The Carb Controversy

I'm new here, and I have just been reading about the L/G diet but when I try to add some carbs, the blood sugar jumps up to 170 or 185. I am pre-diabetic & trying to manage with diet. I am afraid to do much experimenting...I follow Dr. Bernstein's plan mostly. have any of you all here done well on the low gllycemic style of eating?

Sunny, with blood sugar levels that high, you should have been diagnosed as being diabetic. It is obvious at this point, to me at least, that you are beyond the stage of being controlled with diet alone. Later might be different. I haven't read it yet, but David has a listing on online support groups. May I extend my personal invitation to one that I belong to? It is diabetes_international, I believe David is there too. Come join us, you will find a lot of support and help. Helen

I have just been diagnosed as pre-diabetic with an A1C of 6.5. After a month of low carb diet and significantly more fat (to repalce the carbs) and of course almost daily exercise, the A1C dropped to 6.1 and the fasting blood sugar to an all time low of 79. I am starting to really believe in low carb diet. I will continue testing it and see how it does in the long term and hopefully report it here. Thanks for sharing your info on diet for diabetics. Ahcene

I disagree that those levels of blood glucose mean necessarily that Sunny can't bring them under control through diet alone, without recourse to medication. A friend of mine was diagnosed with diabetes a month & a half ago, with fasting levels in the 400 mg/dL area. She threw out all the refined foods with sugar & high starch, & has paid attention to some of I had been learning about low GI & other dietary changes, & her fasting BG is now in the 110-120 range -- not perfect, but hugely better. This without any diabetic medications whatsoever. That said, talk with your doctor, & also learn all that you can about proper nutrition for diabetes control! (Or prediabetes -- I too am prediabetic.) You'll probably have to educate yourself: most medical doctors know very little about nutrition, as most medical schools give it cursory attention at best. I recommend the book __How to Prevent and Treat Diabetes with Natural Medicine_ by Michael Murray, N.D. and Michael Lyon, M.D., which discusses nutrition, medications, etc., & is also where I first learned about the glycemic index.

Another couple of good support lists (I belong to both), at Yahoo Groups, are LowGlycemic Eating and Insulin Resistance . Best wishes.

It is certain that in the future some, perhaps even a large part of what we now believe will seem quaint at best - and dangerous at worse. Which things will be which I do not know. But I know that upon diagnosis I perused the opposing theories on the web re:carbs and simply decided to test. Up to 25 times a day. The verdict, for me, was clear. My enemy was carbs. I have controlled my blood sugar for 3 years with diet and excercise, no drugs, with average a1c's of 5.1. However, some success notwithstanding, I believe my first statement to be unassailably true. Some of what we are now doing will be shown in later years to have been foolish. But doing nothing would be even more foolish. I also believe the wise Greek thinker who praised moderation in all things. So while I am NOT moderate in my carb intake approach (testing was too clear), I believe a less than fanatic view of all other approaches to be wise. Therefore I do not ingest handfuls of supplements, I do not run for herbal remedies, I do not limit vegetable based carbs like Cauliflower, Broccoli, etc., I DO avoid bread, rice, and pasta, but indluge in whole grains and whole wheat tortillas, I have lost weight but not enough, I excercise moderately, but not too strenuously, and I jump on no new bandwagons. I am a diabetic doing the best I can. The simple fact that we are all engaged in the process already sets us apart from millions who believe they can take a pill and eat like before. At the very least we know we can't. Oh, and pre-diabetic is a meaningless term. It is a gradual downward slope, as your pancreas beta cells burn out, and your insulin resistance rises. You can change the gradient, but you are unlikely to ever have the insulin response you once had. Pre suggests you can quickly change things and the virus will disappear. Better to think of it like keeping a boat from flooding. The boat has leaks, but proper care can keep the water levels from rising. (and 6.5 isn't pre, it's welcome to the club). So welcome.

It is interesting that the ADA is so big on carbs - in Europe they understand that carbs need to be restricted. I was shocked when my friends' 13 year old son got onset Diabetes 1 last year. At Methodist Hospital in Houston, they told my friends that they should not deprive their son of sugar, but give him a bit more insulin! Personally, I am doing very well on the Atkins approach to glucose control and plan to stay on that. BTW - there is a fiber cracker you can get at netrition.com - a bran crisp cracker, also a Scandinavian version by GG Scandinavian is available. Thanks for a great website. Anne David's Response That's a terrible story from Methodist Hospital, Anne. I have heard of ignorant people saying that they could cover sugar and other carbs by just taking more insulin. But I never heard of health professionals saying that.

What do we do now that a study suggests glycemic-based diets should be abandoned? DOesn't the medical community realize what this inability to get their information straight does to us who are trying to do the right thing. I'm 100 pounds overweight, Type II and everything I've try has failed to work....What's the answer? David's Response The American medical establishment is continuing to bash the glycemic index. This report by University of South Carolina researchers in the British Journal of Nutrition is just one of many such attacks, and I am not surprised. See http://www.ingentaconnect.com/content and http://uscnews.sc.edu/hlth049.html. I know from my own experience that the glycemic index works to help me control my blood glucose. But nothing that I ever tried helped me control my weight more than Byetta. I wrote about my initial experiences with it here at http://blogs.healthcentral.com/diabetes/david-mendosa/going-to-byetta-2006-02-17. That could be your answer too. The leading glycemic index researcher, Professor Jennie Brand-Miller of the University of Sydney, just wrote me that her organization is preparing a rebuttal to the South Carolina report. It is "a flawed study," Dr. Brand-Miller says.

When I watched the carbs AND the glycemic index, my numbers improved and I lost weight. I also added moderate exercise and came to the conclusion that perhaps moderation was the key to my approach. I learned to live without some foods and learned a new appreciation for food in general. I am now a gourmet for salads! I wish the medical community would find a happy ground though -- I was puzzled when I was diagnosed that I wasn't immediately helped with a dietician and an exercise coach. I had to ask and ask. That was the first step for me - finding what made my sugars jump up and holler.

Could anyone please inform me,if or when Byetta will be available in Europe? Thanks in advance. David's Response: The Amylin customer service staff told me this morning that they expect Byetta to be available in Europe by the end of the year.

When I was diagnosed with Type II last fall, I looked around to see what food advice made sense, i read "The New Glucose Revolution" and decided to try that approach, with my doctor's blessing. Six months later, I've lost 20 pounds (it's a beginning), my last A1c was 6.1, and my blood glucose rarely spikes above 135 after meals, (I'm also on two pills.) I don't spend my day being hungry, either. Everyone is different, but eating lower on the glycemic index is cretainly working for me.

I'm a doctor with early mixed Type I and II diabetes, controlled so far by diet, exercise and a few herbs. Humans can make glucose out of all kinds of things. We do not have to eat glucose or chains of glucose (called starch, or complex carbohydrates). I have no idea why the ADA so stauchly says eat tons of carbs, but it can't be just science. The food industry is incredibly powerful. And the ADA is huge. It takes alot to turn a whale. If I ate the amount of carbs the ADA says I would be overweight, feel lousy, be on many more meds (probably large doses of insulin), and die a slow, early death, dying bit by bit. Not necessary. Insulin is THE fat storing hormone, whether you make extra yourself to overcome your insulin resistance, or you inject what you "need" to cover the carbs you eat. One cup of plain oatmeal with a little milk raises my blood sugar 90 points. Why would I do that to myself? If you want to know what carbs do to you then check your sugar one hour after you begin a meal. Compare results from different foods. Very simple. Very scientific. If humans truly needed to eat carbs then all the people on Atkins would be brain damaged or dead, because brain cells need 2 essential fuels to survive: oxygen and glucose. Remember we can make glucose out of most anything, including triglycerides from our fat stores. Tri-glyc-erides are made from 3-glucose molecules. Most Type 2 diabetics have already eaten their lifetime allotment of carbs. That's why their beta cells are worn out. Many of those carbs are still stored around their middles. Use 'em up before you eat any more. Type 1s can save what beta cell function they have left by not forcing their beta cells to make insulin, which is what they do when we eat carbs. That way the beta cells that are left can help with fine tuning without getting exhausted. It also keeps them from getting exposed to antibodies which will kill them. Take good care of yourselves.

Added comment. Insulin is not bad, it is a wonderful, miraculous, natural substance and medication which I will use when I need it. But unnaturally high levels of insulin are bad for us in many ways, whether we make it ourselves or inject it.

I was about a 450 meter reading and had all kinds of bad health problems. I was a 100 pounds overweight, had high blood pressure, a high pulse rate, my toes were tinkling, my legs were swelling up twice their size, I had all kinds of aches and pains, arthritis, nerve twitching, and my vision went so bad I could not read the big signs on the freeway, and I could not walk 100 feet with out huffing and puffing. My doctor put me on insulin and variaous pills. This caused my blood sugar to drop and then I would take orange or apple juice to keep from passing out and then my sugar count would spike up. Thanks to Mr Mendoza. I obtained Dr Millers low glycemic index book. I do not eat any thing with a load of ten or more. I will eat a little fruit with an index of 55 or more provided the load is 10 or less. That got me on the right track. How ever there was much more to go. Based upon numerous studies I also 100% completly eliminated all processes foods, and I consume no product with any kind of chemical, preservative, food coloring, or any non orangic ingrediat. Chemcials and fats from processed foods cut an average of 26 years of a typical persons life span according to the WHO. I then eliminated all red meats and limit skinless chicken and turkey to four to five ounces per week. What do I eat. I eat all kinds of vegatables, fruits, squashes, melons, nuts, spices, peppers, egg whites, fish, plenty of fish including canned fish canned in water only. Very importantly I only use Virgin Olive oil to cook with. I never use any kind of other oil for any kind of reason. I also never use any kind of Soy product as it is bad for you. There are many research articles avaiable on soy. I use lots of vinegar, garlic, lemon jucies, lime jucies, peppers, and spices on my salads and fish, I never use butter or poison margerine or poison package salad dressings, I do drink a small amount of non fat milk only on my morning cereal of organic oat bran not oat meal but oat bran. Finally I have one helping of beans a day. This is very, very, very, important. Beans are complex carborhydrates and take 24 hours to break down. One helping of beans will keep you from being hungry for twenty four hours. The result is: I no longer have to take diabetic meidine. That right -- no medicne. My blood sugar is now in the 70 to 115 range with an average of around 90. My weight is 155 instead of 255, my blood pressure is 95 to 100 down from 145, My pulse rate went from 90 to 60 to 65. My vision came back after 45 days. My aches and pains went a way. No more twitching muscles, I am playing Ice Hockey again and I can go mountain hiking all afternoon with normal breathing. In conclusion I owe many thanks to Mr Mendoza and Dr Miller's Glycmic index. William Hankins David's Response: That's wonderful, William! You have done what so many people with diabetes attempt and you have had great success at it. Keep it up!

i have been type 1 for 20 years now and have almost always carb counted.i have had varied success with this but on starting to follow the glycemic index have achieved more stable bm readings.the only thing i have trouble with is adding lemon juice or viniger to my meals to bring down the index even more,it seems to extend the life of the carbs to such an extent that the insulin runs out then my bm's start to run high,bearing in mind that i am on natural pork insulin via a pump is there anybody out there that can offer any advise on this.

I was diagnosed in 2002. H1Ac was 8.5. Wt 185lbs. Hi trig, hi ldl and low hdl. For 1 full year, went on glycemic index based diet and religious exercise and metformin/avandia combination. Monitored blood glucose 7-8 times a day..my levels correlated so well with the glycemic load, it was uncanny. Within a year, brought H1Ac to 5.1..has remained

Just wanted to correct this statement: "Remember we can make glucose out of most anything, including triglycerides from our fat stores. Tri-glyc-erides are made from 3-glucose molecules." Humans can't make glucose from fatty acids. They can make a little glucose from the glycerol backbone of fat. And triglycerides are not made from 3 glucose molecules. They have 3 molecules of fatty acids attached to glycerol (the glyceride).

I to am pre-diabetic, but only because I have been relativley low-carbing for the past 10 years. However with my advancing age (67) I am now probaly a full type 2. I am scheduled for a doctors visit soon to get confirmation. However my point is that I can no longer tolerate refined carbs..For example one slice of whole meal toast in the morning will raise my blood sugar readings to 180+. My A1c is 6.2 (high normal) but this does not show the hourly swings to high and low as does an hourly meter reading. In my case the difference from high to low was close to 100 points. So to cut a long story short I have had to cut ALL refined carbs from my diet and replace them with protein and green leafies..... I do not take insulin and will always be guided by the glycemic index and the glycemic load tables.

Diabetic16yearsyears.Always Used the CDA/ADA guidelines for eating.Not working. Blood sugar totally out of control.I am told that I can eat anything just watch the size, count the carbs and take insulin to cover what you eat.Too much insulin now. I feel sick all the time. I feel better when I eat less carbs and more veggies, beans and some fruit.Want to try low GL diet. Pamela David's reply: You were following the standard advice, Pamela. With what is so unfortunately the standard results. When you begin to avoid high-glycemic carbs, especially baked potatoes, rice, and anything made from wheat flour, your blood glucose will not go so high and you won't need so much insulin to cover it. And of course the more insulin you have to take the more that it makes your weight increase.

Iam a type 2 diabetic and after numerous tests and checks it became absolutely clear to me after a while that refined carbs cause my blood sugar to shoot up. By eliminating refined carbs and sugar - and potatoes ( also cause b/sugar leaps for me )and keeping to meat, fish, eggs , cheese and lots of vegetables ( except potatoes)my blood sugar is around 6.8 A1c - a lot lot lower than before. It also has enabled me to relax about my diabetes for the first time as I know if I stick to the diet my diabetes will stay under control. Still need to test though and monitor.

Although I could give a lengthy story, I'll just give the essentials.

Nine years ago I was diagnosed as a type II. My A1c was 12.7.

Taking Rezulin and changing my diet some brought my A1c down to 7.5.

I decided to go on the Atkins diet seven years ago this month. It only took a few months to bring my A1cs down and I was able to discontinue taking any medication.

My A1c now is routinely in the 4.5 to 5 range. I have had no problems at all sticking to low carb eating.

As regards the above posts, for the person who claimed to be a doctor, but said that a triglyceride contains three glycerine molecules, I have serious concerns that the person is either not a doctor, or at least not a doctor that I would want to ever see. That is such a fundamental mistake, and I appreciate that someone else pointed out that mistake. However that post was correct in all other regards.

The body does produce some carbs from stored triglycerides by using the glycerine skeletons to form a molecule of glucose. It breaks down the fatty acids into ketones and the body can use the ketones as a perfectly acceptable fuel for almost all the body's needs. For the parts where the body has to have carbs, it uses the glucose that it creates from the glycerine that it liberates from triglycerides (both dietary and from stored fat). The process by which the body makes carbs from non-carb sources is called gluconeogenesis (which is different from glucogenesis).

I encourage everyone to at least give low-carb dieting a try. Some of you could stick with it and some couldn't. For those of you who would stick with it, it could be the most important thing you ever do in your life.

I have sleep apnea and what I have learned in the course of optimizing my treatment over the last 2 and a half years is that everyone is different and therefore everyone requires a "modified" approach. I have recently discovered that I very like have pre-diabetes and like with my apnea treatment where I had to "titrate" the optimal CPAP pressure ... I think that maybe I also have to learn to "titrate" my carb intake to normalize my glucose and insuline levels.

 

Whether a low-carb or low_GI or low-GL or paleolithic diet is the correct diet is probably a moot issue since we are all different. As I understand it, we all fall somewhere along a continuum on the path through pre-diabetes and on to type 2 diabetes. Why not use a glucose monitor and a food diary to determine what amount of carb is right for YOU. The other thing to keep in mind is that it is a dynamic state ... as we get older our carb sensitivity changes and the amount of exercise we get must also figure into the titration, again making everyone's carb needs is unique and different.

hmmm... low carb diets...

 

i'm not going to say anything against low carb diets because it is true that Carbs is the only macronutrient that directly corelates to blood glucose levels.. but it is true that the body needs around 130 - 140 grams of carbs each day for normal physiological processes... the brain lives mostly on glucose, it cannot use any other fuel or rather, energy source.

 

130-140 grams sounds a lot but if you think about it as being the allowance for the whole day, then it will come to something like this:

 

Breakfast

half cup oatmeal (15g Carb w/o milk and sugar)

1 serving fruit (15g Carb)

 

AM snack

half an english muffin (15g Carb)

 

Lunch

half cup cooked pasta (15g Carb)

half cup vegetables (5g Carb)

1 serving Fruit (15g Carb)

 

that's just 80 grams carbs we still have 50-60 grams for two snacks and supper.

 

PM Snack

1oz bagel (15g Carb)

 

Dinner/Supper

half cup Mashed Potatoes (15g Carb)

half a cup of vegetables (5g Carb)

1 serving of Fruit (15g Carb)

 

Bedtime Snack

1 cup milk (12g Carbs)

 

for a total of 142 grams carbs. i just put in the carb rich foods to illustrate how much carbs per meal can be eaten on 130-140g carb allowance, meats and other proteins are not included because they don't have carbs but proteins are important too...

 

6 meals are recommended in order to avoid fluctuations in blood glucose levels.

a bedtime snack is also adviced to prevent the condition known as reactive hyperglycemia. reactive Hperglycemia happens when blood sugar dips to low levels during the night prompting our body to produce more glucose from the glycogen (human starch) stored in our liver and muscles.  this process is done through the action of another hormone from the pancreas called glucagon, now the hormone that stops glucagon when enough glucose is in the blood is insulin. but insulin resistance inhibits the hormone from doing its job so blood glucose continues to rise.

 

45%-60% of calories from carbs is the usual recommendation because this "diet" provides enough glucose for our daily needs.. the 130-140g carbs is only for the basal metabolism. Do people only lie or sit all the time? well if you do, then go for the really low carb diet because you won't be using the glucose from the carbs anyway... but if you are an active person then you need the glucose from carbs..

 

the glycogen in our livers and muscles only give enough glucose for about an hour or less during fasting and physical activity.

 

Ketones... too much ketone bodies in the blood and urine leads to ketoacidosis. which can lead to coma and/or death. Diabetic KetoAcidosis or DKA occurs mostly on TYPE 1 Dm. but some cases of DKA on Dm TYPE2 are reported.  People with DM Type 2 are also at risk of another acute complication called Hyperglycemic Hyperosmolar NonKetonic Coma..  Both occur when blood glucose levels are too high either because of too much carbs or reactive hyperglcemia.

 

BUT REMEMBER:

IT IS STILL YOUR CHOICE OF WHO AND WHAT TO FOLLOW

 

experiment with yourselves.. follow a restricted carb diet like Dr. Atkins' or the SBD... but please take note of what happens to you during the course of the diet... if you experience nausea or headaches or fatigue then please eat 15g carb immediately.. your brain is hungry and you have no more source of glucose..