A blog reporting glucose impact of low-carb products

Aside

This site helps fill a need. Low Carb Review is a new site dedicated to reporting the results of one person’s test trials of low carb foods and products.  He reports the part that matters, which is the rise in blood sugar after eating.  His test subject is himself, but, being an engineer, he takes a very careful approach.

Each person’s blood sugar responses can be unpredictably different, but still this is helpful and a valiant contribution.

I think the pumpkin and ricotta cheese breakfast dish is tempting (he refers to this as pumpkin “cereal”).  You can click through from his site to the recipe, which he found on About.com Low Carb Diets.

Low Carb Review  lcreview.org

Impact of high blood glucose on vascular events and death

This study is just published.  When looking at this study, there are four key factors to consider:

  • This is a study that looks at correlation, it does not specifically test cause. People who had evidence of sustained exposure to higher blood glucose levels had worse outcomes, for whatever mix of reasons.
  • This study did not look at micro-vascular disease (such as nerve damage, kidney damage or eye damage) or rate of deterioration of glucose control, so the study does not say that there might not be health benefit from achieving a HgA1c of less than 6.5%
  • I’ll have to wait to see the full text of the study (and consider input from others who will doubtless publish commentary) to consider what further might be said of this study. For example, the fact that the results of the study did not suggest a protective effect from having HgA1C below 6.5% could be related to low numbers of the study group reaching such a relatively good level of control – although this was probably accounted for. Only further examination of the full study report will tell.
  • Also, HgA1C is only one way of looking at blood glucose levels.  It does not give information about aspects of blood glucose that vary between people, such as the degree of elevation of fasting glucose versus glucose spikes after meals.
Diabetologia. 2012 May 26.

Relationship between HbA(1c) levels and risk of cardiovascular adverse outcomes and all-cause mortality in overweight and obese cardiovascular high-risk women and men with type 2 diabetes.

Department of Cardiology, Gentofte University Hospital of Copenhagen, Niels Andersens vej 65, 2900, Hellerup, Denmark, ca@heart.dk.

Abstract

AIMS/HYPOTHESIS:

The optimal HbA(1c) concentration for prevention of macrovascular complications and deaths in obese cardiovascular high-risk patients with type 2 diabetes remains to be established and was therefore studied in this post hoc analysis of the Sibutramine Cardiovascular OUTcomes (SCOUT) trial, which enrolled overweight and obese patients with type 2 diabetes and/or cardiovascular disease.

METHODS:

HRs for meeting the primary endpoint (nonfatal myocardial infarction, nonfatal stroke, resuscitated cardiac arrest or cardiovascular death) and all-cause mortality were analysed using Cox regression models.

RESULTS:

Of 8,252 patients with type 2 diabetes included in SCOUT, 7,479 had measurements of HbA(1c) available at baseline (i.e. study randomisation). Median age was 62 years (range 51-86 years), median BMI was 34.0 kg/m(2) (24.8-65.1 kg/m(2)) and 44% were women. The median HbA(1c) concentration was 7.2% (3.8-15.9%) (55 mmol/l [18-150 mmol/l]) and median diabetes duration was 7 years (0-57 years). For each 1 percentage point HbA(1c) increase, the adjusted HR for the primary endpoint was 1.17 (95% CI 1.11, 1.23); no differential sex effect was observed (p = 0.12 for interaction). In contrast, the risk of all-cause mortality was found to be greater in women than in men: HR 1.22 (1.10, 1.34) vs 1.12 (1.04, 1.20) for each 1 percentage point HbA(1c) increase (p = 0.02 for interaction). There was no evidence of increased risk associated with HbA(1c) ≤6.4% (≤46 mmol/l). Glucose-lowering treatment regimens, diabetes duration or a history of cardiovascular disease did not modify the associations.

CONCLUSIONS/INTERPRETATION:

In overweight, cardiovascular high-risk patients with type 2 diabetes, increasing HbA(1c) concentrations were associated with increasing risks of cardiovascular adverse outcomes and all-cause mortality.

PMID: 22638548

Do you know where your blood sugar climbs after eating?  BloodSugar101.com

Celiac disease limiting fuel for endurance – keto-adaptation would solve that!

Nutritional Ketosis as an Effective Strategy for Fueling Endurance

From New Zealand comes this report of an ultra-endurance athlete who had difficulty meeting fuel needs.
One solution for this would be the strategic use of nutritional ketosis.  To use this strategy, the athlete needs to be metabolically adapted to burning ketones for fuel.  This means being in nutritional ketosis for at least some weeks before the race day. The term that is used is “being in a state of keto-adaptation“. The advantage is that during the endurance exercise, the body can draw on the vast calories stored as fat (even in very slim people), while using less of the glycogen stores.

Case Study: Nutritional Strategies of a Cyclist with Celiac Disease During an Ultra-endurance Cycle Race.

Department of Human Nutrition, University of Otago, Dunedin, New Zealand.

Abstract

Food intolerance is becoming increasingly prevalent and increasing numbers of athletes participating in sporting events have celiac disease. This poses challenges as dietary recommendations for exercise are largely based on gluten containing carbohydrate-rich foods. The K4 cycle race covers 384 km around the Coromandel Peninsula, New Zealand. Lack of sleep, darkness and temperature variations pose a number of nutritional challenges. Limited food choices present those with celiac disease with even greater challenges. This case study describes the intakes of one such athlete during training and competing in the K4. Nutritional intakes were obtained during training using weighed food records and during the race via dietary recall and the weighing of foods pre- and post- race. As simple substitution of gluten containing foods for gluten-free foods leads to increased energy intake, alternatives need to be considered. During the race, insufficient energy was consumed to meet the nutritional guidelines for endurance performance. This was probably due to the nature of the course, racing conditions, the consistency of gluten-free food, and towards the end of the race, sensory specific satiety.  PMID: 22645170

To go to the font of the scientific knowledge on this, the book to read about the use of nutritional ketosis as a strategy for athletic performance 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).

The Flower Food Group

English: Borage, also known as "Starflowe...

Edible Flowers

Adding fun and spice to a controlled carb diet:

http://www.ext.colostate.edu/pubs/garden/07237.html

http://whatscookingamerica.net/EdibleFlowers/EdibleFlowersMain.htm

Ginger and Nasturtium butter (for use in cooking)

http://www.cbc.ca/nxnw/featured-guests/2012/06/01/edible-flowers-and-honey-recipes-with-chef-bruce/

English: Flower of a nasturtium

English: Flower of a nasturtium (Photo credit: Wikipedia)

A Sunday Morning in June

When “normal” blood sugar is not normal:

A great day to save life and limb …

On a Sunday morning, some reading that is all about taking charge of your health, getting results and protecting your future.

This is the introduction to the BloodSugar101.com website, it will open in a new window.

“A Very Brief Summary”

The focus of this particular article is controlling blood sugars when you have diabetes.

In her new book, Diet 101, Jenny provides the reasons why every person should be aware of their blood sugar health, even if they do not meet the lab test cut-off values that are used in the diagnosis of diabetes or pre-diabetes. She covers how to understand your blood glucose (“sugar”) test results and then what you can do to claim your health.

To encourage you to linger a while and learn about this vital aspect of protecting your health, here is some music to go along with your reading:

Michael Hedges, Aerial Boundaries

The Four Faces plus Black Box of Low Carb

Tailoring a Carb Control Plan Just for You, Today and Tomorrow, Requires Understanding Your Personal Health Needs:

Part One: The Four Faces Plus Black Box of Low Carb

Did you know there may be wonderful health benefits even if you do not follow the kind of very strict low carb diets you may have heard of or may have undertaken yourself in the past?

Don’t let the goal of perfection cause you to lose out on claiming and keeping your gold nugget to be found within a controlled carb eating lifestyle.

The key is to understand which benefits from carb control are important specifically for you. This will allow you to find the choices that bring the most benefit for the least “cost” in terms of changes you are willing to make.

Low carb eating is actually four medical interventions mixed together:

  • (1) it reduces the need for insulin, and thereby reduces the impact and expression of metabolic syndrome, which at its core is insulin resistance (with initially higher levels of insulin and later falling and inadequate levels of insulin) and inadequate control of blood glucose levels. Other aspects of metabolic syndrome include weight gain in the abdomen, a tendency to develop high blood pressure and changes in blood lipids, most specifically an increase in triglycerides and decrease in HDL
  • (2) it is a means to maintain abstinence for people who find that they have an addiction-like response to sweet or starchy foods OR to fatty or salty foods that are also sweet or starchy. They can learn that they do not need to eat any sweet or starchy foods and therefore abstinence is available as an option.
  • (3) it improves the ability to maintain a stable blood sugar within the healthy range by dietary means with or without the help of medications. It also can be used as a means to reduce the doses of medication needed, therefore reducing the risk of adverse effects.
  • (4) it allows a person to be in the metabolic state known as “nutritional ketosis“.

… and a black box:

Are there other basic mechanisms by which a low carb or controlled carb lifestyle can help your health?  Probably yes. There is a lot of discussion about other possible mechanisms of benefit.  Much is speculated and much more is unknown. The answers to many questions still lie in a black box that needs to be illuminated by research.

The biggest question is probably whether being on a very low carbohydrate diet with a resulting state of nutritional ketosis provides a “metabolic  advantage” in weight loss by leading to increased non-activity burning of calories.  There is some evidence that a low carb diet can lead to less systemic chronic inflammation.  The research on this is only in the early stages and it will be difficult to separate what effects are from the change in carbohydrate intake itself and what of the effects are from changes in adverse effects from specific food stuffs, like gluten.

By understanding your own health needs and responses, you can make plans you find to be worthwhile staying with long term and you can understand how to sensibly adjust your eating plans when needed.  This way, everything becomes about what you find worthwhile.  The more you understand about your options, and the more you understand about your individual needs, the better this will work out.

People are unpredictably different. This has to be kept in mind when listening to other people’s stories of how any particular thing they have tried has worked out for them.

This is especially true when hearing about other people’s experiences when they have decided to take control of the carbohydrate in their diet – whether by cutting back on sugar, or changing the type of carbohydrate foods they eat, or cutting down to a very low amount of total carbs.  The reason is that these kinds of changes in the diet can be beneficial in so many different ways.  For any one person who finds benefit from reducing or changing the carbs in their diet, any one of many different effects may be responsible for that benefit – or the benefit could come from many different factors acting together.  The story you are listening to may be the experience of someone whose health needs are not similar to yours.

Sources of Confusion Can Cloud the Picture

When people switch to controlled carb or low-carb eating, there are many things that occur that can affect symptoms and health that have nothing to do specifically with the change in carbohydrates themselves. For example, some of these could be:

  • the enthusiasm of starting something new
  • the breaking of old habits and patterns
  • change in meal times
  • an increase or, more often, a decrease in caffeine consumption, which can lead to various effects such as a severe withdrawal headache
  • starting to eat (or eat more of) some food the person has an adverse reaction to
  • more commonly, stopping eating (or eating much less of, at least for a time) some food that the person has an adverse reaction to. This can be very confusing and it is of great importance that such problems be actively sought out and identified (see my posts on the importance of recognizing gluten sensitivity even in those people committed to a low-carb and/or grain-free lifestyle).
  • a decrease in alcohol consumption, with various possible consequences up to withdrawal symptoms.

The list of things that can confuse the picture could go on and on.

What is meant by a “controlled carb” eating plan or lifestyle?

That term is used when a choice has been made to control the types and/or the amounts of carbohydrate-containing foods that are eaten.

“Controlled carb” can mean anything from:

  • “A” (what most would consider the first level of control – cutting back or eliminating liquids with sugar in them, such as soft drinks and fruit juice) but not trying to cut back on the total carbs in foods in a day, to
  • “Z” (a very low carb diet with less than 20 grams of carbs and only as much protein as needed for health)
  • and everything in between, which represents a vast array of choices.

This does not refer to choices made for reasons other than the amount or type or form of starch and/or sugar content of the food eaten.** For example, a person might decide to eliminate wheat due to concerns about immune reactions to gluten or concerns about other potential harmful effects from wheat (for example, the human digestive tract is not able to properly digest gliadin).  That wheat elimination would not be, in itself, a controlled carbohydrate program.  Many people who have decided to limit or control their carbs also have eliminated wheat with or without a full gluten elimination, but it is important to keep in mind the differences between metabolic effects (e.g. sugar), toxic effects and immune effects.  Because it is acting through the immune system, gluten can be an issue for people down to 20 parts per million, whereas it takes gram levels of sugar or starch to have an effect on metabolism.

An Aside: Keep in mind that no research studies can ever offer firm conclusions about what will be best for you personally. In the end, after all the research and information is looked at, it always comes down to three stepsFirst, the available choices must be considered in terms of their suitability for that particular person, in their particular circumstances and at that particular time.  Second, if an intervention (treatment or lifestyle change) is chosen and undertaken, it is always an individual trial-of-therapy and third, the results have to be assessed.  One can never take the expected results for granted.  Again, we are just so unpredictably different.

** Technically, the term “dietary carbohydrates” includes dietary fiber

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Study Shakes Up Cholesterol Concepts

There is a lot of dispute about cholesterol and this new study is going to push that even further.

LINK to the FULL TEXT of the article

“Is the use of cholesterol in mortality risk algorithms in clinical guidelines valid? Ten years prospective data from the Norwegian HUNT 2 study”

From the “Conclusions” of the article:

Based on epidemiological analysis of updated and comprehensive population data, we found that the underlying assumptions regarding cholesterol in clinical guidelines for CVD prevention might be flawed: cholesterol emerged as an overestimated risk factor in our study, indicating that guideline information might be misleading, particularly for women with ‘moderately elevated’ cholesterol levels in the range of 5–7 mmol L−1. Our findings are in good accord with some previous studies. A potential explanation of the lack of accord between clinical guidelines and recent population data, including ours, is time trend changes for CVD/IHD and underlying causal (risk) factors.

and

 ‘Know your numbers’ (a concept pertaining to medical risk factor levels, including cholesterol) is currently considered part of responsible citizenship, as well as an essential element of preventive medical care. Many individuals who could otherwise call themselves healthy struggle conscientiously to push their cholesterol under the presumed ‘danger’ limit (i.e. the recommended cut-off point of 5 mmol L−1), coached by health personnel, personal trainers and caring family members. Massive commercial interests are linked to drugs and other remedies marketed for this purpose. It is therefore of immediate and wide interest to find out whether our results are generalizable to other populations.

It is interesting to note the funding sources for this research:

This work was supported by the Research Unit of General Practice, Department of Public Health and General Practice, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; the Norwegian Medical Association’s Funds for Research in General Practice; and the Research Fund of the Icelandic College of Family Physicians.

To convert cholesterol numbers from the type of units used in this study to the form of reporting used in the United States, here is a handy site that gives a quick conversion:

Cholesterol Number Conversion

There is bound to be quite a lot of media attention and discussion of this study.

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Diabetes – Not Just Type 1 and Type 2 Anymore

English: Diagram shows insulin release from th...

English: Diagram shows insulin release from the Pancreas and how this lowers blood sugar levels. (Photo credit: Wikipedia)

Need for Wider Recognition of Non-Classic Forms of Diabetes

Almost all discussion of diabetes revolves around what are called Type 1 diabetes and Type 2 diabetes.  Type 1 diabetes is the term used when there is a very low or absent production of insulin, due to destruction of the type of cells in the pancreas that make insulin.  Classically, this onsets in childhood and is the result of an immune attack on those cells.  The term is also used when those cells are destroyed by other processes.  An example would be repeated or severe bouts of pancreatitis (inflammation of the pancreas), which may bring a great deal of pancreatic tissue destruction.

Type 2 diabetes is the term used when the amount of insulin being produced is as much (or more) as would normally be needed to do its job, but the blood glucose is high because the signal of the insulin is not being recognised properly at the level of the cells – most prominently, in terms of blood sugar levels, the muscle cells and the liver.  The cells are “resistant to insulin”, and the person has “insulin resistance”.  The insulin production is higher than normal, but not high enough to keep blood glucose in the normal range, die to cells not responding properly to the insulin.

These two types can also get mixed up together.  A person with Type 1 diabetes (not able to produce enough or any insulin) can also becomes resistant to insulin, which would mean that they need higher amounts of insulin to keep their blood sugar controlled.  Someone with Type 2 diabetes can, over time, have a gradual destruction of their ability to make insulin, becoming more like a Type 1 diabetic.

It turns out there is more to the story.  There is also MODY and LADA.  It turns out that these need to be included more in our awareness.  The term “MODY” is an acronym for “Maturity Onset Diabetes of the Young” and “LADA” is an acronym for “Latent Autoimmune Diabetes of Adults”.

For an explanation of these, I refer you to Jenny Ruhl’s site, BloodSugar101.com.

Keep in mind as you read these two articles that our present understanding of both LADA and MODY is not well developed. More research will fill in gaps in our knowledge, so it is to be expected that the known facts and the concepts will develop over time.

From Diabetes in Control comes an article discussing new findings about LADA:

AACE: Latent Autoimmune Diabetes in Adults often Misdiagnosed

Almost half of nonobese adult with poorly controlled diabetes have latent autoimmune diabetes that has been misdiagnosed as type 2 diabetes….

Ankit Shrivastav, MD, from the Institute of Postgraduate Medical Education and Research in Kolkata, India, said that, “Young, nonobese, adult-onset diabetic patients with a negative family history, a rapid deterioration of glycemic control, and a rapid onset of complications should be screened for autoantibodies.”

Here is a recent article about MODY:

“Systematic Assessment of Etiology in Adults With a Clinical Diagnosis of Young-Onset Type 2 Diabetes Is a Successful Strategy for Identifying Maturity-Onset Diabetes of the Young”

It is time for these two other forms of diabetes, which had been thought of as uncommon, to be included more generally in our thinking and our approach.

Short Link for this article http://wp.me/p2jTRh-9Z

2 Child-Size Concepts About Treats

Two Simple Guiding Concepts to Consider

When my son was heading into adolescence, and so starting to have more food out of the home and more opportunities to buy food (and food-like substances), I realised there could be real health trouble ahead.  I suggested to him a couple of concepts to use for guidance.  It was a very brief conversation, and was only referred to again a couple of times over the years, but I know he found these concepts useful as he has incorporated them matter-of-factly into how he lives now as an adult.

Two child-size concepts about treats:

  • treat foods are fine to enjoy occasionally, but not when you are hungry.  If you are hungry, eat real food.
  • treat drinks, such as pop (soda), are alright to enjoy occasionally, but not when you are thirsty.  If you are thirsty, drink water.

For example, you deal with your hunger by eating dinner.  If dessert is served, this is eaten and enjoyed after people have had as much dinner as they want to serve themselves.

Of course, the key to this is also providing a general experience for the child that communicates what is meant by “occasionally”.  For example, my son was never exposed to the concept that pop is something you simply buy as part of your normal groceries.  It is for special events or special outings, never a routine part of daily life.  Also, something is not special if it happens every week.

I think the word “enjoy” also is key to how this worked out for him.  If it is a special occasion or special outing and you are having a treat, that is something fun – it is to be enjoyed, and then you go back to your normal life.

There was no policing or stringent application.

There is far more to healthy eating than is covered by this, but I think these two concepts are something that even small children can understand and might be useful.

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