some protein really does get converted to glucose. it first gets rid of its amino-group and then it enters gluconeogenesis which results in formation of glucose-6-phosphate which is then converted into glucose. the ATP is "hidden" in the "phosphate" part of glucose-6-phosphate because there is what is called a macroergic bond (the bond really does not exist but the term is used for biochemical simplification :-)).
If you don't believe, try eating A LOT of protein with no bolus at all. You'll see your BG gradually rising after 4 hours or so....
Ilana, I have been following Bernstein's approach for a year now though I have known about it for several years. When I finally decided to stop ignoring the fact that I have diabetes, I immediately started the Bernstein approach. Just on the face of it, the simple logic is hard to deny: diabetes is, simply put, an inability of the body to handle glucose, the obvious solution then is to stay away from the stuff.
Bernstein's philosophy is that "Diabetics are entitled to the same blood glucose levels as non-diabetics". Not only is it a realistic approach for Type 1s, I would say it's crucial for anyone that wants to find a high quality of life as a diabetic. Doctors often worry about A1cs in the non-diabetic range, they will usually warn about possible low blood sugars. If a doc ever mentions this, keep in mind that in the world we live in most people have a notion of what diabetes "is" and while that notion may often include blindness, kidney failure and amputated limbs, it rarely includes death from hypoglycemia. Therefore, doctors tend to get nervous if a patient is going low, a death from hypoglycemia is far more likely to result in a lawsuit than a hyperglycemic complication is. That's why the 'official' A1C recommendations are always so much higher than non-diabetic A1Cs.
Fortunately, most body tissues don't actually require that much glucose, if any. They are perfectly capable of running on ketones (fat) as well. If you try Bernstein's diet for a while you will most likely find that you are far more tolerant to lows, it gives me a great peace of mind. So, if you are eating Bernstein's diet or a similar one, you can probably take the low bloodsugar warnings with a grain of salt.
It happens by gluconeogenesis. Your body can convert excess amino acids from protein to glucose. That glucose can then undergo any of the normal processes. I've seen several attempts to estimate the amount that converts, but I think it has a lot to do with how much of the protein your body needs for growth, repair and maintenance.
I've never done Dr B, but did cut carbs to about 50-60 g/day for about two months. I found that I could run my usual (7-8 miles), but not as often. Before low carb I could do that 3 days in a row no problem. After, I could do it once and a shorter run on the second day. Longer runs were mostly out of the question though I think I did manage one 10 miler. But that comes with the caveats that:
* I was not officially Dr B and probably needed to be to more efficiently use low carb sources
* I am irregular with carb supplementation during runs except when low, I'm just not used to it and often forget even when I plan to
* I wasn't very patient and things might have improved with time
I'd say that it depends on what the goals are, but I would not make the transition at a point where training is important. It probably needs tweaking to find out what works best for a specific individual. Personally, I've gone up to 120-150g/day with lots of protein and can do what I could on twice that many cho before. For now, that is my happy medium for how much I'm running, but would probably need to change if I trained harder.
I have not followed Bernstein's plan, and my A1cs are under 6. In fact, I've been a member of "the 5 club" (A1cs 5.9 and under) for over 1 year. People who were in the "tight control" group in the Diabetes Complications and Control Trial (DCCT for short) experienced up to 300% more severe hypoglycemic incidences than those who were not following the tight control. That is the source of your doctor's satisfaction with an A1c of 6 and his warning to not go lower.
I can attest to the fact that though I am quite happy with my tightly controlled bgs, I have frequent lows, sometimes up to 4-5 a week, sometimes 2-3 a day. Just to clarify: I take very little insulin, with no dose greater than 5 units at any one time -- even for my long-acting insulin -- so in that respect, it could be said I follow Bernstein's "law of small numbers".
Does this mean you should not try Bernstein's plan? No, it does not. I would encourage you to look at your insulin doses, your exercise regimen, and your diet plan in conjunction with your blood sugar readings. Are you taking large (according to Bernstein, more than 7 units) doses of insulin? Do you have frequent lows already? Do you exercise regularly and how does it impact your bgs? Have you honestly .examined your diet, weighing and measuring your foods, writing down the amounts (and types) of carbohydrates, proteins, and fats you've consumed? I ask like that because when I was having problems a couple of years ago, I had not been honest with myself about my diet; I was eating far fewer calories than I believed I was and was eating more carbohydrates than I thought I was. I'd been kidding myself for a long while and at that time, I needed a wake-up call. After you've gathered a couple of weeks of data, I would encourage you to examine your records carefully, decide which areas need some changes, and then discuss those changes with your doctor. To me, it sounds like you're doing everything well, and while Bernstein would argue you need to do better, you have to do what's right for you.
And that is the reason why Inuit (Eskimos) who historically lived on a diet consisting entirely of meat (seal, walrus, polar bear, whale, etc.) and fish, were healthy and active and slender.
Of course, they ate the entire animal, including innards, like brain, liver, kidney, marrow, cartilage, stomach, etc. and we tend to only eat muscle meats, so we need to get a lot of our nutrition from fruits and vegetables, but the concept still holds.
I tried this diet for about six months, and got my A1c down to 6.0. Then I got a life. Now I cycle thousands and thousands of miles a year (a few in Tour de Cure and Ride to Cure - 100 at a time!) and gobble carbs when I exercise. And eat heartily when I'm off the bicycle. Current A1c is 6.4. My resting heart rate is 45 BPM. I kick ■■■.
IMHO this diet is akin to the starvation approach of the early 20th century. You can't climb a mountain, kayak a river, ski a powder bowl, run a 10k, cut a pile of firewood, mow a giant lawn, help a friend move, etc etc if you are on this wimpy diet.
Does weightlifting count as intense? I regularly do intense exercise and have not had a problem with energy or performance. But I am old and I am not competing. I also don't go low during intense exercise, I go high, over 200. If I do steady state aerobics I can drive a low, but not being on insulin, my body counterregulates. I used to regularly do aerobicswith an hour on the elliptical for an hour on Bernstein, no problem.
OMG. I don't have time for that. I have a job and a family (and tudiabets). I try to keep my exercise very time efficient. I'm sorry you felt starved. I actually felt free on a low carb diet, never having to count calories. I went like two months totally pigging out, eating like 5,000 calories a day and didn't gain weight. And I love me some barbeque.
Implying that people who choose a certain way don't have a life is quite insulting & condescending.
There are people, who either through disinterest or physical limitation, don't climb mountains, kayak a river & the other physical feats of prowess you lay claim to.
My current A1c is 5.2. I have a great lipid profile & perfect BP. While I don't keep track of miles I've biked, miles I've hiked, lawns I've mowed & firewood I've hauled (not that anyone would be remotely interested in anything so mundane), I have energy to spare.
I don't climb mountains any more (I did climb Mt. Lassen and Cinder Cone!), and I did kayak once, but I really don't have any desire to be a super-athlete, so the way I eat works for me. Even non-diabetic high-intensity/endurance athletes eat differently from other folk -- they need more calories and protein because they're burning them up rapidly.
So it makes sense to eat for your own lifestyle -- and what works for one may not be the right thing for another. YMMV -- Your Mileage May Vary (an abbreviation used on another list that dates from the early 90's).
I think you can run a 10K on like a 15-20 G of carbs. I don't eat after lunch the day before races either and have done ok, no passing out, hypos, etc. I don't usually eat more than 12G bread. I have no interest in a huge pasta feed if I'm gonna be running a lot.
I like biking a lot when it gets hot out, although I agree w/ BSC it's more time consuming. It is certainly a lot handier than running since you can lug carbs with you but I don't hit much more than 15-30G of carbs (Gatorade powder) for about 40 miles AVG 17 mph or so? Your bike looks faster though, as I don't have drop bars?
I do work out a lot, these days... I still have tons of energy... even more energy than when I did BMX biking and cycling as a kid. Haven't flopped yet. lol
Thanks everyone for your advice. From what I've read, I am not too concerned about the safety of the diet. My main question is whether someone with type 1, not producing any insulin, can achieve the numbers Bernstein recommends (BG around 90 and A1c<5).
I've been trying to eat significantly less carbs, and while I've notice huge improvements in the sense that I am not bouncing up and down anymore, my mean BG is still well above 100. I do think (at least hope) that my A1c's may have gone down a bit.... but is an A1c<5 a realistic goal for someone like me? I know my doctor doesn't think so.
I read the testimonials in his book and while it's clear that all diabetics seem to do better on low carb, I still can't tell if type 1s are able to achieve the target numbers he suggests.
Well, Bernstein himself is a Type 1, and he says he has achieved it. And he says that his Type 1 patients who religiously follow his diet achieve it. I'm sure it takes a lot of self-discipline, and that's why I don't follow it to the letter, but I do think he has a point. He trained as an engineer before he became a doctor, and he is certainly very rigorous about his method.
If you decide to try it, you will need to be very careful and test a lot, because you don't have anyone to really guide you. Bernstein spends hours and even days with his patients to be sure they have it right, and you don't have access to that.
Only one way to find out:) In addition to diet, of course, it's tweaking of doses & timing. Wonderful you've seen improvement. We're all "someone like you." Hope you won't let your doctor discourage you. I mentioned earlier that I believe I'd be below 5 if I didn't have gastroparesis to contend with. My between meals & morning fasting are spot on, so at least I've got basal correct. If I could only know when my stomach decides to empty.
Cardiovascular exercise exceeding 90 minutes requires intake of carbs and water. 16-24 oz water per hour, and about 45 grams carbs every hour. If you lack conditioning reduce your basal a lot - on a pump go down 50%. Less if you are in reasonable shape. Eat a mix of carbs and protein immediately after you stop. Bolus at about 1/2 your normal rate. Do not stop insulin intake.
This plan is proven. It's not something I dreamed up - it's developed by medical professionals for diabetic athletes. I can cycle through the mountains of Colorado for 10 to 12 hours on this plan.
I do! I have been running like 2 or 3 every week for a couple of months since bicycling season ended for me (I don't ride <30....). I usually take around 55 min or so, not world record or anything but I think I am in ok shape, although my resting heart rate is only 52!, I stretch it out to 9 miles on the weekends as I'm gonna do a 1/2 marathon in April. I am way ahead of where I need to be for that but I like to run so that's ok. I want to run a full marathon next fall, we'll see how that goes?
For a 10K, I want to be around 100B and have a glass of V8 w/o any insulin, about 12-15G of carbs before I start and maybe 1/2 a bag of jelly beans 1/2 way through or about 10G of carbs most of the time. I lug about 60G with me, just in case but I also am trying to keep my basal a shade higher, around 60% as that seems to produce a nice smooth finish BG wise and post race 'curve'? I just bolus normally afterwards too and usually my BG will sort of crash out within a couple of hours but I'd rather have that than a spike as I figure I would blow my 5.4 A1C if I'm running up to 150 all the time?
I've read about the 45G of carbs/ hour too but I don't think that you actually need that much (cf. Galloway's book of running, he also advocates blowing off the 'pasta feed' before races, except for the social aspects of it...). I also always hit some protein afterwards but I like to run a bit leaner on the carbs, again b/c my BG seems to spike if I eat a lot while I'm running. I have been at 'serious' running (haha, from the times, I'm not that serious!) for about 3 years now and have pretty much stuck with it and trialed and errored a bunch of stuff. I don't agree that 30G of carbs perhaps adding in the 'fuel' as needed but I will admit that I'm not sure if that's because I am attuned to eating more? It doesn't appear that I will find out any time soon though?
lol, this is why I had a hard time answering the question, because everyone has different preferences as far as exercise goes. I consider weightlifting to be intense. I don't do much, so I can't really add much other than to say that I usually also rise. But, on the other hand, I also find circuit training to be intense but will normally drop slightly but it doesn't require much adjustment to basal like running does.
That's a very interesting question from which, unfortunately, medical science seems to shy away from? I know there are some doctors who would suggest that may not be 'kick ■■■' however I wouldn't say it's definitively 'bad' either b/c of the dearth of studies of people who are in the 5s all the time? Or are there such studies?
