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Mastering diabetes

Hi, just a comment about different ways of expressing HbA1c results. I think the reading of 9 would be a % but 114 would be in mmol/mol so there is no valid comparison. Either way both of those readings are very clearly in the very high blood glucose range. There are lots of conversion charts and ready reckoners available online.
And previous post has covered that!
 
Hi Condorhulse, thank you for posting pictures of your meals. I was a little sceptical about your vegan approach (and I'm not going to use plant-based as a term here as it can include a greater range of foods than vegan) but I can see how it might be working. Firstly portions are relatively small and are providing a limited amount of energy. Secondly, the meals that do not include fruit are actually fairly low carbohydrate both by portion and by the use of pasta that is based on plant protein. Thirdly, the high fruit meals are providing more energy in the form of fructose which is non-insulinogenic and will not set off a cycle of insulin release - hypo - sugar craving etc. If you are then using all the glucose released by rapid release or slower digestion of the limited complex carbohydrates in your meals or by the much slower conversion of fructose into glycogen and some glucose then your glucose intake could be matching your daily energy needs over a day without any peaks and troughs.
Are you losing weight? If so, is it weight that you want to lose?
I'm sure others will come along to further the discussion of this rationale. Interestingly $700 would be an awful lot to pay for this approach!!!
 
I am early into my 5th month of doing this diet and have had great results. Keep it up!
 
Just buy the book - it's very easy to follow if you are a Type 2. If you are a type 1, you may need more guidance (but buy the book anyway). The divide all foods into one of three groups: green light (eat as much as you want), yellow light (limit intake - this applies to high fat foods like nuts and avocados) and red light (don't eat at all).
 
As someone who has been doing this approach for going on 5 months, I'm going to jump in here.
1. The reason for this approach, as opposed to avoiding foods that raise your blood sugar, is to lose body fat and limit severely dietary fat because it is the accumulation of fat in your organs, muscles, etc. and dietary fat that induces insulin resistance (first demonstrated in a study in the 1920's). This was not information I had ever heard of before I found out about this diet, but there are lots of studies supporting this. Your blood sugars will drop faster on a low-carb diet, but, as someone who ate very low-carb for 20 years, the diet and the results are much easier to maintain (especially if you have already given up processed foods and have been eating a very low carb diet).
2. Actually, vegan has a much wider range of foods one can eat than whole-food, plant-based, low-fat diet (all three adjectives apply to this diet). The only consideration for a vegan diet is that no animal products are used (so you can eat refined sugars, refined grains and products made for vegans to your heart's content). This diet requires that you eat foods made from whole plants - so no flours, no refined anything. It is very low fat - so no oils of any kind (nuts should be raw, not roasted), etc. So foods that you could buy that contain olive oil would be fine on a vegan diet, but not this one. If you eat rice, it must be brown rice - a "whole food" (white rice would be fine on a vegan diet).
3. There is no limit on quantities of green light foods and you are encouraged to eat a lot of food to build up your gut biome. The fact that Condorhulse chooses smaller meals is not required by the diet.
4. My daily food include beans, rice, potatoes and a lot of fruit. Typically over 200 gr of carbohydrates, which is quite a lot compared to a very low carb diet like I used to eat (I think a Hershey bar is only 26 gr, so the equivalent of eating 8 or more Hershey bars in a day.
5. You don't have to belong to the program to do it, though if you are a Type 1, the extra guidance might be necessary. I jut bought their book and read it and watched a few videos. Also helpful was a book called How Not to Die and the accompanying website - NutritionFacts.org, which has lots of short videos on any topic of diet and health using this approach that you can think of.

6. - My results -

Within about 4 days of starting this diet, I had to get off of Metformin. I would eat a meal of 220 gr. of carbohydrates which would cause a spike in my blood sugars, but my body had already improved it’s sensitivity to insulin that it would slam the level down to the low 70s or less (mg/dL) which I believe is around a 4 in mmol/L. Metformin works by turning off gluco-neogenesis, so my body was unable to generate the sugar it needed to stop my blood sugar falling.

So I am currently in the second week or so of my 5th month of eating this way. I am still not on Metformin. I am also off my statin (many people who fast experience a rapid rise in LDL cholesterol and I was one). I do a 16-hour fast most days, by not eating breakfast. My most recent A1c was 42 mmol/mol (6.0%) and I expect to reach an actual normal A1c. My current weight is 10.14 stone which is a loss of 1.42 stone. I don't even think about weight loss - it just comes off on it's own. Weight loss slowed a month ago and I don't expect to lose much more as I am at a normal weight with a BMI of 22.24

If you want to know about this diet, read the book.
 
Very interesting. Thanks for sharing your experiences. How do you deal with the bodies need for some fats? Do you get them from nuts, for example?
 
lucylocket61 said:
Very interesting. Thanks for sharing your experiences. How do you deal with the bodies need for some fats? Do you get them from nuts, for example?
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Most foods have a combination of fats, proteins and carbohydrates, though they may be primarily one or the other. I actually have a little trouble keeping my fats as low as the plan asks for because I am so used to eating some high-fat snack from my very low-carb days. I still have a bit of trouble grabbing an apple instead (though that is what I usually do). So I limit my servings of nuts to one 1/4 cup servings per day. I eat 2 or 3 tablespoons of flaxseed a day (in a smoothie or sprinkled on fruit) which is a good source of omega 3 fat. I get a total of 40-50gr of fat per day, but only a couple of gr. of saturated fat (and none from animal products). The online tracking program, chronometer.com, is an easy way to check and see exactly how much of which nutrients you are eating.
 
How little fat does the plan ask for - in grams?
 
They ask for 15 as best, under 30 OK. You can also shoot for under 30% of your diet if I recall correctly. I'm just doing the best that I can. I don't quite have my carb intake for protein where it needs to be, but I am reticent to put too large a load on my system just yet, as I am still getting used to doing this. The doctor here https://nutritionfacts.org/ has a daily dozen list that are things you should eat every day and amounts, which is quite helpful. I've attached the list. There is a lot of support info on the site. There are three doctor(s) supporting this diet with minor variations in what they recommend - The Mastering Diabetes guys, the doctor referred to above and Dr. Esselstyn, whose diet is specifically for reversing heart disease, but is virtually the same as this one.
 

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lucylocket61 said:
This thread underlines my belief that there are several types of type 2 diabetes, and different approaches work for different people.
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I agree there are different diabetes types, but I think the word "work" should be defined. The approach gets the A1c by as the contributor stated slamming down the glucose to low levels. This is achieved with higher amounts of insulin under the curve to counter act the massive spike. So is it better for the body to get a 42 with minimal spikes or significant variances, I do not have the references to hand but 7.8 is the the "normal" upper spike level (I dont go over 6 as I am closer to Bernsteins method|), in another thread on the MD series someone had a variance of 4 mmol/L, considered this alright as their A1c was low due to covering with insulin.

Next on the "work" point, is what are the other metrics for this WOE, HDL, Trigs, HS-CRP, etc. If they are somewhere near the Virta Healths (i.e. similar to other protocols and mine on this site), then perhaps this method has some efficacy, especially if maintained for circa 5 years. For me it is not all about A1c. I believe post prandial rises are important, health metrics and vitality.
 
I agree. A take away is that the spikes are continuing to get lower, the more time I spend on the diet. The episodes referred to were on the first week of the diet while still on Metformin. Had I not been on Metformin, the lows would not have happened.

The desired lab levels using American units are as follows. My levels are in parenthesis alongside along with my goals if they are different:
Total cholesterol - < 200 (135)
Triglycerides < 150 (75)
LDL < 100 (90 - I want this at 70 or lower)
HDL > 40 (35 - higher would be better, but is not that important given my other labs)
HS-CRP < 2 (1.5 - below 10 is acceptable but below 2is considered safe so far as hearth health is concerned - I want it at 1.0).
So from one lab to the next I am so far, continuing to improve. I have more labs done in the next month.

The important thing is not to consider the pros and cons of this diet based on the little I've said, but to read the book, examine the studies and decide for yourself whether or not there is merit. I can tell you that in my 40 years of Type 2, including 20 years of Bernstein-like low carb, this works better and is easier to maintain than anything I have done. I tried it because, after 40 years of Type 2, achieving the results I wanted on a very low-carb diet continued to be more and more difficult. For me, the fat explanation made sense.
 
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Greetings @Cedartop
Am I reading that correctly, you've been a T2 for 40 years & are still controlling through diet only ?
If so that's inspirational.
 
I came across this interesting post by HYPERLIPID.

ACCORD and musings on insulin

There are a couple of things I would just like to mention in passing. Jenny Ruhl has just posted a nice entry about ACCORD. This is very im...
high-fat-nutrition.blogspot.com


I posted the key concepts here: (THOSE IN ITALICS IS ADDED BY ME)

I have posted on insulin, which is probably the ideal drug for diabetes management provided it is combined with low carbohydrate eating, in the past but it bears reiterating.

This is my opinion. If you can control your diabetes with metformin and wish to eat lots of carbohydrate, by all means get on with it, that's your choice. Not checking or not worrying about your blood glucose excursions might be a mistake. What you mean by good control might not involve HbA1c values in the 5% region or below.

If you need insulin to control your blood glucose, you have no choice. It's low carb. Live with it.

Why?

Some researchers (who write third rate papers using a rather inappropriate pancreatectomised dog model) are now starting to wake up to the fact that the pancreas secretes insulin in to the portal vein, not the subcutaneous tissues. In normal individuals insulin/glucose arrives at the liver via the portal vein and insulin facilitates transport of the glucose in to the liver, being metabolised in the process. Relatively little post pranial insulin or glucose penetrates to the peripheral circulation in a normal individual.

Once a person needs insulin to control their blood sugar levels they inject it subcutaneously. This will invariably elevate the systemic concentration of insulin. It will only modestly elevate the portal vein level. This is very important. (It is impossible to inject exogenous insulin into the portal vein, also what was secreted into the portal vein is about 25x concentrated insulin comparable to the U100/ml regular insulin)

In the cited paper the dogs get a meal with 50% of calories from carbohydrate, 30% from fat and 20% from protein. In control dogs, instrumented but not pancreatectomised, the portal vein insulin after the meal is, at certain time points, ten times the peripheral systemic concentration. This is what is needed to allow the liver deal with the glucose load from the meal while simultaneously protecting the body from both hyperglycaemia and hyperinsulinaemia.

Subcutaneous insulin will make the rest of the body do the liver's job of clearing post prandial glucose, the liver can't manage because it never sees the requisite ten times the normal peripheral insulin concentration needed to deal effectively with the portal glucose load.

What happens when you use the rest of the body as a glucose sump? From the paper:

"Peripheral hyperinsulinemia is associated not only with increased risk of hypoglycemia, but also an increase in catechol and cortisol secretion and lipolysis [14], deleterious effects on vessel walls [6], ischemic heart disease, hypertension and hyperlipidemia [8], and abnormalities in hemostasis [10]"

As always, I would add that it's the obese, blind, legless person in the queue for dialysis who pays the bill for eating the carbohydrate.

This is the situation for all type I diabetics and the more advanced type 2 diabetics. The only route round it is to use intra peritoneal insulin which is, in part, absorbed through the mesenteric veins so is partially portal vein selective. There are, needless to say, a stack of complications to intra peritoneal insulin infusion. Tight control of glucose using subcutaneous insulin from a blood glucose controlled pump is no solution. Though glycaemia is better controlled it is still at the cost of too little insulin in the portal vein and too much in the periphery, using the body as a glucose sump. Over the years I have never been quite able to decide whether hyperinsulinaemia or hyperglycaemia is the primary factor which kills nerves and kidneys. It's a difficult call. And a fascinating discussion in its own right.

What happens if you eat a diet very low in starch?

Very little insulin is ever secreted by the pancreas, especially as glucokinase down regulates. Very little glucose ever needs to be taken up by the liver. Very little insulin will be metabolised by the liver. The insulin gradient between the portal vein and the systemic circulation will be as low as you can practically get it. If someone still needs to inject insulin alongside a very low carbohydrate diet, and many might not, injecting a very small amount subcutaneously will deliver an arterial concentration to the gut, pancreas and eventually to the portal vein and liver which is still quite close to what the portal vein might have supplied. If the body is not using insulin the tissues will not extract it, so portal and systemic concentrations will converge. Everything pans out at some near basal level.

A very low carbohydrate diet is not perfect for insulin dependent diabetics but it is streets ahead of anything else. What people do or do not consider a "normal" human diet will not get around this. Need exogenous insulin? You are not in a position to eat ancestral starch. It's a simple matter of anatomy, physiology and biochemistry.

(I would like to add that there are many third rate experts after listening to some nephrologist and some others on internet saying that Type 2 are over expressing insulin - hence to control you only need to go low carb and it is even okay to eat so called resistance starch by freezing bread and then reheat to take off the sharp rise so called blunt the response. This way of treating the Type 2 are allowing blood glucose (BG) to rise above 90s in the morning due to the dawn phenomena and also allowing BG to rise above 130s after a meal due to incretin effect. This in a way is allowing the remaining beta cells to continue to be whittle away allowing the diabetes to progress .)
 
The Mastering Diabetes thesis is very closely argued in the book. It is very interesting but also potentially highly disconcerting for those like myself who have so far bought wholesale into the LCHF way of life. The core claim of MD is that our high fats will preserve and worsen our insulin resistance, even for those already in remission, and will set us up for future ill health. It seeks to demolish the view that carbs are all the same for us and so must be indiscriminately avoided. It instead claims we should embrace unhibitedly whole plant carbs whilst minimizing animal fats. What is one to make of all this? Does anyone truly know anything? Can any opinions be accorded any merit at all? The whole type 2 business looks like the madness of middle-ages alchemy, it seems to me.
 
Since I had labwork done today, and I have been following the Mastering Diabetes diet for 6 months, I thought I would share the results. Bear in mind that I have been a diabetic for 40 years and for the last 20 years, until 6 months ago, I ate a very low-carb diet. I'm posting the numbers as presented on the labwork (US values) and then post what I believe to be the UK equivalents, but someone may want to check to see if my conversions are correct.

Labs as follows:
A1c - 5.6 or 37.7
Total Cholesterol - 119 or 3.08
LDL - 78 or 2.02
Triglycerides - 86 or 0.97
HDL 33 or 0.85
No diabetes or cholesterol medication. Finally hit my goal of a non-diabetic A1c.
6 months in on the diet.

An ApoB and aHS-CRP was also done, but those are send out labs so I won't get those results for a couple of days. Also, this lab measure LDL instead of calculating it.
 
Well done on getting into the remission range and posting some results. This makes the contrast so far almost perfectly between the low caliorie high carb method for others. What were your results on low carb.

Not a criticism as we are all using hypothesis, but your trigs are "better" than average (according to modern ways of reviewing lipids), howver they are 33% more in absolute terms more than mine - more fat in the blood on a low fat diet than someone eating lots of fat. The HDL of 0.85 is below both US and UK standards and compares to my latest a couple of weeks ago of 2.9, whilst your LDL is over 2 times lower than mine (so on modern metrics better). So on lipids a traditional Doctor would say LDL trumps everything making yours better. The low carb Doctors would favour mine as being more protective.

Here are my Medichecks tests a few months ago, which show a similar A1c to yours and a very low HS-CRP of 0.3:



To round this out can you post typical meals on your protocol and if you do exercise, what is it, here are some of my meals this week:






I am hoping you send your exercise (if any), hs-crp, typical meals and indication of your post-prandial readings (mine 1.7 mmol/mol); people can make an assessment as to which protocol suits them more, essentially do they believe in the high LDL kills you hypothesis or low HDL and higher Trigs does and plant or animal based food preferences. Whilst this is an oversimplification some of the big ticket items are addressed.
 
Congratulations on your excellent results. Hope you stick around
 
Speedbird said:
Good news Cedartop
This is interesting too.
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Watched this a few days ago and thought it worthy of being in my signature.

There are so many positives about this video. Not only is is he independent of all the dietary tribalism so common in the online nutrition space, allowing him to assess his many experiments without prejudice or motivated reasoning. But having come to this armed only with the book and I assume maybe watching a few videos, rather than signing up for the (expensive) coaching and support plans, he shows the results are accessible to anyone who knows how to follow a handful of recipes.

While it is of course great to see the growing number of T2D using the MD program to get their health back, its the results with T1D that are perhaps the most illuminating. Due to how T1D need to dose insulin for the carbs they wish to consume, there are many datapoints being logged, by many people, over various periods of time. This window into the ongoing interaction between carbs and insulin, under ever-increasing (in the case of the MD program) carbohydrate load is invaluable and I believe the implications far outreach those with T1D.
 
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