More Protein Please

A great study shows an inverse association between Protein intake and body composition (Clin Med Insights Endocrinol Diabetes. 2010; 3: 25–35. Higher Dietary Protein Intake is Associated with Lower Body Fat in the Newfoundland Population. Kristian K. Green, Jennifer L. Shea, Sudesh Vasdev, Edward Randell, Wayne Gulliver, and Guang Sun).

Results:
Significant inverse relationships were observed between dietary protein intake (g/kg body weight/day) and weight, waist circumference, waist-to-hip ratio, BMI, %BF, and %TF (P < 0.001). Significant positive relationships were observed with %LM and %TLM (P < 0.001). Additionally, significant differences in weight (12.7 kg in men, 11.4 kg in women), BMI (4.1 BMI units in men, 4.2 units in women), and %BF (7.6% in men, 6.0% in women) were observed between low and high dietary protein consuming groups (P < 0.001). Dietary protein explained 11% of the total variation in %BF in the NL population.

Conclusion:
This study provides strong evidence that higher protein intake, even in the absence of energy restriction, is associated with a more favorable body composition in the general population.

Eat more protein, get leaner.

 

Thoughts on the Zone Diet

The Zone Diet seeks to create a fixed mix of macros by specifying fat, carbs and protein levels. The starting point is:

The numbers are in percentage of calories. On a “standard” 2000 calorie diet that would be:

  • Carbs = 2000 * 0.40 = 800 calories (200 grams)
  • Protein = 2000 * 0.30 = 600 calories (150 grams)
  • Fat = 2000 * 0.30 = 600 calories (67 grams)

Zone vs Standard American Diet (SAD)

According to the CDC (Trends in Intake of Energy and Macronutrients in Adults From 1999-2000 Through 2007-2008):

In 2007-2008 the average energy intake for men was 2,504 kilocalories (kcals) and for women it was 1,771 kcals.

The average carbohydrate intake was 47.9% of total kilocalories (% kcals) for men and 50.5% kcals for women; average protein intake was 15.9% kcals for men and 15.5% kcals for women; average total fat intake was 33.6% kcals for men and 33.5% kcals for women; and average saturated fat intake was 11.0% kcals for men and 11.1% kcals for women.

That means the Zone Diet is lower in carbohydrates, much higher in protein, and a lower fat than the Standard American Diet (SAD).

Macro SAD (Men) SAD (Women) ZONE Difference
Carb 47.9 50.5 40 Zone Lower
Protein 15.9 15.5 30 Zone Much Higher
Fat 33.6 33.5 30 Zone Lower

The main lever of the Zone then appears to be Protein. Doubling someone’s Protein should do some very good things for their health. Added to that is the advantage of the lower number of total calories on the zone.

But would the Zone be a good thing for a Type 2 Diabetic? Certainly it would help some who are diagnosed as pre-diabetic. Anything they do to reduce their carbohydrate consumption will help their pre-diabetes.

Zone vs Ketogenic Diet

The Ketogenic diet has various protein goals depending on you who follow. For a 200 lb male typical numbers would be (using a higher level of protein in this example):

Macro grams kCal/macro Calories % Cals
Carb 20 4 80 4%
Protein 160 4 640 32%
Fat 142 9 1280 64%
2000

Where the two diets differ are their fat and carbohydrate macros.

Macro ZONE Ketogenic
Carb 40% 4%
Protein 30% 32%
Fat 30% 64%

Carbohydrate Effects on a Type 2 Diabetic

Carbohydrates raise blood sugar and therefore Insulin levels much more dramatically in a Diabetic than in a non-Diabetic person. That’s what makes a person an Diabetic. Before I went on the Ketogenic diet I was averaging only 100 grams of carbohydrates per day. I know this since my Insulin pump required me to enter any carbohydrates I ate. And, in spite of being on an average of 100 units of Insulin a day, my blood sugars were all over the place.

My highs were over 200 and my lows never got to 100. Around the start of August I went on the Ketogenic diet. For me, that was going from 100 grams (on the average) of carbohydrates a day to less than 20 grams. I was also not tracking the other macros (fat, protein). Here are my blood sugar numbers from the first three months of the Ketogenic diet.

That chart is the very definition of stable blood sugars. It took being at 20 grams or less of carbs a day to get stable. And before the Ketogenic diet I was nowhere near the Zone Diet carbohydrate levels. I can only imagine how messed up my blood sugar numbers would have been if I had been on the “balanced” zone diet.

 

Christmas Status Letter

Reflections

Holidays provide time to reflect on the past year. It’s long overdue to circle back to the purpose of this BLOG. I started this journey of hacking my Type 2 Diabetes almost 18 months ago. In that time, I fixed my Diabetes and so much more.

No More Insulin or Medications

I am on ZERO medications. No diabetes medications. No hypertension medications. I still use a CPAP machine since I am afraid of quitting the machine.

Weight Loss

I have lost over 100 lbs. My starting weight was around 285 and it was 178 this morning. I’ve been in maintenance for a month now and my weight has stayed steady. I wish I had charted better in the beginning.

Added Exercise

After I lost most of my weight (around 80 lbs) I added exercise. I have been doing CrossFit for about four months now. I can lift weights that match the girl’s weights. I usually finish the Workout of the Day (WOD) last but I do finish – even the hard ones. I workout five days a week. The typical CrossFit workout is less than one hour. I take rest days Thursday and Sunday.

Blood Sugar Control

My blood sugar after working out last night was 65 (US units) which is really good. I most often see numbers in the mid 80s. My last HbA1C was taken this summer (before CrossFit) and it was 5.8 (which is at the bottom end of the prediabetes range).

My Macros

My diet consists largely of chicken, nuts and broccoli.

Chicken is a good Protein and different cuts provide different amounts of fat. Kim Chee (from Walmart refrigerated veggie section) is a good probiotic (good for stomach biome). Broccoli is a good veggie and easy to heat in a microwave bag. Finally, nuts fill in the fat numbers in a healthy way.

My Macros

My daily macros are:

My current macros are 1800 calories with 125g of Protein, 20g of Carbohydrates and 136g of Fat. Protein is a minimum. Carbs are a maximum. Fat fills up the remaining calories to meet the limit. If I go over on Protein I will go under on Fat to match. In percentages of daily calories this is 27% Protein, 5% Carbohydrates, and 68% fat.

Supplements

Here is what I take daily.

Breaking Stalls

I had a long stall this year which lasted for maybe six months. I did some extended fasts which helped a little bit. I then tripped across the idea of doing Protein Sparing Modified Fasting. That broke the fast and gave me a way to make progress with the last 25 lbs that I needed to lose.

My Goals

My goals have shifted over the past 18 months. They started with hacking my Diabetes. I wanted to get off Insulin. That took two weeks.

Since then I have worked at improving my Insulin Sensitivity. For me, the main tool was Intermittent Fasting (IF). One thing that interferes with this is getting in enough Protein. I have added a Protein meal at lunch time. This hasn’t hurt my Blood Sugar numbers.

Another way of improving Insulin Sensitivity is High Intensity Training. I do CrossFit. Training with increasingly heavier weights and intensity will improve Insulin Sensitivity. I hope to keep up this training and there are plenty of goals to reach. I got my first box jump and pullup in the past month.

 

Healing Diabetic Neuropathy

In diabetic neuropathy, one of the most common forms of peripheral neuropathy, nerve damage occurs in an ascending pattern. The first nerve fibers to malfunction are the ones that travel the furthest from the brain and the spinal cord. Pain and numbness often are felt symmetrically in both feet followed by a gradual progression up both legs. Later, the fingers, hands, and arms may become affected. (Peripheral Neuropathy Fact Sheet).

Is this a permanent condition?

It is a progressive condition which gets worse. The only solution is to reverse the underlying diabetes. That’s where Low Carb comes in. Once the underlying condition gets reversed the body begins to repair/regrow the nerves. Nerves can regrow around 1 mm/day. The growth starts at the spine and goes to the extremities. So neuropathy in the feet or hands can be reversed in around three years or so.

 

Protein Sparing Modified Fast (PSMF)

There’s a lot of scientific data concerning Protein Sparing Modified Fasts (PSMF).

Here’s one article (Nitrogen Metabolism and Insulin Requirements in Obese Diabetic Adults on a Protein-Sparing Modified Fast), ).

When this fast was applied to seven obese adult-onset diabetics who were receiving 30–100 units of insulin per day, insulin could be discontinued after 0–19 days (mean, 6.5). In the three patients who had extensive nitrogen-balance studies, balance could be maintained chronically by 1.3 gm. protein per kilogram IBW, despite the gross caloric inadequacy of the diet. The PSMF was tolerated well in an outpatient setting after the initial insulin-withdrawal phase had occurred in the hospital. Significant improvements in blood pressure, lipid abnormalities, parameters of carbohydrate metabolism, and cardiorespiratory, symptoms were associated with weight loss and/or the PSMF. For diabetics with some endogenous insulin reserve, the PSMF offers significant advantages for weight reduction, including preservation of lean body mass (as reflected in nitrogen balance) and withdrawal of exogenous insulin.

Another paper (Multidisciplinary treatment of obesity with a protein-sparing modified fast: results in 668 outpatients. A Palgi, J L Read, I Greenberg, M A Hoefer, B R Bistrian, and G L Blackburn – Full Text) showed excellent results. Here’s the abstract:

Six hundred sixty-eight obese outpatients, 71 per cent (+/- 34) in excess of ideal weight, were enrolled in a multidisciplinary weight control program. The major components of the program included nutrition, education, behavior modification, and exercise. Rapid weight loss was accomplished using a very low calorie (less than 800 kcal) ketogenic diet. Patients adhered to the protein sparing modified fast (PSMF) for 17 +/- 12 weeks and averaged 9 +/- 17 weeks in a refeeding/maintenance program. Mean weight loss was 47 +/- 29 lb (21 +/- 13 kg) at the point of minimum weight and 41 +/- 29 lb (19 +/- 13 kg) at the end of the maintenance period. Systolic and diastolic blood pressure and serum triglycerides fell significantly in men and women. Success in weight loss was greatest in the heaviest patients, those who adhered the longest to the PSMF, and those who stayed the longest in the maintenance program.

 

CrossFit and Nutrition

CrossFit really gets nutrition.  A few caveats about this video:

  • Not sure I completely agree with their body fat percentage goals for older people – or at least making it the priority.
  • Also their initial macro mix has a much higher carb amount (1/3 of calories from carbs) than what Type 2 Diabetics should eat.

Video Points

  1. Eat real food.
  2. Not too much of it.
  3. Mostly plant based.
  • Living = grew out of the ground or had eyes.
  • Stay out of the middle aisles of the supermarket.
  • No man-made food like substances.
  • Don’t use your macros as a way of avoiding eating right.
    • Macros are your mix of Protein/Carbs/Fats within overall calorie limit.

Very-Low-Carbohydrate Diet Studies

This will be a growing list of Very-Low-Carbohydrate Diet Studies (and related subjects).

 

What if the History of Diabetes Went Wrong?

In an interesting paper the question is asked what if the history of the development of our understanding of diabetes has it wrong? The paper (J. Denis McGarry. What If Minkowski Had Been Ageusic? An Alternative Angle on Diabetes. Science, Vol. 258, No. 5083 (Oct. 30, 1992), pp. 766-770).

Despite decades of intensive investigation, the basic pathophysiological mechanisms responsible for the metabolic derangements associated with diabetes mellitus have remained elusive. Explored here is the possibility that traditional concepts in this area might have carried the wrong emphasis. It is suggested that the phenomena of insulin resistance
and hyperglycemia might be more readily understood if viewed in the context of underlying abnormalities of lipid metabolism.
Some powerful food for thought in the paper. Another paper (Arius, Energy Metabolism) summarizes the argument as:
The author considers the possibility that the hyperinsulinemia of early non-insulin—dependent diabetes is coincident with hyperamylinemia, since insulin and amylin are cosecreted. Amylin would cause an increase in plasma lactate (Cori cycle); and lactate, a better precursor than glucose for fatty acid synthesis, would indirectly promote the production of very-low-density lipoproteins (VLDL). There would follow an increased flux of triglycerides from liver to muscle (and adipose tissue) and, as proposed and elaborated on, an increase in insulin resistance and production of many of the metabolic disturbances occurring in diabetes.
 The author of the paper draws heavily on the Randle Cycle.
The Randle cycle is a biochemical mechanism involving the competition between glucose and fatty acids for their oxidation and uptake in muscle and adipose tissue. The cycle controls fuel selection and adapts the substrate supply and demand in normal tissues. This cycle adds a nutrient-mediated fine tuning on top of the more coarse hormonal control on fuel metabolism. This adaptation to nutrient availability applies to the interaction between adipose tissue and muscle. Hormones that control adipose tissue lipolysis affect circulating concentrations of fatty acids, these in turn control the fuel selection in muscle. Mechanisms involved in the Randle Cycle include allosteric control, reversible phosphorylation and the expression of key enzymes.[5] The energy balance from meals composed of differing macronutrient composition is identical, but the glucose and fat balances that contribute to the overall energy balance change reciprocally with meal composition.
Interesting thoughts.
Fatty acids may act directly upon the pancreatic β-cell to regulate glucose-stimulated insulin secretion. This effect is biphasic. Initially fatty acids potentiate the effects of glucose. After prolonged exposure to high fatty acid concentrations this changes to an inhibition.[13] Randle suggested that the term fatty acid syndrome would be appropriate to apply to the biochemical syndrome resulting from the high concentration of fatty acids and the relationship to abnormalities of carbohydrate metabolism, including starvation, diabetes and Cushing’s syndrome.
My own weight had been in the 280 range for a long time. In the months before I was diagnosed as Type 2 Diabetic my weight dropped 50 lbs without any lifestyle changes. After I went on Metformin my weight was relatively lower for a while. When I eventually went on Insulin my weight went up 40+ lbs fairly quickly. It is well known that Insulin adds weight.
My own thought is that the Insulin is both the lock and the key. Increased levels of Insulin pushes glucose or fat into cells and decreased levels of Insulin allows fat to come out of cells. That’s why Intermittent Fasting is such a great bullet for Type 2 diabetics. It allows our fasting Insulin levels to drop. Add to that Low Carbohydrate diets and the perfect recipe for controlling Diabetes comes into play.
The problem never really was Insufficient Insulin. The problem was too much Insulin. And clearly it is a fat related problem.

Blood Sugar Responses Compared

I asked a friend to be part of an experiment which involved him poking himself with a needle most of the morning. And he agreed. We are both fat adapted (me for 15 months and him for more than 6 months).

We both started fasted from the previous night (no breakfast for myself or my friend). We both ingested 50 g of Whey Protein (IsoPure Zero Carb Protein Powder) at the same time and measured our blood sugar responses over the course of the same morning.

I am a Type 2 Diabetic who has their Blood Sugar “under control” via diet and am no longer on meds. I am 57-years old and do some exercise (CrossFit) five times a week for the past two months.

My fried is a Tri-athlete in his mid-30’s. He’s not a Diabetic and runs frequently.

Here’s the two responses to the same amount of Whey Protein:

 

The results were very interesting.

  1. His fasted (starting) Blood Sugar number was higher than mine. We’ve compared numbers before and noted this same thing. We did not use the same meter since we were looking for relative differences not absolute values.
  2. After ingesting Protein, the Tri-athlete’s blood sugar went down. My blood sugar (the Type 2 Diabetic) went up.
  3. His Blood Sugar returned to normal much more quickly than mine (less than 2 hours. Mine took over three hours to return to normal.

I am not sure if his Blood Sugar went down due to him not having Insulin Resistance. If his Insulin went up in response to the Protein it could have driven his Blood Sugar down. Since I still have some degree of Insulin Resistance my Blood Sugar doesn’t go down nearly as well.

Support for this idea comes from (“Liver Metabolism“):

Overall, gluconeogenesis is stimulated by glucagon and
epinephrine and inhibited by insulin, as observed most
dramatically in insulin-dependent diabetes mellitus, in
which uninhibited gluconeogenesis contributes significantly
to the hyperglycemia.

Insulin favors oxidative decarboxylation of pyruvate and, therefore, also indirectly tends to diminish gluconeogenesis.

Interesting!

 

High Protein Diets are Good for Type 2 Diabetics

High Protein Diets are good at reducing NAFLD (Non-Alcoholic Fatty Liver Disease). From the study (February 2017, Volume 152, Issue 3, Pages 571–585.e8. Isocaloric Diets High in Animal or Plant Protein Reduce Liver Fat and Inflammation in Individuals With Type 2 Diabetes. Mariya Markova, Etc.):

In a prospective study of patients with type 2 diabetes, we found diets high in protein (either animal or plant) significantly reduced liver fat independently of body weight, and reduced markers of insulin resistance and hepatic necroinflammation. The diets appear to mediate these changes via lipolytic and lipogenic pathways in adipose tissue. Negative effects of BCAA or methionine were not detectable. FGF21 level appears to be a marker of metabolic improvement.

And from the conclusions section:

Postprandial levels of BCAAs and methionine were significantly higher in subjects on the AP vs the PP diet. The AP and PP diets each reduced liver fat by 36%−48% within 6 weeks (for AP diet P = .0002; for PP diet P = .001). These reductions were unrelated to change in body weight, but correlated with down-regulation of lipolysis and lipogenic indices. Serum level of FGF21 decreased by 50% in each group (for AP diet P < .0002; for PP diet P < .0002); decrease in FGF21 correlated with loss of hepatic fat. In gene expression analyses of adipose tissue, expression of the FGF21 receptor cofactor β-klotho was associated with reduced expression of genes encoding lipolytic and lipogenic proteins. In patients on each diet, levels of hepatic enzymes and markers of inflammation decreased, insulin sensitivity increased, and serum level of keratin 18 decreased.