Mastering diabetes approach - I don't get it!

[Vectian]

I have been looking into MD,which suggests that you get around 70% of calories from carbs. According to their calculations, to achieve 2000 calories per day would involve eating 350g a day of carbs! That seems like an insane amount, the most I ever dare to eat in one meal is 50, and then I have to walk for 40 mins to counteract the spike (LADA, controlled with diet and exercise only).

How on earth can you eat 350g a day without massive spikes? I get with T2 the theory (although that is debatable) is that a low fat diet reduces insulin resistance, but with LADA or full blown T1 insulin resistance may be part of the picture but typically not a massive issue. So why doesn't eating that amount of carbs skyrocket blood sugar?

 

[mentat]

Edit: Never mind I misunderstood what you meant by MD

 

[EllieM]

There have been a few people who have posted here with success on this approach, both T1 and T2.

Some threads with discussions below

T1 thread

Mastering Diabetes

Hi all, does anyone follow a plant based approach? Looking for any anecdotes. Specifically about increased numbers from higher carbs over time. Many thanks.

www.diabetes.co.uk

T2 thread (very long)

Mastering Diabetes by Cyrus Khambatta and Robby Barbaro

I understand the premise of their regime is that the cause of t2 diabetes and insulin resistance is fat and that it gets taken up by the cells and blocks glucose receptors in those cells and to eat the “goods” carbs. What experience does anyone have, what are the “good or bad” points? Where is...

www.diabetes.co.uk

To be fair, this forum has a bit of a low carb bias, so you probably need quite a thick skin to post about successes with this approach here.

 

[Vectian]

There have been a few people who have posted here with success on this approach, both T1 and T2.

Some threads with discussions below

T1 thread

Mastering Diabetes

Hi all, does anyone follow a plant based approach? Looking for any anecdotes. Specifically about increased numbers from higher carbs over time. Many thanks.

www.diabetes.co.uk

T2 thread (very long)

Mastering Diabetes by Cyrus Khambatta and Robby Barbaro

I understand the premise of their regime is that the cause of t2 diabetes and insulin resistance is fat and that it gets taken up by the cells and blocks glucose receptors in those cells and to eat the “goods” carbs. What experience does anyone have, what are the “good or bad” points? Where is...

www.diabetes.co.uk

To be fair, this forum has a bit of a low carb bias, so you probably need quite a thick skin to post about successes with this approach here.

Thanks, yes I am low carb as well but really struggling with fatigue after a year of it. The fatigue improves after eating more carbs so I think it's depletion of glycogen stores, so I was looking if there is a way of increasing carbs a bit without blood sugar going through the roof and came across MD.

The idea that eating any fat (including olive oil and nuts) causes insulin resistance seems suspect to me, why is it then that T2s can overcome IR and put it into remission on a LCHF diet? According to that it should have the opposite effect. And tryglycerides which have been shown to correlate well to IR in different formulas go down substantially on a LC diet, indicating lower IR. But I think I'm right in saying that nobody has unequivocally proved what causes IR, there are various theories but nobody knows 100%.

 

[mentat]

But I think I'm right in saying that nobody has unequivocally proved what causes IR, there are various theories but nobody knows 100%.

The error here is that humans are heavily biased towards assuming that problems have a single cause, and scientists aren't immune from this bias. (This is why we are so good at scapegoating.) Problems in the body are usually inherently multifactorial with complex interactions between the factors themselves. That is to say, one person with T2 might have factors A, B and C and another might have factors C, D, E and F, and even in a single person the factors can interact with each other and change over time. And so, effective treatments will vary from person to person. As such, my advice is, "if your intuition tells you to try it, give it a go, see what happens."

I've observed that when scientists have the robust arsenal of measuring tools required to measure all the factors in multifactorial problems, they will map it out pretty well, but when they don't, they tend to each choose some pet theory to cling to rather than assuming the problem is probably multifactorial and make their best attempt to compile the factors. When there are various theories surrounding such a well-studied problem, and nobody has been able to "prove" any of them for decades, you can be pretty sure it's either a multifactorial problem, or the problem is simply being approached from the wrong angle.

Oh, but as to your specific problem...

Thanks, yes I am low carb as well but really struggling with fatigue after a year of it. The fatigue improves after eating more carbs so I think it's depletion of glycogen stores, so I was looking if there is a way of increasing carbs a bit without blood sugar going through the roof and came across MD.

You could be right about the glycogen but seeing as it took a year for this to come up, it's worth considering other possibilities.

Frankly, sometimes these things are simply psychosomatic. With all the advertising and social pressure surrounding carby foods perhaps your body is trying to give you an excuse to reintroduce carbs.

Carbs do also produce a dopamine rush and without this you may be more prone to feeling flat and fatigued. (You could try nootropic supplements like Tyrosine, L-Theanine, Citicoline that can help increase the supply of dopamine or other neurotransmitters.)

If you do seem to need to reintroduce carbs, plant-based carbs are more likely to be slowly digested than processed foods, which might reduce the glucose spike. But when eaten in such large quantities as you mentioned, your body still needs to generate large amounts of insulin over a sustained period of time and is likely to struggle with that. Best you can do is experiment and see how various foods affect you.

 

[SimonP78]

The error here is that humans are heavily biased towards assuming that problems have a single cause, and scientists aren't immune from this bias. (This is why we are so good at scapegoating.) Problems in the body are usually inherently multifactorial with complex interactions between the factors themselves. That is to say, one person with T2 might have factors A, B and C and another might have factors C, D, E and F, and even in a single person the factors can interact with each other and change over time. And so, effective treatments will vary from person to person. As such, my advice is, "if your intuition tells you to try it, give it a go, see what happens."

I've observed that when scientists have the robust arsenal of measuring tools required to measure all the factors in multifactorial problems, they will map it out pretty well, but when they don't, they tend to each choose some pet theory to cling to rather than assuming the problem is probably multifactorial and make their best attempt to compile the factors. When there are various theories surrounding such a well-studied problem, and nobody has been able to "prove" any of them for decades, you can be pretty sure it's either a multifactorial problem, or the problem is simply being approached from the wrong angle.

There's also the problem of trying to boil down complex and incomplete research into either health guidance or a newsbite. Which is not helpful, especially once any nuance has been removed by regurgitation through multiple reporting layers, but this tends to be the way people digest the information (including GPs - it's interesting to read the papers which NICE guidance is based on, they often don't say quite what the GPs are telling you!)

The guidance to eat carbs was driven by the demonisation of fat, which is slowly being undone and some nuance added, which is a good thing.

I would have troubles eating that much carbohydrate and I'm 6'2" and active (so there's quite a bit of me to feed.) I can make it to those lofty heights of carb consumption on days with long rides, but normally I sit around ~250g/day of carbs.

With my T1 hat on, as I have no other experience, I find that (and there's a physical basis for) eating smaller quantities at a given sitting makes it easier to manage BG - namely that any mistakes I make in either insulin dosage or carb estimation have smaller effects, which are then easier to fix. I avoid taking more than ~6U of bolus at a time, though I do almost always split bolus, so it's not quite as limiting as one might expect, but I might eat a total of 60g for lunch, 100g for supper and I also snack habitually (which is probably because I'm so used to it having being diagnosed quite a while ago when single injections per day were the thing and therefore carb intake had to be spread across the day.)

As with all guidance, large pinch of salt (though actually reducing salt isn't a bad thing )

 

[Vectian]

The error here is that humans are heavily biased towards assuming that problems have a single cause, and scientists aren't immune from this bias. (This is why we are so good at scapegoating.) Problems in the body are usually inherently multifactorial with complex interactions between the factors themselves. That is to say, one person with T2 might have factors A, B and C and another might have factors C, D, E and F, and even in a single person the factors can interact with each other and change over time. And so, effective treatments will vary from person to person. As such, my advice is, "if your intuition tells you to try it, give it a go, see what happens."

I've observed that when scientists have the robust arsenal of measuring tools required to measure all the factors in multifactorial problems, they will map it out pretty well, but when they don't, they tend to each choose some pet theory to cling to rather than assuming the problem is probably multifactorial and make their best attempt to compile the factors. When there are various theories surrounding such a well-studied problem, and nobody has been able to "prove" any of them for decades, you can be pretty sure it's either a multifactorial problem, or the problem is simply being approached from the wrong angle.

Oh, but as to your specific problem...



You could be right about the glycogen but seeing as it took a year for this to come up, it's worth considering other possibilities.

Frankly, sometimes these things are simply psychosomatic. With all the advertising and social pressure surrounding carby foods perhaps your body is trying to give you an excuse to reintroduce carbs.

Carbs do also produce a dopamine rush and without this you may be more prone to feeling flat and fatigued. (You could try nootropic supplements like Tyrosine, L-Theanine, Citicoline that can help increase the supply of dopamine or other neurotransmitters.)

If you do seem to need to reintroduce carbs, plant-based carbs are more likely to be slowly digested than processed foods, which might reduce the glucose spike. But when eaten in such large quantities as you mentioned, your body still needs to generate large amounts of insulin over a sustained period of time and is likely to struggle with that. Best you can do is experiment and see how various foods affect you.

The fatigue has not appeared recently sorry if I was unclear, it has been there since a couple of months after I started low carb, so for quite a while now. I have been tested for deficiencies and other than low iron and vitamin D which have since been corrected (with no improvement) I have come to the conclusion that it's insufficient glycogen stores, it isn't psychosomatic I'm sure as other things that could have had a placebo effect like iron supplements made little difference.

I don't have super low carbs, probably 50 - 80g most days, and haven't eaten meat for 40 years so eat a lot of beans, le tils, quinoa etc. If you are not in ketosis, glucose is still the primary source of energy and it seems some people can cope well with limited carb intake but others less so. I have been reading research about fat intake increasing IR, so may try a little more carbs but less fat, I eat a lot of nuts at the moment.

 

[mentat]

The fatigue has not appeared recently sorry if I was unclear, it has been there since a couple of months after I started low carb, so for quite a while now. I have been tested for deficiencies and other than low iron and vitamin D which have since been corrected (with no improvement) I have come to the conclusion that it's insufficient glycogen stores, it isn't psychosomatic I'm sure as other things that could have had a placebo effect like iron supplements made little difference.

I don't have super low carbs, probably 50 - 80g most days, and haven't eaten meat for 40 years so eat a lot of beans, le tils, quinoa etc. If you are not in ketosis, glucose is still the primary source of energy and it seems some people can cope well with limited carb intake but others less so. I have been reading research about fat intake increasing IR, so may try a little more carbs but less fat, I eat a lot of nuts at the moment.

Hmm, well you could also try reducing your carbs and trying to get properly into ketosis. Apart from that it seems like you're going to need to find a way to increase the carbs, which at the end of the day may need the help of insulin or meds.

 

[Vectian]

There's also the problem of trying to boil down complex and incomplete research into either health guidance or a newsbite. Which is not helpful, especially once any nuance has been removed by regurgitation through multiple reporting layers, but this tends to be the way people digest the information (including GPs - it's interesting to read the papers which NICE guidance is based on, they often don't say quite what the GPs are telling you!)

The guidance to eat carbs was driven by the demonisation of fat, which is slowly being undone and some nuance added, which is a good thing.

I would have troubles eating that much carbohydrate and I'm 6'2" and active (so there's quite a bit of me to feed.) I can make it to those lofty heights of carb consumption on days with long rides, but normally I sit around ~250g/day of carbs.

With my T1 hat on, as I have no other experience, I find that (and there's a physical basis for) eating smaller quantities at a given sitting makes it easier to manage BG - namely that any mistakes I make in either insulin dosage or carb estimation have smaller effects, which are then easier to fix. I avoid taking more than ~6U of bolus at a time, though I do almost always split bolus, so it's not quite as limiting as one might expect, but I might eat a total of 60g for lunch, 100g for supper and I also snack habitually (which is probably because I'm so used to it having being diagnosed quite a while ago when single injections per day were the thing and therefore carb intake had to be spread across the day.)

As with all guidance, large pinch of salt (though actually reducing salt isn't a bad thing )

There is research that shows fat intake causes or at least worsens IR, even unsaturated fat, which is the premise of mastering diabetes. However there are a number of issues with that, 2 I can think of are if fat intake increases IR, why has the LCHF diet been shown countless times to reverse IR in T2? And triglycerides have been shown to correlate well with IR in different formulas, which go down substantially when low carb. I'm not on insulin still after 1 year, so can't just take more insulin to compensate, but maybe some tweaking would help.

 

[Vectian]

Hmm, well you could also try reducing your carbs and trying to get properly into ketosis. Apart from that it seems like you're going to need to find a way to increase the carbs, which at the end of the day may need the help of insulin or meds.

I don't really want to go the keto route for various reasons (including the effect on blood lipids, which are already not ideal) and anyway it's pretty hard to stay in ketosis if you don't eat meat. I have been reading research about fat intake (even non saturated) causing or at least worsening IR, which is the premise of mastering diabetes approach although that is as restrictive as keto and quite extreme. I might try reducing fat a bit and increasing carbs a bit, the increase in insulin sensitivity may offset the extra carbs, hopefully there is a sweet spot somewhere!

 

[mentat]

I don't really want to go the keto route for various reasons (including the effect on blood lipids, which are already not ideal) and anyway it's pretty hard to stay in ketosis if you don't eat meat. I have been reading research about fat intake (even non saturated) causing or at least worsening IR, which is the premise of mastering diabetes approach although that is as restrictive as keto and quite extreme. I might try reducing fat a bit and increasing carbs a bit, the increase in insulin sensitivity may offset the extra carbs, hopefully there is a sweet spot somewhere!

Have you seen the research that suggests the HDL:triglyceride ratio is a much better predictor of cardiac risk than LDL? If you haven't you may want to calculate your ratio and see where that's at. People on low carb diets often have quite a good ratio there.

Understandable that keto is very challenging if you can't tolerate meat though.

If you've never tried a Libre now might be a good time to get one.

 

[Vectian]

Have you seen the research that suggests the HDL:triglyceride ratio is a much better predictor of cardiac risk than LDL? If you haven't you may want to calculate your ratio and see where that's at. People on low carb diets often have quite a good ratio there.

Understandable that keto is very challenging if you can't tolerate meat though.

If you've never tried a Libre now might be a good time to get one.

Yes I have, although there is also evidence that HDL has limited use as a predictor (they did trials of a drug that increases HDL and it made no difference at all to incidence of heart disease etc) and some leading cardiologists don't see much value in any figure that includes HDL as part of the calculation. Note that the NHS uses Qrisk, which uses HDL/LDL ratio, more recent and supposedly accurate calculators use non HDL cholesterol which is the best predictor on a lipid panel.

I have been using a Libre for the last year so can keep a close eye on what is going on. I am 100% in range, usually no higher than 8 so reluctant to mess that up.

 

[HSSS]

I have been tested for deficiencies and other than low iron and vitamin D which have since been corrected (with no improvement)

No idea about MD or type 1 but lots of experience with deficiency here. Are you certain it’s corrected as both of these cause fatigue amongst many other effects? (Same for b12 which if a vegetarian or vegan is likely to be low too)

The nhs lab reference ranges for iron and D (and b12) are abysmally low and just try and stop you dying from the deficiency. They also reflect 95% of what’s tested (who ar evening tested because they have a problem usually) - not what’s optimum for health.

The best easily done tests for iron deficiency are not just haemoglobin but ferritin and transferrin saturation index. Ferritin should be well above the minimum (13 ish) and my haematologist recommends around 100 with at least six months for the benefits to be felt.

Vit D optimal is around 200nmol (research shows only limited amounts absorbed in one go and as a result daily dosing maintains levels more consistently than weekly or heaven forbid monthly) and B12 optimal is 800-1000 (Some countries treat anything under 500 as deficient whilst the nhs thinks above about 160 is fine)

 

[ianf0ster]

We are all individuals and so even within Type 1's or Type 2's etc, the detail of what works for one person may well not works for another.
For example I'm a slim T2 rather like Dave Feldman's 'Lean Mass Hyper-responders'. I was only ever overweight by 3lbs and even that after being pre-diabetic for many years. I found that legumes and moderate carb fruit and veg had a bigger BG effect on me than most on T2's. So, if I eat apples, pears, carrots my BG suffers, even a whole raw carrot or 1/2 an apple is too much for me.

Fortunately, soon after full T2 D diagnosis I found my personal diabetes advisor, which is my BG meter. I used it to test various suggestions and found what works for me - Low Carb (in and out of Keto each day) High Protein and much higher fat than I had eaten since the turn of the Centuary. The most I can manage with is around 40gms of carb per day depending on the carb i.e. no legumes. So on a normal day I eat 20gms to 40gms of carbs, lots of protein and lots of fat (though I don't go out of my way to add fat to meals i just eat a lot of cheese as much as 200gms or more per day and can eat as many as 7 eggs in a day.
I personally would find it impossible to still be in T2D remission after 5yrs (in April) if I was a veggie, but I know that others do manage to do so.

 

[Vectian]

No idea about MD or type 1 but lots of experience with deficiency here. Are you certain it’s corrected as both of these cause fatigue amongst many other effects? (Same for b12 which if a vegetarian or vegan is likely to be low too)

The nhs lab reference ranges for iron and D (and b12) are abysmally low and just try and stop you dying from the deficiency. They also reflect 95% of what’s tested (who ar evening tested because they have a problem usually) - not what’s optimum for health.

The best easily done tests for iron deficiency are not just haemoglobin but ferritin and transferrin saturation index. Ferritin should be well above the minimum (13 ish) and my haematologist recommends around 100 with at least six months for the benefits to be felt.

Vit D optimal is around 200nmol (research shows only limited amounts absorbed in one go and as a result daily dosing maintains levels more consistently than weekly or heaven forbid monthly) and B12 optimal is 800-1000 (Some countries treat anything under 500 as deficient whilst the nhs thinks above about 160 is fine)

Yes ferritin was 28 last test test about 6 weeks ago, GP said it's not iron you are within range (which is down to 15) and I then quoted NICE guidelines saying below 30 is deficient in all people and she laughed. Anyway I have been on daily iron pills since. I have taken B12 for years and last time it was fine, vitamin D 73 in normal range now even tested in winter after being deficient last year.

Another one I have been looking at is iodine, which is essential for thyroid function but mainly found in meat and fish. I have started taking kelp tablets as my TSH was higher than it should be (again GP: it's not thyroid you are in range, despite the ranges being higher here than elsewhere in the country)

 

[Vectian]

We are all individuals and so even within Type 1's or Type 2's etc, the detail of what works for one person may well not works for another.
For example I'm a slim T2 rather like Dave Feldman's 'Lean Mass Hyper-responders'. I was only ever overweight by 3lbs and even that after being pre-diabetic for many years. I found that legumes and moderate carb fruit and veg had a bigger BG effect on me than most on T2's. So, if I eat apples, pears, carrots my BG suffers, even a whole raw carrot or 1/2 an apple is too much for me.

Fortunately, soon after full T2 D diagnosis I found my personal diabetes advisor, which is my BG meter. I used it to test various suggestions and found what works for me - Low Carb (in and out of Keto each day) High Protein and much higher fat than I had eaten since the turn of the Centuary. The most I can manage with is around 40gms of carb per day depending on the carb i.e. no legumes. So on a normal day I eat 20gms to 40gms of carbs, lots of protein and lots of fat (though I don't go out of my way to add fat to meals i just eat a lot of cheese as much as 200gms or more per day and can eat as many as 7 eggs in a day.
I personally would find it impossible to still be in T2D remission after 5yrs (in April) if I was a veggie, but I know that others do manage to do so.

Low carb but not keto is easy enough as a vegetarian, I have 50 - 70g most days. Getting down to 20g would be difficult. I would be concerned about the effect on cholesterol of all that saturated fat and eggs personally, always a difficult balance to avoid improving one area but worsening another.

 

[zand]

I understand it's the standard modern diet of 50% fat and 50% carbs that causes the problem with IR. Therefore either LCHF or HCLF should help reduce it. The problem I have with the latter is that we need fat in our diets, whereas we don't need carbs. So how low is too low in fats? That's where I tripped up when I tried HCLF. Easier for vegans to negotiate as animal produce is normally higher in fats than plants.

Thanks, yes I am low carb as well but really struggling with fatigue after a year of it. The fatigue improves after eating more carbs so I think it's depletion of glycogen stores, so I was looking if there is a way of increasing carbs a bit without blood sugar going through the roof and came across MD.

The idea that eating any fat (including olive oil and nuts) causes insulin resistance seems suspect to me, why is it then that T2s can overcome IR and put it into remission on a LCHF diet? According to that it should have the opposite effect. And tryglycerides which have been shown to correlate well to IR in different formulas go down substantially on a LC diet, indicating lower IR. But I think I'm right in saying that nobody has unequivocally proved what causes IR, there are various theories but nobody knows 100%.

 

[SimonP78]

There is research that shows fat intake causes or at least worsens IR, even unsaturated fat, which is the premise of mastering diabetes.

Is this true though - see this post and the posts leading up to it:

Food combining?

afaiu having high triglyceride levels in the blood stream does increase insulin resistance - Going down a bit of a rabbit hole, but wanted just to pick at this - It's one of the things that is ... used as evidence ... but isn't quite correct. In a lab (and this is all Ben Bikman, he did the...

www.diabetes.co.uk

 

[HSSS]

Yes ferritin was 28 last test test about 6 weeks ago, GP said it's not iron you are within range (which is down to 15) and I then quoted NICE guidelines saying below 30 is deficient in all people and she laughed. Anyway I have been on daily iron pills since. I have taken B12 for years and last time it was fine, vitamin D 73 in normal range now even tested in winter after being deficient last year.

Another one I have been looking at is iodine, which is essential for thyroid function but mainly found in meat and fish. I have started taking kelp tablets as my TSH was higher than it should be (again GP: it's not thyroid you are in range, despite the ranges being higher here than elsewhere in the country)

Ferretin under 30 is considered absolute iron deficiency even by the nhs. Your dr needs more education along with many others. They have no answer for those in the gap between bottom lab number and 30! It’s taken me years to get to haematology and someone who pulls his hair out at his colleagues ignorance and lack of training. Sending the GP these got the ball rolling for me

Iron deficiency without anemia – a clinical challengehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5986027/
Iron deficiency without anaemia: a diagnosis that matters www.ncbi.nlm.nih.gov/pmc/articles/PMC8002799/
cks.nice.org.uk/topics/anaemia-iron-deficiency/diagnosis/investigations/
The Royal College of nursing states that a ferritin level of less than 30 is absolute iron deficiency:https://www.rcn.org.uk/professional-development/publications/pub-007460
The Royal College of physicians states that a ferritin level below 100 can give debilitating symptoms;https://www.rcpjournals.org/content/clinmedicine/21/2/107
Iron Deficiency Without Anemia – Common, Important, Neglected

Your D is adequate but not great. I’d continue to work on that personally if it were me. If your b12 is in the high hundreds that’s unlikely your cause. People do get symptomatic even in the 3 and 400’s though.

 

[KennyA]

Low carb but not keto is easy enough as a vegetarian, I have 50 - 70g most days. Getting down to 20g would be difficult. I would be concerned about the effect on cholesterol of all that saturated fat and eggs personally, always a difficult balance to avoid improving one area but worsening another.

I've been on ~20g carb/day for five years, plenty of animal and dairy saturated fat and my cholesterol hasn't altered. Around 80% of the body's cholesterol is made in the body, not derived from diet. Statins work by interfering with the liver making cholesterol - they have no impact on dietary cholesterol.