Dr. Roy Taylor's Diabetes Summit Presentation

I received some fanmail yesterday -- it was a nice email!! -- encouraging me to share Dr. Roy Taylor's presentation at the 2015 Diabetes Summit -- of Newcastle Diet aka "crash diet" for reversing diabetes.   It's too bad he ended the talk encouraging the host to keep spreading good information ... sadly his is a rare inclusion in this event.

HURRY -- I thought these would be available through Thursday Noon, but it's saying 3 hours :(  -- hopefully they'll extend that.  SORRY!!

This summit is the second annual event put on by the director of Sweet Life Diabetes Centers, a chiropractor turned nutrition expert and other things, Brian Mowll DC.  Last year he co-hosted the event with Jimmy Moore, and I dubbed it the Reversing Diabetes Knowledge Summit.   There are more of the same chiropractors, naturopaths, and such spreading their views on how you basically should eat a very low carb diet and avoid this or that bad food that is killing your pancreas, etc.   Mark Sisson was back spreading his misinformation on how diabetes develops, which is why it is all the more important to wonder why Taylor was not made THE keynote speaker?!  But that diabetes expert Jimmy Moore ... is on deck tomorrow ....

If you scan down my article from last year, my main complaint with calling it the "Reversing Diabetes" Summit was that low carb diets rarely reverse the disease, and in the cases where they do, adherents are practically pummeled at every turn with the falsehood that they must eat fewer and fewer carbohydrates to continue in their remission.  But therein lies the rub.  Because while Tim Noakes downs 2000 mg of metformin a day as he runs (does he still?) around the globe spreading his #LCHF-cures-diabetes message, the difference in Taylor's approach is that at the end of the day, folks are actually non-diabetic!  As in, they can eat carbs and not have blood sugar control issues.  I believe the phrase he used in this interview was something to the effect of having an athletic insulin response.

I've blogged on this quite a bit:
Although I believe Taylor's take and mine disagree (and disagree with scientific evidence) in some places, the bottom line is spot on, and I believe he is more relying on older evidence than the LC schtick.  Two points:
Taylor emphasizes that the source of glucose in hyperglycemia is the liver, a point made in this post, and a point, I might add, that is known, or should be, to every low carb researcher and doctor out there.   Further, towards the end Taylor mentions that he has just submitted a paper regarding a personal fat threshold, which seems to be becoming more and more recognized.   Here is a 2010 post on a decade old paper discussing a similar concept:  Critical Visceral Adipose Tissue Theory.

I have seen much derision in the low carb community both towards Roy Taylor's work, and the man himself.  Indeed it may have been my blogging on his discoveries that got the attention of a particularly disgruntled diabetic in the UK.  I suppose they see Taylor's efforts as a threat to the low carb way of life.  Jenny Ruhl called his diet "idiotically dangerous", as if PSMFs haven't been used safely in various contexts for decades, and insisted the same results could be attained with moderate carb restriction.  Every other blogger went on and on about it not being a sustainable diet -- ignoring the fact that it was NEVER intended to be!  And if you really think that adhering to this is too far fetched, take it up with Dr. Eric Westman.     

I believe the problem is one where diabetics seem to turn on one another.  You see it in various communities of those with health/physical challenges -- somehow if there is the opportunity for someone in the community to "get out" -- this is seen as turning on their peers.  I saw it in the deaf community several years ago when cochlear implants became more accessible and feasible.  I have a deaf cousin (and another by marriage) who attended the very famous New York School for the Deaf (eons ago) which was at the center of this controversy early on.   There were some contentious news stories regarding how to deal with a "cure" for many of the hearing impaired, and it was as if those who chose to embrace the technology were turning their backs on the others.  They were viewed as turncoats who didn't want to be "like them", rather than perhaps just wanting to be able to hear like everyone else which was bad somehow?  Anyway ... I see an analogy here in the behavior. 

Ahh ... sorry folks.  I went on there.  Posting this up because I just noticed the clock is ticking on this.  I recorded this so if anyone has specific questions, I'm happy to help.


charles grashow said…
If Noakes is still taking 2gms of Metformin per day then is VLCHF diet is NOT working!! Period - End of Discussion!!


In the “Lore of Running” Noakes recommended a high carbohydrate diet. He now tells people to rip out those pages. Noakes 64, changed his diet a few years ago after reading “Good Calories, Bad Calories” by Gary Taubes. Noakes came to the conclusion that his diabetes is caused by carbohydrate intolerance. Noakes writes:

“My biology is such that I am unable effectively to clear from my bloodstream, the breakdown product of ingested carbohydrate, glucose. As a result my pancreas must over-secrete the hormone, insulin, one of whose normal functions is to direct the glucose from the bloodstream into the liver and muscles. But instead, in my case, under the action of insulin most of the carbohydrate that I ingest is directed into my fat cells where it contributes to progressive weight gain, continual hunger, lethargy and, in time, pancreatic failure and the onset of the irreversible and universally fatal condition, adult-onset diabetes.”

Dr. Noakes has lost weight, improved his running and his irritable bowel syndrome and severe allergies have disappeared. He admits that these improvements may be the result of his eliminating gluten in his diet as he no longer eats grains. It’s possible that gluten intolerance may have been the cause of his symptoms.

Although Noakes is running well at the age of 64, he still requires metformin (glucophag) to help control his blood glucose which he claims still fluctuates wildly. He attributes this to his liver overproducing glucose. Dr. Noakes does not offer any scientific evidence to support his conclusion.

"I subsequently decided I had type 2 diabetes and needed treatment, but my diabetes is quite well-controlled on Metformin and this low-carbohydrate diet"

This is pure BS!!
Glenn Dixon said…
My wife is still getting HBA1C tests every quarter. Still near or below 5, everything is all in the normal range. Completely off Metformin for a year now. She did the Newcastle Diet using off-the-shelf protein drinks and veggies. 800 kcal/day for 8 weeks. Type II - reversed.
carbsane said…
Thanks for the update Glenn! Wonderful news. As I recall it wasn't necessarily easy, but the reward here is high!
MacSmiley said…
Thinking I missed it? The link takes me to an hour-long interview instead of a presentation.
Emmie said…
Most diabetics think like Noakes--if the meds and diet control the blood sugar, that's all they think is possible.

My sister was frightened into weight-loss surgery because she was having difficulty controlling her blood sugar with THREE meds. She began to have eye problems, and the specialist told her she could lose her sight. Her primary doctor assumed that weight loss would 'help' and encouraged the surgery.

Two months after her gastric sleeve, she was off all meds and running normal blood sugars--it's the AMOUNT eaten rather than the type of food because she's been stable for the past 2 years, and she eats a varied diet--carbs, protein, fats--although in very small portions. She still 'has' diabetes, but is able to maintain normal blood sugars with no meds.
carbsane said…
It's an interview. If it's still live, go for it!
Karin said…
"It's too bad he ended the talk encouraging the host to keep spreading good information"

Sorry, I keep coming back to this sentence and re-reading it. Is it mistyped, or maybe sarcasm and I'm just not getting it?

Anyway, I did watch the interview. I almost never listen to podcasts, because I much prefer reading to having information shoveled at me in an audio-visual format. Most of the information I knew already from your very excellent blog, but I did learn something. I didn't know (or maybe remember) that it's diglycerides specifically that interfere with insulin signaling. Would you say that's correct science? I was wondering when he said that DNL specifically causes fatty liver, and I'm glad you cleared that up in the text.

I guess I have one concern. I've read that gallstones are a common side effect of crash diets. Is there a way to prevent them, or are some people just going to get them, and tough luck for them? Honestly, crash diets scare me for this reason. I kind of wish he had some data on that.
carbsane said…
Yeah that reads awkwardly Karin, but I'm not referring to Taylor's talk but the other talks mostly by folks who make stuff up as they go along.

I have talked about diglycerides here -- perhaps by a different name which I think he did use once: diacyl-glycerols or DAG. These ARE an issue and kind of what I was referring to in my webinar in general terms for things in fat metabolism that can "gum up the works". Ideally the fatty acids are plucked off and burned fully, but the overloaded cell the first FA can come off but the second doesn't and the DAG is reactive. This is current, but how much the DAGs effect the actual signalling of insulin has not borne out in a few studies I've come across over the years.

He didn't mention them, but ceramides are another thing that can be created from fatty acids and are implicated in what we call IR. Again there, the data is not always consistent.

What is, and this was his overarching message at the start, is that overnutrition leads to a "backlog" = stress in cells.

Hope that helps :-)
Glenn Dixon said…
Emmie - it was this type of effect from gastric surgeries that inspired the testing that led to the Newcastle Diet.

Question: If you have normal blood sugar with no medications, how is that diabetes?
MacSmiley said…
Hmm. Fuhrman's presentation is an interview as well. Are they Skyped long distance? Or is there an audience and speakers at this summit?
MacSmiley said…
No diabetes is when you can eat a baked potato without your metabolism going beserk. 👀
Emmie said…
The way my sister's doctor explained it, anyone who has BEEN diabetic and can get off all meds is considered a 'controlled' diabetic--UNLESS they can have a normal 3-hour Glucose Tolerance Test.

Many of the 'cures' from gastric bypass were validated by the GTT. My sister had the "gastric sleeve' procedure, and she didn't bother taking a GTT because her goal was to control her BS. She actually never expected to be off all meds. She still checks her BG periodically because while 'controlled' now, her doctor has told her that her diabetes could resurface at some point. Although she can eat a lot more now than immediately post-surgery, she still can only eat very small portions, and it's the amount that seems to keep her BS under control because she eats carbs freely.
charles grashow said…
Jimmy Moore is a diabetic - plain and simple!
charles grashow said…
Question - My last fasting glucose was 83 and my HA1C was 5.7% I've read that an HA1C > 5.8% qualifies me as pre-diabetic BUT the fasting blood sugar must be >100 to be considered as pre-diabetic.

Shouldn't fasting blood sugar and HA1C be in sync?
MacSmiley said…
Not blames his prior carby eating habits for the diabetes. He refuses to admit LCHF is not a cure.
Glenn Dixon said…
exactly. Which is why my wife is no longer diabetic :)
Wuchtamsel said…
Not necessarily. I also wouldn't say they both have to be too high to be (pre-)diabetic. It's not unusual to see fullblown diabetic patients with perfectly normal FBG. But they have terrible, terrible glucose responses after minor glucose loads. I think you would qualify for a glucose tolerance test.
carbsane said…
Actually there's only about a 60% overlap if memory serves. Can't find the study I'm thinking of in a quick search, but about 40% of those with IFG (impaired fasting glucose) don't have IGT (impaired glucose "tolerance" on the OGTT, usually from 2 hr post level over 140) and vice versa.
carbsane said…
The format of these appears to be all video /slide in interview format. Likely done with Skype or other software. No audience.

The way most of these things work is they are marketing schemes to make money and grow mailing lists. That's why you're supposed to have to register to view, and there's the big sell. The person who sells the package through their link makes most of the money. The house gets a cut. The "talent" sadly usually gets squat (e.g. Roy Taylor) except for that carrot of "exposure".
carbsane said…
At this point, he likely is. A person who cannot eat a potato without wild glucose swings if beta-cell dysfunctional, which is, in the end, the ultimate thing that makes one diabetic.
Glenn Dixon said…
My wife has tested her body's ability to deal with glycemic load on many occasions. Her blood sugar response post-prandial consistently shows to be in normal ranges now.
Rich Rojas said…
His statement about fitting into the trousers you wore at 21 means that just about everyone over the age of 25 is too heavy.
Vikram said…
If you start to gain weight, you're at risk of gaining it back in your liver/pancreas and becoming diabetic again.
Jane Karlsson said…
Wow Evelyn, I didn't know that. I looked up 'insulin resistance lysoPC' and found this paper

Lysophosphatidylcholine as an effector of fatty acid-induced insulin resistance

This must be what you mean. Very interesting.
carbsane said…
Yeah, but if a normal person gains a lot of weight they become diabetic -- so in a way, unless it has progressed significantly. Perhaps it's more like breaking a leg. Once the leg heals it is no longer broken. The leg may always be a bit more susceptible to breakage in the future, you may want to be more careful in some circumstances, but everyone is likely to break their leg too if they fall out of a tall tree.
carbsane said…
Yeah, don't think that everyone needs to, but some (and this seems moreso for men because they generally don't have as much safer storage capacity in butt/thighs) may indeed need to be that slim to be healthy.
Glenn Dixon said…
Absolutely! Which is why she has kept her weight at or near 125lbs ever since. Me, I eventually did a much less drastic diet, but have dropped 35-40 pounds and have maybe 15-20 to go before I get to my ideal range.

I'm sure there is a genetic factor as well relating to susceptibility, but why test it? I'll just stay lighter. So many benefits!
Rich Rojas said…
Enjoying the presentation from Dr. Richard Bernstein. He's my kind of guy: an engineer that likes to tinker with stuff.
carbsane said…
I, too, enjoy that aspect of his work, but he is responsible for so much of what is misunderstood in the diabetes community.

It is disturbing to me, that someone who embraced technology to some degree -- measure BG -- is so reticent to embrace the advances in diabetes control technology such as insulin pumps, etc. He seems responsible for a lot of the insulinophobia of many T1s in the diabetes community, many of whom are already drowned out by the T2s online.
Rich Rojas said…
This is my first exposure to him and I have virtually no experience with the topic of diabetes other than the typical associations the LC community likes to make with carbs, insulin and weight gain. I thought his statement about how concentrated human insulin is was pretty eye-opening. And I liked the analogy he made about how glucagon allows the body to fine tune glucose levels like is done on a short wave radio that has two tuning knobs. That analogy clicked for me.

I thought it was also interesting that T1 diabetics still produce glucagon despite having blown out Beta cells which produce no insulin. If nothing else, I'm learning some of the basics about the disease.
carbsane said…
I have mixed feelings regarding Bernstein because I have seen so many become neurotic and self-critical when they don't get results following his "one and only" method. By that I mean Bernstein seems to view insulin as something to be minimized at all cost. When he began his journey, this was a more valid concern because far less was known and folks didn't have BG meters to test and had to guess more. Nowadays there are different kinds of insulin, etc., and the risk of hypoglycemia is much less for the person who is diligent -- no more diligence than he seems to call for with his diet.

Bernstein's claim about normal BG's in the 80's throughout the day is based on his random samplings of pharma reps or somesuch?

Yes, a big part of hyperglycemia is the unchecked glucose production and glucagon plays a role in that insulin suppresses glucagon. There's been quite a bit of research on ways to suppress glucagon in T1s as combination therapy with insulin. I'm not sure why we don't have such a regime available yet.
StellaBarbone said…
I've often wondered if the genetic factor is what drives the appetite that leads to excess weight that leads to the blood sugar problems. In my experience, people with DM2 or pre-diabetes are usually hyper-aware of food and slow to feel "full" as they eat. You can certainly see the trend in both my extended family and my husband's family.

In the 1950s, when diabetes was only diagnosed in very extreme cases (BS>300 causing glucose to spill into the urine) my obese but lifetime non-smoking grandfather had an MI in his mid-50s. He wasn't diagnosed with DM, but I bet that he would have been a few decades later. He went on the Rice diet, lost weight and maintained the loss for the next 25 years by eating regular food once a day and white rice with white sugar (no milk!) for his other meals before dying of a head injury in a bicycling accident. The criteria for DM was different then, but he probably reversed his disease adequately without statins or medications and with a nearly pure carbohydrate diet.
rob999 said…
Is that with a stick of butter and a slice of bacon?
Hello_I_Love_You said…
Bernstein is probably single most deceptive guy in the LC community. His claim of a normal A1c is 4.1-4.4, which you can only attain if you're hypoglycemic. He wants to put people with 5.1 A1c on insulin. According to him, the claim of 83 FBG being normal is based on his experiment on non-diabetics, where he tested BG levels on UPS deliverymen who show up at his office. He claims they consistently tested in the mid-80s. However, even for such people, BG fluctuation is to be expected post-prandially. So to assume the equivalent of a constant 83 FBG being translated into A1c (4.5 based on the Nathan formula) would still exceed his optimal level of 4.1-4.4, which is an idiotic level of BG control. When you run a blood sugar cult and think 110 will burn off beta cells and make you insulin deficient, you have to emphasize FBG= 83 + 4.2 A1c = Great Health.
Hello_I_Love_You said…
Your FBG will move around and it's a random sample taken on any day of the week. It's influenced by the lateness of your dinner, glucagons and the dawn effect, cortisol, etc. It's a spot check. Having said that, your A1c is too high for your FBG. You might want to take an 2h or 3h OGTT and track insulin or C-Peptide with your BG readings at 30 minute intervals, just like those with Reactive Hypoglycemia do. As long as you consume normal amounts of carbs (150g+), the tests are very accurate. That usually tells your BG control and what's the problem. If you're anemic, you might want to order Fructosamine.
Hello_I_Love_You said…
Wow. So she was dxed as diabetic but turned it around and now her A1c is sub-5.0 eating normal amounts of carbs (150g+)? Any side effects from being hypocaloric for 8 weeks? High cortisol, anxiety, cold hands, low body temperature, hair falling out?
Hello_I_Love_You said…
Also, if you VLC, your FBG will be normal without medications. So will your A1c. The only way to dx such people as diabetics would be with an OGTT, which they loathe since they feel it will "kill off all my remaining beta cells." Plus, you'll need to consume normal carbs for a few days and, heck, no, they won't ever do that. In the LC community there are always some undiagnosed diabetics walking around thinking they don't have diabetes, since their FBG and A1c are normal. Plus, since their fasting insulin is so low because they hardly eat carbs, they think they have no insulin resistance whatsoever.

Sometimes, they're diagnosed when they actually become insulin-deficient T2s, long after their diabetes deepens for reasons other than hyperglycemia caused by carb consumption.
Hello_I_Love_You said…
Noakes is drinking the LC Kool Aid and is now invested enough in the movement to deny any ill health effects he's suffering from, just like Jimmy Moore. That wild BG gyration is probably related to high stress hormones caused by LCing, for which Jimmy Moore should be a poster child.
Glenn Dixon said…
She anticipated some effects, like perhaps confusion, lethargy, etc. None of that happened. If anything, she felt *more* energetic! No anxiety and certainly no hair loss, egads! She felt a little colder than normal, but mostly *after* the weight loss, just because she had lost a lot of the remaining body fat she was used to wearing. Other than that, no negative effects were observed.
carbsane said…
The fatty acid "trafficking" in the mitochondria/within the cell has been the topic of much research and there is some evidence that a predisposition to diabetes may involve some insufficiency in these processes. While PeterD is all uncoupled over Complex I, the main UCP is responsible for shuttling fatty acids out of the mitochondria to counter excessive influx in times of high availability (e.g. fasting), not energy wasting/thermogenesis. I have quite a mountain of research in this area and not nearly enough hours in the day to blog on it :-)
carbsane said…
Yeah, this is mostly a medical and insurance establishment thing. T2 has been thought to be a progressive degenerative disease. Once you are dxed, that's it and the best you can do is slow it down. Hopefully the news that has been coming out re: GBP and the "crash diet" will begin to change some minds on this.
carbsane said…
But most low carbers like Noakes run around claiming that LC "cures" diabetes. :(

Then if they can control their blood sugars with the "LC Approved" metformin and avoiding carbs, it's the ONLY way to go.
carbsane said…
It is truly mind blowing how many take Bernstein's word as gospel of sorts when he has based his numbers on such impossible-to-validate measures. It's not like there aren't numerous studies out there demonstrating what a normal HbA1c or FBG or random BG reading is.
Hello_I_Love_You said…
The whole LC movement is premised on BG as the only determinant of health at the exclusion of all else. And what have they sacrificed to maintain their BG at near hypoglycemic levels? Hormonal and immune dysfunctions that will haunt them for the rest of their live. Once you blow the cover on their overstating the BG aspect, the movement will fall apart. Especially this normal A1c range: even nondiabetics hardly report A1c under 5.0. The optimal range is like 4.7-5.2, not 4.1-4.4.
Hello_I_Love_You said…
At 800 kcal, how big was her carb portion? Supposedly at ~20g or below, “glucocorticoid metabolism" falters and there is less clearance and excretion of cortisol through urine. At about 50g, not as serious. It's not dependent on ketosis or how much protein you consume, at least according to the study.

Glenn Dixon said…
She ate a bit of toast and veggie soup for about half of her total daily intake. The other half was GNC's Total Lean shake, which is 50-60% carbs if I recall.
Hello_I_Love_You said…
Yeah, that would still be 110-150 grams of carbs. That would steer clear of supposed hormonal dysfunctions. Again, I'm begining to think it's not being hypocaloric but not reaching the "threshold" level of carbs that might be behind hormonal and immune dysregulation. Until you reach a hypocaloric level that makes you practically ketogenic.
Rich Rojas said…
I got my blood work back and was kinda puzzled by some of the results. FBG: 80, A1C: 5.6. TG: 61, TC: 179. I was expecting my A1C to be lower - much lower. Initially I thought my lipids were very good - TC is the lowest it's ever been, but now I'm worried my TG are actually too low. It's recent news to me that it's possible for them to be too low. What's really puzzling, are my CBC results (both red and white). Some numbers are either just slighting outside the normal range - either a bit higher or lower. If I were more of a paranoid/hypocondriac I'd begin to suspect an immune issue such as anemia or hypothyroidism. My daily carbs range from 50-100g.
billy the k said…
"By that I mean Bernstein seems to view insulin as something to be minimized at all cost. "

Not so. You are confusing Bernstein with Taubes, Schwarzbein, et. al. I have every book in every edition that Bernstein wrote, as well as the written testimonies of some of his patients. Many of his patients at a first appointment with Bernstein are unpleasantly surprised when he tests their BG levels in the office and says he's going to give them an insulin injection right away—they're disheartened because they've been led to believe that if you ever need the needle—then it's basically all over for you. Bernstein has to then try to convince them that this needle right now is being given precisely to save their remaining pancreatic ß-cells. Saving and even restoring those which haven't yet been completely destroyed. Because to have even some ability to produce endogenous insulin makes one's life immeasurably easier than it is for those who've lost the ability to produce any insulin whatsoever. Insulin is not a demon, a culprit, etc., and even when elevated, Bernstein regards it as nowhere near the sort of problem that hyperglycemia is.

For Bernstein, chronic elevated blood sugar is the Number One physiological culprit. Insulin is not "something to be minimized", as it is for Taubes; on the contrary, by enabling you to maintain the anabolic processes that keep you in health,—that indeed keep you from melting away—insulin is marvelous, and maintaining the health of one's ß-calls is worth whatever effort it may take because one's endogenous insulin is especially precious ( being very much superior to any exogenous injected insulin). It's insulin that saves everyone from the pathologies of hyperglycemia. If anything, Bernstein regards insulin much as Elizabeth Hughes did:

Elizabeth Hughes—the first person person in the world treated with insulin,—a type 1 diabetic that Dr Banting injected with insulin in August 1922: She would turn 15 in 3 days. Banting's handwritten notes survive:

"wt 45 lbs. height 5 ft. patient extremely emaciated, slight aedema of ankles, skin dry & scaly, hair brittle & thin, abdomen prommt [sic], shoulders drooped, muscles extremely wasted, subcutaneous tissues almost completely absorbed. She was scarcely able to walk on account of weakness. Respiratory, digestive & cardio-vascular systems normal."

Banting began insulin treatment at once. The first injections cleared the sugar
from Elizabeth's urine. Banting immediately began increasing her diet. At the
end of the first week's treatment Banting had Elizabeth up to 1,220 calories—up
from the previous 889; another week and she was on a normal girl's diet of 2,200 to 2,400 calories....In her rooms at the Athelma Apartments, on Grosvener Street
next to Toronto General Hospital, little Elizabeth Hughes found herself slowly awakening from her nightmare of diabetes, diet, and starvation. [regarding this
magical new discovery of insulin] Elizabeth exclaimed to her mother:
"Isn't that unspeakably wonderful?"
StellaBarbone said…
Anemia will affect A1C.
carbsane said…
Law of large numbers.

I did not say avoided at all costs. Minimalized. Yes. I do believe that is accurate.

You are correct, however, that his rationale is not Taubesian.
billy the k said…
I believe you must have meant Bernstein's Law of Small Numbers. The point of which was not at all to minimize insulin, but rather to avoid the large swings in postmeal blood sugar levels that are practically unavoidable for both Type 1's and Type 2's when large amounts of carbs are eaten. The larger the amount of carbs eaten, the larger the margin of error for those having difficulty normalizing their BG levels. The point of his Law of Small Numbers is not a fear of elevated insulin, but rather of both hyper—AND—hypo glycemic consequences. The key was to eat foods that will affect one's blood sugar in a very small, slow way.

Or as he put it: "Small inputs, small mistakes."
carbsane said…
So if you agree with me, why the nit pick? I think you get my gist. The ultimate distillation is to minimize carb so as to minimize insulin usage.

Why does this guy hate insulin pumps so much?
billy the k said…
The "nit pick" is not about the appropriateness of Bernstein's very strict diet for NON-diabetics, but rather about your "gist"—i.e., that "the ultimate distillation is to minimize carbs so as to minimize insulin usage." Which is not correct, as I've explained [above]. For Bernstein, carbs are minimized IN ORDER TO prevent large blood sugar levels and/or large blood sugar swings—not IN ORDER TO minimize insulin! Hyperglycemia is the culprit. Not insulin.

Q. "Why does Bernstein hate insulin pumps?"

A. 1. Pump failure, tubing coming out of the skin, insulin coagulation, tubing blockage, or kinking can occur in spite of sophisticated alarms and safeguards. As a result, ketoacidosis has occurred overnight in many Type 1 users.

2. There is a moderate incidence of infections at injection sites. Many of these have formed abscesses requiring surgical drainage.

3. Severe hypoglycemia is more common among pump users, posssibly because of mechanical problems.

4. All of the long-term (seven-plus years) pump users that Bernstein had seen (as of 2011) had fibrosis (scar tissue formation) at their injection sites. This had impaired
their insulin absorption so much that even high doses failed to control their blood sugars.
In addition, blood sugar effects of pump boluses appeared to be inconsistent in these individuals.

5. Many individuals are turned off by the idea of constantly having large-bore tubing sticking in their abdomens.

6. Users experience at least some inconvenience with the four S's—sleep, showers, swimming, and sex.

7. Over the past five years (as of 2011), the FDA has received reports linking 7,170 deaths to infusion pump problems...FDA officials believe that software and design problems underlie this situation.

8. Raising or lowering an insulin pump above or below the injection site can cause siphoning that will speed up or slow down the delivery rate by up to 123 percent if above the site, or 73 percent if below the site...The above variations in delivery rate can render blood sugar control impossible.

[AND]: "In our experience, insulin pumps to not provide better blood sugar control than multiple injections. Contrary to a common misconception, they do not measure what your blood sugar is and correct it automatically. Furthermore, most pumps are programmed to produce meal boluses that are computed to cover varying amounts of carbohydrate, totally ignoring both dietary protein and the Laws of Small Numbers."

There are more reasons, but I think these will give you his gist.
Hello_I_Love_You said…
TG is indeed very volatile, based on what you ate the days before. I'd increase the carbs above 100 grams. 61 isn't too low but it could be if you're consuming too little carbs. You need some starches, fruits, and grains, if you tolerate them.

Your A1c is too high when compared to your FBG. That could be due to many things but you should look at your Hb and RBC. If you have anemia, your A1c will be too high. You might want Fructosamine in lieu of A1c. Keep an eye on WBCs and Globulin; they decline consistently if you've LCed for too long a la Bernstein and his blood sugar cult.
carbsane said…
You disagree with my distillation. Fine. I don't see there's much difference, but it's been a long weekend here and perhaps I'm not seeing it. I get that he is concerned about hyperglycemia, and doesn't fault insulin like some others do. It seems futile to address this further.

Got a link to this list of his?

>>>All of the long-term (seven-plus years) pump users that Bernstein had seen (as of 2011) had fibrosis (scar tissue formation) at their injection sites. This had impairedtheir insulin absorption so much that even high doses failed to control their blood sugars.<<<

Given this man's scientific basis for BG levels and HbA1c, I put little faith in his reporting. I looked briefly for some of the other statistics. Does he provide a link?
carbsane said…
Ahh, as I Googled I found this is in his book. Also in his book, a totally unsubstantiated claim that several studies have indicated increased risk of cardiac death at HbA1c's above an equivalent of 80 mg/dL.
Rich Rojas said…
I'm about to slowly up my daily carb consumption as I'm concerned about some of my health markers. I also experienced something this winter that was completely new to me: fingers went numb almost immediately during cold weather. It's been very cold in the northeast US this winter - single digits - but I've never been affected in this way by extreme cold. Maybe it's just old age (58) catching up with me.

I've done LC on and off for the past 20 years, and continuously for the past 2.5, but have rarely gone below 50g CHO/day, so not exactly a NuttyK diet. And having come of age during the 60s and 70s, I've been conditioned to fear dietary fat (AHA), so have never quite been able to bring myself to eat the amount of fat the LCarbers ingest. I've also followed the training advice of Arnold S. and his ilk, and have always consumed as much protein as I could get my hands on, again, not a standard LC approach.

I do like keeping the weight off though, so it looks like it will come down to a delicate balance of the macros. I may do LC, but I'm certainly open to having my views changed, especially if it's for the betterment of my long term health.
Hello_I_Love_You said…
That's fine. But like I said 50g CHO is too low if you mean just total carbs. On a net carb basis that could be as low as 35-40, depending on what you eat. And it isn't so much the absolute carb amount as whether you ate some fermentable carbs and insoluble fiber. Most people think they eat a lot more carbs than they do. If you don't eat any legumes, starches, grains and fruits, you're VLCing. Period. And you'll probably end up with same health effects as those who eat Bernstein's.

Take a look at your Hb and RBC to see if they're low-normal. Then focus on your WBCs: you're probably around 4.0. Then look at your Globulin: many people fall from around 3.0 to 2.0. Those are probably the best health markers for those who've LCed for so long.
Hello_I_Love_You said…
He's very good at misrepresenting studies. This guy is the master of deception, misrepresentation and exaggeration to scare people about their hyperglycemia. I'm not joking when I say he'll try to put people with 5.1 A1c on insulin.
billy the k said…
Hi Evelyn—me again. I get it that you don't think much of Bernstein. Which is certainly
A-OK with me, and certainly no surprise, since of course the whole thrust of the website—name being CarbSane, after all!—is to elucidate the various errors of those who promote low carb diets, be it for weight loss or for general health and well-being, and Dr Bernstein does occupy a prominent position in that group.

If you don't see the the difference between advising low carbs in order to minimize damagingly high blood sugars [&/or large BG swings] and advising low carbs in order to merely keep insulin low,—a completely different target/goal!—then, just as you say, it's futile for me to labor the issue, and so I'll leave it there and not bother you further on that score.

Re the pros & cons of insulin pumps: I too wish that Bernstein had included the journal articles that support his various statements; I don't know why Little, Brown didn't regard the lack of such a list of references as a serious omission. But I've received courteous replies whenever I've phoned his office [usually to get his latest recommendation on blood sugar meters], perhaps you might call to ask for his links to these papers: (914) 698-7525.
carbsane said…
You're funny. Sorry you don't get the point of my website, but that's OK.

I GET your point. I believe it's a distinction without a difference but I guess I'm wrong. That's OK, it happens sometimes. Bernstein believes diabetics should minimize any impact of dietary carb on blood glucose levels, but in doing that he is advising minimizing insulin therapy. See? But I do understand the man has pretty unscientifically based notions on what constitutes a normal blood glucose level.

Publishers don't care about referencing or the accuracy of references. This is abundantly clear, and Bernstein's publisher is no exception. Perhaps since you have a relationship with the doctor you can call him for the benefit of all readers here and report back.

Perhaps you could also ask him about the 7000 deaths. All I could find was this: http://www.fda.gov/ForHealthProfessionals/ArticlesofInterest/ucm295562.htm
Hello_I_Love_You said…
His diet is also not appropriate for diabetics, both T1s and T2s. That normal BG at all coast have resulted in untold suffering and side effects of his patients, who've been hoodwinked that that their "hypothyroidism" and other immune problems are inevitable consequences of diabetes. Watch that video that I linked. 25% of his patients have an incurable immune deficiency called CVID, which will require them to be in immunoglobulin therapy. I wonder how many people who's read his books ended up with it and can't afford the therapy, because they are in danger of dying from infections and, worse, lymphoma, which is how such people usually die.
billy the k said…
Your comment [above] to Rich Rojas reported an HgA1c of 5.0 to 5.2 over the past two years while enjoying a carb intake of >200g/day. This would be excellent even for a normal person, but is absolutely outstanding for a Type 2 diabetic, and certainly presents a powerful counter-example to the idea that diabetics are best to follow a VLC diet.

Very impressive, indeed, Hello_I_Love_You.
Q: Did you severly restrict all dietary fat in order to get such excellent glucose tolerance?
carbsane said…
I re-read my OP and insulinophobia would probably not be a good term for Bernstein. He definitely seems to prefer that people use the least amount of insulin to maintain rather lower than necessary BGs. This is accomplished by ingesting a nearly bare minimum of carbohydrate.
Rich Rojas said…
Thanks a lot for the info as well as your advice. I do appreciate it. I love fruit and will be eating more of it than I currently do. I don't have much of a taste for starches these days, especially rice and potatoes, but have always enjoyed bread and pasta. I've begun making my own "lower" carb versions of bread and pasta by mixing refined flour with an equal amount of almond flour. I don't know if there's much to GL and I don't test BG, but these versions are at least easier on my digestive system if nothing else. I'll also start having a bowl of oatmeal for breakfast a few times a week in place of my usual eggs and sausage.

Surprisingly, my WBC is 5.25 and Globulin is 2.7, however my RBC is 4.29 and my red cell width is lower and my corpuscular vol is large. This is what makes me think there's some anemia going on, but this may be the result of asthma. My TSH was 1.50, which is supposed to be normal, but I've read elsewhere that it's low. I didn't have a full thyroid panel run, so in isolation, I'm not sure how meaningful it actually is.

My body temp was 97.4F - this has me more concerned from what I've read about LC affecting core temp and cold sensitivity. It will be interesting to have these tests rerun in a few months after making some dietary adjustments. Apologies for posting personal test results - not sure if that's appropriate here, but thought it might help with the discussion. Your feedback regarding them has certainly helped me.
StellaBarbone said…
There's a circadian rhythm to body temperature and yours is pretty normal, anyway. Your TSH is normal. Its hard to guess at what is going on with your CBC without seeing the whole thing, but you should probably follow up with your doctor. B12 deficiency comes to mind, but there are other possibilities.
Hello_I_Love_You said…
Those are good numbers. You have no issues other than RBC; you escaped scot-free. You didn't achieve those numbers while taking thyroid medications, right? Your RBC is at the low reference range for females; for men, it's much higher, like 4.7. So you need to look at your Hb, that's Hemoglobin, which is more important than your RBC. Your TSH is not low. It's at a sweet spot. Can't be better. Which moron told you 1.5 is too low? Even .85 isn't too low. As long as you don't have cold limbs, your temp isn't much concern. They fall as you get old and it's just one data point. Just like your FBG, measure it like for a week. Average it. But even at that level, it's not too bad. I've seen people in the 95s, 96s with frigid fingers. You shake their hands and you almost have to say, "Wait a minute, you haven't been VLCing, have you?"
Hello_I_Love_You said…
Nope, billy the kid, but I'm very disciplined. I portion my carbs and spread them out throughout the day. About 40 per meal. And then 3 snacks at about 30g each. Those are total carbs so on a net carb basis I'm probably at around 130-150, since I eat lots of fiber. Lots of lentils, beans, avocadoes, etc.
Rich Rojas said…
Thanks again for your comprehensive input. Coincidentally, my doctor's office called today to discuss my lab results. I was told that I have anemia LOL. My Hb is 13.9 - just below normal range according to the report. The doc ordered another set of tests coming up in two weeks. It seems unusual for a meat-eating male to come down with anemia, but it might explain why I sometimes run out of breath when talking and not being able to get my HR down despite HIIT cardio and being tired despite getting a good night's sleep. It's possible that there's some low-grade, internal hemorrhaging going on somewhere as this is a recent issue.

No, I don't take thyroid meds. Not sure where I read about the TSH
range - might have been an article on that non-condition: adrenal
fatigue. My hands are generally pretty cold. My wife refuses to allow me to touch her, but that's been the case long before I started LCarbing (sounds like a Rodney Dangerfield line).
Hello_I_Love_You said…
Good, your doc should know why your A1c is on the high sde, then. For TSH, midpoint is not the optimal number. Around .85-1.75 is optimal. As for your cold hands, tour T3 might be low-normal or you may have other issues. If they're that cold, it's usually below 97.5. Measure your basal temp every morning for like a week and see if you go below 97. You might. But it would be due to things other than your diet.
Jane Karlsson said…
HelloILoveYou, what looks like B12 deficiency can actually be copper deficiency. The enzyme activated by B12 (methionine synthase) is thought to require copper as well.

Anemia can also be due to copper deficiency. I think someone who eats meat like Rich is more likely to have copper deficiency than iron deficiency. His doctor is unlikely to know about this.

Copper researchers have been trying to tell doctors for years that copper deficiency is very common. Some doctors are listening, and are starting to recognise it in patients they thought had B12 deficiency.

"Acquired copper deficiency has been recognised as a rare cause of anaemia and neutropenia for over half a century. Copper deficiency myelopathy (CDM) was only described within the last decade, and represents a treatable cause of non-compressive myelopathy which closely mimics subacute combined degeneration due to vitamin B12 deficiency."
Hello_I_Love_You said…
Jane, what makes you positive that his anemia is due to lack of copper. Most people who do not supplement with B vitamins are gonna be low on B12 period. Only those who deliberately take B vitamins will be above the median, which I consider to be optimal given wide-spread deficiency and also because of his purported neuropathy. The article you cite tout copper deficiency as a cause of "rare" B12 and neutropenia. His WBCs are normal, to my surprise, given his umpteen years of LCing. So his neutrophils, which account for ~60% of his WBCs, are likely to be normal. He has no neutropenia. There are at least 8 different causes of anemia and his GP needs to order an iron panel along with RBC size parameters to diagnose this properly.

I reject PHD's focus on micronutrient deficiency as an important and overriding cause of degenerative diseases, especially copper. It is possible but copper deficiency can't be that widespread. Certainly, PHD's focus on copper-high lipids isn't very convincing, although I find Paul to be one of the most reasonable and erudite voices in the Paleosphere.
billy the k said…
Thanks for replying—your info here has immediately triggered more questions!


1. If your net carbs are up to ~150g/day, and you say that you're also having
about 15% calories from animal flesh, and supposing you're having ~2000kcal/day, that would make your protein + carb calories at 45% of total, which would mean that you must therefore be getting ~55% calories from dietary fat. If so, your case is even more remarkable, i.e., that you have such good BG values as a Type 2 diabetic while having that much dietary fat in addition to that 150g/day carb intake. [This would be supportive of Himsworth's conclusion that the sole dietary factor for improvement of glucose tolerance and insulin sensitivity is the presence of sufficient carbs, period—not the absence of dietary fat]. Something for which I'm always glad to see supporting evidence!

2. You mentioned avocados—which supply a pretty fair amount of fat for a plant food, but I think you can't be getting 55% fat calories from just avocados!
So then: do you use olive oil or any other bottled oils?

3. Do you drink milk or eat any dairy foods? If not, do you then rely exclusively on plant food sources for your calcium requirement, or do you use mineral supplements as well?

4. You mentioned lentils & beans, but I wonder whether you have them with their traditional accompaniments—rice, or pasta? If so, is it exclusively brown rice and/or whole wheat pasta, i.e., do avoid you avoid all fiber-free starches?

5. Do you eat any potatoes—a starch that has received such a bad rap for a long time due to it's purportedly damagingly high Glycemic Index?

6. Speaking of which—what is your view of the value of using Glycemic Index/Glycemic Load calculations for meal or snack choiceworthiness?

7. You mentioned cold-cuts as a typical lunch: as in a sandwich? If so, what kind of bread(s) do you use?

8. You mentioned 3 snacks, having ~30g [total] carbs each: would these be mostly fruit or starch snacks? Are these snacks exclusively carb snacks, or do you also try to "balance" the carbs with some protein & fat, as is frequently advised for reducing the subsequent impact of those snack carbs on one's blood sugar level?

9. You mentioned taking metformin @ 500mg every other day, but that "...you've never bothered to look for Glucophage" But Glucophage is metformin,—i.e., one particular commercial brand of metformin—isn't it? [And how does one go about getting one's pharmacy to supply free meds???!!!]

10. Do you regard exercise as being an important factor for maintaining good glucose control? If so, do you rate aerobic exercise higher than anaerobic?

11. Looking back on your past, what do you now think was the factor(s) that led to your developing Type 2 diabetes—any specific dietary culprit, or just excess total calories irrespective of the macros per se, or perhaps mostly due to genetic factors?

Wow,—I see my list of questions is going on and on, so I'll stop it here. I hope you won't mind taking a few moments to answer them. I'm sure I won't be the only visitor to the CarbSane website interested in blood sugar control who can benefit from what you have found that works [or not].

As Type 2 diabetic who has clearly found a strategy that has yielded such good blood sugar results without having to employ a low-carb diet, your personal example should resonate for those who are—as Evelyn puts it—"...seeking refuge from low carb dogma."
carbsane said…
>>>Wow,—I see my list of questions is going on and on, so I'll stop it here. I hope you won't mind taking a few moments to answer them. I'm sure I won't be the only visitor to the CarbSane website interested in blood sugar control who can benefit from what you have found that works [or not].

As Type 2 diabetic who has clearly found a strategy that has yielded such good blood sugar results without having to employ a low-carb diet, your personal example should resonate for those who are—as Evelyn puts it—"...seeking refuge from low carb dogma." <<<

billy the k said…
Yikes—I think the construction of my last sentence has just led to it being misread as my saying that I myself am a Type 2 diabetic. Not so!—I was merely repeating the self-report that my good friend Hello_I_Love_You passed along in a reply to Rich Rojas; H_I_L_Y's being a Type 2 diabetic who has managed to maintain excellent blood sugar control makes his own personal strategies of special value to me. While I myself am not a diabetic, I nevertheless do have a continuous interest in all aspects of the topic of blood sugar control. Apologies if my less than precise sentence construction has misled!
billy the k said…
Rodney on couch...
Wife to Rodney: "Take out the garbage!"
Rodney to wife: "You take it out,—you cooked it!"
carbsane said…
Actually, I was quite taken aback by the seemingly aggressive questioning of HILY's contributions in comments here.

Seems rather more invasive than various clinical trial backgrounders.
Hello_I_Love_You said…
The first thing you need to realize is that BG control does not equal health. BG may equal about 60% of health but other parameters impact your overall health. It is but one input to the overall equation. Second, you need to stop being a one-trick pony. Cut the carbs is simple and can be effective but BG is a bit more complex. There are counterintuitive ways how BG homeostasis is maintained. Ask youself, if the "beta cells are killed off then you become insulin-dependent" is correct, how are supposedly insulin-deficient T2 diabetics being cured when they undergo gastric bypass? The reduced small intestine somehow enables you to produce insulin and there are mechanisms we don't really understand.

That's why you need carbs and fiber. Lots of fiber. The breakthrough came when I went from eating tubers to eating lentils. 3 different kinds of lentils: orange, green, beluga. But I'm at top 5% in discipline and don't eat more than 35 grams of net carbs in one sitting. That will maintain my BG and the low GL of what I eat will keep my BG rise very slow. 1H probably at 140. 2H I'm down to 90. Fasting is at around 85-95.

There're probably others who eat Fuhrman's way who keep around 5.0. But my endo refused to believe that I had diabetes and wanted to see all my records. He still thinks I'm misdiagnosed. But I know I have diabetes. I had neuropathy (gone now) from my undiagnosed days and I do go over 200 when I eat more than 100 grams of pure fast carbs.

Some other tricks: 4 cups of green tea in the afternoon -- keeps hunger at bay and lower BG, take some Chromium Picolinate (100 mcg), Gymnema Sylvestre (200), aged garlic extracts and raw garlic diced in water with a bit of apple cider vinegar, turmeric, kale/collard greens. Eat lentils, black eyed peas, chick peas, collard greens, kale, Bismatti rice, yams, yuca, green plantains (all microwaved), Lunch is 2 sandwiches with Ener G's gluten free tapioca bread. Avocadoes are mostly fiber; even Bernstein allows them in his diet. So avocadoes with cranberries, blue berries, and raspberries. Some Pinot Noir or Merlot mixed with Almond Breeze non-dairy coconut/Almond drink. For sweets, I take Stevia and about 2 squares of Lindt's 85% dark chocolate. That's about it. The macronutrient breakdown is probably 35% carbs, 50% fat, 15% protein. About 2400 kcal. 200g carbs, 90g protein, 135g fat. Some palm oil, 2-3 egg yolks similar to PHD, burgers or steaks every 3-4 days, etc.
billy the k said…
Well, I do hope that my questions re the details of H_I_L_Y's dietary strategies and valuations of various factors posited to be important determinants of someone's glucose tolerance and insulin sensitivity will no be seen by H_I_L_Y as being either
"aggressive or invasive."

What H_I_L_Y—as a Type 2 diabetic—does and does not do to maintain such excellent BG control, is valuable information that I think cannot fail to be of benefit to others.

The questions represent my genuine interest in the details of the actions and food choices that have produced such excellent blood sugar results,—in someone who has a condition that typically makes getting such excellent results exceedingly difficult.
Hello_I_Love_You said…
It's all in the discipline. You can't eat fast acting carbs all in one sitting. No one's gonna argue against that. But spread your carbs around during the day. If you have diabetes, foget about IFing or skipping meals. Eat 3 square meals and 2 snacks, 1 in the mid-afternoon, 1 3 hours before sleep. Evenly distribute your carbs so that your FBG can be ready for its onslaught and only slow-acting fiber-laden carbs. The only fast acting carbs I eat are Basmatti rice but I eat about 1/8 cup uncooked mixed with 2 different lentils per meal.
billy the k said…
I thought it was 3 meals and 3 snacks—which sounds like a lot of eating bouts!
Hello_I_Love_You said…
See that's the Newcastle argument, that removing the fat from liver and pancreas may be behind that. The quick loss of accumulated fat could restore functionality to the beta cells that were just turned off. I think the gastric bypass may have another mechanism. That's not what's happening in obese T2s. They're not losing any fat. They lost portions of their stomach and small intestine and they start having normal BG control BEFORE they lose any weight. It's not because their stomach is about the size of an avocado. As soon as they're done with surgery and regardless of whether they have fatty liver or fatty pancreas, they immediately have normal BG control. How does that explain the beta cell kill off theory?
Hello_I_Love_You said…
Well, that's for me. My last snack is usually 55 g of of Lindt's 85%. But it doesn't have to be a snack for everyone. I just like the dark chocolate late at night. And I also eat around mid-morning.
billy the k said…
If you can eat ⅛ cup of uncooked rice—withot experiencing gastrointestinal distress—then have without doubt a most remarkable constitution.
Hello_I_Love_You said…
I'm talking about the portion - 1/2 of a 1/4 cup of Bismatti rice before cooking. That's about 18g of net carbs when cooked.
Jane Karlsson said…
It's a very complicated and confusing topic. I've been trying to find out how palmitate is toxic to beta cells for years. As you say, the evidence on ceramide and DAG is inconsistent. I think palmitate -> lysoPC looks promising.

I've read papers saying UCPs shuttle fatty acids out of mitochondria and others saying they don't. Everybody seems to agree that UCP2 and UCP3 lower ROS, whether they shuttle fatty acids or not. UCP1 is different of course.
Jane Karlsson said…
Copper deficiency is indeed widespread.

"The Western diet is often low in copper, [3] according to the pooled data from several articles on more than 900 diets chemically analysed. About 62 and 36% of diets of 80 randomly selected adults in Baltimore [4] were below the recommended dietary allowance and the estimated average requirement for adults, respectively, 0.9 and 0.7 mg daily."

So it looks like the diet of most Americans is below the RDA for copper. The RDA may actually be too low, because that level has been found to produce symptoms of heart disease in volunteers. In other countries the RDA is higher.

A recent study has shown that supplementation with B vitamins can slow
brain shrinkage in early Alzheimer's. The authors have pinpointed B12 as the
critical one, although none of the patients had B12 deficiency. The dose was astronomical, 500 times the RDA. Since the enzyme activated by B12 requires copper as well, one interpretation is that the patients actually had copper deficiency, which has often been suggested as a cause of Alzheimer's.
carbsane said…
Yes, the function of UCP1 is well established. The role(s) of 2 & 3 are far less so, likely because of the initial "mislabeling" as UC because of similar structure.

I'm reminded of ASP - acylation stimulating protein -- which is very similar to complement C3 that is involved in inflammatory pathways.

I hope to have more later.
Glenn Dixon said…
It's not just an argument, it's their observations:

"Weight loss averaging 15kg (2 stone 5lb) achieved over 8 weeks caused two distinct sets of changes. Within 7 days, liver fat had fallen by 30%, liver insulin sensitivity had returned to normal and fasting blood glucose had become normal. By 8 weeks, pancreas fat content had returned to normal and insulin secretion by the pancreas had returned to normal."


carbsane said…
I think Taylor can be correct and there still be more to it for GBP surgery. It's not really a conflict.

In Newcastle, the complete reversion isn't seen immediately and the treatment lasts several weeks. In GBP, it is within the first few days, and while initial intakes are quite low, this isn't enough to explain it.

For me, my bets are on the incretins -- either GLP and/or GIP -- that are likely suspects as they either mimic insulin action on the liver and/or stimulate insulin secretion by the pancreas. I have a number of studies looking into these connections though I don't recall anything definitive.

Interestingly GBP outperforms other WLS like lapband, sleeve, etc. so there's something to the "shortcut". I would also add that one study I recall mentioning hypoglycemia following GBP requireing insulin suppression treatment. This would square with an incretin effect maximized by more direct delivery of nutrients to the intestine per GBP ... then the first weight lost is from the ectopic fat.
LWC said…
There may not be a conflict, but given the choice of liquid diet for 8 weeks and re-arranging my insides in major surgery for the same effect... pass me the shake.

This isn't entirely a hypothetical for me (though I am actually not the one likely to be faced with this choice, rather it's a loved one). I've said before, but I say again: I very much appreciate your research and writings about T2 diabetes.
Hello_I_Love_You said…
Clearly you knew what I meant. You seem to know something about the LC community and Bernstein. But not enough in detail. That Glucophage statement previous intended for an inside joke on B's insistence on anyone to take Glucophage in lieu of the generic, based on his purported observation that it's much better. It's in all of his editions of books and his teleseminars and he berates anyone who argues otherwise or want to spare any expense. What's your agenda? You seem to know some things but not enough about biomarkers to be a clinician or a researcher. What's your metier, as the French would say? A casual reader usually doesn't get this far, with all the limitations to access to information which a non-specialist would have in plumbing the depths of diabetes and medical literature.
Glenn Dixon said…
on a related note - RYGBP vs calorie reduction:

"In summary, weight loss directly influences thyroid hormone regulation, independently of the weight loss strategy used. The effects may be explained by a combination of decreased leptin levels and transient changes in peripheral thyroid hormone metabolism."

Glenn Dixon said…
also this:

"These data indicate that deterioration of glucose metabolism in T2DM is associated with a decline of GLP-1 levels. Calorie restriction facilitates glucose metabolism and blunts hyperinsulinemia in obese (diabetic) humans. Additional duodenal exclusion through RYGB induces gut hormone release and hyperinsulinemia but does not improve postprandial glucose levels any further. Our data thus strongly suggest that calorie restriction underlies the short-term metabolic benefits of RYGB in obese T2DM patients."

billy the k said…
"Clearly you knew what I meant..."

Actually, I didn't, and so I do apologize for having misunderstood that you meant that your mealtime portion size was ⅛ cup of rice, dry, i.e., before cooking;—I really did think you meant that you ate that much rice as uncooked!—Why?—I suppose because you had mentioned in several places that getting lots and lots of fiber [often referred to as unavailable carbohydrates] was something you regarded as quite important, and so I thought, hmm..., well maybe this is just another way you've found to increase your intake of undigested, unassimilated plant foods! And you had already mentioned your regular intake of some unusual [to me] substances—"Gymnema Sylvestre (200), aged garlic extracts and raw garlic diced in water with a bit of apple cider vinegar,...& something called "tapioca bread". Also, since I always portion out my rice by weighing it—as well as the water!—on my Acculab digital balance prior to cooking, it was a slip that I failed to remember that most folks do just measure their portions by volume.

(BTW, my own package of Trader Joe's Basmati rice [white!—product of India] lists ¼ cup dry as being one portion, weight 51g and having 40g carbs. I don't deduct the 1g of fiber, and just use the rule of thumb that 100g white Basmati = 80g carbs, which would make your ⅛ cup portion at ~25g = ~20g carbs.)

My "agenda"? I have no underlying ideological plan or program. I remain unconvinced by the research I've examined to become either a very-low carb enthusiast or a very-low fat enthusiast. I merely developed an interest in diet & health some years ago, with a particular interest in glucose metabolism & regulation.

My "métier"? Hmm...I suppose my vocation may perhaps be described as:
self-employed peasant, independently poor, hunting & gathering info wherever it may happen to lead.
Hello_I_Love_You said…
Bud, those may sound exotic to you but they're fairly standard in diabetes forums. People take Chromium, Gymnema, cinnamon, Fenugreek Extract, bitter melon, Alpha Lipoic Acid, green tea, and everything under the sun for their purported BG controlling effects. Just like body builders are into whey, Creatine and L-Glutamine.

As for tapioca bread, they're standard gluten-free alternatives made from powders of tapioca, white rice, brown rice, omega flax, millet-chia, etc. National brands like Udi's and Ener G make them and are carried by places like WholeFoods, Trader Joe's, Fairway, etc. You sound a bit like Brie Vegas, the half-wit from downunder who used to rant about cholesterol. This may be the second coming of Brie Vegas, who came back heavily medicated this time, possibly on tranquilizers.
billy the k said…
And you accused me of manifesting a "pooh-poohing tone".
billy the k said…
Addendum: "You sound a bit like Brie Vegas, the half-wit from downunder who used to rant about cholesterol.
a. You might have at least gotten his name right—I'm pretty sure it's Bris—not—Brie Vegas.

b. Now that you've started in with the personal insults, I see that it will no longer be worthwhile to continue this particular series of exchanges. Experience shows that once you start in with the personal insults, it frequently results in the situation where insult just begets insult, in an escalating series that ends up illuminating nothing, and boring both Evelyn and the readers of her website.

Further, my innate politeness and courtesy prevent me from returning your insults. I was raised to be considerate of others less fortunate. I have seen whole books devoted to the methods of coping with the depression and irritability that typically occurs in people who are compelled to live the unwelcome, restricted life
of a diabetic. Before you start insulting Bris Vegas or me as being "half-wits, you might remember that it wasn't he or I who ate ourselves into developing Type 2 diabetes and now have to spend the rest of our lives eating things like "gymnema sylvestre (200), fenugreek extract, and ersatz "bread."

I had hoped to learn something of value from your personal example, but it appears you have concluded that my real goal is to discredit you. Which is completely and absolutely false. Because Type 2 diabetes runs in my family, on my father's side, I am always on the lookout for proven strategies and actions that will help me to avoid the same fate.

So you see it's not just a matter of luck that I myself don't (yet) have diabetes—I take steps to help to keep it that way. I have the usual 3 meals a day, no snacks, and the meals are neither very low-carb nor very low-fat. Full fat milk and dairy foods are staples, and although gluten is the popular dietary culprit du jour, my investigations have led me to regard the current fear of gluten as baseless—similar to the past hyping of oat-bran as a being a dietary saviour. My own choice in bread is Bavarian Whole Rye [product of Germany]:
(Is it a hyperbole to say it's the most delicious bread in the world? Well, maybe so...)

In addition to rice and pasta, I also have potatoes—which Walter Willet will tell anyone to never touch with a 10-foot pole. [glycemic index, you see]. Yukon golds at last night's supper—the terrific traditional accompaniment to broiled buffalo cheeseburgers, big salad, and cabernet sauvignon.

I also place great value on aerobic exercise; I do believe it's one of the most important actions one can take to help prevent the liver and pancreas from accumulating fat: http://care.diabetesjournals.org/content/30/3/683.full.pdf
I recommend it,—that is, if you aren't already an aerobic practitioner. Before heading out for my regular pre-dawn 2-mile run this morning, my fasting blood sugar was 76mg/dl. Low-normal is what I like to see. I wish you good luck in managing your disease. Sincerely, not sarcastically.

[Final note: perhaps it's just an unfortunate and mistaken association, but the moniker "Hello_I_Love_You" immediately brings to mind the song of that name by
Jim Morrison [of the Doors fame]—i.e., "Hello, I Love You (Won't You Tell Me Your Name)". I say "unfortunate", because as an alcoholic who poisoned himself to death at the age of 27, Jim Morrison is, if anything, a paradigm of a genuine half-wit.

I'll close off this piece with the noting of a much better song—in the wonderful words of Roy & Dale: ♪♬♩"Happy trails, to you..."♫ ♪ ♬♭
John Meagher said…
Don't post much, but thought it might be useful here. It won't take much conversation with pump users (like myself, +15 years) to understand that each of the above claims, among others, are valid concerns. I've experienced all at one point or another, and some that weren't mentioned - durability of equipment, for example. Doesn't mean I'll stop pumping, but also doesn't mean they aren't very valid concerns for those of us unlucky enough to not have any other viable alternatives. Everything is relative. Are pumps better than injections? Generally, yes. Are they without flaws? Absolutely not.
jackson c said…
Seem to be a lot of smart people here.

Here's my problem in a nutshell: poor carb tolerance, despite being lean (waist size same now as when I was 19, since 2013) and never having done LC for more than a few months. 6 oz of potato by itself will send BG to 170. However it will be back down same as FBG levels of 80s-90s by 90 minutes. So I only have rice or potatoes 2x a day, and only about 3-4 oz so as to keep my spikes 130-140. Breakfast these days is usually a low-carb smoothie with avocado, kefir, eggs, yogurt, lots of prebiotic fiber (green powder, raw potato starch, inulin, glucomannan, psyllium seed, acacia). The rest of my food is paleo with dairy.

Seems to point to weak first-phase insulin response, with OK 2nd-phase. Recent 1-hr post-mixed-breakfast with 6 oz potato and butter test showed BG=170, insulin = 22, and c-peptide = 3.7.
Fasting insulin was <5.

I was never really a big SAD eater; lifted weights, was never fond of gulping big sodas and always liked eating a lot of meat and fat with modest amounts of rice or bread. Most I weighed was 30 lbs more, but for several years was 20 lbs. more. Back in 2005 I did an OGTT because I complained of reactive hypoglycemia. Starting BG was 98, at 1 hr was 89, and 2 hrs, 50 (but not feeling terribly weak). What happened to my robust insulin response? A recent OGTT got me to 217 @ 1hr and 101 @ 2 hrs. From 2005 to 2013 I first fixed my reactive hypo by going low-carb for just a few months with 3 square meals, then re-introduced carbs. Typically had burrito for lunch, and rice with dinner.

Here's another weird thing. In 2013 I discovered my poor starch tolerance and went LC Paleo for a couple months. Then started Potato Starch supplementation. After 6 weeks re-introduced rice and potatoes and discovered that I could eat an 8 oz potato with a BG spike at 35 minutes of only 130! Hooray, I was cured! I started eating "normal" amounts of carbs. It only lasted 2 months. Some spot checks revealed post meal spikes of 160-180. Chagrined, I dialed back my starches to limit spikes to 130-140. I also take 500 mg metformin 2x/day now, and this has lowered my FBG by 10 points. This is where I am now. I want that starch tolerance back.

Is there a NEFA blood test I can take? Should I do it 2 hours post meal with some starch to see if it's normal? Because fasting insulin is <5, I probably don't have insulin resistance, right? Because I'm lean, my liver and pancreas are probably lean, correct? How else can I check that? Aside from fibers, what else promises to improve first-phase insulin response?
jackson c said…
P.S. 23andMe and Interpretome show that I have 2 nasty diabetes-related SNPs.
billy the k said…
You've got the causal sequence mixed up: people don't get diabetes because their ß-cells have become exhausted; ß-cells only become exhaused later in the game, afterwards, if—and some would say only if—those who have first accumulated enough liver fat—and then pancreatic fat—continue to eat carbohydrates in quantities that they formerly could control but now are now unable to properly control (due to the accumulated fat in their liver and pancreas). The prolonged elevations in postmeal blood sugar levels in such a state and the subsequent continuous demand for insulin is what is said to be responsible for the eventual ß-cell burnout.

Low-carb enthusiasts will say that reducing one's carbs will necessarily reduce the demands on your ß-cells, and thereby help to save them. But while this low-carb strategy will result in less bad postmeal BG levels, it won't correct the underlying problem,—that is, the insulin resistance secondary to accumulated hepatic and pancreatic fat. What we should want therefore is not just a less bad postmeal BG level, but a restoration of normal glucose tolerance. So that we can then have an ordinary, normal mealtime carb and process the damn thing normally.
billy the k said…
"Because I'm lean, my liver and pancreas are probably lean, correct?"

It's definitely possible to be lean yet still some accumulated fat in your liver and pancreas. This is a fear I have too, which is why I try to minimize this by regular aerobic exercise: http://care.diabetesjournals.org/content/30/3/683.full.pdf

Check out the following—Richard Doughty's story of how a lean guy can have—and overcome—this problem:
StellaBarbone said…
Your results are essentially normal. For diagnostic purposes, the two-hour reading is used and yours is fine even if your one hour reading appears high. There is no validated way to say that it is "high", though. It's probably just reflecting your genetic potential.

There is a phenomenon of lean DM2s, but they're mostly Asian and they still have more abdominal fat stores and higher waist circumferences than similar weight, non-diabetic Asians. It's one of the reasons why people have suggested that current BMI standards should be revised for Asians. I'm of northern European heritage, but my A1C crept up into the pre-diabetes range when my BMI was 25 and change (but my body type is very thin). If you were to have an imaging exam to look for intra-abdominal fat, you would probably have some stores. A "Bodpod' or a more formal metabolic lab evaluation of body fat percent might be a useful guide. I know that this sounds terribly dated and old-fashioned, but you might do a bit better by losing a few pounds and monitoring calories rather than macronutrients.
Hello_I_Love_You said…
Don't be a drama queen. You've committed worse deeds and I should've sized you up properly before even responding.
Hello_I_Love_You said…
You have a diabetic-level of 1st phase insulin response. It's shot if you're going over 200 in the 1st hour. In fact, some people might interpret that as diabetes and it's possible you could be and that 1st phase may not be restored. What was your fasting insulin and the FBG taken at the same time? 5< is a meaningless number. You have to look at it simultaneously to see how much fasting insulin is on to control your FBG.

A 6 oz potato has about 30-33g net carbs. That shouldn't take you to 170. Maybe to 140. But you have no starch tolerance because of wrecked insulin response in the 1st hour.

More intriguing though is your 2005 OGTT going from 98-89-50. You sure you took 75g of fast-acting glucose? You had 1st phase then but it's gone now --- that would be the interpretation. But you crashed to a ridiculous number after 2 hours, but you claim to be asymptomatic. How about now? Do you have any RH symptoms, although it's now 90, not 50.

You have issues, bud. You need to go see a good conventional endo who specializes in liver hormones hypoglycemia. If bottoming out at 50 was true, you may have had glucagon/liver issues. Because that's not Reactive Hypoglycemia but just hypoglycemia -- check your liver enzymes (AST/ALT/Alk Phos/Bilirubin/Albumin) and your endo might do a sonogram to check for any hemangiomas that could affect your glucagon. But that was 10 years ago.
What's happened in 10Y? Your BG control has slipped and there is something wrong there. It can't be fixed by VLCing or any conventional methods suggested by popular diets like Paleo, etc. I'm strictly going by your non-RH in 2005 and the RH now; who ever sees you must know your history of crashing to 50 from a non-peak of 89. You don't need naturopaths, back crunchers, not PCPs, GPs, not an endo who specializes in obese T2s, but an endo who can check you out based on your hypoglycemic history and current diabetes-level insulin resistance. Good luck. I'd look for someone affiliated with a university hospital. Trust me, no one in the Paleosphere can help you in that regard. They'll start their idotic VLCing protocol and you'll be worse off and have other unnecessary hormonal and immune ailments piggyback when you already seem to have a hormonal issue.
jackson c said…
I had a standard OGTT in 2005. Probably was 75g glucose. The BG=50 at the end of it, I as feeling hungry and weak but not faint. I went and ate and felt OK. In the months after that I cured the reactive hypoglycemia by following the "5 leptin rules", mainly, 3 meals a day, no snacks, early dinner, low carb high protein breakfast. After that I was able to go much longer between meals and never got shakey before meals anymore, til today. I also lost 20 lbs but regained 10 over the years (which I lost again very recently). The lowest BG I've seen in recent months was 72 before bed and 74 FBG.

Liver and kidney numbers back in 2005 didn't raise any flags with my GP. He just "indeed you have reactive hypo, eat 6 meals a day". (instead I followed the leptin rules).

The recent fasting insulin <5 was with an FBG in the 80s. That means no insulin resistance, right?

From 2005 to 2013 my FBG was always in the mid-high 90s. It was only after someone told me that reactive hypo can lead to diabetes that I read up and checked my post meal BG and was shocked to find poor starch tolerance. I then went low carb paleo for a few months and lost 10 lbs to reach my current weight until I read about Resistant Starch in late 2013. I started on raw potato powder. My FBG went down to the 80s and my post starchy meal BG went down to 130. I was ecstatic but it was short lived. What happened during those 2 months of bliss? Why did it go away?

So the 3 LADA antibodies are GAD, Islet Cell, and Insulin? How about ZnT8?

Thanks a bundle!
Hello_I_Love_You said…
It could mean the opposite, Jackson. You're getting bad advice from Paleoland. That low insulin when you have almost no insulin response in the first phase means your insulin doesn't mobilize because at fasting there isn't much of it. You need to look at the postprandial since you seem to have a strong insulin response then but you could be moving toward overall insulin deficiency. Look at your CP and FBG; if you measured PP CP then there must be fasting CP and FBG.

Like I said, if you let your BG over 200 within the first hour and it's been like this for a while, you might already have minor diabetic complications like tingling, pins and needles at your bottom of your feet. That's why you need an MD who knows what he's talking about. Not a bunch of clueless Paleo docs or Paleo groupies who think great BG control is low fasting insulin.
jackson c said…
I'm the leanest I've been since I was 19, and I grew up skinny. If I flex I have a 5-pack (bottom 2 aren't divided :) ). I didn't even have this 5-pack when I was 19. If I were to guess I'm at 15% bodyfat or less now. As I was losing weight when I went paleo with intermittent fasting in 2013 I had to buy new pants... twice. At one point looking at my subcutaneous fat I thought that was it and bought pants. But I continued to lose weight, and my waistline shrunk more. Had to buy pants again. Sounds like I lost intra-abdominal fat. My weight has been very stable. And through that all my strength in the gym was maintained.

I'll ask my gym to measure my bodyfat % (I know it's not perfect, but they have my numbers from like 2009).
jackson c said…
Does lifting weights and doing 12 minutes of HIIT work too?
carbsane said…
Have you had an OGTT with insulin levels done? It sounds, as you say, that you might be a MODY with delayed insulin secretion. The longer I look into this, that "first phase" GSIS is intended to suppress glucagon and glucose production in the liver.

Wondering out loud: I've often wondered if those ith reactive hypoglycemia might benefit from a pure carb load -- 10 grams? -- about 15 min before a meal. Then the delayed insulin is pumping when you eat the rest of the meal, no hyper and no overcompensation of insuin secretion. Seems an experiment worth a shot.

As to NEFA, my guess would be that this is not your issue as your problem isn't in the fasted state.

The drug Prandin is apparently used with those in your situation to stimulate insulin in a timely fashion.

What's your HbA1c?
Rich Rojas said…
This is the same way I eat, and come to think of it, have for most of my adult life. I find it difficult to eat large main meals, so as a consequence, I need to refuel (get hungry) about 2-3 hours after a meal. I've learned the hard way that it makes a big difference what I eat at both mealtime as well as snacktime. Just working now on increasing daily carbs.

I never bought into the "metabolic advantage" of the ketogenic diet and going long periods between eating, though I think it has some interesting implications for endurance athletes provided it's undertaken for short periods leading up to a competition - not as a on-going way of eating. Has to be better than getting a lifetime ban for using PEDs.
Jane Karlsson said…
"Four-day composite solid food and beverage duplicate plates and 1-L
samples of drinking water were collected from a stratified random sample of 80 individuals as part of the National Human Exposure Assessment Survey in Maryland. The media were obtained from each participant in up to six equally spaced sampling cycles over a year and analyzed for copper by inductively coupled plasma mass spectrometry. Copper concentrations (μg/kg) and consumption rates (kg/d) of solid food, beverage and drinking water were used to derive average daily aggregate oral intake of copper (μg/d)."

What's the problem?
jackson c said…
There are 20, maybe 30 genes identified as being correlated with diabetes type 1 and 2. Do a $99 23andMe test, then submit the raw data into Interpretome (free). I for example, have 2 nasty ones. My history is weird. Scroll up and read my post from yesterday if interested.
jackson c said…
And why did I have stellar starch tolerance for 2 months after starting potato starch supplementation, which went away again, even though I stayed lean since? I started eating normal amounts of starch, and had to cut back when my short-lived starch tolerance went away.
jackson c said…
Perhaps there are multiple etiologies of type 2. Either pancreas fat is just one of them, or there are multiple factors that promote pancreas fat than just fat or caloric intake and intra-abdominal fat.

Here’s an interesting article that mentions genetics and Zinc:


“Collins points to one potential drug target: A gene with the sole job of getting zinc to insulin-creating cells. Zinc's a key part of the recipe; **too little or too much, and insulin isn't secreted.”**

I couldn’t find any more references discussing “too much or too little Zinc, and insulin isn’t secreted”

The 2 worst diabetes-correlated SNPs I have are:

7903146 (CT)
7901695 (CT)

The first one affects the ZnT8 “zinc transporter” protein.

Now here's an interesting twist in my case. A few months ago I discovered I needed Zn supplementation to bring my serum Zinc up from marginally low levels. Zn and B6 supplementation got rid of a slight lack-of-focus and concentration issues that started a few years ago. Perhaps there's a Goldilocks level of Zn that optimizes my first-phase insulin, but which is not enough for my mental performance?
jackson c said…
I only had a 1 hour post-mixed meal insulin and C-peptide test done. It was with a 6 oz potato and some butter. Insulin was 22.4, C-peptide was 3.7, BG was 170.

A1c has varied from 5.2 when I was low-carbing, to a high of 5.8 when I was regularly getting >140 post-meal spikes.

I did try something like eating a plum 15 minutes before a 5-oz potato, and the effect on the post-meal spike wasn't measurable. Ditto some apple cider vinegar. What does help is a scoop of whey protein, potato starch and other fibers before a starchy meal, and eating rice that was cooked with some coconut oil and cooled in the fridge for 12 hours before reheating gently (see article making the rounds, it converts a bunch of the rice into resistant starch) and also lowers its GI.
jackson c said…
BG only gets above 200 with an OGTT and if I eat a very starch and dessert heavy meal, which even when I was oblivious, didn't do very often. Yes these days I try and eat just enough carbs for lunch and dinner to get my BG spikes to around 130. Brekkie is usually a low-carb smoothie with kefir, avocado, eggs, yogurt, and fiber powders.

The big mystery is, why did I have outstanding starch tolerance in a 2 month window in early 2014 after starting resistant starch supplementation? I had just lost a bunch of weight from low-carbing (and have lost slightly more since).
billy the k said…
"Don't be a drama queen..."

As I said, personal insults illuminate nothing, so I won't take up space on Evelyn's website by responding in kind.

You've concluded—mistakenly—that I'm out to discredit you, so you'll be surprised to hear that I forgot to mention that I did, in fact, derive some benefit after all from your personal example, namely seeing the importance to you of having legumes as your dietary foundation has persuaded me to reintroduce the addition of an old favorite to my morning scrambled eggs and bacon—beans & salsa, well-know down here in Arizona as the Mexican breakfast "huevos rancheros". The zing of a medium-hot salsa is a really nice counterbalance to the mildness of the buttery scrams.

Also, to place an order for another old favorite which I haven't had in quite a while,—these marvelous organic french lentils:

"A Persian variety, they are tiny grey to green-black ovals. Many seeds are beautifully marbled in greenish-bluish-black hues."

If you haven't had these, I think you'll find them worth trying. In comparison to which, red lentils seem insubstantial and regular green lentils seem too mealy. These have just the right balance of texture, taste, plus the best visual appeal with their bluish-black seed coats. As you must know, boiling and turbulent cooking damages the seed coats and can cause the beans to disintegrate. So I've found the best method is to cook them, covered, atop a double boiler, for 40 minutes (wherein the water won't get any hotter than ~200ºF, which is still hot enough to get the job of tenderizing done, but not so hot as to do damage to the seed coats.)
Bon appétit!
billy the k said…
Unlike aerobic exercise, traditional weight lifting and high-intensity interval training will deprive the muscles of oxygen, tiring them quickly, which is great for reducing blood glucose because such all-out 100% muscular effort requires about 14 times as much glucose to do the same amount or work as aerobic exercise; the muscles quickly burn up their glycogen stores and then are then readily able to suck up glucose from the blood to replace that glycogen without really requiring much help in the way of insulin mediation.

So you can almost think of lifting weights as a sort of insulin substitute. In fact, a famous diabetes doctor [whose name I must be careful to whisper!] wrote in the 2nd edition of his
Diabetes Solution (p.204): "I have one Type 1 patient who keeps her blood sugars essentially normal. She still makes a little insulin and dislikes insulin injections so much that she works out—lifts weights—every day after lunch to save herself a shot to cover the lunch."

Lifting has other benefits—raises HDL, lowers TG's, and by increasing your muscle mass thereby reduces your need for insulin. But since you're not a Type 1 diabetic, you won't have the same primary goal of reducing blood glucose—what you'll want is to restore/maintain normal glucose tolerance, which means having the different primary goal of reducing accumulated fat. And it's sustained aerobic exercise that really gets this job done.
Hello_I_Love_You said…
It is indeed probably MODY, if I had to put my money on it. Which is what Jenny Ruhl has. Initial hyperglycemia followed by normal BG on OGTT. Possible mild diabetic symptoms. On a semi-permanent honeymoon. Won't be positive for T1 antibodies.
The moment his BG went above 200, that should've screamed diabetes. My old endo who passed away would've spotted this just looking at his OGTT. That 200 BG breach rule is still reliable. You spend the 1st hour of your OGTT over 200 and you pretty much have diabetes. It just confuses lots of GPs.
Hello_I_Love_You said…
Normal BG metrics like A1c and FI don't apply if you have MODY. The 6.5 diabetes rule is based on your BG behaving like most people as they gradually lose BG control as FBG rises. That's not what's happening if you have MODY. That's why you need to look hard at your OGTT numbers. The numbers above 200 are significant, because it's evidence of loss of BG control. Non-diabetics do not register above 200. No matter how much starch they eat. That's why when you go over 200 and you are confirmed to do it again, you're considered to have diabetes.
Hello_I_Love_You said…
Ok, I'm sorry Billy the K. But it's hard to tell whether you're being sarcastic or not. You have a knack for sounding flippant and frivolous, perhaps unintentionally.
StellaBarbone said…
Skin fold testing won't help you assess intraabdominal fat.

Well, since you already have a genetic profile, you could look to see if you also have one of the known MODY genes and that would help distinguish MODY from early type II (or you could have both conditions). The problem is that there isn't really any valid treatment, so what would you do with the information? Sulfonylureas will slow but not reverse the progress of both early diseases. I know that you are looking for a nutritional solution, but I'm sorry to say that I don't think there is one, at least beyond eating a moderate diet, regular exercise, controlling weight and avoiding cardiac risks.

HILY asked what the change was between 2005 and 2013 and I'm afraid that the answer is 8 years.
Hello_I_Love_You said…
Jackson, I'd google those SNPs and see if they're linked to the problem of insulin secretion specifically, rather than other aspects of diabetic pathogenesis.
billy the k said…
All's well that ends well.
Rich Rojas said…
I love my cold cuts as well - something I've been eating for lunch since at least the first grade. I've taken some flak about the nitrates in lunch meats, but it's one of those nutritional compromises I'm comfortable making. It's certainly easy enough to give yourself food neurosis as it is - see Jimmy Moore.

I've also started eating bread and pasta again, but prefer to make my own, lower-carb versions. I even use a bit of Bisquick to make the bread, again not worrying about the refined flour and what little trans fat comes through. Fortunately, I can tolerate gluten. I may give Ezekiel bread a shot, but not sure I'm going to like the taste.

I've been hearing a lot of good things about Lindt chocolates lately. I believe CarbSane has a preference for their truffles. Lindt could turn out to be the missing dietary link.
JJ said…
Dr. B doesnt like insulin pumps because of the potential for the equipment to fail, also insulin resistance at the pump site, and fat and scar tissue build up there. But I believe he has been lightening up to them, especially for children.

His method of choice for insulin are regular syringes. He prefers them even over insulin pens (which are inaccurate in dosage up to 10-15%).
jackson c said…
Thanks I spent a few hours reading a bunch of articles. My SNPs don't seem to be related to MODY but to a decrease in first and or second phase insulin secretion. It's also related to reduced insulin secretion in response to incretin.
jackson c said…
Thanks I spent a few hours reading a bunch of her articles. My SNPs don't seem to be related to MODY but rather to a decrease in first and/or second phase insulin secretion. It's also related to reduced insulin secretion in response to incretin. I'm still gonna get the LADA antibodies test to rule it out.
jackson c said…
Thanks for that tip. I just got back from an 8-day cruise ship vacation. Whenever I ate more starch and dessert than I could handle, at the 30 minute mark I'd do 1 or 3 laps sprinting up 10 flights of stairs. 10 minutes after that, my BG would be between 90 and 120. Good thing I can sprint and not throw up!
jackson c said…
Nobody seems to be taking note of the fact I got stellar post meal sugars in a 2 month window 16 months ago after starting Resistant Starch supplementation? I have multiple test results. We're talking 130 35 minutes after an 8 oz potato and <110 at 60 minutes.
Catweazle said…
130 after 35 minutes isn't stellar, its absolut normal!
jackson c said…
OK, normal, but it's a far cry from the usual 170 from just 6 oz of potato! And normal only lasted me 2 months! Where did it go?!
Hello_I_Love_You said…
LADA Abs are basically T1 Abs. MODY can only be dx'ed through gene testing. You have mild hyperglycemia that's > 200 in the 1st hour. You're normal weight and not IR, as evidenced by your normal BG @2H. That fits MODY than LADA. Your order of bidness: go to an endo specializing in T1D, who'll test T1 Abs. R/O T1 & LADA. Depending on whether it's worth the hassle of gene testing, that may leave MODY, which is a disease of impaired insulin secretion, not insulin resistance. That seems to fit you from what I can tell.
Hello_I_Love_You said…
What is this supposed to mean? Where is the context? And what periodical are you citing? In context of what? Like many, you're good at fetching citations but I'm not sure if you understand the citations you fetch. Most assertions in research studies are not absolute and stated in ways to show their limited applicability. They're never very broad or sweeping. Why don't you try a bit harder.
jackson c said…
Thanks. It's too bad 23andMe doesn't test for the MODY genes (that I can tell, I could be wrong).
Any opinions as to why I had a 2 month window of excellent starch tolerance in early 2014 when I had just started supplementing Resistant Starch? (which I'm still continuing, because the improved 90 minute post-meal BG is still there).
jackson c said…
Could you tell me more about her "one-way street" thinking? When I study anything I like to be aware up front of the bias so I can contrast different points of view.
jackson c said…
Additionally, I just did a quick urine sugar test, which supposedly spots MODY3 as per Jenny Ruhl's site. I emptied my bladder, then ate 6 oz cooled reheated rice with my liver/onions/sauerkraut/greens dinner, and my sugar peaked at 162 at 1 hour. 15 minutes later it was down to 145. I then went and used the Diastix per instructions, and urine sugar showed 0.0. So this test likely rules out MODY3... (At 100 minutes BG was down to 101).
Hello_I_Love_You said…
She's just a one trick pony: hyperglycemia kills beta cells and you become diabetic and move toward insulin dependency so you must circumvent hyperglycemia by eating as little carbs as possible. She doesn't understand that there are ways of enhancing insulin sensitivity by eating carbs and fiber.
Hello_I_Love_You said…
U do realize there're dozen varieties of MODY? 3 oz is only about 15g carbs so that 162 is abnormal. I have T2DM and I don't go over 140 when I eat 15g. Look, do u have insurance? If so, why not just go to your PCP and have you referred to an endo who'll R/O T1DM? It's a dx of elimination.
Hello_I_Love_You said…
They might, I'd look into it. Access the SNP portion of 23andme see if you've got the genes. First, let me tell you: T2DM happens from insulin resistance; you're not IR. Your pattern seems to be MODY because T1DM is happens when your insulin supply declines due to autoimmune attack. People with T1DM are not IR either but they can't secrete insulin whose supply dwindles to a trickle. There's no problem with the secretion, it's just that the supply has run out. Your problem is secreting insulin which you seem to have; there's no indication your supply is dwindling. It's very similar to gestational diabetes in BG pattern. You have mild hyperglycemia. So if I were you, I'd "prime" myself by whetting my appetite with 5-10g of carbs for 30-60 minutes before digging in.

If by resistant starch, you mean RS in beans and lentils, I do follow Furhman's Eat to Live and am a big fan of his diet. After being in the mid-5s, my A1c dropped to the 5.0-5.2 range last 2 years after I introduced legumes to my diet.
jackson c said…
I thought 6 oz rice has 45g carbs? Yes I have insurance and yes I plan to get the LADA tests
Hello_I_Love_You said…
I thought you said potato. 3 oz = 85g. 85g of rice = 64grams of carbs for most white, Basmatti varieties. So I could go near 200 for that one. I only cook a 1/8-1/6 cup of rice (pre-cooked) per meal along with lentils and beans. If eating rice alone, I eat no more than 1/4 cup, which is ~ 35g. I'm always below 150 1h and my peak is probably no higher than 150.
jackson c said…
Is it bad to "eat just enough carbs to spike to 120-130" (what I do) as opposed to "as little as possible"?
jackson c said…
I made a mistake. I had 6 oz rice by *volume* in a measuring cup. I just weighed that much cooked rice and it was 100g. It has 25g carbs and it got me to 162 (ulk!)
Early 2014 I had 2 months of excellent starch tolerance when I had just started supplementing with Bob's Red Mill Potato Starch as a source of Resistant Starch. My theory is it got my gut flora in some (transient) state that improved my incretin response. I still take the PS, and recently added a bunch of other prebiotic fibers (inulin, FOS, GOS), to no avail. And most recently (months ago) my starch tolerance took a turn for the worse when I started taking Zinc and B6 which address a mild brain fog / lack of focus I started getting about 2 years ago.
Hello_I_Love_You said…
Yes, she has warned people about beta cells being killed off at 110 fasting and 100+ on OGTT 2H. People have misinterpreted these research to mean even any BG levels above 110 will kill your beta cells. That's baloney. Beta cells lose their functions in those people who're moving toward diabetes, i.e., in those with FBG ~110, OGTT 100+. The real BG level that will be harmful is sustained BG readings above 150; she does cite that but she and most of the VLC crowd read this as the first line of the 10 commandments: thou shalt not elevate thy BG above 110. And that's how the myth of 4.1-4.4 as the optimal HbA1c range was born. She herself does not follow a strict VLC diet but she has scaremongered enough that people following a VLC diet that is harmful in other ways. Look in her book, chapter 4: BG levels and organ damage. She's earnest, dedicated and has pockets of knowledge about things like MODY which most doctors are clueless about but is limited by her myopia. She's looking down the wrong end of the telescope.
jackson c said…
I have my RS from Bob's red mill potato starch.
I tried eating a plum 15 minutes before a meal and it had no effect on my post-meal spike. I'll try 30 minutes. Or, does it have to be starch and not sugar?

I searched in SNPedia for "MODY" and got over a dozen SNPs. If you click each SNP it goes to a page where on the right column there's a direct link to 23andMe and it goes to that SNP from your database. Most of the SNPs aren't tested by 23andMe. 4 were. I searched for each off them and none of them were conclusively linked to MODY.
Hello_I_Love_You said…
If you're expecting to restore your 1st phase insulin response by eating RS, that's unrealistic. If you have MODY, that's permanent. Having said that, I do eat RS in food form. I eat dried green plantains and sometimes microwave them. As long as you eat green plantains, the BG effect is minor. There is probably the highest concentration of certain types of RS in green plantains. I also eat leeks, kale, collard greens, along with 3 types of lentils and various legume types. Those can help you and supplements like inulin/FOS can be helpful. But I'm not sure about the effect of those on someone who is normal in every way except for the malfunction of insulin secretion. That's your issue. Prediabetics and even T2DM people may significantly improve their FBG and/or A1c but I'm not sure the same will apply to you.
Hello_I_Love_You said…
Why not eat 10-15g carbs 1 hour before. Doesn't your insulin mobilize fully after 1 hour? I think 15-30 minutes are too short. If your 1H reading is above 200 but at 100 at 2H, then your insulin gets moving sometime after 1H.
jackson c said…
Thanks for the clarification. I now understand the different sides of the argument. As for your recommendation consumption of legumes and/or lentils for their fiber, I'd rather err on the side of "legumes are bad for you" (based on Paul Jaminet's arguments), and just eat his "safe starches" below my 140-peak threshold, and eat more of the gut flora "stars" e.g. cooled-reheated rice, beets, onions, asparagus, as well as supplement with potato starch, inulin, FOS and GOS. I may change my mind on legumes with better evidence... or maybe lentils are pretty benign among the legumes... When I quit grains, legumes, and veggie oils 2+ years ago, my frequent headaches all but disappeared. And then that time in early 2014 I had 2 months of great starch tolerance, I had just come from a few months of LC, and then started potato starch supplementation. I thought the PS was the magic bullet. IMO that datapoint can't be ignored and probably holds an important clue - e.g. are my beta cells all there but just not responding due to the relationship between incretins and the makeup of my gut flora? Do I have the MODY genes but did something in that 2-month window prevent the symptoms? It's very tantalizing and elusive.
jackson c said…
P.S. I tried 25g of rice 30 minutes before a smallish brunch, then 80g of rice for said brunch.

The result suggests a slight improvement in the peak as compared to not having the "pre meal snack". Total carb load including the snack is greater than otherwise. It suggests that I can eat more carbs by eating them 30 minutes apart LOL. Maybe I can eat a bit of starch, then 30 minutes later eat a small dessert.

Here's the data:
time BG comment
10:00 83 just before eating 25g rice
10:30 98 started eating brunch
10:40 finished brunch
10:50 94
11:30 138
11:50 110

PPS I don't want to eat more than 3 meals a day because of the research that 4 hours are needed between meals to get insulin down to baseline, which allows mitochondrial DNA repair.. and that 12 hours between dinner and breakfast maintains leptin and insulin sensitivity. Learning to go 5-6 hours between meals back in 2005 is what cured my reactive hypo (where I had a robust 1st-phase, but hit 50 @ 2 hrs). Also, >4 hours between calorie intakes, helps prevent SIBO, FWIW.
Hello_I_Love_You said…
You're holding onto lots of dogma here, including the precepts of PHD which are very suspect. First IF and those long hours between meals are for healthy people. If you have BG issues, you're better off eating 3 square meals and snacks, especially if you have hyperglycemia. Mitochondrial DNA repair? Is that from PHD or Wahls? Seriously, holding onto faulty concepts of leptin and insulin which circulate in Paleo and low-carb communities is the road to disease states that could do you under down the road. I would eat 3 square meals, given your state, plus 2 snacks. Eat lots of fiber and as much carbs as you can. I eat 200g_ total carbs. That is what I do and I'm at 5.0 A1c.
Hello_I_Love_You said…
PHD completely missed the boat on legumes. Legumes should be off limits for those who are food sensitive and react to them. However, I've never met anyone who's sensitive to lentils, which do not need to be soaked. If you have BG issues and you avoid lentils, I'm sorry, you're a damn fool. I've achieved a major breakthrough in my BG control through lentils. Plus PHD probably wants to parade around the Paleo banner and ruling out legumes was probably the cost of doing business. Go over to his board: he allows legumes in his diet as long as they're soaked. I would also ignore all comments regarding micronutrients and minerals at his site; they're somewhat important but not to the degree he makes them out to be. Plus intermittent fasting, which is unnecessary for those with BG issues.
jackson c said…
Here's another possibility: I don't have MODY but instead some form caused by a problem with the incretin system, and can be improved by some yet-unknown gut flora fix. The outlying data is the 2 month window I had great starch tolerance when I started RS. (Yes continuing the RS is no fix) As per Karl Popper's Critical Rationalism, data that falsifies a hypothesis is much more important than supporting data. e.g. the hypothesis "Once MODY starts it's a permanent downward slide, and I have MODY". That statement is falsified by the 2 months of great starch tolerance. Either I don't have MODY, or one can have remissions from MODY, which I somehow managed to do, for 2 months.
jackson c said…
What property of lentils do you think make them so magical for you? Why would they be so magical for all etiologies of diabetes?
jackson c said…
Mitochondrial DNA repair comes from recent research by Rhonda Patrick. Then there's also this theory of the etiology of type2 diabetes - frequent snacking and insulin:
When I showed reactionary hypo back in 2005 I used to eat 5 times a day. I quit that and went longer between meals and my shaking and crabiness before meals and sleepiness after meals went away. I also lost 20 lbs.
Hello_I_Love_You said…
Fiber, resistant starch, low GL, insulin sensitivity. Connect the dots, jackson. I have T2 diabetes and am hitting 5.0 consistently. I just got my most recent A1c and it's 4.6. I don't think that's accurate and that's too low. I'll take a fructosamine test to see where my average BG level is really. But I can tell you, my FBG is consistently between 85-95 and I'm back to 85-95 after 2H. Heck, I'm sometimes back there after 1H. Just try it. Get some turmeric also and spray that on your rice when you cook your lentils with Basmatti rice.