High Carb II – My Diabetes Diet Battle Continued By Adam Brown, dia. Tribe. I've discovered a therapy that: . I've been doing this for about six years now, and my Low Carb vs. High Carb article last fall showed some of these takeaways in a 2. About the Author: Peter Attia, M.D., is a physician in private practice in NYC and CA. His practice focuses on longevity and healthspan. His clinical interests are. The Low Carb Connoisseur is dedicated to helping the ketogenic diet, low carb, sugar-free dieter obtain the highest quality and best selection of products available. Doubling my carb intake led to the same average blood sugar, but four times as much hypoglycemia, 3. Since then, I've been dying to repeat the same experiment, but with two key tweaks: (i) eating even lower carb (to get more separation between the two phases); and (ii) dosing insulin slightly less aggressively during the high- carb phase (to cut the hypoglycemia). This article documents what happened after I tripled my carb intake, comparing six days of ~1. For comparison, last fall I roughly doubled my daily carbs: 1. The topline results were similar to version one, but even more in favor of low carb this time: . A1c. I also needed more bolus insulin for each high- carb meal (1. ![]() The round two glucose and insulin results are shown below in more detail, followed by five more fascinating lessons learned: insulin- dosing danger, extreme blood glucose levels, why the low- carb results are better this time, eating out, and the impact of calories. I've also added some thoughts for people with diabetes and healthcare providers. You'll find strengths, limitations, and more notes on setup in the appendix. My greatest hope is for the diabetes community to more expansively evaluate the pros and cons of different dietary approaches – the impact on glucose (time- in- range, hypoglycemia, variability), insulin- dosing danger, diabetes burden and stress, and quality of life. Low- carb eating helps me balance all those factors like nothing else I've ever tried. I would love to hear your feedback by email or on Twitter! This lower- carb diet was nowhere near Atkins level (2. The black line shows the average at that time point, while the bars indicate the range of values at that time (yellow=high, gray = in range, red = low). Can you guess which is high carb and which is low carb? These results are very similar to my previous experiment, with two caveats: the low- carb results are slightly better overall, while the high- carb results are more troublesome in the afternoon. Time- in- Range My blood glucose stayed in range 9. That translated to five more hours (!) every day in the zone of 7. This was better than I expected and I unpack it further below. ![]() Hypoglycemia was quite low in both periods, though it was once again greater on high carb. At 3% this time, however, it was half of last fall's 6. Both the Ketogenic Diet and Paleo Diet have been in the news recently as celebrities endorse them for . Fitness Guides Weight Loss. Is This Diet Method For You The 17 Day Diet (2011) by Mike Moreno: Food list 100% Guaranteed Results The 90 Day Bikini Transformation plan is known as the worlds leading female specific plans, with 1000 Caitlin Weeks grew up eating southern comfort food and battling the bulge. After college she lost 90 lbs on a low fat diet with excessive cardio exercise. We all falter sometimes. If you want to get back on track with your healthy low carb or keto diet, keep reading. The best tips from the low carb experts! PureFoods Low Carb is a meal delivery program that supports the lifestyle of those follow in a low carb diet in a convenient and nutritious way. My time spent high quadrupled during the high carb II phase. Average glucose was +1. A1c. This was slightly different from my previous experiment, where I achieved a similar average glucose in the two phases: 1. Two factors probably played a role in the higher average during high carb: (i) eating a slightly larger percentage of my calories from carbs this time; and (ii) the natural tradeoff to having half as much hypoglycemia. These high- carb glucose results are still very solid: 7. A1c of 6. 1% - far better than I did as a teenager! In comparison, however, the low- carb results are substantially better by every metric: more time- in- range, one- third as much hypoglycemia, a lower average glucose, 6. Insulin I needed 6. Last fall, my bolus insulin doubled, and my overall insulin was 3. I did not change my daily basal insulin (2. The bolus insulin data confirms that I was not under- dosing insulin on high- carb – the three- fold increase in bolus insulin is what would be expected when tripling carb intake. Lessons Learned II 1. Eating high carb magnifies the dangers of dosing insulin. Meals with 1. 00+ grams of carbs needed more bolus insulin in one dose than I use in an entire day eating low- carb. The difference between an in- range blood sugar and severe hypoglycemia can be just a few units, and when estimating bolus doses of 1. I would much rather make a 3. Put differently, there is nothing . Errors of 3. 0%- 5. For me, a low- carb diet minimizes or eliminates the influence of many of these factors, which is why it seems to improve my glucose AND decrease my diabetes burden. Under these very common circumstances, taking 1. Low- carb diets can help defend against many of these worst- case scenarios – e. The ADA's nutrition recommendations note that evidence is lacking to recommend a specific number of carbs per day. That may be true when measuring the effectiveness of different diets from an average A1c or weight perspective, but I hope we can think on a more personalized level: what might low- carb diets offer to different individuals? Diabetes is a battle of staying in range, and high- carb days made extreme blood glucose levels (over 2. In both experiments combined (3. I measured all carbs out, ate unprocessed food, dosed insulin 2. CGM trend and insulin- on- board. By contrast, I had zero low- carb days with a blood glucose above 2. A low- carb diet helps minimize excursions and maximizes the probability of staying in range for more of the day. Conversely, extreme highs take hours to recover from. Look at this example from a high- carb excursion to 2. I spent nearly four hours above range – even after doing as much as possible with my insulin dosing to stay in range. One of the big reasons I find low- carb helpful is it minimizes these big excursions. How did I spend 9. In comparing these new lower- carb results to last fall, the 1. I believe three factors helped: . Carbs increase blood glucose far more than fat or protein, so it's not surprising to see my time- in- range improved with fewer carbs. Fiber does not impact blood glucose significantly, and it has the added advantage of blunting post- meal glucose spikes. The additional fiber (above nuts and vegetables) came from two new sources: low- carb/high- fiber tortillas & chia seed pudding (both discussed in my Homerun Breakfast column). This tactic contributed a bit to the results in this round, since both phases had better overnight and morning blood sugars vs. Eating out is often more manageable on a lower- carb diet. I ate the following two restaurant meals during this experiment: half a plate of vegetables with a chicken breast vs. The high- carb rice meal was so much tougher to bolus for, since the pile of rice could have been two cups, or three cups, or 1. I took my best guess and crossed my fingers I had it right. By contrast, a big plate of vegetables with a piece of chicken is an easy bolus – almost always 1- 2 units, and no need to . Calories were not associated with time- in- range – even though I ate ~2. II. As noted in the initial table, I ate 2,9. II vs. 2,6. 57 during high- carb II. This was unintentional, but as you saw above, it didn't give high- carb any big glucose or insulin advantage at all (nor did it change my weight). The graph below supports this assertion with more data, comparing calories per day to time- in- range from all 3. My takeaway: no clear relationship between calories consumed and time- in- range in these trials. While low- carb diets are higher in fat (and thus, more calories per gram), there are many things to consider: . Read this excellent Atlantic article by Cynthia Graber and Nicola Twilley for some of the measurement nuance and history of calories. For instance, the number of labeled calories in foods like almonds over- reports what the human body actually absorbs! See our recent article on The Biggest Loser for a biological view on this topic. Read the Q& A from last fall for more on this topic. If you decide to change to a low- carb diet, do so slowly. It takes the body time to adjust to a very different diet, and you may need drastic changes in your insulin doses. I would recommend starting with just one low- carb meal per day (my choice would be breakfast) – and of course, let your healthcare provider know you are doing this. Messages to Healthcare Providers Imagine a therapy that could keep your patients in range for more of the day, reduce the hassle of diabetes, substantially decrease insulin needs, and dramatically cut the dangers of dosing insulin. Is that a therapy worth trying? A1c and average glucose are not the only metrics to determine if a diet or therapy is effective. We should take into account insulin- dosing danger, time- in- range, hypoglycemia, variability, extreme blood glucose values, and the mental and emotional burden different diets impose on people with diabetes (e. Randomized controlled trials (RCTs) are not the only standard for establishing the evidence of an intervention. As someone who studies science every day, I recognize that the . On the other hand, I think it would be a disservice to wait for long- term RCT evidence to tell us what diet is most effective for diabetes. Read this fascinating editorial from Nutrition: ? A lower- carb approach requires some tradeoffs (convenience, variety, time) that may not be worth it for everyone. But for me, it's a gamechanging therapy unlike any other I've tried. The Ultimate Quickstart Guide For The Slow- Carb Diet. It’s a common frustration. You’re about to start the 4- Hour Body diet, and you want to make sure it’s perfect. Even in your mind you know this is the thing that’s going to work for you, finally, once and for all. Food. The truth is nutrition is the 8. This isn’t the case with a proper slow- carb diet). You want your calories to be nutritious, so you want to keep the fluff out. As for wine, I prefer a nice Argentinian Malbec. Don’t eat fruit – If you’re like me, you might balk at that statement. Fruit is healthy, right? Yes, in a healthy person it’s great for you. For an overweight person looking to lose fat, it’s only going to make it more difficult. Same thing for super healthy foods like sweet potatoes. You’ll get some later. Take one day off per week – Also known as “cheat day” or “faturday” or whatever name you want to give it. If you get results, keep going. If you go backwards, stop eating cottage cheese. It can be as simple or extravagant as you like, as long as it fully complies with the list. Be sure to include a protein, legume, and vegetable in each meal. I’ve got months worth of meal plans ready for you over in my slow- carb meal planner. Or if you want to try to go it yourself for a minute, I’ve got you covered there too. Here’s a post I wrote with just about a month’s worth of meals if you need something to get going, and eating the same thing every day doesn’t sound appealing to you. Days of Slow- Carb Meal Plans Just For You. Breakfast. A specific point Tim makes in the book is to make sure to get at least 3. He says it would be nearly impossible for someone to be less active than he was. If you’re eating a proper diet, you’re getting the nutrients your body needs and you generally don’t need to take any supplements. There’s almost a science to it. It goes like this: Lay the foundation. Eat a solid slow- carb breakfast first. This will help digestion and it will help hold things together. The increased carbohydrate, fat, and oil consumption you will likely experience on your cheat day could disrupt an otherwise- well- functioning internal plumbing system. I’d wait at least 3. I try to get about 3. Drink extra water. Much of the weight gain will be water weight. Drinking more than enough water will help your body get rid of it quicker. Grapefruit juice and coffee. Tim says that grapefruit juice before meals helps keep the insulin spike lower, and lower insulin levels seems to be the key to fat loss. Caffeine, as I understand, helps increase metabolism. Limit it to one waking day. My biggest problem at first was that my cheat “days” often started on Friday night and ended Sunday evening. You don’t want to give your body extra crap to work on for more than a day. Stick to one day between the time you wake up and the time you go to bed to maximize results. If you cheat for more than a day, don’t expect the weight to come off in 3 days. Extras. Over the course of a couple years, I’ve put together a few extra posts that are designed to help you get on your way with the 4- Hour Body’s slow- carb diet. Between me and the FMF community, they’ll all get answered.
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