Dietary advice appreciated

mikeb508 said:

Would appreciate some input from some of the more experienced members regarding diet / exercise, I was diagnosed type 2 about 4 weeks ago, fasting BG about 16, on Metformin and Simvastatin, Doctor said to avoid simple carbs white bread, pasta etc and lose weight (17.5 stone BMI 37).

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You have an incredibly progressive Doctor. That's the kind of advice that we all needed when we were diagnosed.

mikeb508 said:

Results are a bit confusing and would appreciate feedback, first week lots of energy lost 4-5 lbs but carbs were pushing BG too high, after reducing carbs to minimum BG is hovering around mid 6s, lot less energy and strong smell of amonia when sweating at the gym, I understand that this is due to ketosis and the body using protein / fat rather than carbs. weight loss seems to have stalled.

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That's not entirely surprising. Mark Sisson (a former ultra runner and low-carb triathlete) thinks that it can take around 3 weeks to switch from being a "sugar burner" to becoming ketone-adapted. I highly recommend this podcast on ketsosis:
http://livinlavidalowcarb.com/blog/ask- ... sson/13269

mikeb508 said:

Main questions are, am I better off increasing the carbs and accepting the higher BG, or keeping BG down with the low carbs, I know the ketosis is normal if there are no carbs to burn and do not think this is an issue if the BG level is not elevated but am I doing more damage with the increased load on the liver kidneys and higher fat/protein intake.

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Others might disagree, but I'm certain that you're better off low-carbing. I prefer to reduce the known risk of DIABETIC complications rather than worry about SPECULATIVE complications from higher fat and protein intake.

(...and I actually I'd go further than that, I strongly believe that we evolved to follow a low-carb/ moderate-protein/ high-fat diet, and that T2 diabetes is a compication of forcing our body to eat a diet rich in carbohydrates).

The other thing to note, is that you can probably bring up your carbs a little to take yourself out of ketosis (or at least to stop yourself leaking keytones). When I was first diagnosed I was strictly eating less than 30g a day, as I lost weight and upped my exercise I found I could maintain a goo HbA1c with more carb (probably about 70g).

However, (for those of us not on insulin), I don't think that becoming keto-adapted is a bad thing at all. With that in mind I've been trying to zero-carb this week (I know that this is technically impossible, but I'm only eating meat, salad, non-starchy veg and cheese). I ran a 5k race this morning and, even though my time sucked, I didn't feel any different to normal.

Good luck!

Stephen

Hi Mike

Have a look at Viv's Modified Atkins Diet which is in the Sticky Thread list. You sound to me to be half-way there already, and if you want weight loss and better BG readings this diet will certainly help. If you don't want to take your carbs so low and stay in ketosis, buy a carb-counting book and add carbs in from low GI foods until you hit the level that suits you.

A good book is Atkins Diabetes Revolution, by Dr M C Vernon and J A Eberstein. There are plenty of others about as well.

I'm struggling to stick to my preferred way of eating at the moment (February is always a bad time for me :roll: ) but I'll get back to it shortly and I know it will work - weight, BG and cholesterol will all go down.

Best of luck

Viv 8)

borofergie said:

Others might disagree, but I'm certain that you're better off low-carbing. I prefer to reduce the known risk of DIABETIC complications rather than worry about SPECULATIVE complications from higher fat and protein intake.

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Its hardly SPECULATIVE Stephen google 'dangers of high fat/protein diets' you will find all the proven information in amongst all the highly speculative low carb high fat stuff

Sid Bonkers said:

Its hardly SPECULATIVE Stephen google 'dangers of high fat/protein diets' you will find all the proven information in amongst all the highly speculative low carb high fat stuff

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I did exactly as you said Sid and got lots of mixed advice. I certainly didn't see any proof that high fat / protein diets are dangerous though (although, having read extensively around the subject, I'm not really that surprised).

Maybe you could help me find some...

Hi mike, I won't add much to the great advice you've already been given, but maybe you could stay on your low carb diet until you get the weight you want, which will also get your BGs under control, then slowly up the carbs until you get to a level that maintains your weight AND keeps your BGs in range. Takes a while with sensible testing to establish that balance.
Good luck.
Grazer

borofergie said:

Others might disagree, but I'm certain that you're better off low-carbing. I prefer to reduce the known risk of DIABETIC complications rather than worry about SPECULATIVE complications from higher fat and protein intake.

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I think you have to take a short and long term view of this.

When I was first diagnosed I low carbed at around a 40g / day level and didn't give a hoot what I replaced the carbs with so I had no issue with eating a fry up of bacon eggs and mushrooms for lunch on quite a few days each week or vast quantities of cheese and eggs etc. My entire focus was on getting my BG's back to normal ranges at all times. Now 10 weeks down that path with my BG control predominately sorted I am still low carbing at around 70g / day but am gradually finding how to make the carb / fat / protein balance better. Even with the high fat / high protein route I've lost around 30lbs of weight and do nowhere near the exercise you do although I'm in no way saying you should stop exercising if you want to or enjoy it or have been advised to exercise by your doc etc. I'd rather be walking the dogs though!

xyzzy said:

I think you have to take a short and long term view of this.

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It depends what your aim is.

As Grazer and xyzzy (and I) are suggesting, as you find out a bit more about your body's reaction to carbohydrates you can start to add in some carbohdrates that will bring you out of ketosis. I think this is the place that most of the "low-carbers" on this board eventually find themeselves in, with good control of their BG and a diet that includes some carbohydrate for variety.

If your goal is rapid weight loss, then it's probably a good idea to stay where you are now (essentially on the Atkins induction phase), a very low carb (<<50g a day) diet that puts you in ketosis (burning fat as your fuel, rather than glucose). Even if you eat more fat and more protein in this phase, then you'll probably still shed loads of weight. As you are finding, it hurts a bit for the first two or three weeks while your brain switches over from burning glucose as its primary fuel to a mixture or ketones and glucose (this glucose doesn't have to come from dietry carb, as your liver will create enough glucose for this purpose from protein).

It is (technically) possible to keep up a ketogenic diet long term, as advocated by some of the hardcore "Paleo" people. The thinking here is that you evolved to eat a low-carb, mid-protein, high-fat diet, and not one where most of the energy comes from refined carbohydrate, and that diabetes and "metabolic-syndrome" are a result of forcing your body to eat a high-carb diet for which it is not properly adapted. To do this, without losing lots of weight as described above, you need to significantly up your fat intake, which is where most of the controversy the Sid is alluding to comes from.

Taking the third approach is tough, it bascially means giving up carbohydrates forever (no bread, pasta, rice, sweeties) forever. For all of the talk of "low-carbing" I'm not aware of anyone on this board that is attempting to follow this strategy long term.

I started in the "ketogenic" camp (<30g a day) as suggested by Bernstein et al), then after about 7 or 8 months gradually increased up to about 80g a day, enough to arrest the ketogenic weigh loss, but still keep good control. For the past week I've been back on the very low carb (almost zero, essentially eating meat, non-starchy vegetables and some cheese), mainly because I want to lose a bit more weight for my running, and because I'm intreged about Dr Stephen Phinney's ideas of becoming keto-adapted. Not sure if I'm going to be doing that forever though.

borofergie wrote:

Others might disagree, but I'm certain that you're better off low-carbing. I prefer to reduce the known risk of DIABETIC complications rather than worry about SPECULATIVE complications from higher fat and protein intake.

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That's a false dilemma - in addition low carb diet with little medication (recommended by e.g. Bernstein) and high carb with little medication there's at least the third option that is recommended by the NHS - high carbs with more medication (high carb with initial little medication will lead to high HbA1c, and thus to higher medication).

I'm not saying that your conclusion is wrong, just that your argument would be more persuasive if you didn't resort to (what I would consider) misrepresenting the alternative position.

AMBrennan said:

That's a false dilemma - in addition low carb diet with little medication (recommended by e.g. Bernstein) and high carb with little medication there's at least the third option that is recommended by the NHS - high carbs with more medication (high carb with initial little medication will lead to high HbA1c, and thus to higher medication).

I'm not saying that your conclusion is wrong, just that your argument would be more persuasive if you didn't resort to (what I would consider) misrepresenting the alternative position.

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No, you're entirely right, it wasn't a intentional ommision. As AMBrennan suggests, there is a legitimate third choice which is more medication plus low, medium or high carb. It isn't much represented on this forum, but I'm sure that there many successful diabetics adopting this strategy.

The truth is that there is no easy answer to any of this. There are pros and cons to all the approaches, you just have to do your own research and work out what risks you want to minimise, and what alternative risk you are prepared to take on to achieve this objective.

borofergie said:

Maybe you could help me find some...

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Just google 'kidney decease diet' or 'what effect does a high protein diet have on kidneys' of course if you only google 'high protein diets diets are they safe' you will only get the information you are looking for. Its all about what you look for and your perception of the facts.

One fact we can surely agree on is that there are no long term studies of high fat and high protein diets so they are at best a gamble

borofergie said:

If your goal is rapid weight loss, then it's probably a good idea to stay where you are now (essentially on the Atkins induction phase), a very low carb (<<50g a day) diet that puts you in ketosis (burning fat as your fuel, rather than glucose).

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It is actually generally accepted that to be in and stay in a state of ketosis you need to eat >30g of carbs a day. Read the second paragraph of the keto.org page

http://www.keto.org/summary.htm

AMBrennan said:

there's at least the third option that is recommended by the NHS - high carbs with more medication (high carb with initial little medication will lead to high HbA1c, and thus to higher medication).

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But even the NHS good route would be considered an unwise option if you were Swedish. Not saying it isn't another option though.

Sid Bonkers said:

One fact we can surely agree on is that there are no long term studies of high fat and high protein diets so they are at best a gamble

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Just as there are no long term studies of ULC < 30g low carb diets either!

Just think the best approach is to concentrate on achieving safe BG control. How you achieve that is largely a psychological thing that everyone decides for themselves based on their acceptance of personal risk and their own personality.

The key thing this forum should do imo is to gently but firmly and especially truthfully present new people with the real dangers they face if they ignore what they have and then SECONDARY to that a range of life style diet / exercise choices they could choose to safely sort themselves out by allowing them to make their own informed choices.

zxxy,
Your last paragraph should be adopted by all posters.

Sid Bonkers said:

borofergie said:

If your goal is rapid weight loss, then it's probably a good idea to stay where you are now (essentially on the Atkins induction phase), a very low carb (<<50g a day) diet that puts you in ketosis (burning fat as your fuel, rather than glucose).

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It is actually generally accepted that to be in and stay in a state of ketosis you need to eat >30g of carbs a day. Read the second paragraph of the keto.org page

http://www.keto.org/summary.htm

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I see little to disagree with about the diet on the link you've given, Sid (except his spelling and punctuation - those apostrophes :shock: . Sorry - just my prejudices showing!). Nor do I think weight-lifting is essential - that's another prejudice! :lol: just 'cos I can't do it. :wink: Atkins also recommends exercise as essential, to the best of one's ability.

I'm a lot fatter than the people he seems to be talking about, and I do seem to be in ketosis above 30g carb some of the time - up to 45g once. I think maybe that can depend on how much weight you have to lose - how much fat you're carrying. Also, I don't test positive for ketones 24/7 - I think it varies with the amount of protein you eat at each meal. As it gets processed, so you have some glucose to run on.

Didn't I read somewhere that almost everyone goes in to ketosis sometimes, usually overnight when the body runs out of glucose? or is that an urban myth?

Viv 8)

Sid Bonkers said:

One fact we can surely agree on is that there are no long term studies of high fat and high protein diets so they are at best a gamble

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Yes Sid, I agree with this. Like I said above, there is no simple answer to this and everyone needs to do their own research and work out what risks they are comfortable with.

Sid Bonkers said:

It is actually generally accepted that to be in and stay in a state of ketosis you need to eat >30g of carbs a day. Read the second paragraph of the keto.org page

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Yes, <30g is the usual number. Stephen Phinney reckons below 50g a day, but I suppose it depends on the individual (and in my defense I did say <<50g which means "much less than" 50g).

Whatever it is, I know it's not much fun. Less than a week in and I'm already sick of meat, which I think is my body's reaction to too much protein. I do wonder if it really is possible to live like this all of the time...

Good luck stephen. You know it's only for a while as you lose weight. Make yourself feel better thinking about the good stuff you can eat at the end. ???????????????????? roblem:

Grazer said:

Good luck stephen. You know it's only for a while as you lose weight. Make yourself feel better thinking about the good stuff you can eat at the end. ???????????????????? roblem:

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Thanks mate. I solved my low-carb blues with a huge plate of raw fish (Sashimi) at my favourite Sushi restaurant. The good thing about being in America this week, is that the servers will tolerate any amount of variation from a menu choice, so I've been practising getting all the carbs off my plate before it even arrives at the table.