Since my interesting experience at diabetes.co.uk a few weeks back, it appears that things have changed for the better over there. You may recall that I started posting on their low-carb forum and quickly found myself in a protracted argument with the forum moderator and a group of his supporters. The problems stemmed from the fact that the moderator et al were claiming to be eating a sustainable diet that was very low in carbs and also low in fat. As you may know, this is possible while one is burning off stored body fat, but once weight has stabilized, those stored calories need to be replaced with dietary calories, preferably from fat. I had patiently laid out the argument with examples of daily menus which showed that the claims of the low-fat/low-carb folks were unsupportable. I persisted because it appeared to me that this important low-carb venue was leading people astray on the benefits of low-carb/high-fat. Many of the posters there were proud of their HbA1c’s on their version of low-carb but were also taking meds. And, not all of them were achieving normal HbA1c levels, even when combining “low-carb” and meds.
When the moderator was not able to refute my arguments he began to delete my posts and eventually labeled me a troll and permanently banned me from the forum. I was then contacted by another fellow who, as it turned out, was one of the original moderators of that forum and a proponent of low-carb/high-fat who had met a similar fate. I found myself caught up in a struggle that had been going on for some time and in which the current moderator and his preposterous dietary claims had, until now, prevailed.
Things got more interesting when I alerted Jimmy Moore to what was happening across the pond. Jimmy contacted the former moderator and interviewed him on his widely read blog, www.livinlavidalowcarb.com. Things began to change quickly after that. I soon received a sincere apology from one of the administrators of diabetes.co.uk and the moderator and his side-kick were suspended. My “permanent ban” was lifted and I was, once more, allowed to post on that forum. There was a slight hiccup when a new moderator took over (someone proud of a HbA1c of 9.7!), who again banned me. The reason was not given but I suspect it was for “promoting a low-carb diet” for which I had been admonished after suggesting that once you have type 2 diabetes you have two choices: very low-carb and no meds or recommended diet and meds. Interesting that one can be banned for “promoting a low-carb diet” on a low-carb diet forum. Once again, however, when he was alerted to the situation, the administrator apologized and re-instated me.
I have been observing and making the occasional post over the past few days and I have to admit that the atmosphere seems to have improved. The original moderators are nowhere to be found; clearly a good thing. Also, their band of sycophants and supporters seem to be much more muted in their non-sensical ranting. I am hopeful that this forum has, once again, become a place where diabetics can benefit from accurate advice on low-carb/high-fat dieting.
Seems like that old saying is true: the best disinfectant is sunshine.
“. . . once you have type 2 diabetes you have two choices: very low-carb and no meds or recommended diet and meds.”
I support LC diets. But I think we have to remember that not everyone can have normal BGs off meds even on a LC diet. It depends on how far advances your diabetes was when you were Dx’d.
If most of your beta cells were already gone, you’ll need some medication assistance no matter what, just as type 1s can’t control with diet alone.
Dr Jay’s Reply:
You are correct, of course. It really depends on how much beta-cell capacity you have preserved when you start carb restriction. The comment I referenced in my post was directed at a newly diagnosed type 2 diabetic. I think for people like that it is reasonable to try to get completely off meds by carb restriction. For those who are restricting carbs but who still require meds to achieve normal sugars, I would encourage them to go as low as possible on the carbs before concluding that they must have meds.
The problem with holding off on meds is that high BGs can kill beta cells. The old philosophy was to try diet and exercise and come back in 6 months. In some people, 6 months of high BGs ensured that they’d be on meds forever.
Today some are suggesting starting right off with insulin to bring BGs into normal range. Then you can back off the insulin (or orals) as the LC diet, sometimes combined with weight loss, is able to keep the BGs normal.
Bernstein says that 2 weeks of normal BGs with the use of the Biostator (a closed-loop system available only in research settings) resulted in much improved pancreatic function some years ago. But very few have access to that.
Of course, as you well know, the initial treatment depends on the patient and how well they’d be able to change diet, how high the BGs are at Dx, what they can afford, and so forth.
The reason I feel strongly about this issue is that I think if you tell people they’ll be able to be free from meds if they just follow some diet, they follow the diet, and they still need meds, they’ll feel it’s their fault, that they’ve failed somehow.
Dr Jay’s Reply:
There is a lot of lip service paid to the idea of diet and exercise as first line therapy to control diabetes. The reality is that most physicians and other diabetes care-givers well know, this approach rarely works. People, therefore get onto metformin right away and maybe even insulin. In that context, I understand the rationale for early rather than late use of insulin as it will help preserve pancreatic function. However, when it comes to low-carb, the effect of the diet is almost instantaneous. People literally have to greatly reduce or discontinue altogether their insulin and meds very quickly after starting a low-carb diet. I mean by this, actually cutting out the carbs, not tapering them off or cheating so much that the efficacy of the diet is compromised.
If people understand this and have sufficient beta cell capacity and actually adhere to the diet, it is definitely a reasonable goal to get off meds completely. If they fool around with the diet or if they have lost too much of their beta cell capacity, this will not result in getting off the meds. In either case, I would not suggest going six months with unacceptably high blood sugars while trying any kind of diet. For newly diagnosed diabetics (or metabolic syndrome patients) a few days on the diet with close monitoring will quickly determine how much, if any, meds are needed. For those who are already on meds, a sharp reduction when starting the diet is necessary and further reductions can be made based on close monitoring.
Going into this, people need to understand what is going on and what are the factors that determine the outcome. Beta cell loss is a factor. So is non-compliance. Some people have a really hard time sticking to the diet. Should they feel bad about it? I think that is counterproductive while, at the same time, I believe every effort should be made to help them succeed. In the end, they may not. Like smoking cessation, maybe they need to keep trying to eventually succeed. Or maybe they will end up eating some carbs and using meds to maintain BG control. I have no problem with any of those choices as long as people are making an informed decision and to make a properly informed decision they have to know what is possible.
In the current state of affairs, however, most people are not making an informed decision about the possible benefits of a low-carb diet. This is what has to change.
Natures perfect plan.
Things haven’t improved that much over there – there is still a clique to get through. I’ve given up trying, so yes I could be classed as a bit bitter.
“Clicks” or groups of people that “got there first” on every board out their, be it a hunting forum or bowling or nutrition or health related or ping pong or boating, or all of the other thousands of boards, all have their “clicks” and bully’s that feel they own the boards and are senior and superior. It’s a human nature phenomena. — We are territorial creatures and group and clan accordingly. — Moderators are supposed to monitor this but more often than not succumb to the same arrogance themselves. — If yours is out of step with the “mainstay” you are shunned and attacked and stoned into obliviation! — Not quite, but you get the point!
I agree with both of you. Ideally you’d be diagnosed early enough that diet should work, but this is usually not the case in the UK. In US forums you routinely see the alternative approach where doctors may throw a whole bunch of meds including insulin at a newly diagnosed Type 2 and then have to back them off rather quickly as the diet takes hold and reduces insulin resistance. Breaking out of glucose toxicity often takes medicine.
I found this on the diabetes uk site:
” What are ‘free foods’ and why can’t I eat lots of them?
‘Free foods’ typically contain fewer than 20 calories and 6 g of carbohydrates in every serving. When eaten in moderation, they do not influence the diabetic exchange. However, moderation is still extremely important, as these foods do not contain zero calories. Some ‘free foods’ such as vegetables become more concentrated when cooked, and should be eaten in smaller portions than when raw. ”
I’m not diabetic [per blood tests done last week] but I’ve noticed for years now that when I eat many foods cooked, especially those that taste even sweeter cooked than raw, [fruit such as used in pies, carrots, onion, corn, sweet peppers, tomatoes, pumpkin and more] I get a lot of unpleasant reactions.
I’ve been wondering if cooking dehydrates these foods so that the sugars become indeed more concentrated relative to all other components of the food item; or whether heat per se alters something that causes the strong reaction? I had also wondered if it had to do with quantities ingested: eg, it’s far easier to eat 2 cooked, soft yummy carrots than munch thru the same 2 raw so I’d never eat 2 raw ones.
THe ONLY thing I found that mentions ‘concentrated sugar in cooked food’ was from this site. In light of all the goings-on with this site, Is there any basis to this claim?
I’m fascinated about how you reversed diabetes and while I’m not diabetic, I have these odd reactions that perhaps you’re familiar with from all your study and personal experience.
Curioser and curioser and would love to hear some feedback. Would also be happy to be pointed to additional reading material. [I’m also more sensitive to foods of the Brassicaceae group when they’re cooked, and extreme-pain sensitive to garlic in all forms ever since I was a kid – and that is definitely a paternal lineage inheritance!]
thanks for your time and care.
sz
Dr Jay’s Reply:
I am not really in my zone of expertise with this topic but here is what I understand. When you cook vegetables, you can soften the fibre which will make the absorption of the carbohydrate molecules happen faster than more raw versions. Cooking can also separate the sugar molecules that make up the more complex versions of carbohydrate which can increase the glycemic index of the food. I don’t think that either of these effects are going to be a big factor when you are following a low-carb diet, however, since the relative amounts of carbs you will be eating is going to be small anyways. I don’t know if this would explain gastric symptoms but you could easily find out by experimenting with yourself. Eat the vegetable in its raw form one day and cooked form the next. That should give you an answer of sorts. I am sorry to hear you can’t eat the Brassicaceae group. So many excellent foods there. I would really miss my cauliflower and arugula!
Although you may not be “officially” diabetic you may have insulin problems. Cooking, and especially juicing, speeds the absorption of the carbs just as Jay says. If, like me, you have a poor Phase 1 insulin response but an adequate Phase 2 insulin, you can spike your BG high briefly after eating such things, and when the insulin turns up late and in excessive quantities your BG may subsequently drop rapidly, which may produce symptoms.
Get yourself a BG meter and try doing this
http://loraldiabetes.blogspot.com/2009/04/test-test-test.html
only start half an hour after eating and go out half-hourly to about 4 hours.
If I couldn’t have my purple sprouting broccoli and brussels sprouts life wouldn’t be worth living. Crucifers may affect thyroid function so it may be worth getting that checked.
Try some of these
http://www.diabetes-support.org.uk/info/?page_id=139
Dr Jay’s Reply:
Thanks for you helpful input.
re: “What we need is a study that compares the Ornish diet to a very low-carb high fat-diet.”
Its been done at Stanford 2007:
http://jama.ama-assn.org/content/297/9/969.full
watch the video too:
http://www.youtube.com/watch?v=eREuZEdMAVo
Regards
Dr Jay’s Reply:
Thanks for those links. I know Chris Gardner and am familiar with his work. The A to Z study tested the effectiveness of four diet books. Effectiveness studies are good for learning certain things but they don’t necessarily tell you what are the potential physiological benefits of the intervention. In the A to Z study, people didn’t really conform to the Ornish diet, their fat intake was far higher than Ornish’s recommendation. In the Atkins group, they increased their carbs during the study which is what the diet book recommends. In both cases, you will have a hard time determining what would have been the result if people actually ate a LCHF diet vs a very low fat diet throughout the study period.
One of the reasons that there is so much confusion about diets in general is that people look at the results of an effectiveness trial, like the A to Z study, which measures compliance along with the effect of the intervention, and draw conclusions about the efficacy of the diet, which can be obscured by issues with compliance and attrition. To settle this debate we would need to have a LCHF vs Ornish diet study done in a metabolic chamber. That would be very difficult and expensive to do. I believe that if such a study were done the LCHF would deliver the greatest benefit which is the major reason you will never see that kind of study funded as long as the lipophobes control the research agenda. I think they know this in their heart of hearts.
Not only difficult and expensive, it would have extreme difficulty getting past an Ethics Committee.
The best you can do at the moment is to pay attention to bloggers like Michael Eades, Peter at Hyperlipid etc. who are good at deconstructing studies and teach yourself to read between the lines.
Nutrition And Metabolism
http://www.nutritionandmetabolism.com/
is well worth trawling through. Increasingly, competent researchers are getting their work into more mainstream journals but you still have to pay attention to what is measured and what is not, and what is excluded from the abstract which is often the most important part.
Check out the NMS board members
http://www.metabolismsociety.org/board-members.html
(where did Eric Westman go?)