Blood sugar haywire on McD - and I'm not diabetic

[TanneryGulch]

Geoffrey: I haven't read Graham's book, but prima facie it seems to me it would suffer from the same "calorie paradox": you'd have to eat like 8-10 lbs of fruit every day. Fruit has a low GL because (1) it has no calories (ex. bananas), and (2) a lot of the calories it does have are fructose -- which isn't necessarily healthy just because it's low-glycemic. (I think McD has addressed this.) Basically, I think the entire concept of GI/GL is a red herring. (It's helpful insofar as it steers people away from flour/sugar.)

I suspect that anybody who gets by on a raw diet for any length of time does so because of "cheats" -- although they think it's despite their "cheats." A diet can't be based on low-energy density foods. That means that after eating your fruits/veggies, ultimately you must cast your lot with either starch or animal fat (or I guess nuts). Any program that doesn't explicitly take a position on that is a gimmick, not a diet; at least, that's how I'm beginning to see it. What do you think? Does your doc on the Graham diet really eat 20+ fruits a day?

[TanneryGulch]

Dinner tonight:
- huge pile of steamed kale
- 1/2 cup adzuki beans
- ~1lb sweet potato

BG at 0:45 - 133
Immediately did 80 body-weight squats; tested again at 1:15 - 94

The peak isn't improving. Shopping for life insurance now. Perhaps I should be shopping for grass-fed steaks instead, but not yet.

[TanneryGulch]

Suebee: I've been eating a lot of brown rice, just not last night. Also, I've been eating mostly canned beans (Eden Organics no-salt) and going through at least a can a day -- that's 1.75 cups and almost double Dr. F's quota. On some days I've thrown red lentils in with my rice, so that's even more. From Jeff, McDougall, and elsewhere I understood that excess protein is neither necessary nor recommended.

My basic framework has been oatmeal for breakfast and then greens + beans + starch at every other meal. I haven't been mixing the "starch" components as you suggest. Guess I could try it, but I haven't noticed any difference in glycemic impact of different starch foods based on published GI, etc.; it seems to be a linear function of the carb load. Yams have a GI of only ~35 vs. brown rice at ~66, but I haven't noticed a significant difference (and if anything, a higher "hit" from the yams).

My weight has finally stabilized. I think I've settled on four meals a day for now. Trying to eat for true hunger, but it's been tricky; the first week or so when I did that and ate only three meals, I clearly underate and let my weight fall way too far.

After oatmeal (1.5 cups pre-cooked) this morning:
0:45 - 135
1:15 - 95

[TanneryGulch]

http://www.diabetes-symposium.org/index ... t=4&id=322

Last night I watched this presentation again, and I think I've spotted a couple of misinterpretations by the low-carb camp.

First, the claim that normal BG never rises over 100 mg/dl seems to be based on the Riddle study cited on slide 19 (http://www.ncbi.nlm.nih.gov/pubmed/2192851). I wish the full text of that one were accessible, because it seems to have been based on type-1 diabetics using exogenous insulin; also, I don't know what method of BG monitoring was used, but I doubt the fancy Roche devices existed. In any case, I think Christiansen has clearly refuted/updated that with his continuous capillary and tissue glucose monitoring of normal (screened by both A1c and OGTT) subjects in real-life conditions. With the mean 45-minute peak after breakfast at 125 and the +2SD at 160, the low-carbers' claim of clear abnormality at >100 or even >120 is suspect. Of course, Jenny Ruhl argues that not all the "normal" subjects were truly normal, since their A1cs ranged up to 5.4% (which is what mine was 1 year ago -- the origin of my freaking out).

Second, Jenny claims "that the same amount of carbohydrate eaten at a meal other than breakfast does not raise blood sugar anywhere near as high. The body seems exceptionally unable to process carbohydrates first thing in the morning. So throw out the Corn Flakes!" I don't think this reading is tenable either. I don't know where she got the "same amount of carbs" part, but Christiansen clearly states that the subjects had free choice of meals (but not meal times). If these subjects are anything like Americans, they tend to eat more carby breakfasts and more fatty/meaty lunches and dinners. Christiansen points out that while the breakfast had a much higher peak, both lunch and dinner had much greater AUCs -- exactly what you'd expect from adding fat to the meal, since fat slows the absorption of glucose. What it does suggest, I think, is that his breakfast data are more applicable than lunch/dinner to people eating a McDougall-style meal of 70%+ carbs.

Clearly I shouldn't expect to ever "adjust" to where a meal of 150g of complex carbs doesn't spike me over 100 mg/dl.

So, the big question: You've eaten McD like your life depends on it and achieved fasting BGs and HbA1cs that will make your doctor happy. But how do you know those excursions aren't killing you slowly? Dunno, but at bare minimum, I'd think you'd want to be below Christiansen's +2SD breakfast curve, so that's:

- fasting <90
- never >160 (peak is at 45 min)
- <120 by 2 hours
- very close to fasting again by 4.5 hours

What do you guys think?

[TanneryGulch]

I haven't been testing my BG as obsessively lately, but I did test after lunch today of:
- fruit-free "blended salad" of 1/2 cup almond milk, 1 tbsp ground flaxseed, 8 oz spring mix (yeah, not the tastiest concoction)
- 3/4 cup chickpeas
- small dried tomato
- really big (~18oz) yam
- 1/2 cup? brown rice

Did 100 body-weight squats and 100 toe-raises a few minutes after eating.

BG at 0:45 - 94
at 1:20 - 90


Granted, these readings are not typical; I'm usually seeing peaks in the 130s.

Co-workers are of course doing what they can to help. Yesterday they brought in some incredible-smelling pizza and home-brewed root beer from the local gourmet pizzeria. When I politely declined, they put it right in front of me on my desk. But I'm hanging in there!

Reflux has been bugging me again slightly. I am eating known trigger foods like raw veggies, tomatoes, cruciferous. I also ate closer to bedtime a couple times recently. I wonder if my LES will ever truly get well.

I've been ravenous between meals -- probably because I'm just not eating enough, since I lost 1/2 lb yesterday. I'm still paranoid of the BG spikes. I'd appreciate any suggestions on number/timing of meals.

[BoulderJD]

I haven't been testing my BG as obsessively lately, but I did test after lunch today of:
- fruit-free "blended salad" of 1/2 cup almond milk, 1 tbsp ground flaxseed, 8 oz spring mix (yeah, not the tastiest concoction)
- 3/4 cup chickpeas
- small dried tomato
- really big (~18oz) yam
- 1/2 cup? brown rice

Did 100 body-weight squats and 100 toe-raises a few minutes after eating.

BG at 0:45 - 94
at 1:20 - 90


Granted, these readings are not typical; I'm usually seeing peaks in the 130s.



I've been ravenous between meals -- probably because I'm just not eating enough, since I lost 1/2 lb yesterday. I'm still paranoid of the BG spikes. I'd appreciate any suggestions on number/timing of meals.

Hi T!

I would never want to belittle anyone else's problems, real or imagined. And, although I'm not a doctor, I do have diabetes, and I watched my dad and grandmother waste away in nursing homes from diabetic complications. I just read Dr. Barnard's book on diabetes. He referenced people with fasting blood sugars of 250 plus. Mine today was 155. Yesterday after one bowl of oatmeal my sugar hit over 400 at the two hour mark. I can tell you I would kill for your numbers. You need to relax, take a deep breath and be very thankful you have the numbers you have. You do not have diabetes, only the fear of diabetes. You are truly blessed, my friend!

-John

[SactoBob]

It is good to be concerned about your health and act positively to preserve it. At some point a healthy concern becomes an unhealthy phobia. When you are concerned about healthy levels of sugar in your body with no scientific basis for that concern, I would wonder if a line has not been crossed.

A health phobia itself is a serious ailment that should be treated, and I think some of the posters here are concerned about what you may be doing to your health with this anxieties and worries. They are a serious matter.

To put it another way, sanitation is valid concern. In the case of Howard Hughes, it became a compulsion.

[TanneryGulch]

I know I'm a bit of a hypochondriac, but I also believe that the blood sugars I've seen (highest ever was 147) aren't normal and that they don't get "a little elevated" until serious damage has already been done, at which point the disease progresses in a positive-feedback loop. The stats on conversion from pre-diabetes to diabetes are dismal. I want to stomp this monster to death while it's still a baby. I'm also intellectually curious and still unsure which diet guru(s) to believe. If this "works," I believe I'll have my answer and will know exactly what to recommend to several friends and family members suffering from diabetes or related chronic diseases.

I'm no longer in a panic, as my weight is stable and the numbers seem to be trending the right way now (peak after dinner was 123), but I'll keep an eye on it over the next few weeks and post my results. I appreciate everybody's support and hope it doesn't seem like I'm trivializing others' serious health problems.

[SactoBob]

, but I also believe that the blood sugars I've seen (highest ever was 147) aren't normal and that they don't get "a little elevated" until serious damage has already been done, at which point the disease progresses in a positive-feedback loop. .

I know of only one person who even suggests that a 147 bs taken at 45 min pp is abnormal. I looked at that person's qualifications and was not impressed. Also, no data or studies were cited to support the conclusions.

As for who to believe, I don't believe anybody. I believe the evidence - and even then I am suspect because evidence can be spun. The evidence seems clear that populations who eat as Dr. McDougall suggests don't experience diabetes as an epidemic, and controlled studies show that this diet does the best at controlling blood sugars (have you read Dr. Barnard's book?) BTW, I don't believe that you are even pre-diebetic.

IMO, worrying about becoming a diabetic with your numbers is beyond hypochondria, and it sounds like the worry is interfering with your life. You really can't control whether you become ill. You can only control what you do. By eating as Dr. McDougall suggests, I believe the evidence is strong that you are doing the best thing you can do for your health. So stop worrying and enjoy your life. If you find you can't do that on your own, please look for some help. You could spend a lifetime worrying about diseases you could possibly get. The only guarantees are death and taxes.

[TanneryGulch]

I'd love to read the study if you can find it.

Lunch today was a blended salad with mustard greens, spring mix, ground flaxseed, almond milk; 2/3 cup black beans; great-big (~18 oz) sweet potato -- 6g fat, 142g+ carbs per CRON-O-Meter....

BG at 0:45 - 103
at 1:15 - 102
at 1:45 - 85

Amazing. Two weeks (or even one week) ago this would have put me in the 130s easily.

[TanneryGulch]

BG peaked @ 114 after a big, starchy meal yesterday. I'm gaining weight, which I think is good.

"But where do you get your protein?" It's amazing how hard it is to get out of your head the idea of protein as King Macronutrient, even after reading McDougall, Fuhrman, and others on the subject.

I've been reading the Rice Diet Papers and came across an interesting finding from the early 1950s: Rats fed a low-protein diet were much more sensitive to exogenous insulin than rats on a high-protein diet. This difference was counteracted when ACTH was administered to the low-protein rats. They speculated that a low-protein diet over time down-regulates the secretion of ACTH by the pituitary. Could this be part of the mechanism by which insulin resistance is reversed on a high-carb diet?

Another protein-related point occurred to me: There was a time in my life when I worked out and foolishly ate canned albacore tuna and Muscle Milk every day on top of my regular meat-heavy diet, and now I wonder if I not only planted the seeds of this insulin resistance but also damaged my kidneys (not to mention the methylmercury addling my brain!!). My creatinine was 1.2 mg/dl a year ago and dropped on ETL to 1.1 earlier this year and to 1.07 a week ago, which (based on the MDRD equation) estimates a GFR of 86 mL/min/1.73m^2. The lab reports this ">60, normal" but stuff I'm reading online claims that truly normal glomerular filtration is 90+.

I remember last year reading McDougall's newsletter where he says to limit beans/legumes and thinking that sounded nutty. How can you overeat on wonderful, nutrient-dense, protein-and-fiber-rich beans??

The Rice Diet targeted 20-25g protein out of 2400kcal; that's 3.3-4.2%! I've been eating a full 15oz can of beans every day. Along with the oatmeal, brown rice, and at least a pound of greens, that puts me in the neighborhood of 80-85g. I'm going to severely curtail (but not cut) my beans. I'll give up my beloved oatmeal when you pry it from my cold, dead (of kidney failure) hands, though!

In summary, thinking in terms of "starch-based," everything is finally making sense.

[TanneryGulch]

Update: 5th week in, blood sugars seem to have normalized! I've tested only occasionally the last few days, at peak postprandial times, but it's been days since I've seen a reading above the mid- to high-90s. I drew another fructosamine at 4 weeks but won't get the results back until next week.

I broke the diet slightly for the first time yesterday, only because an Indian co-worker had brought in a homemade chicken Biryani specifically for me to try. (I'd commented before how great his authentic Indian food smelled.) I had only one small bowl with perhaps 2 oz of really lean chicken in basmati rice, and he said he used only a tiny amount of olive oil in a big batch of the stuff. Otherwise I'm still 100% MWL with 1-1.5 lb of greens every day.

I'm still barely able to maintain my weight, despite eating what seems like a ton of food.

Reflux returned for a while but is basically gone now, even with the inclusion of a lot of raw vegetables. I still feel some direct irritation from things like raw onions and peppers. I do have a fair amount of gas, even with zero beans. Dunno, maybe that's a favorable sign?

Latest concern: The 2-week bloodwork showed elevated liver enzymes (AST=44, ALT=90). Originally I wrote it off to the fact that I'd worked out pretty hard late the night before the draw. But with the BG coming down I guess I needed something new to worry about. According to what I've read, AST is nonspecific and lots of things, even intense exercise, can elevate it. However, ALT is specific. One of the low-carb claims is that high-carb diets contribute to NAFLD.

Jeff, do you know if it's common to see liver enzymes jump when switching to this diet?

[TanneryGulch]

Update: Liver enzymes are back in the normal range, but still not what I'd call truly normal or optimal, and still with ALT prominent (AST=29, ALT=30). Previously they were both in the teens.

For a while it seemed I was getting blurry/cloudy vision after meals, but that seems to have pretty much resolved with the blood sugar spikes.

Fructosamine at 4 weeks was 248. Still way too high, but trending the right direction. It was just a few days before this blood draw that my postprandials really started looking normal, so I expect it to be much improved in another 2-3 weeks. I'm using this as an indicator of whether I've fully adjusted to the high-carb diet (i.e., where it "levels off" and how long it takes to get there), whether that makes sense or not.

I mentioned before that my blood pressure had dropped even further on this diet, to around 95/60. I checked it the other day, right after working out, and it was 108/55. From what I understand, a lowered diastolic with exercise is a very favorable sign typically seen only in highly trained athletes (which I'm definitely not!). To me that's pretty amazing and another sign that I'm on the right track with this diet.

[TanneryGulch]

After 6 weeks, fructosamine was 237. Coming down but still not great.

Liver enzymes were back up (AST=32, ALT=69). I sure wish I knew why my liver is taking damage on this diet!!

Compliance still 100% with the possible exception of one restaurant meal that may have had some cheese or oil. (The chef swore it didn't.) Eating out (I had to for work) is no fun; I even called ahead as suggested by Esselstyn and was assured that "no animal products and no oil" wasn't a problem, but when I got there they were totally unprepared. (This was a $30-40+/plate place.) I ended up with a small pile of mushroom ravioli with no sauce and some plain steamed vegetables. (If the chef was right, they did an amazing job of making mushrooms taste just like ricotta!) Anyone have advice on how to be sure of what you're eating in a restaurant?

I feel fine overall, but I've still been having blurry/cloudy vision. It's subtle but undeniable. Also, I now get an intense, sharp headache right behind my eyes when I start exercising. It resolves after a while even if I keep exercising. Worse with weight training than with cardio. Never experienced that before.

I remain cautiously optimistic.

[TanneryGulch]

After 8 weeks, fructosamine = 232 (= A1c 5.6%). I really expected it to be lower by now, and I hope this isn't where it's going to "settle." Fasting glucose in the high 70s. Liver enzymes close to normal again (AST=21, ALT=44).

Still 99% compliant. ~3 lbs of sweet potatoes; 1-1.5 lbs of raw and cooked greens and other non-starchy vegetables; 1.5 cups (dry) oatmeal; beans occasionally; brown rice and some white potatoes to fill in the gaps. No fruit except tomatoes. No nuts except 1 tbsp ground flaxseed. 4 meals/day with no snacking.

I wish I could say I felt better. Getting lots of "toxic hunger" symptoms after meals; glucometer confirms hypoglycemia (low 60s). Still seeing postprandials of 115-120. BG now seems to peak later and fall off more gradually, like you always read about "low-glycemic" carbs, whereas GI didn't seem to matter at all in my first few weeks. That's just my impression; I haven't been testing fanatically.