The Difference Between Reversal and Remission of Type 2 Diabetes

Some speak of having “reversed” Type 2 Diabetes (T2D) as a result of dietary changes whereas others refer to having achieved “remission“. What is the difference and why is the distinction important?

What is meant by Type 2 Diabetes “reversal”

Reversal” of a disease implies that whatever was causing it is now gone and is synonymous with using the term “cured”.  In the case of someone with Type 2 Diabetes, reversal would mean that the person can now eat a standard diet and still maintain normal blood sugar levels. But does that actually occur? Or are blood sugar levels normal only while eating a diet that is appropriate for someone who is Diabetic, such as a low carbohydrate or ketogenic diet, or while taking medications such as Metformin?

If blood sugar is only normal while eating a therapeutic diet or taking medication then this is not reversal of the disease process, but remission of symptoms.

We do see Type 2 Diabetes reversal in a majority of T2D patients who have undergone a specific kind of gastric bypass surgery called Roux-en-Y; with 85% having achieving normal blood sugar levels within weeks of having the surgery, without taking any blood sugar lowering medications or following any special diet[1]. The mechanism that is thought to make Type 2 Diabetes reversal possible with this type of surgery are (a) that the operation results in more of the incretin hormone GIP being released in the upper part of the gut (duodemum, proximal jejunum) which results in less insulin resistance [2,3] or (b) that the presence of food in lower gut (terminal ilium, colon) stimulates the lower incretin hormone GLP-1, which results in more insulin being secreted [3], which lowers blood sugar levels.

Is Type 2 Diabetes “reversal” possible with diet alone?

One matter that needs to be overcome is that both the mass and function of the β-cells of the pancreas that produce insulin are thought to be reduced by 50% by the time someone is diagnosed with Type 2 Diabetes [5]. Furthermore, the β-cells are thought to continue to deteriorate the longer a person has Type 2 Diabetes.

It is currently believed that T2D may be reversible by non-surgical intervention if diagnosed very early on in the progression of the disease, but it is unknown for how long or at what stage it becomes irreversible [6].

What is meant by Type 2 Diabetes “remission”

There is evidence that indicates that weight loss of ~15 kg (33 pounds) can result in remission of Type 2 Diabetes symptoms and that β-cell function can be restored  to some degree either by (a) dormant β-cells being reactivated through a variety of means or (b) by existing β-cells functioning better [6].

Type 2 Diabetes “reversal” defined

In 2009, the American Diabetes Association defined Type 2 Diabetes partial remission and complete remission as follows;

Remission is defined as being able to maintain blood sugar below the Diabetic range without currently taking medications to lower blood sugar and remission can classified as either partial or complete.

Partial remission is having blood sugar that does not meet the classification for Type 2 Diabetes; i.e. either HbA1C < 6.5% and/or fasting blood glucose 5.5 – 6.9 mmol/l (100–125 mg/dl) for at least 1 year while not taking any medications to lower blood glucose.

Complete remission is a return to normal glucose values i.e. HbA1C <6.0%, and/or fasting blood glucose < 5.6 mmol/L (100 mg/dl) for at least 1 year while not taking any medications to lower blood glucose.

Remission can be achieved after bariatric surgery such as the Roux-en-Y procedure outlined above or with dietary and lifestyle changes such as a low-carbohydrate or ketogenic diet, weight loss and exercise.

According the American Diabetes Association, people who are able to achieve normal blood sugar through diet, weight loss and exercise but also take blood sugar lowering medication such as Metformin do not meet the criteria for either partial remission or complete remission.*

Those who have achieved normal blood sugar levels as a result of following a low-carbohydrate or ketogenic diet and are also taking the medication Metformin are sometimes referred to in published studies as having “reversed” their Type 2 Diabetes.  I think this is problematic because clearly if these people go back to eating a standard diet again, their blood sugar would not remain normal. As well, in some well-designed ketogenic diet studies subjects are allowed to use Metformin but no other blood sugar-reducing medication, but based on the American Diabetes Association definition the use of Metformin which helps regulate blood sugar (largely via reducing gluconeogenesis of the liver and making the muscles less insulin resistant) precludes these cases from being referred to as either partial remission or complete remission*.

Don’t get me wrong; having normal blood sugar (and insulin) levels as the result of a well-designed low carbohydrate or ketogenic diet and the use of Metformin enables people to reap significant health benefits and lower their risk of the chronic diseases related to hyperglycemia (high blood sugar) and hyperinsulinemia (high circulating levels of insulin) but it’s normal glycemic control  achieved through diet with or without the use of Metformin. Perhaps a term such as “partial remission with Metformin support” would be a more accurate descriptor.

Some final thoughts…

I think it’s important what terms we use.

There are genuine cases of Type 2 Diabetes “reversal” and we should use that term for those who can now eat a standard diet and maintain normal blood sugar levels, without the use of any medication or diet.

There are also genuine cases of “partial remission” or “complete remission” according to the American Diabetes Association definition that are a result of dietary and lifestyle changes and these terms should be reserved for cases where the defined criteria is met.

There are also genuine cases of “partial remission with Metformin support” that have been achieved as the result of people implementing dietary and lifestyle changes plus the use of Metformin that should be acknowledged and celebrated, but calling these either “Type 2 Diabetes reversal” or “Type 2 Diabetes remission” is confusing, at best.

Yes, Type 2 Diabetes a) reversal, b) partial remission and complete remission as well as c) partial remission with Metformin support are all possible. It may well be that people such as myself who had been Type 2 Diabetic for many, many years can eventually transition to genuine partial remission with eventual discontinuation of Metformin. That is my hope, at any rate!  The bottom line is that maintaining normal blood glucose levels and normal circulating levels of insulin is necessary in order to put the symptoms of Type 2 Diabetes into remission, as well as to reduce the risks to the chronic diseases associated with high blood sugar and insulin levels — and for that there are well-designed dietary and lifestyle changes. This is where I can help.

If you have Type 2 Diabetes or have been diagnosed as being pre-diabetic (which is the final stage before a diagnosis, not a “warning sign” — more about that here) and would like to work toward putting your symptoms into remission, then please send me a note using the Contact Me form above to find out more about how I can help.

I offer both in-person and Distance Consultation services (via Skype or long distance phone) and would be glad to help you get started as well as support you as you achieve your health and weight loss goals.

To yours and my good health!

Joy

You can follow me at:

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Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Xiong, S. W., Cao, J., Liu, X. M., Deng, X. M., Liu, Z., & Zhang, F. T. (2015). Effect of Modified Roux-en-Y Gastric Bypass Surgery on GLP-1, GIP in Patients with Type 2 Diabetes Mellitus. Gastroenterology research and practice2015, 625196.
  2. Schauer P. R., Kashyap S. R., Wolski K., et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. The New England Journal of Medicine2012;366(17):1567–1576
  3. Lee W. J., Chong K., Ser K. H., et al. Gastric bypass vs sleeve gastrectomy for type 2 diabetes mellitus: a randomized controlled trial. Archives of Surgery2011;146(2):143–148.
  4. Laferrère B., Heshka S., Wang K., et al. Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care2007;30(7):1709–1716
  5. Taylor R. Banting Memorial lecture 2012: reversing the twin cycles of type 2 diabetes. Diabet Med. 2013;30:267-275
  6. Watson J., Can Diet Reverse Type 2 Diabetes? December 12, 2018 https://www.medscape.com/viewarticles/905409_print

Where the Last Twenty-Five Pounds of Weight Came From

When I set out on my “journey” on March 5, 2017 I didn’t have a particular weight loss goal in mind.  I just knew that I was metabolically unwell and very overweight and that something needed to change (you can read a summary of that story here)!  For years, I’d look in the mirror and long to see someone that looked like “me” looking back.

Over the first year since adopting a low carbohydrate and then a ketogenic therapeutic diet (March 2017-March 2018) I lost 32 pounds, put my Type 2 Diabetes into remission and significantly improved my blood pressure, but I didn’t reached the goal of getting my waist to height ratio (i.e. waist circumference half my height) so I knew I wasn’t “done” yet.

Since last December, I’ve lost 25 pounds (45 pounds in total) and today while cleaning a shelf over my desk, I found a piece of paper on which I had been keeping track of my body measurements since June 2017, including those taken from this time last year.  That’s when I decided to see where on my body these last 25 pounds came from.

Of course, where my body took the weight from is specific to me, but for those reading this who are ‘women of a certain age’ or the friend of one, you might find this encouraging.  It was a physician who teaches a low carbohydrate approach to her patients who suggested two summers ago that I take my measurements periodically to see where I am losing fat from and suggested measuring at my umbilicus*, chest (under my bust-line), neck, bicep and thigh. And so I have.

*umbilicus isn't the same as "waist".  Waist is measured in a particular location explained in this article and umbilicus is the region where one's "belly button" is.
taken November 2017

Since December of last year, I lost 6.5 inches off my umbilicus region. That’s pretty cool and yes, it shows as I recently had to punch 4 holes in my belt which I hadn’t worn since then. I’ve lost an additional 1 inch off my chest and 1 inch more off my neck (that shows too), 1.5 inches off my bicep (while adding muscle!) and here’s where it’s crazy; I lost 4 inches off my thighs — also while gaining muscle. In the first year I had only lost a total of a 1/2 an inch off my thighs, as can be seen here.

taken November 2018

When I look at these measurements over the last year and a half (from June 2017 until now), it is very encouraging.  I’ve lost 9 inches off my umbilicus region, 2 inches off my chest (below my bust-line), a whopping 4 inches off my neck, 2.5 inches off my bicep while gaining muscle, and 4.5 inches off my thighs also while gaining muscle.

It’s my opinion that weight loss, like improved metabolic health is best done gradually but consistently.  I don’t promote “rapid weight loss” even though a low carbohydrate or ketogenic diet is often promoted that way in the media.  I also don’t believe that a ketogenic diet is necessary for all people, or even for most people. In fact, those who do not have significant metabolic health issues often do just great on a low carb diet, so my view is why limit good whole-foods that happen to contain carbohydrates if it is not needed to improve metabolic outcomes?  In the four and a half years that I have been teaching this lifestyle, I have only had a handful of clients who were metabolically unwell enough for a long period of time that needed to keep lowering their carbohydrate intake down, some to a ketogenic level. Necessarily, each is being overseen by their own doctors — especially when it comes to monitoring (and adjusting the dosage of) their medications.

I approached my health as if I were my own ‘client’, so I didn’t start off at a ketogenic level of intake. I started “low carb” and only lowered the level of my carbohydrate intake gradually and only as much as necessary to achieve the metabolic improvements necessary.  Since I had been overweight for 25 years and was diagnosed as Type 2 Diabetic 10 years earlier, I ended up needing to lower my carbohydrate intake to a ketogenic level but did so under the supervision of my doctor and with the oversight of my endocrinologist.

Whether you have a few pounds or like I did — many to lose or want to put one or more metabolic conditions such as high blood pressure, blood sugar or cholesterol into remission, you may want to find out more about how a low-carbohydrate approach can help, and why.

Feel free to send me a note using the Contact Me form above and I will reply as soon as I’m able.

To our good health!

Joy

You can follow me at:

       https://twitter.com/lchfRD

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Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Twenty One Months – a major goal achieved

From the beginning of my ‘journey’, I’ve said that I had no specific “ideal weight” in mind — that my goal was to reach a body weight where my waist circumference was half my height; whatever weight that was.  This week, I reached that goal; 21 months from when I began.

This story began March 7, 2017.  I was sitting at my office desk and didn’t feel well.  I dug out my blood pressure machine (sphygmomanometer) which I had not used in ~ 2 years and took my blood pressure.  The reading defied comprehension. I rested a bit and took it again.  It was nominally lower, but still in the “hypertensive emergency” category.  A hypertensive emergency  is where the top number (systolic pressure) is at or over 180 millimeters of mercury (mm Hg) and the bottom number (diastolic pressure) is at or above 120 mm Hg, or higher. Mine systolic pressure was significantly higher than 180 mm Hg! I was seriously concerned that I could have a stroke! I was scared.  Then I went to dig out my glycometer to measure my blood sugar.

Hint: it is never a good thing when someone with Type 2 Diabetes does not know where their sphygmomanometer or glycometer are!

I should have known where my glycometer and sphygmomanometer were and should have been using them regularly, but I was in denial. After all, I was eating “properly”; lots of fruit and vegetables, whole grain bread and rice and while I was overweight, my weight had been stable for a long time. Okay, I was obese, but was consistently fat.  Like I said, I was in denial!

My blood sugar after lunch was 13.0 mmol/L (234 mg/dl). That was bad. I was clearly not tolerating the amount of carbohydrate in the fruit and whole grain crackers and it didn’t matter how many salad vegetables and lean protein I ate with it!  I was carbohydrate intolerant.

A few months earlier,  two women I had known from school died suddenly. Both were in healthcare.  One was a public health nurse who retired on the Friday and was dead on the Monday and the other was a care aid working in long-term care who died alone in her home of a massive heart attack.  She had been diagnosed about 8 months earlier with Type 2 Diabetes and was working with her “Diabetes Dietitian” and was diligently following the recommendations and eating 65 g of carbohydrate at each meal and 45 g at each snack. When I mentioned I had been doing a lot of reading in the literature about the application of a low carbohydrate diet in controlling Type 2 Diabetes, she said “I’m going to follow this for one year. If it doesn’t bring my numbers down enough, I will look into it“.  She didn’t live long enough for either.

Obviously she didn't die from following the recommendations, but I have to wonder what difference 6-months on a well-designed, supervised low carb diet might have had.

The fact is, I was no example! Why should she listen to me? I was as overweight as she was (okay, we were both obese!) and I had Type 2 Diabetes for 10 years.  Who was I to suggest it if I wasn’t actually doing it?  All the scientific literature and knowledge isn’t convincing coming from an obese Dietitian.

As I sat there March 7, 2017 reflecting on my astronomical blood pressure and blood sugar, I realized I could be next in having a heart attack or stroke if I didn’t DO something. As I’ve said many times before in this blog, I should have gone to my doctor and let him prescribe blood pressure medication, medication for lowering my blood sugar and the statins for my cholesterol that would have come along with them (as he’d been recommending those for a while), but I didn’t.  What I did instead was immediately adopt a low carbohydrate diet. I designed myself a Meal Plan, as I do for my clients, based on the best evidence at the time. I’ve never looked back.

Without using any medication, here is what I was able to accomplish in one year’s time, as it appeared on Diet Doctor.

The full measurements are there, but in short, I had lost 32 pounds and lost 8 inches off my waist.  I still had 4 inches to go until my waist circumference would be half my height, but I no longer met the criteria for Type 2 Diabetes and my blood pressure ranged from between normal and pre-hypertensive. My triglycerides were ideal and I had excellent cholesterol levels.

Here is my “before” and “after” pictures now, at 21 months. I’ve lost the additional 4 inches off my waist – a foot in total! I lost a FOOT off my waist!!

In total, I’ve lost 45 pounds.

My 3-month average fasting blood glucose is 5.1 mmol/L (92 mg/dl) and 3-month overall average blood sugar is 5.4 mmol/L (97 mg/dl). I am below the diagnostic criteria for Type 2 Diabetes provided I limit the amount of carbohydrate-based foods I eat.  I expect these numbers will continue to improve now that (based on my waist circumference being half my height) it is unlikely I have fatty liver (NAFLD) disease. It will still take more time for my liver to continue to get well, as well as my pancreatic beta-cells, if recovery is possible.

I am not an “angel” when it comes to eating.  I do indulge in some dark chocolate after meals each weekend and I do taste non-low carb treats like pizza and cake. After all, this is not a diet, but a lifestyle and to be a lifestyle, it has to be sustainable.  The question for me is the same as for anyone: “how much” and “how often”.

Was it difficult? No. It really wasn’t…isn’t.

I eat real, whole food that can be as simple or complicated as I feel like preparing. It can be some store-bought BBQ chicken and a boxed salad or moussaka from scratch (which is what I’m making for dinner, tonight). I eat animal-based sometimes, plant-based other times, I eat nuts and seeds, fish, poultry of all types and a wide range of vegetables and some fruit and I include some “starchy” vegetables like winter squash and yam from time-to-time. I eat dairy such as cheese and plain Greek yogurt and I occasionally eat eggs (I am not a big “egg person”!). I eat grass-fed beef when I get it and supermarket meat, pastured chicken and the one that goes on sale when I’m picking up staples. My butter is regular, local and unsalted (not fancy imported butter) and I don’t slather it on everything.  It is just one of my fat choices along with really good olive oil and other pressed oils such as avocado oil and the occasional macadamia nut oil. If I’m craving a really good pizza, I make my Crispy Keto Pizza which is 85% the texture of a yeasty flour-based pizza. If I feel like one that’s a little less rich, I make my Crispy Cauliflower Pizza (see Recipe tab).

I usually don’t make “low carb bread”, although one of the most popular recipes on my recipe blog are my  Low Carb Kaiser buns. Here’s a picture, so you can see they are pretty legit for a sandwich and are great as hamburger buns.

I even make the occasion dessert, with my most requested being my low  carb New York Style Cheesecake (also under Recipes).

Low carb or not, I think desserts are “sometimes foods”, not “everyday foods”.  As a formerly obese person, I don’t think it’s helpful to think of dessert as a necessary part of an everyday meal.  I think they’re great for a special occasion, and make special occasions…well, special. After all, what’s not to love about a slice of cheesecake with the same number of carbs as a slice of bread, but the added fat, above and beyond what is found in the whole foods I eat is still an ‘extra’.

I invent recipes for myself that my ethnic clients find really helpful, including things such as Low Carb Roti (Indian flatbread) and Low Carb Chow Mein Noodles because I believe that a low carb lifestyle is not a “one-sized-fits-all”.

 

 

 

 

 

Everybody’s nutritional needs are different based on their stage of life, age,  gender and health conditions and people have different food preferences. What works for me may not be what’s best for you.  I design people’s Meal Plans based on the evidenced-based principles and their own preference, because it has to be sustainable.

Low Carb as a Maintenance Lifestyle

So, I’ve finally entered that wonderful phase known as “maintenance“; of needing to balance intake so I don’t continue to lose significant amounts of weight, but continue to achieve a more idea body composition (less extra fat, more muscle).  That involves adjusting my “macros” (the percentage of protein, fat and carbohydrate) as I do for my clients when they reach this stage, and continuing to engage in activity that challenges my muscles.

It’s also about continuing to evaluate (as I do for my clients) which carbohydrates I can or cannot successfully eat, and in what quantities. I know that from research studies, carbohydrate is best tolerated after eating some protein and low carb veggies (you can read more about that here) but even then a 2105 study showed that each person’s response to carbohydrate is very different (discussed in this article). For example, I found that my blood sugar is great with whole, cooked chickpeas cooked from dried but is terrible with hummus as the grinding of the chickpeas makes the starch in them more available to digestion and absorption (you can also read more about that here). So, just like I follow-up my clients who are seeking long-term weight loss and healthy improvement, I do the same for myself.

Low carb is not “magic”. It’s not like the food you eat somehow doesn’t “count”.  It has more to do with the different way our body metabolizes carbohydrate, compared with protein and fat and finding the mix of those that best achieves our goals.  For me, that setting my intake in a way that maximized lowering my blood sugar and blood pressure and achieving a normal body weight.  For someone else, it will be different. That’s why I say there is no one-sized-fits-all “low carb (or ketogenic) diet.

What are your weight loss and nutrition goals? Depending on your health and metabolic conditions, most can be realized using a well-designed, individualized, low carbohydrate Meal Plan.

Have questions?

Why not send me a note using the Contact Me form on the tab above and I will reply as soon as possible. Remember, I provide both in-person services as well as via Distance Consultation, using Skype or phone.

To our good health!

Joy

You can follow me at:

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https://www.instagram.com/lchf_rd

 

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

Insulin Resistance, Hyperinsulinemia and Hyperglycemia

The distinction between insulin resistance and hyperinsulinemia is often unclear because these terms are frequently lumped together under “insulin resistance“, but they are separate concepts. Hyperinsulinemia (“too high insulin”) is when there is too much insulin secreted from the pancreas in response to high levels of blood sugar (hyperglycemia) and insulin resistance is where the taking in of that glucose into the cells is impaired.

Blood glucose is a tightly regulated process. A healthy person’s blood glucose is kept in the range from 3.3-5.5 mmol/L (60-100 mg/dl) but after they eat, their blood sugar rises as a result of the glucose that comes from the broken-down carbohydrate-based food. This triggers the hormone insulin to be released from the pancreas, which signals the muscle and adipose (fat) cells of the body to move the excess sugar out of the blood. What happens in insulin resistance is that the cells of the body ignore signals from insulin telling it to move glucose from broken down from digested food from the blood into the cells. When someone is insulin resistant, blood glucose stays higher than it should be for longer than it should be (hyperglycemia).

The Process of Moving Glucose Inside the Cell

A special transporter (called GLUT4) that can be thought of as a ‘taxi’ exists in muscle and fat cells and is controlled by insulin. This ‘taxi’ moves glucose from the blood and into the cells. GLUT4 ‘taxis’ are kept inside the cell until they’re needed. When ‘taxis’ are required, they go to the surface of the cell, bind with insulin and pick up their ‘passenger’ (glucose) and moves it inside the cell. Both the ‘taxi’ (GLUT4 receptor) and the insulin are also taken inside the cell and then replaced on the surface of the cell with new receptors. As long as there are GLUT4 ‘taxis’ available on the surface of the cell to transport glucose inside everything’s good, but when blood sugar is quite high, the pancreas keeps releasing insulin to bind with the GLUT4 ‘taxis’, but those ‘taxis’ may not appear fast enough on the cell surface to pick up the glucose. In this case, blood sugar remains higher then it should be for longer, a state called hyperglycemia. When there are insufficient receptors to move glucose into the cell, this is called insulin resistance. It may be temporary, as in the example above, or may be long-term. If it is temporary, the rise in blood sugar (hyperglycemia) is short but if the receptors don’t respond properly long-term, then blood sugar remains higher for a longer period of time, until the ones that do work can bring the glucose inside. In one case, the blood sugar may be quite high for a short time or may be moderately high for a long time. In both cases, the body is exposed to higher blood sugar than it should be, and this causes damage to the body. It isn’t known whether insulin resistance comes first or hyperinsulinemia does. It is believed that it may be different depending on the person.

What Triggers Hyperinsulinemia?

It is known that excessive carbohydrate intake can trigger hyperglycemia, as well as hyperinsulinemia. Eating lots of fruit, for example or foods that contain fructose (fruit sugar) will cause the body to move that into the body first in order to get it to the liver, before it deals with glucose. This causes glucose levels in the blood to rise, resulting in both hyperglycemia and hyperinsulinemia. Lots of processed foods contain high fructose corn syrup (HFCS) which contributes to problems with high blood sugar and hyperinsulinemia.

There are other things that can also trigger hyperglycemia and hyperinsulinemia include certain medications (like corticosteroids and anti-psychotic medication) and even stress. Stress causes the hormone cortisol to rise, which is a natural corticosteroid. It is thought that long-term stress may lead to hyperinsulinemia, which increases appetite by affecting neuropeptide Y expression. This may explain why people eat more when they’re stressed and are very often drawn to carbohydrate-based foods that are quickly broken down for energy.

Diseases Associated with Hyperinsulinemia

It is well known that hyperglycemia that occurs with Type 2 Diabetes contributes to problems with the eyes, kidneys and nerves of the extremities, especially the feet and toes. Less known are the diseases and metabolic problems that can occur due to hyperinsulinemia.

Hyperinsulinemia has a well-establish association to the development of Type 2 Diabetes and Gestational Diabetes (the Diabetes of pregnancy), but also to Metabolic Syndrome (MetS).

Metabolic Syndrome (MetS) is a cluster of symptoms that together put people at increased risk for cardiovascular disease, including heart attack and stroke.

These symptoms of MetS include having 3 or more of the following;

  1. Abdominal obesity (i.e. belly fat), specifically, a waist size of more than 40 inches (102 cm) in men and more than 35 inches (89 cm) in women
  2. Fasting blood glucose levels of 100 mg/dL (5.5 mmol/L) or above
  3. Blood pressure of 130/85 mm/Hg or above
  4. Blood triglycerides levels of 150 mg/dL (1.70 mmol/L) or higher
  5. High-density lipoprotein (HDL) cholesterol levels of 40 mg/dL (1.03 mmol/L) or less for men and 50 mg/dL (1.3 mmol/L) or less for women

Hyperinsulinemia is also an independent risk factor for obesity, osteoarthritis, certain types of cancer including breast and colon/rectum, Alzheimer’s Disease and other forms of dementia[1], erectile dysfunction[2] and polycystic ovarian syndrome (PCOS)[3].

The damage associated with hyperinsulinemia is due to the continuous action of insulin in the affected tissues[4].

Risk factors for developing insulin resistance include a family history of Type 2 Diabetes, in utero exposure to Gestational Diabetes (i.e. an unborn child whose mother had Gestational Diabetes), abdominal obesity (fat around the middle) and detection of hyperinsulinemia.  Assessors of insulin resistance using blood tests such as the Homeostatic Model Assessment (HOMA2-IR) test which estimates β-cell function and insulin resistance (IR) from simultaneous fasting blood glucose and fasting insulin or fasting blood glucose and fasting C-peptide[1]. As well, incorporation of some forms of exercise including resistance training may lower insulin resistance in the muscle cells and weight loss – even when people are not very overweight can increase uptake of glucose, due to lowered insulin resistance of the liver.

Detection of hyperinsulinemia can occur using an Oral Glucose Sensitivity Index (OGIS), which is similar to a 2-hr Oral Glucose Tolerance Test (2-hr OGTT) which is a test where a fasting person drinks a known amount of glucose and their blood sugar is measured before the test starts (baseline, while fasting) and at 2 hours. In the OGIS, both blood glucose and blood insulin levels are measured at baseline (fasting), at 120 minutes and at 180 minutes [5].

Glucose and insulin response patterns that result after people take oral glucose can also be used to determine hyperinsulinemia status. Between 1970 and 1990, Dr. Joseph R. Kraft collected data from almost 15,000 people which showed five main glucose and insulin response patterns; with one being the normal response. Kraft’s methodology was to measure both glucose and insulin response over a 5-hour period, noting the size of both the glucose and insulin peaks, as well as the rate that it took the peaks to come back down to where it started from. Kraft concluded that a 3-hour oral glucose tolerance test with both glucose and insulin measured at baseline (fasting), 30, 60 120 and 180 minutes was as accurate as a 5-hour test. Most striking about the original study and recent re-analysis of this data found that up to 75% of people with normal glucose tolerance have carrying degrees of hyperinsulinemia [9]. You can read more about that in this recent article.

Hyperinsulinemia and insulin resistance together are the essence of carbohydrate intolerance; the varying degrees to which people can tolerate carbohydrate without their blood sugar spiking. This is not unlike other food intolerance such lactose intolerance or gluten intolerance which reflect the body’s inability to handle specific types of carbohydrate in large quantities.

Some final thoughts…

Insulin resistance and hyperinsulinemia are present long before a diagnosis of pre-diabetes and are now are considered an entirely separate stage in the development of the disease (you can read more about that here). A recent study reported that abnormal blood sugar regulation precedes a diagnosis of Type 2 Diabetes by at least 20 years [6] which means that long before blood sugar becomes abnormal, the progression to Type 2 Diabetes has already begun. Knowing how to recognize the symptoms of insulin resistance and hyperinsulinemia and to have them measured or estimated, as well as to detect the abnormal spike in blood glucose that often occurs 30 to 60 minutes after eating carbohydrate-based food is essential to avoiding progression to Type 2 Diabetes as well as the complications associated with hyperglycemia and hyperinsulinemia.

If you would like my help in lowering your risk to developing Type 2 Diabetes and the chronic disease risks associated with hyperinsulinemia or in reversing their symptoms, please send me a note using the Contact Me form on the tab above. I provide both in-person consultations as well as by Distance Consultation,using Skype and phone.

To your good health!

Joy

You can follow me at:

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References

  1. Crofts, C., Understanding and Diagnosing Hyperinsulinemia. 2015, AUT University: Auckland, New Zealand. p. 205.
  2. Knoblovits P, C.P., Valzacci GJR,, Erectile Dysfunction, Obesity, Insulin Resistance, and Their Relationship With Testosterone Levels in Eugonadal Patients in an Andrology Clinic Setting. Journal of Andrology, 2010. 31(3): p. 263-270.
  3. Mather KJ, K.F., Corenblum B, Hyperinsulinemia in polycystic ovary syndrome correlates with increased cardiovascular risk independent of obesity. Fertility and Sterility, 2000. 73(1): p. 150-156.
  4. Crofts CAP, Z.C., Wheldon MC, et al, Hyperinsulinemia: a unifying theory of chronic disease? Diabesity, 2015. 1(4): p. 34-43.
  5. Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.
  6. Sagesaka H, S.Y., Someya Y, et al, Type 2 Diabetes: When Does It Start? Journal of the Endocrine Society, 2018. 2(5): p. 476-484.

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

There Are Officially Two Stages BEFORE a Diagnosis of Type 2 Diabetes

This past Wednesday (November 28, 2018) the American Association of Clinical Endocrinologists (AACE) announced publication of a new Position Statement[1] which identifies four separate disease stages associated with an abnormal glucose response including Type 2 Diabetes;

Stage 1: Insulin Resistance
Stage 2: Prediabetes
Stage 3: Type 2 Diabetes
Stage 4: Vascular Complications — including retinopathy (disease of the eyes that can result in vision loss),  nephropathy (disease of the kidneys which can lead to kidney failure) and neuropathy (disease of the nerves —especially of the toes and feet which can lead to amputations), as well as other chronic disease risks associated with Type 2 Diabetes.

For those who have read the first two articles in this series (links below), the existence of a stage before blood sugar becomes abnormal (Prediabetes) and two stages before a diagnosis of Type 2 Diabetes will sound very familiar!

In the two previous articles, I explained the findings of a recent a large-scale study which found that 3 out of 4 adults with normal fasting blood glucose test results and whose 2 hour blood glucose after after a standard glucose load is below the cutoff for impaired glucose tolerance have very abnormal glucose spikes after eating and very abnormal levels of circulating insulin (“hyperinsulinemia“) associated with these dysfunctional glucose spikes.

It has been reported that abnormal glucose responses are present as long as 20 years before a diagnosis of  Type 2 Diabetes [2], so it should come as no surprise that it is now recognized that there are two stages BEFORE that diagnosis. Those who have read the two preceding articles will know that it is the hyperinsulinemia that leads to the insulin resistance, so in effect the first stage in this disease process really includes both of these together.

This Position Statement also recognizes;

“According to a recent analysis using data from the
U.S. National Health and Nutrition Examination Surveys
(NHANES; 1988-2014), patients with prediabetes have
increased prevalence rates of hypertension, dyslipidemia,
chronic kidney disease and cardiovascular disease (CVD)
risk.”

The Position Statement focuses on early intervention to reduce chronic disease risk which include diet and lifestyle changes as well as weight-loss. The goal of the release of the statement is to prevent the progression to Type 2 Diabetes, cardiovascular disease (CVD) and the metabolic diseases associated with it.

What is the importance of these two early stages?

What these stages mean is that long before blood sugar becomes abnormal, the progression to Type 2 Diabetes has already begun.

What it also implies is that people need to be given additional lab tests when their fasting blood sugar results are still normal in order to detect the presence of abnormal glucose spikes 30 minutes and 60 minutes after a glucose load as well tests measuring the abnormal insulin spikes associated with it as it is chronic hyperinsulinemia (high insulin levels) that leads to insulin resistance and the progression to Type 2 Diabetes as well as the associated chronic diseases.

Since 3 out 4 adults may have normal fasting blood glucose but with hyperinsulinemia, if we are going to stop the tsunami of Type 2 Diabetes, we must start treating it when fasting blood glucose is normal.

As I said in my last article, the time to think about implementing dietary changes and using updated lab testing procedures is now. We must act to  keep people from becoming carbohydrate intolerant and from developing hyperinsulinemia, Pre-diabetes, Type 2 Diabetes and the host of metabolic diseases that go along with it. This proactive approach is long overdue.

If you would like my help in lowering your risk to developing Type 2 Diabetes and the chronic disease risks associated with hyperinsulinemia or in reversing their symptoms, please send me a note using the Contact Me form on the tab above. I provide both in-person consultations as well as by Distance Consultation,using Skype and phone. Please let me know how I can help.

To your good health!

Joy

Note: If you haven’t yet read the two related previous articles, I would encourage you to have a look. The first article explains the existence of ‘silent Diabetes‘ in those with normal Fasting Blood Glucose test results and is titled When Normal Fasting Blood Glucose Results Aren’t Necessarily “Fine” and can be read here.

The second article titled Carbohydrate Intolerance & the Chronic Disease Risk of High Insulin Levels explains what hyperinsulinemia (chronically high levels of circulating insulin) is and why it’s a problem and can be read here.

You can follow me at:

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          https://plus.google.com/+JoyYKiddieMScRD

and now on Instagram, too:

https://www.instagram.com/lchf_rd

Reference

  1. American Association of Clinical Endocrinologists Announces Framework for Dysglycemia-Based Chronic Disease Care Model, November 28, 2018, AACE Online Newsroom, url: https://media.aace.com/press-release/american-association-clinical-endocrinologists-announces-frameworkdysglycemia-based-c
  2. Sagesaka H, S.Y., Someya Y, et al, Type 2 Diabetes: When Does It Start? Journal of the Endocrine Society, 2018. 2(5): p. 476-484.

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Carbohydrate Intolerance & the Chronic Disease Risk of High Insulin Levels

In the previous article titled When Normal Fasting Blood Glucose Results Aren’t Necessarily “Fine” I explained how normal results on a fasting blood glucose (FBG) test may simply mask ‘silent Diabetes’ and that even when fasting blood glucose is normal and results from a 2-hour Oral Glucose Tolerance Test (2-hr OGTT) do not indicate glucose intolerance, a person can still have a very abnormal blood sugar response after they eat refined carbohydrates. These ‘spikes’ can be seen between 30 minutes and 60 minutes on 2-hour glucose curves and are reflected by equally abnormal insulin curves. Chronically high circulating levels of insulin (called hyperinsulinemia) result from these blood sugar ‘spikes’ that occur every time the person eats carbohydrate-based foods, which is usually every few hours, for meals and snacks.

Insulin is released in order to take the excess sugar resulting from the digestion of carbs and move it out of the blood and into the cells and even though these people’s blood glucose returns to below the impaired glucose tolerance range by 2 hours, the abnormal glucose response particularly between 30 and 60 minutes drives hyperinsulinemia (chronically high levels of insulin) and is made worse by insulin resistance (which is the ignoring of insulin’s signal by the cells).  It is this hyperinsulinemia and insulin resistance that are the essence of carbohydrate intolerance; ; the varying degrees to which people can tolerate carbohydrate without their blood sugar spiking. It is not unlike other food intolerances such lactose intolerance or gluten intolerance which also reflect the body’s inability to handle specific types of carbohydrate in large quantities.

It is the hyperinsulinemia, rather than the high levels of blood sugar that puts people at risk for the serious chronic diseases of cardiovascular disease (heart attack and stroke), high cholesterol and high blood pressure[1] that people usually associate with Type 2 Diabetes. High blood sugar does have risks of course, including loss of vision, chronic kidney disease and amputation of limbs but if high blood sugar (hyperglycemia) is the “tip of the iceberg”, then high circulating levels of insulin (hyperinsulinemia) is the bigger part of the iceberg that can’t be seen. We can’t see it simply because it is rarely, if ever measured.

Most concerning is that based on a large-scale 2016 study which looked at the blood glucose response and circulating insulin responses from almost 4000 men aged 20 years and older and 3800 women aged 45 years or older during a 5-hour Oral Glucose Tolerance Test, 53% had normal glucose tolerance (normal fasting blood sugar and did not have impaired glucose tolerance (IGT) at 2 hours after the glucose load) but of these people, 75% had abnormal blood sugar results between 30 minutes and 60 minutes (two points in time that are not normally looked at in a standard 2-hour Oral Glucose Tolerance Test (2-hr OGTT).

In the previous article, I showed what the three abnormal glucose responses looked like compare to a normal glucose response and explained that a normal blood glucose curve represents Carbohydrate Tolerance, and the three abnormal glucose response graphs represent the Three Stages of Carbohydrate Intolerance; Early, Advanced, and Severe Carbohydrate Intolerance and culminates with the diagnosis of Type 2 Diabetes (T2D).

Hyperinsulinemia combined with insulin resistance form the heart of Carbohydrate Intolerance.

Insulin Resistance

In the early stages of Carbohydrate Intolerance, receptors in the liver and muscle cells begin to stop responding properly to insulin’s signal. This is called insulin resistance. Insulin resistance can be compared to someone hearing a noise such as their neighbour playing music, but after a while their brain “tunes out” the noise.  Even if the neighbour gradually turns up the volume of the music, the person’s brain compensates by further tuning out the increased noise. This is what happens with the body when it becomes insulin resistant. It no longer responds to insulin’s signal. To compensate for insulin resistance, the β-cells of the pancreas begin producing and releasing more and more insulin resulting in hyperinsulinemia, which is too much insulin in the blood.

Normal Insulin Response

The β-cells of the pancreas of healthy people are constantly making insulin and storing most of it until these cells receive the signal that food containing carbohydrate has been eaten. β-cells also constantly release small amounts of insulin in very small pulses called basal insulin. This basal insulin allows the body to use blood sugar for energy even when the person hasn’t eaten for several hours or longer. The remainder of the insulin stored in the β-cells is only released when blood sugar rises after the person eats foods containing carbohydrate and this insulin is released in two phases; the first-phase insulin response occurs as soon as the person begins to eat and peaks within 30 minutes and can be seen at 30 minutes on the graph below. The amount of the first-phase insulin release is based on how much insulin the body is used to needing each time the person eats. Provided a carbohydrate tolerant person eats approximately the same amount of carbohydrate-based food at each meal day to day, the amount of insulin in the first-phase insulin response will be enough to move the excess glucose from the food into the cells, returning blood sugar to its normal range of ~100 mg/dl (5.5 mmol/L). If there is not enough insulin in the first-phase insulin response, the β-cells will release a smaller amount of insulin within an hour to an hour and a half after the person began to eat.

Below is the same Carbohydrate Tolerance curve (normal glucose curve) as in Chapter 2. The solid black line is unlabeled here and is shown along with its corresponding normal insulin curve (dashed line). The insulin response more or less mirrors the glucose response; as glucose rises in the blood, insulin is released mainly as a first-phase insulin response, which results in the blood glucose level falling in

Carbohydrate Tolerance based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.

Early Carbohydrate Intolerance

Below is the same Early Carbohydrate Intolerance curve as in Chapter 2, and the solid black line (glucose) is shown along with its corresponding abnormal insulin curve (dashed line). As glucose rises in the blood even more insulin is released; initially as a first-phase insulin release and then as a second-phase insulin release.  This results in blood glucose level falling but not to baseline (fasting level) by 2 hours afterwards. Notice too that the fall is not as a straight line, but there are two peaks in the glucose curve, before it falls.

It is insulin resistance of the liver and muscle cells which results in the β-cells of the pancreas making more insulin and as can be seen from the graph below it takes more insulin to move the same amount of glucose (carbohydrate) into the cell.

Early Carbohydrate Intolerance – based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.

Advanced Carbohydrate Intolerance

By the time people have progressed to Advanced Carbohydrate Intolerance, the first-phase insulin response won’t produce enough insulin be able to clear the extra blood glucose after a carbohydrate load and even the second-phase insulin response won’t be enough to overcome the insulin resistance of the cells. At this point, the β-cells of the pancreas are unable to make enough insulin to clear the excess glucose from the blood and blood glucose rises well above the normal high peak of 126 mg/dl (7.0 mmol/L).  What is also apparent is that even with all the insulin release, blood sugar levels begin rising sooner and rise to much higher levels.

With ongoing high intake of carbohydrate every few hours, especially refined and processed carbohydrate such as bread, pasta and rice which are broken down quickly to glucose, the amount of insulin that must be released from the β-cells of the pancreas to handle a steady intake of carbohydrate-based foods increases substantially.  The dashed black line on the graph below shows the insulin curve of Advanced Carbohydrate Intolerance. While the Early Carbohydrate Intolerance glucose curve (above) doesn’t look significantly different then the Advanced Carbohydrate Intolerance curve (below), it’s easy to see that the insulin curves are very different.

The hyperinsulinemia (high levels of circulating insulin) present in Advanced Carbohydrate Intolerance is what makes these two states different.

Advanced Carbohydrate Intolerance  – based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.
Most concerning is these people had normal fasting blood sugar and 2-hour postprandial blood sugar which did not indicate that they had impaired glucose tolerance.  On a 2-hr OGTT, these folks would be told they were not pre-diabetic and would assume that everything was find – yet they had both an abnormal glucose response between 30 minutes and 60 minutes and abnormally high levels of insulin which accompanies it.

This high insulin response occurs every time these people eat significant amounts of refined carbohydrate and puts them at increased risk of the chronic diseases associated with chronic hyperinsulinemia including heart attack and stroke, hypertension (high blood pressure), elevated cholesterol and triglycerides, non-alcoholic fatty liver (NAFLD), Poly Cystic Ovarian Syndrome (PCOS), Alzheimer’s disease and other forms of dementia, as well as certain forms of cancer including breast and colon cancer [1].

A standard 2-hour OGTT would not show the significant abnormality in terms of how the body is able (or rather, not able) to process carbohydrate because standard blood tests do not test either glucose or insulin at 30 and 60 minutes.  It's not that there aren't abnormalities, it is just that they are not measured!

 Severe Carbohydrate Intolerance

As Carbohydrate Intolerance progresses, some people’s glucose-insulin curves look like the ones below. Blood sugar levels don’t rise as high, but the β-cells of the pancreas are producing less insulin and releasing it much later. They have no idea, because their fasting blood sugar is still normal.

Severe Carbohydrate Intolerance II – based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.

Type 2 Diabetes

Type 2 Diabetes (T2D) is the final stage of Carbohydrate Intolerance and is the natural outcome of a person continuing to eat a diet high in carbohydrate-containing foods at each of their meals and at snacks when their body is unable to tolerate it and is made worse by insulin resistance.

Too often this is the natural outcome of people following Dietary Guidelines (US or Canadian) which are designed for a healthy population, not people who are metabolically unwell. The problem is most people think they are healthy because they have normal blood glucose tests, and their metabolic dysfunction is never diagnosed. No one is looking for it.

The Dietary Guidelines recommend that people eat 45-65% of their dietary intake as carbohydrate and people in both countries dutifully eat considerable amounts of carbohydrate in the form of bread, cereal, rice and pasta, as well as fruit, milk and sweetened yogurt and starchy vegetables such as peas, corn and potato. Not knowing their body has become carbohydrate intolerant, this chronically high intake of carbs continues to put strain on their pancreas, until udder the pressure of the combination of hyperinsulinemia and insulin resistance, their β-cells burn out, resulting in Type 2 Diabetes.

Some Final Thoughts…

It has been said that Type 2 Diabetes is a “chronic, progressive disease”, but does it doesn’t have to be this way! It can be stopped LONG before fasting blood sugars become abnormal.

Diagnosing hyperinsulinemia is simple and can be done with existing standard lab tests; namely a 2-hour Oral Glucose Tolerance test with an extra glucose assessor and extra insulin assessor at 30 minutes and 60 minutes. When patients request this test because they are at high risk, too many are told that it is “a waste of healthcare dollars” when quite literally they could be spared the scourge of Type 2 Diabetes by having the changes in insulin and glucose response diagnosed in the 20 years before standard blood sugar begins show abnormalites [2].

It’s time to think about ways to implement dietary changes and lab testing procedures that will prevent Carbohydrate Intolerance and from developing the abnormal glucose and insulin responses and the host of metabolic diseases that go along with them.

In fact, it is long overdue.

If you would like my help in lowering your risk to developing Type 2 Diabetes and the chronic disease risks associated with hyperinsulinemia, or reversing their symptoms, then please send me a note using the Contact Me form, on the tab above. I provide both in-person consultations as well as by Distance Consultation using Skype and phone.

To your good health!

Joy

NOTE: The third article in this series titled "There Are Officially Two Stages BEFORE a Diagnosis of Type 2 Diabetes" can be read by clicking here.

You can follow me at:

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and now on Instagram, too:

https://www.instagram.com/lchf_rd

References

  1. Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.
  2. Sagesaka H, S.Y., Someya Y, et al, Type 2 Diabetes: When Does It Start? Journal of the Endocrine Society, 2018. 2(5): p. 476-484.

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

When Normal Fasting Blood Glucose Results Aren’t Necessarily “Fine”

hen people have a fasting blood glucose test and the results come back normal, they’re told (or assume) that everything’s fine. But is it? Certainly, a fasting blood glucose test is the least expensive test to find out if someone is already pre-diabetic, but for those wanting to avoid becoming Diabetic and to lower their risk of the other chronic disease associated with Type 2 Diabetes and high levels of circulating insulin (called hyperinsulinemia) noticing abnormalities in how we process carbohydrates is essential and these changes are estimated to take place a decade before our fasting blood sugar begins to become abnormal.

Our bodies have to maintain the glucose (sugar) in our blood at or below 100 mg/dl (5.5 mmol/L) but each time we eat or drink something other than water or clear tea or coffee, our blood sugar rises as our body breaks down the carbohydrate in the food from starch and complex sugars to glucose, a simple sugar.  Eating causes hormones in our gut, called incretin hormones to send a signal to our pancreas to release insulin, which moves the excess glucose out of our blood and into our cells. When everything is working properly, our blood sugar falls back down to a normal level within 2 hours after we eat (called 2 hours “postprandial”).

If we’re healthy and don’t snack after supper, our blood sugar falls to a lower level overnight but that too is maintained in a tightly regulated range between 60 mg/dl (3.3 mmol/l) and 100 mg/dl (5.5 mmol/l). During the night and as we approach morning, our body will break down our stored fat for energy and convert it to glucose in a process called gluconeogenesis.

When we have a fasting blood glucose test, it measures our blood sugar after we’ve fasted overnight and when we’re healthy, the results will be between 60-100 mg/dl (3.3-5.5 mmol/L). If it is higher than 100 mg/dl (5.5 mmol/l) but less than 125 mg/dl (6.9 mmol/L) we are diagnosed with impaired fasting glucose, but what if it’s normal? Is a normal fasting blood glucose test result enough to say that we’re not at risk for Type 2 Diabetes? No, because a fasting blood glucose doesn’t tell us anything about how our body responds when we eat.

A 2-hour Oral Glucose Tolerance Test (2 hr-OGTT) may be requested for people whose fasting blood glucose is impaired (higher than 100 mg/dl / 5.5 mmol/L) in order to see if it returns to normal after they consume a specific amount of glucose (sugar).

If their blood sugar returns to normal (less than100 mg/dl / 5.5 mmol/L) 2 hours after drinking a beverage containing 75 g of glucose (100 g if they’re pregnant) then the diagnosis remains impaired fasting glucose because it is only abnormal when fasting. However, if the results are greater than 140 mg/dl (7.8 mmol/L) but below 200 mg/dl (11.0 mmol/L), then they are diagnosed with impaired glucose tolerance which is called “pre-diabetes“.

If the 2-hour results are greater than 200 mg/dl (11.0 mmol/L), then a diagnosis of Type 2 Diabetes is made because their fasting blood glucose is > 7.0 mmol/L (126 mg/dl) and their 2-hour blood glucose is > 11.0 mmol/L (200 mg/dl).

But what if their fasting blood glucose is normal? Does that mean everything’s good? No, because we don’t know what happens to their blood sugar after they eat carbohydrate containing food, most notably between 30 minutes and 60 minutes.

A 2016 study looked at blood sugar and insulin response from almost 4000 men aged 20 years or older and 3800 women aged 45 years or older who had a 5-hour Oral Glucose Tolerance Test using 100 g of glucose. The study found that 53% had normal glucose tolerance; that is, they had normal fasting blood sugar and did not have impaired glucose tolerance (IGT) 2 hours after the glucose load. Of these people with normal glucose tolerance, 75% had abnormal blood sugar results between 30 minutes and 1 hour.

Normal Blood Glucose Pattern

A little less than 1000 people (990) out of the total with normal glucose tolerance (4030) had a normal glucose pattern (see graph below). It’s easy to see that the blood sugar rises to a moderate peak and then decreases steadily until it’s back to where it started from at 2 hours. This is what blood sugar is supposed to do.

Normal Glucose Curve (carbohydrate tolerance) – graph by Joy Y. Kiddie, MSc, RD (based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.)

Abnormal Glucose Patterns

AAlmost the same number of people (961) as had normal glucose curves showed early signs of carbohydrate intolerance which can be seen most noticeably between 30 and 60 minutes. Keep in mind, this graph represents the average blood sugar response of these individuals. These folks had normal fasting blood glucose but after 2 hours blood glucose did not return to baseline but was not high enough to meet the criteria for impaired glucose tolerance. Unless someone was looking between 30 and 60 minutes, no one would know it not was not normal. Rather than blood glucose going up to a moderate peak and then falling gradually in a straight line, a two-stage rise in glucose can be clearly seen between 30 minutes and 60 minutes before beginning to drop.

Early Carbohydrate Intolerance (Early Abnormal Glucose Response) – graph by Joy Y. Kiddie, MSc, RD (based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.)
A little more than 1200 people (1208) had the following abnormal glucose response which represents Advanced Carbohydrate Intolerance. These people had normal fasting blood glucose, but their blood glucose did not fall to baseline at 2 hours but was below the cut-offs for impaired glucose tolerance. Between 30 and 60 minutes their blood sugar went slightly higher at 60 minutes than at 30 minutes compared to the Early Carbohydrate Intolerance curve, before beginning to fall.

Advanced Carbohydrate Intolerance (Advanced Abnormal Glucose Response) – graph by  Joy Y. Kiddie, MSc, RD (based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.)
Slightly more than 800 people (807) had an abnormal glucose response curve shaped as follows, indicating Severe Carbohydrate Intolerance.  They had normal fasting blood glucose and 2-hour postprandial blood glucose results that were higher than at baseline yet did not meet the criteria for impaired glucose tolerance. What was significant is that blood sugar was significantly higher at 60 minutes than at 30 minutes, compared to the Advanced Carbohydrate Intolerance curve.

Severe Carbohydrate Intolerance (Severe Abnormal Glucose Response) – graph by Joy Y. Kiddie, MSc, RD (based on [1] Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.)

The Significance of These Curves

The results of this study show that even if fasting blood glucose is totally normal and 2-hour postprandial blood glucose does not meet the criteria for impaired glucose tolerance, it often does not return to baseline and the blood sugar response between fasting and 2 hours is very abnormal. What can’t be seen from these graphs is what happens to the hormone insulin at the same time. This will be covered in the next chapter but suffice to say that Normal Carbohydrate Tolerance, blood sugar response mirrors what is happening with insulin but in Early, Advanced and Severe Carbohydrate Intolerance, insulin secretion is both much higher and lasts much longer. This is called hyperinsulinemia (high blood insulin) and contributes to many of the health risks associated with Type 2 Diabetes, including cardiovascular risks (heart attack and stroke), abnormal cholesterol levels and hypertension (high blood pressure).  This is like having “silent Diabetes“.

A “Waste of Healthcare Dollars”

As a Dietitian, when a person’s clinical symptoms and risk factors warrant it, I’ll request a 2-hour Oral Glucose Tolerance Test (2-h OGTT) with an extra glucose assessor at 30 minutes (and sometimes at 60 minutes) to determine how their glucose response compares to the above curves. While these blood tests are done with 75 g of glucose and not 100 g, the shape of the curves and the endpoint as well as the size of the peak between 30- and 60-minutes reveals much about their carbohydrate intolerance. Since these people have normal fasting blood glucose test results, a request for an Oral Glucose Tolerance Test (with or without the extra glucose assessor) is often declined as a “waste of healthcare dollars”. Unfortunately, this is where being “penny wise” can be “pound foolish” as these people don’t know they are at risk and as a result, are not motivated to change their eating habits or lifestyle.

What About Glycated Hemoglobin (HbA1C)?

A glycated hemoglobin test (HbA1C, also called A1C) measures a form of hemoglobin that binds glucose (the sugar in the blood) and is used to identify the person’s three-month average glucose concentration because blood cells turnover (get replaced) on average every 3 months.

While having a glycated hemoglobin test and a fasting blood glucose test is better than only having fasting blood glucose, it will still miss a significant percentage of people who are able to control their sugars between meals and overnight but who have significant spikes between 30 minutes and 60 minutes, immediately after eating carbohydrate-based food, but that return to normal by 2 hours. Most physicians will not requisition a HbA1C test if a person’s fasting blood glucose is normal, and even if they do, that test may miss that glucose ever spikes at all between 30 minutes and 60 minutes.

In the absence of available lab testing, I sometimes resort to using a Glucose Response Simulation.

Glucose Response Simulation

A simple, if somewhat crude means of assessing glucose response under a load can be done at home using an ordinary glucometer (a meter for measuring blood sugar) such as would be used by people with Diabetes, and either a 100 g of dextrose (glucose) tablets available at most pharmacies or the equivalent. As part of the services I provide to my clients, I work with those that want to do this type of estimate so that they can understand whether they fall into the 75% of people that have normal fasting blood sugar and do not have impaired glucose tolerance at 2 hours postprandial but do have an abnormal glucose response. I explain how to prepare for the test, step by step instruction for conducting the test and then I graph and analyze the data then teach them what the results mean.

Basis for Individualizing Carbohydrate Intake

These results are very helpful as firstly they help people understand the reason for reducing their carbohydrate intake over an extended period of time, in order to restore insulin sensitivity and insulin secretion. These results also enable me in time to individualize their carbohydrate intake once they have reversed some of their metabolic response, based on their own blood sugar response to a specific carbohydrate load.  In time, some of these individuals may want to add some carbohydrate back into their diet in small quantities, so with this information, I can guide them to test a standard size serving of rice, pasta or potato compared to their own blood glucose response to 100 g of glucose.

Below are three curves that I’ve plotted from individuals that used the same type of glucometer (Contour Next One) and a standard 100 g glucose load as dextrose tablets or equivalent to 100 g of glucose [2]. I provided each one with identical instructions on how to run this simulation, how to collect the results and ensured each one understood.

Example 1: The person below had a single glucose peak (similar to the early carbohydrate intolerance of the first abnormal curve, above) but blood glucose did not come back down to the fasting level even after 3 hours.

Early Abnormal Glucose Response – graph by Joy Y. Kiddie MSc, RD

Example 2: The person below had a single glucose peak  that reached abnormally high levels and that didn’t fall continuously downward but slowed, then dipped below baseline at 2 hours (mild reactive hypoglycemia) and that gradually came back to baseline over the following couple of hours.

Advanced Abnormal Glucose Response – graph by Joy Y. Kiddie MSc, RD

Example 3: This person had a similar initial rise as the person above, but no hypoglycemic dip however, this person’s glucose didn’t fall to baseline until almost 5 hours.

Some Final Thoughts…

An abnormal fasting blood glucose test may warrant further testing; however, a normal result is frequently dismissed as being a sign that “everything’s fine”. Data from this study indicates that as many as 75% of people with normal fasting blood sugar may have abnormal glucose responses and associated hyperinsulinemia, meaning they could have the same risks to other chronic diseases as someone who has already been diagnosed with Type 2 Diabetes. They simply don’t know it.

With reliable and relatively inexpensive glucometers, as well as continuous glucose monitors (CGM) people don’t need to wonder whether they have an abnormal glucose response to eating carbohydrate (are carbohydrate intolerant). They can use simulation tests, such as the ones I did above, to find out.

Not knowing one is at risk does nothing to provide motivation to make dietary and lifestyle changes, but knowing one has an abnormal response to carbohydrates not only enables people to want to make these changes, it also helps them to find which carbohydrates they can eventually add back into their diet, once they’ve lowered their glucose and insulin levels, and in what quantities.

If you have questions as to how I can help you get started in knowing your own glucose response and to lower risk factors, please send me a note using the Contact Me form located on the tab, above.

To your good health!

Joy

Note: The second article in this series explains what hyperinsulinemia is and why it's a problem. It's titled Carbohydrate Intolerance & the Chronic Disease Risk of High Insulin Levels and can be read by clicking here.

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References

  1. Crofts, C., et al., Identifying hyperinsulinaemia in the absence of impaired glucose tolerance: An examination of the Kraft database. Diabetes Res Clin Pract, 2016. 118: p. 50-7.
  2. Lamar, ME et al, Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening, Am J Obstet Gynacol, 1999 Nov 18 (5 Pt 1): 1154-7

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

 

 

Low Carb Pumpkin Pie – with or without the crust

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me).  This recipe may or may not be appropriate for you.

What would Thanksgiving be without pumpkin pie? This recipe is so delicious that you don’t really need the crust, but if you insist my flaky all-butter crust posted here would be just perfect!

Flaky all-butter keto crust

Low Carb Pumpkin Pie – makes 2 pies or a 9 x 14″ custard

Ingredients

6 eggs
796 ml / 29 oz can pure pumpkin
6 oz Swerve® granulated sweetener
2 tsp cinnamon, ground
1 tsp nutmeg, ground
1/2 tsp ginger, ground
1/2 tsp salt
1 1/2 cups heavy whipping cream, not whipped

Method

  1. Preheat oven to 425 F
  2. Beat eggs in bowl of stand mixer or by hand
  3. Add pumpkin, sweetener, spices and salt, mix well
  4. Blend in cream, mix until uniform in colour
  5. Pour into pre-baked pie crusts (recipe here) or into a lightly butter-greased 9″ x 14″ stainless steel baking pan
  6. Bake for 15 minutes at 425 F, then lower heat to 350 F and continue baking 55 minutes (or until set and a toothpick comes out clean)
  7. Allow to cook well before serving. Can add a dollop of fresh, homemade whipped cream (unsweetened, or sweetened with Swerve®)

Macros per slice (crustless)

Energy: 147 kcals
Protein: 4.7 g
Net Carbs: 3.2 g
Fat: 12 g

If you would like to know how I can help you follow a low-carb or ketogenic lifestyle, please send me a note using the “Contact Me” form above.

I provide both in-person services as well as appointments via Distance Consultation (telephone / Skype) so feel free to let me know if I can help.

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content

 

 

 

 

One Month Left to Maximize Your Extended Benefits!

Most Extended Benefits Plans and Health Spending Accounts reset on December 31st, which means there is only one month left to take advantage of the benefits that you’ve already paid for.

Whether you want to see me in-person or via Distance Consultation (Skype or telephone) now is a great time to make an appointment if you want your Meal Plan before the holidays.

If you’d rather wait until New Years to implement your weight-loss goals, by booking services now you can claim reimbursement for this year, even if you complete your services in 2019.

As well, I make sure to provide receipts with the specific information required by your Extended Benefits provider in order to speed your reimbursement.

If you want to get started, please visit the drop-down menu under the Services tab for more information or download the Intake and Service Option Form available here.

If you have any questions, please click on the Contact Me tab to send me a note and I’ll reply shortly.

To your good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Will This Knock Me Out of Ketosis?

Earlier this week I heard someone ask in a low-carb Facebook group if eating a particular food would ‘knock them out of ketosis‘ and I decided it was time to write an article about this, but first I ran a short poll on Twitter to find out what my readers thought.

The first answer in the poll was my tongue-in-cheek reaction to hearing the question asked for the umpteenth time and the other three options were reasonable answers that people could choose from.

Twitter poll: “Will this knock me out of ketosis?”

So what’s the answer?

According to Dr. Stephen Phinney, MD, PhD. Professor of Medicine Emeritus at the University of California, Davis who has over 25 years of clinical experience studying multi-disciplinary weight management programs, including the use of a ketogenic diet;

“Carbohydrate tolerance varies among individuals.  Some people may need to limit themselves to no more than 30 grams of total carbohydrates per day to remain in nutritional ketosis and maintain its benefits; while others may be able to consume more.  However, most people with underlying metabolic issues find that they need to maintain a carbohydrate intake below 50 grams per day, especially if they have Type 2 Diabetes.”

For the most part, men who are insulin sensitive and seeking to follow a ketogenic diet can do very well on 50-100 g of carbohydrate per day and women who are insulin sensitive who want to follow a ketogenic diet can do well on 50-75 g of carbohydrates per day. As Dr. Phinney points out, those with metabolic issues such as Type 2 Diabetes will usually need to keep their carbohydrate intake less than 50 g per day.

People with epilepsy or seizure disorder or who have been prescribed a ketogenic diet as an adjunct treatment to chemotherapy for specific types of cancer will need to follow a very strict high-fat ketogenic diet and the level of carbohydrate restriction is specific for those conditions.  For those who are insulin sensitive who are simply seeking weight loss, a low carbohydrate diet is often sufficient. I’ve found over the last several years of designing low carbohydrate diets for my clients that insulin-sensitive individuals often do very well simply cutting the total amount of carbohydrate down significantly and altering the types of carbohydrate they eat. For those with pre-Diabetes and Type 2 Diabetes, the types and amounts of carbohydrates they eat can be individually determined by testing glycemic responses to specific foods and I help my clients do this and understand the results.

What is the difference between someone who is insulin sensitive and someone who is insulin resistance?

People who have Type 2 Diabetes or pre-diabetes or Metabolic Syndrome are by definition insulin resistant but for those without these conditions, how would someone know?  There are two blood tests that can be done together (fasting blood sugar and fasting insulin) that can help estimate the degree of insulin resistance but there are visual cues that can also help.

insulin sensitive (from Klöting N, Fasshauer M, Dietrich A et al, Insulin-sensitive obesity, Am J Physiol Endocrinol Metab 299: E506–E515, 2010, pg. 5)

People who store most of their fat as subcutaneous fat, rather than visceral fat (fat in their abdomen) are often insulin-sensitive — even those that are very obese. These are people whose fat is mostly the type that hangs loosely over their belt and jiggles when they walk or laugh. Surprisingly, these are not the people that necessarily have metabolic issues, provided they also don’t have significant amounts of visceral fat (where it can’t be pinched and where it wraps the organs, resulting in metabolic disruption).

insulin resistant (from Klöting N, Fasshauer M, Dietrich A et al, Insulin-sensitive obesity, Am J Physiol Endocrinol Metab 299: E506–E515, 2010, pg. 5)

Those who store most of their fat inside their abdomen as visceral fat rather are often insulin resistant and as a result may have high blood pressure, abnormal cholesterol (lipids) or been diagnosed as having either pre-Diabetes or Type 2 Diabetes.

In order to reverse the symptoms of these chronic diseases, people with insulin resistance often need to maintain their intake of carbohydrate at a lower level than those who are insulin sensitive.

As far as the question as to whether eating a particular food will “knock someone out of ketosis“, if that food contains more grams of carbohydrate than their daily limit then yes, they will temporarily burn glucose instead of producing ketones from burning fat.

That said, for a low-carbohydrate lifestyle to be sustainable long term for the average individual without metabolic issues seeking weight loss, I don’t understand why some are focused on how many ketones they are producing.  This is not one of those cases that ‘more is better’. The body is very good at not wasting energy, be it as glucose or ketones so if people have been in ketosis for a considerable length of time, their body will often stabilize and produce a lower level of ketones, so as not to produce more than is needed. A lower level is just fine.

If you have been prescribed a low carb or ketogenic diet for a specific health condition or are taking one of the medications that puts you at risk of developing ketoacidosis (a potentially life-threatening condition which is very different than ketosis!) then yes, tracking ketones is important, but for the average person, eating the foods are on your Meal Plan will enable you to enjoy your meals while keeping to the amount of carbohydrate that your body tolerates, without counting anything!

That’s the beauty of this style of eating! There’s no need to weigh and measure food, so why become focused on carbohydrate counting or on ketone measuring?

If it’s a special occasion and you want to have a piece of something that is not normally part of what you eat then decide if eating a small serving fits your own health and nutrition goals.  If it does, have a small piece and enjoy it. If it doesn’t than choose not to.

Overall, if you focus on eating real, whole foods including plenty of healthy animal protein, low carbohydrate vegetables and leafy greens with just enough fat to make it tasty, then relax, eat and enjoy!

If you would like to know more about what’s involved in me designing a Meal Plan for you, then please send me a note using the “Contact Me” form above and for information on the various in-person or distance consultation services I provide, please click on the “Services” tab.

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

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Reference

Virta Health Blog, Dr. Stephen Phinney, https://blog.virtahealth.com/how-many-carbs-ketogenic-diet/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Low Carb Dark Chocolate Raspberry Scones

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

This recipe began as the result of a recipe that someone posted on Facebook for Keto Blueberry Scones.  Since had raspberries in the house, I mentioned that I would use those instead when the person who posted the recipe suggested I add stevia-sweetened chocolate chips.  Since chocolate-raspberry is one of those epic combinations but not liking stevia-sweetened anything (I find the aftertaste terrible!) I decided to chop up a piece of a 95% dark chocolate bar into small chocolate chips, and use those.  Perfection!

Low Carb Dark Chocolate Raspberry Scones

Low Carb Chocolate Raspberry Scones

Ingredients

1  1/4 cup almond flour
1/3 cup coconut flour
1/4 cup Swerve® Granulated Sweetener
1/4 tsp. sea salt
1/2 tsp. baking powder

1/4 cup coffee cream (15 % BF) *
1/4 cup heavy whipping cream (33% BF) *
2 Tbsp butter, softened
1 tsp. natural vanilla
1 egg, large, lightly beaten

1/4 cup raspberries, chopped finely
1/4 cup 95% dark chocolate, chopped finely

* Note: cream in different parts of the world is called by different names.  This table should help:

Method

Preheat oven to 375° F and line a baking sheet with a piece of parchment paper.

Mix all the dry ingredients together in a medium size bowl.

Mix all the wet ingredients in a small bowl.

Fold wet ingredients into dry ingredients.

Add chocolate chunks and raspberry pieces and fold them in gently (don’t over mix).

Pat into a flat disk con the parchment paper.

Cut into 6 pieces with a large knife or a pizza cutter.

Bake at 375º for 18 minutes then remove from the oven and gently move the pieces apart from one another and return to oven until lightly golden in colour.  Don’t over bake!

Enjoy topped with a little fresh unsalted butter!

(idea based on a recipe from /www.simplefunketo.com/blog/scones)

Macros

Energy: 217 kcal
Protein: 6 g
Net Carbs: 4.2 g
Fat: 18.2 g

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Twenty Months Today

It’s twenty months today that I adopted a low-carb lifestyle and it’s hard to believe how very different I feel.

March 5, 2017, I was sitting in my office working on Meal Plans for my clients and I just didn’t feel well. I didn’t know what was wrong but for lack of a better term I felt “unwell”.  I went and took my blood pressure (after not taking it for almost 2 years!) and it was dangerously high!  I laid down and waited a bit until I took it again, and it was only nominally less.  I was scared.

I decided to take my blood sugar too and opened a new package of test strips and took it.  It was crazy high and I didn’t eat anything out of the usual.  While I can’t remember exactly what I ate that morning, I’m guessing it was a few thin gluten-free crackers with peanut butter substitute and a bit of marmalade — which is what I usually ate along with a double espresso cappuccino made with low fat milk, without sugar. I just looked up the carb content of those crackers; 24 g of carbs for 3 and I probably ate 5 or 6, so, 50 g of carbs right there. Another 8 g of carbs for the 2 Tbsp of soya butter spread and 14 g per Tbsp for the Seville Marmalade — so altogether, that was 72 g of carbs, plus another 3 for the milk in the cappuccino. I had 75 g carbs for breakfast —’at least’ the 65 g of carbs that was recommended for me to eat as a Type 2 Diabetic.

Mid-morning, I probably had 2-3 ounces of cheese and a piece of fruit.  Given it was early March, for sure it was an Ataufo mango — 25 g of carbs; a recommended combination of carbohydrate and protein…and not even the 45 g of carbohydrate recommended, as cheese doesn’t have any carbohydrate. The mots I would have had after that would have been some plain tea, so no additional carbs but knowing what I know now, my blood sugar probably continued to climb from breakfast for the next 3 hours, then I had the “healthy (recommended) snack” of protein and carbohydrate for another 25 g of carbs which would have caused it to rise some more.  It was no wonder my blood sugar that day was 13.0 mmol/L (234 mg/dl).

I was a sick!  I had out of control blood pressure and blood sugar that was anything but controlled! I contemplated going to my doctor but figured he’d either send me to the hospital by ambulance because of my crazy high blood pressure, or he’d prescribe at least one kind of blood pressure medication, blood sugar medication and a statin for my cholesterol (which he wanted to put me on for some time).  In retrospect, I should have gone to see him and let him put me on the blood pressure and blood sugar medication and THEN changed my lifestyle. The meds would have protected me in the meantime until the dietary and lifestyle changes began to have their effect.  But I didn’t.  What I did do was instantaneously adopt a low-carb lifestyle — the same type of plan I had been designing for my clients for over 2 1/2 years.

The rest, as they say, is history.

All the details are in previous entries in “A Dietitian’s Journey”; all the lab tests, all my blood glucose and blood pressure readings and all my fat pictures! There it is in Technicolor for anyone to see!

The photo on the left (below) was taken April 21 2017 — 7 weeks after I began my current lifestyle and the photo on the right was taken last week or the week before.

Yes, I am a lot grayer, but the change in the shape of my face and my neck (I have a neck!!) is evident. When I look in the mirror, I now recognize the person that looks back.

Best of all I feel good and my lab tests and blood pressure readings indicate that I am much healthier — not just for someone diagnosed 10 years ago with Type 2 Diabetes (T2D), but for someone of my age without any chronic diseases!  My T2D is in remission, which means that as long as I keep eating the way I do, it will stay that way. This is not a “short-term fix”.  If I want to remain healthy, I need to keep eating the way I do. Does that bother me? No! The alternative is being as unhealthy as I was 20 months ago. No way.

Note: I use the word “remission” and not “reversal” because for Diabetes to be reversed, a person should be able to eat like a non-Diabetic and not have their blood sugar spike.  For me, that’s not likely to ever happen because I was Diabetic for so long, so I use the term “remission”.

Remission is a good thing!

Having normal blood sugar levels and normal blood pressure is fantastic, and catching my reflection in a store window or on a store video camera isn’t an unpleasant experience.

Of course I’m not going to look like I did in my mid-twenties when I was last at this weight but to be someone of normal body weight, with labs that testify that I am not the metabolically unwell mess that I was 20 months ago is just fine with me. I’m not going to get any younger, so I will just have to keep getting better!

If you are wondering if it is even possible to go from being obese and metabolically unwell to being normal body weight and metabolically as healthy as reasonably possible, I hope my story encourages you that yes, it is entirely possible.  Is it hard? No, not really.  It takes learning how to do things differently, but if doing the same thing was making me sicker and sicker, I didn’t need my Masters degree to figure out doing the same thing was not going to make me better. There were years of scientific data before I began teaching this almost 5 years ago and now there is significantly more. Even the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) now recognize that a low-carbohydrate diet is safe and effective and has deemed it appropriate Medical Nutrition Therapy for the treatment and management of T2D (you can read more about that here).

If you have questions about how I might be able to help you please send me a note using the form on the Contact Me tab above and I’ll be happy to reply.

I provide both in-person visits in my Coquitlam, British Columbia office as well as visits via Distance Consultation on Skype or by phone if you prefer, so please let me know how I can help.

To our good health!

Joy

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Zoodles Perfected!

This recipe is posted as a courtesy to those following a variety of low-carb and ketogenic diets (not necessarily Meal Plans designed by me). This recipe may or may not be appropriate for you.

Last March, I made “zoodles” for the first time. I thought it was ingenious to use shredded zucchini in place of noodles – not realizing that people long before me had thought of the idea! I posted my recipe here, but have since tried to perfect them, to keep them from ending up sitting in a puddle of water.

Someone online mentioned baking the shreds first, immediately after making them. While they oozed less water when served, they were limp. Quite disappointing!

Yesterday, I was craving spaghetti and Bolognese sauce and had some beautiful pastured beef to make it with and fresh oregano that was still surviving in my garden so I decided to see if I could solve the “water problem” of zoodles, without affected the texture.  I did it!

Zoodles perfected!!

Zoodles perfected!

I had both yellow and green zucchini in the house (2 of each) and decided in the interest of colour, to use the yellow ones.  Here’s the technique for perfect zoodles!

  1. Shred the zucchini lengthwise on a mandolin down to the core on each side (but not including the too-soft core).
  2. Lightly salt the shreds and then toss well and let them sit a few minutes to let it start to draw out the water.
  3. Microwave the zoodles for 3 minutes on high, covered with a microwave cover.
  4. Dump into a mesh colander (the kind for sifting flour).
  5. Allow to cool just long enough to handle them (don’t rinse with water to cool them, as they will absorb it readily) then gently squeeze out all the water in cupped hands (as one would do with frozen spinach when preparing it for a recipe).
  6. Top with your favourite spaghetti sauce, serve and enjoy!

These were amazing!! No pooled water!

…and they twisted just like pasta!

zoodles twisted like pasta

I hope you enjoy these as much as I do!

To our good health,

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

You can follow me at:

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I Did This – a short summary of a Dietitian’s Journey

me – May 2015

Today I reached “normal body weight” according to Body Mass Index (BMI) classification  no longer obese and not even overweight. Normal. It seems surreal.

When I began my health and weight loss journey on March 5, 2017 (19 1/2 months ago) I was obese. My weight bordered between Class I and Class II Obesity and I had multiple metabolic health issues. I was diagnosed with Type 2 Diabetes 10 years earlier, had elevated blood pressure and abnormal lipids (cholesterol).  Most significantly, I was in denial as to just how ill I really was. The undergraduate and post graduate degrees on my wall did not inform reality. The mirror did.

I didn’t feel well that day and took my blood pressure. It was dangerously high— classified as a hypertensive emergencyI decided to take my blood sugar too and it was way too high. I sat and considered the numbers of both and considered my options. At the time, I only saw two choices; I could go see my doctor who would have immediately put me on multiple medications or I could change my lifestyle. In hindsight the safest option would have been to do both, but I chose instead to begin to “practice what I teach”.

You see, I had two girlfriends suddenly die of natural causes within 3 months of each other just previous to that day; one of them I had known since high school and the other since university. They were both my age, both chose careers in healthcare, just like I did, and both died from preventable causes. They spent their lives helping others get well, yet unable to accomplish the same for themselves.  It was not for lack of trying, but for not having found a solution before death ended both of their lives. March 5, 2017, I realized that if I didn’t change I would likely die of heart attack or stroke, too. Their deaths may have saved my life.

I began a low carbohydrate diet immediately. I cut refined foods, ate whole unprocessed foods, didn’t avoid the fat that came with whole foods but didn’t add tons of fat either. While it helped a great deal, after several months I realized that I needed to lower my carbohydrates further in order to achieve the remission from Type 2 Diabetes that I sought.  I didn’t simply want to lose weight — I wanted to get healthy!

I consulted the experts and continued to make dietary modifications that got me closer to my goal. The first significant improvement was in blood pressure followed by blood sugar. I lost weight and more significantly lost inches off my waist.  While I hadn’t been formerly diagnosed with non-alcoholic fatty liver disease based on my lab work I more than likely had it. I tweaked and adjusted my Meal Plan many times over the last 19 1/2 months — each time moving myself closer and closer to my goal. Ten days ago I was within an inch of my waist circumference being half my height and now I am within 3/4 of an inch of it. It’s happening!

Body Mass Index (BMI) October 17 2018

Two days ago, I got on the scale and saw a series of digits that I had not seen since my twins were born 26 years ago tomorrow. I decided to crank some numbers.  I was almost there.  The photo on the left shows the weight category form two days ago. Today it was in the normal range!

I am not one of those people that the press frequently writes about that pursued a low carbohydrate or ketogenic diet for “quick weight loss”.  I wanted to get well. I chose a low carbohydrate diet for therapeutic reasons because it was my underlying high insulin levels which drove my high blood glucose and high blood pressure. To get well, I needed to address the cause, not the symptoms.

So here I am, having reached normal body weight!

Did I think at the beginning that I would actually get to this point? I wasn’t sure. I knew it was possible because I had helped others achieve it, but had never tried myself, so I didn’t know.

For health reasons, I no longer had the option of doing nothing!

At first, I set my preliminary goal as “no longer being obese“. Then I revised it to “being less overweight“.

I found some old photos recently of what I looked like as a young adult and realized what the weight was where I felt and looked my best then reset my goal weight once again. I knew it was entirely doable!

I am almost there!

Then the hard work begins.

Losing weight has been challenging, but not difficult.  Sure, I needed to determine what was holding things up at various stages of my journey and make dietary adjustments just as I do for my clients, but it’s much easier to do that for someone else than for oneself. The “hard work” will be finding out how to eat where I don’t lose any more weight, while maintaining my blood sugar and blood pressure at the best possible level.

If possible, I want to achieve full remission from Type 2 Diabetes and if not, I will learn how to maintain full reversal of symptoms.

I’ve documented the entire process throughout “A Dietitian’s Journey”, including “fat pictures” and lab test results to demonstrate the therapeutic benefit of a low carbohydrate diet and that this lifestyle is both practical and  sustainable.

Perhaps you would like to find out how I can help you achieve your own health and nutrition goals?

Please send me a note using the form on the Contact Me tab above and I’ll be happy to reply.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

Cannabis’ Effect on Appetite, Blood Sugar and Insulin Levels

As of October 17th 2018, marijuana (cannabis sativa, cannabis indica) will be legal to be sold to or possessed by adults 18 years or older in Canada and to be consumed for recreational use.  Medical marijuana has been available for sometime in Canada (and in some US states) to those with authorization from their healthcare provider, but will now be widely available to the general adult population. So why am I, as a Dietitian writing about marijuana? Because food cravings, commonly referred to as the “munchies” are one of the known side-effects of cannabis and result in people eating even when they’ve just eaten.  For those who have made a decision to lose weight and keep it off, knowing how marijuana affects appetite is something that needs to be considered. As well, for those that are at risk for Type 2 Diabetes, knowing how marijuana impacts blood glucose and serum insulin levels is also important. So as a public service, this article is about the effect of marijuana and the “munchies” on blood sugar, serum insulin and weight gain.

The “Munchies”

Tetrahydrocannabinol (THC) is one of the active components in marijuana that is responsible for people feeling “high” and is also responsible for “the munchies”.  It’s been know for sometime that the THC in cannabis activates a cannabinoid receptor in the brain (called CB1R) which triggers an increased desire to eat but a 2015 study indicates that a group of neurons (nerve cells) called pro-opiomelanocortin (POMC) which normally produce feelings of satiety (no longer feeling hungry after eating) become activated and promote hunger under the influence of THC. As it turns out, cannabis “hijacks” the POMC neurons, resulting in them releasing hunger-stimulating chemicals rather than appetite-suppressing chemicals. This is why despite having just eaten a full meal and being satiated, ordering a pizza suddenly becomes a priority. It is thought that THC from the weed binds to mitochondria inside of cells (the “powerhouse of the cell” that generates energy) and this binding acts to switch the feelings of satiety to feelings of hunger. But how does marijuana use affect weight gain, blood sugar and insulin levels?

Marijuana’s Effect on Fasting Blood Glucose and Fasting Insulin, Insulin Resistance and Weight Gain

Interestingly, epidemiological studies (studies of populations) have found lower rates of obesity and Type 2 Diabetes in those that use marijuana compared to those that never used it, suggesting that cannabinoids play a role in regulating metabolic processes. A 2013 study that analyzed data from almost 4657 adult men and women who participated in the National Health and Nutrition Examination Survey (NHANES) study from 2005 to 2010 were studied; 579 were current marijuana users and 1975 were past users. Results indicated that current marijuana use was associated with 16% lower fasting insulin levels and 17% lower insulin resistance as measured by HOMA-IR  which is calculated from fasting blood glucose and fasting insulin. As for weight gain as a side-effect from the “munchies”, this study  reported significant associations between marijuana use and smaller waist circumferences.

Marijuana and Metabolic Syndrome

A 2015 study which looked at 8478 adults 20-59 years of age who also  participated in the National Health and Nutrition Examination Survey (NHANES) study from 2005 to 2010 reported that current marijuana users had lower odds of presenting with metabolic syndrome than those that never used marijuana. Current marijuana users in the 20-30 year old range were 54% less likely than those who never used marijuana to present with metabolic syndrome.

Marijuana’s Possible Role in Type 2 Diabetes Treatment?

The epidemiological studies above indicate that fasting insulin levels were reduced in current cannabis users but not in former cannabis users or in those that never used it. This leads to the question as to whether THC may be of medical benefit to those already diagnosed with pre-diabetes or Type 2 Diabetes. Given that epidemiological evidence demonstrates there may be a correlation but not provide proof of causation, further study is warranted.

Some Final Thoughts…

Certainly as a reasonable precaution, those who are Diabetic and who will begin using marijuana now that it is legal (or already use marijuana) should monitor their body’s blood sugar response, especially if they are also taking medications to lower blood sugar. Assuming that cannabis can lower blood sugar on it’s own, taking it along with medications to lower blood sugar may result in blood sugar dipping too low (hypoglycemia).

Perhaps you’re curious how I can help you achieve your weight-loss and other health goals such as lowering risk factors for Type 2 Diabetes by making dietary and lifestyle changes. I provide both in person services in my Coquitlam, British Columbia office as well as via Distance Consultation (Skype, telephone). You can find out details under the Services tab above or in the Shop.

If you have questions regarding getting started or would like more information, please send me a note using the Contact Me form above and I will be happy to reply as soon as I’m able to.

To your good health!

Joy

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

Government of Canada, Cannabis Legalization and Regulation, http://www.justice.gc.ca/eng/cj-jp/cannabis/

Koch M, Varela L, Kim JG et al, Hypothalamic POMC neurons promote cannabinoid-induced feeding, Nature, Volume 519 (2015), pages 45–50

Penner EA, Buettner H, Mittleman MA, The Impact of Marijuana Use on Glucose, Insulin, and Insulin Resistance among US Adults, Amer J of Med, 126 (7) July 2013, Pages 583-589

Vidot DC, Prado D, Hlaing WM et al, Metabolic Syndrome Among Marijuana Users in the United States: An Analysis of National Health and Nutrition Examination Survey Data, Amer J of Med, 129 (2) Feb 2016, Pages 173-179

 

19 month update – A Dietitian’s Journey

This week has been 19 months since I started a low carbohydrate lifestyle and 10 months since I began following a ketogenic diet with my doctor’s and endocrinologist’s oversight and I’m very close to reaching most, if not all of my health and weight loss goals.

Weight

When I began my health and weight loss ‘journey’,  I had 30 lbs to lose to get to the preliminary weight goal that I set for myself — which was still in the overweight classification, but was the only goal that seemed theoretically attainable at the time.

When one is obese, it's difficult to imagine being anything but "only overweight", even for a Dietitian. As I do with my clients, I set a preliminary weight target that seemed it may be attainable.

I reached my preliminary goal weight in February of this year and said to myself “okay, now what“?  My waist circumference was still not 1/2 my height (associated with the lowest risk of cardiovascular disease, described in this article) so I carried on.

So far this year, I’ve lost 15 additional pounds and 4 more inches off my waist.

As I jokingly quipped on social media recently;

“my waist circumference is FINALLY half the height I was before I started shrinking… does that count?”

Based on my current height (an inch less than I was as a younger adult), I have another inch to lose. I’m so close!

I’m also 10 pounds from the weight I was before I had children — and given my twins will be 26 years old soon and my singleton will be 25 at Christmas, achieving my “pre-baby weight” has been a long time coming!

Me with my 3 sons in 2002

What We Believe is What We Achieve

I realized yesterday that what we believe is possible has a lot to do with what we achieve.

There are a handful of life goals that I thought I’d never achieve because I didn’t believe they were attainable, but after a few years of using a low carb approach with my clients and seeing their success, I started “practicing what I teach”… and here I am, 10 pounds from the weight I was before I had children. With having had twins and then a singleton within 14 months of each other, that is a lot of weight that was not lost previously by trying to cut calories and exercise more…plus the added weight I gained from eating foods that were a mixture of fat and carbohydrates because they were irresistible.

For the last number of months I have been steadily losing inches off my waist but without losing any weight at all. I knew that as long as I was losing either inches or pounds, I was not at a “plateau”, so I carried on.

Adapt Your Life Vancouver – September 15, 2018

September 15th, a little less than month ago, I had the opportunity to hear Dr. Eric Westman speak in Vancouver on the ketogenic diet that he uses in his own clinical practice.

Dr. Westman is Associate Professor of Medicine at Duke University Health System and the Director of the Duke Lifestyle Medicine Clinic and is an internationally known researcher specializing in low-carbohydrate nutrition. Dr. Westman is currently the Vice-President of the American Society of Bariatric Physicians and a fellow of the Obesity Society and the Society of General Internal Medicine and has co-authored three books to date, including The New Atkins for a New You (co-authored with Dr. Stephen Phinney and Dr. Jeff Volek).

I welcomed the opportunity to learn from someone that has been following a ketogenic lifestyle, researching and publishing about it and teaching it to his patients for many years.

One of things I learned was a very practical way to determine one’s idea body weight. According to Dr. Westman, it’s the adult weight that a person felt and looked their best at. The other thing that I learned was in his approach to following a strict ketogenic diet, there is a need to eliminate fruit and nuts. More on that later…

I began to think about what was the adult weight I felt and looked my best? 

I came up with what that weight was and thought to myself; “What? Really? That’s very…low!” To try to look at it more objectively, I asked myself if that weight was either unrealistic or unattainable.

My ‘best’ adult body weight is 18 pounds more than my lowest adult body weight (where overweight family members were concerned I had an eating disorder!) but is 5 pounds less than the weight I was before I had my children, including multiples. I concluded that this weight seems both attainable and realistic.

When I calculate my Ideal Body Weight, it’s the weight I was at 21 years old when family members worried about me and which was only sustained for a  very short time before my wedding. It was certainly not where my natural set point was when I was physical active and fit. That weight was where I looked and felt my best. Dr. Westman’s method made sense for me.

Calculated Ideal Body Weight

I’ve always found that calculated Ideal Body Weight (IBW) based on established formulas to be a discouraging and unattainable goal for my overweight or obese clients.

Ideal Body Weight (IBW) Formulas

Men: 50 kg + 2.3 kg for each inch over 5 feet
Women:
45.5 kg + 2.3 kg for each inch over 5 feet

Clinically, I’ve tended to use Adjusted Body Weight (ABW) as “ideal” with my overweight and obese clients as it is applicable if a person’s Actual Body Weight (what they currently weigh) is greater than 30% of the calculated Ideal Body Weight (IBW)To most, if not all of my overweight and obese clients, achieving Adjusted Body Weight usually seems like a Technicolor dream.

Adjusted Body Weight Formulas

Men and Women: IBW + 0.4 (actual weight – IBW)

For me, my Adjusted Body Weight is also the adult body weight that I felt and looked my best at so that is my next goal.

Using Dr. Westman’s method of aiming for the adult weight that I felt and looked my best, which is also my Adjusted Body Weight,  I still have ~15 pounds to lose.

The Exercise Factor

Something else I needed to factor in to my weight loss plan is the “exercise factor“. Now that my eating is no longer driven by cravings for carbohydrate, made worse by high insulin levels, I am naturally “eating less and moving more“; which is a natural outcome of eating a low carbohydrate diet, not a means to an end! I am ABLE to move more BECAUSE I am eating less!

For the last 6 weeks, I’ve been doing resistance training 4-5 times per week (using body weight, resistance bands and dumbbells and barbells) and this is resulting in me building and toning muscle.

I expected that my weight loss would be slowed because muscle is heavier, but that’s not actually happening.

Strict Ketogenic Diet – Dr. Eric Westman’s Approach

Since January (i.e. for the last 10 months) I have necessarily been following a ketogenic diet in order to lower my blood sugar to below the Diabetic range, eliminate high blood pressure and to achieve and maintain a waist circumference that is half my height. As I’ve told many of my clients, my level of carbohydrate intake is significantly lower than any Meal Plans that I have designed for others and this is because of the degree of metabolic disruption I had previously caused myself. I had been Type 2 Diabetic for 10 years, was obese and worse, was in complete denial about the health risk to myself until March 5, 2017 when this ‘journey’ began.

Dr. Westman taught at the conference was that in the weight-loss phase of a strictly ketogenic diet he recommends that his patients stick to real protein foods (meat, poultry, fish and shellfish and eggs), salad greens and low carbohydrate vegetables, plus limited quantities of healthy fats and oils, cheese and cream. What isn’t included in this phase of the ketogenic diet he has his patients follow is fruit and nuts, not even on salad.

Since I saw Dr. Westman speak on September 15th, I gave up nuts and fruit and since then, I’ve since lost 2 pounds and another 1/2 inch off my waist.

Effect on Blood Glucose

The effect of giving up fruit on blood glucose is also observable.

September 15-October 10 2018 blood glucose versus previous 2 months

During July and August it was local blueberry and blackberry season and I ate far too many, way too often. I justified that they are good antioxidants, which they are, but they are not ideal foods for someone like myself who’s been Type 2 Diabetic for 10 years…at least not at this stage of my metabolic reversal.

As can be seen in the graph of my own glucometer readings (above) my average blood glucose in July and August was 6.3 mmol/l (114 mg/dl). Since September 15th, I’ve cut out all fruit, not even a few berries on my salad and I no longer reach for nuts as part of a mid-day meal, but a hard boiled egg or hard cheese or fish, instead. My average blood glucose has dropped to 5.1 mmol/L (92 mg/dl).

Based on the literature, about half of this effect is due to the Metfomin that I continue to take (protective measure given the Alzheimer’s diagnosis of my father and family history of cardiovascular disease) and the other half is due to me having stopped eating fruit.

I am currently achieving normal blood sugar levels, which is amazing! Both my endocrinologist and I hope that in time she can withdraw the recently prescribed Metformin and I will be able to sustain my blood glucose with diet alone, once my liver and pancreas have more fully healed. Time will tell. In the meantime, I am doing everything I can do to get well and stay well.

NOTE: Keep in mind, these are my (n=1, sample set of 1) results based on my specific medical history and metabolic conditions. Since everybody's needs are different, there is no one-size-fits-all "low carb" diet for everyone.

Perhaps you wonder how a carefully-designed low carbohydrate or ketogenic diet could help you improve symptoms of Type 2 Diabetes, lower high blood pressure or simply lose weight? Please send me a note using the “Contact Me” form above to find out more.

Feel free check out the various services that I offer under the Services tab or in the Shop and if you’d like to get started, you’ll find everything you need there.

I provide both in-person in my Coquitlam, British Columbia office or via Distance Consultation on Skype of long distance phone, so please let me know how I can help.

To our good health,

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

ADA Deems Low Carb Diet Medical Nutrition Therapy for T2D

The American Diabetes Association (ADA) just released an updated position statement in conjunction with the European Association for the Study of Diabetes (EASD) which deems a low carb diet as Medical Nutrition Therapy for the treatment of Type 2 Diabetes in adults [1]. In fact, the joint position paper approves a diet of <130 g of carbs and states that a diet of >130 g carbs is ineffective for managing T2D.

The American Diabetes Association is responsible for educating over 30 million Americans diagnosed with Diabetes and the European Association for the Study of Diabetes (EASD) is responsible for overseeing the care of over 60 million Europeans and both now consider a low carbohydrate of < 130 g of carbohydrate not only safe, but effective therapeutic treatment. This recognition comes on the heels of Diabetes Australia having just released in late August their own updated position paper designed to provide practical advice and information for people diagnosed with Diabetes who are considering adopting a low carbohydrate eating plan [2].

What is Medical Nutrition Therapy?

Medical Nutrition Therapy (MNT) is defined as;

“nutritional diagnostic, therapy and counseling services for the purpose of disease management, which are furnished by a Registered Dietitian or nutrition professional” [3].

The American Diabetes Association and the European Association for the Study of Diabetes preface their updated position statement by saying;

“A systematic evaluation of the literature since 2014 informed new recommendations.”

That is, upon a review of the most current research, these two organizations have updated their prior position statements and now consider a low carbohydrate diet defined as <26%* of daily calories as carbohydrate [1] is suitable for the purpose of disease management of Type 2 Diabetes in adults.

*Note: based on an 1800-2000 calorie per day diet this amount of daily carbohydrate would be less than < 113-125 g daily. In fact, the position paper concludes that carbohydrate restriction of 26–45%  is ineffective.

The new joint position statement elaborates that Medical Nutrition Therapy (MNT) is made up of an education component and a support component in order to enable patients to adopt healthy eating patterns with the purpose of “managing blood glucose and cardiovascular risk factors” and “reducing the risk for Diabetes-related complications while preserving the pleasure of eating” [1].  The paper defines the two basic dimensions of MNT as diet quality and energy restriction and outlines the benefits of a low carbohydrate diet in the section on diet quality.

page 12 of the joint position statement (courtesy of Jan Vyjidak)

Furthermore, the joint consensus paper lists  under diet quality (Table 2, page 13) which is one of the aspects of Medical Nutrition Therapy, several diets considered suitable for adults with Type 2 Diabetes, including a low carbohydrate diet.

Table 2 —Glucose-lowering medications and therapies available in the U.S. or Europe

This move has far-reaching significance!

It moves a low carbohydrate diet from the realm of a popular lifestyle approach to Medical Nutrition Therapy.

Most importantly, this consensus paper means that qualified healthcare professionals throughout the USA and Europe can now recommend a low carbohydrate diet to their adult patients in order to enable them to manage their Type 2 Diabetes. This is a huge step forward from only being able to provide such a diet based on person’s individual preference to follow a low carbohydrate lifestyle.

Publication of this paper indicates that the current scientific literature supports that a low carbohydrate is safe and effective in lowering metabolic markers of Type 2 Diabetes, as well as  delaying or eliminating the need for blood-glucose lowering medications for up to 4 years [1].

Some final thoughts…

The American Diabetes Association, European Association for the Study of Diabetes and Diabetes Australia have collectively led the way for international Diabetes Associations the world over to re-evaluate their own treatment and dietary recommendations in light of the most current scientific evidence and update their position statements regarding the safe and effective use of low carbohydrate diets in the management of Type 2 Diabetes in adults.

Here’s hoping this will occur in a timely manner.


Perhaps you have wanted to follow a low carbohydrate lifestyle and have questions about how such a diet could help you manage some of your clinical conditions or lose weight. Please send me a note using the Contact Me form above and I will reply as soon as I am able.

Whether you live locally or away, I provide services in-person in my Coquitlam (British Columbia) office, as well as via Distance Consultation (Skype or phone).  You can find more information under the Services tab and in the Shop including the Intake and Service Option form to send in to get started.

To your good health!

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.


you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Davies M.J., D’Alessio D.A., Fradkin J., et al, Management of Hyperglycemia
    in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care, October 2018,  https://doi.org/10.2337/dci18-0033
    Click here for pdf of the full article.
  2. Diabetes Australia, Low Carbohydrate Eating for People with Diabetes – Position Statement, August 2018,  https://www.diabetesqld.org.au/media-centre/2018/august/low-carb-position-statement.aspx and https://www.diabetesqld.org.au/media/583017/da-low-carb-statement-21-august-2018.pdf
  3. U.S. Department of Health and Human ServicesFinal MNT regulationsCMS-1169-FCFederal Register1 November 200142 CFR Parts 405, 410, 411, 414, and 415

 

ADA & European Association Classify Low Carb Diets as Medical Nutrition Therapy

The new joint American Diabetes Association (ADA) / European Association for the Study of Diabetes (EASD) position paper [1] published online ahead of print on October 4th now classifies a low carbohydrate diet as Medical Nutrition Therapy. in the treatment of Type 2 Diabetes in adults. What this means is these two organizations which are responsible for educating over 30 million Americans and 60 million Europeans diagnosed with Diabetes consider a low carbohydrate not only safe, but effective therapeutic treatment. This recognition comes on the heels of Diabetes Australia having just released in late August their own updated position paper designed to provide practical advice and information for people diagnosed with Diabetes who are considering adopting a low carbohydrate eating plan [2].

What is Medical Nutrition Therapy?

Medical Nutrition Therapy (MNT) is defined as;

“nutritional diagnostic, therapy and counseling services for the purpose of disease management, which are furnished by a Registered Dietitian or nutrition professional” [3].

The American Diabetes Association and the European Association for the Study of Diabetes preface their updated position statement by saying;

“A systematic evaluation of the literature since 2014 informed new recommendations.”

That is, upon a review of the most current research, these two organizations have updated their prior position statements and now consider a low carbohydrate diet defined as <26%* of daily calories as carbohydrate [1] is suitable for the purpose of disease management of Type 2 Diabetes in adults.

*Note: based on an 1800-2000 calorie per day diet this amount of daily carbohydrate would be less than < 113-125 g daily. In fact, the position paper concludes that carbohydrate restriction of 26–45%  is ineffective.

The new joint position statement elaborates that Medical Nutrition Therapy (MNT) is made up of an education component and a support component in order to enable patients to adopt healthy eating patterns with the purpose of “managing blood glucose and cardiovascular risk factors” and “reducing the risk for Diabetes-related complications while preserving the pleasure of eating” [1].  The paper defines the two basic dimensions of MNT as diet quality and energy restriction and outlines the benefits of a low carbohydrate diet in the section on diet quality.

page 12 of the joint position statement (courtesy of Jan Vyjidak)

Furthermore, the joint consensus paper lists  under diet quality (Table 2, page 13) which is one of the aspects of Medical Nutrition Therapy, several diets considered suitable for adults with Type 2 Diabetes, including a low carbohydrate diet.

Table 2 —Glucose-lowering medications and therapies available in the U.S. or Europe

This move has far-reaching significance!

Publication of this paper indicates that the current scientific literature supports that a low carbohydrate is not only safe for use in adults, but is also effective in lowering metabolic markers of Type 2 Diabetes, as well as  delaying or eliminating the need for blood-glucose lowering medications for up to 4 years [1].

It moves a low carbohydrate diet from the realm of a popular lifestyle approach to Medical Nutrition Therapy.

Most importantly, this consensus paper means that qualified healthcare professionals throughout the USA and Europe can now recommend a low carbohydrate diet to their adult patients in order to enable them to manage their Type 2 Diabetes. This is a huge step forward from only being able to provide such a diet based on person’s individual preference to follow a low carbohydrate lifestyle.

Some final thoughts…

The American Diabetes Association, European Association for the Study of Diabetes and Diabetes Australia have collectively led the way for international Diabetes Associations the world over to re-evaluate their own treatment and dietary recommendations in light of the most current scientific evidence and update their position statements regarding the safe and effective use of low carbohydrate diets in the management of Type 2 Diabetes in adults.


Perhaps you have wanted to follow a low carbohydrate lifestyle and have questions about how such a diet could help you manage some of your clinical conditions or lose weight. Please send me a note using the Contact Me form above and I will reply as soon as I am able.

Whether you live locally or away, I provide services in-person in my Coquitlam (British Columbia) office, as well as via Distance Consultation (Skype or phone).  You can find more information under the Services tab and in the Shop including the Intake and Service Option form to send in to get started.

To your good health!

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.


you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Davies M.J., D’Alessio D.A., Fradkin J., et al, Management of Hyperglycemia
    in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care, October 2018,  https://doi.org/10.2337/dci18-0033
    Click here for pdf of the full article.
  2. Diabetes Australia, Low Carbohydrate Eating for People with Diabetes – Position Statement, August 2018,  https://www.diabetesqld.org.au/media-centre/2018/august/low-carb-position-statement.aspx and https://www.diabetesqld.org.au/media/583017/da-low-carb-statement-21-august-2018.pdf
  3. U.S. Department of Health and Human ServicesFinal MNT regulationsCMS-1169-FCFederal Register1 November 200142 CFR Parts 405, 410, 411, 414, and 415

 

 

American Diabetes Association & European Association Approve Low Carb Diets

The American Diabetes Association (ADA) & the European Association for the Study of Diabetes (EASD) have just released their new joint position statement which includes approval of low carbohydrate diets for use in the management of Type 2 Diabetes (T2D) in adults. This comes on the heels of Diabetes Australia having recently released an updated position statement in August titled Low Carbohydrate Eating for People with Diabetes (you can read more about that here).

This is huge!

By releasing this updated joint position statement, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) indicate that they now recognize a low carbohydrate diet as safe and effective lifestyle management of T2D in adults.

In the newly released joint position statement that was published online ahead of print on October 4, 2018 in the journal Diabetes Care, it was stated that the new recommendations were based on “a systematic evaluation of the literature since 2014” [1].  That is, approval for the use of low carbohydrate diets is based on current research.

A Full Range of Therapeutic Options

The new joint ADA & EASD position statement endorses “a full range of therapeutic options” including lifestyle management, medication and obesity management and indicate that:

“An individual program of Medical Nutrition Therapy (MNT) should be offered to all patients”.

The new joint position statement elaborates that Medical Nutrition Therapy (MNT) is made up of an education component and a support component to enable patients to adopt healthy eating patterns with the goal of “managing blood glucose and cardiovascular risk factors.” The goal is to reduce risk for Diabetes-related complications while preserving the pleasure of eating” with the two basic dimensions of MNT including diet quality and energy restriction.

Diet Quality and Eating Patterns

The joint American and European position paper on the management of T2D states clearly;

“There is no single ratio of carbohydrate, proteins and fat intake that is optimal for every person with Type 2 Diabetes.”

but

“Instead, there are many good options and professional guidelines usually recommend individually selected eating patterns that emphasize foods of demonstrated health benefit, that minimize foods of demonstrated
harm and that accommodate patient preference and metabolic needs, with the goal of identifying healthy dietary habits that are feasible and sustainable.”

Included in this category are;

  • the Mediterranean Diet
  • the Dietary Approaches to Stop Hypertension (DASH) Diet
  • Low Carbohydrate Diets
  • Vegetarian Diets

The joint position paper noted that;

“Low-carbohydrate diets (<26% of total energy) produce substantial reductions in HbA1c at 3 months and 6 months with diminishing effects at 12 and 24 months.”

Unfortunately the paper failed to note that the one-year Virta study data that reported that HbA1C continued to decline at one year but yes, a diminished rates.

The new joint ADA and European Association for the study of Diabetes also noted that moderate carbohydrate restriction was of no benefit;

“no benefit of moderate carbohydrate restriction (26–45%) was observed.”

page 12 of the joint position statement (courtesy of Jan Vyjidak)

The paper acknowledged that there are many different types of “low carbohydrate diets’ and the particular benefits of a low – carbohydrate Mediterranean eating pattern was in reducing the requirement for medication over 4 years;

“people with new-onset Diabetes assigned to a low carbohydrate  Mediterranean eating pattern were 37% less likely to require glucose-lowering medications over 4 years compared with patients assigned to a low-fat diet”.

The paper outlines that the primary physiological actions depend on which diet is followed.

It lists advantages of using diet, including a low carbohydrate diet in the management of T2D symptoms in adults is that dietary changes are inexpensive and have no side effects

Disadvantages of using diet, including a low carbohydrate diet in the management of T2D symptoms in adults is that it requires instruction, motivation, lifelong behaviour change and may pose some social barriers.

Yes, a well-designed low carbohydrate diet does require instruction, but for those that have the motivation to avoid the chronic health complications of Diabetes through diet and who are committed to maintaining the behaviour change, I can help!

Perhaps you’re curious about the types of services that I provide both in person in my Coquitlam, British Columbia office and via Distance Consultation (Skype, telephone)? You can find out more under the Services tab or in the Shop.  If you have questions regarding getting started or would like more information, please send me a note using the Contact Me form above and I will be happy to reply as soon as I’m able to.

To your good health!

Joy

P.S. Read here why the ADA and EASD classifying a low carb diet as Medical Nutrition Therapy is so significant!

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Davies M.J., D’Alessio D.A., Fradkin J., et al, Management of Hyperglycemia
    in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), Diabetes Care, October 2018,  https://doi.org/10.2337/dci18-0033
    Click here for pdf of full article.
  2. Diabetes Australia, Low Carbohydrate Eating for People with Diabetes – Position Statement, August 2018,  https://www.diabetesqld.org.au/media-centre/2018/august/low-carb-position-statement.aspx and https://www.diabetesqld.org.au/media/583017/da-low-carb-statement-21-august-2018.pdf
  3. Hallberg, S.J., McKenzie, A.L., Williams, P.T. et al. Diabetes Ther (2018). Effectiveness and Safety of a Novel Care Model for the Management of Type 2 Diabetes at 1 Year: An Open-Label, Non-Randomized, Controlled Study.  https://doi.org/10.1007/s13300-018-0373-9

Silver Bullet for Addressing Carb Cravings

I was asked an interesting question recently which was “have you found the silver bullet for reducing carb craving“? This was an interesting way to phrase something I have been asked in many different ways the last few years.

Some people have been told that it really doesn’t matter what or how much they eat as long as they only eat “real” food. Others have heard that they need to eat plenty of fat each day, and that this will work to keep them full and reduce cravings. Some have read that what they need to do is eat mostly protein with some fat or only eat during a very small ‘eating window’.

So what is the answer?

There really isn’t a ‘silver bullet’ as much as there is the need for a well-designed low carbohydrate diet that is specific to each person’s physiological needs.

Every person has different nutrient needs based on their age, stage of life, gender and activity level. As well, each individual has different degrees of insulin resistance and hyperinsulinemia and each person’s blood sugar responds differently to a carbohydrate load (called glycemic response). Much of these depends on their specific family history, their medical history and the type of foods they normally eat. [You can read more about all three of these here.]

There isn’t a “once-size-fits-all low carb diet”.  Based on all of the above factors, some people will do better with a higher ratio of protein to fat, whereas others need plenty of natural, healthy fats and average amount of protein. The amount and type of carbohydrate each person can tolerate will also be different. Since everyone’s needs are different, in designing a Meal Plan for someone, I start by conducting a complete nutritional assessment (personal medical history, family medical history, review of recent lab tests, dietary and lifestyle review, etc.) so that the Meal Plan that I design is tailored to their individual needs.

If there was a ‘silver bullet’ to eliminate carb cravings it would be to understand what causes them. Carb cravings are driven by several different hormones that the body produces in response to the way each person eats, as well as how much and how well they sleep, how they manage stress (or don’t), as well as any conditions or diseases that they have and any medications that they take.  All of these affect the various hormones that impact cravings for carbohydrate-based food. When I design people’s Meal Plans, I take all of these into account.

A well-designed low carbohydrate diet designed specifically for each person and taking into account the various factors that are driving their specific carbohydrate cravings is the most effective means to addressing them.

A person’s Meal Plan is not carved in stone. If a person has a fair amount of weight to lose, their Meal Plan will change once they’ve lost a significant amount of weight or if they’ve hit a plateau where they haven’t lost either weight or inches in a while.  Achieving optimal body weight is a dynamic process not a static one — as people’s needs change, so should their diet.  It’s not that a person’s Meal Plan needs to be re-designed, as much as ‘tweaked’ or ‘adjusted’ to keep them moving towards achieving their goals. This is where follow-up can be helpful.

If you have questions as to how I can help you achieve your health and nutrition goals — either by taking service in-person in my office or via Distance Consultation please send me a note using the Contact Me form above and I will be happy to reply as soon as I am able.

To your good health!

Joy

If you would like to read well-researched, credible “Science Made Simple” articles on the use of a low carb or ketogenic diet for weight loss, to improve or reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

 

A Trial of the Evidence

In a landmark decision yesterday the Australian Health Practitioner’s Regulation Agency (AHPRA) dropped all charges of wrong-doing against orthopedic surgeon Dr. Gary Fettke for recommending a low carb high fat lifestyle to his patients. This is great news for a physician who had tired of amputating the gangrenous limbs of patients with uncontrolled Diabetes when lifestyle changes could not only spare their limbs, but their lives. It was not only Dr. Fettke that was investigated, but also the strength of the scientific evidence behind his dietary recommendation of a low carbohydrate diet. That is the subject of this article.

It is great news that AHPRA ruled that Dr. Fettke had caused no patient harm by his recommendation of a low carb high fat (LCHF) diet:

“…no significant risks to public safety have been identified that require a regulatory response under the National Law. In the case of each of the three issues considered, there is no evidence of any actual harm and nor does the Board discern any particular risk to public health and safety moving forward. For these reasons, the Board has decided to take no further regulatory action.”

— AHPRA medical board

It is outstanding that AHPRA apologized in writing to Dr. Fettke for the 4½ years of distress caused to him by the investigative process;

“I would like to take this opportunity to apologize for the errors that were made when dealing with this notification. We recognize that these errors are likely to have compounded any distress that you experienced as a result of being the subject of this investigation. We appreciate your cooperation and engagement through the complaint management process, and the reconsideration of the previous decision.”

— AHPRA medical board

This is fantastic news and must come as a tremendous relief both to Dr. Fettke and to his family who have endured untold stress from this long ordeal.

Dr. Fettke’s exoneration comes on the heels of the results of not one, but two trials over a 4-year period against South African Professor Tim Noakes for his response to a tweet on Twitter social media from a breastfeeding mother in February 2014 where he recommended that good first foods for infant weaning are low carbohydrate high fat foods. As noted by Dr. Sarah Hallberg in a letter to the Health Professions Council of South Africa (HPCSA), low carbohydrate foods such as meat, chicken, fish and leafy green vegetables align closely with South Africa’s pediatric guidelines which advise that;

“From 6 months of age give your baby meat, chicken, fish, or egg every day as often as possible. Give your baby dark green leafy vegetables and orange coloured vegetables and fruit every day.”

—Food-based Dietary Guidelines for South Africa

In April 2017 and again in the appeal which concluded in June of this year, Noakes was cleared of all charges of professional misconduct by the HPCSA which confirmed that his advice to the breastfeeding woman in his tweet was neither “unconventional” nor “dangerous medical advice“.

In June, Noakes’ lawyer Adam Pike said in a statement that the HPSCA’s ruling;

“preserves the right of scientists and doctors to express scientific opinions and disseminate medical information”

— Adam Pike, Professor Tim Noakes’ lawyer

Phrased another way, Noakes acted as a scientist who tweeted scientifically based information.

While it was Dr. Gary Fettke and Professor Tim Noakes that have been investigated as individuals, what was largely on trial was the scientific evidence behind their recommendation of a low carbohydrate diet. This evidence indicates that well-designed low carbohydrate diets are both safe and effective for treating obesity and for managing the symptoms of Type 2 Diabetes.

In an article I wrote in January 2018 titled A Preponderance of the Evidence, I documented that not only is a low carbohydrate diet for the treatment of Diabetes not new, but almost a year ago there were already many research  studies and meta-analyses published in 76 publications which spanned 18 years which involved 6,786 subjects which used a low-carb intervention — which included 32 studies of 6 months or longer and 6 studies of 2 years or longer all of which indicated that a low carbohydrate diet is safe. Not only has it been amply documented that a low carbohydrate diet is safe, but a low carbohydrate diet performed as well, if not better than competing diets in all of the above studies.  Dr. Sarah Hallberg who compiled the above list is Medical Director at Indiana University Health Arnett and Virta Health Medical Director. She pointed out in a letter to the Health Professions Council of South Africa that data available from the US government as reported in a 2015 study indicates that in 1965 (which is just prior to the beginning of the current obesity and Diabetes epidemic) Americans ate 39% of their calories as carbohydrate and 41% of their calories as fat which is considered by many nutrition researchers today to fall within the realm of a “low carbohydrate high fat diet”. Dr. Hallberg is correct. Dietary Guidelines in both the US and Canada currently recommend that the diet be 45-65% of calories as carbohydrates and that up until 2015, the US recommended a upper limit of 35% calories as fat (<30% of calories as fat in Canada). Both countries currently still recommend limiting saturated fat to <10% of calories.

Nutrition researchers today generally consider diets less than 45% of calories as carbohydrate and >35% of calories as fat to be "low carbohydrate high fat diets", so the average American diet that was 39% carbohydrate and 41% fat in 1965 would be considered "low carb high fat" by most nutrition research studies today. 

Given the much lower rates of overweight and obesity and Type 2 Diabetes in 1965 — at a time when the average American ate what is now considered a “low carb high fat diet”, should not such a macro distribution be granted “generally recognized as safe” (GRAS) standing?

For the last 40 years, the Dietary Guidelines in both the US and Canada have been counselled people to limit fat, especially saturated fat and to eat 45-65% of their calories as carbohydrate yet even a cursory look at the rates of overweight and obesity in both countries and the steadily increasing rates of Type 2 Diabetes indicates that something is terribly wrong. Clinicians (Physicians, Dietitians, Pharmacists) educated since 1977 which is the vast amount practicing in both countries (and in South Africa and Australia apparently, where Dr. Fettke and Professor Noakes are from) have all been educated within a “low fat paradigm”— where fat is vilified as the cause of cardiovascular disease and increasing carbohydrate intake is promoted as the ‘solution’ to reducing fat intake. Unless clinicians educated in this time period stayed current with the literature they simply keep teaching what they were taught; eat less fat, eat more carbs.

In the past number of years there are increasing numbers of clinicians around the world that have considered the evidence; both epidemiological and clinical studies that indicate that a low carbohydrate high fat diet not only has no adverse impact on individual health but is safe and effective for reducing overweight and obesity, as well as reducing (and in some cases reversing) the symptoms of Type 2 Diabetes. Two such clinicians are Australian orthopedic surgeon Dr. Gary Fettke and South African Professor Tim Noakes; both of whom were investigated for having recommended a low carb high fat diet which was viewed as “dangerous” and both of whom, when the scientific evidence was considered, were exonerated. To their credit both Dr. Fettke and Professor Noakes conducted themselves with integrity and transparency through the entire process and all charges of wrong-doing against them were dropped, but let’s not lose sight that it was also because of the amount and strength of the scientific evidence which indicates that a well-designed low carbohydrate high fat diet is both safe and effective for weight loss, as well as for reducing symptoms of Type 2 Diabetes.

Both men have no doubt been through a very distressing and incredibly stressful >4-year ordeal which forever changed them and their families that went through it with them, however this story is not only about them but what they believed about the safety and efficacy of a low carb diet. It was low carb high fat diets that were investigated and put on trial and the conclusion in both cases as that such a diet is neither unconventional nor dangerous.

Yes, there are other dietary options for weight-loss and targeting the reduction of symptoms of Type 2 Diabetes and diets such as the classic Mediterranean Diet or a very low-fat calorie-restricted plant-based diet are effective for those that maintain them long term. The issue is that a well-designed low carbohydrate diet is at least as effective as these and may be easier for some to stick with long term, making it more effective for those individuals. Since the scientific evidence indicates that all three of these diets are safe and to varying degrees effective for weight loss and glycemic control, it is time for clinical guidelines in both the US and Canada to be formulated to enable clinicians in both countries to offer their patients a well-designed low carbohydrate diet as an option.

Perhaps you have questions about whether a low-carbohydrate diet would be appropriate for you or wonder how medical conditions you have or medications you take may factor in? I provide both in-person services in my Coquitlam (British Columbia) office, as well as via Distance Consultation using Skype or phone and I would be happy to answer your questions and help you reach your goals. Please send me a note using the “Contact Me” form on the tab above and will reply as soon as possible.

To your good health,

Joy

If you would like to read well-researched “Science Made Simple” articles on the use of a low carbohydrate diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please click here for a list of articles by topic.

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

References

  1. Fettke Free at Last, Foodmed.net, Sept 28 2018 (http://foodmed.net/2018/06/noakes-free-hpcsa-licks-wounds-lchf/)
  2. Noakes: Top Doctors Globally call on HPCSA to Stop Prosecuting Him, Foodnet.net, February 14, 2018
  3. Food-based Dietary Guidelines for South Africa, S Afr J Clin Nutr 2013;26(3)(Supplement):S1-S164
  4. Noakes Free at Last, Foodmed.net, June 10 2018 (http://foodmed.net/2018/06/noakes-free-hpcsa-licks-wounds-lchf/)
  5. Cohen E, Cragg M, deFonseka J et al, Statistical review of US macronutrient consumption data, 1965–2011: Americans have been following dietary guidelines, coincident with the rise in obesity, Nutrition (2015), Vol 31 (5), Pg 727-732.

Extended Benefits?

Many people only think about using up their extended benefits in November and December but here are 3 reasons why now is the best time:

    1. Getting a Meal Plan takes a bit of time – After you’ve sent in the intake paper work, there is setting the first appointment for your assessment. The Assessment visit usually takes an hour and a half and afterwards, there’s the time that I need in order to design your individual Meal Plan based on your specific needs and preferences. Waiting until the last minute means there will be several other people’s plans to design ahead of yours and it may be difficult to find a one and a half hour slot at a time that’s convenient for you. Then there’s the appointment time for us to meet for me to go over your Meal Plan with you, and to teach you simple, yet accurate ways to estimate your portion sizes, as well as to answer your questions. Booking in October means you will have your Meal Plan sooner and have time to implement it long before the holiday season!
    2. Time for support and follow-up – some people want some follow-up over the first few weeks in implementing their Meal Plan and waiting until November or December often doesn’t provide enough time for that. Most extended benefits plans will only reimburse for services once they’ve been completed, so getting started now means you will have the support and follow-up you want.
    3. A discount! This year, in order to limit the amount of overtime I need to work in November and December, I’ve decided to offer incentive for people to book their Assessment in the first 3 weeks of October and what better way then by offering you savings?
      From now until Friday October 19th, mention this ad and get $50 off a Complete Assessment Package.

Ready to get started? 

Please download and complete the Intake and Service Option Form available here and return it to me at the email address listed on the form. If you can send it to me with a copy of your most recent blood test results that will save time.

That’s it! That’s all that’s needed to get started.

Appointment Times

I can provide you with a choice of appointment times and you can book the time that suits you best.

Payment Methods

If you’re seeing me in-person you can pay by cheque or by e-transfer made out to the business, and if you are taking services via Distance Consultation (Skype, telephone) you can pay via credit card on the secure server in the Shop.

Have questions?

Please send me a note using the Contact Me form on the tab above and I will reply as soon as possible.

I look forward to working with you!

To your good health,

Joy

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Chili Lime Salt-Roasted Almonds

Last weekend I felt like something yummy; something like popcorn with butter and salt or fresh corn tortilla chips. As a Type 2 Diabetic in partial remission I’ve worked to long to get healthy and either of those wouldn’t have been helpful for me to eat.

I grabbed some raw almonds, drizzled them with some almond oil (but any good quality nut or seed oil would have done) and tossed them all around until they were well coated and shiny and placed them on a double layer of aluminum foil.   I preheated the oven to 350°F and then topped them with a healthy amount of freshly-ground sea salt and roasted them for 15 minutes until they were slightly golden and smelled aromatic.

Tajin Seasoning® – chili, sea salt and lime

When I pulled them out of the over, I bathed them liberally with Tajin Seasoning® – a Mexican spice mixture of mild chili pepper and dehydrated lime juice (available at most supermarkets that carry international foods).

That was it!

I’ve enjoyed these so much, I thought others would too.

Chili Lime Salt-Roasted Almonds

Ingredients

5 oz / 140 g raw almonds
2 Tbsp almond oil (or other cold-pressed nut or seed oil)
1 tsp freshly ground sea salt
1 – 2 tsp Tajin Seasoning®

Method

  1. Preheat oven to 350°F
  2. Place raw almonds on a piece of folded heavy duty aluminum foil with the edges folded up to make a little pan
  3. Drizzle liberally with almond oil (or other cold-pressed nut or seed oil)
  4. Top with a liberal amount of fresh ground sea salt
  5. Bake 10-15 minutes, until golden in colour and they smell aromatic
  6. Remove from oven and when still hot, top with desired amount of Tajin Seasoning®.

Enjoy!

freshly roasted Chili Lime Salt-Roasted Almonds

Macros – per 28 g / 1 oz

Protein: 6 g
Fat: 19.5 g fat (monounsaturated fat)
Carbs: 6 g


If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

You can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Low Carb and Ketogenic Diets – articles by topic

Are you looking for well-researched, credible articles about the therapeutic use and practical applications of Low Carbohydrate and Ketogenic Diets, as well as related topics? You’ve come to the right place!

I have written 100+ “Science Made Simple” articles that people without a science background can easily understand and apply and that are now arranged by topic so that they are easy to find.

Current list of topics includes:

-Low Carb High Fat (LCHF) Diets

-Ketogenic (Keto) Diets

-Therapeutic Low Carb Diets

-Low Calorie / Low Fat Diets

-Diet & Food Choices

-Myths about Low Carb / Keto Diets

-Low Carb / Keto Diets & Medications

-Dietary Fat

-Carbs & Carbs with Fat

-PUFA / Industrial Seed Oils

-Effects of Food Processing on Insulin and Blood Sugar

-Insulin Resistance

-Type 2 Diabetes

-Cardiovascular Disease (CVD)

-Older Adults & Diet

-Concerns and “Warnings”

-Clinical

-Setting Health and Nutrition Goals

-Anthropometrics (Body Measurements)

-Practical Applications

-Media

-Background & History

These articles are located under the Food for Thought tab located above or you can click here.

Perhaps you have questions about how I can support you in following either a low-carb or ketogenic diet — either remotely via Distance Consultation (Skype, long distance phone) or in-person in my Coquitlam (British Columbia) office? Please send me a note using the Contact Me form and I will reply shortly.

To your good health!

Joy


you can follow me at:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.

Are Low Carbohydrate Diets Linked to Risk of Premature Death?

Once again, dire warnings about the alleged dangers of “low carbohydrate diets” scream out from headlines across the internet;

“Low-Carb Diets Linked to Higher Risk of Premature Death”

~Newsweek August 28, 2018, 12:51 PM

“Low carbohydrate diets are unsafe and should be avoided, study suggests”

~ScienceDaily, August 28, 2018

The general public relies on journalists to thoroughly research their stories before publishing them however in the above two examples and the other incidences of reporting this story it was not indicated that (1) there was no published study (2) the story was based on researcher’s conclusions in provided materials based on an Abstract from a Poster presentation and (3) the provided materialsAbstract didn’t define the term “low carbohydrate” (# of grams of carbohydrate per day) which is central to the claims of the researchers.

The supposed link to “premature death” of a “low carbohydrate diet” were said to be part of a large study that was presented at the European Society of Cardiology (ESC) Congress 2018 in Munich, Germany, but when I went to find the journal in which the study was published so I could read it, I discovered that it’s not even been published yet.  I even checked the lead author’s Publication page on ResearchGate and could not find the published study. Furthermore, the findings were not presented as one of the more than 500 Conference sessions of research studies at the European Society of Cardiology Congress, but was one of the 4,500 Abstract presentations — not even as a talk, but as a Poster Session.

A “Poster Session” at  an academic Conference is where 100s of researchers assemble in a large hall and stand in front of a poster summarizing their research. People walk by, look at the poster and if they wish, ask questions.

Journalists wrote stories based on “materials provided to them by the European Society of Cardiology” (see story source at bottom of ScienceDaily article) which is based on the Abstract available on the website of the European Society of Cardiology’s 2018 Congress from the yet-to-be-published study by M. Mazidi  (Gothenburg, Sweden), N Katsiki (Thessaloniki, Greece), DP Mikhailidis (London, Great Britain) and M Banach (Lodz, Poland) and also published the same day (August 28, 2018) in the European Heart Journal, Volume 39 Supplemental on pages 1112-1113.

The Abstract (viewable below) is downloadable from the journal’s website and the 2018 Congress website and clearly indicates that it was a “Poster Session”.

A glaring omission from the Abstract is that it is not stated anywhere how many grams of carbohydrate per day is defined as a “low carbohydrate diet”.

The Abstract and supplied press materials claim that there is a relationship between “low carbohydrate diets” (not defined!) and death from all-causes, as well as specific death from coronary heart disease, cerebrovascular disease (stroke) and cancer and that the data analyzed was based on a representative sample of 24,825 participants of the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2010.

The researchers conclude that compared to participants with the highest carbohydrate consumption (also not defined!), those with the lowest carbohydrate intake had a 32% higher risk of all-cause death during the ~6.4-year follow-up. As well, the risk of death from coronary heart disease from “low carbohydrate”diets was 51% higher, from cerebrovascular disease (stroke) was 50% higher and from cancer was 35% higher. They furthermore state that their results were confirmed by a pooled meta-analysis of 7 prospective cohort studies with 447,506 participants and which had an average follow-up of 15.6 years which indicated that risk of death from all causes resulting from “low carbohydrate diets” was 15% higher, from cardiovascular disease was 13% higher and from cancer was 8% higher compared to high carbohydrate diets.

Wait a minute…

The researchers found risk of death from coronary heart disease and cardiovascular disease (heart attack and stroke) as ~50% higher and the pooled data of the studies they compared it to found a 13% higher incidence. Even without defining what a “low carbohydrate diet” is, a 50% increased chance of death is not comparable to a 13% increased chance of death.  Similarly, the researchers found risk of death from cancer from a “low carbohydrate diet” was 35% greater and said their findings were comparable to an 8% higher incidence in the pooled data.

The researchers (1) did not define how many grams of carbohydrate per day was considered a “low carbohydrate diet” and (2) said their data was confirmed by studies that reported very different results.

Yet, they conclude;

Our study highlighted the unfavorable effect of low carbohydrate diets (LCDs) on total- and cause- specific mortality, based on both individual data and by pooling previous cohort studies. Given the fact that LCDs may be unsafe, it would be preferable not to currently recommend these diets. Further studies to clarify the mechanisms involved in these associations and to support our findings are eagerly awaited.

Which “low carbohydrate diet” did they study? How many grams of carbohydrate per day? We don’t know because the Abstract doesn’t say and the study hasn’t yet been published.

Some Final Thoughts…

It is not responsible journalism for the media to scream headlines warning of higher risk of premature death from “low carbohydrate diets” based on supplied press materials and an Abstract of a Poster Session of an unpublished study that doesn’t even define “low carb”.

There are many studies and meta-analyses using a low-carbohydrate or ketogenic dietary intervention that span 18 years and that are outlined in detail in 76 publications involving  6,786  subjects and that include 32 studies of 6 months or longer and 6 studies of 2 years or longer that demonstrate that low carb diets of a specified number of grams of carbohydrate per day are both safe and effective. You can read more about that here.

Perhaps you have questions such as is a low-carbohydrate diet appropriate for you given your health goals, medical conditions or medications you are taking? Please feel free to send me a note using the “Contact Me” form and I will reply as soon as possible.

I provide both in-person services in my Coquitlam (British Columbia) office as well as Distance Consultation services (via Skype / long distance phone) and I’d be happy to help you achieve your health and nutrition goals.

To our good health,

Joy

If you would like to read more well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

You can follow me on Twitter and Facebook:

 https://twitter.com/lchfRD

  https://www.facebook.com/lchfRD/

Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.)

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Low carbohydrate diets and all cause and cause-specific mortality – page 1

 

Low Carb diets and all cause mortality – European Society of Cardiology_Page_2

 

Reference

Mazidi M, Katsiki N, Mikhailidis DP et al, Abstract (P5409): Low carbohydrate diets and all-cause and cause-specific mortality: a population based cohort study and pooling prospective studies, European Heart Journal, Volume 39 (Supplemental), pages 1112-1113.