Random Ads for the Big D...

I put up an ad-sense block, although I kept it out of the way, in my other blog about racing, primarily since it would keep track of hits for me, which makes it easy for me to see if anybody is reading it (answer, a few). When I started it was also a source of unintentional hilarity. You see my very first post was about my deciding to get my race car’s nose fixed during the pre-season, since it was dinged a bit from a prior incident. I called the post, “The Nose Job.”

For the next month all the ads were about plastic surgery.

I swear for awhile it seemed like if you googled Rhinoplasty my blog might have made the top ten.

Anyway, I put a block at the bottom of this blog as well as a column to the right, partly in the hope that if I ultimately developed a modest readership it would provide me with beer money, even though, ironically, I had to stop drinking beer. But I’m thinking it’s a mistake (the Ad-Sense bit, not, sadly, the stopping beer bit).

I actually followed one of the ads myself, something called “Levolar Forte” which is a supplement that is mainly mushrooms, but which also claims a Mega-Dose of Chromium. Nearly six times the recommended dosage of Chromium in each and every pill and they are suggesting taking four a day. Twenty plus times the recommended dosage and completely ignoring the fact that most western diets already have more than enough. So it’s partly harmless (OK, in the diet some mushrooms may, or may not be helpful, but as a supplement, just how big a pill is it?) and partly a potential toxic overdose. Here I am researching like mad to pluck the best practices out of this mass of confusion and yet I put a link to stuff un-vetted that may reach near-quack if not quack status in the hope of picking up a three dollar check in six months.

God, sometimes I wonder if I was born a moron or have just been practicing my stupid for too long...

Anyway, I’m taking the random blocks down, but keeping some referral’s up like for Diabetes Daily. That way if you do click on something it is less likely to lead to something flim-flam. No guarantees, this is the Internet after all.

Drat

Now I know all about fantasies. Angelina leaving Brad for my obvious prowess and good looks, Ferrari offering me Masa’s seat in their F1 car, and Dr. Yang apologizing profusely for the mixed up test results, “No, really you’re the picture of health” being my current top three. The point being I know I haven’t quite lost my mind as long as I know they are just that. Fantasies.

I did kind of expect that my efforts would be starting to pay off and that at my next appointment Dr. Yang would remark, “Terrific, you are completely under control, just keep up what you’re doing and you will be fine.” And I’ve certainly been pleased with my recent results.

I had another meal lined up to test, to keep on plugging away, pulled out the meter to get the pre-meal baseline and…

225.

That can’t be right, I was disappointed yesterday with a pre-meal 91. So I tested again.

225.

No way. That’s only five points lower than my all time highest, post meal, reading. Maybe I got the calibration wrong or it’s a bad batch. Swap to the spare strips, code is 30, check it in the meter, prick, bleed and…

225.

Damn.

Lunch-time Timewaster

The lovely Jessica, my trainer, sent me this one: here that calculates your "real" age. She was so happy that it put her well under thirty. As for me, well if this was the standard I'd be expecting my social security checks to start arriving any day now...

Fat vs. Lean Muscle

While I am waiting a bit for the opportunity to get a GAD test, to be sure I’m with the 70% of lean people who have type 2 and not the 30% who have 1.5, I decided to go with the odds for now and revamp my workout under the assumption I’m a two.

The difference is simple enough. Insulin resistance, which type 2’s have, can be decreased by increasing the ratio of lean muscle to fat. I have some fat, I am pushing fifty (not that I get any credit for lugging such a large number around) and my waist has expanded to a 33” over the last couple of years. So my aerobic routine continues. But with the fairly low amount of fat for me to lose it makes sense for me to make an effort to gain lean muscle at the same time. If I am in fact a 2. Once I get the test, if I come back positive for the antibodies, then exercise isn't quite as critical to success and I can reevaluate.

So Saturday it was over to the Y for some weight training. And Sunday was a day to remember just how much that can hurt if you over do it.

Sirloin steak w/lemon sauce, fish sticks’n tarter, and banana w/chocolate dollop

Here’s a test I’ve been thinking of, a nearly no-carb meal. The dollop is, frankly, a tiny bit of syrup, otherwise it has virtually no carbs. So what does going so low in carbs mean to my meal spike? Will I still have one at all? Just a modest raise, or stay flat? Here goes…

Carbohydrates: 6-10
Fructose: Very Low
GI Index: N/A


Ingredients:
4 tblspns margarine
½ Cup Onion
1 Bay Leaf
½ tsp. dried thyme
1 ½ cups, red wine
1 New York steak (@1 pound)
3 tblspns dried parsley
1 tblspn lemon juice
10 Groton’s fish sticks
Tarter sauce
1 Medium Banana
Very small, remember I said very small, dollop of Hershey’s chocolate syrup.

How:
Put tarter sauce aside, let it get to room temp. Start baking fish sticks in oven bake at 425 for about fifteen minutes.

Start the steak sauce. In skillet melt 2 tablespoons of margarine over high heat. Sauté onions, bay leaf, and thyme 2-3 minutes or until onions are transparent. Add wine and cook until reduced by 1/3 in volume. Set aside everything but the bay leaf (toss it). The sauce itself is good for two or three steaks and will keep in the fridge for a bit.

In same skillet, still on high, sear steak for 1 ½ minutes per side. Reduce heat to medium, add 2 more tablespoons of margarine, parsley, and lemon juice. Then add sauce. Cook steak for 2-4 minutes per side to suit.

Cut banana into chunks and place in bowl, pour just a whisper of chocolate syrup and serve cold.

Results:
This is my very best steak and I’d be willing to put it up against anybody’s. I used to serve it with a baked potato, but I tried fish sticks thinking the tartar sauce would work OK with the lemon.

Remind me to stop thinking. As a combo it’s beyond awful. The Steak is so good and the sticks so bad, and the flavors clash besides, so much so that I couldn’t stand it. I’ll try again someday with something else for a side.

It was impressive how just a tiny bit of chocolate, once you’ve stopped shoving it down your throat every minute, can be a real dessert treat.

Effect on BG Level:
Lowest spike of any meal I’ve tested so far (not that that is many yet), just a 125 despite starting with a bit of a high baseline of 91. It also seems to drop very slowly still being 6 points above baseline two hours after the meal. It fits with everything I’ve been reading.

First they came for my potatoes…

While researching some stuff for the Carbohydrate wars I kept stumbling across references to fructose. So I picked up Dr. Johnson’s book, ‘The Sugar Fix.’ Bottom line, fruit is bad for me too.

Oh well.

It doesn’t mean no fruit of course. And it isn’t even fruit that is the source of way too much of our fructose. No, it’s corn. It seems that we’ve discovered how to create fructose, a specific kind of sugar, out of corn. Called High Fructose Corn Syrup, or HFCS, it’s pretty much in everything these days.

His audience is mostly people trying to loose weight by dieting. He does, however, have a number of tidbits for diabetics. Among those are his lab rat studies in which he induced glucose intolerance by putting the little boogers on a high fructose diet while his control group was actually on plain sugar. His theory, in a nutshell, is that as we’ve added fructose to most everything over the last thirty years we’ve got over selves overloading on a food that used to be available only in moderation.

He goes on to explain the important of ‘Uric Acid’ as a mechanism, and provides advice on reducing intake.

The one piece of good news is that I’ve already dropped soda, and that seems to be the biggest single source. I will miss Gatorade through, since that was a common fruit drink for me.

To bottom line it, he doesn’t claim it causes a BG spike. In fact, fruit is highly recommended, in moderation, for diabetics following the Low-GI method. No, his research tends to point to fructose increasing insulin resistance in type 2’s. Type one’s probably don’t have that much fruit in their diet anymore anyway since they are so high in carbohydrates.

Garlic Cheese Turkey-Burger, Fries, Banana

The hope against hope was that by substituting out the bread, killing off the starter, and having a banana instead of cake for dessert, I could preserve a small measure of fries.

Even the low-GI types are still suggesting a top end of just 50-60 grams of carbohydrates at any particular sitting, and with the fries this doesn’t quite make the cut at 63 grams, but for science sake and to clear out the fridge, I thought to give it a try. Five grams can be cut by dumping the modest amount of bread crumbs to fit low-GI and the bread could be dumped and drop it another 28 at which time it would be nearly low-carb, despite the small serving of potatoes.

I’m going to assume, for the purpose of these experiments, that you can’t cook. So even something quick and simple like this I’ll be giving instructions.

Carbohydrates: High
Fructose: Low
GI Index: Medium

Ingredients:
1/3 pound Jenni-O ground turkey
1 tablespoon Progresso garlic and herb breadcrumbs
Powdered garlic to suit
Dellao pre-sliced garlic in water (half dozen slices)
1 Oro-wheat cracked wheat hamburger bun
12 Ore-Ida crinkle-cut fries (to bake, not fry, please)
1 medium size Banana
Olive Oil
Black Pepper, Dried Basil
2 Slices of Sargento reduced fat medium cheddar
Pickles, Mustard, Mayo, Ketchup

How:
Start by placing the fries on a cookie sheet and bake in the oven at broil. Slice the banana and put in a small bowl and place in the fridge to cool.

Take the ground turkey and blend in the breadcrumbs and garlic by kneading. Once blended, use your hands to roll it into a smooth ball and gently squeeze into a patty about an inch to an inch and a half high. It should be smooth since any cracks might make it fall apart.

Once the fries are half done, put a triple dollop of olive oil (turkey does'nt self-oil as well as beef) in a frying pan, then the patty and put the flame on high. Sprinkle black pepper and dried basil to suit on up side. Sear for about a minute on each side, should turn a nice dark brown to slightly burnt, and the meat shouldn’t be visibly raw on the edges. Then turn down the heat to medium and cook for another three minutes or so on a side. It’s fairly hard to overcook, so if in doubt give it another minute.

Results:
Far… far better than most fast food cheeseburgers it’s mean to replace. I’ll really miss the fries (have I told you how much I like potatoes?) but I think I’ll try fish sticks with a dipping tarter sauce as a fries replacement. The banana somehow felt more like dessert, already being chopped into bite size pieces in the bowl, and chilled. A dollop of chocolate,even without ice-cream, would have helped but first I'd have to really drop the carbs.

Effect on BG level:
Not bad. As you can see from the chart I didn’t spike all that high, although I admit I have to decide on a more consistent testing regimen (I did a hour apart instead of a half hour.) What was different, and worrisome, was how long it took to return to baseline. I’ll try the same meal with fish-sticks in place of fries, to lower the carbs and see if I can get it to return to baseline quicker.

Yes, it has some potatoes...

I do enjoy soup.

This one has a lot of carbs since it has some chuncks of potatoes in it.

44 grams of carbohydrates and a high GI Index, with testing this would come off the shelf. Now I'm not so sure. Obviously if I use it as a starter, unlike this test where I had it as a small meal, it would probably have to be with a no-carb main and side.

I was impressed with how fast I returned to baseline. I'm begining to think of carbs as being like paper and fire, while protein is more like a log.

The high-GI stuff spikes quicker, but does it return to baseline quicker as well?

The war is over, the war never ends...

The war is over, a truce is called, a treaty is signed and nobody lost. A dream, sure, I mean Dr’s Bernstein and Miller aren’t exactly in danger of a famous ‘Sailor to Nurse’ lip-lock any time soon. And the ADA, JAMA and the like may hate fat more than carbs till the end of time, and with some reason.

But I think I understand it, and can see where both schools of thought are right, and how they could work together if they tried.

Carbohydrates are absorbed faster than fat and protein. This creates a special challenge for type I’s who are not producing their own insulin. Dr. Bernstein is right, if a reserve of insulin isn’t sitting in the pancreas ready to be released the fast acting nature of carbohydrates will cause a spike. This explains why type I’s are more sensitive to carbs than early to middle type II’s since the II’s will still have a latent ability to put out more insulin to at least try to snuff out a spike. And the ones don’t.

With more and more two’s out there, the ADA may simply be ill-suited to deal with the complexity of providing advice and setting guidelines that fit for most one’s, and one and a half’s. If there is one thing I know with certainty, it’s hard to get even the simplest word out when massive numbers of people are affected. The more complex the message the less good the ADA can do overall; but too simple a message may do some of us more harm than good.

Meanwhile, Dr. Miller is also right when she says, “What we eat plays an important role, too. Specifically eating too much fat, especially saturated fat, and too little carbohydrates can increase your insulin resistance.” But 1’s and 1.5’s are not necessarily insulin resistant at all. And even if they are, it does little good to slow the progression of your insulin resistance at the price of a toxic level of blood glucose. And the more longstanding two’s may find themselves developing the same sensitivity to carbs, over time, as their beta cells overload and drop out. It is a progressive disease after all.

Frankly, it may make a lot more sense to modify your diet again and again as the disease progresses, with an eye toward minimizing the pace of the decline by frequent testing of BG levels to see what’s actually happening to your body at the moment, rather than complete reliance on this or that generic plan without regard to specific circumstance.

And testing is where it seems everyone agrees.

Dr. Miller and the low-GI’s goal, after all, is the exact same goal as Dr. Bernstein. Keep the blood glucose range within a boundary that avoids damage to the body, or accelerates the progression of the disease. And toward that end the low-GI’s have a very valid point; various carbs act at different speeds. If you can swap slower acting carbohydrates for higher, and reach your target range, you’ll be able to function on less fat and protein than you would otherwise, and type two’s may even delay their progression. Add the GL (Glycemic Load) method onto the GI method, specifically adding low or no carb fillers along with your meal to slow down the digestion of the faster acting carbs, is also a reasonable method.

It’s all about how to flatten the area under the curve.

They agree on that. So test for that. Frankly, many type ones and longstanding two’s will simply be hyper-sensitive to carbs no matter what and so they need to go as low-carb, and as low-GI when they do eat carbs, and as low-GL with their whole meals if they have any carbs, as possible. As the disease progresses it may become harder to stay in range, but if you follow low-carb before you need to, you may accelerate rather than hinder the progression.

Dr. Bernstein does sometime sound too much like a fanatic at times. When he compares a carbohydrate to nicotine in cigarettes, for example, but he is a fanatic who lived when his peers with type one have all long since died of the diseases’ complications. He has a systematic, science based approach that works, has a solid basis in our current understanding of how our bodies work, and encourages testing and the use of the resulting feedback to make improvements. His book is an invaluable resource for anyone with any type of diabetes.

And testing is where Dr’s Bernstein and Miller agree and should form the basis of our truce. To combine their ideas, whenever you try a new food, whatever your type, first get a base-line and test, test, test. If a food makes you spike, either dump it from your menu, cut the amount, or add something along with it to try to change how fast you are digesting it.

Swap high-GI for low, and if it fails, swap low for no. You may start with Miller, and end with Bernstein.

So my ten point treaty to end the carbohydrate wars:
1. Set a high bar. My goal is to handle a spike as well as a non-diabetic by staying below 140 in the near future.
2. Plan ahead. I will know what I am going to eat and how it affects me as much as I can before I eat it. Minimize rules of thumb and guesswork.
3. Heavily test a meal that is new to my diet. The first time I eat it I’ll test every thirty minutes for at least two hours and graph the spike. If it spikes over my target, I’ll change it or drop it.
4. Go Low-GI whenever I do have carbs.
5. Don’t test in isolation. Test the whole meal, together, and if I need to change something to lower my result, I’ll treat it as a new type of meal. Don’t mix and match.
6. Don’t eat in isolation. If I’m eating something with carbs, I’ll eat one or more zero-carb fillers at the same time.
7. I will get to know my carbohydrate sensitivity but won’t depend on it. My first test, mostly pasta, had a sensitivity rate of .5 ml per gram, leaving me with eighty to a hundred grams to play with. The next, wheat bread and peanut butter and jelly, was .3 while the Diabetes Daily Blogger Amylia, a type one, hit her max with unspecified types of carbs at just fifteen grams. In his book, Dr. Bernstein, also a type one, pegged his own sensitivity at 5 ml per gram. Ten times my current maximum rate.
8. Re-test a meal periodically. As my beta cells drop and/or my insulin resistance increases I may become more and more carbohydrate sensitive.
9. Minimize my variables. Don’t make other changes when testing a meal. If I’m under stress, travelling, or if I’ve made other recent changes in supplements or my exercise routine, I’ll wait a bit for the new meal, try and test it later.
10. Test my variables. If I know the variables are going to reoccur, I’ll pick my best few meals and test them under the new conditions.

Over the coming weeks and months I’ll be testing my own meals and posting my results. While everybody is different, it may be interesting to compare and contrast what the glycemic index considers slower carbs, with what actually happens to me. I might even sneak in a potato, despite being pretty much banned by both sides, all in the name of science of course.

Resistance is futile

Gods, that Star Trekkie phrase is overused, but any excuse to post a picture of Jerri Ryan in that skin suit will make up for the poor, hackneyed pun.

Anyway, a Type I diabetic doesn’t produce insulin; his or her pancreas has beta cells that are destroyed or plain not working. A Type II does produce insulin on his or her own, but have become insulin resistant and can’t produce enough extra insulin to overcome the resistance. Over time, the type II’s pancreas loses more and more of the ability to produce the ever higher amounts of insulin while at the same time, the body being drenched in insulin, he or she becomes more and more resistant; a vicious circle. It’s conventional to think of type II’s as both insulin resistant and incapable of producing insulin even if they are still producing more insulin than a non-diabetic.

The argument is made, too often in my opinion, that because both the I’s and II’s need to manage their blood glucose, especially the spikes, they are pretty much the same. I disagree. I think that the treatment and prognosis is going to vary considerably. For example, once a type II goes on insulin, their insulin resistance can reasonably be expected to increase. Therefore it may pay dividends to postpone insulin as long as other methods of controlling blood glucose levels can be successful. A type I, meanwhile, may need to go on insulin as early as possible to reduce the demands on his remaining Beta cells. Type I’s are often thin, so exercise, while always generally helpful and specifically helpful in using up excess glucose, isn’t going to push a type I back to homeostasis. Nothing can. But type II’s are often overweight (80% of T2’s are overweight), and so if caught early enough and having a diet and exercise plan that is done effectively enough, and perhaps with some luck as well, they may reach and remain closer to a normal level of glucose homeostasis without insulin, slowing the progression of this chronic disease.

There is a school of thought that most of the remaining 20% of thin to normal weight individuals diagnosed with type II are actually misdiagnosed type one and a half’s. A one and a half is generally a diabetic with an autoimmune disease that is, or has, destroyed his or her Beta cells, reducing and eventually eliminating their ability to produce insulin. Effectively they are a type I, they just got to the party a lot later since they took a much longer road to get there. One and a half’s are usually over thirty-five while one’s are diagnosed in childhood.

I’ve always been thin to normal in weight. 5’ 10” in the middle 180’s with a waist line bopping around between 32” and 34”. Many one and a half’s don’t have a family history of type II. I don’t. You can go back four generations, no diabetes at all. I have overweight relatives, some significantly overweight, but no diabetes. I don’t have high blood pressure, which is another common sign for type II that is missing in one and a half’s. So maybe I’m among those misdiagnosed. The way to be sure is to get a test for the GAD antibodies.

I think it’s worth my finding out, while it makes little difference in my short–term planning, since I’m at an early stage, knowing if I am, or am not insulin resistant may save my life in the medium to long term by changing how I expect the disease to progress. It will also change my expectations.

What an animal

As a kid I loved making animal shadows using a flashlight. The devine Ms M, put up a post doing pretty much the same using her BG charts...

The Carbohydrate Wars, Part 4, Blood Feud

Amazon delivered my copies of Dr. Bernstein’s famous books. I’ve skimmed the main text, “Diabetes Solution” and it is not at all what I expected. The introduction alone was well worth the price of both books. Dr. Bernstein was an engineer before he was a doctor, and so he recognized the value of being able to test his various ideas in a very impressive and rational format. We engineers do love process.

To quote from the introduction, “Every few days I’d make a small, experimental change in my diet or insulin regimen to see what the effect would be on my blood sugar.” Bingo. What he’s done here is invite the GI/GL ideas in for a no holds barred cage match. He might even lose, but seems very confident that if it’s tested, low-carb is better than right carb for diabetics.

What’s more, by tested, Dr. Bernstein means that a diabetic should match a non-diabetic set of blood glucose levels throughout the day. If you look at what is, traditionally considered well controlled diabetes and compare it to a non-diabetic the overall range is quite different. A non-diabetic shows meal spikes in the 30 ml range. Dr. Bernstein put his own sensitivity to carbohydrates at a 5 ml per gram ratio. In his case, just six grams of carbohydrates would put him smack at the top of a non-diabetic’s curve.

One very small dollop of peanut butter.

John Hopkins’s, the AMA and the ADA (the mainstream) meanwhile consider your diabetes to be, as the John Hopkins’s guide to diabetes put it, “Stable, well controlled” if kept under 180, which is why that is my current goal. Their top of the curve had a variance of 72 ml for dinner for a "good" diabetic.

So far, the best point made by the traditionalists is that the lowest (average) carb diet in the world is in the U.S. which also has the highest incidence of type II. You don’t see the same explosion going on in Asia or Africa where diets are often 80% carbohydrates. The ADA’s recommendation is just 45% by comparison. The new school among them, the mainstream, is blaming the type of carbohydrates Americans eat, rather than the amount. High GI carbs are faster acting, therefore the glycemic index will help us control spikes by steering us to slower acting carbs.

The counter-punch though, from the low-carb believers is, if carbohydrates in general aren’t making diabetics meals peaky, then why the artificial difference between a good level for a diabetic, and a just plain good blood sugar level? Why shouldn’t they be the same?

They might both be right.

It violates the principle of small changes, over time, but I thought to do a smack down, right here, right now, not as definitive but just to see my own bodies response. The good Doctor has a large group of foods that are off limits that I still had in the fridge. Pasta, tomato sauce, bread, carrots, and fruit; all Bernstein’s no-no’s.

So I tested for a baseline and got a 91. Then I carbo-loaded on pasta, ate noodles in commercial soup, ate two slices of sourdough bread and had a fruit-cup. A pound an a half of high carbohydrate, low glycemic index food. Thirty minutes in I was at 175. An hour in I was beginning to drop at a 128. Ninety minutes along and I’m 141? Even the curve for unstable, uncontrolled diabetes doesn’t swing back up. Am I sticking myself like mad just to feed a faulty meter? Just a bad strip? Ugh, test again and I’m running out of fingers. Next test is an error. Drat. 140, if it’s an error it certainly is a consistent one. Just two more tests at two hours and four. Two hours in, the traditional time to measure and I’m a 125. Finally, 109. Ouch, my poor fingers.

My results, for my body, show that even with the highest volume of low-GI carbs I don’t match the extremes of Dr. Bernstein’s sensitivity of 5 ml per gram. Thank God, at about a hundred and sixty grams of carbo-loading that would have put me in the morgue with top end near nine hundred. Anyway, my spike was 84, or about a half a ml per gram. I’m already “well-controlled” even with that extreme load, for a diabetic, and if the ratio holds up I should be able to target a hundred forty as a peak by keeping, as a rule of thumb, my carbohydrates to a hundred grams of low-GI carbs, or less, which should be easy.

The double spike was interesting. When combined with my being thin it leads me to suspect I’ve been misdiagnosed as a type 2. I may be a 1.5, but that is a later post. Next up I’m going to drop my carbs in a similar size meal and do it again (sorry fingers) just to see if the ratio holds up.

Mr. Potato Head Must Die!

Potatoes are a staple for me. Every meal I was eating included potatoes. Baked potatoes, boiled potatoes, fried potatoes, country style home potatoes, mashed potatoes, I don’t care. I’ve forgiven the French for being… well, excessively French, just because their name comes before the word 'fries'. Idaho is my favorite state, despite not being shaped like a potato and I refused to vote for the first President Bush because his Vice-President added an e.

I love potatoes.

So obviously I had to take a peek at where my favorite side dish fell on the Glycemic Index (GI) that being the diet I’m counting on to control my BG spikes. Turns out it fell somewhere between ‘are you crazy’ and ‘here’s my gun, just end it now and try not to make too big a mess.’

Sigh.

So last night I started looking for a replacement for my beloved potatoes. Obviously I’m not looking at the side in isolation. So here is my whole menu from last night:

Starter; Progresso chicken barley soup
Main; Turkey Cheeseburger
Sides; Garlic bell pepper oats and a half slice of sourdough bread
Dessert; Chiquita grape and apple bites

What I would have eaten, last month, was a cup of chicken noodle soup as a starter, cheeseburger, mashed potatoes, and a biscuit for the main, and cake for dessert. It really was easy, except for the potatoes, to do the GI substitution, and I didn't lose out on taste.

Behold:

Whole Meal Substitutions
Turkey for ground beef
Whole wheat bun for white bun
Light mild cheddar for regular cheddar
Barley for noodles
Sourdough for biscuit
Apple and grape bites for cake
And finally, Oats for potatoes

Yes oats. Oats look ok on the index and I can mix in some veggies, which frankly I have a hard time dealing with on their own preferring them in soups or as add-ons. So I went ahead and tried replacing mashed potatoes with a bell pepper garlic oats combo as follows:

Ingredients
½ cup chopped red bell pepper
½ cup chopped yellow bell pepper
½ cup chopped mushrooms
2 cloves garlic, minced
1 tblspoon olive oil
1 ¾ cups of uncooked oats
1/3 cup egg whites
¾ cup chicken broth
Dried basil and black pepper to suit

How
In a non-stick skillet, on medium heat, drop in peppers, mushrooms, garlic, and onions and fry for two or three minutes in olive oil.

In a large bowl mix oats and egg whites until oats are covered evenly.

Add oats to skillet and keep cooking on medium for five or six minutes, stirring now and then. Add broth, then basil and pepper to suit. Keep cooking for two or three more minutes, stirring, and make sure broth is absorbed.

It should make six sides, with 130 calories, Calories from fat: 37. Total Fat: 4g. Saturated Fat: .5 g. 0 cholesterol, 19 grams of carbs and 6 grams of protein.

Result:
Compared to potatoes it’s a bit like kissing your sister, with the exception that people won’t think less of you if you enjoy it. Its texture is actually better than mashed potatoes but it was lacking flavor despite the garlic. What it needs is gravy, even mashed potatoes don’t work without gravy.

Effect on BG Level:
Before dinner my reading was 88. After finishing dinner the result was an ok, but not outstanding 179. My current goal is to limit a spike to 180 or less, so this combo can work as a staple for me, barely. Obviously if you are on another side of the Carbohydrate Wars, say the low-carb side, such a small side taking up a third of your carbs for the day would be much less attractive.

Chromium

While studies of Chromium’s impact on type II diabetes are also mixed, the mix in this case follows a helpful pattern. It seems that looking at the meta-study data all of the positive effects were regional. People in India and China, who appear to have a chromium deficiency in their diet, accounted for all of the positive data; meanwhile a test of obese Europeans showed no helpful effects at all.

It’s pretty certain that if you have a chromium deficiency it may be aggravating your BG swings, but if you live in the U.S. or Europe you are very unlikely to have such a deficiency. It would be terrific if there was a test for chromium, but there is not.

Authors of the meta-study found on the ADA website do have another caveat, “the authors state that the results found in their study groups may not apply to other types of groups, such as lean people with type 2 diabetes”

Complications from short term low dosage use, per the NIH, include “weight gain, headache, insomnia, skin irritation, sleep problems, and mood changes.” While, “High doses can cause serious side effects. The foremost concern for persons with diabetes who use chromium is the development of kidney problems. Other possible effects include vomiting, diarrhea, bleeding into the gastrointestinal tract, and worsening of any behavioral or psychiatric problems.”

Bottom line; despite being thin, and acknowledging that it can drop BG levels for Type 2’s who are not overweight or on insulin yet, it appears that my being on a western diet will already insure I have all the chromium I need and I don’t need the side effects. So I’m saying no to chromium.

Update: Found some more detailed information from the Linus Pauling Institute at Oregon State University. Full details are here but their research, while still mixed, shows a bit more promise than I thought, especially for pre-diabetics. It shows an adequate intake chart, adult males under fifty need 35 mcg, females 25. Now if there was just a way to know how much we are getting in our diet...

The Carbohydrate Wars, Part 3, simpler please

From the site Glycemic Index.com is the simplest description of a low-GI diet I’ve seen so far.

"The basic technique for eating the low GI way is simply a "this for that" approach - ie, swapping high GI carbs for low GI carbs. You don't need to count numbers or do any sort of mental arithmetic to make sure you are eating a healthy, low GI diet."

* Use breakfast cereals based on oats, barley and bran
* Use breads with wholegrains, stone-ground flour, sour dough
* Reduce the amount of potatoes you eat
* Enjoy all other types of fruit and vegetables
* Use Basmati or Doongara rice
* Enjoy pasta, noodles, quinoa
* Eat plenty of salad vegetables with a vinaigrette dressing

Very simple, but what is “Basmati” rice and how is it different from plain old brown rice? Per Wikipedia it seems mostly to have to do with being a longer grain, mostly cultivated in India, while “Doongara” is also long grain, but is from Australia.

So, when starting the switch to lower GI it turns out I can continue with a number of the changes I made when first diagnosed. With just a few a few tweaks I’m on a lower GI diet. So the plan for the moment is:

1. Keep eating six times a day instead of one or two.
2. Keep eating breakfast at six am; just change it to some form of oatmeal at least half the time.
3. The nine am snack (at work) can still be a Nutri-grain bar, for now.
4. Increase the Tuna content for lunch, keep the banana, and stay off of soda.
5. Keep the fruit cup, apple, grapes, or light yogurt for the three pm snack.
6. For dinner, first switch the chicken noodle soup to chicken barley, fairly often. Second, keep pasta as a staple, but check into effects of tomato sauce and watch for spikes on pasta night. Try stone ground tortilla with chicken strips, lettuce, Basmati rice, tomato and cheese. Drop breads with pasta or switch to sour-dough. Keep the whole grain turkey burgers as the replacement for cheese burgers. Keep thinking.
7. For the nine pm snack, drop ice-cream etc in favor of yogurt.

DD Forum, Highly Recommended

I found the Diabetes Daily Forum, and liked it so much I not only joined but put a permanent ad for it up top. It’s a free forum for 1, 1.5 and 2’s (and I didn't even know there were 1.5's.) It suggested making an intro post, I put one up that also mentioned my complaints about my longer workout recovery and got five responses from people in Minnesota, South Dakota, all over in just a few minutes.

Very worthwhile.

Problems with my X

This is the first time in quite awhile I’ve done my exercise program two days in a row. Some observations:

1. I’m used to having at least one day of recovery between workouts, and I really could use it.
2. It’s easy to get up at five am when you have to take a leak anyway.
3. Even if the supplements don’t help with my BG level, they may help keep me going.

The diabetes makes me tired and I’m pretty sure that it, rather than age as I previously thought, is the reason my recovery between workouts seems to take longer each month. Nothing I can really do about either other than just suck it up and solider on I guess.

The other thing I noticed was how I was handling a spike. It may be a different for others, but for me it felt remarkably like I you do right when you realize you just got the flu. It was a combination of dehydration despite drinking a lot of water, headache, and a fever like quality. It happened toward the end of the workout, when Jessica decided we could stick around for an extra twenty minutes do abdominal work.

The Carbohydrate Wars, Part 2; a Lab Rat of one.

In my first post from this front I was thinking seriously about which side to join first. Three sides are available, the ADA and its 45-65% carbohydrate recommendation (high carb), Dr. Bernstein’s diet for diabetics (low carb) and Dr. Miller’s glycemic Index for diabetics (right carb.)

I’m siding with Dr. Miller and “The New Glucose Revolution” for now.

My reasoning is partly guesswork, since like so many other objects of study the reality on the ground is extremely confused. But the fog of war was parted for me, just a bit, on reading this particular graf from Dr. Miller’s book.

“What we eat plays an important role, too. Specifically eating too much fat,especially saturated fat, and too little carbohydrates can increase your insulin resistance.”

One of the hardest parts for me to grasp, before reading this sentence, is how I got it. I have no family history, I’m not overweight and I was already exercising three hours a week for years before being diagnosed. I had none of the traditional risk factors.

But my diet was horrible.

By the standards laid down in Dr. Miller’s book I was bound to get the Big D purely on the basis of diet, since I used to eat almost nothing but saturated fat in the form of low carb meals. Worse, I tended to ignore eating all day until I finally had one huge high fat low carb meal just before bed. Since her book has the first clue I’ve found as to why I got it in the first place, my best guess is to join that side first and see what happens.

Of course the ‘seeing what happens’ part is a bit tricky too (and what isn’t with this stuff.) Obviously if there was a magic pill out there everybody would take it and be done. We’d only have the one variable to test. But to manage diabetes takes a combined campaign of diet, exercise, and maybe supplements. This means I’m going to become a Lab Rat of One, with all the perils such anecdotal data may provide.

I have to start somewhere, so I’m going to do the GI diet, choose a reasonable set of supplements and add an hour to my exercise routine. Even if, as I hope, it works and my BG gets under control, it still begs the question as to which change was most responsible for any positive effects? Or was it the combination? Would another combination work as well for me? Better? And will what works for me work as well for others who may, in fact, have gotten the big D under completely different circumstances? I’m not even entirely certain, at this point, if my diabetes is based on insulin resistance or a faulty pancreas although it certainly appears to be the former.

The only way, it appears, to move forward is to test. So for the rest of this week, the last in April 2008, I’m going to stick with my 50% carb diet (until the refrigerator is cleaned out) and test BG very often to get a better baseline. Then I’ll go on the new program until my next A1C test in late June, while testing often again just before then. In June then I should have a better idea as to how well it all works, assuming the lab rat survives the experiment.

Omega-3

Popular enough for the NIH to do a meta-study, the end result is, as they are all too often with supplements, mixed.

"Among 18 studies of type II diabetes or the metabolic syndrome, omega-3 fatty acids had a favorable effect on triglyceride levels relative to placebo (pooled random effects estimate: -31.61; 95% CI, -49.58, -13.64) but had no effect on total cholesterol, HDL cholesterol, LDL cholesterol, fasting blood sugar, or glycosylated hemoglobin, by meta-analysis. Omega-3 fatty acids had no effect on plasma insulin or insulin resistance in type II diabetics or patients with the metabolic syndrome, by qualitative analysis of four studies"

So while it’s no help for managing BG directly or improving cholesterol, it does seem to drop triglycerides. This can be important for many Type II’s who are over-weight and at high risk for heart attack and stroke. Even though I'm not overweight, dropping triglycerides is one of my major goals since my symptoms match up with too high a triglyceride level impairing insulin's action and messing with my liver. When first diagonosed I had a swollen liver, most likely from eating too much saturated fat.

Getting over "fatty liver" is high on my list of objectives.

A downside, or at least a risk to try to manage, is that since many of the Omega-3 supplements are made from deep-sea fish oil, is the possibility of contamination with mercury and other heavy metals. This can be avoided, since the vendor can remove the metals during processing, but is something to be aware of. In this case especially, a bargain may include stuff you don’t want.

You also need to avoid, as in all supplements, over dosing. The NIH recommendation for a dosage is 650-900 mg. Be warned, some advertised pills have doses as high as 3000 mg.

Other possible downsides include clinical bleeding, gastrointestinal complaints or nausea, diarrhea, headache, and dermatological problems.

Bottom line; I’ll be adding a daily pill, from a trusted vendor, to my regimen in the hope of slightly lower triglycerides.

Alpha-Lipoic Acid

From http://www.pubmed.gov/:

"Available data strongly suggest that LA, because of its antioxidant properties, is particularly suited to the prevention and/or treatment of diabetic complications that arise from an overproduction of reactive oxygen and nitrogen species. In addition to its antioxidant properties, LA increases glucose uptake through recruitment of the glucose transporter-4 to plasma membranes, a mechanism that is shared with insulin-stimulated glucose uptake."

It’s pretty clear that Alpha-Lipoic Acid, sometimes ALA or just LA, works in a test tube and while the studies are mixed, one critic complained that it drops BG too much. If, or when, you are struggling with too high BG levels, that is not such a bad thing.

Adverse side effects include lower minerals such as iron, and it seems to interact poorly with some medications, including anti-cancer drugs. It can cause headaches, skin rash and indigestion.

Bottom line; I haven’t started it yet, since once on we’ll need to increase BG monitoring to avoid a crash. But definitely worth thinking about if BG is consistently too high.

The Carbohydrate wars, Part 1

I knew less of diets than many newbie soldiers knew of war before the balloon went up. But like many a poorly trained solider I quickly found myself stuck in no-man’s land watching with a horrid fascination as the flaming posts whizzed overhead striking trolls and innocent bystanders alike. On one side of the line are the traditionalists, led by the American Diabetes Association which itself advocates a forty-five to sixty-five percent carbohydrate diet. Meanwhile we have Dr. Bernstein and his acolytes in a headlong, pell-mell rush for a diabetic low carb diet which is currently ranked #6 on diabetes books with Amazon dot com. His reviewers have peppered the reviews with phrases like, “this book will save your life.”

Opening a second front in this open multi-directional war are the ‘low-glycemic’ warriors whose bible is Dr. Jennie Brand-Miller’s The New Glucose Revolution. To whom the kind of carb is more important than the number, except when it’s not. Regardless, they wound-up coming down squarely and decisively between the other two camps… For the most part. Meanwhile, the Joslin center has its own diet book out with an emphasis on low fat, high fiber, moderate protein, carbs… what about carbs… Oh some meals are high and others low. Lovely.

Now I’m a guy who is willing to embrace uncertainty, as a racer I once actually saw an old shoe give two drivers completely opposite pieces of advice on how to handle the same kind of car in same corner, and be right both times. I often call it fuzziness, a lack of clarity that depends on there being more factors than human beings can take into account. And if anything appears to be fuzzy its diet.

It is, sadly, all too likely that our systems are complex enough that no two of us are going to react the same way to the same diet. Anecdotal evidence, which I can only come by for me by trying one side or the other, appears to be the only way out of this morass. So I’m going to study one, then pick one, and try a heavy dose of monitoring my BG levels, and if it doesn't work I'll just try another, because if I just keep sitting out here without picking a side I’m gonna get creamed.

Exercise or die

(GI Jessica, fitness trainer)
So far on in this blog I’ve been covering supplements and diet. Here is a first entry on the other, equally important method of controlling blood sugar.

Exercise.

I had an advantage here, since I was exercising for years before being diagnosed. It was the diet part that has been really hard so far, and I’ve only just started scratching the surface of what I need to learn about that. Not that getting started with exercise is easy. It might just be one of the hardest things you have ever done, but like most hard things it is well worth the time and effort. Since I’m presuming you’ve been diagnosed with at least pre-diabetes it is most important to knock one fact into your head that your reality is now; exercise or die.

But how to get started?

I started almost as an afterthought. I race a car on weekends and when I first bought my Mazda GT I could barely make it through a thirty minute race despite being in fair shape, it is that hard. By the end of a race weekend I really wanted to die. So I decided I needed to get a program going, went to my local Bally’s, and got a trainer named Jessica. The day after I met her somebody handed me a pencil and my arm dropped to the table like I was bench pressing a Volvo. Now I thought I really was going to die and the only remaining worthwhile goal in life was to take that pretty little b***h with me before she did the same thing to some other innocent. As it turned out by the time I was feeling strong enough to pick up the gun I felt much better and within a few weeks I was actually looking forward to working out, and you will too. So yes, Jessica lives. She has since left Bally’s and started her own fitness business, and I’m still going to her group workouts two or three times a week. It'll be five years in August.

And that is lesson number one on getting started, if you can afford it, get a trainer. A trainer will help in many ways, but the most important two are:

• He or She will help plan your regimen and teach you to do it right, avoiding unnecessary injury.
• Having an appointment with someone will, if you are like most people, help motivate you to make it which in turn will prevent you from dumping the routine when your body hits the initial shock.

For those of us more economically minded, while a personal trainer for the first few days or weeks is great, before too long you are going to need to find a group to avoid the high cost of individual training. The YMCA is a great source, especially for various group activities. Check your local Y to see what they offer. And of course Jessica is great if you live anywhere near Newport Beach, CA.

The main thing is to get into a routine.

A lot of us will complain about not having enough time in our busy lives for exercise, but it is, you will admit, more likely that you don’t have the energy. We need four hours a week of exercise, and if you are a typical American you do have the time to crash on the couch for three hours a day watching TV. No, it’s time to be honest with ourselves and admit that it isn’t really a lack of time that is an issue; it’s a lack of energy and to make matters worse, diabetes itself causes fatigue.

That’s why you need to do the diet and exercise together in a combined campaign. The diet will help boost your energy level, which will make it easier to exercise, which will also help your energy level, helping you exercise, all to try to avoid the dying part...

Bottom line; I’m adding an hour, going from three hours a week to four, with three hours being a group exercise led by Jessica on the beach in Corona Del Mar and one hour Saturday mornings at the Y either on weights or doing a spin class. If you are overweight or out of shape it is especially important to get a certified personnel trainer to help you get started, but its expensive so start making plans for a regular group workout at your local gym or the Y as soon as you can.

Lunchtime blogspotting

Obviously I knew that another blog on diabetes would be less than orginal, what with twenty million or so diagnosed. So I've been spending as much time checking them out as I have been studying on my own.

The number one favorite so far, Diabetes mine. Well written and very well organized, Amy runs a very good site and is keeping a close watch for pretty much every trend.

Not so bad after all...

While my target range for blood sugar, or bg (Blood Glucose), is 70-120 and I went well over that on my race weekend and stayed high, checking the well organized Mayo Clinic page it seems its not quite as bad as I feared. Maybe I'm still too new at this beacuse their recommendation for pre-exercise levels are 100-250 which is a lot wider range than I expected.

I figure I'd best buy their book, more homework, sigh... which is available on-line here: http://bookstore.mayoclinic.com/products/bookDetails.cfm?mpid=28

Garlic

Here is a compound that has been in use for quite awhile. Since Hippocrates first recommended garlic for the treatment of battle wounds, it has had a reputation for potent medicinal properties. This reputation may or may not be deserved. Clinical studies, and studies of clinical studies have broke both ways on the various benefits of garlic, but have never indicated much of a problem with taking it as long as you don’t have preexisting problems with thin blood.

One of the reasons for the differences is that garlic seems to be very dependent on the manor of ingestion, the form (powder, liquid, pill, cloves), and even the age. Allicin, claimed by some supplement makers to be the active ingredient in garlic (see the picture of Allicin’s 3-D balls, above) tends to degrade very quickly and is destroyed by cooking. Beside which, it appears that it isn’t absorbed by the body under any circumstance. This eliminates from my consideration products like Allimax.

Part of the problem with evaluating Garlic’s potential is that it may be a combination of compounds that deliver the effect. To quote the site Allicin.com

"Though individual compounds, such as S-allyl cysteine, have shown activity in studies and are absorbed by the body, it is likely that a synergism of various compounds provide the benefits of garlic. This is in agreement with Dr. Koch, a renowned Austrian scientist who stated that the activity of various sulfur compounds could not alone be responsible for the benefits of garlic and fixation on a single group of components can lead to mistakes and wrong conclusions"

All of which, in turn, goes a long way to explaining the variation in clinical studies along with the wide variety of forms for recommended for ingestion. Ever since an NIH study indicated that garlic lowers the harmful effects of LDL cholesterol and lower blood pressure, the supplement industry has gone berserk over it, but by often ignoring the details that might lead to the beneficial effects claimed, in favor of an easy advertising campaign designed only to pump up sales.

As to the harmful effects, aside from allergic reactions and possible blood thinning, they appear to be few. Nevertheless, check with your doctor, as always, before starting such a regimen especially if you have other issues such as being on an aspirin (also a blood thinner) regimen, suffering from HIV, or, most importantly for this site if you are already taking insulin. For those of us on insulin, absolutely avoid garlic until after you talk to your doctor. Garlic should be avoided during pregnancy and while breast feeding since it has abortifacient properties, as well as within a week of surgery because of the blood thinning property.

My bottom line; the consensus appears to be that garlic has a helpful moderate short term lipid lowering effect and is therefore worthwhile but hardly a cure. I take two pills in the liquid capsule form per day, and often cook with it in both a powder form and from cloves to help ingest a wider variety of forms. Besides, the cloves and powder taste great.

Bitter Orange

With the Scientific name of “Citrus Aurantium” (may be either when examining the ingredients label.) This is the replacement ingredient for many weight loss “metabolism pills” after the ephedrine alkaloids they were using were found to be killing people. It’s found in fat loss products like ‘Miracle Burn.’

The irony is that both ephedrine and citrus aurantium work, after a fashion, as a weight loss pill. It’s just that they accomplish this feat by ripping up your heart. You lose weight, die, and then lose even more weight.

Of course, it is a “natural” way to cause vasoconstriction and a racing resting heart beat which brings me to my own pet peeve. The “Natural is good” vs. “Artificial is bad” assumption. Arsenic is perfectly natural but I’m not about to start taking it as a supplement. Insulin injections are artifical, but if my type II ever gets that bad I’ll get over my dislike of needles pretty damn quick.

So sure, the Chinese were taking bitter orange hundreds of years ago to cure everything from indigestion to the wonderfully named anal patosis. (Imagine a Harry Potter spoof with the incantation, “Anal Patosis!”) But the Chinese didn’t have a western diet causing coronary disease and besides, people back then didn’t have enough food or live long enough to get arteriosclerosis like we do anyway. And I’m sure most of them would be perfectly happy to swap with any of us for their ‘natural lifestyle’, especially since most of them died before thirty.

Bottom line to me, stay away from Bitter Orange like the plague if you don’t want to die of a coronary.

L-Carnitine

Google L-Carnitine and you’ll get “about” 2,750,000 hits. The “about” is Google’s way of saying too damn many to count. Among supplements L-Carnitine is popular for body builders, dieters and diabetics since it, as Wikipedia puts it:

‘...helps in the consumption and disposal of fat in the body because it is responsible for the transport of fatty acids from the cytosol into the mitochondria. It is often sold as a nutritional supplement. Carnitine was originally found as a growth factor for mealworms and labeled vitamin Bt.’

All of which appears to be true. The issue is that, as with so many other pieces of advice on supplements, there are too many contradictory opinions that fit in that gap between the effect of the compound itself and the dosage.

The journal of the American college of nutrition had an article, which Wikipedia again, summaries as,

‘…improved glucose disposal among 15 patients with type II diabetes and 20 healthy volunteers.[7] Glucose storage increased between both groups, but glucose oxidation increased only in the diabetic group. Finally, glucose uptake increased about 8% for both.’

This sounds like really good news; that led to me to start taking them within a few days of being diagnosed. Then I took a closer look, and read the article’s abstract. It appears that the design of the study involved artificially creating a condition by inserting a “euglycemic hyperinsulinemic clamp” in both the diabetics and the healthy control group. In other words, they created a short term artificial shortage to see what L-Carnitine does. Looking at another article from Vanderbilt University they found that most studies came up with the conclusion that, “…unless an individual is deficient in l-Carnitine, it is an unnecessary ergogenic aid…” In other words, L-Carnitine does exactly what it is promised to do if you have enough, but any extra is thrown away, and you probably already have enough.

My bottom line, it’s not harmful and keeping a small dosage as insurance against an unlikely shortage (which may be hard to detect) is (barely) worthwhile. But it is unlikely to lead to a measurable improvement. If after a few months my levels do not improve I will assume I am, like most people, producing all I need and stop wasting cash on it.

The dose makes the poison.

Paracelsus was a fifteenth century alchemist who coined the phrase, “The Dose makes the poison.” This is something to keep in mind when considering supplements. The shorthand human idea is that things are either good or bad in and of themselves, while a better if more complex, reflection of reality is that something can be either good or bad depending on the context; context in this instance meaning dosage.

For example, we all need Vitamin A. Without it you’ll go night blind, and then suffer from impaired immunity, keratosis pilaris and other dreaded conditions best left in Latin. But too much Vitamin A, like those found in some supplements, leads to a whole different slew of problems such as hair loss, drying of the mucous membranes, fever, insomnia, fatigue, weight loss, bone fractures, anemia, and diarrhea. Even in non-toxic amounts, too much Vitamin A is already common in industrial countries and leads to lower bone density.

So when considering supplements we need to remember that the amount we take is as important, if not more important, than what we take.

Day Tripping

I’m going to the long beach grand prix on Saturday; it’s local to me so it’s just a day trip. I’ll be taking some of the Glucerna meal bars with me and try them out since I'll be away from healthy food for eight hours or so…

BS is still off after traveling

I've been back, and back to my new routine, for two days and my blood sugar is still well over a hundred before eating. My fitness trainer, GI Jessica, suggested I try her "holistic" doctor. Something in my mind flips from "holistic" to "witch" when she said that, but at this point it might be worth a try as long as there aren't any gothic looking kids with knifes involved. Goth is so ninties...

On the road

I race a car for fun on weekends, in fact I started my other blog, the GT Campaign, first. This last weekend was an away race in Sonoma CA at a track called Sears Point and so I had my chance at more than a few firsts. I had to tell everyone about the diagnoses since I was skipping the BBQ, snacks and sundry goodies everyone brings to share. I was controlling my diet. Also I was testing my glucose level a bit more often, a blood sugar crash combined with the adrenaline of driving a race car is a bad combination. Turns out I need not have worried about it going too low because it shot up thru the ceiling instead.

After a week of very good readings in the middle eighties, on Saturday my reading shot up to 184. Why I had no clue. So I went to the American Diabetes Association web site, looked up stress and blood sugar levels and got this:

Scientists have studied the effects of stress on glucose levels in animals and people. Diabetic mice under physical or mental stress have elevated glucose levels. The effects in people with type 1 diabetes are more mixed. While most people's glucose levels go up with mental stress, others' glucose levels can go down. In people with type 2 diabetes, mental stress often raises blood glucose levels.

Of course racing isn’t a form of bad stress, its fun, but the butterflies start racing around my gut before I start racing around in the car. What to do about it is another question, but I’ll be out of the car for a few months so I’ll have plenty of time to figure it out.

The Virtuous Circle

The right diet will give you more energy. The right exercise will give you more lean muscle mass. More lean muscle mass will help maintain your blood sugar level. As you get fitter you’ll need to eat more (and more delicious) food to maintain the new and expanded muscle fibers. When it goes right it’s a virtuous cycle.

But when it goes wrong it can go really wrong. Many people who have pre-diabetes or full blown Type II got it, in part, due to being overweight. Almost everyone I’ve known who is or ever was overweight have spent most of their life on some kind of a diet. Almost all of the diets don’t work at all. Some of them make you fatter. And the few, like low carb diets, that will “work” if you can stick with them would kill you even if you were healthy, which you and I are not.

So if idea number one is that we must combine diet and exercise what is idea number two? Dump the correlation in your head between diet and going hungry. Going hungry when you have Diabetes is a bad thing, and while if you are overweight you must lose the pounds, even if you could lose them for good through starvation, which you can’t, it would turn your blood sugar levels into chaos. We need to use “diet” in the proper sense meaning a plan of nutrition. Simply, when you eat what you eat, is your diet.

The “when to eat” was particularly hard for me. As a child I never had breakfast and often skipped lunch as well, a bad habit that continued through my forties. When diagnosed I started reading and realized that I was alternating crashing my blood sugar through starvation, and then stuffing my face and flooding it. In my own case I believe this was the cause of my Type II since I have none of the regular risk factors for diabetes. I have never been overweight, I had been exercising, strenuously, for five years beforehand, and I have no family members with the condition.

So when do I eat now? I went from one big meal per day to six small ones. I eat something every three hours, between six am and nine pm, to eliminate the big peaks and valleys in my blood sugar levels. I need the constant levels to avoid damage to nerves and various body parts, but as an additional advantage I found that my overall energy level, after less than a week, zoomed off the scale. I found myself not only feeling better than before, but better than I ever have. In turn that made my morning exercise routine a lot easier and I found myself doubling it from two hours a week to four, and enjoying it rather than dreading it.

That doesn’t mean that everyone needs to eat six times a day, if does mean you need to talk to your Doctor or, if you can get one, your nutritionist. So, idea number three, you can’t just eat when you’re hungry anymore.

That still begs the question of what to eat. Again, a proper nutritionist, or your primary care physician, can point you in the right direction for your particular condition, but what worked for me was a surprise. I found the surprise when I started keeping a log of what I was eating. My habit before was to stuff my face with whatever was close at hand when I was hungry enough. Once I started planning I found myself tracking what I found were the two most important elements of food; Calories and Carbohydrates. Keeping track I suddenly found that I had been on an extreme low-carb diet, by accident, for years.

In the days right after my diagnosis I was trying to plan eating and created a simple log of what I ate, when, and the number of calories and carbohydrates. My goal was to get as close as reasonable to 2614 calories with 50% from carbohydrates. The math for carbohydrates is (1/2 of calories) divided by 4 which means 327 grams of carbohydrates is 50% on a 2614 calorie diet. Eating this, in my case newly discovered, healthy food, try as I might I couldn’t figure out a way to get 2614 calories and 327 grams of carbohydrates from it. I finally emailed a friend who is knowledgeable about such things that in order to get this to work I’d need to find some source of food that had a thousand calories and no carbohydrates. Duh; what I was eating before, steak… chicken… etc have no carbohydrates at all and lots of calories from fat. This is how I discovered I’d been on a low-carb diet for many many years.

So, idea number four; use a log to keep track of what you eat and when. In fact, being an Information Technology guy I was determined to find a program to handle the messy details for me and believe I’ve found a reasonable winner with Calorie King. This particular application includes a database with most of the food you eat already in it. The interface is a bit clunky, but the application is reasonably solid and once you get past a few peculiarities it works very well. I’ll be doing a post on the application at a later date.

On computer or on paper, to understand why the log should keep track of calories and carbohydrates and not just calories it’s necessary to have at the least a very simplified understanding of the difference between the two, and how they affect blood sugar levels.

I like to use toilet analogies. Not in the potty mouth, dirty words sense but literal toilets. Carbohydrates are like the water in your toilet’s tank. A part of your pancreas and liver are like the float that shuts the water off once the tank is full. When you flush, your toilet uses the water available in the tank. When you use energy your body uses carbohydrates in the form of blood sugar or “glucose” if you prefer that are available in your blood. As the water rushes out of the toilet tank the float drops, tripping a switch, which starts to refill the tank. As your blood sugar drops, the alpha cells in your pancreas send signals to your liver, tripping a switch to put more sugar into your blood. Once the toilet tank is full again, the float trips the switch cutting off any more water. As your blood sugar levels rise, the beta cells in your pancreas send signals to your liver, in the form of insulin, to stop putting out more sugar. If the switch in your toilet tank is broken, it’ll keep putting water into the tank until it overflows and makes a mess. If your pancreas is broken, or if the insulin it puts out isn’t properly used, your blood sugar will overflow and make a mess. It’s amazing, but almost anything on earth that needs to be understood, can be understood, by using a toilet.

So carbohydrates are short term energy and the non-carbohydrate calories are long term energy. This is why a sudden burst of sugar, say in a 12 oz can of soda, isn’t necessary a good idea for you anymore. To go back to our toilet for a moment, you’ve just done the equivalent of suddenly dumping a gallon of water into an already full tank. That doesn’t mean you can’t eat sugar anymore. Yes, sugars are carbohydrates and carbohydrates are sugar, but how fast you fill the tank counts at least as much as how much you put in it. Pour a gallon in, at a rate of an ounce per hour, and it’s not going to overflow.

So now you need a diet plan, X number of calories with Y grams of carbohydrates spaced over Z number of meals per day. Consult your doctor or nutritionist to change X, Y, and Z into actual numbers and you’ll be good to go. For me, I’m as I said I’m on 2614 (ok, not exactly) calories with 327 grams of carbohydrates spread across six meals, three hours apart, starting at six am and ending at nine pm. Now I’m not going to explode the instant I miss those exact numbers at those exact times, but sticking with the plan means coming as close as you can to your X, Y and Z.

Stick with the plan and your toilet will never overflow.

Diet and Exercise and Bears… Oh My…

Damn.

There is no way around it, if you’ve been diagnosed with Type II like I've just been, or even pre-diabetes you are going to have to exercise and diet like your life depends on it… because it does.

Just to keep your attention, here are some of the wonderful things to look forward to if we don’t get our blood sugar under control, and if they sound a lot like Al Qaeda interrogation techniques, well, yes.

• You can lose your kidneys and be forced to sit for hours at a time with needles sticking in your arm until, thankfully, you die.
• You can go blind faster than a sixteen year old boy with a webcam in Pamela Anderson’s shower.
• You can have your feet cut off after a bout with gangrene and blood poisoning.
• Impotence (and forget Viagra; you might as well start peeing sitting down).
• Acute-onset femoral neuropathy will keep your thighs in constant pain for the rest of your life.
• Gastroparesis and Diabetic diarrhea. Now you get to spew what little food you can still manage to eat, out from both ends.
• Abnormal blood lipids. Just a heart attack, stroke, not so bad comparatively.
• Ketoacidosis leading to coma or death.

Terrific; not as bad as being lowered, slowly, feet first through an industrial paper shredder perhaps, but just barely.

It’s not all bad news; one advantage of combining diet and exercise is that they tend to reinforce each other. Think back, when you were a kid exercise wasn’t really the chore it is now, was it. In fact we called it playing back then. Why the change? It’s because when you were younger you had more energy and if you are honest with yourself you’ll admit that it isn’t really a lack of time to exercise but a lack of energy. When you have the time you are too tired and want nothing more than to pass out in front of the T.V. and munch on some cheese doodles, and when you aren’t too tired, it’s time for work or kids or something and now you really are too busy.

The only secret of diet and exercise is that once you do force yourself to start a combined campaign, it gets a lot easier. Maybe not quite like playing when you were a kid, but a lot closer than you’re thinking right now. So our first goal is to get a combined plan together and start a virtuous circle.