I've lost 16 pounds so far following my wife's diet for diabetics.

[Tobin S.]

It's one of the simplest diets I've ever run across, making it easy to follow. The important part for diabetics is tom limit carb intake. You can also watch your calories for weight loss.

Basically, I get 180 carbs a day spread evenly throughout the day as a moderately active man. I shoot for around 1800 calories a day. It doesn't work extremely fast, but it is a steady and healthy way to lose weight. I also understand the importance of not skipping meals now or waiting too long between meals. I feel really crappy when I wait too long to get some carbs in me.

I should add, my wife didn't create the diet. We learned about it at a class at our local hospital. It is necessary for her to follow it. It's optional for me, but I'm becoming much more healthy.

[mnhtnbb]

1. That's terrific, Tobin!

There are a lot of benefits to eating in a more healthy way! Don't be surprised if you
also find yourself with more energy!

[Helen Borg]

2. "watch your calories for weight loss"

That is what makes you lose weight, actually. Not the carb/non carb distinction. If you stay within 1600 Kcal per day, you will lose weight, carb or no carb.

[politicat]

13. Um... Not in our experience.

My partner and I have been fighting for years to keep him from going into Type II. (He's at the insulin resistance/metabolic syndrome stage.) when he first got his DX, the nutritionist we were referred to built him a low fat, mostly vegetarian diet because that was the conventional wisdom -- Type II is the result of too much fat and meat and not enough whole grains and legumes. For three years, we followed it rigorously -- whole grains and legumes, metric tons of vegetables and kept his daily calories at around 1800 for 6'3" and 240. He gained weight on that diet (despite his BMR being about 2400) and was consistently miserable -- tired, always hungry and cranky, and his gout got worse.

Last year, I asked for a new referral because his blood work was not improving, he was deteriorating emotionally, and his gout was getting worse. The low fat, calorie restriction seemed to be making him worse, not better. The new nutritionist looked at my data, agreed with my findings and gave us a 180 reversal -- essentially Paleo/Primal, very low carb and higher fat. She also increased his caloric intake to 2400 for the first 6 weeks to get his metabolism back on track.

He lost 10 pounds in the first six weeks, and his bloodwork improved significantly. His mood lightened. He's not always hungry (and since the satiety-ghrelin mechanism is such an important part of treating metabolic syndrome, it really does need more investigation) and the gout is gone. He's consistently lost about 1 pound a week since then. Bloodwork is now perfect. In another 6 months, his insulin resistance dx goes away.

Since I eat this diet too because cooking two meals is not fun, I've ended up losing 30 pounds so far, and I don't seem to have hit a plateau yet. I think I am also eating more calories, though I really don't track that part for myself. (ETA: I was at the low end of overweight, mostly due to muscle mass and the gifts of the Boob Fairy. I'm now in the mid range of normal.)

I don't think low calorie is always the answer, especially when considering basal metabolic rate. Low calories cause stress, which raises cortisol, and insulin resistance means that eating does not trigger sufficient ghrelin release to signal satiety. Chronic hunger causes even more cortisol to be released (because historically, chronic hunger meant famine), which pushes the blood sugar to fat storage feedback loop, which is essentially "starvation mode". Which reduces thyroid production and makes the whole system work even less well.

I am not saying don't monitor. I'm not saying calories don't matter. What I am saying is that calories in, calories out is highly flawed. Human beings are not internal combustion engines. We have complex and non-linear hormonal feedback loops that mean people can and do gain actual fat (3500 calories worth of it) on diets where that should not be physically possible.

[Helen Borg]

14. It's not that complicated

You eat calories, you burn calories. If you eat more than you burn, you gain weight. Everything else is nonsense, in terms of weight gain. If this seems not to be the case it must be due to not counting the calories you are ingesting properly, or perhaps the metabolism changed (and so did the amount of calories burnt in a day). Of course the kind of food you eat to get the calories can make a big difference in terms of health etc. I'm just talking in terms of weight gain/loss. You can eat all your calories has lard or as bread, but if you measure them carefully, your weight gain/loss will be determined by the amount of calories.

[politicat]

17. I don't know where you're getting your information, but not according to current research.

Our first nutritionist shared your opinion; zie went to school in the 80s and took some continuing ed. The current one graduated from zie master's program in 2009 and is working on her doctorate, so zie is on the current edge of the information curve.

If you're not reading the actual peer-reviewed journals of endocrinology, biochemistry, obesity studies, and nutrition, you're probably relying on 30 year old data filtered through journalists who by definition are not scientists. This is complicated and there's a lot of conventional wisdom that doesn't work, or only works temporarily, or only works in a healthy subset of the population, or only under clinical conditions that aren't replicable in the real world, or in (thankfully rare cases) is actively harmful. (Such as a high soy and complex carb vegetarian diet for treating metabolic syndrome. That diet has a better than even chance of causing metabolic syndrome to become Type II.)

Let me give you a basic, simple example. Take a 35 year old woman, two children, office job, good marriage, BMI around 28 (a little overweight, but not obese). Exercises 3-4 times a week, chases after the kids, is responsible for 80% of the housework. In other words, entirely average. If you reduce her TSH (thyroid stimulating hormone, not thyroid itself) by .1%, her maintenance caloric needs drop by 150 calories per day. At the same time, she is likely to need 24 more minutes of sleep per day, will feel cold at a warmer ambient temperature, and will reach her point of fatigue when exercising at 70% maximal heart rate 14 minutes sooner. Her calorie in-calorie out balance is broken. She'll gain weight much more easily because effectively, her TSH deprived body is more efficient. Her core temp is reduced (essentially setting her internal furnace at 55 instead of 65), she's depriving her muscles of needed calories to keep her essential systems running, and likely her gut bacteria are processing things like cellulose (normally indigestible) as a means of acquiring more calories. Take the same woman, lower her TSH levels by 5% and she will gain weight on 800 calories a day. At that level, if untreated, she'll probably die of fatigue within 3 years. This is why we supplement when thyroid hormones get out of balance, though the current defined normal ranges are probably too conservative.

Ghrelin and leptin are specifically more difficult to track. We don't yet exactly know their mechanisms, but we know that people who have had bariatric surgery have altered levels of both hormones versus people who haven't had the surgery. We know that their levels will remain altered for the rest of their lives no matter what their weight, and that people who have lost significant weight will always have ghrelin and leptin profiles that match those of still-obese people, not of their never-obese new peers. We also know that some viruses can permanently alter the proportion of ghrelin and leptin.

It would be nice if it was as simple as calories in, calories out. It's a comforting notion for people who need to see obesity or Type II as a just punishment for eating The Wrong Things (whatever those are -- carbs, sugar, butter, meat, bacon, corn. Pick your poison.) But it is nothing more than a cognitive justification, a superstitious warding off of the current evil. And it contributes to the cruelty that fat people live with every day. It's bad science.

Really, start with the Journal of Endocrinology. It's available through the National Library of Medicine at plumbed.gov. If you don't have the biochemistry background, the abstracts are usually enough to get started.

[lolly]

19. Thanks for taking the time

To write that out.

If only it were as simple as "just watch your calories..."

[Helen Borg]

24. IF Calories IN > Calories consumed THEN you gain weight.

That is a fact. Yes, everybody is aware of the fact that metabolic rates are affected by a ton of factors. So, the basic issue is how to know how many calories you need, not the truth of the basic equation above. There is no cheap, accurate, and easy way to measure your metabolic rate at home, unfortunately.

[IdaBriggs]

22. No. This ignorance is part of the problem

we have with preemie babie nutrition. (Search me for rants about this.)

It is NOT JUST the calories - it is what is IN THEM that counts.

One of the lecture videos from the Project addresses this in detail - living on cookies, cake and ice cream versus spinach, chicken and rice. If all we "needed" was the calories, the Girl Scouts would be restaurant owners, and "Popeye the Sailor" wouldn't be pushing spinach.

Logically, if it is true for growing healthy babies ("not just calories, but what is in them that counts&quot , it is probably true for adults, too.

[Helen Borg]

25. Counts for what?

1 Kcal is 1Kcal, in terms of energy. I'd rather get my proteins and calories from plants than from meat because of health reasons, but energy-wise it makes no difference where they come from. 2000 KCal from plants make you gain weight as much as 2000 KCal from pasta or meat, if you only consume 1500 per day.

[riderinthestorm]

29. Your information is outdated. Even lab animals are getting fatter

I work with animals all day, every day for the past 25 years and am immersed in animal nutrition studies.

For example, an interesting study came out that demonstrably concludes that even lab animals are getting fatter even though they've been on the exact same diet they've been fed for the past 50 years.

http://www.the-scientist.com/?articles.view/articleNo/29373/title/Animals-are-getting-fatter--too/

To investigate, David Allison a statistical geneticist at the University of Alabama, Birmingham, and his colleagues gathered data on body weights of more than 20,000 adult animals from 24 populations of 8 different species from around North America. The authors included only those mammals for which there were two weight measurements in the past 50 years, and whose weight was not deliberately manipulated as part of research or a livestock feeding program.

All 24 populations of animals, which ranged from primates housed in research facilities to feral rats living in the greater Baltimore area, showed significant increases in body weight. Average body weights of captive chimpanzees increased at a rate of 33 percent each decade, and 9 percent per decade in captive marmosets. Laboratory mice got 12 percent fatter every ten years, laboratory rats did by 3 percent; the average body mass of Baltimore's feral rats increased by almost 7 percent each decade. And house pets were no exception, either. The average weight of cats increased by almost 10 percent each decade, while dogs' weights increased by 3 percent every decade. Not only did body weight increase significantly, but so did the chances than an animal would be obese. In 23 out of the 24 populations, animals were more likely to be obese -- defined as weight above the 85th percentile at the initial time-point -- at the second time-point than at the first.

What's more, the increased body weights and increased likelihood of obesity were found even in animals whose diets and physical activity levels were known to be the same throughout the study period. So if dietary changes and energy imbalance weren't responsible for the rise in obesity, said Allison, it may be some environmental factor.

snip

"If we're seeing these trends in other mammals, it shows that there must be another explanation" besides the main culprits of inertia and poor diet, Kuk said. Of course, some animals -- such as research animals -- could be eating more and exercising less just as we are. Allison acknowledged that this is likely possible, but noted that scientists have records of exactly what research animals were fed, and housing conditions haven't changed much in the past 50 years. Environmental toxins and viruses are at the top of Allison's list of potential suspects. Several studies have linked endocrine disruptors such as bisphenol A (BPA) and some tin-containing compounds to increased body mass. Infections by viruses, specifically a type of the common cold-causing adenovirus, have also been linked to significantly increased body mass. "We've got to really open our minds to thinking about some other things," Allison said.

[riderinthestorm]

16. I agree with this. Its not just calories in, calories out.

I have human anecdotes but let me move to the animal world where subjectivity is minimized. I own and operate a 40 horse farm. Most of them are competitive sport horses. About half of them are in consistent training with my husband. Same feed, same hay, same water, same supplements, same amount of turnout, and exercise, and yet I have horses with wildly differing diets to accommodate their needs. A large pony eats three times as much as a thoroughbred, and the pony still can't put on weight. I have one client who owns an Andalusian/Thoroughbred cross - BIG guy on near-starvation rations and who still struggles with being overweight after 6 years with us, who also owns a tiny Arab who consumes the most hay and grain of any other horse in the barn.

If it were simply a matter of calories in, calories out then I could simply calculate their BMI, height and weight, and voila! create a standardized feeding plan.

Yet soooo many other factors matter: their temperament, whether they have ulcers or other pain related issues, their genetics, their past medical history (yes actually that matters - if a horse has had poor management in their past say they weren't properly dewormed, that also takes a toll on their gastro-intestinal system) etc etc.

Feeding animals becomes science. Anyone with multiple cats or dogs will tell you the same. Its not as simple as calories in, calories out.

[politicat]

18. Wow. I would love to have access to your records. You've got something amazing.

You've got an incredible statistical sample there. You're doing something that can't be replicated in humans. I wish I wasn't committed to my current project and was more deeply focused on bio nutritional statistics. (My focus is neuropsych, but it's all bioinformatics.) I would love to use your data to build a statistical model.

Thanks for your comment. Would you mind if I PMed you at some point? I've got some undergrad students in bioinformatics who are starting to consider their senior projects, and horses have the advantage of not being subject to HIPPA.

[riderinthestorm]

21. Of course! I'm outside of Chicago so I'm not sure how close I am to you

You could speak to virtually any sport horse training farms though and they'd tell you the same. Can't speak of dog training operations like sled dogs but I'd bet $ they have similar experiences.

[kristopher]

3. Not all carbs are created equal

You'll be doing your health a huge favor if you become familiar with the rate different carbohydrates metabolize. The flatter the curve, the better it is in terms of dealing with diabetic risks.

There is a powerpoint at this link that goes over it in detail.
http://www.glycemicindex.com/about.php

[1StrongBlackMan]

4. Mrs. 1SBM is on a similar diet ...

because her diabetes numbers were out of whack ... she's lost 35 lbs. (in about 5 months) and I've lost 15 (I am far less diligent) ... but more importantly, she is off her diabetes meds.

[BrotherIvan]

6. That's fantastic news that she is off her meds

The ability to control diabetes early without graduating to medicine and then to insulin also means the other damaging effects of diabetes are lessened. I've worked with many friends & neighbors with great success. Many of their doctors only told them to stop eating simple sugar, but didn't tell them that carbs = sugar. Changing their diet got it under control and their blood test came back great.

Give her a big brava from me!

[1StrongBlackMan]

8. That is so true ...

When she was first diagnosed, I sat with her in the ADA's Healthy Eat For Diabetics classes ... and that's really all it was about, "Don't eat sugar." But nothing about fruit=Sugar, Carbs=Sugar and "Sugar substitutes"=all kinds of bad stuff, including insulin spikes (and plunges).

10 years (and literally 100s of diets later), her doctor referred her to a 3 year old program of a retired heart surgeon that had, since the 60s been treating diabetics with a radically different protocol ... Low Carbs and dietary education.

He has 50+ years of data, suggesting this radical course is the correct course ... and it has worked for my wife.

[Boomerproud]

12. I'm so happy for your wife and you StrongBlackMan!

I'm a former Type2 (got very ill with esophagitis) and the 10-15 years I was on the little white pill no one told me to stay away from the carbs (only sugar). I lost 50 pounds when I was sick and was still taking my meds when I passed out one Saturday and was taken to the ER where they told me my blood sugar level was 19 and to get the hell off of the meds because it was keeping my blood sugar level too low (obviously). I had had a follow-up with my GP after the hospitalization but they didn't take a blood test. I guess I should have demanded one, but I still don't feel it was totally my fault.


Continued success to your wife!

[CaliforniaPeggy]

5. Good for you, my dear Tobin!

Somehow, that terrible disease of diabetes could turn out to be a really good thing for both of you.

Sometimes, you have to be really sick in order to get well...maybe this is one of those times.

Congratulations to you both!

[Phentex]

7. Good job!

Did you cut out all the beer?

[riderinthestorm]

9. I'm not a beer drinker but there are several low carb beers

I buy them when I have parties since so many people are watching their carbs.

http://www.examiner.com/article/the-10-best-low-cal-low-carb-beers-for-dieters

[Tobin S.]

28. No, I had to backtrack on that one.

But I at least compromised. I drink Miller Lite now which has a decent flavor for a light beer and only has about 3 carbs per 12 ounce serving.

[kenzie0418]

10. Good

Good for you

[gopiscrap]

26. Welcome to DU

[Tobin S.]

27. Yes, welcome to DU.

And thanks for picking my thread for your first post.

[doxydad]

11. 180? DAMN!

I only get 140 carbs per day!! However, A1c is down to 5.8...so I'm not complaining!

[grasswire]

15. the famous diabetes expert Dr. Bernstein....

....limits carbs to 30 for his patients. Six for breakfast, twelve each for lunch and dinner.

So these huge numbers of carbs per day that people are reporting as their target sound really unusual to me.

[Tobin S.]

23. These people are on medication

If you are trying to control your diabetes strictly through diet, then maybe 30 a day makes sense. If you are taking medication in part to control your diabetes, you will need more carbs. It's also a much more pleasant diet than a 30 carb a day diet.

The daily recommended allowance for carbs for a healthy individual is 300 on a 2000 calories a day diet. My wife takes in 140 and she takes a lower dose of Metformin, 1000 mg a day. Her blood sugar has gone from the mid 200s to the 100 to 140 range.

[Mrdrboi]

20. Congrats man.

Keep working at it and you will feel better in the long run.

[hunter]

30. Straight A's and losing weight... You are soaring, Tobin!

wikipedia

[Tobin S.]

31. Thanks, hunter

It's good to see you, hoss. I hope you are doing well.