One of the most important parts of diet we fail to educate the public on is glycemic index vs glycemic load. Index is essentially the raw score for how drastically a particular food will raise blood sugar. Glycemic load looks at the totality of what one eats then predicts what the effect of one's blood sugar will be. For example eating sugar with fat will spike blood sugar less than simply eating sugar.
Glycemic Load = GI * carbohydrates (g) ÷ 100. Accordingly, the GL in the example would only decrease if fat replaced some of the sugar. GL does not consider the totality of food intake but can be calculated for individual foods. (https://www.gisymbol.com/what-about-glycemic-load/)
What you are referring to may be the glycemic response, which, apart from GL, also depends on the intake of fat and protein among other things. Adding fat and protein does indeed reduce the glycemic response:
"It is generally accepted that adding fat and protein to carbohydrate reduces glycemic responses by delaying gastric emptying and stimulating insulin secretion (1,2). These effects have a number of possible implications for human nutrition, such as supporting the role of high protein or high fat diets in the management of diabetes (3,4) or being a source of criticism for the application of the glycemic index to mixed meals (1,5)."
https://academic.oup.com/jn/article/136/10/2506/4746688
Agreed. What glycemic load gets at is the concentration of carbohydrates. So for instance, watermellon has a high glycemic index because it has a form of carbohydrate that moves quickly into the blood stream. But it doesn't spike your blood sugar hardly because there is so little total carbohydrate.
I think a bigger issue is that GI is only defined over 2 hours after eating. The four-hour GI is always higher and a much better indicator of high blood sugar exposure (due to eating that food).
After all, pizza is low GI if you only measure it over 2 hours.
I think you're on to something. I think the large portion of people have an addiction to certain foods.
My first inkling was when my friend, Dr. Ross, said to me, "None of my type II diabetic patients are able to control it with diet. They all need medication." (His patients are all upper-middle class, well-adjusted for the most part).
I've seen it with my dad (type II), an ex-marine (type II), a marketing executive (type II). In all cases they were eating french toast with maple syrup (the crack cocaine of type II diabetics). It was something they knew they should not be eating, and yet they were.
These are people with discipline and strength, and yet they are unable to stick to a diet. What gives? Rather than blaming them, we should ask, "Why is this so hard for them? Why can these people who can do so many things, not eat properly?"
More accurately diet can prevent 100% of type 2 diabetes cases, while it can be used to reverse some cases it can not reverse 100% of cases. And yes the focus on these kinds of diets is managing blood sugar levels/insulin spikes which includes sugars, carbs, starches, and alcohol.
So when you say “nearly all” that’s right...but cutting out nearly all carbs doesn’t have to be the same as low carb, or paleo/Keto, carbs can still be the main source of daily calories such as spinach, kale, romaine, Broccoli, cabbage, kimchi, sauerkraut, etc... and even higher carb foods like nuts and seeds. Those foods “are carbs” but won’t typically spike insulin and in fact many of those “carbs” will actually improve blood sugar stability/management.
Agreed. And I'd like to expand on the term "reverse 100% of cases."
Other than gestational diabetes, there is no cure for type II diabetes: once your insulin response is broken, it stays broken.
In the medical literature, when they use terms such as "improved", they often mean that "the subject no longer needs to take medication to control their type II diabetes." But it's understood that the subject must maintain a very strict diet regimen.
I think "permanent remission" is a misleading phrase. I think a better phrasing would be along the lines of "...cutting out nearly all carbohydrates ... allows the diabetic to have 'normal' results for standard blood tests such as fasting glucose and hemoglobin A1c."
My doctor said to me my last check-up, "These numbers are great! If a doctor were to see these, they wouldn't be able to tell you were a type II diabetic."
Me: "I'm cured?"
She looked at me: "Make no mistake: you CANNOT afford to gain ten pounds or to go back to your old way of eating. Those days are gone. If you go back, your symptoms will return in full bloom."
My insulin response is permanently broken, diet notwithstanding. As long as I don't slam my body with too much glucose, my impaired system can manage.
Remission in medicine is the absense of symptoms without requiring treatment. Under remission, a person passes all diagnosis tests, without doing anything different than a normal, healthy person.
Having to avoid carbs to keep low blood glucose is similar to an allergy that does not show unless you are exposed to the allergen; that is NOT remission.
I do research on the topic; there is indeed a lot of confusion online, but remission of t2dm has been possible.
www.diabetesremission.org .Working my ass to disseminate well grounded knowledge on that.
You still need insulin to digest protein and for general living throughout the day, even when fasting. It'd be more accurate to say "if you don't eat carbohydrate, you need less insulin, so your insulin requirements may be met by your (degraded) pancreatic output."
On remission: if your Type II diabetes is in the early stages, and is largely due to lifestyle, then a lower carbohydrate diet could help you lose weight and improve insulin sensitivity. If your insulin sensitivity reaches the point where your pancreas' produced insulin is adequate (even for high-carb meals), then you've beaten the disease. This is the remission they speak about.
I read it once and the part of what causing Type 2 Diabetes seems reasonable to me, however his advocate for extended fasting (namely, 36h+) sounds too aggressive.
You do realize that, compared to eating too little, eating too much is really not that bad? Yes, starving yourself does change your relationship with food (in that it makes you hungry and miserable). And, for many people it can start a cycle of food related anxiety (an eating disorder). Perhaps some benefits do exist, but it’s wrong to advocate for fasting without fully addressing the serious health risks.
I'm no fan of fad diets, but a lot of Westerners have a real problem with simply not knowing what hunger feels like.
A lot of people are so habituated to large portions and frequent snacking that they're never meaningfully hungry, just somewhere on the spectrum between "reasonably sated" and "physically incapable of ingesting another morsel". Their eating habits have fundamentally broken the connection between food and sustenance. They've lost the ability to usefully distinguish between the body's natural hunger signals and other motivations for eating like habit, boredom and emotional self-soothing.
I'm not wholly persuaded by the claims made about the health benefits of intermittent fasting, but I do think it's a potentially useful psychological experience if you have a problematic relationship with food.
True. I found that when I switched to a low-carb diet, my relationship with hunger changed.
For one thing, I was always hungry: nothing makes you feel full like a good batch of carbs. But the hunger was similar to a low-grade background noise; it was fundamentally different than the I-gotta-eat-right-now hunger of the carbolicious diet.
The other thing I noticed is that since I switched diets (7 years ago), I have never "bonked" (run into a wall because I was so hungry). I simply get more hungry, but again, it's more like the background noise gets louder.
That begs the question, "Why not eat more if you're hungry?" The truth is that eating gets tiresome after a while. I remember spending over and hour shoving salad into my mouth and finally saying, "I need to get stuff done; I can't sit here all day eating salad."
Yes, meat can fill me up if I eat enough of it (20 oz. prime rib), but I tire of meat after a while.
For me, paying closer attention to how I’m feeling has helped me better identify when I’m hungry. I think starving yourself is a really extreme step to take that probably isn’t necessary
I can personally attest that fasting is not necessary to control type II diabetes without medication.
I'm strict about my diet, but I never fast. My numbers? My A1c was 8.7 when I was diagnosed, and now, seven years later, it hovers around 5.8 - 6.0 (high normal).
I find fasting difficult, and I suspect that fasting comes more easy to some than to others. If it works for you, great, but if it doesn't, don't push it. I suspect that part of the difficulty is that I'm thin, so I don't have much in the way of reserves when I stop eating.
One thing that is worth noting: A number of well-referenced studies you can find on pubmed show that some 80% of people with type 2 diabetes who are also overweight or obese would be asymptomatic if they reduced their weight.
There was a small study giving oral carnosine (2g/d) to participants to study whether "carnosine supplementation in individuals with overweight or obesity improves diabetes and cardiovascular risk factors".
I have a question in case there are any experts here.
What is the mechanism of this:
>On the other hand, high-intensity, short-duration exercise (like weightlifting, sprinting, and rock climbing) will spike your blood sugar temporarily, but keep your blood sugar lower overall for a period of time afterward:
What exactly happens here, in as much detail as someone could reply. (For the first part, "spike your blood sugar temporarily".)
There are two types of exercise aerobic and anaerobic.
Aerobic is easy exercise (walking, jogging, etc...) where the body can supply enough oxygen to oxidize glucose to convert to energy.
During Anaerobic or high intensity exercise the body can not supply enough oxygen, so a bunch of things happen including: 1.) the body begins needing to rely on lactic acid for energy instead of oxygen/glucose, and 2.) while the lactic acid is being used for energy the glucose (blood sugar) builds up (lactic acid also builds up which is why intense exercise can not be sustained for long periods).
My understanding is that anaerobic exercise uses glucose and stored glycogen to generate energy and produces lactic acid as a by product. Oxygen is not required for this process but its presence does make glycolysis more efficient and is needed to stop the lactic acid buildup
Aerobic is certainly not easy exercise. Your body is releasing stored glycogen from the liver and burning oxygen to clear out lactic acid and starting to break down fat reserves.
Short duration high intensity exercise actually uses Creatine phosphate stores in the muscles for energy but this is quickly exhausted
It is correct, just look at the definitions of the terms.
You somehow have 3 types of exercise...aerobic, anaerobic and short duration/high intensity.
There is only aerobic and anaerobic (short duration/high intensity is anaerobic - high intensity is going to result in a build op of lactic acid which in turn will cause the burnout/short duration).
Anyway aerobic means “with oxygen” and anaerobic means “without oxygen.”
High intensity exercise is generally anaerobic yes, not a third type of exercise.
I was really querying your point about high intensity exercise using lactic acid as an energy source. My understanding is that during any exercise, the muscles will first use creatine phosphate as an energy source and will then use blood glucose and stored glycogen for energy, and it is the breakdown of glucose that creates the energy - lactic acid is a by product of this reaction and is not a source of energy so I don't think this would cause blood sugar levels to increase?
Any increase in blood sugar levels following short duration exercise would be due to the body reacting to the fall in glucose levels and so releasing more from the liver to compensate.
Blood glucose would rise because youre unable to provide enough oxygen to break it down/convert it into energy (ie more unused glucose accumulates in the blood).
Lactate/Lactic acid is a byproduct of broken down glucose, but also temporarily picks up the slack in energy when the body can’t supply enough oxygen to breakdown glucose for energy requirements. Lactic acid is used in the mitochondria of cells and keeps the heart pumping during these intense phases of exercise where the oxygen/glucose can’t do the job...again as lactic acid is temporarily being used as fuel it would follow glucose builds up as the body can’t break it down fast enough and is now using an alternate fuel source.
Creatine as I understand it isn’t a fuel/energy directly, but does facilitate recycling of energy. Moreover, as ATP (energy) is produced in the mitochondria and used by the cell it is converted into ADP, but the body/muscles will use creatine to recycle ADP back into ATP. On its own though I don’t think creatine is fuel/converted into ATP at any point like glucose/ketones.
I measure blood ketones and glucose. After heavy weight training (10-15 reps total of between 85-92% max), invariably my blood sugar is higher and ketones lower. This seems to be a standard response. I wouldn’t say I feel lactic acid after powerlifting, but I am generally beat a bit. I generally stay in ketosis.
This is interesting, what tools are available to measure one's blood sugar and chart it throughout the day? I find it's pretty inconvenient to measure and report it accurately enough to get these trend lines with my regular meter.
The Freestyle Libre is good for 14 days at a time, and as far as I know costs $110-120 for a 2-pack. No it's not cheap, but it's not as expensive as the Dexcom. My son wears a Dexcom (type 1 diabetic) and my dad wears a Libre (type 2 diabetic.) The Dexcom is far more expensive, but it's the only one that will integrate with my son's insulin pump.
And about 450€ per transmitter that lasts for three months. Using open source tools you can extend the sensor lifetime to 2-3 weeks and transmitter to 6-9 months and I advice to read on that and try tools like xDrip.
Further reading: https://www.health.harvard.edu/diseases-and-conditions/the-l...