Intrigued by a theme I'm noticing on here re: low carb diets in the US [Archive]

blonde kiddo

09-27-2007, 03:42 AM

Cyborg

09-27-2007, 03:57 AM

Personal experience shows that eating carbs have the largest impact on bg. It's only common sense to realize eating foods that affect the bg less requires less insulin and less associated issues (large bg swings, etc.)

JediSkipdogg

09-27-2007, 04:00 AM

The only theory for low carb is for type 2s. I'm not sure how treatment over there is for a type 2 compared to the US, but most start on diet and exercise. The diet consists of lowering carb intake as much as possible so that the body doesn't have to produce as much insulin. If diet doesn't work, then medicines are added which either inhibit the production of glucose by the liver or the ingestion of carbs in the intestional tract.

Now, there is a theory for type 1s in the US that lower carb is better. Carbs are what cause the BG to rise. And with ONLY insulin, carbs will make your BG peak before it returns to normal/a safe level. Therefore, the old theory is to eat as few carbs as possible....until now.

You may wonder, well, why aren't all people (non diabetics) that way then if they eat carbs. So shouldn't they be on a low carb diet to so they may live longer and not have harmful high BG rises. Well, not until recently was there a drug to take care of that. When a diabetic stops producing insulin, they are stop producing Amylin. Amylin is a product of the body that helps to reduce the peaks from food intake. It works along with insulin so the food doesn't have as much of an effect on the body. Sometime in early 2006 (I think) they created Symlin, which is the synthetic form of Amylin. Now, a diabetic should be able to truely eat what they want without the high peaks from food. Therefore they can maintain a BG pattern as close to a non-diabetic. Of course though, like all drugs, it doesn't work for everyone the same way. So some people may not have that option and some don't want to inject another shot, as Symlin has to be a seperate shot injected with each meal.

I hope that helps some.

shabbie6247

09-27-2007, 04:03 AM

Hi everyone,

As a Brit reading and using this forum I am very intrigued by a theme I seem to be noticing on here regarding the treatment of diabetes in the US. The impression I get over what is advocated in the US is that a diabetic diet should be a low carb diet? But this doesn't seem to be so for diabetics in Britain. On the contrary it seems the emphasis in the UK (for type 1's at least) is on being able to adjust carb intake, to the patient's liking, in programmes such as DAFNE. I wondered if the low carb ideal in the US (if it really does exist) is merely down to Dr. Bernstein or whether there's any research out there suggesting low carb diet can improve long term diabetic control?

Comments from both sides of the Atlantic appreciated!

Sarah

hi sarah,
good thread ;)

its my belief and experience that the uk diabetics arent as well educated as our US friends.
i have noticed that uk diabetics are expected to magically reduce blood sugars and keep an A1c hovering around 7%, but unless you are lucky enough to get onto a DAPHNE course, you wont get any further help. the dietitian only tells you to eat a third of your diet in carbs, and unless you know to ask about carb counting you wont get any help there either.
~ now dont get me wrong my healthcare team are pretty good, and let me get on with my own management. the D nurse told me that i am an exception at the hopsital clinic with an A1c of 6.2 ~ apparently this is unheard of here!

re: your carb counting question, i find my Bgs are much more stable if i confine my carb intake to under 50 grams per meal. (sorry to dedicated low carbers!) so while im not a true low carber i will always select lower carb for my meals. evening meals give me the most trouble BG's-wise so i choose not to eat what i call 'hard-carbs' ie bread, pasta, rice, potatoes. i fill up instead on veggies and proteins. seems to do the trick for me anyways ;)

someone pointed out the other day that the uk information is more about glycemic index and glycemic loading (how much a given food raises your BG and how long it lasts)

REDLAN

09-27-2007, 05:35 AM

I'm unconvinced of the low carb argument for type 1's.

I believe we had a very unscientific poll on here a while back about carb intake and A1c results - I believe the poster was hoping to show that type 1 low-carbers had better A1c's than high carbers, thereby proving Cyborg's contention.

However there were a significant number of posters with high carb diets (250 grams plus) who had achieved lower A1c's than the low carbers who posted.

I think that what matters for good control is accurately matching your insulin requirements for your food intake. And some people find this easier with a low carb diet.

me personally, I seem to do well on a high carb diet (my typical daily intake is around 250 grams). I need to eat at least 30grams at a sitting to actually have some carbs to inject against (my I:C ratios are fairly low).

As a side note - very low carb diets may be risky if you engage in strenuous exercise. Failure to replenish depleted glycogen afterwards has been responsible for several deaths. If your liver's supply of glycogen is depleted then a night time hypo can be very risky, as your liver is unable to respond to the hypo and raise your blood sugar.

I regularly engage in strenuous activity - and I eat a lot of carbs when I do so - my daily intake can rise as high as 400g on my cycle days.

xMenace

09-27-2007, 05:45 AM

The natural tendency is to lower BGs by lowering carbs. If that means cutting them out altogether, so be it. In reality I think low carbers are unecessarily missing out on important dietary components as well as the enjoyment of foods.

I readily admit that we as a society eat too many carbs and too many of the wrong types of carbs. A recent show on CNN suggested that over 60% of the average US resident's carb sources were derived from corn. The health implications of this are just plain scary. We do all need to eat a variety of healthy carbs in much lower quantities, but we do need to eat them. They provide the energy we need to function. I don't for a minute believe extreme low carbers are healthy, happy, or productive.

As for type 1's, we cannot eat everything despite what some claim. Lowering carbs and eating more complex ones is just as important for us. Personally I can't handle any more than 40g at breakfast, and I can only do that with pre-bolusing. When I eat a large meal or fast acting carbs, I know keeping my BGs in check will eb a challenge. Every additional carb increases the variances in my numbers. Eating like the typical non-diabetic is also at least risking cardiovascular and obesity complications plus the usual diabetic ones.

I've come up with thre predominant reasons for (extreme) low carbing by type 2's: fear, guilt, and lack of education.

Most type 2's I've observed maintain an inherent fear of both complications and injections and a guilt associated with increasing medications. The fear I can understand, it is a very powerful force. It can be overwhelming. It can and does drive people into radical dietary choices. We see evidence here on DF all the time.

Don't ever think us type 1's don't fear the future. Most of us have regular thoughts about our futures, and it does affect us and our decisions too. The needles I have little sympathy for. Suck it up princesses! When you start getting 3" needles poked into your eye sockets, I'll start to listen.

The guilt I can understand from experience. I always felt guilty my BGs were off. I still do. It's a powerful force. IMO avoiding this guilt is a big reason for low carbing. Type 2's often feel guilty about having to take more meds or go on insulin. Type 2's will almost all progress. There's no stopping it. It doesn't depend on your decisions. There is no need to feel guilty. There is nothing wrong with increasing your meds or going on insulin. The disease is advancing and you'll need to go there anyway. Why torture yourself?

I'm not a type 2, so I can only speculate on what training they get. My observation, and I've talked and chatted with many and I've hung around the DE centre many times, is that training can be different from town to town and country to country. I do know that their training is no where near sufficient. People in my local support group have almost no clue what this disease is about. All they know is they should test a few times a day and watch their diets. Jesus H. Christ some of these have been D for several years and don't even see a doctor! Us long termers that have read dozens of books, have been to training classes every decade or so, ask our doctors questions until we get thrown out of their offices, and who live on the net seeking answers MIGHT be educated enough. I still fall down once in awhile, and it's not ****ing pretty when I do. Basically there are too many diabetics and not enough DE's, and the information we get does not stay with us. I think we need regular, ongoing support. DF anyone?

I don't ever want to riducule peoples choices, that's not what this is about. We all make difficult choices daily, and they are life and death decisions. I have no problem with anyone deciding to low carb as long as they understand what they are doing and why. Information is power people. Seek it and make informed choices.

kgm0612

09-27-2007, 05:49 AM

My personal opinion is.......follow a diet that works for YOU and YOU alone. For me, it's low carbing and matching my insulin to it. My younger brother prefers a higher carb diet and is happy if his blood sugar is a bit higher than the norm two hours after eating.

Karen

cheryl

09-27-2007, 05:58 AM

Beautifully stated X-menace. That is how I feel, I do believe that the normal population is killing themselves with these high high carb diets..There are bad carbs...

I think some low carbers went from eating whatever to restricting even good carbs(LIKE FRUIT)......I cannot still for the life of me see how you take that out of a diet...I can see some types of fruit, but not all...

I have got to say when I did low carb it for a bit, you kind of can understand your body, what a lot or what I can suggest is to low carb it, get yourself in good control, then bring back healthy carbs, and see which one's you can and cannot tolerate.....

I was on low carb and I still ate my one fruit strawberries, because let me tell you there are barely any carbs in those suckers to sneeze at....then I started to add all the healthy carbs back.......a lot of fruit, ate potato's again, I even found healthy french fries, low carb tortilla wraps, low carb yoguart....Low carb soy milk.....and I find what bad foods, don't have a ton of bad **** in them.....so if I want to indulge, atleast I am not putting harmful harmful stuff in my body...

I consider myself lucky as to have this knowledge, The most important aspect is finding what works for you and that you are truly happy with what you do....If you are and your healthy then go for whatever makes you feel that way...

I guess I have my Nani(grandmother)in me I think she'd fall over dead with a heartattack if she heard people didn't eat fruit, I got her genes LOL>.....

Cheryl

Alice

09-27-2007, 11:10 AM

I agree that the US has become a country of "supersize" portions...of all foods, not just carbs. On the otherhand, I don't feel that someone who eats moderate carbs (I eat a healthy 2-3 servings a meal, sometimes more, sometimes less) is necessarily a "high-carber"...this is what bothers me about the carb debate. I think there is a middle ground.

I don't believe in the "more insulin" makes you more fat...as the author was pitching on Good Morning America this morning. But I know a few on this list do believe this. I think your body naturally produces what it needs to process carbs. I think Type I's take only the insulin they need to process carbs (obviously, it's very difficult to walk around with too much insulin in your body!)...Therefore, I just don't buy the excessive insulin production as a problem for weight loss. But that's my opinion, I'm happy others can disagree with me.

I also think that manufactured insulin is very different than natural insulin. Therefore, the sensitivity is different as well.

In summary, I think as long as you are treating your carb intake with the proper amount (and timing) of insulin, carbs should not be an major issue. For Type II', there seems to be a big resistance to medication, therefore, many hope (and some succeed?) to minimize carb intake.

I just don't care for the "low carb is best" mentality. There is a middle ground. There is also a need for more exercise to get the calories burned...and improve overall tissue health.

notme

09-27-2007, 01:00 PM

I think this really is a question seperated by the type of diabetes you are treating. I do believe that type two's have to follow a stricter carb intake and match it with meds and exercise. I think it is also an issue of "know your carbs". Some carbs, (many times it is carbs added with fats or simple sugar) can drive your blood glucose out of range and it is hard to recover. That is a much tougher issue for type two's since they cannot do an insulin correction.

People with type one diabetes have to know their carbs, but have an easier time treating more complex carbs. Once you figure out your food (like pizza or Chinese food) you can make those adjustments with insulin.

Simple answers like a percentage of daily intake or carb counting doesn't work for anyone. Sadly, it is a lot more complex depending on the food, your insulin sensitivity or resistance and activity level.

I think the people on the boards realize the complexity of this question and that is why we get such a variety of answers.

I am one of the people that do believe, the more insulin you take, the more weight gain is possible. I live it. :( I also believe in moderate carb intake.

rzrbks

09-27-2007, 01:40 PM

Point 1. Many people in the US have a sick and unnatural fear of Education and Expertise so they go hunting for anything that Does Not include Experts and is NEW, different and makes them feel special.

Point 2.That is why the Institute of Medicine (IOM), part of the National Academy of Sciences, recently issued a recommendation that children and adults get a minimum of 130 grams of carbohydrate a day to maintain maximum brain function. >>>perhaps # 2 explains #1<<<

Point 3. The only research I've been able to find on Low Carb + Diabetes is either Type 2 and weight loss related or is such a small sampe as to be worthless or nearly so--10 people, 18 people, 27 people-- coupled with the fact that their trial period is so short the results are again, very questionable.

Point 4. Medicine is an Art, what works for BillyJimBob, doesn't necessarily work for JimBillyBob without tinkering designed for their individual systems

Conclusion You and your Dr./Health Care Provider have to work out what best for YOU and don't listen to the latest Doofus to buy a computer with a good word processing program and the need to make a Gazillion bucks.

BlueSky

09-27-2007, 01:48 PM

.... it seems the emphasis in the UK (for type 1's at least) is on being able to adjust carb intake, to the patient's liking, in programmes such as DAFNE. ...

DAFNE is essentially a type 1 control methodology, based on the intensive therapy paradigm. As such, it does not address the needs of 95% of the people out there who are trying to control their blood glucose - all the T2s. The DAFNE "like what youeat ... eat what you like" motto also pre-supposes that all T1 diabetics respond to insulin in a similarly consistent fashion. While this may be true for most of them, it is certainly not the case for all of them. A lot of us (like me and cyborg) have some degree of insulin resistance. It changes the way we respond to insulin and reducing carbo intake is a much more important tool for achieving satisfactory control.

There is a growing awareness that perhaps eating what we like, or what is easily available, may not be such a good idea. Even for T1s. People like Bernstein and Eades probably have had a lot to do with this. And their ideas are becoming more acceptable as the realisation that there is nothing wrong with getting most of our energy from fat, gains momentum.

The UK establishment may be some way from accepting this position. But so is the American medical establishment. The difference, I guess, is that dissenters in the US are more vocal and have attracted a more enthusiastic following. The popularity of low-carb eating is being driven by rapidly increasing numbers of frustrated T2 sufferers who are looking for more effective treatment options. The number of people in this situation has been boosted by more stringent diagnostic benchmarks and the enormous amount of publicity T2 diabetes has been getting.

rzrbks

09-27-2007, 01:59 PM

I guess, is that dissenters in the US are more vocal and have attracted a more enthusiastic following. The popularity of low-carb eating is being driven by rapidly increasing numbers of frustrated T2 sufferers who are looking for more effective treatment options.

I know what I want and I want it NOW-------btw, it'd better fun, easy and painless.

NoelD

09-27-2007, 02:01 PM

Low carbing made a big impact on my A1C and over all BG's, regardless of what anyone says.

Merry

09-27-2007, 02:56 PM

For my type 2, I have to take meds, go walk a couple of times a day, and distribute my carb intake into three or four meals and a couple of snacks. Anything else and the blood glucose level goes up, and I get on a see-saw of up and down, feeling out of sorts. I do not know about everybody else.

I went to a class a few years ago the they advised diabetics to get on a schedule, take meds, walk, and write down what they eat and how much they walk/swim/bike for a while until they learn to deal with their own condition. Sometimes meds will change. I think it is a personal thing. Fast food is something that has to be watched. But that is changing, and there are a variety of foods to get at fast food places now, and it is becoming easier to remain fed and sane.:D

Alice

09-27-2007, 04:21 PM

I'll throw this out to the "low carbers"...what exactly do you consider "low"? I'm not seeing a big difference in eating a few healthy carb servings and "low carbing"...or are you talking about eliminating carbs?

I think when someone says they eat "low carb" it would help if they quantify what works for them. We all take different insulin ratios and different carb amounts will vary by person as well. I don't consider this "eating whatever I want"...I consider it eating a planned amount...whatever amount.

I'm not clear on what is meant by "low carb"...too vague and that's what bothers me about the debate. (Friendly debate, of course!)

Wildbill

09-27-2007, 04:32 PM

Along these same lines of thought, do any members have comments about Dr. Ron Rosedale?

Alice

09-27-2007, 04:45 PM

I am not familiar with him..so did a quick google. I'm immediately distrustful of anyone selling "supplements". Sorry, but I find the credibility drops in my book! Too many people taking money from diabetics...just my opinion...but I didn't spend more than 15 seconds with the web page open.

notme

09-27-2007, 04:49 PM

I eat approximately 45 carbs at breakfast and lunch, sometimes a bit more at dinner. I consider this moderate.

Very good question.

Trinifar

09-27-2007, 04:54 PM

I too am not sure we all mean the same thing by "low carb." To me, the way I eat now is much lower carb than what I did pre-dx, and it's had a pretty dramatic effect on my BG level's. But I'm one of those who's never met a carb they didn't like, so perhaps I'm just eating a typical "recommended diet" now rather than lots of potatoes, rice, pasta, etc as in the past. My DE says 2 to 3 servings of carbs per meal, a snack between meals, and always get some fruit. I've found if I keep it to 2 servings of carbs per meal I do well on BG. Went from 8.6 A1C to 7.7 in 3 weeks.

(Oh, I'm an American.)

Alice

09-27-2007, 05:30 PM

Well, I try to drink 3-4 glasses of milk a day...so, there's a carb serving for me at most meals...really, more for snacks. I like milk and it's good for my bones! (Low fat or skim...depending on the dairies where I live!)

BlueSky

09-27-2007, 05:51 PM

....what exactly do you consider "low"? I'm not seeing a big difference in eating a few healthy carb servings and "low carbing"...or are you talking about eliminating carbs?....
Strictly speaking, the term "low carb" means restricting carbo consumption to the point where ketosis occurs. Fat becomes a major source of energy and keytones appear in the urine. Usually, it means eating less than 50 grams of carbohydrate a day.

Blood sugar levels can often be stabilised with a more modest reduction in carbs. But eating much more than 50 grams of carb a day means that you may miss out on the other low-carb benefits - disapearance of carb cravings, reduced hunger, improved energy levels, and sleeping better.

cheryl

09-27-2007, 06:12 PM

BlueSky

09-27-2007, 06:38 PM

.....I don't ... think it is wise for anyone to not eat fruit. It is a natural cleanser, your asking for extreme colon issue's eek, not cool....

Sorry I can't let it go...I am fine with the less then 50 carbs a day, but darn man that's why there are strawberries...
Cheryl,

The only reason to avoid fruit is because of the carbo in it. In terms of low-carbing, you can eat whatever you like, as long as it fits into the carb limit. Which is why low-carbers limit themselves to fruit that contains minimal amounts of fructose. Like berries and melons. Strawberries are good...

Fruit contains vitamins and phyto nutrients that are good for you. But sweet fruits also contain lots of that nasty fructose. So low-carbers get most of their fibre, vitamins and phyto nutrients from salads and vegetables. These foods contain little, if any, sugar and are a lot more healthy than sweet fruit. Especially for a diabetic.

matingara

09-27-2007, 09:39 PM

I have known about my Type 2 diabetes for nearly three months now.

I got the Bernstein book 2 months ago.

i have REDUCED my carb intake - but i am not a low carb'r. I have 0-20g carbs at breakfast, 20-30g at lunch, probably another 20 grams in snacks (nuts mostly at the moment) and 30-50 g at suppertime. (i seem to do best in the evening and i can even eat real cake and real ice cream).

My blood sugars are averaging around 6.0 (108) now. my bad cholesterol is tiny and for the first time in my adult life my triglycerides are normal (low even).

my doc says that if my a1c goes below 6.0% i can come off my half dose of Diamicron MR. according to my calcs my bgl averages indicate i may get to an a1c of 5.3-5.5 (gee i HOPE my calcs are right!!!).

So REDUCED carbing (not low carbing) certainly seems to work for me.

BTW: my doc approves of my low carbing! My diabetes educator DOES NOT approve of it. she wants me to eat more carbs and treat my sugars with more meds if necessary! i'll go with my GP's advice for the moment.

:)

-- Joel.

matingara

09-27-2007, 09:50 PM

I still don't agree in eating a big darn steak or cheese or tons of nuts over fruit....I am still not over this one....or fish or like chicken or turkey or whatever fat slash protien one might consume, and what the heck is still wrong with strawberries 6 medium one's have 4 carbs so like eat three and eat your loads of fat with but people please eat some fruit.....I don't or really really don't think it is wise for anyone to not eat fruit. It is a natural cleanser, your asking for extreme colon issue's eek, not cool....

Sorry I can't let it go...I am fine with the less then 50 carbs a day, but darn man that's why there are strawberries...

Cheryl

i can live with reduced fruit intake and i carefully restrict how often and how much fruit i eat. i do love all berries and all melons.

HOWEVER, i adore and have always adored salads and vegetables (especially raw veggies). So, i now have an excuse to have salads (that include alot of broccoli and cauliflower and cabbage) whenever i want! if a salad is made with a well made vinaigrette it is Ambrosia to me.

-- Joel.

shabbie6247

09-28-2007, 03:04 AM

I'll throw this out to the "low carbers"...what exactly do you consider "low"? I'm not seeing a big difference in eating a few healthy carb servings and "low carbing"...or are you talking about eliminating carbs?

To me, the way I eat now is much lower carb than what I did pre-dx, and it's had a pretty dramatic effect on my BG level's. But I'm one of those who's never met a carb they didn't like, so perhaps I'm just eating a typical "recommended diet" now rather than lots of potatoes, rice, pasta, etc as in the past.

im with trinifar, in that my carb intake is now considerably less than it was pre-diagnosis. back then i could eat an evening meal with 250 grams of carbs in it no problemo ~ pasta made up my staple every evening meal and stacks of bread for lunches and snacks.

my decision to lower my carbs was purely based on my own bodies reaction to higher carb intake especially in the evenings. for instance if i was to eat a 250g meal with all the breads or rice with it even though i bolused for it i would have higher readings through all of the next day. i like to feel well so lower carb for me is the way forward, i still get to eat lots of yummies and dont feel like im missing anything out of my diet at all.

cheryl

09-28-2007, 05:13 AM

I was getting nervous there, I don't eat a ton of fruit either, I do avoid grapes, and banana's and and oranges, since they spike me too bad to bother with it....

I was just hoping some of you ate at least something LOL......that contained fruit.....

Cheryl

DeusXM

09-28-2007, 05:17 AM

Back on the original topic...

Personally I think the reason low-carb diets have more adherants in the US than in the UK (or indeed, anywhere else) is less to do with 'the NHS doesn't teach enough people in Britain about treating diabetes' and has far more to do with the cultural differences.

From my (admittedly limited) experience of America and Americans, I'd say that there's a certain bit of Calvinist thinking that pervades almost every aspect of American lives - namely, the idea that you alone as an individual are responsible for whatever happens to you.

Now I'm not saying that everyone in Britain is part of some collective hive mind; I'm just saying that Americans tend to have a belief, deep down, that they are the sole masters of their destiny, and that people in Britain probably feel more affected by broad trends.

Regardless of the merits of either position, it does mean that we approach things in different ways. If you're more comfortable with the idea of the collective then you're probably more comfortable with the idea that there are a wide variety of factors affecting any one outcome. So in Britain, most people probably don't think someone is fat because they eat too much of one food type; it's because they eat a general unhealthy diet and don't do any exercise. Whereas, Americans, because they're more used to seeing things in individualist terms, seem to be happier with identifying one particular cause - so in America, you're probably fat because you eat too many carbs or because there's MSG in the food.

Americans also seem to have a very different relationship with brands than us Brits too. You guys seem to be much happier namechecking very specific brands and are much more 'brand aware' to the point it seems that unbranded things (like say, tap water) end up being alien concepts. Yet you're also far, far more suspicious of corporations - presumably because since they're run by individuals out to make their own success, it's easier for you to understand how they could try to screw you. So of course then you get all the usual scare stories that aspartame causes cancer, MSG is the root of all evil and carbs are the four horsemen of the apocalypse.

So that's why I think low-carb diets (which are essentially based on the idea that someone is trying to screw you and there's only one cause of a problem) do better in America than in Britain. Britons aren't very good at appreciating the role of individual things and are better at seeing things holistically, whereas Americans aren't very good at appreciating how things all work together but are very good at understanding the nuts and bolts.

This is also probably the same reason why any specific sort of diet seems to work better in America and probably also explains a lot of other difference - from what I've seen on this board, Americans generally take far more prescription drugs, more vitamin supplements, drink bottled water and eat prepackaged food and eat out at restaurants more frequently than us Brits. I would suggest that the reasons for each of these behaviours is interlinked.

And I'm really looking forward to getting flamed for saying all that too, despite the fact I'm not attaching any value judgements to either side.

Alice

09-28-2007, 06:00 AM

I think Americans are more prone to fad diets as well. Adkins (which is basically what Bluesky is describing) is not something I could live with, or would want to live with. But if it works for some people, that's fine. I just think that if you are altering your diet to the point of ketones...that's too extreme and in my opinion, unnessary.

Like most have said, any diabetic working toward good number has most likely reduced their carb intake from pre-diabetic years. Those of us on insulin have more flexibility but still count the carbs and in my case, the calories.

Yes, I eat fruit. I eat bread. I eat pasta. I drink milk. I still can lose weight eating carbs...it's the overall calorie count that matters.

I worry that many type II's avoid medication in the hopes that low-carbing is a permanent solution. Your body still produces glucose and your basal (non-food) glucose must be covered. You are most likely producing enough insulin naturally, at least in the beginning, to cover basal. So, low-carbing will work for a while. I'm not convinced it will work permanently.

I was on Weight Watchers and ate extremely low-carb (yes, they're allowed, but the points are counted just like carbs)...I of course lost weight...not due to the lack of carbs, but due to the reduction of calories. So, I don't feel carbs/insulin are a sole reason for weight gain. If I reduce carbs, I reduce insulin. But, the calories are reduced...resulting in weight loss.

I just didn't write a book and make millions like all these authors that pop up on a daily basis in the U.S.

shabbie6247

09-28-2007, 06:26 AM

i agree with deus's argument/comments, but wonder if the british culture is more a result of 'nanny state' herding and not taking responsibilty for oneself. the majority of the british population will use the phrase "there weren't any signs" as an excuse for doing or not doing something

........................Now I'm not saying that everyone in Britain is part of some collective hive mind; I'm just saying that Americans tend to have a belief, deep down, that they are the sole masters of their destiny, and that people in Britain probably feel more affected by broad trends.......

Trinifar

09-28-2007, 08:52 AM

From my (admittedly limited) experience of America and Americans, I'd say that there's a certain bit of Calvinist thinking that pervades almost every aspect of American lives - namely, the idea that you alone as an individual are responsible for whatever happens to you.

Well, as an American with several years experience working in the UK, I think you are spot on. Sure, it's a generalization, but one that more or less fits.

cheryl

09-28-2007, 09:31 AM

God I wish I was that American you talked about LOL.....I'd love to eat out at resteraunts all the time, and I would love to get brand name stuff....and I don't take no scripts except insulin, and I don't take supplements...

I am joking....Just thought wow this must apply to the Americans that are worth talking about the middle and upper class ones....they are the one's that obviously count in a lot discussion....

Cheryl

Lloyd

09-28-2007, 10:49 AM

Lower carb intake has one inherent advantage for anyone on insulin. A 10% error in figuring a bolus matters little if you are eating a 10 carbohydrate breakfast, but if you have a 100 carb meal a 10% error is fairly significant.

-Lloyd

DeusXM

09-29-2007, 12:41 AM

i agree with deus's argument/comments, but wonder if the british culture is more a result of 'nanny state' herding and not taking responsibilty for oneself.

Hmm...I'm not so sure about that. When it comes to responsibility, we don't really have the litigation culture that they do in the US. In fact, that kind of thing fits in perfectly with the rugged individualism theory - you sue the tobacco company or MacDonald's or whoever because they did something to interfere with your own individual pursuit at success. These things don't really happen that often in the UK or Europe because we've always been more about a group identity and historically up until about 150 years ago most people didn't really have any control over the direction of their lives here.

I just didn't write a book and make millions like all these authors that pop up on a daily basis in the U.S.

Well, this is the other thing. The US has a culture designed to enable entrepreneurs to enjoy success. If you have a good idea, you can sell it and create your own success. There isn't really the same cultural encouragement in the UK or Europe.

kidvid

09-29-2007, 03:57 AM

I think Lloyd is spot on. If I reduce the volume of insulin I take ( because I ate fewer carbs) the risk of a hypo is less. For me it's very important to reduce the chance of insulin resistance and hypoglycemic unawareness (or catastrophic hypos) over the course of my lifetime. A catastrophic hypo and I lose my job, or my life. Either case sucks. I lose my job and I lose my insurance.
Lower carb intake has one inherent advantage for anyone on insulin. A 10% error in figuring a bolus matters little if you are eating a 10 carbohydrate breakfast, but if you have a 100 carb meal a 10% error is fairly significant.

-Lloyd

cheryl

09-29-2007, 06:06 AM

I think Lloyd is spot on. If I reduce the volume of insulin I take ( because I ate fewer carbs) the risk of a hypo is less. For me it's very important to reduce the chance of insulin resistance and hypoglycemic unawareness (or catastrophic hypos) over the course of my lifetime. A catastrophic hypo and I lose my job, or my life. Either case sucks. I lose my job and I lose my insurance.

But that's why you have options, some just want the diabetes to magically work without the work in figuring how to have high carbs. If you want a 100 carbs in one meal Either A don't take all the insulin all at once B, eat a tad more fast acting carbs, C this is why if your on the pump, you got the pump.....you can manage if you figure it out....

Cheryl

dbc

10-01-2007, 12:31 AM

DeusXM

10-01-2007, 12:50 AM

Agreed. In my book, this is the most convincing argument for a low/restricted carb way of eating.

In my book, it's the most convincing argument for getting it right in the first place.

An error margin with a normal carb diet usually results either in mild hypoglycaemia or mild hyperglycaemia.

An error margin with a low/no-carb diet usually results in severe hypoglycaemia.

BlueSky

10-01-2007, 01:29 AM

... An error margin with a low/no-carb diet usually results in severe hypoglycaemia.
How does taking smaller shots of insulin result in more severe hypoglycemia?

shabbie6247

10-01-2007, 02:15 AM

interesting arguments.

i wonder if anyone has calculated how many carbs they actually NEED based on calorific value? whether over-weight or trying to gain weight? or indeed to just maintain a healthy weight?

i calculated mine backwards just to see and i seem to be inputting just the right amount of calories for my sedentary office job and age group (i am of average weight), which was very interesting.

BlueSky

10-01-2007, 02:59 AM

.... i wonder if anyone has calculated how many carbs they actually NEED based on calorific value? whether over-weight or trying to gain weight? or indeed to just maintain a healthy weight?....
I have worked out that I need about 1800 calories a day to maintain body weight. And yes, I worked it out backwards too. I figured out how much I need to eat to keep my weight stable, and then worked out its calorific value.

When it comes to maintaining weight, it really doesn't matter where the calories come from - fat, protein or carbs. I don't need to get any calories from carbo. The less the better. Fat is a far more suitable source of calories for a diabetic. I only eat carbs because it gives me access to vitamins and phyto nutrients in salads, fruit and vegetables.

mho357

10-01-2007, 03:41 AM

What formula did you use to work it out backwards? Did you add up the estimated calorie consumption for your daily activities or is there some other method?

Thanks,

Mark

DeusXM

10-01-2007, 05:43 AM

How does taking smaller shots of insulin result in more severe hypoglycemia?

Simple. The overall volume of the insulin you inject doesn't affect your chance of hypoglycaemia. The overall volume of insulin in relation to your food intake does.

Say you you're on a 1:10 ratio for insulin and you eat 100g of carbs. So you take 10u. Now say that there is another factor potentially affecting your insulin ratios that day, so you're actually at say, 1:11. You will go low, but because we're talking about such a small change averaged out over a large volume, you won't drop like a stone. You may also find that the large amount of carb acts as a cushion anyway since it's sitting in your stomach and converting to glucose. It is also replenishing your liver's glycogen supplies. So in other words, you're very neatly set up to deal with the drop in blood sugar and you shouldn't drop too much.

Now let's repeat the same experiment with 10g of carbs. You will again go low, but here's the thing - you've got nothing left in your digestion to bring you out of it. The protein you may have eaten at that meal won't kick in for a while yet. Your liver is also probably running low on glycogen. So in other words, you've got no cushioning left in your system.

Simply put, an error margin of a few units when you're taking a larger amount of units isn't going to affect you that much, especially when you consider that insulin actually loses its efficiency at larger doses. An error margin of a few units when you're only taking a few units in the first place can be far more pronounced - hence why low-carbing can cause severe hypoglycaemia far more easily than a normal diet.

This is precisely why the old advice used to be to stuff yourself with carbs - there was a much greater fear of hypoglycaemia (since the dangers of a high calorie diet and high blood sugar weren't fully understood), and a diet high in carbs was recognised as making the error margins for low blood sugar less significant - indeed if you actually look at the literature from the time you will read the scientifically accurate assertion that starchy foods persist in releasing glucose for the entire duration of the insulin's presence in the body. The problem from a high carb diet comes from matching enough insulin to cope with this digestion, which is actually a lot harder than taking too much.

shabbie6247

10-01-2007, 09:25 AM

What formula did you use to work it out backwards? Did you add up the estimated calorie consumption for your daily activities or is there some other method?

Thanks,

Mark

i think it was a table in the "using insulin" book.

i started with my total average carbs per day turned it into calories then checked the table to find the correct calories i should be consuming.

am at work at the mo so havent got my book with me :(

perhaps one of the weight loss websites might have the info?

BlueSky

10-01-2007, 01:13 PM

... The overall volume of the insulin you inject doesn't affect your chance of hypoglycaemia. The overall volume of insulin in relation to your food intake does ....
Absolutely. As long as the the glycemic action of the food you eat is well matched with the action profile of the insulin you inject, it really doesn't matter how much carb you eat and insulin you inject. The problem is that this well matched situation is the exception, rather than the rule. It is why we find our blood glucose is typically either going up or going down and doesn't stay in the same place for very long. This is what Lloyd and dbc were commenting on in their earlier posts. The more insulin you use to cover carbs, based on your insulin:carb ratio, the greater the risk of a mismatch gets.

A recent study shows that the within-person variability in the glycemic index is 43%. That is a lot of variability! And variability in insulin absorption is about 25%. Adding these together gives you the potential worst-case scenario for a mismatch between the actions of food and correctly dosed insulin. Even if you have got the carb count right and applied the correct carb:insulin ratio, there could still be a whopping 68% mismatch, based on these two variables alone.

If you injected 10 units to cover 100 carbs, you could be out by as much as 6.8 units of insulin action (68% of 10 units). That is enough to cause a severe hypo, with rapidly falling BG, for someone with a 1:10 insulin/carb ratio.The usual pattern is a spike after the meal, followed by a hypo as the insulin gets to work, although with modern fast acting insulin, it often happens the other way round.

The chances of a severe hypo if you inject 1 unit to cover 10 carbs, on the other hand is very much smaller. You could be way out again, but it only amounts to 0.68 units of insulin action (68% of 1 unit). Blood glucose drops much more slowly and by not nearly as much.

Injecting insulin is a very crude tool for controlling blood glucose. Using a pump helps, but the same rule still applies. The less insulin is used (correctly dosed, of course) the better control becomes.

The glycogen issue, IMHO, is a bit of a red herring. It has never caused me any problems. And it didn't cause problems for communities that thrived for many thousands of years in austere conditions and a zero carb diet (the Inuit). We adapt to the food supply and liver glycogen stays topped up regardless of what we eat.

xMenace

10-01-2007, 01:42 PM

Therefore, the more insulin you take, the greater your chances of a hypo.

My personal experience bears that out.

xMenace

10-01-2007, 01:49 PM

In my book, it's the most convincing argument for getting it right in the first place.

An error margin with a normal carb diet usually results either in mild hypoglycaemia or mild hyperglycaemia.

An error margin with a low/no-carb diet usually results in severe hypoglycaemia.

In my experience

an error margin with a normal carb diet results in anything from extreme hypoglycaemia to extreme hyperglycaemia.

An error margin with a low/no-carb diet results in anything from mild hypoglycaemia to mild hyperglycaemia.

I do a lot of testing to verify my rates and patterns, I pay close attention to my site's absorption tendencies, and I try to accurately count my carbs. I still get extreme variances, but far fewer than in previous years.

DeusXM

10-02-2007, 02:07 AM

Hang on, let's play this fair now, shall we?

A recent study shows that the within-person variability in the glycemic index is 43%. That is a lot of variability! And variability in insulin absorption is about 25%. Adding these together gives you the potential worst-case scenario for a mismatch between the actions of food and correctly dosed insulin. Even if you have got the carb count right and applied the correct carb:insulin ratio, there could still be a whopping 68% mismatch, based on these two variables alone.

Then logically the same problems still apply at small doses. Say I'm eating 100g of carbs, take 20u and overshoot by 2u. I'll get mild hyperglycaemia. Now say you're eating 10g of carb, take 2u, and you overshoot by 1u. Your overshot is DOUBLE what you should have taken.

I'm not disagreeing that low-carbing makes you less likely to overshoot, but that when you do, you're actually going to overshoot in far more extreme way. You say yourself that injecting insulin is a very crude tool - and arguably we don't have a delivery method that lets you micromanage in the way that you need to with low-carbing. It's a bit like comparing a big statue with painting a tiny figurine, whilst using the same brush. Any mistakes you make are far more likely to show up when you're dealing with the smaller scale.

The glycogen issue, IMHO, is a bit of a red herring. It has never caused me any problems. And it didn't cause problems for communities that thrived for many thousands of years in austere conditions and a zero carb diet (the Inuit). We adapt to the food supply and liver glycogen stays topped up regardless of what we eat.

Oh now come on. Let's compare like with like, shall we? If you've just slated injecting insulin as a tool, you simply cannot compare people whose bodies automatically manage their insulin requirements with someone who has to do it manually. That's like arguing no-one with diabetes should ever go hypo because most people around the world don't. An Inuit's pancreas can deploy 0.002u of insulin if necessary. Yours can't, and neither can your pump or pen or syringe.

You cannot look at the lifestyle of non-diabetics and then say the rules must automatically apply for people with diabetes. Otherwise I could quite easily argue that I could stuff myself with carbs, since billions of people around the world do this every day and never suffer from hypo- or hyperglycaemia.

I don't mind debating this subject with you but I really would ask that you actually debate it fairly, instead of making comparisons with things that simply aren't relevant.

xMenace

10-02-2007, 04:48 AM

Then logically the same problems still apply at small doses. Say I'm eating 100g of carbs, take 20u and overshoot by 2u. I'll get mild hyperglycaemia. Now say you're eating 10g of carb, take 2u, and you overshoot by 1u. Your overshot is DOUBLE what you should have taken.

For example #1 the error rate is 10% (2u/20u) and for example #2 it's 50% (1u/2u). If you use the same error rates of 10%, then the risk in #2 is only .2u. The resulting hypo/hyper would not even be noticed.

Iy's interesting to consider what error rates are and how they might change with meal sizes. Maybe Brion can write a paper on this topic in his future studies ;)

I'm not disagreeing that low-carbing makes you less likely to overshoot, but that when you do, you're actually going to overshoot in far more extreme way. You say yourself that injecting insulin is a very crude tool - and arguably we don't have a delivery method that lets you micromanage in the way that you need to with low-carbing. It's a bit like comparing a big statue with painting a tiny figurine, whilst using the same brush. Any mistakes you make are far more likely to show up when you're dealing with the smaller scale.

Oh now come on. Let's compare like with like, shall we? If you've just slated injecting insulin as a tool, you simply cannot compare people whose bodies automatically manage their insulin requirements with someone who has to do it manually. That's like arguing no-one with diabetes should ever go hypo because most people around the world don't. An Inuit's pancreas can deploy 0.002u of insulin if necessary. Yours can't, and neither can your pump or pen or syringe.

You cannot look at the lifestyle of non-diabetics and then say the rules must automatically apply for people with diabetes. Otherwise I could quite easily argue that I could stuff myself with carbs, since billions of people around the world do this every day and never suffer from hypo- or hyperglycaemia.

I don't mind debating this subject with you but I really would ask that you actually debate it fairly, instead of making comparisons with things that simply aren't relevant.

Good point. Our therapy really only works within given parameters. There are definately carbohydrate constraints re quantity and complexity. Unfortunately, unlike a computer program, these values are at best vague and impacts not easily measurable.

DeusXM

10-02-2007, 08:56 AM

For example #1 the error rate is 10% (2u/20u) and for example #2 it's 50% (1u/2u). If you use the same error rates of 10%, then the risk in #2 is only .2u. The resulting hypo/hyper would not even be noticed.

Which is precisely my point. I would argue that a non-low carb diet will result in a more likely probability of an error than a low-carb diet, but when the error happens in a non-low carb diet, the overall magnitude of the error is less.

I would say that you are less likely overall to have hypos with a low-carb diet (provided everything is spot on), but when when you do have them, they are more significant because a)you are more likely to have a greater error margin and b)your body is not as well cushioned to protect itself from hypos.

For the record, from my own personal experience, I've found that low-carbing invariably causes frequent hypoglycaemia but I attribute this to me not setting my basal rates accordingly rather than anything inherantly wrong in the diet.

However this would then also suggest that fluctuations in basal rates will be more significant in those on low-carb diets, which then leads on to yet more possibilities of extremes from hypoglycaemia, this time caused by basal rather than bolus insulins.

Once again, for the record I've nothing against people selecting low-carb diets. However I do object to the belief that many low-carbers seem to hold that low-carbing is in fact superior to any other form of eating pattern. It's not. It's simply superior to the old advice of stuffing yourself with starch every 3 hours. It is just as plagued with problems as any other diet, and wilfully ignoring these problems is just plain intellectually dishonest. No dietary plan is perfect and I would strongly suggest that if someone argues that insulin injections are a crude and generally inaccurate method of treatment, it should not also be argued that a dietary method that seems to rely on insulin injections being exceptionally accurate is a sound one.

Simply put, you can't say insulin's crude and then advocate an eating plan that means you're dealing with anything less than whole units of insulin. This was precisely the rational behind the old system when insulins were even more inaccurate.

Alice

10-02-2007, 09:22 AM

I caution anyone reading these internet topics that you really need to talk to your own doctor. This isn't a time for self-diagnosis or the bending of "research" that really isn't research. (Is a book or supplement being sold?)

Insulin is a life-saving medicine. I refuse to follow the school of thought that it's "bad" for my body. Again, taking a micro sample of research out of context can twist a theory in any direction. I feel the same way about supplements that in truth, are trace elements in the body found naturally through foods (many carbs!)

Speaking of research (and we've had a lot mentioned on this topic!)...it would be helpful if the source of the study is included in the postings. "Studies have shown"...isn't going to sway my thinking on all these theories that pop up in articles and forums.

I hear a lot of people talking others out of their medication on this forum, and that is a concern for me. But, I'm not anyone's babysitter. I've just heard a lot of theories over the years. What hold's true for me is that diet is very individual. That insulin is a life-saving medication. And that diabetes is like a religion. There are those who go to both extremes of control.

I don't think anyone has found the cure yet. But a lot of people have gotten rich selling books and cinnamon capsules.