Trying out lower carb living
At the recent diabetes care summit, I was fortunate to share a ride from the airport with a great diabetes blogger, David Mendosa.David has type 2 diabetes. and one of the things we talked about was low carb diets and the benefits of using them. I know I'm not alone in this, but I have a terrible time controlling my cravings for carbohydrates. David told me that it had taken him about 2 weeks to get over the desire for carbs. And he can talk about the benefits, including better blood sugar control and weight loss.
Despite my Dexcom and insulin pump, I still have too many days where the curves look like the ocean on a stormy day. This week I decided to experiment a little with changing what and how I eat. For the last 3 days I've been avoiding excess carbs and eating more vegetables, protein and fiber.
And the results? See for yourself.
The green area represents readings between 80 mg/dL and 140 mg/dL. And I'm spending a lot of time in that range.What have I learned so far?
First of all I can live with fewer carbs and it makes a huge difference to my blood glucose control. And with some thinking I can still exercise and maintain a semblance of control. Part of those 2 days included two 14-mile bike rides and my levels were reasonable for most of those.
I also know that 3 days does not make for a really changed relationship with food. Tomorrow I'm going to borrow Dr. Bernstein's book Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars. And I'm going to checkout whether I can take some of his approach and use it for my life with type 1.
Have you tried a lower-carb diet? What challenges did you have and did you figure out a way to deal with them? I'd love any help you can offer.
Update 10/26: I just got my A1C and the number was (drum roll) 6.8%. This is a great number, but not really as good as I was hoping and expecting. Mostly I've managed to stay away from snacking and over doing the carbs. Some days are better than others. The biggest problem I've found? Getting a good set of low carb recipes to replace all the old recipes I already have.
Labels: bernstein, blood sugar, carbs, control, lowcarb
posted by Bernard @ 10:29 PM
15 Comments:
I went very low-carb during my pregnancy (I'm type 1), and also typically carbs are very hard for me to avoid, it's true that once you get past the first few days, the cravings are much easier to handle. My blood sugars were better and I felt better all around. (Well, once I got over the first few days, as I mention.)
I was diagnosed with Type 2 in January with an A1C at 11.7 (it's now 6.1 with meds and I'm trying to get into the high-5s).
From one day to the next, I gave up potatoes, pasta, pizza, bread, and all starches. And desserts. I do have sugar-free, fat-free pudding (that I mix up, not the pre-packaged kind) and jello with whipped cream for desserts. Occasionally I have sugar-free cookies on hand all the time so I'll have one of those (about 4 carbs) occasionally. But my primary treat is Breyer's low-sugar (5 net carbs) ice cream bars. That is my nightime snack EVERY night. I should own stock in that company. It's interesting that my glucose levels remain steady after I've had one of those. So for six months, that's been my snack an hour or so before bedtime. That satisfies my sweet tooth and it's easy to pass by desserts when I know I can have that later.
I tested morning, before and after meals (one hour AND two hours) and at bedtime for several months. I wrote down everything I ate and compared with meter readings to see what else I had to give up. Fruit was next on the list. There are only three fruits I can eat without shooting up my glucose levels.
Bottom line: I gave up carbs cold turkey and never missed them. And I don't cheat either. I've made a list of the foods that I can eat, that I like. At first it was really short and my meals got boring after a few weeks. Then I started experimenting with new types of meats and veggies and did lots of online reading to find more foods that were low- or no-carb.
Now I have enough meals for 5xweek for about 4 weeks. I have leftovers for lunch. It was difficult giving up sandwiches and subs because they're so convenient. But I've found work-arounds for that.
It was not difficult for me because I watched my glucose readings carefully and am just determined to do whatever it takes to get a normal non-diabetic A1C. I am only 54 and I figure if I'm lucky I have a lot of years left and I don't want any complications that result from DB. The only way to do that, is to do whatever it takes to maintain normal glucose levels.
I only test about once a day now (different times of day) as my routine. However anytime I eat something new or different, I always test one-hour and two-hours after to see how it affects my glucose levels. Depending on the results, I put that food either on my "ok" list or my "no-no" list. And that's where it stays.
Good luck. It's not easy. The hardest thing is that different foods affect people different ways. You might be able to eat strawberries but I can't. I might be able to eat apples but you can't. The only way to tell is to test one-hour and two-hours after eating a particular food. Some people can eat a half a baked potato but if I eat more than 4 tiny bites, my glucose will soar. It's all trial and error.
My wife just asked me if I would like a fresh, hot biscuit she had just taken out of the oven. My answer, "No thank you." In reality, who was I saying "No" to? Yeah, me. In my effort to lower my carb intake, it always comes down to either giving myself permission to eat carbs or not. In the last few years, I have attempted on various occasions to limit carbs from my diet. My current effort is approaching the 9 month mark. Is it a daily struggle? A bit. But as others have said, once you get past the initial period, it gets a lot easier. Having said that, it's still a meal by meal choice. Diabetes effects us all differently, and our approach to dealing with it must be our own as well. Having said that, for me, attempting to limit carbs is a choice I have made. And for me, it is working.
Do I eat carbs? Yes, of course. Do I have meals where I decide to go ahead and have carbs I would normally avoid? Yes, of course. But that has become pretty rare.
What is a normal meal? As much as possible, it's just what you would think. Green vegetables (lots and lots of them), an appropriate size portion of meat or chicken (mostly chicken, but not with every meal, sometimes it's just veggies) Salads as often as I can (it's a large salad believe me). Sometimes, I'll make homemade vegetable soup, to which I'll add a bit of beef or chicken. And I can eat a ton of it, get really full, and still know that I've limited the carbs. I limit the starchy vegetables, but will occasionally treat myself to a little potato or a small amount of corn in the soup. How often? Maybe 1 out of every 10 times.
Added butter? No. Not usually. Added salt? No. Not usually. Do I miss it? No. Not usually. When I do, guess what? I have some. It's just not that often any more.
For lunch I will have a sandwich. That usually means 2 slices of bread, ham, lettuce and sprouts, etc, and uh, 1 small slice of cheese. Cheese? Yep. But instead of the 2 or 3 slices I used to put on it, it's now 1. And I really don't miss the extra fat. What do I eat with it? Used to be some chips. And occasionally, sure I'll have a few. Meaning a few = 5. Most of the time now, to get my crunchy fix, I'll eat pickles and pepperocini peppers with the sandwich (which itself already contains crunchy lettuce and sprout, you get the idea). Lately, I've taken to also eating some small baby carrots or a little celery to get some crunches'. Could I go without a sandwich, or just eat everything minus the bread? Sure. It's a choice. Could I cut out carbs almost completely? I suppose. It's a choice.
And for me, that's what it all boils down to. Making a day by day, meal by meal choice.
I have also been working out 3-5 times a week, doing cardio (spin), weights, and crunches, etc.
In the last 9 months, I've lost 45 pounds, my energy level is way up, and most of all, my bg levels are much more stable, and do tend to stay in a range which for me i am very happy with. Are they perfect? Not a chance. Do I have high's and lows? Sure. We are all different, but this seems to be what is working for me. More often than not, I limit the carbs.
Last night? Well, it was my birthday. And I went to a movie, ordered the largest tub of popcorn they had, told them to add all the butter they wanted to, and ate the entire thing. All of it. Every bit. Without 1 single regret. Oh yea, you should have seen the smile on my face. :-) Today, it 's back to doing what i normally do.
Not sure what "low carb" means but I never eat more than 60g of carb for any meal and no more than 150g in a day. Most of my meals are 40g of carb. What does that do for me?
I know that my carb addiction is the source of many of my diabetes management woes. But I've had such a hard time trying to limit them.
I personally loved Dr. Bernstien's book, and learned a great deal from it. I'm sure you will too. Can't wait to hear your thoughts on it. The diet is extremely strict, but for many people it really works wonders.
Maybe someday I'll push myself through whatever barriers I have and limit my carbs more.
I've read the book. It's interesting. I think he has a point. I just don't think I could have the will power to do it.
the book is a good and informative read regardless of whether you decide to manage your diabetes as bernstein advocates.
I actually went to the hospital last week to talk to my dietician about lowering my carb intake. I was on the DAFNE course (http://www.dafne.uk.com/) last year and since then have been counting carbs and adjusting bolus doses for it.
If my before lunch blood glucose is fine, I can eat whatever I like and (providing my carb estimate is correct) my BG will be fine again before dinner. However, the more carb you eat, the higher the BG spike between lunch and dinner is going to be, and my A1C will creep up along with it.
I'm now trying to not have more than 40-50g of carb per meal, totalling at 150g or so per day. I've tried carb-free meals and while my BG will be flat and steady, I end up being absolutely starving! Hence I'm not going to cut them out altogether.
A sandwich is fine at around 40g. I'll snack on carb free things like veg with a dip or cooked and chopped chicken if I get a bit peckish. I'll have a carb-free meal like a salad, so I can indulge in a carb-tastic pudding.
I don't have a CGM (I really want one but they're not covered on the NHS and cost an absolute fortune over here in England) and don't test at any other time than waking, before meals and before bed unless I feel hypo, sick, or just really want to.
Also, reducing carb intake reduces the margin for error when estimating the carb content of a meal and therefore the bolus dose required to counter it. Less carb means less chance of hypoing after a meal.
George.
Thanks for you comments on David Mendosa.
I am working on becoming low carb, but it is difficult. I have read The New Glucose Revolution by Jenny
Brand-Miller et al and this is also helping by working with glycemic index and glycemic load.
Good Luck.
Bob
I read his book several years ago, and found that his description of his Type 1 compared very similarly to mine (high resistance, consistent normal-ish weight, etc). So naturally I gave it a try.
I found it helped, alot, but I fell off the wagon. Working back to it now, it did get my HbA1c down from around 9 to under 6 the last time.
As others say, it takes 1-2 weeks (took me about 2 weeks) for the cravings to stop, particularly bread and morning foods, but once you get past that, it's a no-brainer.
He advocates a higher fat diet - I'd warn that you want to be careful. I personally believe he's right - drop the A1C and the lipids will follow, but I suspect there's different types of Type 1's, and while that worked for me, it mightn't for others.
Still, his story is amazing (the "if no-one will believe me as a civilian, I'll just become a doctor" stuff is pretty inspiring) and I wish I lived on the east coast :). I wish my endo was a Type 1 (never have found one)...
A while back, I contemplated switching to a vegetarian diet, but didn't take it very far.
More recently, I've been training for a 100 mile bike ride for JDRF (thanks for your donation!) and have lost some weight in the process.
This Time article has been getting quite a bit of press recently, and I can actually FEEL my body trying to compensate for the weight loss I've recently experienced. I am constantly hungry.
And I just couldn't imagine doing any rigorous exercise without consuming massive amounts of calories from carbohydrates. Most sources suggest trying to consume 300 calories for every hour of intense exercise -- mostly from carbohydrates.
It's hard to balance in my head the relative costs/benefits of intensive exercising and eating lots of carbs vs. lower intensity exercise and reduced carb intake, but it's an interesting question.
Good luck with your experiment!
I've done low carb for more than 10 years, on and off... if I can. I can't always for a myriad of reasons. I do still have the occasional teat, and I do have a piece of fruit about once a week, but on lower carb, I definitely do a whole lot better. My A1C is normal. I can't do as low as Dr Bernstein suggests (can for breakfast & lunch but no way for dinner), but average carbs is between 60 and 120 a day. That's still much lower than recommended.
If you can do it, your diabetes will thank you!
I'm fighting my carb desire with Acupuncture, and it seems to be working fine. I'm Type 1 too and I have a quite natural diet and controled glicemic levels (6.8 A1C), but i am (or was, i don't know yet) addicted to chocolate. I recommend everyone to get acupuncture sessions.
I love Dr. Bernstein's book. I tried his method of going very low carb and got my A1c from 6 to 4.6-normal non-diabetic range! It takes discipline but, doesn't EVERYTHING worth doing??? Good luck!
Emma, I'm with you. Carbs are hard to avoid. Even though I've been doing this for a while now, I'm still tempted and break down. But many days I'm managing to stay around 30g carbs or less per meal.
Sherlock, what an amazing A1C. I know this is easier with type 2, but it's still never a walk in the park. I wish I was able to give up carbs like that. One challenge is a lack of usable recipes, but I'm working on that.
tMac, losing 45 pounds is awesome. It sounds like you're doing wonderfully, good for you.
Khurt it sounds like you're heading in the right direction low carb wise. Dr. Bernstein would advocate a lot lower. If I can have a good meal and get by with 20g of carb I reckon that's a success.
George, sorry you don't have a CGM. I know the NHS will eventually learn the benefits and savings of CGM, I hope it's not too long a wait for you.
Everyone, thanks for all the support and suggestions. I love the DOC (Diabetes Online Community), because I know that's how we're all getting along, with help from each other.
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