Low-carb eating for diabetes

Jenny provided permission to reprint her very excellent introduction to low-carbohydrate eating for people with diabetes. You can also view the original version on her Diabetes 101 website.

Jenny is a stickler for monitoring the effects of blood sugar. We might take some lessons from her experiences for improving management of people with metabolic syndrome or borderline blood sugars. In other words, monitoring the blood sugar-raising effects of various foods and food portions can provide great feedback on what foods are preferable, what undesirable, given your physiology.

Even if you are not a diabetic, Jenny's discussion is must reading to gain a better understanding of food choices, particularly carbohydrates. Along with seizing control of health, she has also gained deep wisdom in how to best manage this disease and its physiology.


Introduction to low-carb nutrition for diabetics

It's carbohydrates that raise blood sugar.

Sugars and starches, not the fats that dietitians have been warning you about for so long. If you've been testing your blood sugar after meals, you've probably noticed that already and you are starting to understand why a healthy diabetes diet will have to be one that limits carbohydrates to an amount that doesn't push your blood sugar up over the level where you are damaging your body.

But if your previous experience with restricting carbohydrates involved doing a weight loss diet like Atkins or Protein Power, which worked well for you until you crashed off it entirely and gained back all the weight you'd lost, you may be hesitant to embark on another course of dieting that requires some carb restriction.

I've been there myself. I've done the extremely low carb diet Dr. Richard Bernstein recommends for months on end. I did Protein Power for 3 years. And I've gone on the "Eat all the carbs you didn't eat over the past three years all at once" diet, too. The following observations grew out of my 8 years of experience with learning how to make carb restriction work long-term.

Unlike much of what you've read before, there are no scholarly references for this section. It's based entirely on my own observations and the experience of many dozens of people who have participated in online discussion groups devoted to low carb dieting and diabetes.


Weight Loss Diets Usually Fail but Diabetes Diets Can't Afford To Fail

People who adopt a low carb diet to lose weight tend to start out with great enthusiasm, adapt extreme dieting strategies, swear they will never eat another piece of bread or french fry for the rest of their lives, lose some weight, stall out, burn out, and slink back to their old diets, where they gain back all the weight they lost and more.

This is not a surprise. People on any diet, including low calorie and low fat, do the same thing. The body is very resistant to weight loss and deeply buried instincts in our brains do everything they can to maintain our weights, no matter how unhealthy they might be.

But while this pattern of dieting may be tolerable for those who are dieting to shed a few pounds before their class reunion, it spells disaster for those who must change their diet in order to prevent the high blood sugars that result in amputation, blindness, kidney failure and heart attack death.

Low carbing for diabetes means low carbing for life, long after the thrill has worn off of eating that runny brie and steak. Despite the hype in the diet books, it is not easy, simple, and fun. I know only a handful of people who have been able to sustain a low carb lifestyle for more than five years. And that is after years of online participation in low carb groups.

What you'll find below is what I've found works for me. I used a low carb diet to control my blood sugar for more than five years and have gone through the whole cycle, from enthusiasm, to boredom, to burnout, to saying "To hell with it, we've all got to die some time!" to starting all over again determined to avoid the mistakes that sent me round the bend the first time.


How Many Grams of Carbs to Eat? As Many as Allow You to Reach Your Blood Sugar Targets

When people think about adopting a lower carb diet, their first question is almost always, "How many grams of carbs can I eat at each meal?" Most of the diet books will answer that question with a hard and fast number. Atkins, for example, tells you to start out with 20 grams a day. Protein Power starts you at 30 grams. And Dr. Bernstein suggests 6 grams for breakfast and snacks and 12 grams at lunch and dinner.

Adopting these very low carbohydrate limits will control your blood sugar very nicely. But over time, many people find that sticking to a diet this low in carbohydrate becomes impossible. That's why I'm going to ask you to throw away all those diet books and try a new approach to restricting carbs.

What you will do is to try the strategy used by the people from the alt.support-diabetes newsgroup who informally call themselves "The 5% Club" because their A1c test results fall in the 5% range which doctors consider normal: use your blood sugar meter after each meal to determine how many grams of carbs you can eat and still meet a healthy blood sugar target.

You will start out by measuring your blood sugar one and two hours after each meal. Write down what you ate and observe what it did to your blood sugar. If a meal allows you to reach your blood sugar targets, try eating it again on a different day and test it test again, possibly at a later time, to make sure that your good numbers weren't just a result of slow digestion.

If you end up too high after a meal, the next time you eat it, cut back on the portion size of the carbohydrate elements in the meal and test again. Do this until you can hit your targets, or flag the carbohydrate-containing foods in that meal as ones your body can't handle.

What you're doing here is creating what newsgroup activist Alan S. calls, "a low spike diet" rather than a low carb diet. He can achieve normal post meal blood sugars by eating as many as 30 or 40 grams of carbohydrates at a meal. Others will find that they need to eat a lot less than that amount to hit safe post-meal blood sugar targets.

Usually how much carbohydrate you can manage has something to do with your body size. The more you weigh, the less each gram of carbohydrate you eat will raise your blood sugar. Those of us whose weight is less than 150 lbs often find that we can eat between 12 and 20 grams of carbohydrate and still reach normal blood sugar targets without the help of medications, and that we can add perhaps another 10 or 20 grams more, with medications. People who are much heavier can often eat 30 or 40 grams per meal and still reach their blood sugar targets. In general, men can eat more carbohydrates and still reach their targets than can women, again, because of their larger body size.


How to Learn How Much Carbohydrate is in Your Food

To make this system work, it helps if you start to learn how many grams of carbohydrate are in the foods you eat. That way you won't have to test hundreds of foods once you've learned how a representative sample affect you.

The best way to learn how many grams of carbohydrates are in the different foods you eat is to read food labels carefully, invest in a nutritional guide like one of Connie Netzer's books of nutritional information, download nutrition software like LifeForm (http://www.lifeform.com) or use online calculators like Fit Day (http://www.fitday.com). Software and online sites will compute the amount of carbohydrates and other nutrients in your meal for you as long as you know the portion size.


Learn about Portion Sizes!
This brings up an important point: When you estimate how many grams of carbohydrate there are in a portion of food, it is very important to find out if the amount of food on your plate corresponds to the amount in the "one serving" listed on a label, in a book, or in your software.

The best way to do this is to invest in an electronic food scale and to weigh your foods for a few weeks until you get the hang of estimating portion size. You can get a good food scale at a gourmet kitchen shop for $25 to $40 dollars. This food scale may be the best nutritional investment you'll ever make.

Once you start using your scale, you will find that the muffin you bought at the coffee shop weighs 8 ounces, which is fully four times the 2 ounces that most food databases give as "one serving" of a muffin. When you read that a mythical 2 ounce portion of muffin contains 27 grams of carbohydrate you will realize why that 8 ounce coffee shop muffin with its 108 grams of carbohydrates sends your blood sugar into the psycho zone!

With ice cream, when you weigh your ice cream on a food scale, you'll quickly see that the "one portion" listed on the package turns out to be only a few teaspoons' worth. That bowl you've been considering as one portion of ice cream weighs in as four servings or 72 grams of carbohydrate and 600 calories, which may explain its damaging effect on both your blood sugar and your waistline.

This may sound like a lot of work, and when you first start, it is. But after you do it for a few weeks you'll find you have memorized the carbohydrate gram counts and the portion sizes for the foods you usually eat, and once you have tested your blood after eating these portion sizes, you won't have to test every time you eat a favorite meal, because you will know what it is going to do to your blood sugar.


Eating Away from Home

The biggest challenge you'll encounter as you start learning what you can eat will be eating away from home. You aren't going to be able to weigh restaurant foods nor can you look up the nutritional values of many restaurant offerings--though many of the common fast food outlets do provide nutritional information online--though often without listing portion sizes.

That makes it a very good idea to avoid starchy or sugary restaurant foods or, if you do eat them, to eat only a small portion of what you are offered. Measure your blood sugar an hour or two hours after eating if you aren't sure about how a restaurant food will affect you.


Fat and Carbs Eaten Together will Digest Slowly

Foods with a lot of fat in them take longer to digest than those without a lot of fat. This is why pizza and ice cream often give deceptively good readings on your meter. If you test a meal and see a reading that is too good to be true, be sure you test at 3 or four hours after eating.


The Truth About Pasta

Pasta was long recommended to people with diabetes as a food that would not raise blood sugar and you will still see it starring in many cookbooks and magazines intended for people with diabetes.

However, if you test pasta 4 or 5 hours after eating, you may get an unpleasant surprise. This is true with the so-called "low carb" pastas, too. These foods give you excellent readings at one and two hours because they are resistant to digestion so they don't turn into glucose right away. But five hours later, they do break down into glucose and when they do, the 52 grams of carbohydrates found in each 2 ounce serving of pasta will hit your blood stream with a nasty wallop. (Not to mention that you almost need a microscope to see a 2 ounce portion of pasta. Most people's idea of a portion of pasta is closer to 6 ounces--and 156 grams of carbohydrate!)

If you have pasta for dinner and don't see a peak 3 hours later, be sure to check your fasting blood sugar the next morning. You may see the blood sugar rise there, too.


Sugar Alcohol and "Sugar Free" Foods

The sugar alcohol used in so-called "sugar free" foods can also show up in your blood sugar an hour or two after you'd expect to see them, especially the maltitol used in "sugar-free" candy. At least half of the sugar in Maltitol does turn into glucose in your blood stream and it can raise your blood sugar, but the rise is delayed so you may miss it on testing. So if a "sugar free" food seems to be kind to your blood sugar, try testing it an hour or two after your first tests. Erythritol is the one sugar alcohol that usually does not show up in your blood sugar.


Dealing with Limited Blood Testing Supplies

In in ideal world, we'd all have all the testing supplies we needed to control our blood sugar, but in real life blood sugar test strips are very expensive and many insurers sharply limit the number of strips people with Type 2 diabetes can get each month.

Here are some strategies that can help you if your access to strips is limited.

If you only have 50 strips to get you through a month, plan out what you are going to test ahead of time. Pick one of your favorite meals, and test at 1 hour after eating the first time you eat it and 2 hours after eating the second. Do this with a couple different meals and see if there's a pattern as to when you see the highest reading--whether it is at one hour or two. Then choose another meal and test it at the time when you saw the highest reading in the earlier meal. If you ever get a surprisingly low reading, try testing an hour later or earlier, to make sure you aren't missing the peak.

Make the goal of your testing be learning how many grams of carbs you can tolerate in one meal. If you learn that 30 grams is your upper limit, use software and your scale to find portions of other foods that will also clock in at 30 grams or less. Test one or two of these, and if you see the result you expect, you don't have to test every time you eat these foods again.

Wal-mart sells a cheap and effective blood sugar meter with strips that cost one half as much as other vendors. Some drug stores also sell store brand meters with cheaper strips. If you need more strips, consider the $50 you pay for another 100 strips an investment in your health. It's far better to spend that $50 now, than to spend it on expensive doctor bills caused by complications you don't need to develop!


Keep the focus on Achieving your Blood Sugar Goals

By testing after meals, you'll learn how many grams of carbohydrate your own, unique, body can handle. And more importantly, you'll also be able to decide if you are going to be able to control through diet alone, of whether it is time to talk to your doctor about supplementing dietary control with drugs.

Many people are so excited to learn that they can achieve normal blood sugars by cutting way back on carbohydrates that they become zealots for low carb dieting. I've been there and I've done that. But it's important not to get too carried away with a "Carbs are Evil" mentality which makes it a matter of religious zeal never to let evil carbs cross your lips again. Like all conversions this one tends to fade out in time. And as we said at the start of this chapter, your ultimate goal is to maintain your blood sugar targets for the rest of your life. So the safest approach is to get the most blood sugar benefit you can out of restricting carbohydrates, but restrict them to a level you can maintain year in and year out.

Most importantly, I have learned it is best to treat carb restriction as a strategy, one of many, which used in combination with other strategies including medications if needed, can give you normal blood sugars, rather than the One and Only True Way. If you can be flexible and find more than one tool to help you meet your blood sugar targets, you are more likely to be able to maintain those excellent blood sugars for years to come.


Eliminate "Habit Carbs" and Concentrate on "Value Carbs"
When people think about restricting their carb intake they assume this means never eating any of their favorite foods again.

But for many of us, this doesn't have to be true. Why? Because a quick look at your daily carb intake will often reveal that the bulk of the carbohydrates you are eating are what I call "habit carbs." These are the carbs you eat without a second thought because they are there. Not because they taste good. Not because you couldn't live without them. Just because you're in the habit of eating them.

Here is a list of some prime "habit carbs."

Steam table mashed potatoes

Limp french fries

Squashy hamburger buns

Cardboard toast

Cold home fries

Stale boxed cookies


How many of these flavorless, starchy foods are you consuming everyday just because they're there? Probably more than you realize. So before you lift that fork-full to your mouth, ask yourself, "Is this food thrilling me?" If not, put it down. This should go a long way towards getting your carb intake down.

What I'd call "value carbs" are those carb-rich foods that really do mean something to you. I'm not going to lie to you. You are not going to be able to make them the mainstays of your diabetes diet. But by using the strategies describe below, you should be able to eat enough of these foods to keep yourself from feeling deprived--without destroying your health.


Don't Create "Forbidden Foods!"

If you are one of those people who could live happily on Purina People Chow, you can skip what follows. But if food has been important to you, and if you have hitherto had a long and emotionally satisfying relationship with food, or if, like me, baking from scratch was one of your favorite ways to show love and express creativity, restricting your carbohydrate input will mean that a whole lot of what you've been eating (and baking) up until now is suddenly, completely, off limits. I can't eat cake and get a healthy blood sugar level. Even with two different diabetes drugs in my system. I can't eat cake even with an insulin shot before I eat it. I love cake but there is no way I can eat more than a bite or two without seeing very high blood sugars and there is no way I can eat two bites of cake and be happy. The same goes for french fries and Thai noodles.

During the first enthusiastic weeks of exploring carb restriction most people deal with this kind of discovery by coming up with new recipes and finding new, delicious and healthy things they can substitute for old, high carb standards. They appreciate the way cutting way back on carbohydrates curbs their hunger and makes food much more manageable. This is good and it is why long term low carbing is possible. But our old favorite foods do not go away that easily.

If you decide that some food you have been eating and enjoying all your life will never again cross your lips, it is almost 100% guaranteed that you'll end up pigging out on that very same food at some time in the future, hating yourself, and even beginning a binge that can throw you completely off your diet for months.

It might not happen the first month you are restricting your carb intake or even the first year. It took me three years of low carbing to get to where I crashed off my stringent low carb diet. But eventually it happens, and because after almost a decade of counting my carbs I've learned that I will never lose my love for certain foods that don't love me, I've put a lot of time into finding a way of restricting my carbohydrate intake in a way that avoids the buildup those feelings of deprivation that eventually lead to long periods of unwise eating.

The key, for me, is to build safety valves into my diet. I don't call them "cheats" or "bad foods" for reasons I'll get into later. I call them "off plan" foods because they are not food I can make an ongoing part of my daily food plan. Because my goal is life-long blood sugar control, I accept that I will occasional eat "off plan" and that this is okay as long as I am meeting my blood sugar targets most of the time. "Good enough" control that I can adhere to year in and year out beats a few months of perfection followed by crashing off the diet entirely and ruining my health. Here is one way to approach doing this:

Do the Diet Straight for a Month or Two Before You Try Off-Plan Goodies

As you learn what foods raise your blood sugar and what foods don't, you will almost certainly find that there are a lot of foods you used to love that don't work for you anymore. Waffles for breakfast, coffee cake at coffee break, three slices of pizza with crust, a burger with a bun and a side of fries are just a few of the foods that it is almost certain will not allow you to meet your post-meal blood sugar targets.

As you keep using your meter to test what you eat, if you are like most people with diabetes you'll also learn that some of the so-called "low glycemic" foods and the supposedly "healthy" whole grains that nutritionists recommend for people with diabetes won't work either. Oatmeal and whole wheat bagels raise my blood sugar far too high, so does cracked whole wheat, whole wheat bread, and brown rice.

If the dietician tells you a food is good for you, but your meter tells you it is raising your blood sugar to a level that is high enough to cause complications, you will have to listen to your meter. Your meter will tell you what is safe to eat and for the first couple of months while you are learning how to get your blood sugar under control and how bring those high blood sugars down to normal levels you will have to accept that you can only eat those foods that don't cause spikes.

If you attempt to add in off-plan foods before you are solidly on-plan you may never really get into the swing of eating a diet that controls your blood sugars and you may not get to where your body learns to enjoy the lower carb foods that don't give you blood sugar swings.

But after you've gotten your blood sugar under control, nothing horrible will happen if you make room for a small portion of some high carb treat every now and then.


How to Add Off-Plan Foods to the Plan

If you've avoided bread for a couple months, the humble roll in that restaurant bread basket may start to call out to you with an irresistible siren song. If you give in and eat it, with each bite you may find yourself feeling as if you are doing something incredibly sinful--the way you might have felt if you had eaten a whole box of chocolates in the past.

That feeling is the sign that you're heading for trouble. You've created a "forbidden fruit" and sooner or later that forbidden fruit is going to get you. You may find yourself thinking about that roll, craving another, sneaking off to eat one where nobody knows you, or, alternatively, you may declare that you will never again eat a roll ever--and then ruin your Thanksgiving holiday when you go to Aunt Glenda's and refuse to eat even a single one of those wonderful rolls of hers you've eaten every year of your life which say, "This is the family Thanksgiving" to you.

It is far better to make a bit of room in your diet for high carb treats so that they don't build up a charge. If you do this, you'll find that they almost never taste as good as you remembered, and you'll be able to leave them behind without turning them into an object of obsession.

Just knowing that you can eat some specific off-plan food at some future time, when it is scheduled, makes it that much easier to say, "No thanks" to it, and maintain your healthy blood sugar the rest of the time.


How Often Can You Eat Off-Plan?
How often you have an off-plan food depends a lot on your dietary goals, how high your blood sugar is before you eat carbs, and whether you are willing to exercise after eating. It also depends greatly on what medications you are taking for your diabetes. Whatever I eat, I try to keep my blood sugar below 120 mg/dl (6.7 mmol/l) at 2 hours after any meal.

Forty minutes of cardiovascular exercise will burn off a lot of extra carbs, so if you exercise regularly, try to eat your high carb treat before you head for the gym.

If you're trying to lose weight, you may have to keep off plan treats few and far between. When I was actively losing weight on a low carb diet without medications I ate one off-plan meal about once every two weeks.

Once I reached my weight loss goal I loosened up a bit but I found it best to cycle between weeks of eating a strict very low carb diet, and then a week of eating slightly more carbs--but I tried very hard not to ever anything that would cause my blood sugar to be over 120 mg/dl (6.7 mmol/L) at 2 hours after a meal because doing so makes me feel rotten.


Throw Away the Vocabulary of Self-Destructive Dieting

When you eat something with carbs in it, don't think of it as a "cheat." Cheating is what you do when faced with an authority figure--your 9th grade math teacher or the IRS. But you are the one in control of what you eat. So when you eat something that is off-plan, you should stop thinking of it as "getting away with something" and treat it instead as something you've decided to do--for a reason that should be clear to you while you do it.

If you keep eating things that were not what you had intended, rather than beating yourself up, it's time to reconsider your food plan and figure out why it isn't working. Are you having trouble finding foods in restaurants that don't raise your blood sugar? Maybe it's time to bring your lunch along to work for a while, or to find new place to dine.

Are you bored with what you have been eating? Google for good low carb recipes you can try at home. There are thousands of them. If you use the Google Groups search and look for messages in alt.support.diet.low-carb that start with "REC" you'll find a treasure trove of ideas to try.

Keep the vocabulary of sin and guilt for the confessional. You're going to eat a lot of things in the years to come that will mess up your blood sugar. But if you are kind to yourself and dust yourself off after you mess up and keep on going, doing the best you can to hit your blood sugar targets, you may very well end up healthier than many people who do not have diabetes. The important thing is to keep at it, doing the best you can and forgiving yourself when the best you can do isn't as good as you wish it was.


Know Your Limits
I've learned the hard way I can't eat half a blueberry muffin, so I don't even try portion control for that particular food. I know blueberry muffins are trouble and I also know that I will eventually eat one. That's just how it is, so every blue moon or so I eat a blueberry muffin, experience the miserable high blood sugars that follow, and then remember why I don't eat muffins every day any more. What I don't do is fool myself that I can buy a muffin and only eat half. Everyone has a few foods that fall into this category. Treat them with caution!


Eat Off-Plan Foods Out of the House
I've learned the hard way that if a big box of something full of carbs is in the fridge, bad things are going to happen. So I try to eat my off-plan foods away from home. I eat my muffins or cookies at a coffee house. I have a slice of pizza at a pizzeria. I don't buy a box of muffins or a whole pizza and bring them home.

Getting this strategy to work requires that your whole family understand what's at stake. It took me a couple years of harping on what "complications" means, but by now, my family understands that if my blood sugar is too high, I'm damaging my body. They want to keep me around for a while, so they understand that there are some foods that shouldn't be brought into the house--ever.

When other family members want to have treats at home, they are kind enough to buy things I don't like. For example, if someone wants Ben & Jerry's they buy the Chunky Monkey flavor that I find revolting, not the New York Fudge. By the same token, when my kids lived at home, I didn't buy them the brands of cookies I can't resist. There are plenty of others cookies they liked that don't tempt me at all, and those were the ones in the cupboard.

Over the years the nondiabetic members of my family learned that no one is doing themselves a favor scarfing down 300 grams of fast acting carbohydrate every day--particularly not people with a family history of diabetes and heart disease!


Medications Can Help

I'm not a big fan of medications because I've learned the hard way that drug companies lie about side effects and some of these side effects are permanent and can ruin your life. But I learned the hard way, too, that some of us (like, say me) can't get normal blood sugars no matter how low our carb intake. For us, adding a diabetic drug or two to our daily regimen may be the only way we can get normal blood sugars without a life of tormenting self-denial.

Drugs I have found useful over the years include metformin, precose, and post-meal insulin shots. The new incretin drugs, Januvia and Byetta help some people make dramatic improvements in their blood sugar, but the way that they work makes it necessary to eat a slightly higher amount of carbohydrates with them because they only work when your blood sugar rises over a certain threshold. Even with these drugs (including Januvia) I've never been able to eat more than 120 grams of carbohydrates a day, but after many years of eating an extremely low carb diet--which was the only diet that would control my blood sugars--120 grams of carbs a day feels like a completely normal diet!


Be Aware of Rising Insulin Resistance

Some people may find that eating a low carb diet is not enough to control their blood sugar because they are very insulin resistant. Perhaps they have been diagnosed with PCOS, or have to take a drug, like Prednisone that increases insulin resistance. The book, Dr. Bernstein's Diabetes Solution by Dr. Richard K. Bernstein, the distinguished diabetes doctor, recommends Metformin as an appropriate drug for patients on a low carb diet whose blood sugars are still not completely controlled. It isn't a cure by any means, just one more tool you can use to keep blood sugars under control, and if you limit your insulin resistance you may solve both weight and hunger problems that otherwise can derail your diet.

You can read more about the different drugs available to help control blood sugars HERE. Just remember that all these diabetes drugs work best when you combine them with some level of carbohydrate restriction. How much restriction? Test your meals one and two hours after eating, and your blood sugar meter will tell you exactly how much.


Top Medical Journal Publishes Landmark Study Showing Very Low Carb Diet Most Effective and Safest for Lipids etc.

In case you are still being given out-of-date medical or nutritional advice by people who tell you that a low carb/high fat diet will give you a heart attack, take a look at this recently published study, which appeared in the Journal of the American Medical Association.

This study found that an Atkins style low carb diet not only caused double the weight loss of the low fat diet at the end of one year, but it did not adversely affect cholesterol levels.

This finding, added to the Women's Health Initiative finding (after $40 million dollars of research) that low fat dieting does NOT prevent heart disease, should lay to rest any last fears you might have about the impact of cutting carbs on your health.

The findings of this study, are not news to anyone who has tried a low carb diet and stuck with it for any period of time, but they appear to amaze the entire medical community who continue to cling to their to the "Fat is Bad" religious belief long no matter what evidenced-based medical studies might come up with.

Bottom line: You can cut your carbs way down, replace carbs with fat, and await the better health this kind of eating will provide.

Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study: A Randomized Trial.Christopher D. Gardner, PhD; Alexandre Kiazand, MD; Sofiya Alhassan, PhD; Soowon Kim, PhD; Randall S. Stafford, MD, PhD; Raymond R. Balise, PhD; Helena C. Kraemer, PhD; Abby C. King, PhD


Here's the summary of the WHI findings:

NIH News: News from the Women?s Health Initiative: Reducing Total Fat Intake May Have Small Effect on Risk of Breast Cancer, No Effect on Risk of Colorectal Cancer, Heart Disease, or Stroke


Here's a study that documents the effectiveness of lowering carbs and increasing fat and protein consumption for the control of blood sugar in the absense of weight loss:

Control of blood glucose in type 2 diabetes without weight loss by modification of diet composition. Nutrition & Metabolism 2006, 3:16.


To Get More Help with Making a Low Carbohydrate Diet Work

My "Low Carb Facts and Figures" site, which now shares this server, has more information I collected back in the days when I used a low carb diet for both weight loss and blood sugar control.

You'll find articles there that address a few of the issues people run into while eating a very low carb diet,which are not answered in a completely honest fashion by the people who sell diet books promising you can lose weight easily while gorging on all your favorite foods--which, sadly, is 99% of all authors writing diet books.

Comments (15) -

  • Anonymous

    4/3/2008 12:18:00 AM |

    Thank you for this post. By the way, none of your links work because there's an extra http:// at the front. Same problem in previous posts as well.

  • phishery

    4/3/2008 3:16:00 AM |

    I have tried to centralize as much as I can about using a low carb / low glycemic approach which allows for low insulin diabetes management at http://www.dsolve.com.  The site is free and has scientific research, recipes, as well as a "how to" course by a great doctor in the UK.

  • bob (the traveller)

    4/3/2008 9:59:00 AM |

    Extremely great post! As one who had gone through the low-card path (unguided by an expert but yet successful now into the 6th month) I can identify with a lot of the things mentioned here. I did not have the luxury of a mentor or a guide and so discovered a lot about sugar, carbohydrate and the body hands on and through research. But through it all, I'm glad that I now have a diploma in nutrition!

  • Peter

    4/3/2008 12:10:00 PM |

    I use the strips to test my blood glucose, but I don't know how high is too high.

  • Anonymous

    4/3/2008 12:21:00 PM |

    What an outstanding website.  Jenny could be writing the books.  She certainly has spent years researching this, and her approach makes sense.  It's mind boggling to me that the ADA (American Diabetes Association) hasn't figured it out--that high carbs do not work.  No wonder health care is so expensive in the US. Jenny's website gives anyone the tools to understand the sugar issues and take control themselves.  Thank you for posting this.

  • Anne

    4/3/2008 6:04:00 PM |

    Zevia is a new, natural alternative to diet soda.  All the flavors are carbohydrate and sugar free!  There are no artificial sweeteners, flavors, or colors.  Zevia satisfies my soda craving and allows me to avoid compromising my health with sugar and or artificial sweeteners such as Splenda.  Stevia an ingredient in Zevia, is a herb native to central and South America  and 200-300 times sweeter than sugar.  Zevia is an excellent product for people diagnosed diabetes.

  • Anonymous

    4/4/2008 1:21:00 AM |

    I bought one of the newer glucose meters.  The insert listed the readings that are still within normal on their meter, but they are higher then those listed as "normal."  I don't know why there's a difference but the meter normal ranges are higher.

  • Anonymous

    4/5/2008 1:29:00 AM |

    My story is ditto to yours Jenny. I started with Atkins, upset all my docs and was scolded even though got off insulin and statins. No support except atkinsdietbulletinboard.com but I was one of the leaders there on diabetes so didn't really have a mentor.

    I was a reborn again lo carber and was rigid for 3 yr and have fallen a few times, but like you have found a way to try stay within the norms and eat to my meter.

    As I age I need to eat less and work harder.
    Peter the norms I aim for are under  6.1 . However, that is not always attainable.

    Thnx Jenny for taking the time to write.Too bad nutritionists, diabetologists ect weren't as educated as us patients.


    chick

  • Jenny

    4/6/2008 2:39:00 PM |

    Thanks for the kind words! And thanks to everyone who visited the site from this blog. Obviously there are a lot of people reading here!

    The "normal" range that came with your meter is probably the one defined by the American Association of Clinical Endocrinologists. They currently recommend that people with diabetes get under 140 mg/dl (7.7 mmol/L) at 2 hours.

    This, however, is FAR from normal if we use CGMS studies of normal people's post meal response to define normal.

    This is discussed in detail on my web site on THIS PAGE.

  • Red Sphynx

    4/9/2008 5:07:00 AM |

    Jenny is wonderful.  I'm thinner and healthier today because of the excellent advice at alt.support.diabetes; starting more than five years ago.  And Jenny was always one of the best.

    Adam Becker Sr.
    5 years in the 5% club, thanks to Jenny, Jennifer, Quentin, several Alans, Jefferson and more.

  • jpatti

    4/28/2008 9:19:00 PM |

    I agree with sphynx, I'm a big Jenny fan also!

  • Anonymous

    6/5/2008 6:21:00 PM |

    re: exercising to burn off carbs

    i understand the point about burning calories and utilizing blood glucose and glycogen stores and such... but i've always understood from sports nutrition research that most of us should eat carb-rich foods after exercise.  i thought that carbs before exercise is generally just to keep you going through the workout...

  • cymoore

    7/1/2008 8:54:00 AM |

    Thanks for the detailed and thoughtful post.  In response to anonymous, I don't believe that carbs are ever really "necessary", and in any case, it's hard to avoid them entirely.  I've been low carbing for 6 months now (lost ~18 lbs) and run/hike a lot.  Even after a 16 mile trailrun covering a couple thousand feet elevation, my blood sugar was 94 (without eating any carbs during the exercise).  I guess the body is just very good at supplying glucose even if you don't eat carbs (gluconeogenesis from pyruvate). Supplementation with branched chain amino acids might be helpful since these are broken down during endurance exercise and need to be replaced, but I see no evidence that carbs are needed.  Still,carbs are better tolerated when people exercise because insulin sensitivity is increased.

  • Healthy Womens

    10/3/2009 3:22:37 AM |

    [...]There are plenty of information and tips about the low carb diet recipes. No matter what sources of information or tips you choose you need to always keep in your mind that the low carb diet recipes should consist of healthy and match with your diet plan[...]

  • buy jeans

    11/3/2010 6:41:54 PM |

    Unlike much of what you've read before, there are no scholarly references for this section. It's based entirely on my own observations and the experience of many dozens of people who have participated in online discussion groups devoted to low carb dieting and diabetes.

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A niacin primer

A niacin primer

A reader of Life Extension reminded me of a piece I wrote about niacin a couple of years back.

Anyone desiring a primer on how and why to use niacin to correct lipid and lipoprotein patterns might find this useful.

While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.


Q: I recently had a cholesterol profile blood test and learned that I may be at risk of heart disease because my levels of beneficial HDL (high-density lipoprotein) are too low. I read that niacin could help increase my HDL, but my doctor said niacin is dangerous. Whom should I believe?

A: Your doctor would be right—if we were still living in 1985. Since then, however, we have learned how to use niacin (vitamin B3) safely and effectively. Unfortunately, many physicians have not yet caught up, or are still trapped by the idea that cholesterol-lowering statin drugs are the only way to decrease cardiovascular disease risk. I have personally prescribed niacin for thousands of patients as part of our program to reverse coronary disease. In fact, niacin is the closest thing we have available to a perfect treatment that corrects most of the causes of coronary heart disease.

Continued here.

Comments (19) -

  • Ganesh Kumar

    7/29/2009 7:20:35 PM |

    Do you therefore prescribe Niaspan since its considered to be the gold standard of niacin? If so, I urge you to look up user views on side effects at http://www.askapatient.com/viewrating.asp?drug=20381.  This was key reason why I chose NOT to take Niaspan and got the HDL, triglycerides level just with Vitamin D and Omega 3s

  • Kiwi

    7/30/2009 11:17:42 AM |

    Ganesh:
    Reading through some of the comments it seems to me people are starting on too higher dose.
    I've been on niacin for almost a year and started with just 50mg/day. Yes, half a tablet.
    Slowly worked up to 500mg standard niacin then switched to SloNiacin and increased to 750mg.
    I take 75mg aspirin at the same time.
    Any slight tingling I get I know the stuff is working and it makes me feel good.

    Only problem, SloNiacin is only available from the US, so I have to import it myself. I'm pretty sure it's not legal to do this as amounts over 100mg are considered a drug in this country (NZ).
    I've just had some vitamin D confiscated by Customs for the same reason. Capsules over 1000iu available only on prescription. Tough.

  • Anonymous

    7/30/2009 1:12:55 PM |

    The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

  • trinkwasser

    7/30/2009 3:49:25 PM |

    I wish it had worked. Frown

    Maybe because it was inositol hexaniacinate, 1000mg niacin "equivalent"

    I had gotten my HDL up from 25 to 55 primarily through low carbing and adding more saturated fat, but that was with simvastatin 10mg

    As an experiment I dropped the statin and added the niacin and also pantethine (NOT pantothenic acid) 600mg.

    Previous results:
    HDL 55 trigs 62 LDL 94
    which is close enough for jazz to your 60-60-60

    Latest results
    HDL 47 trigs 115 LDL 156

    I have now restatinated myself. Either my funky familial genes or the damage from the years of undiagnosed diabetes have caught up with me. Still it was an interesting experiment in showing that the statin actually does have a benefit over and above the diet.

    It would be interesting to see what effect the statin *plus* the niacin and pantethine has but I suspect it will be several years before I am permitted another lipid panel. They prefer saving money to saving lives here.

  • billye

    7/30/2009 8:03:22 PM |

    Is supplementing with niacin the only way to raise HDL and lower LDL without taking Staten's?  Some other doctors are recommending a magnesium supplementation using a topical magnesium oil which can raise the magnesium levels to the top of the reference scale in as little as six weeks.  I quote Dr. Mildred S. Selig MD "most modern heart disease is caused by magnesium deficiency as reported in an article by Chris Jennings "what's all the buzz
    about magnesium oil?".  

    Magnesium in our food and water is drastically lower than it was 100 years ago.  I also understand that heart disease was practically non existent 100 years ago.  If true, what a coincidenc. Hmmm!  

    As you know I respect and honor your medical opinion, so, what say you?

  • billye

    7/30/2009 8:12:16 PM |

    I forgot to mention that I also supplement with high dose vitamin D3 and high dose fish oil.  My triglycerides level is now 66 mg/dl down from 115 mg/dl.  However, there has been no movement in my HDL and LDL level so far. I am waiting for a VAP test to come back.  Bottom line, I would not like to supplement with niacin.  Who wants the discomfort of flushes or itching.  I hope that magnesium supplementation works.

  • George

    7/30/2009 9:48:55 PM |

    Dr. Davis, always appreciate the great information on your blog. I have been taking 500mg of Slo-Niacin for a year with good results. Recently in a Prevention magazine I saw a quote by Dr. Angaston stating that you should only take niacin with a statin, that niacin by itself doesn't do anything. Your thoughts?

  • Dr. William Davis

    7/31/2009 12:42:29 AM |

    The form of niacin I use in 95% of cases is Upsher Smith's Sloniacin. It has a proven and published track record and is 1/20th the cost of prescription Niaspan.

  • Dr. William Davis

    7/31/2009 12:43:14 AM |

    Niacin works great by itself. There is absolutely no need for taking it with a statin.

    I can't imagine why Dr. Agatston would say such a thing. I wonder if it's a misquote.

  • Anonymous

    7/31/2009 12:57:28 PM |

    I recall reading that slow release niacin was the more hepatotoxic form of niacin, and that plain ol' niacin was best... is "sloniacin" the same thing as "slow release niacin?"

  • Dr. William Davis

    7/31/2009 2:49:59 PM |

    Niacin has confusing terminology.

    Sloniacin is closest in properties to "extended-release" niacin rather than "slow-relase," meaning niacin is trickled out over a briefer period with extended release, a property associated with reduced hepatic toxicity.

  • Anonymous

    8/1/2009 1:33:15 PM |

    Baylor college has a great resource if you want more medical study info.  The HATS study showed the staggering impact of Niacin/Statin combo but I don't think this should encourage statin use. If anything it points to a reduction in dose for those who must take statins ( http://www.lipidsonline.org/slides/slide01.cfm?q=niacin&dpg=9 )

    I take 2grms (Now brand)at night before I go to bed.  Sure occasionally I get a flush but the benefits far outweigh the occasional discomfort:-

    "In the group receiving niacin plus simvastatin without antioxidants, LDL-C levels were lowered by 42%; the LDL-C levels in the placebo groups were unaltered. HDL-C was increased by 26% in the niacin plus simvastatin group. The combination of niacin and simvastatin reduced CHD events by 60–90%, with about a 90% reduction seen in those subjects who did not take antioxidants, possibly because the treatment-induced increase in HDL particle size was blunted by antioxidants."

    Trevor

  • Anonymous

    8/7/2009 4:10:03 AM |

    The primer states that niacin blocks the release of fatty acids. So if I am trying to loose fat would taking niacin be counter productive to on trying to burn fat stores to lose weight?

  • cbatterman

    9/25/2009 5:09:59 PM |

    I read a 2002 paper by John A. Pieper in VOL. 8, NO. 12, SUP. THE AMERICAN JOURNAL OF MANAGED CARE that said Slo-niacin was hepatoxic where as IR Niacin was not...Are there more recent studies that support your use of slo-niacin over IR niacin?

  • Diane

    10/7/2009 5:13:56 PM |

    I have been battling slowly rising cholesterol since going through menopause, despite a great diet, ideal weight, and an active lifestyle. I resisted any suggestion of taking statins, especially after the February 2008 WSJ article and the NYTimes Well blog post "Do Statins Make You Stupid?"

    Luckily, I have a very conservative doctor, who is not so quick to prescribe statins. First she recommended fish oil capsules, (which raised HDL but also raised LDL). After that, I tried garlic (which I had to stop after my partner commented on the smell of my skin), plant sterols, (which didn't appear to have much effect), and finally niacin.

    In July I asked my doctor for instructions on using niacin. She recommended Slo-Niacin, starting with 500 mg once a day and increasing to 500 mg twice a day.

    I went back for my three-month visit this morning. My cholesterol has dropped from 220 to 175; HDL still high at 53, LDL down to 102 from 142, triglycerides down to 85 from 160.

    I usually avoid flushing by taking it immediately after a meal and drinking lots of water with the pill. If I eat too late in the evening and go right to bed, the flushing effect is worse - you have to move around for a while.

    I am very pleased and hope that this anecdotal evidence will encourage others.

  • steve

    10/23/2009 9:02:11 PM |

    Steve,
    I used  550 mg Niaspan for 3 months, It made no change in my Lipid Panel. Then I used 750 mg Slow-Niasin for 3 months . My Cholesterol fell from 182 to 174 . LDL dropped from 130 to 118. Triglycerides rose from 82 to 96, HDL went up 1 point from 35 to 36. Not happy with the results .
    I am mow trying 1,000 IU of D-3 and 2,400 mg of Fish oil Supplement along with 1 heaping TBS  each of oat bran and  pure cocoa in my oatmeal every morning along with 1/4 cup of walnuts. Will get checked again in April.
    I will post my results.

  • mongander

    11/16/2009 2:26:34 PM |

    "A small 208-person trial that used ultrasound to examine arteries found that Zetia was clearly inferior to a version of the old drug niacin in preventing clogged arteries. Moreover, in a surprise finding, patients on niacin appeared to have fewer heart attacks and were less likely to die from heart disease than those who got Zetia. It is unusual for such a small trial to show a difference in heart attack rates."
    http://www.forbes.com/2009/11/15/zetia-merck-vytorin-business-health-care-pharmaceuticals.html?partner=alerts

  • Lynn

    3/28/2010 1:26:20 PM |

    I would like to also follow up on the comment about niacin blocking the release of fatty acids.
    I have read elsewhere that nicotinic acid inhibits lipolyis.
    I cannot seem to determine how the recommended dosage (750 mg of SLO Niacin) might set me back in my current efforts to shed body fat?

    Any further reading available on this issue anywhere? Thanks

  • buy jeans

    11/2/2010 7:34:16 PM |

    While some people, no matter what they do, cannot tolerate niacin (about 10% of people), many others enjoy spectacular benefits.

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