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Letter in Telegraph today
- Thread starter hanadr
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phoenix said:
I wonder if I may ask you something. You quite often post articles advocating a... lets say higher carb diet than I would agree with as a T2. Would you like to give an opinion as to how I could get an HbA1c of less than the 4.9 I am now with your suggested levels of carbs?
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phoenix said:
Eh?
How many healthy-wholegrains in their diet? How much sugar?
I think sweet-potatoes are just about the best source of carbohydrate (for a non-diabetic).
A
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lucylocket61 said:
Well, quite! I've come in quite late to this debate and, as a new member of this forum, I would like to contribute.
The effects of food on the body and in particular how certain foods regulate our appetite are well known. In essence, a diet rich in carbohydrates causes us to eat more. Our diet, as it has become more saturated in carbohydrates, has led to an increase in obesity and Type 2 diabetes. This consequence is well known: for example, in the United States refined carbohydrates in the diet of the average American started to become common in the early 1950s, and shortly afterwards there was an explosion in Type 2 diabetes in that population. It is not surprising that the two trends have become connected and, as subsequent research has proven, there is a link between excessive carbohydrate consumption and obesity and Type 2 diabetes.
We need to be honest as a society - carbohydrate is addictive! The food industry has a vested interest in producing foods high in carbohydrates because for them they assure continued demand for their products so that we in the west overeat and the less fortunate on our planet starve. This is utter madness!
The food industry is a massive vested interest and they will always protect their position of power and influence over western governments; it is a tragedy that those they exploit the most are those who are poorly educated or just not very bright - the very people at the bottom of our society - who are being exploited the most.
All of us, whether we're rich or poor, can make choices about the food we eat to avoid getting diabetes in the first place. To do that though means we need clear information about the food we eat and I think we are all being misled.
Dave
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Defren said:
I know you arent asking me. But you have given me something to think about, and I would like to share those though.
I think maybe that our Diabetes is a spectrum. So some people can take more carbs, or different carbs than others. And some diabetics have more pancreatic function than others, so the carbs intake can vary greatly between us. And even our own pancreatic function can fluctuate also, so some days we can eat more carbs than others, no matter how tightly we control our intake.
I know you arent asking me. But you have given me something to think about, and I would like to share those though.
I think maybe that our Diabetes is a spectrum. So some people can take more carbs, or different carbs than others. And some diabetics have more pancreatic function than others, so the carbs intake can vary greatly between us. And even our own pancreatic function can fluctuate also, so some days we can eat more carbs than others, no matter how tightly we control our intake.
borofergie
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Get youself on insulin, and deal with the hypos. That's the only other way.
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lucylocket61 said:
I think Lucy has it just right and also, it's part of our endocrine system and that, to my mind, is so personal, so individual, that it's almost like a fingerprint. Or do we say dactylogram in these days of CSI?
Ju
lucylocket61 said:
Yes, I can go along with that, so how come that I have a very, very low tolerance to carbs yet got the figure I did? Would Phoenix' suggested level of carbs have got me this low? I say the answer is no, I struggle to tolerate 30g of carbs a day.
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ursus262 said:
Welcome to the discussions Dave. I think what you say is the majority view of most of us. Did you read the excellent article Catherine Cherub posted earlier in the thread which says similar things?
http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001254
If you're interested check out these recent threads which thanks to a great deal of effort from Stephen (borofergie) ended up giving out loads of info and had some great debate. They were going on just before you joined.
http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=25&t=29902&hilit=7+billion
http://www.diabetes.co.uk/diabetes-forum/viewtopic.php?f=1&t=30015&hilit=grain
phoenix
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Defren,I have already responded to you on this and would rather not set up some sort of pointless argument so this is the last time I will respond to this type of question.
I am not telling you that this is what you should do.
If I had been overweight on diagnosis (and it was recently), I think that like you I would have attempted the Newcastle diet There is no evidence of it's long term efficacy but at least I would have lost some weight and hence should have reduced insulin resistance.I would have followed the protocol as closely as possible, using shakes with a similar composition to those in the original trial.This was a very low calorie diet , the three daily shakes contained 60g carb , 42g protein and 9g of fat. This was low but not miniscule amounts of carbs. It was very low fat.I would have eaten the suggested vegetables. After the diet I would have followed the Newcastle teams recommendations ie a conventionally healthy diet with appropriate portions... after all if the diet had 'worked' then I would be able to tolerate a reasonable quantitiy of carbohydrates as indicated by 'passing' a glucose tolerance test.
If I were not overweight I would have adopted the strategy I did in fact use for 3 years, that of a low glycemic diet with a lot of exercise. This type of diet can come in a variety of colours. The GI diet as advocated by Jennie Brand Miller would for me include, eating 3 portions of low GI carb rich foods, 3 of protein rich foods and 2 of fat rich foods with 7 fruit and veg servings (25% protein,27% fat and 47% carbs) of which 60-90g would come from low GI starches. It is fairly low calorie because at my weight and age I don't actually need that much. This would be very similar to the type of diet advocated by the hospital here; it certainly works in terms of lack of complications. Daily exercise would (as it does) be an important management tool.
I could alternatively have adopted a diet like that I showed to you before, one that is actually higher in carbs, very low in fat and one where most of the protein comes from a vegetable source. This type of diet is very high fibre and also very very low in GI Most of the starchy carbs in that sort of diet come from from lentils and other pulses.
Again I would have incorporated a lot of exercise
Whether either types of diets would result in as low an HbA1c as yours is impossible to say (there is one low GI dieter on here that has a very low GI for many years) however I would want to look at the larger picture and look for the balance between what I consider to be a healthy pattern of eating and a satisfactory HbA1c (been there at 4.9% but and am quite happy with a slightly higher level). I think that one has to consider things holistically.
Personally, I wouldn't adopt a diet where in order to eat sufficient calories I had to add large quantities of fat. I see this rather like adding large quantities of unnecessary sugar, I also think that this type of diet does nothing to increase carbohydrate tolerance, how often do we read I couldn't eat even a tiny bit of that? I am not anti fat but I believe in selecting the amount and type carefully . I would also not attempt to replicate high GI carb foods like cakes, pastries etc with lots of highly processed ingredients. I believe very strongly that there is a lot of evidence that the healthiest diets are those that involve eating real food, mostly (but not exclusively) plants and not too much food of any sort.
But this is what I would do, and partly what I did do. I am not telling you to do this. Your mileage may indeed vary.
Finally, which is why I like to point out alternatives, I don't like to see facts turned on their heads . Blaming carbohydrates, from whatever source, for the incidence of obesity, calling them poison or suggesting that they are killers ( along with some really mangled science) is crazy. It's a bit like focussing on the wrong end of the telescope and thinking that what you see is the whole picture. There are many societies where very high percentages of the diet came or comes from carbohydrates of one sort or another (whether from rice, sweet potates maize or wheat) and where there were/are low levels of obesity and CVD. Some of these same societies have developed incredibly high obesity, disease rates as they have changed their lifestyles and incorporated modern processed foods into their diets.
I am not telling you that this is what you should do.
If I had been overweight on diagnosis (and it was recently), I think that like you I would have attempted the Newcastle diet There is no evidence of it's long term efficacy but at least I would have lost some weight and hence should have reduced insulin resistance.I would have followed the protocol as closely as possible, using shakes with a similar composition to those in the original trial.This was a very low calorie diet , the three daily shakes contained 60g carb , 42g protein and 9g of fat. This was low but not miniscule amounts of carbs. It was very low fat.I would have eaten the suggested vegetables. After the diet I would have followed the Newcastle teams recommendations ie a conventionally healthy diet with appropriate portions... after all if the diet had 'worked' then I would be able to tolerate a reasonable quantitiy of carbohydrates as indicated by 'passing' a glucose tolerance test.
If I were not overweight I would have adopted the strategy I did in fact use for 3 years, that of a low glycemic diet with a lot of exercise. This type of diet can come in a variety of colours. The GI diet as advocated by Jennie Brand Miller would for me include, eating 3 portions of low GI carb rich foods, 3 of protein rich foods and 2 of fat rich foods with 7 fruit and veg servings (25% protein,27% fat and 47% carbs) of which 60-90g would come from low GI starches. It is fairly low calorie because at my weight and age I don't actually need that much. This would be very similar to the type of diet advocated by the hospital here; it certainly works in terms of lack of complications. Daily exercise would (as it does) be an important management tool.
I could alternatively have adopted a diet like that I showed to you before, one that is actually higher in carbs, very low in fat and one where most of the protein comes from a vegetable source. This type of diet is very high fibre and also very very low in GI Most of the starchy carbs in that sort of diet come from from lentils and other pulses.
Again I would have incorporated a lot of exercise
Whether either types of diets would result in as low an HbA1c as yours is impossible to say (there is one low GI dieter on here that has a very low GI for many years) however I would want to look at the larger picture and look for the balance between what I consider to be a healthy pattern of eating and a satisfactory HbA1c (been there at 4.9% but and am quite happy with a slightly higher level). I think that one has to consider things holistically.
Personally, I wouldn't adopt a diet where in order to eat sufficient calories I had to add large quantities of fat. I see this rather like adding large quantities of unnecessary sugar, I also think that this type of diet does nothing to increase carbohydrate tolerance, how often do we read I couldn't eat even a tiny bit of that? I am not anti fat but I believe in selecting the amount and type carefully . I would also not attempt to replicate high GI carb foods like cakes, pastries etc with lots of highly processed ingredients. I believe very strongly that there is a lot of evidence that the healthiest diets are those that involve eating real food, mostly (but not exclusively) plants and not too much food of any sort.
But this is what I would do, and partly what I did do. I am not telling you to do this. Your mileage may indeed vary.
Finally, which is why I like to point out alternatives, I don't like to see facts turned on their heads . Blaming carbohydrates, from whatever source, for the incidence of obesity, calling them poison or suggesting that they are killers ( along with some really mangled science) is crazy. It's a bit like focussing on the wrong end of the telescope and thinking that what you see is the whole picture. There are many societies where very high percentages of the diet came or comes from carbohydrates of one sort or another (whether from rice, sweet potates maize or wheat) and where there were/are low levels of obesity and CVD. Some of these same societies have developed incredibly high obesity, disease rates as they have changed their lifestyles and incorporated modern processed foods into their diets.
A
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phoenix said:
I think we need to be clear here. The issue is with refined carbohydrates found in processed foods. Unrefined carbs found in wholemeal bread, for example, when eaten in moderation should be fine for most healthy people. I think we tend to confuse the two types of carbohydrates.
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phoenix said:
Phoenix I realise your answer is directed at Jo but hope you don't mind me commenting as I think what you have written really does highlight many of the disconnects.
First as a general comment. You post presents diabetes control much like an entirely voluntary selection from a range of dietary options. This I respectfully suggest is wrong as the average bog standard T2 who wishes to control by diet only has very few dietary choices. All of us have a basic tolerance to carbohydrate and yes that tolerance can be cleverly adjusted somewhat by choosing low GI sources but unless you are one of the outriders like Grazer your choices are restricted by whatever pretty low tolerance to carbohydrate the majority of us have. That basic understanding that as T2 you do have a carbohydrate tolerance is a fundamental fact of life in the same way that for you a requirement to cover carbohydrate via insulin injections is a fundamental fact of life. I would also say that my T2 view doesn't invalidate you making any choice you want as to how to control your condition.
On more specific points
phoenix said:
I would suggest you say that because you have no experience of being an average T2 diabetic. Let me assure you increasing fat and reducing carbohydrate has everything to do with increasing carbohydrate tolerance. I can consume high fat foods like cream or cheese or butter or animal fats and my meter doesn't blink. Yes, I agree, I can substitute low GI sources of carbohydrate like vegetables and pulses for high GI starches but they do still cause a rise in BG's and I actively have to carb count their effect into my daily calculations. I suspect I am no different to many average T2 diabetics.
phoenix said:
Yes I agree if your carbohydrate tolerance is high enough then you may well be able to adopt a low fat approach and get enough calories. It is in fact when I was first diagnosed how I assumed I would be able to control my condition and I suspect that is what many newly diagnosed T2's also expect. The reality is entirely different. When you get your meter and discover your actual carbohydrate tolerance is usually somewhere between 12% and 25% pretty soon you have no option than to eat more fat regardless of how many vegetables or pulses you consume or else you end up on a starvation diet. If you can manage to safely control your T2 in the manner you suggest then fine but I would suspect you will be in a small minority. To be honest while recognising that minority exists I would suggest the advice advocated to newly diagnosed T2's on the forum should be for the majority. In any event from the results many T2's are producing using LCHF diets and a lot of research now suggest that it would appear they are entirely safe or at least offer far less risks long term than having high BG's. If they weren't safe why for the last two years does the ADA recommend a 25% RDA for carbohydrates?
phoenix said:
I don't think anyone does that. A common viewpoint is to maybe blame highly processed carbohydrates. There is then a debate as to whether it is the providers or the consumers of those products that cause obesity. To me its the producers every time and I find the counter arguments that blame the individual both unscientific, unproven, immoral and down right plain scapegoating.
phoenix said:
Now there you see is why I know you are not T2. If your body has a reduced means of processing carbohydrates and that consuming even a "healthy" amount will in the end send you blind, or get your feet amputated what else are they if not poison and killers? I agree the language is strong but that's all part of the T2 control psychology. You control your LADA diabetes using whatever psychological and physical ways that work for you and I for one will always respect whatever route you choose. You are simply not recognising that while it may appear nonsense to you to label carbohydrates in those terms many T2's control their condition by thinking of carbohydrate in that very black and white way. Quite right to in my opinion. As the months have passed my personal view of carbohydrates as killers has mellowed in some respects but once the cat is out of the bag you can never again look at a plate of food without thinking "that's safe" or "that's dangerous" and then making the risk assessment. All part of being T2.
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XYZZ, I disagree with several of your points but am not going to argue with you, as I said it is pointless. I've made my answer.
However you might like to look at the recent post here.
viewtopic.php?f=20&t=31046
Your mileage may indeed vary.
However you might like to look at the recent post here.
viewtopic.php?f=20&t=31046
Your mileage may indeed vary.
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phoenix said:
Yes Phoenix frustrating that isn't it? Now you know how we feel when you and others who do not have T2 and have little comprehension of what it entails to control it try to tell us what is best for us. You then seem to get angry with us when we politely tell you that isn't the way T2 works and point out the reasons why. Yet you persist in doing the same thing again and again. We respect how you control your LADA diabetes and we respect others with T1 likewise and never dream of telling you or other insulin using diabetics what dietary regimes to follow as it would be the height of arrogance to do so. All I ask is you offer me and other T2's that same respect. It really is that simple.
What I never understand is why when the evidence from all these T2 forum members is here, in front of your eyes, that you oppose a low carb lifestyle so vehemently. It has helped so many T2's get normal hBA1c's along with reasonable blood pressures, cholesterol and other key things. Why on earth would you oppose that when time and time again you have seen a new T2 member arrive on this forum and completely turn their lives around in a matter of weeks by adopting a low carb lifestyle? Yes we have a few T2 members who do control successfully using other methods but they are a minority and you will not find ONE post where I have been critical of their method if they say it is keeping them safe. To be critical would be to attack their personal method of control and that is the key point, to attack a diabetics method of control is to attack the very foundations that the person has put in place to control their condition.
[mod edit: members should not attempt to control what other members post about]
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xyzzy said:
This is exactly the sort of garbage that should be moderated as it just scaremongering rubbish. We know that over 60% of T2 diabetics are within NICE guidelines, thats over a million diabetics. They are not being sent blind and they are not having their feet amputated, what they are doing is eating a sensible healthy balanced diet having lost weight where necessary. They are part of the 1 million plus well controlled T2 diabetics who have mostly never heard of low carbing, people like my sister and my mother in law of whom I have spoken before, both have HbA1c's in the 5% range neither are overweight and neither low carb.
Please stop assuming you are speaking for all T2 diabetics you are not, you are just part of a small percentage who low carb and calling carbohydrates poison and killers would be laughable were it not the case that some members here actually believe you.
This is dangerous nonsense, not my opinion, that is fact.
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phoenix said:
Do refined carbohydrates play a role in obesity?
It's not often that I get a chance to present original research, but here is what happens if you plot sugar consumption (FAO data) vs Obesity (BMI>25, WHO data) for every country in the world:
What this says is that 46% of the varition in obesity can be predicted by a nation's sugar consumption alone (Pearson Correlation Coeff 0.67). If I add wheat consumption into this, to make a "refined carbohydrate index" the r2 value goes above 50%.
Correlation doesn't necessarily imply causation (and all that), but my numbers suggest that at least 50% of obesity is directly related to the consumption of refined carbohydrate.
(If you try doing the same thing with fat consumption, or total calorie consumption, then the correlations are very weak).
borofergie
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Here is my Refined Carbohydrate Index* vs Obesity
PCC=0.7
These are strong correlations between two dirty datasets.
If your null hypothesis was "Refined Carbohydrate Consumption does not predict Obesity" then you'd have to reject it.
_________________________________________________________________
RCI= 19.7596 + 0.0739 * Sugar and Sweetners (kcal) + 0.0107 * Wheat (kcal)
PCC=0.7
These are strong correlations between two dirty datasets.
If your null hypothesis was "Refined Carbohydrate Consumption does not predict Obesity" then you'd have to reject it.
_________________________________________________________________
RCI= 19.7596 + 0.0739 * Sugar and Sweetners (kcal) + 0.0107 * Wheat (kcal)
phoenix said:
Firstly, this was not meant in any way other than for me to see where you could get a HbA1c of 4.9 on the kind of carb level you usually advocate for ALL diabetics. Your levels may well work with LADA or T1's but for the vast majority of T2's they are unsustainable. The rest of your post is like a cheap sausage, some good points (the meat) with a lot of waffle (the filler). You bring up the Newcastle diet, what that is supposed to do with sustainability is beyond me, or perhaps you were suggesting I only managed a 4.9 because I did the ND my way rather than spot on the study's way. You see Phoenix, I did it the way I did due to my carb intolerance, and because initially I did it without medical support. I did get medical support shortly into the diet, not that I need to explain my rational to anyone!
I fully accept the diet you advocate suits you, but my over riding concern is this: A newly diagnosed T2 comes here, chances upon one of your diet suggestions early into their research, doesn't realise your are indeed LADA with insulin, and follows what you advocate. That is why I had to be, and will always be vocal, to ensure all T2's get the correct and best information that is known out there.
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[mod note: this message is at least partly in response to a line from xyzzy that was removed]
I will answer here as I feel my integrity has been challenged. However I will not post again on this thread and I will not post again on this forum for a while. Quite frankly I agree with some pms I have received and probably should respond at all.
The idea that I have no idea how it feels to have a fear of diabetic complications is sheer arrogance. Like everyone I have that fear when I undergo my retinopathy scan, I worry when when I get my blood test checks back and those for kidney function. Like you I don't like to see high glucose levels and no I don't just inject. I get out and do something about it; I responded to a 9.2 today with a 1000metre swim. I hope that you will not have to face being told to go straight to hospital followed by large numbers of investigations and tests. I hope that you will not face being told that you haven't got T2 but will have to take insulin for the rest of your life and that you'd better get used to the idea fast. Of course if that happens none of your earlier experiences will be considered valid. I would ask you to look through all my posts as I have done this afternoon and find where I have told people what to eat and what not to eat.
The idea that I have no idea of what it feels like to have T2 is false, I thought I had it for 3 years, and my first glucose reading, using a urine strip was probably higher than many on here have ever recorded. I thankfully was able to control things for a while levels with the use of diet and exercise(though obviously relatively low insulin levels ) However even at LADA diagnosis had a relatively low HbA1c. so I obviously did something right. My doctor thinks I did.
As to pulling me up I don't know why you think you are entitled to do this. If you feel that what I have posted is out of order then report it to the moderators.
This, as many of the discussions I join in is a general one about the multi factorial causes of obesity. I am just like you entitled to have an opinion, I have also had experience of being overweight and having to diet . I was asked for what I would do in someone else cirumstances. I gave my answer accurately saying what I think I would do.
Stephen.
A last point before I go,
Did you not argue the other way on the Twinkie diet? I do not defend over processed carbs and never have done. I do not believe that the type of traditional diets I referred to contains high amounts of these items.
.
I will answer here as I feel my integrity has been challenged. However I will not post again on this thread and I will not post again on this forum for a while. Quite frankly I agree with some pms I have received and probably should respond at all.
The idea that I have no idea how it feels to have a fear of diabetic complications is sheer arrogance. Like everyone I have that fear when I undergo my retinopathy scan, I worry when when I get my blood test checks back and those for kidney function. Like you I don't like to see high glucose levels and no I don't just inject. I get out and do something about it; I responded to a 9.2 today with a 1000metre swim. I hope that you will not have to face being told to go straight to hospital followed by large numbers of investigations and tests. I hope that you will not face being told that you haven't got T2 but will have to take insulin for the rest of your life and that you'd better get used to the idea fast. Of course if that happens none of your earlier experiences will be considered valid. I would ask you to look through all my posts as I have done this afternoon and find where I have told people what to eat and what not to eat.
The idea that I have no idea of what it feels like to have T2 is false, I thought I had it for 3 years, and my first glucose reading, using a urine strip was probably higher than many on here have ever recorded. I thankfully was able to control things for a while levels with the use of diet and exercise(though obviously relatively low insulin levels ) However even at LADA diagnosis had a relatively low HbA1c. so I obviously did something right. My doctor thinks I did.
As to pulling me up I don't know why you think you are entitled to do this. If you feel that what I have posted is out of order then report it to the moderators.
This, as many of the discussions I join in is a general one about the multi factorial causes of obesity. I am just like you entitled to have an opinion, I have also had experience of being overweight and having to diet . I was asked for what I would do in someone else cirumstances. I gave my answer accurately saying what I think I would do.
Stephen.
A last point before I go,
Did you not argue the other way on the Twinkie diet? I do not defend over processed carbs and never have done. I do not believe that the type of traditional diets I referred to contains high amounts of these items.
.
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phoenix said:
I wasn't really - I was just picking up on someone else saying that it was all down to junk food. Obviously quality and quantity play a role, but in the case of refined carbohydrates the low-quality it what drives the large quantity.
I agree with you Phoenix, that it's obviously a multifactored thing - but clearly refined carbohydrates are a large part of it (I think significantly the largest part of it).
And I agree, that traditional (and ancestral diets) don't contain large amounts of refined carbohydrates, and consequently the incidence of obesity (and diabetes) is lower.
