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Welcome all seeking refuge from low carb dogma!

“To kill an error is as good a service as, and sometimes even better than, the establishing of a new truth or fact”
~ Charles Darwin (it's evolutionary baybeee!)

Thursday, December 30, 2010

The Finger Pricking Diet?

Dr. William Davis is touting the success of one of his patients on a No BG Rise After Eating diet.  The post is HERE.

So Jack was overweight and:
Try as he might, Jack could simply not stick to the diet I urged him to follow. Three days, for instance, of avoiding wheat was promptly interrupted by his wife's tempting him with a nice BLT sandwich. This triggered his appetite, with diet spiraling downward in short order. 
Presumably the diet he urged was low carb.  But just going LC and trying to cut wheat lasted only three days.  So the good Dr. Davis told Jack to get a BG meter and strive for 1 hour postprandial glucose levels to be no higher than before eating.  So:
If any food or combination of foods increase blood glucose more than the pre-meal value, then eliminate the culprit food or reduce the portion size. For example, if dinner consists of baked salmon, asparagus, and mashed potatoes, and pre-meal blood glucose is 115 mg/dl, post-meal 155 mg/dl, reduce or eliminate the mashed potatoes. If slow-cooked, stone ground oatmeal causes blood glucose to increase from 115 mg/dl to 185 mg/dl (a typical response to oatmeal), then eliminate it.
Now, I've seen the BG levels in like a gazillion studies and even healthy glucose-tolerant individuals will not see their blood glucose return to what it was before eating any meal containing carbs of any significance.  A person with any degree of insulin resistance or impaired glucose tolerance would have to eat basically zero carb to attain this goal.  Looking at the example dinner, we remove the potatoes and where does that get us?  Pretty much biologically zero carb as Dr. A would have called it in 1972.  

Ironically, isn't it the postprandial hypoglycemia from the hyperinsulinemia that is supposed to trigger the voracious appetite??  But Davis blames the sugar spike and insulin.  But I digress ...

The result?
Having immediate feedback on the effects of various foods finally did it for Jack: It identified foods that were triggering excessive blood sugar rises (and thereby insulin) and foods that did not.... Six months later, Jack came back 37 lbs lighter.
OK, I'm all for the immediate feedback thing and I think it is highly instructive to get a BG meter and know how your body reacts to various foods.  But really, now.  We know what does and doesn't spike BG (except for some of the questionably LC foods like Julian breads IMO.   Still, was not the list of issues Jack faced not scary feedback enough to scare him straight?   So, if several BG readings/day is going to keep you motivated on the VLC straight and narrow I encourage you to go for it!**  Still, I find it hard to believe that someone only lasts 3 days trying to eliminate wheat before a BLT sends him spiraling out of control, but using a BG meter is basically able to cut out all carbs for 6 months.  But then Davis really loses me with his closing words of "wisdom":
...What Jack did not do is limit or restrict calories. In fact, I asked him to eat portion sizes that left him comfortable. There was no need to reduce calories, push the plate away, etc. Just don't allow blood sugars to rise. ...  And he got there without calorie-counting, without regulating portion sizes, without hunger. 
I'm all for ad libitum diets that reduce intake spontaneously, but as my regular readers know well, I can't stand the misrepresentation of such diets as not restricting calories or intake.  If Jack lost 37 pounds it had nothing to do with his insulin and blood glucose levels, it was because he was eating a VLC diet known for rather significant reductions in intake w/o deliberate restriction.  Gosh folks!  This IS the BEAUTY of low carbing!  I long for the day that the "gurus" embrace this rather than trying to convince people that they really do lose weight without eating less.   There are literally thousands of folks out there diligently following a low carb plan and wondering why they aren't losing weight ... or worse, gaining.  

I also have to pipe up a bit about hunger.  It's a NATURAL sensation.  If you are eating a diet that has your body signalling properly, etc., being hungry should not be an issue that sends you face down into a pile of insert-fave-food-here.  Sure, starving yourself so that you get so hungry that you lose control is not the answer, but to expect that your body will be in energy deficit to get you all the way down to an ideal weight without ever experiencing a hunger pang is unrealistic.  I'm sure there's someone out there who can claim that to be the case, but let's talk reasonable expectations for the rest of us.  

** I can see where monitoring ones blood glucose can get as obsessive as counting calories, carbs, weighing daily or even more often, etc.   BG meters just aren't all that accurate down to a few points from what I understand, and although the strips I used were well within expiration date, I noticed distinct differences even for strips within the same lot, and one time a small lot that routinely gave me BG's around 10 pts higher than the other lots.  It's also common knowledge that very low carbing can make you more intolerant to a glucose challenge which is why low carbers are encouraged to "carb up" eating 150g/day for several days prior to an oral glucose tolerance test.  Something about the term "carb cripple" used by Dr. Michael Dansinger in a recent JM interview struck a chord with me.  If you get to a point where your body can't tolerate even 10g carb in a mixed meal this could drive you low omega 6 content nuts!  

18 comments:

Nigel Kinbrum said...

What would be useful is accurate continuous blood glucose monitoring with an alarm that goes off when blood glucose increases too rapidly or exceeds a certain level for too long. Feedback like that would help to control food intake.

Paul Jaminet said...

Hi CarbSane,

I laughed at that post too. This uniform blood glucose idea is basically a way of motivating the guy to adopt a zero-carb diet. Now, that can easily generate weight loss ... but as you know I don't think zero-carb diets are optimal in the long run!

Sanjeev said...

> accurate continuous blood glucose monitoring
> with an alarm

Hey Nigel ...

That might be OK for most folk

But what's the carbophpobe/insulinophobe/Taubesophile (with the ASP blind spot) supposed to do with the info? What would Adam Koslof do with the info?

Inject insulin & immediately put on 5 pounds of fat at the injection site?

Melchior Meijer said...

Maybe a bit off topic, but I was recently baffled by autopsies performed on preserved cadavers from pre white man contact Inuit. These people must have eaten the perfect vlc diet. They were not very healthy and were as atherosclerotic as the disease riddled ancient Egyptians. There goes my pet theory that the combo wheat-fructose-linoleic acid is singularly (word used purposely to upset CarbSane on the last day of the year ;-) ) responsible for most of our 'modern' ailments, specifically CHD. Ad hoc hypothesis to ease my cognitive dissonance, anyone?

http://www.meandmydiabetes.com/wp-content/uploads/2010/03/Atherosclerosis-in-Pre-Westernized-Inuit.pdf

Now it's not known if these atherosclerotic (and brittle!) Inuit actually got MI's, as did the wheat eating Egyptians. Cordain's hypothesis is that wheat lectins activate MMP's, which in their turn make stable plaques vulnerable. So Inuit developed extensive coronary atherosclerosis, but their plaques might not have ruptured.

With regards to Dr Davis' Finger Prick Diet: I do think frequent and prolongued post prandial blood glucose excursions promote disease (who doesn't?). Measuring BG after meals could be an eye opener for many apparently healthy folks, me thinks.

Happy new year to all! And thanks again for challenging my 'beliefs', Carb Sane.

Frank Hagan said...

A couple of points. One, this is a real-world experience where Dr. Davis treated a patient, you know, one of those humans that is so frustratingly variable. Your textbook may say this doesn't work, but talk to a group of diabetics sometime. They will tell you different foods spike their blood sugar.

Two ... different approaches work for different people because of what I call the "fat between the ears". Purposefully restricting food until you are in a constant state of hunger, such as going on a calorie restricted diet, focuses your mind on food, and the goal is to get weight off so you can resume eating without constant hunger.

Someone who has dieted that way can sometimes benefit by a completely different approach; not focusing on weight per se, but BG in this case (and triglycerides in my case), has a powerful psychological effect.

For me, counting only carbs means I have no idea if I lost 50 pounds because of some magic effect, or if I spontaneously reduced the number of magic calories ("magic" because I don't believe we can really tell how food is metabolized by burning it in a furnace and weighing the ash).

Not having hunger consume you every hour of every day is a definite benefit. "Never being hungry" is how I would describe myself, but I do get hunger signals when its time to eat. It is the constant state of unsated hunger, even after eating to discomfort, that is gone with a diet low in carbs, high in fat, and with adequate protein.

CarbSane said...

I've been following the Dangers of Zero Carb series Paul. While I suppose adapted cultures can thrive, it doesn't seem to be anywhere near an optimal diet for the long run for most humans.

CarbSane said...

Hi Frank! Perhaps my post wasn't clear, but I wasn't poo pooing this approach to weight loss so much as Davis' rationale for why it worked. You are correct, the first fat we need to lose is that between our ears. If seeing what his blood glucose levels did eating carbs kept Jack on the straight and narrow eating a very low carb diet (and make no mistake about it, a man with his metabolic disposition would have to eat virtually zero carb to meet Davis' goal) that's great! No doubt eating VLC he spontaneously reduced his caloric intake.

I'm also not saying that all foods have the same impact on BG in all people. Just that for Davis' goal, it's pretty much a no-brainer that sugars and starches are going to spike BG.

AFAIC, Davis is pulling numbers out of a hat as he obsesses over certain foods being particularly bad. For starters, 115 pre-meal is higher than the 100 he usually counsels readers to try for after eating a meal. Too much insulin still around at that level to burn fat according to that *theory*. But the 185 being a *common* glucose excursion for oatmeal is just ridiculous. Common amongst diabetics or those following a VLCVHF diet for any length of time, but not common. A couple of summers ago we had a group of hubby's friends over for a BBQ where quite a bit of beer drinking and eating (potatoes and macaroni salad and ribs w/sugar containing BBQ sauce, etc.) went on. I was curious to know what this did to their BG's. Not a one over 130, most in the low 100's. I encourage folks to test their's and see how they react to different foods, but I disagree with Davis' benchmarks for targets and obsession with transient glucose/insulin spikes.

CarbSane said...

@Frank Part II

The Atwater factors (calories per mactonutrient) were not determined in a bomb calorimeter. They are for human metabolizable energy determined in a metabolic chamber. They aren't perfect, but hold up amazingly well on average, for example, in studies where TDEE is determined and intake adjusted to equal it (weight stable) or create a deficit (weight loss). If you lose weight, whatever you did created a calorie deficit plain and simple. Even Gary Taubes out of one side of his mouth acknowledges this, he just claims the arrow of causation goes the other way. Dr. Eades used to be very matter of fact on this issue as well before he went MAD. I suspect that those who see major differences in the amount of calories they can consume on one regime or another likely have some fat absorption problem or are increasing their TDEE w/o realizing it because they have more energy eating certain foods over others.

I agree with you that purposeful food restriction can lead to obsessing over food. Hello? Former binge eater and yo yo dieter here! But what I cautioned at the end of my post is replacing one obsession with another. Just as in my low fat days I would obsess over a 10-20 cal difference in yogurts, now I see low carbers stressing out over whether a slice of LC toast has 4 or 6g carb. There's a whole lot of carbophobia in the LC community to where folks truly believe that if they eat one burger with the bun they actually gain 5 lbs that day. When they could have it with the bun if they just leave off the slathering of mayo (please, there's enough fat in the burger!). I have seen folks obsess over the minute carbs in spinach for crying out loud. I've seen people weigh daily and sometimes several times a day on a digital scale that measures to the 0.1 lbs. As if when someone is 200 lbs a pound difference is even meaningful at any one instance. My weight fluctuates +- 2-3 lbs around what I consider my true weight. No way that's fat mass fluctuations. This is where I can see the BG approach going awry because long term low carbing definitely leads to a downgrading of insulin response so that folks are unable to tolerate any carb at all. That is not normal, and perhaps Jack is the rare bird who can happily commit unwaveringly to VLC for life.

I also agree with most of your last paragraph, but I also suspect this is why many successful low carbers plateau out 15-20(+) lbs above ideal weight vs. 5-10 lbs. This is anecdotal, so I'm not saying anything scientific here, but a perusal of the blogs and discussion board postings in LC community of the formerly obese are full of accounts of when LC stops working for weight loss or is not sufficient to control intake to prevent considerable regain.

CarbSane said...

Nige, I tend to think this whole "glucose spikes" thing is overblown. Obviously someone with impaired insulin production or sensitivity needs to be more concerned by this, but a normal person (and lots of people have surprisingly normal glucose tolerance and presume the worst) would drive themselves batty with such a monitor. Traditional potato eaters have a good health track record after all and it's one of the highest GI foods out there.

As Sanjeev points out, this really could send an insulin-phobe off the deep end!

Melchior! Happy New Year to you too! I enjoy our exchanges as you make me think too :D Y'know, the Masai have athero but something in their lifestyle accompanies that with increased diameter vessels. It is possible this occurred in the Inuit as well, or perhaps their extremely high omega 3 intake thinned the blood so that it wasn't an issue (I've read that they would sometimes have nosebleeds that lasted a few days).

I don't think frequent prolonged glucose excursions are a good thing, but 1 hr is not prolonged. If someone is drinking Coke throughout the day that may be one thing, but oatmeal for breakfast? There's an increasingly prominent voice in the low carb world who has maintained a slim figure for decades eating oatmeal for breakfast every day ;)

CarbSane said...

I thought I might clarify that I don't have any problem with this means of achieving weight loss. What bugs me is that it is being somehow presented (or that's my take anyway) as a different MEANS of losing weight or different "diet". When it really is a different strategy for sticking to a very low carb diet.

Sanjeev said...

Great discussion.

I'm reminded of Lyle's discussion about dieting "type A's" in his book "Flexible Dieting". These folks are prone to be extremely adamantine and strict about adhering to the diet, they diet for far too long,

and when they cheat even a little bit, they feel like complete failures and over the next week down 20 pints of ice cream (or whatever their calorically dense preferred cheat food is)

It looks like either the patient above did not completely "buy in" and the glucose tracking got the buy in, OR the patient has a tool to temporarily self-flagellate himself into adherence.

This might be a good thing. So far it seems to be for this patient. We can just hope he can run with it permanently.

We do know that becoming flexible helps in not letting an occasional cheat throw one completely off one's diet, so I have my doubts that this technique (if it did indeed make the patient more rigid & inflexible) will work long term.

LeonRover said...

Well, Ah can see this is

Finger Pricking Good!

But don't tell the Colonel, he might sue.

Happy New Year

Frank Hagan said...

CarbSane - nutritionists admit there are errors in our calorie model (if you're a subscriber to New Scientist, you can view their story The Calorie Delusion - Why Food Labels are Wrong. I blogged about it here, mainly commenting on the off-handed comment by an obviously skinny-all-her-life nutritionist who said it didn't matter, because people can't count calories accurately any way. Sort of like saying even IF alchemy isn't real, you can't afford the lead ...

The counting calories model does have one thing absolutely proven about it: it doesn't work for weight loss. It does on paper, but not when humans try it. Since the goal is to get humans to lose weight, and not pieces of paper, then perhaps focusing on the kinds of food you should eat, until sated, would be a better approach. Just sayin'.

CarbSane said...

LOL Leon! Happy NY to you too!

Karen said...

Who eats oatmeal and low carb Carb sane?
As a diabetic I can tell you the fluctuation of blood glucose in the body changes from second to second and the glucometer can and usually is off by up to 20 points. Still better than even 30-40 yrs ago where it was a urine strip and one had to be at about 160 at least to show you were to high!
Happy New Year to all!

Sanjeev said...

> Who eats oatmeal and low carb Carb sane?
I'm not the person you asked, but she's on vacation, so I'll take a stab at this.

here's a few reasons to get you started:

Any low carber who
1. doesn't want cancer from low mucus production (Paul Jaminet documents this on his blog, perfecthealthdiet. I'm looking for studies that dis-confirm his hypothesis. Got any? Link to it if you got it, please).
2. doesn't want levels leptin, thyroid and other metabolic machinery permanently and probably hurtfully lowered,
2a. doesn't want adrenal hormone profiles permanently disfigured
2b. doesn't want the body's insulin handling disfigured
3. doesn't want a permanently catabolic state to strip protein off the body (small amounts of protein + carbs prevents this, large amounts of carb free protein too)
3a. this loss is likely to be permanent if you're past 50

Todd Hargrove said...

Sanjeev,

Why do you think that the negative effects of low carbing you listed above would be permanent?

Sanjeev said...

> Why ... would be permanent?

I hope they are not permanent, But my hoping and willful blindness won't make them go away. I still am on low carb a good fraction of the time, but I try not to delude myself that it's all good, all the time, and I try not to entertain fantasies about the science behind it. Life isn't easier if you walk through the bad parts with eyes closed, but it sure does seem easier.

Mostly I don't delude myself about not needing to control calories. I got to my heaviest weight ever on an extremely low carb diet. Sometimes I would have near zero carb for months. And no, I did not eat hidden carbs. I stayed in ketosis a long, LONG time. the keto sticks stayed at or above "trace" for months at a time. Having believed the low carb BS ("no carb, no insulin, no fat storage") I ate as much as I wanted. Too many calories. Taubes is wrong. Hahn is WRONG. Too many people now have kept careful records of their experiences and gained fat mass on zero or near zero carb for the nay sayers to be taken seriously.

But to your question: Some of that list is pretty well accepted. Strength losses after 50 for most people? It's hard enough to gain strength at age 20 - for most people who lose significant strength after 50, good luck trying to rebuild much of it without steroids. Significant endurance does seem to be do-able though.

Which parts of the list do think are not permanent? If one dies from colorectal cancer that develops because of lack of mucus that's likely to be permanent state. Though I must concede, death provides an unmatched opportunity for low carb eating and, I suppose, depending on post-death insulin levels, Gary Taubes may love it. If you were a Briton I might toss in a Terry Pratchett "Reg" or "Mister Slant" reference here ...

I don't know which of the other effects are permanent. Humans are known to be quite resilient. If people can survive gulags and concentration camps and death marches and the Jay Leno show (and even worse, a Gary Taubes book or monotone interview), they can surely recover from a diet.

why do you think the alleged positive effects will be permanent? Easy, guaranteed fat mass loss surely is not one of the permanent effects for most who've tried low carb.

this has to be my last post for a few weeks.
I'll see all the regulars again late february.
Stay well.

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