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.