tract Infections is a myth promoted by people funded by the cranberry industry. It's extremely high in sugar and terrible for blood sugar. High blood sugar promotes UTIs.
http://summaries.cochrane.org/CD001321/cranberries-for-preventing-urinary-tract-infections
=====
Losing weight using a low fat/high carb diet that raises blood sugar won't reduce heart disease. Duh. It isn't the weight. Note the supposed experts never ask, "What diet?" But just assume "diet" doesn't work. The "experts" cited are drawing huge sums as they are on the payroll of drug companies as "consultants" and other weaselly terms meant to hide the fact that they are drug pitchmen.
http://www.washingtonpost.com/national/health-science/moderate-weight-loss-alone-doesnt-lower-heart-disease-risk-in-diabetics-study-shows/2012/10/19/89cee7cc-1a22-11e2-aa6f-3b636fecb829_story.html
=====
Ex- top insurance exec (at a company I used to write software for) reveals how insurers deceitfully manipulate data to make it look like people are uninsured by choice.
http://www.publicintegrity.org/2012/10/15/11413/opinion-myths-healthy-uninsured
=====
The Sweetarts sold at drug store and convenience store counters have shrunk. The new nutritional info shows they are no longer 2 grams each. Now they are 1.6 grams. Important to know if you use them to correct lows.
=====
Doctors finally admit that lowering post-meal blood sugars is ALL you need to do to avoid heart attack. But they also want to link it to DPP-4 inhibitors, ignoring the cancer and immune system risks. If you can lower your post-meal blood sugar without these dangerous drugs, do it.
http://www.healio.com/endocrinology/diabetes/news/print/endocrine-today/{3d16eba1-1568-4b2d-8e92-b516391831f7}/dpp-iv-inhibitors-appear-to-reduce-cv-risk-in-type-2-diabetes-
====
It took 6.5 years to "decades" before the benefits of tight control became obvious in the landmark diabetes studies. Lowering A1c DOES help. If you wait another decade until ignorant doctors finally admit lowering your A1c 5% range using SAFE technique WILL significantly lower the rates of all complications, it may be too late for you as the higher blood sugars associated with 7% A1cs will have damaged and destroyed your organs.
http://www.nejm.org/doi/full/10.1056/NEJMp1208169
=====
BD is announcing a new Ultra-Fine needle that is supposedly even thinner than their previous ones. My experience with the short ultra-fines is that they are painless. The new ones should be even better. Note, however, that contrary to what you may be told, many of us find we can get several days worth of injections from one pen needle before it starts to blunt.
http://www.bd.com/us/diabetes/page.aspx?cat=7002&id=7409
====
Almost all rice contains the inorganic form of arsenic that’s known to cause bladder, lung and skin cancers. And to destroy pancreas' ability to secrete insulin, too.
http://www.washingtonpost.com/business/economy/fda-working-on-plan-to-limit-arsenic-levels-in-rice/2012/09/18/3238a578-0133-11e2-b257-e1c2b3548a4a_story.html
November 26, 2012
Food Self-Defense for the Holidays
We people with diabetes have just entered the six week period during which managing what we eat can morph from a daily challenge to an ongoing nightmare, culminating, all too often, in diet disaster.
As anyone who has read my books or web site knows, I'm not a fan of rigid regimentation or obsessive self-denial. I believe very strongly that the key to crafting an effective diabetes diet that you can stick to for decades, not months, is to respect yourself and your emotional needs, build in safety valves, and provide enough variety to avoid burn-out.
But over the past decades the holidays have morphed into a celebration of gluttony, not just of food, but of every kind of consumer good. And those of us who don't believe that the best way to show our love for the people around us is to shower them with gifts and stuff them with sugary, fatty food are labeled "Scrooges" or accused of promoting economic slowdown that will rob our neighbors of jobs.
Unless you are an independently wealthy, only child orphan who lives in a cave in the wilds of Montana, the chances are you will find yourselves continually assaulted by the messages: Buy More! Spend More! Eat more!
So the weeks ahead are a minefield. Because food isn't just food. Food is memories. Food is love. Food is what keeps us safe when things get scary. Food is what keeps us alive and when we are feeling threats to our survival, real or symbolic, food is the easiest way to fight them off. It's legal. It's cheap. It's everywhere.
If we didn't have a medical condition where eating certain foods raised our blood sugar in ways that will, over time, clog up our arteries, damage our kidneys, shut down our retinas, and destroy our nerves, the food we are faced with during holidays might leave us a few pounds heavier, but all in all the holiday eating would really be no big deal.
But for people with diabetes the case is very different. Because if we get out of control with our food for a month or longer, we kick off physiological changes that can make us ravenously hungry and lead to months and even years of eating the foods that will ruin our organs.
So while a day here and there of unrestrained eating won't kill us, people with diabetes cannot let those days turn into weeks. And to do this they must NOT rely on the dieter's worst friend, that questionable facility known as,"Will power," but on the known and tested strategies that help us get through weeks of food temptations without having to rely on it.
So without further ado, I list below the techniques you can adopt to keep yourself from going off the rails at this most dangerous time of the year.
1. If It Isn't There, You Can't Eat It. We're talking about the food you bring home. If there is something you are really craving, eat a portion at a restaurant or a friend's house--watching portion size, but don't bring a big box or bag of it home. If the food isn't in the house no matter how much it calls out to you, you can't eat it. It's as simple as that. Meanwhile, stock up on delicious foods that you can eat.
If you have to bring something dangerous home because you have to serve it to others, keep it out of sight. I have learned the hard way that anything left out on the counter will beg me to eat it every time I enter the kitchen. Put things you don't want to have tempt you in the closet or in the back of the fridge where you can't see them.
2. Ask Friends or Loved Ones For Help With Food. If you have a good relationship with people likely to give you food gifts or invite you to dinner and/or parties, explain--briefly--that foods filled with carbohydrates raise your blood sugar and suggest some alternatives that would be a treat for you at the holidays so that, for example, they can show their fondness for you by offering your a delicious platter of low carb imported cheeses, or sausages, or nuts, that will not raise your blood sugar instead of a brandied cake or sugar cookies that will put you into a hyperglycemic fog.
If someone screws up and with the best of intentions gives you something toxic to your diet, like a box of high carb, maltitol-laden "sugar free" cookies, thank them, eat one in their presence to signify that you appreciate their thoughtfulness and throw the rest away when you get home. Later, at some less emotionally-fraught time you can explain to the giver that "sugar free" products are actually full of hidden sugar that raise people's blood sugar. But don't do it when you are presented with the gift unless you want to make the giver feel bad.
If you are given something that was a huge treat before your diagnosis and can't face throwing it out, ask a family member to hide it away and dole out appropriate portions on a schedule you give them in advance. I have been known to ask My Sweetie put certain much-loved candies in his safe (to which I don't have the combination) because I know what will happen if they are too accessible, but still want to eat a small serving now and then throughout the holiday season.
3. Bring Your Own Food to Events Where You Might Not Have Safe Choices. Fortunately many events nowadays are potlucks, so you can bring a rotisserie chicken to the family gathering or a hunk of cheese to the office party if you are eating a strict low carb diet. Salads with nuts, seeds, and mixed greens are another safe option. If you bake low carb cookies or bars, make a plate of them, labeled so people will know what they are--and avoid them if they don't like artificial sweeteners, leaving more for you.
Search online to find low carb options now, so that when you are faced with the need to prepare or bring low carb treats you will have some at your disposal.
If you have to go to a formal event where there are no safe options, it can be harder to bring your own food as doing so might make a poor impression on your hosts or other attendees. Eating at home before you go can be helpful here. There should be something you can eat just about anywhere, and worst case, if you have to eat a token portion of something for politeness sake having eaten earlier will keep you from going overboard.
4. Plan for Indulgences. This is where the safety valve strategy comes in. Decide what is an appropriate level of off-plan eating for the next few weeks and schedule what you will eat in advance, concentrating on things you will really enjoy.
If your diabetes diet is very new, and you haven't learned how to get back on plan after going off plan, you will want to be very conservative. One or two portions may be all you can tolerate this year, but you can limit yourself with the thought that in a year when your new diet has become habitual you can loosen up some.
If you have learned how to get back on track after going off your diet, you can be a bit more relaxed, but make sure that you do go back on your diet when you have planned to.
5. Test, Test, Test! When you go off plan, test your blood sugar 1 and 2 hours after eating, to reinforce your understanding of why you are on your diet in the first place. The point isn't to scare yourself--one day of high blood sugars a week isn't going to make you go blind. But daily exposure to blood sugars that spend many hours over 140 mg/dl will, over time, damage your organs in ways that may be irreversible. Testing after eating keeps a lot of us honest, and I highly recommend it this time of year.
6. Learn How to Get Back On Track. If we have had our blood sugar under control, eating a lot of carbs can catapult us back into a state of rabid hunger, which is the main reason many people believe (erroneously) that they are "addicted" to carbs and that a single bite of high carb food will send them into an unrecoverable tailspin.
I have written about this at length HERE. Read this page BEFORE you contend with holiday treats. Learning how to recover from a high carb, blood sugar spike-fest is the single most useful skill many people with diabetes will ever learn, and the one that will make it possible for them to maintain their blood sugar control for the decades of healthy life they deserve to live after a diabetes diagnosis.
If you've been doing a good job controlling your blood sugar, let us know what you do to to get through the holiday eating extravaganza by posting in the comment section below.
As anyone who has read my books or web site knows, I'm not a fan of rigid regimentation or obsessive self-denial. I believe very strongly that the key to crafting an effective diabetes diet that you can stick to for decades, not months, is to respect yourself and your emotional needs, build in safety valves, and provide enough variety to avoid burn-out.
But over the past decades the holidays have morphed into a celebration of gluttony, not just of food, but of every kind of consumer good. And those of us who don't believe that the best way to show our love for the people around us is to shower them with gifts and stuff them with sugary, fatty food are labeled "Scrooges" or accused of promoting economic slowdown that will rob our neighbors of jobs.
Unless you are an independently wealthy, only child orphan who lives in a cave in the wilds of Montana, the chances are you will find yourselves continually assaulted by the messages: Buy More! Spend More! Eat more!
So the weeks ahead are a minefield. Because food isn't just food. Food is memories. Food is love. Food is what keeps us safe when things get scary. Food is what keeps us alive and when we are feeling threats to our survival, real or symbolic, food is the easiest way to fight them off. It's legal. It's cheap. It's everywhere.
If we didn't have a medical condition where eating certain foods raised our blood sugar in ways that will, over time, clog up our arteries, damage our kidneys, shut down our retinas, and destroy our nerves, the food we are faced with during holidays might leave us a few pounds heavier, but all in all the holiday eating would really be no big deal.
But for people with diabetes the case is very different. Because if we get out of control with our food for a month or longer, we kick off physiological changes that can make us ravenously hungry and lead to months and even years of eating the foods that will ruin our organs.
So while a day here and there of unrestrained eating won't kill us, people with diabetes cannot let those days turn into weeks. And to do this they must NOT rely on the dieter's worst friend, that questionable facility known as,"Will power," but on the known and tested strategies that help us get through weeks of food temptations without having to rely on it.
So without further ado, I list below the techniques you can adopt to keep yourself from going off the rails at this most dangerous time of the year.
1. If It Isn't There, You Can't Eat It. We're talking about the food you bring home. If there is something you are really craving, eat a portion at a restaurant or a friend's house--watching portion size, but don't bring a big box or bag of it home. If the food isn't in the house no matter how much it calls out to you, you can't eat it. It's as simple as that. Meanwhile, stock up on delicious foods that you can eat.
If you have to bring something dangerous home because you have to serve it to others, keep it out of sight. I have learned the hard way that anything left out on the counter will beg me to eat it every time I enter the kitchen. Put things you don't want to have tempt you in the closet or in the back of the fridge where you can't see them.
2. Ask Friends or Loved Ones For Help With Food. If you have a good relationship with people likely to give you food gifts or invite you to dinner and/or parties, explain--briefly--that foods filled with carbohydrates raise your blood sugar and suggest some alternatives that would be a treat for you at the holidays so that, for example, they can show their fondness for you by offering your a delicious platter of low carb imported cheeses, or sausages, or nuts, that will not raise your blood sugar instead of a brandied cake or sugar cookies that will put you into a hyperglycemic fog.
If someone screws up and with the best of intentions gives you something toxic to your diet, like a box of high carb, maltitol-laden "sugar free" cookies, thank them, eat one in their presence to signify that you appreciate their thoughtfulness and throw the rest away when you get home. Later, at some less emotionally-fraught time you can explain to the giver that "sugar free" products are actually full of hidden sugar that raise people's blood sugar. But don't do it when you are presented with the gift unless you want to make the giver feel bad.
If you are given something that was a huge treat before your diagnosis and can't face throwing it out, ask a family member to hide it away and dole out appropriate portions on a schedule you give them in advance. I have been known to ask My Sweetie put certain much-loved candies in his safe (to which I don't have the combination) because I know what will happen if they are too accessible, but still want to eat a small serving now and then throughout the holiday season.
3. Bring Your Own Food to Events Where You Might Not Have Safe Choices. Fortunately many events nowadays are potlucks, so you can bring a rotisserie chicken to the family gathering or a hunk of cheese to the office party if you are eating a strict low carb diet. Salads with nuts, seeds, and mixed greens are another safe option. If you bake low carb cookies or bars, make a plate of them, labeled so people will know what they are--and avoid them if they don't like artificial sweeteners, leaving more for you.
Search online to find low carb options now, so that when you are faced with the need to prepare or bring low carb treats you will have some at your disposal.
If you have to go to a formal event where there are no safe options, it can be harder to bring your own food as doing so might make a poor impression on your hosts or other attendees. Eating at home before you go can be helpful here. There should be something you can eat just about anywhere, and worst case, if you have to eat a token portion of something for politeness sake having eaten earlier will keep you from going overboard.
4. Plan for Indulgences. This is where the safety valve strategy comes in. Decide what is an appropriate level of off-plan eating for the next few weeks and schedule what you will eat in advance, concentrating on things you will really enjoy.
If your diabetes diet is very new, and you haven't learned how to get back on plan after going off plan, you will want to be very conservative. One or two portions may be all you can tolerate this year, but you can limit yourself with the thought that in a year when your new diet has become habitual you can loosen up some.
If you have learned how to get back on track after going off your diet, you can be a bit more relaxed, but make sure that you do go back on your diet when you have planned to.
5. Test, Test, Test! When you go off plan, test your blood sugar 1 and 2 hours after eating, to reinforce your understanding of why you are on your diet in the first place. The point isn't to scare yourself--one day of high blood sugars a week isn't going to make you go blind. But daily exposure to blood sugars that spend many hours over 140 mg/dl will, over time, damage your organs in ways that may be irreversible. Testing after eating keeps a lot of us honest, and I highly recommend it this time of year.
6. Learn How to Get Back On Track. If we have had our blood sugar under control, eating a lot of carbs can catapult us back into a state of rabid hunger, which is the main reason many people believe (erroneously) that they are "addicted" to carbs and that a single bite of high carb food will send them into an unrecoverable tailspin.
I have written about this at length HERE. Read this page BEFORE you contend with holiday treats. Learning how to recover from a high carb, blood sugar spike-fest is the single most useful skill many people with diabetes will ever learn, and the one that will make it possible for them to maintain their blood sugar control for the decades of healthy life they deserve to live after a diabetes diagnosis.
If you've been doing a good job controlling your blood sugar, let us know what you do to to get through the holiday eating extravaganza by posting in the comment section below.
November 4, 2012
Over the Next Weeks I'll Be Updating the Main Blood Sugar 101 Web Site
I haven't been posting much on this blog as I've been very busy with other things over the past few months. Now that I have a bit more time, I am going to be looking over the various pages on the main Blood Sugar 101 web site and bringing them up to date.
I post all significant changes to the main web site on the Changes to Blood Sugar 101 blog, which makes it easy to keep up with them.
If you have any ideas about how to improve the main web site, or any topics you feel should get more coverage, please mention them in a comment on this post. However, keep in mind that there are already over 100,000 words posted on this site and its blog so the challenge with this web site is to keep it from becoming so overwhelming that the people who come to it for the first time don't miss the important information I'd like them to take away from it.
The focus needs to remain on explaining to people what blood sugar levels are normal, what levels cause diabetic complications, and what strategies safely lower blood sugar and prevent complications.
My web stats show me what pages on the site people actually visit, and for now, it is the pages that stick to that core mission that receive the heaviest traffic. The rest of the site, as fascinating as it might be, rarely gets visited. So the only changes I'm really interested in making are those that will make the pages that convey this vital information even more useful.
I post all significant changes to the main web site on the Changes to Blood Sugar 101 blog, which makes it easy to keep up with them.
If you have any ideas about how to improve the main web site, or any topics you feel should get more coverage, please mention them in a comment on this post. However, keep in mind that there are already over 100,000 words posted on this site and its blog so the challenge with this web site is to keep it from becoming so overwhelming that the people who come to it for the first time don't miss the important information I'd like them to take away from it.
The focus needs to remain on explaining to people what blood sugar levels are normal, what levels cause diabetic complications, and what strategies safely lower blood sugar and prevent complications.
My web stats show me what pages on the site people actually visit, and for now, it is the pages that stick to that core mission that receive the heaviest traffic. The rest of the site, as fascinating as it might be, rarely gets visited. So the only changes I'm really interested in making are those that will make the pages that convey this vital information even more useful.
October 12, 2012
Final Update: My Experimental Diet
I continued eating a very low carb, very low calorie, gluten-free diet that matched the parameters set by my nutritional calculator though last Sunday, but I waited to report on the outcome until my glycogen had refilled. That would make clearer what the real impact of the diet had been.
I also went to the lab last Thursday as it was time for my semiannual visit to the endo, which gave me more insight into what changes the diet had made in my health.
Nutritional Breakdown
Here is what I ate during the second week of my diet. As you can see it was only slightly higher than the intake the previous week. Salt was well controlled and protein was slightly higher than recommended for someone on a long term low carb diet, but lower than that for someone not at all adapted to ketosis*:
Impact on Weight
I had set my calories at the brutally low level that the nutritional calculator predicted should yield a weight loss of 1 lb a week. The level was low because I am old and short, and because I started out at a normal weight. Since it only takes about 1,560 calories to maintain my current weight, the nutritional theories I lay out in my Diet 101 book, which are embodied in the calculator, predict I would have to eat no more than 1,060 calories a day for a week to lose a pound of real fat.
Before starting the diet my weight had been hovering around 146.5 lbs, however, it was 148 lbs the day I started the diet thanks to the very salty Vietnamese lunch I'd had the day before with it's miso-based soup and soy-sauce based sauce. I always gain 2 or 3 lbs after eating a soy-sauce laden meal.
My weight on Monday morning after 2 weeks on my diet was 141.2. This was a loss of scale weight of 6.8 pounds, but because I was eating less than 20 grams of carbs all week, I knew that a good 3 lbs or more of my weight loss was due to the loss of glycogen, which is the substance our body uses to store glucose in both our livers and our muscles. (Details about glycogen-related weight loss HERE.)
I had stopped taking my metformin in the middle of the first week as metformin does interesting things to glycogen and I wanted my diet trial to be cleaner. So after 10 days without metformin and 14 without carbs, I figured I'd probably flushed out as much glycogen as I was going to lose. In the past that was usually about 3 lbs.
Since glycogen comes back as soon as you raise your carbs I expected to see the 3 lbs come back within a few days after ending my diet and raising my carbs back to their usual level which is around 100 g a day.
I also expected that some of my weight loss was due to the fact that since I was eating so little to meet my caloric goal there was less weight of food in my stomach and gut. That too would come back.
Since this past Monday, I have started using metformin again and eating about 100 grams of carbs a day, while eating a maintenance diet. My glycogen is probably as refilled as it's going to get. My weight this morning was 144.6. This is almost exactly 2 lbs less than my average weight during the weeks before I started the diet.
This confirms that my nutritional calculator does a good job of predicting weight loss and, most importantly, that there is no "metabolic advantage" for me in eating a very low carb diet. I did not lose any more weight than would be predicted by caloric deficit.
Had I been in a study, however, my specious loss of 6.8 lbs might have made it look like there was an advantage to eating a very low carb diet since low fat diets don't always flush out glycogen and the food may weigh more.
Unfortunately, it looks like, as usual, the weight came off my face and neck which look more wrinkly and stringy than usual. My tummy, which is the only place I carry significant amounts of subcutaneous fat, doesn't seem any smaller. The Tanita readings are fluctuating so much that I'll have to wait another week or so to see if they show any substantive loss of body fat percentage.
Blood Pressure
My two week diet was designed to be low in salt, because it is too easy to eat a lot of salt while eating a classic LC diet and I have issues with my blood pressure. I bought low salt cold cuts without preservatives at Trader Joe's and stuck with cheeses that were lower in salt, too. No pork rinds or other salty low carb snacks!
My blood pressure was all over the place during my diet, high and normal an then high again. When I started to cautiously supplement with potassium chloride (in the form of Morton's Not Salt) it dropped to completely normal and stayed that way for the last few days of the diet.
I was supplementing with the potassium because I get leg cramps and palpitations when I eat very low carb without potassium. This is because flushing out glycogen also triggers a loss of potassium. (This loss is measured in some studies as a rough gauge of how much glycogen has been lost.)
My lab results from last Wednesday when my blood pressure was 122/73 showed that my blood sodium level was at the very bottom of the normal range and potassium was in the middle of the normal range. This was reassuring, as I had a concern that the Captopril I take might cause my potassium levels to rise too high. I was not dehydrated, based on my normal BUN. In the past when eating LC I have almost always had a high BUN. Controlling protein might have helped there as did the potassium.
When I ended my diet and went back to eating normally, my blood pressure soared. As a further experiment I went back to supplementing with potassium, thanks to the suggestion one of you sent me, and today my blood pressure is back to being normal, at 114/74, as opposed to the 151/92 it was three days ago.
Since I had a lot of trouble with very high blood pressure while eating a very low carb diet in the past--the exact opposite of what the LC gurus claim happens--I'm starting to think that BP for me is all about those potassium levels. Low carb diets can be very high in sodium and potassium deficient, and that may be why I had so much trouble with blood pressure eating a long-term low carb diet.
Blood Sugar
My blood sugars had continued to be beautiful--in the 70s and low 80s at all times. So it was daunting to discover that the lab said my blood sugar was 92 mg/dl when my meter said it was 83 mg/dl. This means that the FreeStyle Lite meter that my insurer forces me to use reads low. So it's probable that my 70s were really 80s and 80s were 90s. It also means my occasional 140s were probably really 150s.
My A1c was 5.5%, which is .2% lower than usual. Some of the drop is due to the low carbing I'd done during the previous 2 weeks. Though doctors think that the A1c reflects the control of the last 3 months, this is not entirely true. The A1c most strongly reflects the blood sugar control during the previous 2 weeks, with the rest of the past experience only making a smaller contribution.
My A1cs are always higher than predicted by my average meter readings, and this one is no different. I attribute this to the likelihood that my red blood cells are living longer than average which will raise how much glucose has become bonded to them. It is that, not actual blood sugar levels, that the A1c measures.
Mood and Energy
By the end of my diet I felt like absolute crap. I wasn't sleeping well and was having the vibrant dreams that happen early on in a ketogenic diet, but there was no sign of the energy burst I usually experience at that phase of an low carb diet. This may be a result of how low my calories had to be for me to lose weight.
Whatever the explanation, I felt exhausted and depressed, and just walking around was a challenge. As soon as my diet was complete and I raised my carbs back to their usual level I felt like my old self with much better energy.
I was very hungry throughout the last week, too, even though my fat intake was reasonably high and my blood sugars completely flat.
Because my blood sugars are very well controlled right now I did not get into binging once I stopped my diet and started eating carbs again. In fact, I had a couple days when I was very busy with a new project over the past few days where I didn't end up eating all that much. This verified my belief that, for me, when I am eating carbs, hunger is entirely about how high my blood sugars surge. Right now they aren't surging very high even when I eat 20-30 g of carbs per meal, so I'm not experiencing blood sugar-caused hunger.
In the past eating a very low carb diet for a few weeks has given me decent energy and no hunger, but I wasn't limiting calories. However, throughout the past 5 years when I've done a very low carb diet not counting calories, I haven't lost an ounce of real weight.
Miscellaneous Observations
I ended up having a lot of heartburn on this diet. Peanut butter and Greek yogurt both caused it. Cheese did not (ruling out that I'm sensitive to dairy, per se.) When I went back to eating gluten at the end of the diet I did not experience heartburn. There doesn't seem to be any reason for me to go gluten free.
Conclusions
Calories count. My nutritional calculator is pretty accurate. It is extremely hard to find low carb foods that meet the caloric target I have to hit to lose weight without boosting protein too high.
This diet confirmed that for me to lose any weight at my age (64) and size (5' 3 and 144 lbs) I'd have to eat no more than 1250 calories a day to lose 2 lbs a month, even on a low carb diet, which for me would be an unsustainable starvation diet.
So my conclusion is that my weight loss diet days are over and that now that I'm heading into my misnamed "golden years" I better get used to carrying a bit more weight because the alternative is a starvation lifestyle.
Fortunately, there is a solid body of research suggesting that the healthiest weight for people my age and older skews towards the "overweight" category (BMI of 25 and a bit higher).
What this may mean for you is that the time to lose weight is when you are in your 30s, 40s, and 50s, when you burn more calories just breathing and walking around. Our metabolic rate drops with each decade we survive--even with exercise--so it gets tougher to lose weight as we get older.
Low carb diets are very effective for people with a lot of weight to lose whose caloric needs are much higher, but their main advantage in respect to weight loss is that when people cut out carbs they cut out all the high caloric junk that is what caused them to gain weight in the first place. If you control protein it becomes much tougher to overeat on a low carb diet, too.
The true virtue of low carb diets is, of course, that they control blood sugar very well. If my current blood sugar-control regimen stops working, I know that cutting back on carbs will drop my blood sugar (as long as I have functional beta cells, which fortunately, seems to be the case.)
Comments?
NOTE: In response to a point brought up in one of the comments it's worth noting that after Thanksgiving I did 10 days of a classic "Don't count anything but carbs" diet. In contrast to what happened with the calorie controlled low carb diet described above, I lost a grand total of 2 lbs during the "all you can eat" LC diet which came back when I raised carbs out of the ketogenic range. I was spilling urinary ketones from day 3 to day 10. Blood sugar and blood pressure were normal on that diet (after a rocky first few days for the blood pressure, again) but as has been the case for me for the past 5 years, a ketogenic low carb diet without caloric restriction is worthless for weight loss.
-----
* I used the body fat percentage my Tanita scale provides when using the calculator to estimate intake. If I omitted the body fat percentage, the calculator would tell me that I would have to eat a starvation diet to lose 1 lb a week, which it won't provide numbers for.
I also went to the lab last Thursday as it was time for my semiannual visit to the endo, which gave me more insight into what changes the diet had made in my health.
Nutritional Breakdown
Here is what I ate during the second week of my diet. As you can see it was only slightly higher than the intake the previous week. Salt was well controlled and protein was slightly higher than recommended for someone on a long term low carb diet, but lower than that for someone not at all adapted to ketosis*:
Impact on Weight
I had set my calories at the brutally low level that the nutritional calculator predicted should yield a weight loss of 1 lb a week. The level was low because I am old and short, and because I started out at a normal weight. Since it only takes about 1,560 calories to maintain my current weight, the nutritional theories I lay out in my Diet 101 book, which are embodied in the calculator, predict I would have to eat no more than 1,060 calories a day for a week to lose a pound of real fat.
Before starting the diet my weight had been hovering around 146.5 lbs, however, it was 148 lbs the day I started the diet thanks to the very salty Vietnamese lunch I'd had the day before with it's miso-based soup and soy-sauce based sauce. I always gain 2 or 3 lbs after eating a soy-sauce laden meal.
My weight on Monday morning after 2 weeks on my diet was 141.2. This was a loss of scale weight of 6.8 pounds, but because I was eating less than 20 grams of carbs all week, I knew that a good 3 lbs or more of my weight loss was due to the loss of glycogen, which is the substance our body uses to store glucose in both our livers and our muscles. (Details about glycogen-related weight loss HERE.)
I had stopped taking my metformin in the middle of the first week as metformin does interesting things to glycogen and I wanted my diet trial to be cleaner. So after 10 days without metformin and 14 without carbs, I figured I'd probably flushed out as much glycogen as I was going to lose. In the past that was usually about 3 lbs.
Since glycogen comes back as soon as you raise your carbs I expected to see the 3 lbs come back within a few days after ending my diet and raising my carbs back to their usual level which is around 100 g a day.
I also expected that some of my weight loss was due to the fact that since I was eating so little to meet my caloric goal there was less weight of food in my stomach and gut. That too would come back.
Since this past Monday, I have started using metformin again and eating about 100 grams of carbs a day, while eating a maintenance diet. My glycogen is probably as refilled as it's going to get. My weight this morning was 144.6. This is almost exactly 2 lbs less than my average weight during the weeks before I started the diet.
This confirms that my nutritional calculator does a good job of predicting weight loss and, most importantly, that there is no "metabolic advantage" for me in eating a very low carb diet. I did not lose any more weight than would be predicted by caloric deficit.
Had I been in a study, however, my specious loss of 6.8 lbs might have made it look like there was an advantage to eating a very low carb diet since low fat diets don't always flush out glycogen and the food may weigh more.
Unfortunately, it looks like, as usual, the weight came off my face and neck which look more wrinkly and stringy than usual. My tummy, which is the only place I carry significant amounts of subcutaneous fat, doesn't seem any smaller. The Tanita readings are fluctuating so much that I'll have to wait another week or so to see if they show any substantive loss of body fat percentage.
Blood Pressure
My two week diet was designed to be low in salt, because it is too easy to eat a lot of salt while eating a classic LC diet and I have issues with my blood pressure. I bought low salt cold cuts without preservatives at Trader Joe's and stuck with cheeses that were lower in salt, too. No pork rinds or other salty low carb snacks!
My blood pressure was all over the place during my diet, high and normal an then high again. When I started to cautiously supplement with potassium chloride (in the form of Morton's Not Salt) it dropped to completely normal and stayed that way for the last few days of the diet.
I was supplementing with the potassium because I get leg cramps and palpitations when I eat very low carb without potassium. This is because flushing out glycogen also triggers a loss of potassium. (This loss is measured in some studies as a rough gauge of how much glycogen has been lost.)
My lab results from last Wednesday when my blood pressure was 122/73 showed that my blood sodium level was at the very bottom of the normal range and potassium was in the middle of the normal range. This was reassuring, as I had a concern that the Captopril I take might cause my potassium levels to rise too high. I was not dehydrated, based on my normal BUN. In the past when eating LC I have almost always had a high BUN. Controlling protein might have helped there as did the potassium.
When I ended my diet and went back to eating normally, my blood pressure soared. As a further experiment I went back to supplementing with potassium, thanks to the suggestion one of you sent me, and today my blood pressure is back to being normal, at 114/74, as opposed to the 151/92 it was three days ago.
Since I had a lot of trouble with very high blood pressure while eating a very low carb diet in the past--the exact opposite of what the LC gurus claim happens--I'm starting to think that BP for me is all about those potassium levels. Low carb diets can be very high in sodium and potassium deficient, and that may be why I had so much trouble with blood pressure eating a long-term low carb diet.
Blood Sugar
My blood sugars had continued to be beautiful--in the 70s and low 80s at all times. So it was daunting to discover that the lab said my blood sugar was 92 mg/dl when my meter said it was 83 mg/dl. This means that the FreeStyle Lite meter that my insurer forces me to use reads low. So it's probable that my 70s were really 80s and 80s were 90s. It also means my occasional 140s were probably really 150s.
My A1c was 5.5%, which is .2% lower than usual. Some of the drop is due to the low carbing I'd done during the previous 2 weeks. Though doctors think that the A1c reflects the control of the last 3 months, this is not entirely true. The A1c most strongly reflects the blood sugar control during the previous 2 weeks, with the rest of the past experience only making a smaller contribution.
My A1cs are always higher than predicted by my average meter readings, and this one is no different. I attribute this to the likelihood that my red blood cells are living longer than average which will raise how much glucose has become bonded to them. It is that, not actual blood sugar levels, that the A1c measures.
Mood and Energy
By the end of my diet I felt like absolute crap. I wasn't sleeping well and was having the vibrant dreams that happen early on in a ketogenic diet, but there was no sign of the energy burst I usually experience at that phase of an low carb diet. This may be a result of how low my calories had to be for me to lose weight.
Whatever the explanation, I felt exhausted and depressed, and just walking around was a challenge. As soon as my diet was complete and I raised my carbs back to their usual level I felt like my old self with much better energy.
I was very hungry throughout the last week, too, even though my fat intake was reasonably high and my blood sugars completely flat.
Because my blood sugars are very well controlled right now I did not get into binging once I stopped my diet and started eating carbs again. In fact, I had a couple days when I was very busy with a new project over the past few days where I didn't end up eating all that much. This verified my belief that, for me, when I am eating carbs, hunger is entirely about how high my blood sugars surge. Right now they aren't surging very high even when I eat 20-30 g of carbs per meal, so I'm not experiencing blood sugar-caused hunger.
In the past eating a very low carb diet for a few weeks has given me decent energy and no hunger, but I wasn't limiting calories. However, throughout the past 5 years when I've done a very low carb diet not counting calories, I haven't lost an ounce of real weight.
Miscellaneous Observations
I ended up having a lot of heartburn on this diet. Peanut butter and Greek yogurt both caused it. Cheese did not (ruling out that I'm sensitive to dairy, per se.) When I went back to eating gluten at the end of the diet I did not experience heartburn. There doesn't seem to be any reason for me to go gluten free.
Conclusions
Calories count. My nutritional calculator is pretty accurate. It is extremely hard to find low carb foods that meet the caloric target I have to hit to lose weight without boosting protein too high.
This diet confirmed that for me to lose any weight at my age (64) and size (5' 3 and 144 lbs) I'd have to eat no more than 1250 calories a day to lose 2 lbs a month, even on a low carb diet, which for me would be an unsustainable starvation diet.
So my conclusion is that my weight loss diet days are over and that now that I'm heading into my misnamed "golden years" I better get used to carrying a bit more weight because the alternative is a starvation lifestyle.
Fortunately, there is a solid body of research suggesting that the healthiest weight for people my age and older skews towards the "overweight" category (BMI of 25 and a bit higher).
What this may mean for you is that the time to lose weight is when you are in your 30s, 40s, and 50s, when you burn more calories just breathing and walking around. Our metabolic rate drops with each decade we survive--even with exercise--so it gets tougher to lose weight as we get older.
Low carb diets are very effective for people with a lot of weight to lose whose caloric needs are much higher, but their main advantage in respect to weight loss is that when people cut out carbs they cut out all the high caloric junk that is what caused them to gain weight in the first place. If you control protein it becomes much tougher to overeat on a low carb diet, too.
The true virtue of low carb diets is, of course, that they control blood sugar very well. If my current blood sugar-control regimen stops working, I know that cutting back on carbs will drop my blood sugar (as long as I have functional beta cells, which fortunately, seems to be the case.)
Comments?
NOTE: In response to a point brought up in one of the comments it's worth noting that after Thanksgiving I did 10 days of a classic "Don't count anything but carbs" diet. In contrast to what happened with the calorie controlled low carb diet described above, I lost a grand total of 2 lbs during the "all you can eat" LC diet which came back when I raised carbs out of the ketogenic range. I was spilling urinary ketones from day 3 to day 10. Blood sugar and blood pressure were normal on that diet (after a rocky first few days for the blood pressure, again) but as has been the case for me for the past 5 years, a ketogenic low carb diet without caloric restriction is worthless for weight loss.
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* I used the body fat percentage my Tanita scale provides when using the calculator to estimate intake. If I omitted the body fat percentage, the calculator would tell me that I would have to eat a starvation diet to lose 1 lb a week, which it won't provide numbers for.
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