The Chinese Restaurant Effect

[MarkMunday]

There has been a lot of debate about how different foods affect do or don't affect blood sugar levels. Bernstein describes a process whereby low or no carb food can cause big blood sugar spikes if you eat a lot of it. He calls it the Chinese Restaurant Effect.

It may help you understand unpredictable results. And why we tend to underestimate carbs in large meals.

Cheers,

Mark


THE CHINESE RESTAURANT EFFECT
Many years ago a patient asked me why her blood sugar went from 90 mg/dl up to 300 mg/dl every afternoon after she went swimming. I asked what she ate before the swim. “Nothing, just a freebie,” she replied. As it turned out, the “freebie” was lettuce. When I asked her just how much lettuce she was eating before her swims, she replied, “A head.”

A head of lettuce contains about 10 grams of carbohydrate, which can raise a type 1 adult’s blood sugar about 50 mg/dl at most. So what accounts for the other 160 mg/dl rise in her blood sugar?

The explanation lies in what I call the Chinese restaurant effect. Often Chinese restaurant meals contain large amounts of protein or slow-acting, low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, that can make you feel full.

How can these low-carbohydrate foods affect blood sugar so dramatically?

The upper part of the small intestine contains cells that release hormones into the bloodstream when they are stretched, as after a meal. These hormones signal the pancreas to produce some insulin to prevent the blood sugar rise that might otherwise follow the digestion of a meal. Large meals will cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these hormones. Since a very small amount of insulin released by the pancreas can cause a large drop in blood sugar, the pancreas simultaneously produces the less potent hormone glucagon to offset the potential excess effect of the insulin. If you’re diabetic and deficient in producing insulin, you might not release insulin, but you will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something undigestible, such as sawdust.

The first lesson here is: Don’t stuff yourself. The second lesson is:
There’s no such thing as a freebie.* Any solid food that you eat can raise your blood sugar.

[Cyborg]

This truly is an interesting concept. Wonder why it was named the Chinese Restaurant Effect? They should have called it the Overeating Effect! That is very useful information. Another reason to eat smaller sized meals.

In fact, another one of the 7 things common to those that are successful in losing weight and keeping it off was to eat smaller meals and to eat an average of 5 times a day. So maybe when people over eat this is one of the contributing factors to diabetes...

[sydneya]

There has been a lot of debate about how different foods affect do or don't affect blood sugar levels. Bernstein describes a process whereby low or no carb food can cause big blood sugar spikes if you eat a lot of it. He calls it the Chinese Restaurant Effect.

It may help you understand unpredictable results. And why we tend to underestimate carbs in large meals.

Cheers,

Mark

::top: Okay, you have finally convinced me. I'm on the hunt for Bernstein's book. I hope his ideas are easy to implement. :argh: I seem to get started on something and get excited, then go through burnout. I can use some good A1Cs. Until I read the book, I'll just read your posts. Ever thought of just putting all those in book form and becoming a rich writer. (Your right, that is called plagarism--maybe not a good idea.)Thanks, Mark. I do appreciate your knowledge and sharing.

[msfez]

Hello Everyone.. I'm new here and just wanted to say I have been on a low carb diet for the past 2 years. I am a 50 year old type 1 female. In the past I had a lot of trouble with my blood sugar. Always too low or too high. Now my blood sugar is rarely over 100 and my last A1C was 6.2. Most of the time I have 15 to 20 carbs a day devided up in 3 meals and 2 snacks. It has worked well for me.:ciao:

[duck]

Mark,

Do you like the Bernstein book? I always thought he was something of a pariah in the field of diabetes, but I just broke down and ordered his book from Amazon...

[byu barry]

I was DXed a little over a year ago and I supposed most of you know what the newly Dxed go through (suppliments, reading, hoax cures etc.). I never try be a book pusher but his book was, by far, the best money I've spent thus far. Duck, I know your post was aimed at Mark but you've always come across as intelegent and knowlegable (humor as well) as to the diabetes condition and I look forward to your comments after you read the book.

[duck]

I was DXed a little over a year ago and I supposed most of you know what the newly Dxed go through (suppliments, reading, hoax cures etc.). I never try be a book pusher but his book was, by far, the best money I've spent thus far. Duck, I know your post was aimed at Mark but you've always come across as intelegent and knowlegable (humor as well) as to the diabetes condition and I look forward to your comments after you read the book.

From what I know about Bernstein, the American Diabetes Association basically loathes him because he is sooooo aggressive with his blood-sugar goals. From what I can tell, he states he is under 100 almost all day long with no hypos. <--that freaks me out just thinking about trying to stay in that range! But I looked the book up on Amazon, and it has a 4.5 star review based on 114 reviews, which is pretty good. Then again, "Dianetics" by L. Ron Hubbard has a 4.5 star review based on 300+ reviews, so...

It may take me a while to read this book, but I will definitely post my thoughts. If nothing else, Bernstein has had this disease for 60+ years, so his experiences alone should be worth the read.

Barry, are you saying you have this book? If so, what do you think?

[DeusXM]

Dr. Bernstein used to be about 15 years ahead of the curve in terms of diabetes thinking. He was advocating getting off high-carb diets years before anyone else in the medical profession 'discovered' the same thing. A lot of his findings can really be boiled down to a combination of experience with medical training. Once you've had diabetes for about 5 years or so you start to realise that you actually know a heck of a lot about how your body reacts to different things, thanks to the trial and error you've been through. Bernstein's also able to explain WHY those reactions happen too.

I think he's a very useful information source and is very helpful for people starting to get a handle on their sugars. On the other hand I do think part of the regime he advocates is too much of a trade-off on quality of life - from what I've heard from (admittedly militant) supporters, he advocates what can end up being quite a restrictive diet.

My personal choice is that I'd rather run an A1c of 5.5-6.5 and eat whatever I like, rather than have an A1c of 4.5-5.5 but have to concentrate a lot more on what I eat and my condition in general. Other people will have different priorities to me and that's fine.

[byu barry]

Yep, I bought it about 6 months ago and to me it was a God send. It was the first book I've read that explained the condition in a way that I could understand it without talking down to me. I think you may be surprised how fast you read the book after you receive it as I found it very interesting. Don't be looking for false hope or miracle cures but I'll bet you will walk away feeling better about controlling your condition.

As a matter of fact it surprises me you haven't already read it.

OK that's all the book pushing I'm going to do :)

[seacomp]

My personal choice is that I'd rather run an A1c of 5.5-6.5 and eat whatever I like, rather than have an A1c of 4.5-5.5 but have to concentrate a lot more on what I eat and my condition in general. Other people will have different priorities to me and that's fine.
I'm glad to see this discussion about Bernstein's approach. It certainly works if your goal is "perfect" bg, but he is also very useful in general on all the aspects of diabetes self-treatment.
After some years, I've personally taken the same path as Deus.

[BriOnH]

http://www.diabetes-normalsugars.com/book/mylife.shtml

Dr Berstein's bio. Whether you agree with low carbs or not his story is quite impressive!

[sydneya]

Yep, I bought it about 6 months ago and to me it was a God send. It was the first book I've read that explained the condition in a way that I could understand it without talking down to me. I think you may be surprised how fast you read the book after you receive it as I found it very interesting. Don't be looking for false hope or miracle cures but I'll bet you will walk away feeling better about controlling your condition.

As a matter of fact it surprises me you haven't already read it.

OK that's all the book pushing I'm going to do :)

Dr. Bernstein is a Type I. Since there are such differences between the type II and Type I, is it as relevant to a type II? Sometimes as I am reading our posts I have to stop and work through the Type I and Type II differences, but we both have to keep the carbs down. What do you that have read the book think?
And while I am thinking of the differences, is there a test that shows how much insulin a body is producing that is actually working? I've never had one and sometimes wonder if I have much helping me through. I realize that I, as a type II produce insulin but some or all of it does not function for me. I don't know if I'd ever know if that changes.

[seacomp]

Since there are such differences between the type II and Type I, is it as relevant to a type II?
There is certainly a great difference between T1 and T2 at the time of Dx, but as (or if) a T2 become insulin dependant the difference, unfortunately, begins to go away. An insulin dependant T2 is making little or no insulin in their pancreas; if hey were they wouldn't be insulin dependant.
Dr. Bernstein has done a lot of work on T2s and has written a book specifically directed to them.

[Cyborg]

I've always been for low carbing because it's made control easier. But at the same time, I've always been afraid of the fats and the subsequent potential for heart disease, etc.

According to the results of the U.S. Government's multi-million dollar, multi-year study on high fat vs. low fat diets, there doesn't seem to be any difference between the two eating styles on the potential for heart disease. Unfortunately, the knuckleheads running the study didn't take into consideration the type of fats...

I know low carbing works, but I can't believe that you can just go and eat any type of fat in any proportion size you want. I do believe there are bad fats and good fats. Does Bernstein talk about good fat vs. bad fat?

[duck]

Dr. Bernstein is a Type I. Since there are such differences between the type II and Type I, is it as relevant to a type II? Sometimes as I am reading our posts I have to stop and work through the Type I and Type II differences, but we both have to keep the carbs down. What do you that have read the book think?
And while I am thinking of the differences, is there a test that shows how much insulin a body is producing that is actually working? I've never had one and sometimes wonder if I have much helping me through. I realize that I, as a type II produce insulin but some or all of it does not function for me. I don't know if I'd ever know if that changes.

C-Peptide, isn't it?

[Cyborg]

C-Peptide, isn't it?

The C-Peptide test is an indication of how much insulin is being produced. While the GAD Anti-body test is a test for the anti-bodies that destroy your beta cells, the cells on your pancreas that create the insulin (an indicator of type 1 diabetes).

[duck]

The C-Peptide test is an indication of how much insulin is being produced. While the GAD Anti-body test is a test for the anti-bodies that destroy your beta cells, the cells on your pancreas that create the insulin (an indicator of type 1 diabetes).

So Sydney would want the C-Peptide test done on her, then?

[Cyborg]

So Sydney would want the C-Peptide test done on her, then?

Without being sarcastic, does it really matter? Isn't diabetes easier to control on a low carb diet for both type 1 and type 2 diabetics?

Isn't that test done as part of the normal blood work done by the endo every few months anyhow?

[duck]

Without being sarcastic, does it really matter? Isn't diabetes easier to control on a low carb diet for both type 1 and type 2 diabetics?

Isn't that test done as part of the normal blood work done by the endo every few months anyhow?

She asked if there was a test, so...I don't recall ever having a C-Peptide test run on me, and I look over those things when I get them. I'll have to go fish one out of the (massive) file cabinet and see.

And since there are some of is who seem to do just fine eating hundreds of grams of carbs a day, I'd have to disagree about low-carb for everyone. There are members here who swear by low-carb, so like many things with this disease, YMMV.

[Cyborg]

She asked if there was a test, so...I don't recall ever having a C-Peptide test run on me, and I look over those things when I get them. I'll have to go fish one out of the (massive) file cabinet and see.

And since there are some of is who seem to do just fine eating hundreds of grams of carbs a day, I'd have to disagree about low-carb for everyone. There are members here who swear by low-carb, so like many things with this disease, YMMV.

I was trying to avoid searching thru my file cabinet ;)

I am NOT promoting the low carb diet. I'm just saying it's easier to control your bg eating lower carbs. I'm not convinced it's healthier. In fact, after I fine tune my pump, I'll be trying a higher carb diet, one rich in veggies, fruits, lean meats/fish, fiber, and low in fats...

[MarkMunday]

..... is there a test that shows how much insulin a body is producing that is actually working? ....
The C-Peptide Test will tell you if your pancreas is producing insulin. But it won't tell you how well it is working. To find that out, you need to have your insulin levels tested. The test measures the actual level of circulating insulin in your blood. A healthy teenager has insulin levels of about 10. So an insulin level of 50 means that your pancreas is producing 5 times as much insulin as it would be if you weren't insulin resistant. And your circulating insulin is only 20% effective.

Apparently, it is not uncommon to see insulin levels of 90+ in severely insulin resistant people. And it is not surprising that a pancreas working 9 times harder than it should be working will eventually wear out. Traditional t2 treatment is focused on treating the symptom, not the cause. If I was T2, I would be very interested in what my insulin level is. And I would do whatever it takes to get it near-normal. Rising blood sugars are simply the consequence of not getting it right.

Cheers,

Mark

[sydneya]

The C-Peptide Test will tell you if your pancreas is producing insulin. But it won't tell you how well it is working. To find that out, you need to have your insulin levels tested. The test measures the actual level of circulating insulin in your blood. A healthy teenager has insulin levels of about 10. So an insulin level of 50 means that your pancreas is producing 5 times as much insulin as it would be if you weren't insulin resistant. And your circulating insulin is only 20% effective.

Apparently, it is not uncommon to see insulin levels of 90+ in severely insulin resistant people. And it is not surprising that a pancreas working 9 times harder than it should be working will eventually wear out. Traditional t2 treatment is focused on treating the symptom, not the cause. If I was T2, I would be very interested in what my insulin level is. And I would do whatever it takes to get it near-normal. Rising blood sugars are simply the consequence of not getting it right.

Cheers,

Mark

Some times I have to :banghead: to understand that I understand.:s: What you are saying, Mark is the C-Peptide is not what I need. I need the test
to have my insulin levels tested. then I can tell if my blood has more insulin in it than necessary and can tell how insulin resistant I am. From there I can tell how much work I have to do. Am I making any sense?
Thanks for everyones responses in this. :ciao:

[seacomp]

I know the insulin test is possible, but it must be difficult and/or expensive since no one seems to ever get it. It logically would be the first test to get if you are a T2, or even if you just are trying to lose weight.

[MarkMunday]

Some times I have to :banghead: to understand that I understand.:s: What you are saying, Mark is the C-Peptide is not what I need. I need the test
to have my insulin levels tested. then I can tell if my blood has more insulin in it than necessary and can tell how insulin resistant I am. From there I can tell how much work I have to do. Am I making any sense?
Thanks for everyones responses in this. :ciao:
Yes, sydneya, that is exactly what I am saying. The test is not commonly used because the metabolic role of insulin is not well understood by most doctors. But some doctors, like Ron Rosedal, insist that their Syndrome-X and T2 diabetes patients have their insulin levels tested regularly. It is the best measure of progress in the fight against insulin resistance.

High insulin levels are bad for you for a whole lot of reasons. If you are up for a lengthy but fascinating read about the metabolic role in insulin, go here : deleted.

Cheers,

Mark

[Cyborg]

Yes, sydneya, that is exactly what I am saying. The test is not commonly used because the metabolic role of insulin is not well understood by most doctors. But some doctors, like Ron Rosedal, insist that their Syndrome-X and T2 diabetes patients have their insulin levels tested regularly. It is the best measure of progress in the fight against insulin resistance.

High insulin levels are bad for you for a whole lot of reasons. If you are up for a lengthy but fascinating read about the metabolic role in insulin, go here : deleted.

Cheers,

Mark

Do you know the name of that test Mark?

[msfez]

My low carb diet is mostly vegetables and low fat protein. All my other tests have been in the normal range. I must admit I heard about Dr. B years ago and dismissed Him as a nut. I got His book and tried it as a last resort. After being in bad health with severe problems controlling my blood sugar for the past few years. I would recomend it to anyone if only to understand their condition better.

[seacomp]

I would recomend it to anyone if only to understand their condition better.
Yes, Dr. Bernstein is very good at explaining the various issues of bg control; you can profit by reading it even if you don't go along with his suggestions. And you probably get it from a library for free.

[byu barry]

His recipe for the cheese crisps was worth the price of the book.

[MarkMunday]

Do you know the name of that test Mark?
Cyborg,

It is simply called the insulin test. Here is a link to a description of it at labtestsonline (note to Harold : this is a non-commercial site) http://www.labtestsonline.org/understanding/analytes/insulin/test.html

Cheers,

Mark

[Harold]

The C-Peptide Test will tell you if your pancreas is producing insulin. But it won't tell you how well it is working. To find that out, you need to have your insulin levels tested.
C-peptides are produced along with the production of insulin. Therefore the fluctuation in c-peptides are directly proportional to insulin levels. Unfortuanatly c-peptides are not check along with bg's when doing a GTT and they should be. This would give an idea how well we produce insulin as well as how resistant we are. In general doctors do not see this information as usefull. Unfortunately when they prescribe Sulfonylureas with out this information they are blindly prescribing medication and treatment. Around here the cost of a c-peptide test is much cheaper than an insulin test.

Traditional t2 treatment is focused on treating the symptom, not the cause.
Traditional t1 treatment is focused on treating the symptom, not the cause.

Rising blood sugars are simply the consequence of not getting it right.
This is simply a careless statement that does more harm than good. Are you implying t2 is simple? Are you simply implying the progression of this desease is all our fault for not getting it right?

[duck]

This is simply a careless statement that does more harm than good. Are you implying t2 is simple? Are you simply implying the progression of this desease is all our fault for not getting it right?

Harold, I read Mark's statement above initially as an indictment of the medical professionals not properly diagnosing the underlying cause and NOT getting it right, not the patient.

[MarkMunday]

Traditional t1 treatment is focused on treating the symptom, not the cause.
This is simply a careless statement that does more harm than good. Are you implying t2 is simple? Are you simply implying the progression of this desease is all our fault for not getting it right?
It seems I didn't express myself clearly,

I wasn't implying anything. To rephrase that comment, rising blood sugar in a T2 is the result of insulin resistance increasing to the point where the pancreas can no longer compensate by increasing the level of insulin production. All I was saying is that rising insulin levels are a leading indicator of T2 diabetes. And if you become T2 diabetic, in other words the blood sugar levels go up, it generally means that insulin resistance is too high and has probably been that way for a long time.

To my mind, this presents pre-emptive opportunity. It should be possible to test at-risk individual's insulin levels and see if they are becoming T2 diabetic, way before their blood sugar levels start rising. Treatment at this early stage would be a lot cheaper and more effective. Instead, the medical profession only starts treating the problem when blood sugar levels become problematic, by which time the horse has already bolted.

I agree that treating T1 is symptom focused. Unfortunately, it has to be that way because there is no way of restoring the lost insulin-producing functionality. By contrast, T2 is a lot more involved, in that it is the outcome of complex metabolic processes.

Anyway, sorry if I offended anyone in my previous post.

Cheers,

Mark

[seacomp]

It should be possible to test at-risk individual's insulin levels and see if they are becoming T2 diabetic, way before their blood sugar levels start rising.
But as far as I know this test is rarely if ever performed. Does anyone know if it is inherently expensive/difficult or if it just isn't "in the books" for most doctors?

As I've mentioned elsewhere, this test is also very relevant to those who are trying to lose weight. If you are serverly insulin resistant, you don't have to overeat to gain weight.

This is where, I believe. the statistical relationship between weight and diabetes come in and why I say that IR obesity is a symptom not cause of diabetes.

[Cyborg]

But as far as I know this test is rarely if ever performed. Does anyone know if it is inherently expensive/difficult or if it just isn't "in the books" for most doctors?

As I've mentioned elsewhere, this test is also very relevant to those who are trying to lose weight. If you are serverly insulin resistant, you don't have to overeat to gain weight.

This is where, I believe. the statistical relationship between weight and diabetes come in and why I say that IR obesity is a symptom not cause of diabetes.

Sorry for jumping in here, but I'd like to get an understanding too. I started out as an overweight type 2...

If you are insulin resistant, isn't your body then prone to not utilizing the glucose in your system? Thus, if you are insulin resistant, you have to overeat to get the glucose to be used by your system, or you have to create alot of insulin, to get your body to absorb the glucose that is in your system?