OK so the losing legs thing is a bit rhetorical, but what Gretchen is trying to say, I think, is that she cannot eat bread and stay in target BG range.
If you can eat bread and stay in range, then by all means, eat bread. Or cake, even.
Grain products disclosure: I only bolus for (i.e., eat) sexy bread.
I’ve heard some talk that people have cured diabetes with a raw food diet. I would be interested to hear more about the raw food diet in general and also how it can help with diabetes.
I think sometimes you have to insert mental earplugs. You are an adult and you are intelligent enough to make decisions for yourself. You can read or not read books, and you can come to conclusions based on your own experiences in your own body. What Gretchen is offering comes from her own research and her own experience in HER body – and she’s offering it as a gift to those whom it might help. If it’s not likely to help YOU, then you need to continue with what IS helping you. In diabetes, as in life in general, one size does NOT fit all!
Because there’s been so much of a brouhaha about my legs comment, I thought I should clarify.
If you’re type 1, which usually means insulin-sensitive, and taking bolus insulin, many people are able to cover their carbs with insulin, and they are OK on a higher-carb diet. Richard Bernstein and others feel it’s easier to obtain near-normal BG levels on a low-carb diet, but everyone has to decide for themselves what diet works for them and what they’re willing to give up for better BGs.
Type 2 not taking bolus insulin is different. Carby foods cause high BG spikes that require a lot of insulin to bring down because of insulin resistance. A long time ago, I suggested to a type 2 that he try a LC diet. He said, “I’d never give up bread.” OK. That was his choice. About 5 years later he had a leg amputated.
Now, it’s possible it was just bad luck and the man would have lost his leg even on a LC diet. I still have feeling in my feet with the pinprick test. But I might drop dead tomorrow from a heart attack.
There are no guarantees of anything when you have diabetes, or when you don’t, for that matter. But thinking of the man in his wheelchair keeps me motivated when a bagel is calling my name.
Eating bread doesn’t guarantee complications. But it seems to me that when I read about type 1s who are still healthy after 60 years of diabetes, they tend to say they’ve always been very strict with their diet and limited carbs.
With today’s tools, it’s easier to determine exactly how high we’re going after meals. Used to be you’d only measure premeal numbers, so you could have “perfect” BGs, maybe always 99 before meals, but you’d be going over 300 between meals, and some people think those peaks and valleys are worse than sustained slightly high BGs. Others don’t agree. This hasn’t been settled yet.
A person with IR has to inject huge amounts of insulin to bring down carb-caused peaks, and that level of insulin may cause problems too.
Hello, Gretchen, thank you for posting here…I am so glad that you are considering writing this book! I have not read the entire thread and am coming very late to the conversation…
My dilemma, not yet being on insulin and yet being still quite reactive to carbs, is that without restricting my carbs very significantly my BG rises into the 160 range 2 hrs post prandially…and I really am not pleased with that (yes, I AM going to talk to my doc about changing meds!).
As I DO restrict carbs…I often look into the fridge, look into the cupboard and ask myself what in the world there IS for me to eat. I get very tired of my “old stand-by” foods, which are very simple proteins (sliced ham and turkey, unembellished…raw green veggies with a bit of ranch dressing or 1000 island I make with low carb ketchup) etc…
I have some tried and true recipes I make for dinner…turkey chili for example…that is fantastic, but again, I get tired of it.
Also, I have interacted with a number of diabetics on line who are flummoxed by the budget issue when told to rely on so many fresh foods. I think this may be a mind set in some ways…that when we eat a healthy diet, we may actually be eating less food…so, perhaps we need to buy less and can possibly spend a bit more on the food itself. But I have no data and cannot prove that hypothesis. And I certainly understand that a single mother on a budget who has been eating what she feeds her kids (chicken nuggets, pizza, fries) feels it will be a challenge to now buy salmon, asparagus and canteloupe. But there is no arguing the whole family will be healthier and the better for it.
So, if your book could also address the issue of how to manage the purchases of foods like these…both on a budget and when one’s time is constrained. I am an empty nester…but a single working mother of two has no TIME to shop farmer’s markets (unless perhaps it becomes a fun outing for the family and the kids look forward to it every week? An idea maybe???)…
In addition, I think advice on how to get all the nutrients (I liked the initial conversation about Vitamin C and the Inuits who certainly did not have oranges).
Oh too funny…I just saw that two posts below this, Natalie brought up the issue of food costs…well, great minds think alike!
Thank you, again, for all of the great work that you do for the diabetic community.
Best Wishes,
Jan’s friend from Cincy
Anni (nickname on this board is April)
First of all I have to let you know you are my hero. Your book has carried me this last year. June 1 was my first year anniversery, and your book sits warn out and rumpled on my dining room server, filled with sticky tags and highlighter. My morning ritual for a year, (after meds and injections and pokes and prods) is to sit with your book, the Diabetes for Dummies book and coffee. Sorry about this, I am not usually a “fanboy”, but I feel like I have had coffee with you every morning for a year.
One nutrition topic about which I get confused is the value of low glycemic index carbs. My BGs react to good carbs or bad carbs the same. So I have just tried to stay away alltogether. Is there any real advantage to “good” carbs?
My second question is associated with the low carb thing. My understanding is that dietary fat doesn’t make you fat, that adipose tissue is entirely the storage of unused glucose from eating more calories of carbs than I used up in motion and body heat. But, as any nutrition lable will tell you that there are calories associated with protein and fat. Where do they go? If not to body energy via blood glucose, do they just exit the body in waste?
Lastly, my understanding is that chemists measure the calory content of food through a “bomb” calorimiter. They just burn it and see how much energy gets released. My question is how do they know that the energy measured this way is the same as the energy used by the body. I take it on faith. Do they?
Hi Anni/April,
I agree that less variety is one problem with LC. But you don’t need to eat only fresh veggies. Frozen are fine. Some people say they’re actually better because they’re often frozen on the field. When you get fresh in the winter, they’re often from Mexico and other countries where pesticide regulations are less stringent than here.
I eat a lot of nuts. Probably too many.
If you find your diet is simply too limited, try a basal insulin. I take a basal insulin and tried bolus insulin, hoping I could eat more things like bread. What I discovered was that it’s impossible to match the bolus insulin exactly with the carbs. And I also discovered I don’t really like things like bread anymore. I wondered why I ever had! So I dumped the bolus insulin. I still take a basal as it keeps my premeal numbers 20 to 30 points lower. That means the peak is also 20 to 30 points lower.
Tofu shirataki adds some variety to meals without a lot of carbs.
The year after I was Dx’d, I found I spent the same amount on food despite eating better food because I ate less of it. I think better food fills you up more because it’s tastier.
Chicken nuggets and pizza are more expensive than chicken cooked at home. Any prepared food is more expensive per pound than homemade food. And there’s no reason she can’t occasionally serve the kids fries. The biggest problem is the busy working mother who doesn’t have time for a lot of home cooking.
The Four Corners Diet book that I coauthored has a chapter on LC on a budget.
Thanks for the ideas.
Jeff, First, thanks for your comments.
Second, I think the value of “good carbs” depends on how much insulin you’re able to produce. Low-GI carbs will make BG go up more slowly, but that means it will stay up longer. Eat some glucose, and you’ll get a very high peak, but it will come down very quickly. There’s an illustration of this in the book. The area under the curve is about the same. Scientists are still arguing about whether a high peak is damaging if it comes down quickly. The effect on A1c would be the same in both cases, but some argue that high peaks cause oxidative damage.
If you can produce some insulin, but not a lot, then you might be able to produce enough to “cover” the low-GI carbs but not enough to cover the high-GI carbs. If you’re producing almost no insulin, then the GI doesn’t make as much difference except that you need to try to match the speed of the insulin with the speed of the BG rise, and it’s almost impossible to do it perfectly.
Derek Paice at dapaice.com has some graphs showing the effect of an apple on BG in several people, including a type 1, and then the same amount of apple with cheese. Click on Potpourri.
I forget if it’s Potpourri 1 or 2.
He also has copies of his booklet on BG vs food for free download.
Calories can be used or wasted. Naturally thin people probably simply convert extra calories into heat. Adipose tissue stores fat, both fat you eat in excess and fat from carbs you eat in excess. Protein that isn’t needed for building new tissue can be converted to glucose.
This blog discusses bomb calorimeters. I suspect he’ll post more on this.
I can’t say as I’ve read every post, but I’m finding this thread a bit all over the map. First of all, I think it’s important to clarify if you are gearing your book to type 2’s only or both types. Even though we both have to watch our carbs and follow similar principals the emphasis is very different for a type 1 or type 2. When you say things like “I decided to skip bolus insulin” you are obvsiously speaking to type 2’s. Things like glycemic index and white vs whole grains tend to be more significant for type 2’s. Type 1’s face other quandries such as decisions about the advantages of eating low carb vs the more inclusive “eating what I want and bolusing for it” . That is not the simple decision that type 2’s might think.
Secondly I think you need to determine what level of knowledge you are aiming to. I think your “First year” was obviously aimed at newly diagnosed people. Will this book be the same? If it is aimed at people like those on TuD who already have significant knowledge of nutrition and diabetes I think it would need to be cowritten by people with letters after their name to appeal as “nutritional expertise”.
The book will be aimed at everyone on a diet, or considering going on one.
This book will be at a slightly higher level than the T2 book. Richard Feinman will be a coauthor. He teaches biochemistry, including nutritional biochemistry.
I asked someone, possibly Dr. Eades, whether naturally thin people excrete calories unused, and he said he thought that they do. While analyzing poo is not the most glamorous job in the world, I would really be interested in a definitive answer to that question, just because I’m curious, LOL!!
Thanks for explaining, Gretchen. Sounds like you have a great coauthor! Not sure, though what you mean be “everyone on a diet or considering going on one” “Diet” as in weight loss, or “diet” as in a planned method of eating to control blood sugar? Isn’t that all diabetics?
I still think type 1 and type 2 needs are very different. Whenever we compare types it seems to get bogged down in “who has it harder”, etc, but there definitely ARE differences in our needs, responses and approaches regarding diet. I’m not sure how a book could be “all things to all people” and contain meaningful information for each, unless it were clearly broken down into Type 1 and Type 2 sections. For example, as a Type 1, my nutritional interests bear most significantly on the relationship between insulin use and carbs. If I was standing in a bookstore considering spending $25.95 on a book on “diabetes nutrition” I would want the majority of the book to cover those issues. A type 2 would probably stand there and say, “way too much material on insulin dosing”. Just my opinion. I’ll be quiet now.
You are TOO funny, Natalie! I guess I’d like to know, too!!!
The Da Vinci syrups are wonderful…love them and their ilk! But, I can live without Boston Cream Pie!
Gretchen…thanks for responding.
I especially appreciate your perspective on basal insulin, as I am just about to have that conversation with my Doc in a few days. AND, honestly, though the big Pharma’s keep trying to come up with oral answers to DM issues…frankly, I’m NOT afraid of needles and insulin is the MOST natural thing in the world. Our bodies produce it!
I’m actually much more averse to the fact that I am on a “DPP-4 Inhibitor!” What exactly does the DPP-4 in my body do? What does inhibitiing it do? Do i WANT to inhibit it - even if it produces a bit more insulin in the short term? What are the long term effects of inhibiting DPP-4?
And, yes, I am aware of the issues raised by the trials with immune function problems. Likely I won’t run into those…BUT, you never know.
Insulin is…well…SAFE! So long as we test and make sure we don’t go way low! But, heck, I’ve been around insuline dependent diabetics my entire life, between my father, a friend in grade school and now my best friend the past 17 yrs. I know the drill. Keep the glucose tablets in every room of the house, including the bathroom, in pockets of every housecoat, in every purse, the car, all nooks and crannies etc…
And I know the signs of a hypoglycemic episode…
Sorry if I sound blase, but perhaps I am … blase. And perhaps I should not be. I do take hypos very seriously because I have seen what they can do. My dad almost died…when he was robbed when suffering a low and the thief left him for dead…I KNOW very well the dangers of lows…
But we won’t dwell on that here.
THANK you again for all you do for the diabetic population, Gretchen…
I’ll have to look into the Tofu…
Please do let me know if you ever visit Jan again…I shall be looking for your book…
Best Wishes,
Anni
Huh?
Anni, DPP-4 breaks down GLP-1. Byetta is similar to GLP-1. When you inhibit DPP-4, your endogenous GLP-1 lasts longer.
The problem is, DPP-4 also affects other enzymes in the body, including some involved with the immune system, and some people taking DPP inhibitors get more infections. I’d rather take Byetta or similar drugs.
Don’t you mean ‘a type 2 not on insulin’?
Surely a Type 2 on insulin would also find material on insulin use and carbs as useful as a Type 1 would.
The other thing is the DPP-4’s don’t give you much bang for your buck. You can expect .5% reduction in A1c on a med that has no generic.