Dare I take metformin?

[douglas99]

Hi Pavlosn.

If it's a rule, it will apply to everyone. Calories either count, or they don't.

All this nonsense we hear about energy in must equal energy expended (aka The First Law of Thermodynamics') is supposed to apply to us. But it doesn't. It only applies in a closed system, and the human body and metabolism don't constitute a closed system. The theory also falls over because we consume energy even as we sleep. It's here that we probably differ most, and some of us will use more stationary energy than others.

When we start exercising to increase energy usage, is when we create the demand for more fuel. If we take in the right kind of fuel, no problems. But if we stuff ourselves with stodgy starchy foods 'for energy', we are immediately in trouble. Then we have to run even more, because we don't burn rubbish so well as we do our proper food.

All running every day did for me was improve my circulation, and stamina, whilst also making me feel hungry. Not knowing any better in those days, I ate lots of bread and pasta as a fill up, in the mistaken belief wheat was a natural product, and thereby healthy. I think we all know better now.

Wheat might be natural, insofar as it's a growing plant, but bread is a processed food, no better than any other form of junk.

Phub (John)

Burn junk, you smoke more, but it still burns,
Try to burn clean fuel, and smoke less.
But, at the end of the day, if you burn too much of anything, the temperature will rise, no matter what you burn.

 

[jack412]

The OP is concerned about having suffered heart failure two years ago. I wonder whether we know enough about such matters to be recommending LCHF or any other diet so unreservedly.

the OP should get his BG down, it's the biggest risk factor

 

[Phub]

Yes I want to get my BG (Blood Glucose?) down. So I need to restrict the eating of anything that contains sugar or starch.
I can do no more. I don't really feel inclined to take a tablet that might give me angina attacks. I've never had that problem and I don't think I want it.

I don't have any ill-effects whatsoever at the moment, so I question the severity of my diagnosed T2. But I will play the game, and see the Doc again, to discuss diet first, and then tablets later. When I can self-test my levels I shall be much clearer myself, and if I can present a decent record of test results to the Doc, maybe she'll take it from there.

 

[pavlosn]

Hi @Phub

If you have not seen this paper on Metformin and heart failure already, it may give you some food for thought or at least some subject matter for discussion with your doctor.

http://m.care.diabetesjournals.org/content/28/10/2585.full

I agree that you should try to bring your BG down to non diabetic levels if you can.

The best advise I can offer is that you self test before and after each meal and adjust the carb content of your next meal until you can keep your after meal counts within 2 mmol of your before meal counts. I would just add that you be a little cautious and make changes to your diet incrementally rather than drastically just in case there are any unanticipated adverse effects.

Although diet is a key, perhaps the key, element of glycemic control it is not the only one.

Although you appear rather dismissive of physical exercise, I have found that this not only helps reduce blood glucose immediately, it tends to have s knock on beneficial effect on my levels for the rest of the day. And I am talking here about a brisk walk for half an hour or so.

Also losing any excess weight, reducing body fat percentage and increasing muscle percentage has been shown to lead to reduction in insulin resistance in T2s making good glycemic control easier.

Good luck with your efforts.

Pavlos

 

[Sid Bonkers]

I appreciate that this may have been your own personal experience with LCHF but I believe that if weight loss is a goal then calorie counting is still necessary. Many have posted that they put on weight when trying LCHF because they ignored the need to count calories as well as carbs. With fats being especially high in calories extra caution is required.
My understanding is that in order to lose weight there must be a calorific deficit of calories taken in by food consumption and expanded to maintain bodily function and fuel physical exercise. The LCHF part relates to the relative proportion of the calorific daily allowance one gets from each macronutrient source: fats, carbs and proteins. LCHF supporters maintain that the majority should come from fats and less from carbs and proteins. The claimed advantage of a high fat low carb diet is that one feels full even on the reduced calories one needs to stick to in order to lose weight.

Pavlos

You are 100% correct, a lchf diet will help to control bg levels just as a reduced carb and calorie diet but only a reduced calorie diet can bring weight loss, its that simple. To lose weight you need to eat fewer calories than you burn in energy if you dont the extra calories are stored as fat whether they are eaten as carbs or fat, energy is energy and can only be used or stored.

I have no idea why low carbers argue about this it is fact and is probably the reason that many low carbers find that their weight lose stops at some point, this I imagine can only be because they are eating too much.

No one in a prisoner of war camp in any war ever puts on weight and they are generally fed cheap starchy foods, fact. They lose weight because they are not given enough food/calories to sustain their weight, and certainly not enough food/calories to make them put weight on.

 

[Phub]

Hi Pavlosn...

I am not dismissive of exercise, as such. I am dismissive of excessive and prolonged running. Excessive, prolonged gym equipment usage. Such as treadmills, cycling machines, rowing machines. I am at present caring for my wife who has been slow to recover from knee replacements and a broken hip. (I won't go into the reasons for her poor recovery.) so that doesn't leave me time for gymnasia anyhow.
Therefore, as I live close to a huge area of parkland, I can get in get plenty of walking. Also I am a keen hand woodworker. In addition I do a reasonable amount of gardening; albeit that at 75 years I have to stop and rest occasionally. Those two activities take care of the 'heavier' work element of exercise. Walking is equally as beneficial as running if you don't bother to count calories. If you do, then depending on the activity, it merely takes about twice as long to use the same energy. Walking isn't nearly so wearing on the joints either.

Had I disciplined myself to stay on the diet I started about 15 months ago, I would now be just two stones short of my 'youthful' weight of 11.5 stones. (When I was also 6 inches taller!!!) Instead I now have to start again. This time with the threat of T2 over me, I shan't have any trouble staying away from sugars and starches.

To Sid...

Low carbers argue about the calories and the carbs theory, because most of us have seen plenty of proper evidence that the theory is questionable. Most of us have lost weight by merely cutting out refined carbs.
Or are you telling me that my weight loss, following a LCHP diet last year was a figment of my imagination?

If you are diabetic, and continue to eat refined carbs, that is up to you of course, but I don't think I would have that much stubborn courage. As for your mention of POWs, there were other serious factors to be taken into consideration. In the case of the Far Eastern POWs, much ill treatment, excessive working, dysentery, and Beri-Beri. Nothing is ever as simple as it seems, and in the world of weight-loss, it's even more pronounced..

It seems the calories in=calories out theory is drilled into our consciousness, almost like a religious faith. Because of that, I would be wasting my time trying to fully explain the laws of Thermodynamics. I've already touched on that once. If you don't wish to read up further on the evidence against counting calories, that's up to you Sid. Me? I am not discussing it any further.
Thanks for your contribution Sid.

Cheers..
Phub (John)

 

[jack412]

You are 100% correct, a lchf diet will help to control bg levels just as a reduced carb and calorie diet but only a reduced calorie diet can bring weight loss, its that simple. To lose weight you need to eat fewer calories than you burn in energy if you dont the extra calories are stored as fat whether they are eaten as carbs or fat, energy is energy and can only be used or stored.

I have no idea why low carbers argue about this it is fact and is probably the reason that many low carbers find that their weight lose stops at some point, this I imagine can only be because they are eating too much.

No one in a prisoner of war camp in any war ever puts on weight and they are generally fed cheap starchy foods, fact. They lose weight because they are not given enough food/calories to sustain their weight, and certainly not enough food/calories to make them put weight on.

probably because you are wrong
simply...high BG insulin resistant T2 lay carbs down as fat that's hard to access and the cells are still hungry, there are the fat mice that you can starve to death, but they keep laying down fat

so they eat 1500cal 500 is laid down as fat and they have a 1000 to burn
hungry people eat...it's the reason diets fail

 

[Sid Bonkers]

To Sid...


Or are you telling me that my weight loss, following a LCHP diet last year was a figment of my imagination?

No im telling you that your weight loss was because you cut back on carbs and as carbs have 4 calories perg you also cut back on calories, had you simply replaced the cals lost by the carbs by replacing them with fat you would not have lost weight.

I am a fan of low carb what I am not a fan of is low carbers why tell people to eat more fat as that is questionable and certainly not proven and if you need yo lose weight you dont need to add anby fat.

I lost 4 stone in under a year by reducing the carbs in my diet to around 60g a day and also eating less of everything else and did not add any fat at all and as I lost weight my body required less fuel as I weighed less so there was still no reason to add more fat.

Over the next 4 years I had increased my carbs to what I dont know as I dont count them but I now eat a fairly normal diet but will still only eat a couple of small roast potatoes with a roast and a couple of spoonfuls of basmatti rice with a curry etc etc

I have never ever counted calories but I know that by eating less with a reduced carb diet I was eating fewer cals, I dont kid myself that it was more fat and that only carbs make you fat as many lchf evangelists tell everyone, if you eat too much of anything it will be laid down as fat.

Oh and you only have to look at Jimmy Moores lipid profile to see that lchf does not always mean lower cholesterol, another often told lc myth.

Sid
Not anti anything just sensible.

 

[Sid Bonkers]

probably because you are wrong
simply...high BG insulin resistant T2 lay carbs down as fat that's hard to access and the cells are still hungry, there are the fat mice that you can starve to death, but they keep laying down fat

so they eat 1500cal 500 is laid down as fat and they have a 1000 to burn
hungry people eat...it's the reason diets fail

What, wrong because I disagree with you?

No idea what you are trying to say tbh, if you eat fewer cals you will lose weight fact it really doesnt matter what food type you eat less of as long as you eat less, but your right about the reason diets dont work is because people break them, and a lc diet is as easy to break as any other, face facts , how many threads are there on here about low carbers saying they have "fallen off the wagon" or their weight loss has stalled? lchf is not a guarantee of weight loss.

Saying you never feel hungry on a lc diet is a myth as many lc'ers testify to in threads on the forum regularly. Low carb diets will help to control bg levels but only eating less will result in weight loss and weight loss maintenance.

 

[pavlosn]

Hi Pavlosn...

I am not dismissive of exercise, as such. I am dismissive of excessive and prolonged running. Excessive, prolonged gym equipment usage. Such as treadmills, cycling machines, rowing machines. I am at present caring for my wife who has been slow to recover from knee replacements and a broken hip. (I won't go into the reasons for her poor recovery.) so that doesn't leave me time for gymnasia anyhow.
Therefore, as I live close to a huge area of parkland, I can get in get plenty of walking. Also I am a keen hand woodworker. In addition I do a reasonable amount of gardening; albeit that at 75 years I have to stop and rest occasionally. Those two activities take care of the 'heavier' work element of exercise. Walking is equally as beneficial as running if you don't bother to count calories. If you do, then depending on the activity, it merely takes about twice as long to use the same energy. Walking isn't nearly so wearing on the joints either.

Had I disciplined myself to stay on the diet I started about 15 months ago, I would now be just two stones short of my 'youthful' weight of 11.5 stones. (When I was also 6 inches taller!!!) Instead I now have to start again. This time with the threat of T2 over me, I shan't have any trouble staying away from sugars and starches.

To Sid...

Low carbers argue about the calories and the carbs theory, because most of us have seen plenty of proper evidence that the theory is questionable. Most of us have lost weight by merely cutting out refined carbs.
Or are you telling me that my weight loss, following a LCHP diet last year was a figment of my imagination?

If you are diabetic, and continue to eat refined carbs, that is up to you of course, but I don't think I would have that much stubborn courage. As for your mention of POWs, there were other serious factors to be taken into consideration. In the case of the Far Eastern POWs, much ill treatment, excessive working, dysentery, and Beri-Beri. Nothing is ever as simple as it seems, and in the world of weight-loss, it's even more pronounced..

It seems the calories in=calories out theory is drilled into our consciousness, almost like a religious faith. Because of that, I would be wasting my time trying to fully explain the laws of Thermodynamics. I've already touched on that once. If you don't wish to read up further on the evidence against counting calories, that's up to you Sid. Me? I am not discussing it any further.
Thanks for your contribution Sid.

Cheers..
Phub (John)

Walking is fantastic exercise and if your fortunate enough to have a park near you that is perfect.

All I am advocating is the benefits to our glucose levels and general health of increasing our level of physical activity.

The choice of activity should be appropriate to our age, circumstances and current level of fitness.

For instance I am forty nine and about a month ago weighed 102 kilos ( now 93kg). Clearly it would not have been appropriate for me to take up running, not if I valued my knees anyway.

I have been going on brisk walks for an hour each morning though, play tennis on a weekly basis and as my fitness has improved I have started going on bike rides as well. The latter are a wonderful opportunity to spent some time with my eleven year old son.

I have even started training sessions at the gym in the last couple of weeks but that is only light weight training to hopefully firm up my body a bid now that the pounds are starting to come off. Little chance of me being in the running for Mr Universe anytime soon ( or ever)

I am enjoying the amount of exercise I do. The health benefits are a nice bonus.

Walking is still my main form of exercise though and a source of pleasure as I can combine it with two other favorite activities photography and discovering new parts of the countryside I have not visited before.

Pavlos

 

[dannyw]

Two questions:
Have you never seen posts where some people, however small a minority complain that they failed to lose weight after going on LCHF.
Is there a suggestion that be lowering carbs and eating more fats one would automatically lose weight even if one actually ends up increasing calorific intake?

Pavlos

I have been lurking for a while and not posted much so apologies in advance if this is not the best introduction but I have been following this thread and I find it a little confusing. Lots of posters here seem to promote LCHF as it has worked and they want their success repeated on others. This seems a fair thing to do. There also seems to be a few that are keen to argue against it but off little or no alternative. Most agree that a reduction in carbs works but the sticking point seems to be what to replace the carbs with. The only option is protein or fats. Fats seem to be the best choice by far.
The main argument against promoting a LCHF lifestyle is that "it doesn't work for everyone" or similar. How can this be a valid argument ? Can anyone name me ANY medication, lifestyle, treatment or diet that primises 100% success rate for all ? I can't think of any, there will ALWAYS be exceptions. The entire premise of medical treatment and medication is basically percentages. A doctor will generally provide medication or treatment that has the BEST CHANCE of success. They won't guarentee success. So, why should a forum be any different ? It seems to me by reading lots here that by far, the most success here is achieved by adopting a LCHF lifestyle. I have not read many other success stories following different advice so far. LCHF is not set in stone, the amounts and type of carbs and fats will and should vary from person to person but I fail to see why anyone would have any problem with it being promoted on a diabetic forum. Yes, there will be exceptions but we should be concentrating on the majority and the percentages, just like the medical profession has done for many 100's of years. Ifnot, and we as a forum can only give advice suitable to EVERYONE, we may as well give up now. Sorry for the ramble and I'll go back to being a lurker now thankyou.

 

[jack412]

of course you don't sid, you think what you think
you don't know about t2 converting 10x the normal rate of glucose to fructose, that the liver lays down as fat

you cut to 60g and was under your insulin resistance and brought your BG down which allowed you to lose weight, your weight loss allowed your IR to reduce and what's left of your Pancreas to handle your increased unknown carb intake, but by your simple description is still a carb reduced diet, you are getting extra from protein and/or fat, or you would continue to lose weight.
if you do blood tests to find your insulin release to carb you can work out your current insulin resistance, if you exceed this level of carbs you will put on weight

the object of LCHF is a diet you can eat for ever, with protein levels diabetics can handle

some will still lay down fat at on 60g

 

[pavlosn]

@dannyw

LCHF is not the only approach that works. People have posted success following alternative approaches such as restricting calories and reducing weight and fat percentage boosting insulin sensitivity for instance.

One of the problems is that LCHF means different things to different people and two people may both validly claim to do LCHF when they are in fact doing very different things. For instance one may be on about 150g of carbs and mainly monounsaturated facts while another may be on less than 30g of carbs and mainly saturated animal fats. As far as I know there is no one definition of what is LCHF.

I am a great believer of eating to your meter, testing and reducing carb intake of the next meal, until you can reach satisfactory glucose counts.

Does that mean you need to increase the amount of fats you consume. In terms of percentage of daily percentage of calories consumed probably yes. In terms of absolute quantities, not necessarily. If a person is overweight then just cutting carbs without substituting anything other than green salad and vegetables may be necessary to reduce weight.

We are all individuals and we need to make allowance for this.

It was the general statement that everyone will lose weight on LCHF without needing to take calories into account that I objected to, not LCHF itself.

Pavlos

 

[dannyw]

@pavlosn, thanks for your response which I agree with. My main point however was various comments suggesting that uf something doesn't work for all, it shouldn't be promoted. There is nothing, medication, lifestyle or diet related that will work for all but it does appear LCHF works for many. Results may vary and more studies needed in my opinion but at present, I fail to see any convincing alternative. Of course, LCHF will always need adjustments for individuals and this will mean eating to your meter but please remember, the vast majority of diabetics are T2 and are not afforded the luxury of a meter. For these, it is easy to say "buy one" but many won't or they listen to their doctors who tell them they don't need one.
Also remember that a lot of forum members just read here and may or may not eventually post. Giving them initial information that includes LCHF seems to make sense to me. Most here will adapt it to suit their own taste which goes without saying.

 

[pavlosn]

@pavlosn, thanks for your response which I agree with. My main point however was various comments suggesting that uf something doesn't work for all, it shouldn't be promoted. There is nothing, medication, lifestyle or diet related that will work for all but it does appear LCHF works for many. Results may vary and more studies needed in my opinion but at present, I fail to see any convincing alternative. Of course, LCHF will always need adjustments for individuals and this will mean eating to your meter but please remember, the vast majority of diabetics are T2 and are not afforded the luxury of a meter. For these, it is easy to say "buy one" but many won't or they listen to their doctors who tell them they don't need one.
Also remember that a lot of forum members just read here and may or may not eventually post. Giving them initial information that includes LCHF seems to make sense to me. Most here will adapt it to suit their own taste which goes without saying.

Nobody is suggesting for a minute that people should not promote LCHF or any other diet that they have found to work for them.

What I object to is some very simplistic and over enthusiastic responses of the "Ear more fat" or "If I ate that I would go blind" variety, which appear to me to just seek to promote a diet of ones choice without taking into consideration the circumstances, emotional condition and other physical health concerns of the original poster. Maybe as fellow diabetics we can recommend a specific diet based on our own experience, however how confident can we be of our recommendation of the original person is also suffering from another condition about which we know very little about.

The fact remains that LCHF is currently still controversial, still not the recommended diet of the medical profession. Although there are studies to support it there are equally other studies to support other nutritional theories.

Personally I wonder if people have been following LCHF for long enough, say 30 or 40 years, for us to know what it's long term health effects are.

My own diet would probably qualify as some kind of LCHF at the moment, I restrict carbs and do not try to avoid fats, although not actively pursuing them. Still I have my doubts though.

Any health treatment/ diet regime is a compromise a best chance approach. My fear is that anyone reading the kind of eulogies to LCHF often seen in responses on this forum, will not appreciate this.

Pavlos

 

[douglas99]

@dannyw

LCHF is not the only approach that works. People have posted success following alternative approaches such as restricting calories and reducing weight and fat percentage boosting insulin sensitivity for instance........................................

Pavlos

Definitely the one that worked for me.

Calorie restricted, portion control, weight loss.
But the ability to say 'no' to food was key, as whether or not I actually felt hungry, there was still going to be years of habit from simply shovelling food in regardless to be overcome.

Maybe that was a part of my personal choice though, I knew I was overeating, I knew I needed to cut back on the amount of food, and not simply swap out one group of foods for another, so I 'went hungry', and re-invented my way of feeding myself.

And for the record, for others reading, after I reached my targets, I did try LCHF as a lifestyle/maintenance diet.
I went back to low GI/GL.

 

[jack412]

Nobody is suggesting for a minute that people should not promote LCHF or any other diet that they have found to work for them.

What I object to is some very simplistic and over enthusiastic responses of the "Ear more fat" or "If I ate that I would go blind" variety, which appear to me to just seek to promote a diet of ones choice without taking into consideration the circumstances, emotional condition and other physical health concerns of the original poster. Maybe as fellow diabetics we can recommend a specific diet based on our own experience, however how confident can we be of our recommendation of the original person is also suffering from another condition about which we know very little about.

The fact remains that LCHF is currently still controversial, still not the recommended diet of the medical profession. Although there are studies to support it there are equally other studies to support other nutritional theories.

Personally I wonder if people have been following LCHF for long enough, say 30 or 40 years, for us to know what it's long term health effects are.

My own diet would probably qualify as some kind of LCHF at the moment, I restrict carbs and do not try to avoid fats, although not actively pursuing them. Still I have my doubts though.

Any health treatment/ diet regime is a compromise a best chance approach. My fear is that anyone reading the kind of eulogies to LCHF often seen in responses on this forum, will not appreciate this.

Pavlos

American diabetic association ( http://www.professional.diabetes.org/)

http://www.professional.diabetes.org/admin/UserFiles/0%20-%20Sean/dc132042%20FINAL.pdf

Evidence is inconclusive for an ideal amount of total fat intake for people with diabetes;

therefore, goals should be individualized; fat quality appears to be far more important than quantity.

In people with type 2 diabetes, a Mediterranean-style, MUFA-rich eating pattern may benefit

glycemic control and CVD risk factors and can therefore be recommended as an effective alternative to a lower-fat, higher-carbohydrate eating pattern.


1977 is the year we went low fat..we were on 40%..it was reduced to 30% but the nutters have got it down to 15%

 

[Phub]

This has developed into a can of worms.
I know what suits me, and I can only go on that fact. if I think it will help someone else, I will talk about it. If it's going to start a vitriolic 'debate', then in future I will refrain. Simple as that.

regards

Phub (John)

 

[jack412]

th

This has developed into a can of worms.
I know what suits me, and I can only go on that fact. if I think it will help someone else, I will talk about it. If it's going to start a vitriolic 'debate', then in future I will refrain. Simple as that.

regards

Phub (John)

no,,it will be fine on the next topic...
it's only when the subject of fat comes up..some seem to forget that low fat for the last 40 years have had diabetes, weight heart disease fatty liver and a host of other stuff happen out of control...but fat is still bad and carbs are good in their minds

 

[Phub]

Hi Pavlosn...

Don't forget that that muscle tissue is more dense than fat tissue. To much weight training, (And not that excessive either) will put on muscle, and the scales might tell you your BMI is too high.

I don't think much of BMI either, because it tells us that athletes like Lawrence Dallaglio and Arnie were obese! I wouldn't want to tell them though. Would you?