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Dec 2014 update: New research on the Low Carb Diet in general practice
- Thread starter Southport GP
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xyzzy thanks. as a newcomer i seem to have posted my Qs, which are real not theoretical, to wrong part of the site.
Moderator please would you reallocate to correct part and let me know where that is.
incidentally what is eat to your meter- at any single eating session you will get a 2-"x" hour response rise in bs but unless you eat exactly the same food each time you will get different results hence my Q about carb/cals stated quantities as rough guide eg tin of peas has info on label but an avocado pear doesn't so how do you predict insulin dose with food + simultaneous short insulin as you don't know any figures till at least 2 hours after the event even treatment of low bs says eat sugar/sweet + biscuit but would be helpfulif said take at least "x" cals of glucose so you can know how many glucose tablets/etc to take
also how does high fat fit with fatty liver?
Moderator please would you reallocate to correct part and let me know where that is.
incidentally what is eat to your meter- at any single eating session you will get a 2-"x" hour response rise in bs but unless you eat exactly the same food each time you will get different results hence my Q about carb/cals stated quantities as rough guide eg tin of peas has info on label but an avocado pear doesn't so how do you predict insulin dose with food + simultaneous short insulin as you don't know any figures till at least 2 hours after the event even treatment of low bs says eat sugar/sweet + biscuit but would be helpfulif said take at least "x" cals of glucose so you can know how many glucose tablets/etc to take
also how does high fat fit with fatty liver?
CollieBoy
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Redfox,
"Eating to your meter" is for me, a process of of try a food, test.
If Bg goes too high, don't retry,
If BG stays low, put on "good list",
If high but not too high, try again with smaller portion.
This is repeated with more foods until you form an "acceptable food list"
"Eating to your meter" is for me, a process of of try a food, test.
If Bg goes too high, don't retry,
If BG stays low, put on "good list",
If high but not too high, try again with smaller portion.
This is repeated with more foods until you form an "acceptable food list"
Fergus thanks very much.
I'm still confused because at any one session you have two variables that you control [and heavens knows how many variables you can't control such as rate of digestion/ non absorption] which are a] cals input b] units of insulin injected. If you start with a blood test you put in enough insulin to reduce that level to zero then you have to guess how much more to put in to counteract what you are about to eat which is where estimating low to avoid hypos creeps in. End result is a 2+ hour reading[ I say + because in my experience bs can go on rising way after 2 hours] which reflects the two contollable variables but you don't know how much of the result is due to each. If you don't inject then you can easily get to bs 20 so have to then inject 14 units of insulin [7 on the pen] to get down to recommended 6 [if you're lucky] in a yo-yo situation. By this time you are into the next eat every 4 hours time.
I'm still confused because at any one session you have two variables that you control [and heavens knows how many variables you can't control such as rate of digestion/ non absorption] which are a] cals input b] units of insulin injected. If you start with a blood test you put in enough insulin to reduce that level to zero then you have to guess how much more to put in to counteract what you are about to eat which is where estimating low to avoid hypos creeps in. End result is a 2+ hour reading[ I say + because in my experience bs can go on rising way after 2 hours] which reflects the two contollable variables but you don't know how much of the result is due to each. If you don't inject then you can easily get to bs 20 so have to then inject 14 units of insulin [7 on the pen] to get down to recommended 6 [if you're lucky] in a yo-yo situation. By this time you are into the next eat every 4 hours time.
xyzzy
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Hi Redfox
Afraid I am a non insulin using T2 and control just by diet and Metformin so calculating insulin for the number of carbs you are eating isn't something I can really advise you on. If you repost your questions in the insulin using T2 section I expect you'll get loads of useful advice
http://www.diabetes.co.uk/forum/category/type-2-with-insulin.57/
Afraid I am a non insulin using T2 and control just by diet and Metformin so calculating insulin for the number of carbs you are eating isn't something I can really advise you on. If you repost your questions in the insulin using T2 section I expect you'll get loads of useful advice
http://www.diabetes.co.uk/forum/category/type-2-with-insulin.57/
paul-1976
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I can't help either sadly-only use a basal insulin myself currently-I'd recommend posting in the forum outlined above by Xyzzy.
CollieBoy
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Redfox,
try the online carb counting course at BDEC http://www.bdec-e-learning.com/
It's for T1s but insulin using T2s can get some good info.
try the online carb counting course at BDEC http://www.bdec-e-learning.com/
It's for T1s but insulin using T2s can get some good info.
Interestingly my research gave results not dissimilar to the newcastle diet which I think was a harsh 800 Cals a day
Let's hope as you say the LCHF diet is gaining ground; as a 'news flash' I can announce it was featured, I think for the first time in the context of diabetes today in the British Medical Journal, arguably the most important UK medical journal !! It's because our work won through to the final round of Primary care team of the year -- We are so proud !! Result not till MayI haven't yet met with the clinical "Diabetes Team" that my GP referred me to,, but, so far, the specialists that I have seen to keep check on DB complications have said that I am doing a good job of using the LCHF diet. This is a good sign, because it might mean that when I finally get around to seeing the Diabetes Team I might be pleasantly surprised to find that they, too, are up on the diets that really work for us. Maybe there is a common-sense standard operating among clinicians, here in the States.
It seems that almost every health professional I have spoken to, including my dentist and my chiropractor, are convinced that the LCHF is the way to go. It isn't only the practitioners who have the highest amount of patients with diabetes, such as podiatrists and neurologists, who are up on this. I can assume from this that the medical profession, in general, is starting to come down to earth, at least from what I personally observe, here in the States.
My GP doesn't seem to care one way or the other how I'm getting my BG numbers under control, as long as I do it. However, she has already tried to push Rx drugs on me, which I have refused.
I appreciate that clinicians, such as yourself, care enough about people who have diabetes to do the work, putting in the time and energy to do the research. The neurologist I met with today actually used the word "cure" in reference to the track that I am trying, and he said that he wished that all of his patients were doing what I am doing. So, there is hope.
Janiept
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Delightful news for a vegetarian. Thank you for your detailed explanation.
tonyS54
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Southport GP reported improved liver function tests in his patients, my own blood tests have not shown any problems all coming within lab values.
Totto
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Non Alcoholic Fatty Liver Disease usually improves fast on a low-carb-high-fat diet, as it is the carbs that causes fatty liver when alcohol isn't the issue.
For how long have you been diagnosed?
Dr Bernstein is a good source for T1 and low-carbing, have you read his book?
phoenix
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Redfox
Just a couple of observations on your post
The Newcastle diet is very low calorie. It has had one short trial with a dozen subjects. Lots of others have tried it out , many reporting success. As a result there is to be a large RCT in the future. I would think that the results of this could influence NHS advice.
A lot of your problems are about insulin use rather than diet controlled T2. May I suggest that you have a look at the book Think Like a Pancreas, it might answer some of your questions, Also do put specific questions on insulin forums, some people may be reluctant to reply on this thread.
Last, this is a UK forum, I live in France and here we also use mg/dl for cholesterol and some other tests, for glucose we are alone using g/l. you soon become bi or even tri lingual
xyzzy
I agree with much of your analysis (ages back, I started this yesterday)
Re partial agreement SDocs diet. In spite of the division that sometimes (often!) occurs on here. I actually don't know of any people on here who use a very low fat diet / high carb diet . This would normally be 20% or fewer calories from fat. Ornish's heart diet is only 11% from fat with 71% from carbs. I've come across T2 vegans/vegetarians elsewhere who have claimed to successfully use this sort of diet
The opposite is the very low carb and high fat (80%fat 18% protein and 2% carb) or the Bernstein 6, 12,12 diet. Again, I've seen only a handful of people who actually use this sort of diet on diabetes forums.
Most peoples diets seem to be somewhere in between the two. There is certainly no way could you eat Southport Docs vegetable soups on the lowest carb diets. Indeed, Bernstein quite explicitly forbids it and even limits tomatoes to a slice. On the other hand, people who eat any animal products would find it very hard to adopt the very lowest fat, with consequent higher carbs and often very much higher fibre than most people are used to eating.(look up the Ma Pi 2 diabetes diet)
Given that most people aren't at the extremes , it's not surprising that many people see at least some similarity between their own and Southport Docs fairly moderate diet. (and yes I do too!)
One place in your post I'd comment on is this:
" "controversial" non standard "low carb" advice is to up natural saturated fats (eggs, cheese, butter etc).....
agree that is very controversial
However there are fats other than sat fats . I think that most things I have read recently still suggest that Sat fats tend to raise LDL and suggest replacing sat fats with polyunsaturated fats rather than carbs (particularly any sort of refined carbs)
The Mediterranean diet is relatively high in fat but that fat is mainly monounsaturated . The successful (re CVD) Predimed diet contained about 20% of cal from monounsaturated, 10% from sat fat and 7% from polyunsatfat . These were mainly from olive oil, nuts, and fish, the diets tended to emphasise white rather than red and processed meats plus fruit, veg, legumes, real whole grains and some dairy. The Lyon heart trial with a similar diet (though they used rapeseed margarine rather than olive oil) was also very successful. (the BMJ article that was headlined in yesterdays newspaper articles comments, favourably on those trials
)
However, as you say there is a gap between the 38/40% fat contained in the Med diet and one of 60+%.
That's where I would think more carbs in the shape of more veg, possibly more low GI fruits but particularly more legumes (their properties were discussed elsewhere on the thread by Yorkman). The people on the Predimed diet ate 3+ portions of legumes a week.
Just a couple of observations on your post
The Newcastle diet is very low calorie. It has had one short trial with a dozen subjects. Lots of others have tried it out , many reporting success. As a result there is to be a large RCT in the future. I would think that the results of this could influence NHS advice.
A lot of your problems are about insulin use rather than diet controlled T2. May I suggest that you have a look at the book Think Like a Pancreas, it might answer some of your questions, Also do put specific questions on insulin forums, some people may be reluctant to reply on this thread.
Last, this is a UK forum, I live in France and here we also use mg/dl for cholesterol and some other tests, for glucose we are alone using g/l. you soon become bi or even tri lingual
xyzzy
I agree with much of your analysis (ages back, I started this yesterday)
Re partial agreement SDocs diet. In spite of the division that sometimes (often!) occurs on here. I actually don't know of any people on here who use a very low fat diet / high carb diet . This would normally be 20% or fewer calories from fat. Ornish's heart diet is only 11% from fat with 71% from carbs. I've come across T2 vegans/vegetarians elsewhere who have claimed to successfully use this sort of diet
The opposite is the very low carb and high fat (80%fat 18% protein and 2% carb) or the Bernstein 6, 12,12 diet. Again, I've seen only a handful of people who actually use this sort of diet on diabetes forums.
Most peoples diets seem to be somewhere in between the two. There is certainly no way could you eat Southport Docs vegetable soups on the lowest carb diets. Indeed, Bernstein quite explicitly forbids it and even limits tomatoes to a slice. On the other hand, people who eat any animal products would find it very hard to adopt the very lowest fat, with consequent higher carbs and often very much higher fibre than most people are used to eating.(look up the Ma Pi 2 diabetes diet)
Given that most people aren't at the extremes , it's not surprising that many people see at least some similarity between their own and Southport Docs fairly moderate diet. (and yes I do too!)
One place in your post I'd comment on is this:
" "controversial" non standard "low carb" advice is to up natural saturated fats (eggs, cheese, butter etc).....
agree that is very controversial
However there are fats other than sat fats . I think that most things I have read recently still suggest that Sat fats tend to raise LDL and suggest replacing sat fats with polyunsaturated fats rather than carbs (particularly any sort of refined carbs)
The Mediterranean diet is relatively high in fat but that fat is mainly monounsaturated . The successful (re CVD) Predimed diet contained about 20% of cal from monounsaturated, 10% from sat fat and 7% from polyunsatfat . These were mainly from olive oil, nuts, and fish, the diets tended to emphasise white rather than red and processed meats plus fruit, veg, legumes, real whole grains and some dairy. The Lyon heart trial with a similar diet (though they used rapeseed margarine rather than olive oil) was also very successful. (the BMJ article that was headlined in yesterdays newspaper articles comments, favourably on those trials
)However, as you say there is a gap between the 38/40% fat contained in the Med diet and one of 60+%.
That's where I would think more carbs in the shape of more veg, possibly more low GI fruits but particularly more legumes (their properties were discussed elsewhere on the thread by Yorkman). The people on the Predimed diet ate 3+ portions of legumes a week.
xyzzy
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I agree with much of your analysis (ages back, I started this yesterday)
Re partial agreement SDocs diet. In spite of the division that sometimes (often!) occurs on here. I actually don't know of any people on here who use a very low fat diet / high carb diet . This would normally be 20% or fewer calories from fat. Ornish's heart diet is only 11% from fat with 71% from carbs. I've come across T2 vegans/vegetarians elsewhere who have claimed to successfully use this sort of diet
The opposite is the very low carb and high fat (80%fat 18% protein and 2% carb) or the Bernstein 6, 12,12 diet. Again, I've seen only a handful of people who actually use this sort of diet on diabetes forums.
Most peoples diets seem to be somewhere in between the two. There is certainly no way could you eat Southport Docs vegetable soups on the lowest carb diets. Indeed, Bernstein quite explicitly forbids it and even limits tomatoes to a slice. On the other hand, people who eat any animal products would find it very hard to adopt the very lowest fat, with consequent higher carbs and often very much higher fibre than most people are used to eating.(look up the Ma Pi 2 diabetes diet)
Given that most people aren't at the extremes , it's not surprising that many people see at least some similarity between their own and Southport Docs fairly moderate diet. (and yes I do too!)
One place in your post I'd comment on is this:
" "controversial" non standard "low carb" advice is to up natural saturated fats (eggs, cheese, butter etc).....
agree that is very controversial
However there are fats other than sat fats . I think that most things I have read recently still suggest that Sat fats tend to raise LDL and suggest replacing sat fats with polyunsaturated fats rather than carbs (particularly any sort of refined carbs)
The Mediterranean diet is relatively high in fat but that fat is mainly monounsaturated . The successful (re CVD) Predimed diet contained about 20% of cal from monounsaturated, 10% from sat fat and 7% from polyunsatfat . These were mainly from olive oil, nuts, and fish, the diets tended to emphasise white rather than red and processed meats plus fruit, veg, legumes, real whole grains and some dairy. The Lyon heart trial with a similar diet (though they used rapeseed margarine rather than olive oil) was also very successful. (the BMJ article that was headlined in yesterdays newspaper articles comments, favourably on those trials
However, as you say there is a gap between the 38/40% fat contained in the Med diet and one of 60+%.
That's where I would think more carbs in the shape of more veg, possibly more low GI fruits but particularly more legumes (their properties were discussed elsewhere on the thread by Yorkman). The people on the Predimed diet ate 3+ portions of legumes a week.
Hi Phoenix
I pretty much agree with all you've said. I'm a devout reductionist at heart and tend to think in terms of the physical effects of any regime on bg's rather than analyse things at the dietary level. I'm quite happy taking bits and pieces from all regimes just so long as they work for me. Two and a half years down the line from diagnosis I'd be the first to admit I have mellowed (slightly) in my opinions somewhat.
Nowadays I'd argue that for probably the first year a newly diagnosed T2 should go low or even very low carb and do "whatever fat except trans fats" to simply concentrate on gaining back normal bg levels, normalising blood pressure and of course losing weight if needed so that insulin resistance is lowered. The major concentration on diet should be on sugar and starch although having an understanding of other carb sources is always worthwhile especially if you choose the full ketogenic lifestyle which for some is a perfectly valid choice to make imo.
I've always thought what my meter said is far more important than grams of carbs. I also totally understand people who "demonise" carbs and appear somewhat fanatical as if you've discovered that unless you gain a control of them you could go blind (and worse) then treating them in the same way as someone who has given up smoking or alcohol is a pretty natural thought process and can become a tool that some find incredibly useful. We should be prepared to accommodate and accept all viewpoints if they patently work for people.
I still think of myself as implicitly low carbing even though nowadays I don't bother worrying about the carbs in most vegetables (except potatoes) and am a lot more tolerant towards fruit and legumes. I find GI a useful tool but honestly think of it in the same way as when I add double cream to fruit i.e. just as a means of slowing down potential spikes. I still apply the "be suspicious of foods that come in a box" and try to cook everything from fresh ingredients when possible.
My major issue at the moment is not in maintaining good bg's but in finding a good balance between carbs and fat. Keeping true to my "eat to your meter" reductionist approach I don't see why I shouldn't eat more good unprocessed healthy carbs if my meter tells me I'm coping with them. Reintroducing some extra carbs means rebalancing my fat intake but that's what the bathroom scales are for! My carb intake is still nothing like a non diabetics and although my ogtt experiments show my response to glucose is still abnormal they do show I have regained some function.t I put all my improvement down to my low carb lifestyle giving my pancreas the rest it needed. I would guess I'm now running closer to 25% rather than the 15% it was for the first year.
I have been diagnosed with another hormonal imbalance that can implicitly cause weight gain so however much function I regain I'll probably always stick to a low carb regime simply to minimise insulin production.
Btw Adam (Pneu) sends his regards. He's very busy with two young children and a house move at the moment but he's getting on fine.
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Izzy I like the way you use a pragmatic approach and reduce things to simple messages, as I have to do as similar thing when first introducing the idea of lower carbing. The single fact that wins with many sceptical Health professionals is the higher glycemic index of even whole meal bread compared to table sugar. Followed up with 'starch is how plants concentrate glucose for storage' If this is accepted the rest follows.
It's a bit bonkers but I would like to see the slogan 'starch in concentrated sugar' on hoardings ,the sides of buses,as a full page advert in the papers. Everyone got the fat debate eventually but it was flawed we need the sugar and starch debate to get going now if the epidemic of diabetes is to be halted
It's a bit bonkers but I would like to see the slogan 'starch in concentrated sugar' on hoardings ,the sides of buses,as a full page advert in the papers. Everyone got the fat debate eventually but it was flawed we need the sugar and starch debate to get going now if the epidemic of diabetes is to be halted
FatGenes999
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Yep, there are many people who don't know that starch IS sugar. Many people think that sugar is only the white/brown granules you use in coffee, and don't know how many hidden forms sugar can take in modern society. it is endless.
Also, I was just reminded again, in a book I am reading, that the word "carbohydrate" is actually nothing else than the scientific word for sugar. It is basically a form of carbon + water.
The world needs so much education on sugar and diabetes and I am very glad that some practitioners are trying to spread the information.
modesty007
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Just want to put a word forward about the the Scandinavian LCHF diet/life style it's much more then eating food low carbs and high fat, it's about;
avoiding gluten and grains, choosing grass-fed beef and lamb, try to buy local produce, try to eat organic, avoid additive, avoid added msg, eating natural food etc
Regarding saturated fat, hopefully the tide is turning - http://openheart.bmj.com/content/1/1/e000032.full
avoiding gluten and grains, choosing grass-fed beef and lamb, try to buy local produce, try to eat organic, avoid additive, avoid added msg, eating natural food etc
Regarding saturated fat, hopefully the tide is turning - http://openheart.bmj.com/content/1/1/e000032.full
Thanks Modesty that is a very well researched piece of work - amazing number of references Also I think far more people have problems with gluten than is generally known The book Grain Brain has a lot more detail
modesty007
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And now you can actually test for non-celiaci gluten sensitivity as the cyrex tests are available in UK
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I have been asked for the reference for the article - its Practical Diabetes2014; 31(2); 76-79 There is an agreement that in a while it will become free to view - will keep you posted.
