Today 2016-08-13

My morning blood sugar at 6:30 AM was 115. Normally I would do a pump bolus but today I decided to skip the extra Insulin. Three hours later (after my shower) the number is 138. I also lowered my basal amounts by 0.25 units an hour a few hours ago so that can account for some of the rise. I am going to once again not bolus (give more Insulin). Perhaps my body takes a while to kick in providing insulin on its own when it has been habituated to externally provided Insulin.

Also I have noticed that after a shower my blood sugar seems to be higher. Not advocating going European or some crazy thing but we do seem to take a lot of showers in the US. I’ve noticed that the Blood sugar after a shower tends to drop faster than the Insulin I have provided would indicate that it should.

If this is still a manifestation of the Dawn Effect then even that will decrease with time.

So I waited an hour and measured again (with no bolus at all this morning). Instead of seeing a high number I was back to 113. If I had given Insulin it would have not dropped so quickly.


Low Carb and Craft Beer (part 4)

One thing I have noticed is that Rye Pale Ales do not blow up my Blood Sugar levels like other IPAs (wheat based Ales) do. Not quite sure why.

The carb levels look comparable. Hard to find anything out there on the difference and I’ve never met a diabetic to share the information with. I do remember that My grandfather had a wheat allergy of some sort and could only eat Rye bread due to some unknown digestion problems.

Is there an analogy to bread? The key may lie in the glycemic index/load. According to (The Glycemic Index of Rye Bread):

One slice of rye bread has a glycemic index of 41 and a glycemic load of 5, according to the Linus Pauling Institute at Oregon State University. In contrast, one slice of white bread, made from refined grains, has a GI of 73 and a GL of 10. A high glycemic index is considered 70 or more, and low is 54 or less; a high glycemic load is 20 or more, and low is 10 or less.

So if beer is really just liquid bread and the carb/alcohol numbers are the same, then it makes sense that Rye beer has a lower glycemic index and load over other Pale Ales of similar alcohol and carb counts.

I did a completely unscientific study and measured my BG at 111 and then drank a Rye Pale Ale beer. I then waited an hour and measured my BG and got 114. When I drank the beer I did not take a bolus like I normally would have in the past. I did the same thing a beer without a bolus and an hour later measured my BG at 112. The taste in my mouth tells me that I am out of ketosis. An hour and a half later my BG was 116 and I was solidly in ketosis.

This has been a disappointing year to find Rye Pale Ale. I bought one or two 12 packs and have not seen them at all over the year. Last year I could find Rye of the Tiger and other brands in the local beer distributors but not this year.

Beer can be healthy in moderation.

Am I in fat burning (ketosis)?

Freeing up fat is the goal of any diet.

If your body has burned enough of the fat that you have eaten and it has freed up the easily accessed stores (the fridge in Dr Fung’s analogy) then it starts burning the fat from your cells.

This is called ketosis. From the WebMD site (What Is Ketosis?).

Ketosis is a normal metabolic process, something your body does to keep working. When it doesn’t have enough carbohydrates from food for your cells to burn for energy, it burns fat instead. As part of this process, it makes ketones.

The article continues.

For healthy people who don’t have diabetes and aren’t pregnant, ketosis usually kicks in after 3 or 4 days of eating less than 50 grams of carbohydrates per day. That’s about 3 slices of bread, a cup of low-fat fruit yogurt, or two small bananas. You can start ketosis by fasting, too.

There are ways to detect ketones. The most accurate measurement is a blood test. Another measurement is easier and cheaper, a ketone test strip. The ketone test strip is activated by your urine.

I got a box (with a bottle in it) of 50 Relion Ketone Test Strips at Walmart in the pharmacy for about $7. That’s less then 15 cents a test.

Here’s a good article on using the sticks to measure your state of ketosis (An Overview of Ketone Testing Products).

For me personally, there’s another way. Taste in my mouth. If I am in ketosis my mouth tastes metallic. This site includes that along with other symptoms (What is Ketosis?).

a metallic taste in mouth
strong smelling urine
random bursts of happiness (it’s weird, but it’s true!)
decreased appetite

If you are in doubt use the strips. I am in ketosis even after eating dinner (a LCHF dinner).

When the Strips stop working (Why You Need To Stop Worrying About The Color Of Your Ketostix).


Atkins Snacks as a way to get Low Carb?

Walking down the Sam’s Club aisle (or the Pharmacy Aisle at Walmart) you can spot the Atkins snacks. This was my favorite.

I was eating those for lunch before I started the IF. I would typically eat two during the day. They didn’t send my sugars super high, but they didn’t let them drop down either. And I quickly found that I couldn’t use the net carbs of 3 grams listed on the label. It was just way too low when I was using the Insulin pump. I had to set the pump to the total carbs minus the fiber count to not have them mess me up. Trust your body over any label.

I think the reason is sugar alcohols. Atkins, likes other low sugar snacks, replaces sugar with sugar alcohols. Picking my favorite bar as an example, the Atkins Caramel Chocolate Nut Roll, they show the nutritional information as:

Atkins-Caramel-Chocolate-Nut-Roll (Snack)

On the face of it this looks great. Let’s do the math.

  • 7g (Protein) * 4 cals/gram = 28 cals from Protein
  • 2 g carbs * 4 cals/gram = 8 cals from carbs

(My guess is Atkins doesn’t list the fat number on the front since most people still believe in Low Fat diets.)

Where are rest of the calories? Here is the detailed chart.

Fat presents 13 grams or 52 calories. Still short on calories. Turns out there are different numbers between Atkins and the nutritional label (forced by law). Atkins doesn’t count sugar alcohol as a carb in the Atkins Diet. They also don’t consider fiber as a carb. So from Atkins perspective the bar is only 3 net gram of carbs.

Atkins nutritionist writes (Ask the Nutritionist: The Scoop on Sugar Alcohols):

Sugar alcohols are not fully absorbed by the gut, which means they provide roughly half the calories that sugar does [ed: per weight]. Thanks to this incomplete and slower absorption, there is a minimal impact on blood sugar and insulin response. Because of this, sugar alcohols don’t significantly interfere with fat burning, which makes them acceptable on Atkins.

To calculate Net Carb count with sugar alcohols, simply subtract grams of sugar alcohols (including glycerin), as well as fiber, from total grams of carbs.

But I can tell you from my own experience the Sugar Alcohol used in these particular bars doesn’t act like that in my body.

Is it the fiber? The FDA estimates the amount of caloric contribution due to bacterial degradation of fiber at about 1.5 calories per gram of fiber. That would correlate to 1.2 calories from the fiber. Not enough there.

This article does a good job of analyzing the idea that Sugar Alcohols provide no net carbs (Can You Really Exclude Sugar Alcohols, Glycerin, Polydextrose, and Fiber?).

According to the article, the type of sugar alcohol matters. The label has two pieces of information with respect to sugar alcohols. This particular label lists 0 grams of glycerin. The sugar alcohol is hidden in the list of ingredients as Maltitol Syrup.

Some of the Atkins products use glycerin as the sweetening agent which the site says isn’t a problem. But this particular product uses Maltitol Syrup and the article says that is not a good sugar alcohol to use. The site states:

The glycemic index of one of their primary ingredients — maltitol — is higher than that of pearled barley or kidney beans.

Is there a solution?

The other ingredient glycerin had no glycemic load. The article concludes with:

You need to check which sugar alcohols are used in any low-carb products you buy. Just like different carbohydrates affect blood glucose to different degrees, so too do some sugar alcohols.

So, the other bar I would eat listed 5 grams of sugar alcohol and they were all glycerin.

Another article (Sugar-Free Labels Can Be Deceptive) reaches the same conclusions.

A Recommendation

I have also had the (Chocolate Peanut Butter Bar) and didn’t have a problem with my blood sugar rising. It also didn’t taste nearly as good. 8 of the 11 grams of sugar alcohol are glycerin. So the secret with Atkins bars is to look at the sugar alcohols and at the number from glycerin.



Is Low Carb Unhealthy?

There was a study done to determine the safety and effectiveness of a Low Carb (LC) diet vs a Calories Restricted Low Fat (CR-LF) diet (A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women).

The study was on fifty-three healthy, obese female volunteers.

The LC diet was more than twice as effective compared to the LF diet.

The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P < 0.001) and more body fat (4.8 +/- 0.67 vs. 2.0 +/- 0.75 kg; P < 0.01) than the low fat diet group.

OK, so the Low Carb diet lost more weight and fat but was it safe? The study looked at the cardio risk factors and concluded.

Mean levels of blood pressure, lipids, fasting glucose, and insulin were within normal ranges in both groups at baseline.

Their conclusion?

A very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.

So no, not only is Low Carb more effective than Low Fat, but it is also not any less healthy.


McDonald’s $1 Breakfast Burritos

Here is the nutritional information for McDonald’s $1 Egg and Sausage Burrito:

  • 300 Calories
  • 16 g Total Fat 25 %
  • 12 g Protein
  • 26 g Total Carbs 9 %

Up until 2 weeks ago (today) was eating two of these for breakfast. Not a bad deal at $2. Tasty, too.

Let’s double the numbers and see what we get:

  • 600 Calories
  • 32 g Total Fat 50 %
  • 24 g Protein
  • 52 g Total Carbs 18 %

A couple of observations here.

  1. Removing the 600 calories a day would result in under one pound a week of weight loss. I should have only lost 2 lbs in the past two weeks. But I’ve lost 14 lbs. Calorie counting doesn’t work.
  2. The claim that the two burritos are half my day’s fat is based on the old “low fat” diet model.
  3. No recommended daily amount of protein. Interesting.
  4. Most disturbing is the suggestion that I should eat more than 250 grams of carbs a day.

The Recommended Daily Allowance (RDA) numbers are (The Recommended Daily Intake of Calories, Carbs, Fat, Sodium & Protein).

Carbohydrates – 45 to 65 percent of your total calories
Saturated fats to no more than 10 percent of calories
Protein 0.8 grams of protein per kilograms

So if you eat 2000 calories a day they are recommending 900-1300 calories from carbohydrates. That’s 225 – 300 grams of carbs a day. This is deadly advice and the government should get it by now. There’s more than enough evidence that this level is just way too high. And telling Americans to get their carbs from non-refined sources doesn’t match what they see in the supermarket. Substituting wheat bread for white doesn’t do it.


How to tell if you are burning fat

If you are on Intermittent Fasting you are burning fat. The same chart from before shows why.

Carbs pass through quickly, Protein less intense but longer and Fat even longer. But what is the significance of the vertical (height) of the curve? Let’s add another line to the graph to try and explain.


What is missing from the chart is scale on the time axis. The red line shows the energy needs of your body. If your energy input is greater than you energy needs then the body stores that energy. If your energy input is less than your body needs the body releases that energy.

In the chart above calories consumed as carbohydrates are consumed quickly but get stored in the body since they exceed the need of the body for energy. Protein is the same, but much less. Fat is below the curve. This is why the Low Carb High Fat diet works so well.

Dr Fung describes the means of storage as being in one of two compartments. There’s a short term storage (the refrigerator) andd a deeper term storage (the basement freezer). The body can more easily access the short term storage. To move from the shorter term to the longer term requires fasting.

This points out what’s the problem is with just Low Carb High Fat as a means of dieting. If you don’t do intermittent fasting you are only getting the benefit of the dinner to breakfast fast.

If you ate breakfast at 8 AM, lunch at noon and dinner at 6 PM you are keeping the energy level up with food you eat for 10 hours of the 24 hours. Worst than that the 10 hours is extended by the time if takes to digest the food from dinner. If it was a largely carb meal then it might be a few hours until you go to consuming what you stored in excess during the day. Your fasting might only be 8 hours and you spend most of that time working off the day’s excess.

Is there a simple mathematical model for this? Should be easy enough to figure out one and then calibrate it for a particular person. Two of the curves are parabolic or could be simulated with a sine wave.


Intermittent Fasting and Type of Diet

I think Dr Fung is often misunderstood. He appears on a lot of youtube videos with Low Carb High Fat (LCHF) diet folks. This has led people to believe that he is a backer of LCHF. From what I see he does support LCHF as a safe way of dieting but his actual advice is more nuanced than that.

Dr Fung’s position seems to be that the main point is to get to where your body is burning fat and they way he gets people there is to use Intermittent Fasting. To his way of thinking the type of diet matters much less than the Intermittent Fasting.

That doesn’t mean eat anything you want. He clearly says (How to Reverse Type 2 Diabetes, The Quick Start Guide):

The first step is to eliminate all sugar and refined starches from your diet. Sugar has no nutritional value and can therefore be eliminated. Starches are simply long chains of sugars. Highly refined starches such as flour or white rice are quickly broken down by digestion into glucose.

As long as the diet eliminates simple sugar and refined starches things are good.

Intermittent fasting allows time for the body to move from processing the last meal and into consuming stored fat from the body. Yesterday I did a 20/4 fast. I ate dinner at 5 PM and drank my last beer by 9 PM.

Good Morning

I had some good news this morning when I stepped onto the scale. My weight had dropped another 5 lbs. 10 lbs in 2 days. Looks like a switch got thrown to get rid of water weight. Plus, it’s been hot and humid here.

My insulin use was way down, too. Two days ago my insulin use was 42.0 and yesterday my insulin use was 29.2. My waking blood sugar was up a bit at 132 and it bounced up to 140 by a couple of hours later but that’s not abnormal for me.

My meal yesterday was satisfying. In fact, I ate until I felt sick of eating. Sick to my stomach of eating.  My total calorie count was too low at 1146 cals. I tried hard to eat Lower Carb and Higher Fat but only got to (% cals from source)

Carbs 11.6%
Protein 22.6%
Fat 42.3%
Alcohol 23.5%

I had less Craft beer than the day before (2 vs 3). However I did feel the effects a lot more than the day before. I attribute this to having less carbs to flatten out the response to the beer.


Intermittent Fasting – The Science

Looking at the science supporting Intermittent Fasting (IF) as it relates to Insulin Resistance/Sensitivity. Here’s  a study which has great information (Effect of intermittent fasting and refeeding on insulin action in healthy men (2005)). They formed the study on:

… eight healthy young men [25.0 ± 0.1 yr (mean ± SE); body mass index: 25.7 ± 0.4 kg/m2] by subjecting them to intermittent fasting every second day for 20 h for 15 days…

What happened to their body weight? The paper continues…

Subjects maintained body weight (86.4 ± 2.3 kg; coefficient of variation: 0.8 ± 0.1%).

So on an every other day 20/4 fast over 2 weeks these eight healthy men did not lose weight. Not a big surprise there. Not a great diet for healthy young men to lose weight on. (Looking closer at the chart shows that they lost a couple of pounds.)

What were the results for Insulin Sensitivity? This is where it gets good.

Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03), and insulin-induced inhibition of adipose tissue lipolysis was more prominent after than before the intervention (P = 0.05).

I am not a scientist by any stretch of the mind, but I think the phrase “Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03″ means they got better at using glucose, ie, their cells became more glucose tolerant. That’s the goal we are after for T2D like myself.

Seems like a change in 2 weeks of the glucose uptake rate from 6.3 to 7.3 is a significant response. When I do the math, that’s a 15% increase. And all these guys did was skip breakfast and lunch every other day.