Low Carb & Low Fat

Hi @Fabstitcher and welcome.

I can see your conundrum. The reason for the higher fat component of low carb is that in the absence of, or reduction in carbs, fat provides energy and helps to keep you fuller for longer. Obviously the side effects of Orlistat make that difficult.

It’s up to you to decide whether to stick to your current regime using Orlistat, despite your struggles or whether to give something else a shot which you may find more sustainable. Many of us here eat few, or indeed no vegetables so that is definitely possible (check out the Carnivore Corner thread of that interests you).

You might find it helpful to browse the dietdoctor.com website for food and meal ideas, and I’m also linking to some useful information for newbies.

http://www.diabetes.co.uk/forum/threads/basic-information-for-newly-diagnosed-diabetics.26870/

Sleep apnea is likely weight related.. or at least mine disappeared after losing a significant amount.
Personally I'd go for a very low carb diet enjoy some fats and ditch the Orlistat,. No idea how much you have to lose but I'm down almost 9 stone by cutting carbs almost completely allied with some intermittent fasting.
Don't eat in the morning and have 1 or 2 meals a day of high protein and fat meals.
Coffee with double cream keeps me feeling full and helped to put T2 into remission with no meds.

Fabstitcher said:

I think that I may stick to what I am doing with the low fat - as that is what the weight loss surgery team want me to do and also reduce my carbs to around 80 -.100g a day.

Click to expand...

What do you consider more important... having surgery or putting T2 into remission while losing weight?

You are going to have very little to eat - is the surgery absolutely necessary? I ask as weight gain is often a symptom of type two diabetes and I found that I had lost almost 3 stone without even thinking about it by eating low carb high fat.
My liver shrank down significantly over the first few months, so that I could bend down to clean the bottom of the fridge without getting my ribs pushed out. My waist is much smaller than when on the 'cholesterol lowering' diet - which didn't work anyway.

When I was diagnosed with type 2 I was offered bariatric surgery but wasn’t keen. I came to this forum and learnt all about low carb eating which I did (and still do) to bring my blood sugars down to a normal level. I’ve never gone overboard on the fats, but have full fat products instead of reduced fat. As a happy side effect I lost 6 1/2 stone eating real food. I’m very glad I didn’t go down the surgical route but only you can decide what’s best for you.

80-100g of carbohydrate per day will mean your primary metabolic pathway will remain glycolysis (burning sugar). This will keep you hungry if also consuming low fat, whereas if you lowered the carbohydrate component to an absolute minimum, you would switch to ketosis and be able to burn lots of stored energy (body fat) while staying less hungry more of the time. In this state you could also maintain a relatively low intake of dietary fat without getting hungry (so long as you have weight to lose).

Your choice of course, but ~100g carbs is no-man's-land if you're also avoiding fat. It's too much for ketosis but not enough to supply adequate fuel. You'll lose weight but will likely be miserable, and starving hungry 24/7. Whatever you do, you must ensure you are getting adequate nutritional value from your food.

Good luck with everything.

Fabstitcher said:

Plus to add into the mix I may also have sleep apnea and may have to have a CPAP machine

Click to expand...

I have both, the machine for about 2 years. It has made a huge difference. I used often to feel so tired in the afternoons that I had to go to bed for a couple of hours. No more! SA is very debilitating because one is repeatedly being smothered and fighting to breathe until one manages to wake up (often making loud snoring noises which are disturbing to anyone in earshot). During my latest sleep test I was enduring this process over 30 times per hour. With the machine it happens to me usually somewhere around 5 times per hour, sometimes less and sometimes much more often, but never as many as 20 times.

When my sleep apnoeia was milder, I was able to ameliorate it with a device I wore in my mouth overnight, made to measure by an orthodontist. (Called a mandibular advancing splint! It brings the lower jaw forward, thus opening up the airways.) That was easier to tolerate than the machine but in the end it began to loosen my top front teeth so I had to give it up. The worst problem with the machine is finding a mask that fits well and then adjusting the straps just right, so that it is reasonably air tight but is also reasonably comfortable. In the beginning I nearly gave up in despair, but I'm so glad I didn't. I can't say I like wearing the mask, but I like the benefits it brings.

Poor sleep is said to cause all sorts of health problems, and also weight gain. I encourage you to grab the chance of a sleep test if you can, and think positively about a machine if you are offered one. Or if you do have mild to moderate sleep apnoeia you could ask about trying the splint first. I am assuming you are in the UK. Be grateful for the NHS! These things are very expensive. I was rather taken aback to be sent away from my hospital appointment with a large shoulder bag full of equipment, of which the mask cost £100 and the machine several thousands!!!

bulkbiker said:

Sleep apnea is likely weight related

Click to expand...

Often but not always. Mine began when I was slim and has continued now I am considerably under-weight. No-one can tell me why, but I am not the only skinny person with this problem.

I understand that sleep apnea is regarded by some as 'just' another symptom in a long list of problems whose aetiology lies in metabolic syndrome. One of many seemingly disparate health issues that improve or resolve simultaneously when the central cause is eliminated. Difficult to say with any degree of credulity that losing wight improved sleep apnea, when sleep apnea may have improved alongside whatever brought about the weight loss.

You write that you are reducing sugar - but are you reducing carbohydrate, the starches as well?
As a type two diabetic, protein and fat are no problem, it is the sugar and starch which hammers the metabolism as we simply cannot cope with the level of glucose in the blood they produce.

Hi. First, have enough proteins which provide nutrients and keep you feeling full. I must admit I have never quite understood the low-fat diet for bariatric surgery. I think it comes from the Newcastle Diet and calorie control which in turn I have never really gone along with as it doesn't reflect my understanding of what causes deposited fat on internal organs. Carbs appear to be the main culprit for this and keeping them down will help both BS and body weight. I accept the role of the fats you eat isn't a simple one but the use of Orlistat might be questioned. I'm only an amateur here and not suggesting you ignore the advice of your medics but you might like to raise some questions with them?

Fabstitcher said:

Hi,

A while ago I approached my GP about having weight loss surgery which he referred me for.

I went to to my 1st appointment with the Weight Loss Surgery team, and was advised that it is a 2yr process in which I have to attend all appointments they make for me - understandable as they don't want someone who is not going to commit to the journey.

I was sent for a whole load of tests including Sleep Apnea and of course the usual blood tests,

I was also given a prescription for the diet tablet Orlistat which limits the amount of fat your body so the advise is to stick to 45g FAT a day or else there are side effects which are not pleasant - i lost a stone during October.

I have now been diagnosed with Type 2 also, and am taking Metformin 500 twice a day and have been advised to limit my carbs.

So my conundrum is how the hell am i going to do low carb/low fat, especially when i am not keen on veg.

The nurse suggested I just stick to eating healthily as I have been doing and just watch my carb and fat intake but I am finding that I am struggling with this.

I really don't know what to do as it is so confusing with all the different advice given to me.

Am currently waiting to see a dietician, my appointment is in January 2020, and have been asked to keep food diary until then, this appointment is for the weight loss surgery and the diabetes (i think).

Plus to add into the mix I may also have sleep apnea and may have to have a CPAP machine.

Can anyone offer some advise.

Click to expand...

I don't know how optional the orlistat is. Whether, if you don't follow the given advice to the letter, but still drop weight, they'd consider you orinary/combative/non-compliant in spite of results. I do know you can lose a lot of weight by cutting carbs back heaps more than you're doing right now, but you would need fats to compensate. If it's this bad, I'd go straight for keto though. (20 grams of carbs or less, a day). It would throw you for a loop for a bit, with aches and pains, (coconut milk and bone broth should help with that), but that'll pass as your body adapts, and you'd probably lose a lot of weight in a short amount of time.

https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ <-- have a read, maybe something resonates with you. This place, as mentioned elsewhere, has a low carb program, and you can check with dietdoctor.com as well for recepies and a lot of free information. Quite a few people here managed to lose quite a bit without bariatric surgery, who knows... That might be possible for you too.

However way this pans out, good luck!
Jo

Two years ago I weight 133kgs I started losing weight even though I was eating the same old stuff August this year diagnosed with type two with blood sugar hba1c of 90. I put on usual Metformin 1000mg slow release. I then started to follow low carb diet keeping to only eating items with only 10 carbs or less three months later my hba1c was 39 wow no more tablets still following low carb diet and now down to 94kgs I still need to loose weight and I have to agree with some others getting blood sugar under control is more important six months ago if someone had told me that my eating habits of a lifetime were about to be turned upside down I would have laughed but that’s what I got two days before my 60th birthday all I can say is not easy but failure is not an option for us good luck Paul n