Sunday Stories of Low Carb – June 17

(travelling to see papa tomorrow, so posted a bit early.)

Sunday Stories:

Today’s stories come from Tom Naughton’s web site (of Fat Head Movie fame).

The June 11th post contains letters Tom has received, including a couple of detailed inspiring stories.  LINK

Sunday Music:

I’m hampered this week. Installing the latest 11.3 version of Flash several days ago has knocked out my online audio.  Adobe knows of the bug and I’m waiting it out to see if they get that fixed, rather than trying to back-track to a previous version. So, from the description, I think this should be good and I’d love to be able to hear it!

 

Circadian Rhythm

Aside

Two interesting interviews on CBC Radio regarding circadian rhythm.

The first is an interview with a researcher about a study linking risk of breast cancer with years of working graveyard shifts.  This is followed by another interview regarding circadian rhythm in general.

Interview on CBC http://www.cbc.ca/thecurrent/news-promo/2012/06/12/the-graveyard-shift-and-risks-of-breast-cancer/

Testing Blood Ketones Update

At the bottom is an addendum to this article (originally published May 28th).

Also, Jimmy Moore, of Livin’ La Vida Low Carb, has posted his very interesting report of the first 30 days of his trial of using blood ketone testing and I’m sure interest is going to rise quickly.

Testing Blood Ketones to Monitor Nutritional Ketosis

A number of people who follow a low-carb lifestyle have become interested in testing blood ketone levels.  The reason for this is that the amount of ketones that show up on urine testing tends to drop over time as your body adapts to burning ketones for fuel.  This makes following your urine ketone level (urine dip sticks for ketones) of limited value.

If you are eating low carb, you may be surprised to find that your level of blood ketones is much less that you expect.  The old “people are so different” game.  This matters if being in ketosis would be helpful to you personally for your fat burning and your appetite/satiety balance.  If your health is fine without dropping your carbs (actually total carbs plus some limit on protein) down far enough for ketosis, then going this extra mile isn’t something that you necessarily need to do to thrive.

It also matters if you are wanting to be in ketosis for some of its other known or proposed medical benefits (such as seizure control) or its benefits in athletic performance.

If you ketones are not in the range that you’d like, the first things to think of are (1) are you having more carbs than you thought and (2) should you cut back a bit on protein, though keeping in mind that adequate protein is essential?

If that’s not the answer, perhaps your liver is just pumping out too much glucose.  This happens when the liver becomes “insulin resistant”.  Yes, your liver can become insulin resistant just like your muscles can.  This effect is noticed most in the mornings. If you are not yet diabetic or heading into pre-diabetes, this may be happening without necessarily showing up as a notable rise in blood sugar (glucose) level if you still have enough insulin effect to clear the glucose from the blood.

If you are eating low carb, you also will have more ketones with greater activity or exercise levels.  There are also medications and medical conditions that could be a factor.  This area of science has not received enough research attention to say that we understand it very well, yet.

If you consume a significant amount of medium chain triglycerides (MCT), such as tablespoon amounts of coconut oil, you will have some ketones in your blood that are produced directly from those medium chain triglycerides that you have just eaten, whether you are truly “in a ketogenic state” or not. This is too much to explain properly in this post, so I’ll write on this topic another day.

If you are at all interested in doing this yourself, you will need to put some time and effort into learning about this topic.  You would need to thoroughly understand the safe and effective use of low carb dieting and the ins and outs of nutritional ketosis.

If you are considering low-carb eating for yourself, especially at the level of going into ketosis, you must discuss this first with your doctor as (1) there may be reasons for you that this might be a bad idea or a bad idea at this particular time, (2) you may need some testing before and during and (3) you may be on medications that could have very dangerous and potentially lethal effects if the medications are not or cannot be adjusted or changed before and during the transition.  You may need frequent medical follow-up in the first days and weeks for adjustment of medications and medication dosages.  This is an interesting problem, when you think about it.  Your health may improve so quickly that you could actually be killed by the medications you take because those medications are to help you with problems you no longer have.

The book to read that is most informative about nutritional ketosis is The Art and Science of Low Carbohydrate Performance by Jeff S. Volek, PhD, RD and Stephen D. Phinney, MD, PhD.  The price is more than reasonable ($8.95 on amazon and no I have absolutely no commercial ties or links). (Update: now available in Kindle format for $5.99)

One of the speakers at the Nutrition and Metabolism Society meeting in 2011 was Dr. Adam Hartman, who is an expert in the use of ketogenic for the control of epilepsy in children.  He made an interesting comment on the timing of testing for ketones.  When eating the typical mixture of foods that people normally consume in our society (a mix of proteins, carbohydrates and fats), ketones are highest in the morning.  This makes sense because the least flow of carbohydrates in from the digestive tract is overnight, so the body burns some fat in the night.  When eating a ketogenic diet, on the other hand, the most exposure to carbohydrates is overnight especially towards morning as the liver produces glucose to keep your brain fueled and to prepare you for getting up.  Therefore, if you are eating a very ketogenic diet, the blood ketones go up during the day as you burn more fat for fuel.

Regarding testing blood ketones, the following refers to the blood ketone test strips for the Abbott Precision Xtra (Medisense).  These come in a box of 10 strips.

Please note that the shelf life of these strips is not long (I don’t know the details) so please be aware of this before ordering a large number of testing strips or before buying from a source you don’t have confidence in.  An expiry date will be on each box and a lot number.

For people in Canada, the first place to turn to is your local pharmacy.  I bought mine at London Drugs (a major chain) over the counter for $20.00 per box of 10 strips.  I checked their on-line ordering site, and they do not offer these strips for on-line sale.  I didn’t shop around to compare price, so I am not advocating London Drugs over any other store.

People in the US face prices for these testing strips that can be quite high and also people in smaller towns may have difficulty getting testing strips locally.  I did some looking around on-line.

Also, of course I can’t vouch for any company on-line or not.  You have to look into any company or on-line seller and make a decision for yourself.

I am just reporting what I have found on-line. I have no idea whether these are good companies (or even real companies) or not.  Exercise caution.

A significant factor in cost could be the shipping fees, so you might want to take that into consideration, not just the price per box.

Well.ca offers at this link a box for $24.29 USD ($2.43 per test strip)

CanadaDrugs.com lists, at this link

  • $32.42 USD (May 28/12) for box of 10 ($3.24 per test strip)
  • for 3 boxes or more (30 test strips or more) this drops to $2.49 per test strip

Universal Drug Store offers at this link a box of 10 for $19.99 USD ($2.00 per test strip)

There may be other sites that are as good or better, this is just what I found with about 20 minutes of checking.

I am not advocating that you purchase from any of these sites or that these sites will link you to a reputable business.  Buyer beware.

If you come up with something better, please let me know.

UPDATE June 14, 2012

My Abbott Precision Xtra (Medisense) is my new BFF.  Turns out I really do need the ketosis (at least for now) to have a reasonable time with appetite and I was not reliably achieving that with my low carb eating.  Despite carbs total about 15 g most days (1-2 times a week up to perhaps 25 g) and protein most days about 90 g (some days about 100 g), I was not getting a good level of blood ketones.  My fasting ketones were 0.4 mmol/L to 0.6 mmol/L and late afternoon ketones 0.9 mmol/L to 1.1 mmol/L. I have cut back a bit on protein and added some MCT oil.  It will be a while to find my best balance, but I feel an effect on appetite with my ketones in the range from about 1.5 mmol/L to 3.2 mmol/L.  Above that I feel a bit tired and out of focus.

It will take some time before there is much collective understanding about the hows and the whys of using blood ketone testing for insight into low carb eating and its benefits.  People will have to put their heads and their experiences together.  Also, we have to avoid jumping to conclusions too soon, based on only a few people’s experiences.

Addendum July 18, 2012

When I originally wrote this post on May 28th and when I composed the update on June 14th, the book “The Art and Science of Low Carbohydrate Performance” was not available in Kindle format. It was released in Kindle format on June 15th.  The price is a paltry $5.99 for this excellent book packed with useful insights into low carbohydrate nutrition.

Short link for this post http://wp.me/p2jTRh-87

Anything “chronic skin”, give thought to gluten

The highly knowledgable and extremely experienced Dr. Rodney Ford, New Zealand’s “Doctor Gluten” has tweeted the following:

“If ANYONE has chronic skin disease look at this. I put heaps of people GF for their skin – they get better”

He has included a link to the following full text medical paper, full of explanation and with excellent pictures.  LINK

Remember, the tests used to diagnose celiac disease ARE NOT trustworthy when considering gluten-related tissue damage any place else than in the intestines.  The blood tests used are only testing for a type of tissue damage that happens to the intestines.  Much of the damage that happens to other types of tissue, such as the skin, can be caused by anti-bodies that are different and DO NOT show on the tests for celiac disease.  The term “celiac disease” refers only to the damage done to the intestines by the auto-immune attack triggered by the gliadin that is part of gluten.

English: HLA-DQ2.5 with a deamidated gliadin p...

English: HLA-DQ2.5 with a deamidated gliadin peptide in the binding pocket(yellow). Alpha-5 (orange) and Beta-2(Blue). Image rendered from 1S9V using MBT Protein Workshop. 3D-structure as part of: Kim, C.-Y., Quarsten, H., Bergseng, E., Khosla, C., Sollid, L.M. (2004) Structural basis for HLA-DQ2-mediated presentation of gluten epitopes in celiac disease Proc.Natl.Acad.Sci.USA 101: 4175-4179. (Photo credit: Wikipedia)

Note: we still often use the term “gluten” because so many people are used to using that word.  In reality, it has long been known that one specific part of gluten, a protein molecule called “gliadin”, is the part responsible for the auto-immune triggering.

If you think you don’t have to understand about gluten-related auto-immune disease because you follow a low-carb or grain-free lifestyle, think again.  With the immune system, an exposure of even 20 PPM can trigger damage and you cannot go by whether you feel symptoms of not. See “Why talk gluten when low-carb or grain-free?” and “Gluten awareness even for low carbers”.

See sidebar for link to Dr. Rodney Ford. Yes, he has unusually strenuous opinions, but consider his degree of frustration from the thousands of people he has treated in his long career who have had their health turned around by a gluten free diet – even in the absence of diagnosed celiac disease. Current lab tests and medical investigations very unfortunately cannot rule out gluten as a cause of ill health in any particular person.

Sleep Link to Cravings

Just out is a study of sleep apnea in people with diabetes.  This is a small study, but worth noting.  LINK to report of study in Medical News Today.

They report:

“They found that in a small sample of clinic patients, the risk for sleep apnea was high among diabetics compared with non-diabetics, and that sleep apnea appeared to be associated with carbohydrate craving.”

The researcher comments:

“Previous studies have shown that sleep deprivation may lead to changes in hormones that regulate appetite and hunger,” Siddique said. “These hormonal changes can lead to significant craving for high-calorie carbohydrates such as cookies, candy, breads, rice and potatoes. The current study supports previous findings by validating this in a community sample of diabetics.”

Have a look at the article to get a better understanding of what was found and what it means.

Reference:

American Academy of Sleep Medicine. (2012, June 15). “Link Between Sleep Apnea And Increased Risk For Carbohydrate Craving Among Diabetics.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/releases/246563.php.
Addendum June 16th, in response to the comment below regarding observational studies:
The many limitations of observational studies are well known and always important to keep in mind.  They do provide a useful role in suggesting directions to look when trying to figure out actual cause and effect.  For many of the questions we need answers for, studies that could validly test for cause and effect are hard to come by or even in practice not going to be done, due to issues of study size, study costs, or simply what would have to be done to the human subjects in the process of testing for cause and effect.
In the case of this study, you get some insight into the motivation to conduct the research when you look towards the end of the article:
“The management of patients with diabetes and or metabolic syndrome based solely on pharmacotherapy, exercise and nutritional modifications without taking into account the risk of sleep apnea may not lead to optimal outcomes for patients suffering from these chronic diseases.”
It seems they are looking to build a case for more attention to the problem of sleep apnea in the era of managed care and protocol-driven medicine. Notice they do not claim any proof of causation and they are not trying to use the study results found in order to justify an intervention of any sort (medication, lifestyle or otherwise), just to justify more awareness of the need to explore for possible sleep apnea in people with diabetes.  Obviously, the well-known “big neck” rule is not succeeding in getting the job done, leaving people suffering from sleep apnea undiagnosed.
Here is a post which links to a discussion between 2 couples regarding their experiences with low-carb, real foods living. Part of the conversation is about sleep apnea.  LINK

The Precious – Sleep Denial and What We Throw Under the Bus

This photo shows an owl perched at a tree bran...

This photo shows an owl perched at a tree branch at night. According to Brit, this is Barred Owl (Strix varia). (Photo credit: Wikipedia)

The rock we are battered against.

The public health hill hardest to take.

The “precious”, gripped ever tighter in our hands no matter the consequences.

We wants it, the “precious”.*

OK, what on earth could I be referring to?.  Well, pick your metaphor or I’m sure you could come up with a few of your own.  What I am referring to is:

Denial of the need for adequate sleep.

Denial of the need for circadian rhythm health.

We don’t like being accountable. I sure don’t. It’s so boring and frustrating.  Aren’t we born to be free?  As a society, we’ve had to learn the hard lessons about money.  Now we are having to learn the hard lessons about food choices and weight health (and no, I don’t mean the simple calories-in-calories-out stuff).  Barely visible yet on the public radar are the hard lessons we will face about chronic under-sleeping and chronic circadian rhythm disruption.

When it comes to weight health, think of all the blogs and comments and tweets out there. I have seen countless posts and comments from people willing to turn their whole eating pattern on its head. (I have.) Willing to learn and chase the smallest details. (I have.)  Willing to spend hour upon hour tracking various people’s opinions and the latest commentary, insights and research. (I do.) Many put time and effort into being more active or engaging in a deliberate exercise program.  People talk about which medications might interfere with weight health.  Some pursue unusual techniques that are like grasping at straws. There are countless ways people take measures aimed at improving their ability to have and hold their chosen target weight.  Many times a lot of time, effort and loss of personal freedom is involved.

In all this, how often is a goal of adequate sleep and normalised circadian patterns targeted or achieved?

How much of all the other stuff we are doing is only necessary because of the chronic sleep/circadian issues?

In other words, what are we throwing under the bus in our attachment (sometimes fierce attachment) to keeping short sleeping hours and eating/sleeping/waking in disordered, non-rhythmic patterns?  One type of cost is the health impact from the sleep/circadian issues themselves.  This is a huge field of study and I won’t try to review it here.  A number of studies have linked sleep deprivation and circadian disruption with a tendency to gain weight.  (You can see some of this under the category “Sleep Heals” in the sidebar.)

The second type of cost is what we do to try to cope with the effects of the sleep disruption – instead of sleeping!  Just as an example, what if most of your tendency to gain weight would resolve if you just got well into a program of regular adequate sleep and a regular circadian patterns of sleep and meal timing?  How much less burden might there be from all the total things you do now that are for the purpose of helping you control your weight?  For example, research suggests that you would likely have some improvement in your ability to handle carbohydrates.  Research also suggests you would likely have less of a desire for sweets or reward foods.

If you have been chronically low on sleep, the benefits of getting regular adequate sleep are not going to be clear in the first weeks. In fact, there is a confusing phenomenon whereby people who have really been driving themselves and then get a night or two of unlimited sleep can suddenly feel much worse as the adrenalin levels fall and the body pushes you towards going into a “repair and recovery” mode of increased sleep for a while. This is very often mis-interpreted. People take this phenomenon, which is really an expression of the body’s desperation for sleep, as an excuse justifying their high-adrenalin habits.

The heart of the matter is time. We want more time. I don’t know of any other topic in weight control that can make so many people respond as if they are personally under threat.  In terms of emotional response, this topic is even worse than that terrible and much dreaded horrific topic – breakfast.

Of course, the topic of breakfast and skimped/skipped meals ultimately also involves time and time pressures for many people. (See the page “Restrict/Rebound” under Key Keys above.)

So, what are you “throwing under the bus” instead of turning the computer off and getting to bed?  I’ll be asking myself the same question more often.

*Lord of The Rings

All Diets Equal – is that the valid study conclusion?

The website “Ancestral Weight Loss Registry” has posted a very good analysis of the widely-reported study by Dr. Sacks, Dr. Bray and associates, which has been presented as showing that there is no benefit to one weight loss diet over another.

 “For example, let us assess a popular randomized clinical trial testing the efficacy of different diets, performed by some of the biggest names in diet and obesity research, such as Dr. Frank Sacks and Dr. George Bray.
The conclusion of their study is simple. All diets are created equal. “

LINK to the full text of the study.

LINK to the analysis posted by Ancestral Weight Loss Registry

Taking a good look at the full report of the study, to see what was actually done and what the researchers were actually working with as data, sheds a very different light on what value the research actually contributes.

Restoring normal blood glucose levels associated with less progression to type 2 diabetes

A study just published in Lancet found that, in people with pre-diabetes, getting their blood glucose levels back to normal was associated with a cut by half in the number who went on to develop type 2 diabetes during the study period.

Coverage by BBC  LINK

Abstract of the research paper, Lancet site  LINK

With 35% of the US population age 20 years and older estimated to have pre-diabetes, it is urgent to understand this issue.  (The US stats are easy to get and among the highest, but certainly this is a major issue developing all over the world.)

The next step is recognition that a major tool to achieve the goal of normal blood glucose is control over the form and amount of carbohydrates eaten, and that post-meal self-testing will reveal each person’s requirements, in balance with their personal choices and circumstances.  This will bring normalization of blood glucose levels into the reach of almost all of those with pre-diabetes and diabetes (provided they have access to the resources and care needed), while enabling the least use of medication and therefore the least risk of medication side-effects.

There are three factors to be teased out here (the usual, more research needed):

  • the degree to which having lower levels of glucose in the blood lessened progression of damage to the insulin secreting cells of the pancreas, or other damaging effect of glucose levels above normal
  • the degree to which some people were less able to achieve normal blood glucose levels because of strictly physical factors, such as how much damage they already had to the insulin-secreting cells of the pancreas. (That is, the degree to which the people who achieved normal blood glucose were a different group of people than the ones who did not achieve normal blood glucose.  In that case, the ability to return to normal blood glucose levels would be a “marker” that distinguishes one group at less risk from another group at more risk – rather that being a “cause” of protection or progression)
  • the degree to which the people who did not achieve normal blood glucose readings were less engaged in trying to improve their blood glucose levels, which might suggest that they are people who do not take as much care of their health in other ways.

Curiously (or not curiously at all, when you think about it), among those who did not return to normal blood glucose levels, the group assigned to “intensive lifestyle” changes fared worse that the placebo group.  Why could that be?  It is highly likely that part of what they were taught as “intensive lifestyle intervention” was the usual higher carb, low-fat diet.

“Among participants who did not return to normal glucose regulation in DPP, those assigned to the intensive lifestyle intervention had a higher diabetes risk (HR 1·31, 95% CI 1·03—1·68, p=0·0304) and lower chance of normal glucose regulation (OR 0·59, 95% CI 0·42—0·82, p=0·0014) than did the placebo group in DPPOS.”

I hope this study gets wide media attention and that it spurs much more investigation into the damaging effects of “non-diabetic” levels of high blood glucose.

Please visit my other blog: Carpe Your Blood Sugar  http://carpeyourbloodsugar.com

Sunday Stories of Low Carb – June

Sunday Stories and 23 Jazz Concerts!

(1) Interview (about 13 minutes) on NEquals1Health.com among 2 couples regarding their experiences with the benefits of low-carb nutrition. LINK

(2) Gary Noreen, of Low Carb Review (lcreview.org), has written the story of his 19 years of controlling Type 2 diabetes with a low carb diet:

http://lcreview.org/main/my-story/

“They made the mistake of giving me a glucometer (blood glucose meter). I quickly found that eating cereal and skim milk for breakfast along with a banana made my glucose take off like a rocket. “Artery-clogging” eggs and bacon had no effect. This was bewildering.

Fortunately for me, the only Type 2 diabetes book in my local library was Diabetes Type II: Living a Long, Healthy Life Through Blood Sugar Normalization by Dr. Richard Bernstein, who recommended a very low carbohydrate diet (30 gm/day) and no restrictions on fat except no trans fats. Dr. Bernstein’s very low carb diet quickly brought my blood glucose under control and dramatically improved my lipid measurements. 19 years later, I have never needed to inject insulin, my most recent A1c measurement was 5.6%, I have no diabetes complications, and my lipids are excellent.”

His story is much longer than the quote above, and he includes his lab test results and details of his medications and how he manages his health.  Note that after 19 years since diagnosis, and with sky-high blood glucose at diagnosis, he reports “I have no diabetes complications”.

Sunday Music

The CBC (The Canadian Broadcasting Corporation) is Canada’s public broadcasting corporation and the radio is commercial-free. They maintain a very extensive website.

www.cbc.ca/radio

One of their features is CBC Music, with multiple genre streams and tons of “concert on demand” recordings.

This link is to a page featuring over 20 jazz concerts.  LINK

Lottttsss of Sunday Music!

Carpe Your Blood Sugar

What if the urgent public health issue of the day is less obesity itself and more about the elevated blood sugar (glucose) levels that occur in the majority of those with higher amounts of body fat?

What if the true cut-off level for concern is less than the target values now used for screening tests, diagnosis and for management targets in diabetes?

What if the urgency comes from the combination of two factors:

  • the fact that at last estimate about half (46%) of the adult population in the US (for example, but other countries are headed in the same direction) have pre-diabetes or diabetes, and
  • these elevated glucose levels are now optional for the majority of people, because a different approach to management can be used (at least, for those who have access to regular medical care and the personal resources to manage a care plan involving self-monitoring of blood glucose).

What if having similarly elevated blood glucose levels (including below the threshold for diagnosis of diabetes) means that people who are classed as ‘normal’ body weight face many of the most worrisome health issues that we have incorrectly been blaming on the total body fat itself?

What if swings in blood glucose are itself a major driver of weight gain and those swings can be eliminated?

Metabolic Syndrome is a term used for a cluster of related medical problems or health indicators that have at their core a reduced ability for the body to handle glucose.  The root causes for this have not yet been understood, so we can’t say that we have a way to treat or correct the source cause of the metabolic syndrome itself.  But we can succeed in keeping the blood glucose in the normal range, and thus largely interfere with the means by which the metabolic syndrome causes damage.

Among the experts in obesity, there is a sea change over the past few years moving towards the realization that the amount of extra fat itself is not the major driver of the degree of health impact of the obesity.  Yes, there are physical impacts of simply being a larger size, such as stress on the joints.  At very high levels of body fat, there can be other serious effects of the physical size, such as strain on the heart and fluid accumulation in the legs.  Certainly we must keep in mind and be very aware that there are emotional impacts, which are related to such factors as weight-based discrimination and (unfairly) feeling personally inadequate for not loosing weight when surrounded by the attitude that it should be so easy.  There are also economic impacts, including discrimination in the work place.

But there is an “illness” aspect that the obesity experts refer to.  Some people who are overweight or obese are actually quite healthy in their metabolism. It is thought that these are not the ones who are headed (at least, not any more than usual) for heart attack, stroke, cancer or the other “illness” consequences that we have come to consider to be caused by high body fat itself. Having a high amount of body fat is not a sole determiner for whether someone is more at risk of these outcomes than someone of “normal” body weight.

Metabolic syndrome is thought to be the major part of the difference, as well as some other factors, such as inflammatory molecules coming from body fat stores, most particularly those in the abdomen.  Control of blood glucose levels, it could be argued, is the most readily attainable change that can be implemented at this time.

Blood sugar levels respond very quickly, in a matter of days, weeks or, at most, months when a well-designed and individually adjusted program is instituted that focuses on reducing the intake of glucose-producing foods, adjusted to create an eating plan that the individual finds acceptable as a long-term aspect of their medical care.

My new web site and blog has been set up as a place to consider these ideas, the relevant research, the experiences of clinicians, the input of people affected by high blood glucose and the implications for individuals and for public health.

www.carpeyourbloodsugar.com

Still in infant form, please visit “Carpe your blood sugar”.