Eat to your meter and Controlled Carb Regimes

xyzzy

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Just a bit more on where I get my info from. In this thread I argue that while GI is a useful tool for T2's to follow it is a secondary one to both "Eat to your meter" and lowering carbohydrates. Here is some stuff to back that up.

Janine Freeman, RD, LD, CDE is a Diabetes Nutrition Specialist and on the 2012 board of directors of the AADE (American Association of Diabetes Educators)

Here are some of her comments regarding GI. I have bold underlined what I consider to be the relevant statements regarding my personal feelings toward the priority of carbs / levels versus GI debate. The quote provided was one she wrote in an editorial of the September 2005 issue of Diabetes Forecast. You will note she also critical of some aspects of low carb as well.

The glycemic index (GI) ranks carbohydrate foods based on how they affect the body's blood glucose levels. "High GI" foods such as corn flakes, instant potatoes, and white bread greatly affect blood glucose levels. "Low GI" foods such as oatmeal, most fruits and vegetables, legumes, and nuts produce less of an effect. Recently, some weight loss diets have popularized the concept of the glycemic index, linking low GI foods to weight loss and high GI foods to weight gain.

The usefulness of the glycemic index in the treatment of diabetes has been controversial since its creation some 25 years ago. It's easy to understand why. The idea of classifying foods into groups -- those that greatly affect blood glucose and those that do not -- sounds very appealing to people with diabetes. It seems like it could make meal planning easier and improve after-meal blood glucose levels.

Unfortunately, it's not that simple. Here are a few reasons why.

The GI of a food varies substantially depending on the kind of food, its ripeness, the length of time it was stored, how it was cooked, its variety (potatoes from Australia, for example, have a much higher GI than potatoes from the United States), and how it was processed.


The GI of a food varies from person to person and even in a single individual from day to day, depending on blood glucose levels, insulin resistance, and other factors.


The GI of a food might be one value when it is eaten alone and another when it is eaten with other foods as part of a complete meal.


The GI value is based on a portion that contains 50 grams of carbohydrate, which is rarely the amount typically eaten.


Most GI values reflect the blood glucose response to food for only 2 hours, whereas glucose levels after eating some foods remain elevated for up to 4 hours or longer in people with diabetes.
Figuring out which foods are "high GI" and "low GI" can be complicated, too, because it depends on which base reference is used to determine the GI -- white bread or glucose. And believe it or not, many high-fat foods, such as candy bars and pizza, have a low GI. If food manufacturers begin lowering the GI of processed foods by adding high-fat ingredients or high-fructose corn syrup (which has a low GI), we'll have the same dilemma we had when low-carb products began inundating the market: junk foods that have been altered and labeled as healthy.

Some studies show small improvements in A1Cs among people who are attentive to the glycemic index. But reducing calories, weight loss, and basic carbohydrate counting have been shown to be more effective in improving A1Cs among people with type 2 diabetes than basing diet decisions on the GI.

I don't suggest eliminating "high GI" foods in favor of "low GI" foods to gain better blood glucose levels for two reasons. First, there is not enough evidence yet to show that such an action actually will improve your blood glucose levels; and second, choosing foods based solely on GI will compromise healthy eating.

I suggest basing your food choices on a nutritionally balanced diet, while controlling total carbohydrates, as a first measure. Then, if you find that your after-meal blood glucose is much higher after eating certain foods, you can either choose to eat smaller portions of those foods or adjust your mealtime diabetes medication.

She seems to make sense to me...
 

xyzzy

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Some more GI related stuff this time relating to weight loss.

This one is a study done in 2007 by Marion J. Franz, MS, RD, LD, CDE.

Here are her credentials

Marion J. Franz, MS, RD, LD, CDE, is a nutrition/health consultant with Nutrition Concepts by Franz, Inc. For over 20 years she was the Director of Nutrition and Health Professional Education at the International Diabetes Center, Minneapolis. Her Masters Degree in Nutrition is from the University of Minnesota, and she is a Registered Dietitian (RD) and Certified Diabetes Educator (CDE). She has authored over 200 articles, books, booklets, and book chapters on diabetes, nutrition, and exercise and lectures frequently in the United States and internationally. She is an author of the American Diabetes Association 2006, 2002, 1994, and 1986 nutrition position statements and technical reviews, work group member of the American Dietetic Association Evidence-Based Nutrition Practice Guidelines for Type 1 and Type 2 Diabetes 2008 and Nutritive and Non-Nutritive Sweeeteners, and was editor of the American Association of Diabetes Educators Core Curriculum for Diabetes Education, 4th and 5th edition. She has received numerous awards including the 2001 American Diabetes Association Charles H. Best Medal for Distinguished Service in the Cause of Diabetes, the 2006 American Dietetic Association Medallion Award, and the 2008 American Dietetic Association Huddleson Award.


Weight Loss Requires Drop in Calories, Not Low GI

Next Section
Question: Does a low glycemic index diet contribute to weight loss?

Answer: The quick answer to this question is “No.” Successful weight loss requires a reduced energy diet and an increase in physical activity. Nevertheless, diet books continue to suggest that high glycemic index (GI) foods trigger high insulin levels that in turn cause low blood glucose that spurs new cravings for food.

To investigate the diet books' claims, the definition of GI first must be clarified. The GI refers to the area under the 2-hour glucose curve following consumption of 50 g of digestible carbohydrate. It does not measure how rapidly blood glucose levels increase; when figures are available, you see the peak glucose response from foods or meals occurring at approximately the same times, although the peak responses may show a modest difference. Insulin responses from low versus high GI meals, when reported, are parallel. Researchers don't know if, long term, the GI of a diet can be changed. It appears that most people already eat a diet in the moderate GI range. In a 12-month study that implemented a low GI diet versus a usual GI diet, there were no differences in mean GI at the study's end.

In the first published debate on the use of GI diets for weight loss, in 2002, one researcher advised against counseling obese patients to follow a low GI diet based on a review of 20 studies (all <6 months in duration). The review found weight loss on a low GI diet in four studies—and on a high GI diet in two studies—with no differences in 14 studies. The average weight loss was 1.5 kg (3.3 lb) on the low GI diet and 1.6 kg (3.5 lb) on the high GI diet. Another research team differed with those findings, concluding from epidemiological evidence and a weight-loss study in obese adolescents that GI does play a role in weight loss and satiety. Interestingly, in two subsequent weight-loss trials in obese young adults, no difference in body weight decreases were found when implementing a low GI diet compared with other weight-loss diets.

Low GI and high GI diets for weight loss in adults have been compared in randomized clinical trials. In one 10-week study, no significant difference in weight loss occurred between the high and low GI groups. Another study compared three diets (high GI, low GI, and high fat), all with calorie levels 500 kcal less than each subject's estimated energy needs. At 12 weeks, changes in weight loss and improved insulin sensitivity were significant in all groups, but no differences between and among the groups were found. All groups maintained their weight loss and improved insulin sensitivity independent of diet composition.

More recently, an eloquently designed 1-year trial compared the effects of two energy-restricted diets differing in GI. All food for the two diets (40% carbohydrate from low GI foods compared with 60% energy intake from high GI foods) was provided to the subjects for the first 6 months. During the next 24 weeks subjects took responsibility for food preparation and continued their assigned diet. Both groups attended weekly behavioral support sessions. No significant differences between groups were found in weight or body fat loss, mean energy intake, hunger, satiety, and metabolic rate for ≤12 months. The investigators concluded that their findings provide more rigorous support that wide variability in the balance of dietary macronutrients and glycemic GI has little effect on long-term weight loss during calorie restriction. They noted a tendency for weight and body fat regain in the low GI group, which suggests “that reduced energy intake may be somewhat harder to sustain with low GI regimens long term.”

Finally, it should be noted that the GI is not necessarily the best indicator of healthy food choices. Soft drinks, candy bars, and premium ice creams have low to moderate GIs. The GI of foods can be lowered by adding fat or adding or substituting sugars, especially fructose and sugar alcohols. Even University of Toronto nutrition professor Thomas Wolever, MD, PhD, one of the originators of the GI concept, has noted, “Whole-wheat bread, brown rice, and brown spaghetti all have the same GI values as their `refined' white versions.”

The bottom line is that calories count! Energy restriction and an increase in energy expenditure should continue to be the focus of weight loss and maintenance intervention efforts. Health professionals and the public know this, but they still want an easier answer.
 

xyzzy

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One more about GI. This time a comparison with a Ketogenic (Very low carbohydrate) diet.

The study can be read here http://www.nutritionandmetabolism.com/content/5/1/36/

but a summary follows...

The effect of a low-carbohydrate, ketogenic diet versus a low-glycemic index diet on glycemic control in type 2 diabetes mellitus

Abstract

Objective

Dietary carbohydrate is the major determinant of postprandial glucose levels, and several clinical studies have shown that low-carbohydrate diets improve glycemic control. In this study, we tested the hypothesis that a diet lower in carbohydrate would lead to greater improvement in glycemic control over a 24-week period in patients with obesity and type 2 diabetes mellitus.

Research design and methods

Eighty-four community volunteers with obesity and type 2 diabetes were randomized to either a low-carbohydrate, ketogenic diet (<20 g of carbohydrate daily; LCKD) or a low-glycemic, reduced-calorie diet (500 kcal/day deficit from weight maintenance diet; LGID). Both groups received group meetings, nutritional supplementation, and an exercise recommendation. The main outcome was glycemic control, measured by hemoglobin A1c.

Results

Forty-nine (58.3%) participants completed the study. Both interventions led to improvements in hemoglobin A1c, fasting glucose, fasting insulin, and weight loss. The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group. Diabetes medications were reduced or eliminated in 95.2% of LCKD vs. 62% of LGID participants (p < 0.01).

Conclusion

Dietary modification led to improvements in glycemic control and medication reduction/elimination in motivated volunteers with type 2 diabetes. The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet. Lifestyle modification using low carbohydrate interventions is effective for improving and reversing type 2 diabetes.
 

Unbeliever

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I have no problem accepting that a low carb approach is more effecive for bg control and for losing weight. It is a quick fix.

I do think however that wwe would have a healthier general population and less obesity had the GI approach been adopted more widely. Maybe it prevents weight gain rather than promotes weight loss.

While probably not perfec in its present form it is a far healthier way of approaching diet than the popular high carb , low fat/
i followed the GI way for many years with my family. None of uswere ever obese or even overweight. There is a strong genetic link with T" {at least I think it is T2] in my family . I am reliably old I have probably had he disease since early adulthood but showed no definite symptoms anad was diagmnosed accidentally just before my 60th birthday.
At least the GI diet causeds you to consider your food choices. It does require some work and study
and not everyone would be prepared o ake he time and trouble.

It is certainly much easier after having received he incenibve of a diagnosis to cut carbs ec.
When I evenually found this forum i certainly workred for me..
GI is probably a good longterm choice for a healhy diet and lifestyle. Reducing carbs is a more immediately effecive way of responding o a diabees diagnosis.

I was somewhat amused at th ewords of the dietitian quoted by yzzy above. She was refusing to endorse the GI diet on practically the same erms as the NHS refuses to endorse ow carb dies and for the same reason. At least she didn;t go n o recommend something worse!
There are dangers in recommending any particular approach or in dismissing any either.
GI is not the villain here alhough low carb may be the good guy for most. It is not GI versus low carb.
GI does not push a high carb low fat diet.
 

xyzzy

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jopar said:
Can you supply the links to the research etc you've been posting... So we can read it all?

I take it you mean the GI stuff Jopar. As I wrote above the first post is just a Janine Freeman editoral post in Diabetes Forecast so it's not research as such. I present it more to show that someone with her credentials is recognising (in my opinion) what I and other diet controlled T2's have found to be the case i.e. GI is a fine tool to have in your arsenal of diabetic weapons but it should be secondary to what your meter is telling you.

You can find the text I posted all over the internet but it is summarised well here http://www.ndap.org.ph/glycemic-index

That page also holds the ADA's (American Diabetes Association) viewpoint on GI at the bottom

ADA Bottom Line: At this time, research does not support the claim that a low GI diet causes significant weight loss or helps control appetite. For people with diabetes, monitoring total grams of carbohydrate remains the key strategy. However, some individuals with diabetes may be able to use the GI concept, along with blood glucose monitoring, to “fine-tune” their food choices to produce a modest improvement in postmeal blood glucose level.

Which I'm sure you will see supports my personal viewpoint.

The second post is just as far as I can see a study that was done to show weight loss is mostly driven by calorie intake which is a concept I tend to agree with. To show the importance of energy density (calories) they use a low GI diet for comparison. As far as I'm concerned they could have choosen any number of diets as like I say I personally think calories are quite important. The link I found that at was here http://docnews.diabetesjournals.org/content/4/11/4.full. I just typed the good doctors name into g**gle to get who she was. Given the amount of stuff she has published there are countless sites that have her credentials listed. I think although cannot prove she died earlier this year.

The third post is again just to show that I feel carbohydrates take priority by comparing GI against VLC. Again as an "Eat to your meter" person I don't do VLC but I thought the research interesting for people to see.

None of the posts are intended to "undermine" the use of GI as like I say I think its a good secondary tool to use. In fact if as T2D you can manage a soley low GI based system and keep safe without having to carb count or lower carbs via plain portion control then fine by me. I would suggest however that people who can do that, especially those on diet only or diet + Metformin, are quite a rare breed.

In the UK the concept of GI has been put on a pedestal over the years but just as I have with the Swedish system I wanted to show that other countries do have other opinions on the benefits of GI which can differ quite strongly to the prevailing UK or NHS view.
 

borofergie

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xyzzy said:
Some more GI related stuff this time relating to weight loss.

This one is a study done in 2007 by Marion J. Franz, MS, RD, LD, CDE.

Weight Loss Requires Drop in Calories, Not Low GI

Next Section
Question: Does a low glycemic index diet contribute to weight loss?

Answer: The quick answer to this question is “No.” Successful weight loss requires a reduced energy diet and an increase in physical activity. Nevertheless, diet books continue to suggest that high glycemic index (GI) foods trigger high insulin levels that in turn cause low blood glucose that spurs new cravings for food.

I see your "dietician" and raise you the Cochrane Review:
http://summaries.cochrane.org/CD005105/ ... nd-obesity

There is a lack of consensus as to the best nutritional management of obesity. We assessed the effects of low glycaemic index or glycaemic load diets in overweight or obese people. Six randomised controlled trials, involving 202 participants, were analysed. Interventions ranged from five weeks to six months duration. Participants receiving the low glycaemic index or load diet lost a mean of one kilogramme more than those on comparison diets. Lipid profile also improved more in participants receiving the low glycaemic index or load diet. No study reported adverse effects, mortality or quality of life data.

I might pretend to be an ultra-low-carber, but I'm really all about Glycemic Load, I minimize both the quantity and Glycemic Index of my carbs.
 

xyzzy

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borofergie said:
I see your "dietician" and raise you the Cochrane Review:
http://summaries.cochrane.org/CD005105/ ... nd-obesity

:lol: Like I said the intent was to show the importance of calories and energy density. I'm not going to argue diets with you cos I'll lose hands down. You can find countless studies that tend to support a "feory" that it doesn't particularly matter what diet you choose (assuming its not stupid) most people will lose weight if they stick to it.

The subtlety is we aren't primarily taking about diets in the everyday meaning of the word are we? We are talking about systems that control blood sugar levels (or at least I am). In that scenario lowering the carbs is what counts first and foremost as most modern health services are increasingly recognising.
 

phoenix

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I could trade studies: (snap Stephen)
http://www.cochrane.org/podcasts/issue- ... s-mellitus
or criticise the studies you cite so:
The Westman study, , huge drop out in the low carb arm, absolutely no mention of the average GI of the low GI arm (was the average less than 45 ?, one study I read yesterday had the low GI group with a GI of 62!) HIgher LDL in the low carb arm . Limited to 6 months.funded by Atkins,Published the nms journal. (check out the aims of the society)

The GI can be used as tool to use to select the type of carbohydrates to eat within the context of a balanced diet; but can naturally be used with any amounts of carbs. You just select lower GI carbs within the same category of food or use other methods to lower the GI of a food or meal
You yourself were eating very low GI carbs when you ate lentils. When you added fat to your hot cross buns you were lowering the GI as do when you are when you suggest chips rather than mash . I don't know of anyone who advocates using the GI to lower carbs that suggests that adding sat or possibly trans fats(as in things cooked in hot fat) is a good thing to do on a regular basis. They might however suggest adding an olive oil and vinegar dressing to a salad or even cooling potatoes and then reheating them (creates retrograde starch; theres a good thread on one diabetes forum where people experimented with this.) They might point out that very few potatoes are really low GI so when you choose them it's best to stick to small waxy varieties.
When you suggested brown bread to a new poster you were not applying GI principles. Brown bread is not necessarily wholemeal in the UK (so fewer nutrients), wholemeal bread has more nutrients but is not lower in GI than white bread (far too processed)). Lower GI breads are leavened with sourdough, made with stone ground flour or better still have lots of whole seeds, or may have a large proportion of rye or barley flour or spelt or a mixture. In my mind this is similar to advising someone that weetabix is low GI .(seems to happen regularly)
The GI index is also used as the basis of a diet rather than a just a tool to determine the glycemic properties of the carboydrates. In all cases the importance of balancing a diet is stressed.
I have a copy of the GI diet by Jenny Brand-Miller(this is the weight loss not the diabetes book). How much you eat depends on how much you weigh, calories are still important. So for a woman of 12st it would be a diet that had 152g carbs, 79gm protein, 40gm fat, 31gm fibre. The carb content would be made up of 4 starch portions (20-30g a portion), 7 portions of fruit /veg, and some from dairy. This 152 grams would be 46% of total calories.
Other GI diet books use different methods to balance a meal . One uses the plate metho , where one quarter of the plate includes low GI starches, half veg and the other quarter protein/fat. + some dairy. The US American ADA now uses this method on it's website (they also have a page on choosing low GI carbs elsewhere.).. ironically this method used to be called the Swedish Plate.
http://www.diabetes.org/food-and-fitnes ... our-plate/
 

xyzzy

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phoenix said:
I could trade studies: (snap Stephen)

Phoenix you and Stephen can trade diets and numbers and try and prove each other right or wrong over this or that. I just care what my meter says two hours later and importantly that I want to control my T2D mostly by diet with a bit of help from Metformin only. To do that I freely admit I largely ignore the UK out of date advice and instead inform myself from other, more often than not, up to date sources like the Americans and the Swedes

Now it seems to me that the good lady and professional Janine Freeman, RD, LD, CDE the Diabetes Nutrition Specialist and on the 2012 board of directors of the AADE (American Association of Diabetes Educators) is a reductionist like me which is why I like what she says. She pushes "Eat to your meter" by "controlling total carbohydrate" as the primary means. After that selection as to what is healthy may be GI driven.

I suggest basing your food choices on a nutritionally balanced diet, while controlling total carbohydrates, as a first measure. Then, if you find that your after-meal blood glucose is much higher after eating certain foods, you can either choose to eat smaller portions of those foods or adjust your mealtime diabetes medication.

That is all I am saying. As I mentioned to Jopar earlier I am simply showing that just as there are alternative and accepted diets that are contrary to the UK NHS diet in other countries with modern Western health services those same countries do not necessarily share the same strength of belief in GI as is promoted in the UK. I do this to inform not to denigrate GI.

Likewise it is not my intent to undermine yourself or anyone else who successfully controls their condition using a GI based perspective. As insulin using diabetics who am I to tell you what system suits you best and in fact I can quite easily see why you and Jopar choose GI. Like many T2's on the forum I am not an insulin using diabetic and like them I would like to chose and advocate a method that works for us.

On the brown bread issue you raise. One simplification too far so I take your point and will amend my text. In my defence I do end up always recommending Burgen Soya bread as it has the lowest carbs and in the context of my post its the reduced carb message I'm pushing primarily. If you read the new text it studiously avoids the use of technical terms such as Carbohydrate and GI so as not to confuse the new member.

Interestingly I now have equal numbers of PM's that say my new text is better as its simpler as I have saying the old text with all the numbers in was better and that the new one is to dumbed down.
 

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Surely the whole point of a GI/GL diet is that because lower GI foods cause less of a peak in bg then when eating to your meter you will see a significant improvement in bg levels eating a low or lower GI diet.

Not really sure what it is you are trying to argue xzzxy as lower GI foods can only help you eat to your meter by the very fact that they will help keep bg levels on a more even keel and not cause the big spikes and higher levels associated with higher GI foods.

Carb reduction and low GI go hand in hand, they can only compliment each other :D
 

xyzzy

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Sid Bonkers said:
Surely the whole point of a GI/GL diet is that because lower GI foods cause less of a peak in bg then when eating to your meter you will see a significant improvement in bg levels eating a low or lower GI diet.

Not really sure what it is you are trying to argue xzzxy as lower GI foods can only help you eat to your meter by the very fact that they will help keep bg levels on a more even keel and not cause the big spikes and higher levels associated with higher GI foods.

Carb reduction and low GI go hand in hand, they can only compliment each other :D

There is nothing in what you've written I particularly disagree with. I personally think that the good doctor Freeman's statement...

I don't suggest eliminating "high GI" foods in favor of "low GI" foods to gain better blood glucose levels for two reasons. First, there is not enough evidence yet to show that such an action actually will improve your blood glucose levels; and second, choosing foods based solely on GI will compromise healthy eating.

...is a too extreme viewpoint and that low GI is useful BUT maybe that's social conditioning because as a British person exposed to the very pro GI message that has dominated for the last few decades that is what I would be expected to think!

I use GI to illustrate that just as there are those in this country who are unwilling to except the importance of lowering carbs in a diabetic regime (call them them pro starchy carb status quo lobby) there are similar fixed views that GI is all important and should override "eat to your meter" or carb counting. Patently in some health services carb counting or total carbohydrate using portion control are seen as the primary control mechanisms and GI as secondary useful tool.

I've said I personally agree with that viewpoint but others are quite welcome to view things differently.

I thought it interesting to show the readers of this thread that just as the lowering carbs debate has varying sponsors and detractors across the world a similar debates surrounds not necessarily the validity but the emphasis that should be attached to GI.

It is this balanced global view of things that I personally feel is sometimes lacking in the information we are told in the UK. I then have my own personal views as to why that increasingly global view is resisted here in the UK.

I honestly don't see you and I have much to disagree on this Sid. We are both essentially "eat to your meter" people. We may have the odd scuffle over semantics like 7.8 v 8.5 but essentially you and I seem to say "eat what you want but let your meter tell you what's safe".

From what I can gather you seem to be lucky, an even more lucky man than Grazer in regards to how much carbohydrate you can consume and keep safe. Others, and I would argue the majority of diet only T2's are not so fortunate and can't follow safely what is recommended by the UK system and consequently have to reduce carbohydrates a lot more. If we have to do that we may as well try and do that reduction as safely as possible by referencing information given out by other countries health services that do advocate lower carbohydrate regimes.
 

Unbeliever

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Totally agree with you xyzzy. Basically we are all agreed on the seesntials - the only disagreements are about semantics.


I totally agree with borofergie about he glycaemic load. This is what I do and I feel that the NHS would find this approach less frightening that low or reduced carbing pure and simple.

Many in the NHS are aware that reducing carbs works but are effecively "gaged " by the sysem and only whisper it ino the ears of he select few. It is probaly more acceptable to use it as a means of weigh loss.

I can't see the NHS coming ou and recommending low carbing anytime soon It will creep in gradually - probably in much the same way as GI has now become respectable and mainstream At least that is an improvement on highcarb low -fat,
Perhaps small seps, having it menioned as an alternaive some diabetiscs use etc and of course providing information here are the best we can hope for in the short erm..

Sweden had very advanced views abou educaion oo which many here would like o have seen adope but i never happened .
There have been various health initiatives in the EEC which could/should have been adoped here but weren't.
Obviously condiions/demographics in Sweden make it useful as a universal guinea pig or model Utopia.

I jst wish the NHS would stop recommending any diet. Inform the paient of all he different methods others use to control thei r diabees and offer them assisance o find their own way.
 

Sid Bonkers

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xyzzy said:
There is nothing in what you've written I particularly disagree with. I personally think that the good doctor Freeman's statement...

I don't suggest eliminating "high GI" foods in favor of "low GI" foods to gain better blood glucose levels for two reasons. First, there is not enough evidence yet to show that such an action actually will improve your blood glucose levels; and second, choosing foods based solely on GI will compromise healthy eating.

...is a too extreme viewpoint

The good doctor of whom I have no knowledge whatsoever is IMO totally wrong in his conclusions, you only have to look at how many forum members here are able to eat Burgen (Lo GI) soya & linseed bread when they cant touch any other bread without spiking badly to know that GI works.

I rest my case your honour
 

xyzzy

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Sid Bonkers said:
xyzzy said:
There is nothing in what you've written I particularly disagree with. I personally think that the good doctor Freeman's statement...

I don't suggest eliminating "high GI" foods in favor of "low GI" foods to gain better blood glucose levels for two reasons. First, there is not enough evidence yet to show that such an action actually will improve your blood glucose levels; and second, choosing foods based solely on GI will compromise healthy eating.

...is a too extreme viewpoint

The good doctor of whom I have no knowledge whatsoever is IMO totally wrong in his conclusions, you only have to look at how many forum members here are able to eat Burgen (Lo GI) soya & linseed bread when they cant touch any other bread without spiking badly to know that GI works.

I rest my case your honour

The doctor is a lady Sid. Don't worry I've done that - twice :oops:

Aha but there we have it Sid. You eat Burgen cos its Lo GI. I eat Burgen cos its Lo Carb. Both views are applicable wouldn't you say? What matters is not one piece of Burgen but what happens overall.

Seriously though my point is you and I would eat the slice of Burgen and then test. No difference.

The difference is if a UK dietician were giving us that eat Burgen advice they would go on to say "and eat a diet of similar starchy carbs with every meal and don't stop until 33% of what you've eaten is starchy and your total carbs amount to 50% of your daily intake".

This overall advice gives the majority of diet only T2's no chance of successfully eating to their meters.

A Swedish dietician recommending their moderate carb reduced system would say "Eat the Burgen in moderation but also try and eat a diet rich in [list of foods] and restrict other starchy carbs so that your total carbs amount to 30%".

This gives the majority of diet only T2's a far better chance of successfully eating to their meters.

Likewise an American dietician would nowadays say a Grazer like phrase of "eat around 130g of carbs a day" and again give the majority of diet only T2's a far better chance of successfully eating to their meters.
 

Sid Bonkers

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xyzzy said:
Aha but there we have it Sid. You eat Burgen cos its Lo GI. I eat Burgen cos its Lo Carb. Both views are applicable wouldn't you say? What matters is not one piece of Burgen but what happens overall.

Its not that simple xyzzy, if you were to eat a portion of white bread that contained the same amount of carbs as a Burgen slice your bg levels would rise more than it would had you eaten the Bugren slice (with the same amount of carbs) therefore Lo GI works. _ This is a discussion not an argument :D



xyzzy said:
The difference is if a UK dietician were giving us that eat Burgen advice they would go on to say "and eat a diet of similar starchy carbs with every meal and don't stop until 33% of what you've eaten is starchy and your total carbs amount to 50% of your daily intake".

So is that what a UK dietician told you personally xzxxy? As I have seen a UK dietician and her advice was to eat no more than I could fit in my hand (portion size) To eat low GI wherever possible and that Low carb was the way forward.



xyzzy said:
A Swedish dietician recommending their moderate carb reduced system would say "Eat the Burgen in moderation but also try and eat a diet rich in [list of foods] and restrict other starchy carbs so that your total carbs amount to 30%".

How can you say what a Swedish dietitian would say when you have never, I assume, seen one?

So often stuff gets repeated as though it was advice given to that person when in reality it is not. And I am well aware of the information given by DUK and the NHS but as I have said many times like a game of Chinese Whispers information gets interpreted differently by by different individuals and I can only go by what I was told by the UK dietician I was referred to who at no time even hinted that I should eat more carbs, I was eating 60g to around 85g a day at the time, all she mentioned after reading my weekly menus was that I should eat more oily fish which I'm sure many low carbers would agree with, unfortunately I do not like oily fish so it never happened.

Perhaps I am in the minority to be given that information, but perhaps I am in the minority of those who have actually seen a dietician and am not just repeating the same old same old? :D
 

jopar

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I asked for the links for your quotes, so that I could see the quote in full context, and to be pedantic if you’ll quote its etiquette and copyright policy to link to the original article.
And again I’m going to be pedantic, the first link you give to the does have its problem. There’s no date to say when the article was published, but because it’s based Janine Freeman, RD, CDE, in her Guest Editorial of the Diabetes Forecast September 2005 on the ADA website… So we can assume that this that the ndap published sometime afterwards… Follow the link to the ADA site it doesn’t link to her article but to the main page, I had a dig around but couldn’t find it..

The article I can only assume that it’s giving a brief on her article she had written as a forecast. But there is no details to research she’s built her conclusions, so can’t look to see if we conclude the same..
But Another problems is information given in the ‘Bottom Line’ Firstly they’ve quoted the ADA, but not linked to this information on the ADA website, The second quote they’ve linked but it isn’t available! But the worst faux pau considering that this article could not have been published until after September 2005, they managed to provide a link to a non-existent website! The British Diabetic Association hasn’t existed since 2000, so the website provide is at least 5 years out of date!

The second Link provided, is actually not dispelling the Gi diet as such, it does link to the various studies it’s looking at, each study though is under 6 months duration… I haven’t had a look at the individual studies though, but happy enough to go along with their bottom line, if weight loss is required, it is about calories, exercise considerations as well…
Wish I think is a message that most of us give to others…

Your third you haven’t linked to!

But you seem to think that I follow a certain diet…. I actually don’t but I do feel that all diabetics do need to understand the GI index/load so they are aware of the probable impact on their glucose levels be they T1 or T2, on whatever diet they chose to follow..

Yes and I would agree carb amounts are an important part of control again whatever type of diabetic we are…
I noticed that you’ve only been diagnosed for a year, Now the problem for every diabetic is has will travel through time, not only does our bodies change, our environments can change etc.. This can lead to an rejig to our regimes we use to suit our current needs, and this is where the problem comes with T2’s and control… At what point does driving down the carbohydrate content of your diet, or increase medication!
 

xyzzy

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Jopar

You and I know that I could go off and find many similar criticisms of the GI system. I picked one. You can either believe that the article was written by the same Dr Freeman or not. I'm sure the readers of this thread can make their own judgement about that and judge the quality and professionalism of the lady making that statement.

The second article we agree on. It just shows like many other studies weight loss can be achieved by adopting any one of a number of sensible diets not just necessarily a low GI one.

Sorry the third one has a link to the research I found that works cos I just tried it.

I apologise if I assumed you follow a GI regime if you don't that's your choice...

As a T2 the diet I choose to give me long term control is my choice. Elsewhere on this forum I have written about my long term thoughts on this. To summarise. I wish to get to a good healthy weight, quite low in fact. I do not want to take medication that would turbo charge my pancreas and shorten its lifespan.

The reason?

At some point your comments may turn out to be true. I might want to start eating a higher carb diet. At that point I would rather choose an insulin option combined with a semi working pancreas as then the amount I would need to inject would be minimised.

This is every T2's ultimate choice but it is a choice that is taken away from so many people by the current system.

Using my plan I will be making that choice from a position of healthy weight, a position where I have had to learn to control my diet and importantly at a time of MY choosing and not when I am forced to go down that route because the health service has tried its best to ruin my pancreas with it starchy carb but don't worry take these meds message. That is the old T2 is a "progressive disease message". It is a depressing self perpetuating message pushed by the NHS in this country. I will fight it every inch of the way.
 

phoenix

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As to how any guidelines are interpreted in practice you might like to read this from Stephanie Dunbar, MPH, RD, director of nutrition and medical affairs at the American Diabetes Association. You will be pleased to see that there is not a mention of the GI directly, though it is perhaps implied in paragraph 3. The main tool she mentions is the one I pointed out last night ie the plate method.
http://forecast.diabetes.org/magazine/f ... -diet-myth

Also compare what the present DUK guidelines for the management of weight and glucose control with those of the ADA. A dietitian in the UK should be using these guidelines. You should also be able to get specialist dietitian support. Unfortunately I agree the amount of this that's offered and it's quality seems to be variable.

In both cases the strength of the evidence is rated alphabetically with A the strongest.
Recommendations
• Weight management should be the primary nutritional strategy in managing
glucose control in Type 2 diabetes for people who are overweight or obese. (A)
• Regular, moderate physical activity can reduce HbA1c by 0.45 – 0.65 per cent
independent of weight loss. (A)
• Focus should be on total energy intake rather than the source of energy in the diet
(macronutrient composition) for optimal glycaemic control. (A)
• The total amount of carbohydrate consumed is a strong predictor of glycaemic
response and monitoring total carbohydrate intake whether by use of exchanges,
portions or experience-based estimation, remains a key strategy in achieving
glycaemic control. (A)
• Low GI diets may redcue HbA1c up to 0.5 per cent . (A)
http://www.diabetes.org.uk/nutrition-guidelines
You might note that these guidelines are quite different to the previous ones:
http://www.york.ac.uk/media/healthscien ... Thomas.pdf

ADA
In overweight and obese insulin-resistant individuals, modest weight loss has been shown to reduce insulin resistance. Thus, weight loss is recommended for all overweight or obese individuals who have or are at risk for diabetes. (A)

For weight loss, either low-carbohydrate, low-fat calorie-restricted, or Mediterranean diets may be effective in the short-term (up to 2 years). (A)

For patients on low-carbohydrate diets, monitor lipid profiles, renal function, and protein intake (in those with nephropathy), and adjust hypoglycemic therapy as needed. (E)

Physical activity and behavior modification are important components of weight loss programs and are most helpful in maintenance of weight loss. (B
The best mix of carbohydrate, protein, and fat may be adjusted to meet the metabolic goals and individual preferences of the person with diabetes. (E)

Monitoring carbohydrate, whether by carbohydrate counting, choices, or experience-based estimation, remains a key strategy in achieving glycemic control. (A)

For individuals with diabetes, the use of the glycemic index and glycemic load may provide a modest additional benefit for glycemic control over that observed when total carbohydrate is considered alone. (B)

Saturated fat intake should be <7% of total calories. (A)

Reducing intake of trans fat lowers LDL cholesterol and increases HDL cholesterol (A), therefore intake of trans fat should be minimized. (E)

Other nutrition recommendations
If adults with diabetes choose to use alcohol, daily intake should be limited to a moderate amount (one drink per day or less for adult women and two drinks per day or less for adult men). (E)

Routine supplementation with antioxidants, such as vitamins E and C and carotene, is not advised because of lack of evidence of efficacy and concern related to long-term safety. (A)

Individualized meal planning should include optimization of food choices to meet recommended dietary allowance (RDA)/dietary reference intake (DRI) for all micronutrients. (E)
http://care.diabetesjournals.org/content/34/Supplement_1/S11.full

These documents aren't saying vastly different things. The ADA diet is very specific on keeping sat Fat down. This would mean that incarnations of a lower carb diet that are heavy in animal and dairy fats wouldn't fit in with their guidelines.

Re your dietitian article , as mentioned by Jopar it dated to 2005 and is outdated.
The ADA guidelines at the time were very much 'old school' and they say that there was no reason to substantially change their advice to that given in the 90s.
http://care.diabetesjournals.org/content/25/1/148.full
It was carb controlled, but not in the way you imply. They suggested 70% of the diet from combined carbs and monosaturated fat but they also stress that there was a concern that fat replacing carbohydrate might promote weight gain and insulin resistance.
In prcatice the starting diet for a woman suggested by US dietitians included 45g carb at each meal and 2 snacks of 25g each, including fruit , veg and dairy 50% of the diet was from carbohydrate. sample here: http://www.diabeteswellbeing.com/1800-c ... -plan.html .
If you look at American forums you will find this standard diet is still prevalent and very much derided on these same forums. And at the time I agreeethat they also were very negative towards the GI. Other associations, European and Australian were far more positive. Indeed the most recent ADA guidelines are a big change towards acceptance.