I think it’s interesting that this discussion has gone on for so long without exactly defining what a “low carb diet” is, so that if one were “shopping”, it would be sort of hard to say exactly what on would want to shop for? I’ve gotten ok results cutting out carbs here and there from what I eat but haven’t bothered “aiming” at a particular number of carbs, like ever. I am also sort of unwilling to say it’s more than a tactic and will still occasionally eat cookies, cupcakes and other goodies that cross my path. And it seems to do ok A1C wise, average BG wise, std deviationwise and, seemingly most of the other numbers I’ve run across?
I think this is stated verey succintly and very elegantly Zoe. It's not jus the 140 threshold, it's time spent at high BGs.
I think it's worth pointing out, again, that none of the studies cited for saying that the threshold for damage is at a BG of 140 actually say that. None of them were even designed to find out what the actual threshold is.
What the studies did was seperate subjects into groups according to their results on the Oral Glucose Tolerance Test using ADA guidlines. ADA guidelines say that anybody who is 140 or above two hours post challenge is considered to have Impaired Glucose Tolerance. What the studies show, conclusively, is that the groups with Impaired Glucose Tolerance had a higher incidence of diebetes related complications.
I don't think those results suprise anybody, but they somehow were interpreted to mean that "the threshold for damage is 140".
The real question I have not been able to answer is why did the ADA pick 140 as their threshold for IGT?
Agreed Maury. For me, an A1C number without a SD to go with it is pretty meaningless anyway.
I keep hearing people talk about Standard Deviation, but I have to admit I really don't know what it means! Is it an average? Where do you get this number?
I don't know that it's really possible to define with one number. I eat around 30 carbs a day (works for me), but I think that's the lower end of the low carb scale. I found this from a study (not about D)
... in 1973, the average daily carbohydrate consumption in America was 400 grams. Nearly three decades later, the average carbs consumed each day jumped to 500 grams. (here).
So, if 500 (!) is average where do we start saying carb consumption is low?
Standard Deviation is basically the variability between numbers. Goal for BG is a small SD, meaning not large swings between readings. Want the equation?
Never realized when I took Stats in college that I'd ever need SD in real life.
There probably isn't an actual threshold for damage in the sense that anything below X is safe. Our bodies don't operate normally and that increases wear and tear on our organs even with the best control. Some of us have better genes than others and can withstand that damage more easily. Some of us are not so lucky. The search for a magic number is just that - magical thinking.
Maurie
What Gerri said ;) Both my Ping and Dexcom give SD in their charts, usually within about 2 points of each other. I don't know if what they're giving is a real statistical SD or a range from the median BG, but whichever... it's useful!
I couldn't tell you why they picked 140 as the threshold, but I can give some anecdotal conjecture! I don't know how everyone else was when they first found out they had diabetes, but one thing I did was make the people I see most test their BG. It was kind of a novel thing for some of them too. I noticed that no matter when I tested them, even if they had just eaten not too long before, I never saw a number above 120. In one case it was my father (non-D) who had about 20 minutes earlier finished a sandwich and chips (crisps, not fries just to be clear for those in the UK ;-) ) followed by a bowl of ice cream, whipped cream and all. I think that time his BG was 108. That particular one just sticks out to me because I thought for sure he'd be 130+.
I'm guessing there's some research that shows around 140 is also the level for IGT, which would make sense to me considering what I found from my limited testing of others. At least I hope there's something backing it and it wasn't just drawn from a hat!
Yeah, I think it' a worthy goal to keep your BGs below 140 at all times but, from the available reseach, the target to reall shoot for, as the American College of Endocrinologists say, is a 2 to 3 hour postmeal below 140.
Looking at the research, I was surprised to see how much variability exists in normal people when it comes to peak BGs after an OGTT. What they all have in common, however, are levels that return to normal, usually below 100, by 3 hours postmeal. Most are normal at two hours.
Here's an interesting symposium on normal bg as measured with CGMs with a lot on the importance of postmeal BGs:
http://www.diabetes-symposium.org/index.php?menu=view&id=322
There's a lot here, but it's really fascinating stuff. You can skip through the slides and each one has it's own narration.
I think I wrote what I buy and eat as a low carber. In a nutshell I eat any and all veggies, eggs, chicken, fish and lean meat, nuts, seeds and cheese. I bake my own bread using almond flour and all my baked goods (cookies, crackers, cupcakes and cakes etc. with nut flours, coconut flour.) It sounds like a lot of work but it really isn't. I work full time so the preparation has to fit into my schedule.
I don't aim at a particular number but with the things I eat I am usually in a certain range. That said, I like what I eat a lot. If I didn't I wouldn't do it. I've kind of lost my taste for the other stuff I used to eat. So for now this is working for me and I will keep doing it. But like anything else in life, it's fluctuant. In other words I'll go with the flow!
I think that, in terms of marketing, “low carbism” comes across a bit like a “cult” as almost everyone advocating it in threads here says “I eat 30G of carbs/day” although I seem to do ok BG-wise and to have lost weight and have decent cholesterol results w/ 3x-4x that many carbs although perhaps I am in a bit of a cult myself “cheating” by exercising a lot? I read Gary Taubes’ two books and he citered one scientist “setting the bar” around 75, which is quite a bit higher than 30G.
It's a good thing you don't have any nut allergies! I'm just wondering how does the expense of nut flour compare with the wheat flour and does it taste different enough to notice?
I hear what you're saying about it being cultish; I think that's because Bernstein's 'number' is 30 carbs. So if someone is 'doing' Bernstein, 30 carbs=low carb. Personally though, I think that's just (as I said above) the bottom of the low carb scale. I just don't know that there's a rule for what the top end is.
Based on 500 carbs being the average American carb consumption per day, there's lots of wiggle room for what I'd call low. I guess IRL it's anything significantly lower than what one ate before 'going LC'? Individual, as is everything with D.
I also use nut flours (almond & coconut). Much more expensive than wheat flour, though you can make almond flour with a food processor. Of course, there's no gluten in nut flours so they behave differently in baking. Extra eggs & other leavening is needed. Coconut absorbs a lot of liquid so extra is needed. Nut flours are heavier & richer tasting-a big difference in flavor. A combo of almond & coconut works great. For things like cookies, muffins, cake, pancakes, waffles, I think the flavor is superior to wheat flour. Very difficult to make bread because of lack of gluten. You can add small amounts of vital wheat gluten, which is high protein & relatively low carb.
In regards to the issue of what constitutes low carb I am influence a lot by Dr. Steve Phinney. He says that your metabolism changes when you go below 70 grams in that fat becomes your body's preferred fuel. He terms this state being ketoadapted. Here's a link to a discussion at the Bernstein group that has links to a couple of interviews with Phinney. He is a published scientist so his concepts carry extra weight with me.
I'm somewhat puzzled that you think of the low carbers around here as cultish. I guess it's because Bernstein's name comes up so often when folks ask for advice about how to improve their numbers. I seldom fail to mention his book when a new T2 asks for advice, so I guess I'm guilty as charged. I have also noticed that many who have been influenced by his ideas, including myself, do not adhere slavishly to the 30 gram rule. The concept that carbs are the problem and restriction is the solution is the key concept IMHO. Since this runs counter to the advice most have been given by the ADA or their health care professionals, perhaps this does make us a cult in the eyes of some.
The first time I remember interacting with you, acidrock, was in an epic flame war concerning low carb. We were on different sides and it got ugly. I think the culture here at tuD has evolved considerably since then, most post's seem to be along the lines of, this is what works for me in case you find it useful, not my way is the only way. Respect for each others choices is the most important value. Since our individual carb consumption is at the heart of what we do to deal with our condition, of course an individuals choice along these lines be it 30 or 300 needs to be included in many posts, to put them in context. I must admit I don't understand when someone feels threatened by the fact that a person is consuming 30 grams/day and is happy with their control. This is useful information and readers are free to make use of it or not.
Agreed. Your assertions at the end there make sense. There's no reason to feel threatened by someone on either end of the spectrum.
The info you provided by Dr. Phinney is good information to have. The fact that my body may change at <70 carbs/day to use fat instead is an incentive to me. Might clear up those "problem" areas, but then I wonder where I'd inject! What seems key here is that people are presented with the information, or sources to get the information they need to make a decision about what will best the them manage their diabetes. Yes, we all have the same condition, but it's also unique to each of us. Kinda like cars on the highway traveling north. Sure, they're all going north, but some are going faster, and there's a myriad of different cars on the road.
Plus a couple in the ditch.
I remember that! That flamewar prompteted me to try eating less carbs for a week I had off. It was January, but mild, and I had a really good running week, 86ed toast w/ eggs and ate nuts instead and felt fine running, which leads me to be very skeptical of the “you need tons of carbs to work out” theory. I’m still friends w/ LizMarie on FB so I must not have been entirely horrible!
I want to know where “the line” is for general purposes? There’s like 6 beers or a couple of margaritas or some potato chips in between 30 and 75 carbs. This week, I’m visiting my in-laws so I’m dealing with my mother-in-law saying “oh no, you are too skinny” and throwing food at me so I’m arguing the other side w/ her.
It's always useful to remember that we've all spent time in the ditch:)