Diabetes 102

martykendall wrote:“BTW an insulin injecting type two diabetic has up to three times the mortality rate (dose dependent) as a non-insulin using type two, there are various reason for this, but are scientifically proven.”

Actually we did know that Marty it was a topic on DCUK  sadly even though it contained a lot of compelling evidence it was deemed as scaremongering and the thread locked by a non diabetic admin

Thread closed. This isn't the place to be scaremongering and dishing out potentially dangerous information.

http://www.diabetes.co.uk/forum/threads/recent-insulin-study.50729/

"BTW an insulin injecting type two diabetic has up to three times the mortality rate (dose dependent) as a non-insulin using type two, there are various reason for this, but are scientifically proven."

Sorry, this is a quote from Eddie.

I was trying to respond to his comment.

martykendall wrote:"BTW an insulin injecting type two diabetic has up to three times the mortality rate (dose dependent) as a non-insulin using type two, there are various reason for this, but are scientifically proven."

Sorry, this is a quote from Eddie.  

I was trying to respond to his comment.  

Apologies Marty   perhaps it would help if you spaced your quotes 

OK Eddie.   Let me have a go at a simplified 'elevator pitch' on why I think the food insulin index data and analysis is useful.  

Exhibit 1: 1997 Holt paper measuring the insulin response to 38 foods.  

Observation:  Interesting, novel, but perhaps confusing and not that applicable.  

See http://ajcn.nutrition.org/content/66/5/1264.full.pdf+html


Exhibit 2:  More recent FII data of more than 100 foods.  

Observation:  Insulin response is somewhat related to carbs, but there are some confounders when it comes to high protein foods.  This data suggests that carb counting alone may not fully explain our blood glucose and insulin response to foods.  Perhaps there is a better way?




Exhibit 3:  The FII data shows that the insulin demand and blood glucose response decreases with increasing fat content of our food.  

Observation:  Perhaps the advice given to diabetics to just eat what everyone else eats (including avoid fat because it causes heart disease) is not that good after all.    



Similarly, sugar, glycemic index and glycemic load all do a shabby job of predicting our insulin and blood sugar response to foods.  


Exhibit 4:  We can manipulate the FII data and find that the insulin and glucose response to foods is much more closely predicted by net carbs plus about half the protein.  

Observation:  If we want to control blood glucose / minimise insulin demand / work within the capacity of our own pancreas / insulin sensitivity then we should consume a diet that is low in net carbs, high in fibre and has moderate protein.  



This understanding can be used to priotise foods that will have the lowest impact on blood glucose (see https://optimisingnutrition.wordpress.com/2015/03/23/most-ketogenic-diet-foods/).  It can also be used to quantify the insulin requirements for people who are injecting insulin.  

While some people do just fine with a paleo or low carb approach when it comes to weight loss or blood sugar control, however some still struggle.  The really exciting applications of this theory are in helping type 1 diabetics who have had the disease for a long time or in theraputic ketosis (i.e. cancer, epilepsy etc).  

I suggest that the theory applies to everyone, however there is a sliding scale when it comes to how much you need to reduce the insulin load of your diet depending on your situation.  


Because high fat foods aren't necessarily high in fibre or a wide range of nutrients, it is even more useful to combine the FII with the nutrient density data to shortlist optimal foods for people with different goals (e.g. diabetes, weight loss, therapeutic ketosis or for people who are metabolically healthy).

If we can agree on the ground rules (i.e. our diet should maximise micronutirents, contain adequate fibre and not have a higher insulin load than our own body can process without gaining weight due to too much insulin or high blood glucose levels) then we can agree on a data driven approach to identify the most suitable foods for an individual without having to subscribe to a faith based system of nutrition (e.g. My Plate, Food Pyramid, paleo, low carb, Atkins, Bernstein etc).

chris c wrote:

martykendall wrote:
I'm surprised that the University of Sydney and Harvard who have been involved in developing this data aren't promoting the implications more.  This probably relates to the fact that it turns the grain based 'balanced diet' food recommendations for diabetics and the rest of the population on its head.  

Yes I suspect you're right.

I see this principally for Type 1s to better calculate their insulin dose.

Just a thought, have you contacted David Mendosa? He has a Satiety Index on his site, an Insulin Index would fit in nicely.

I suspect it's because it would cut into the profits made by Brand-Miller's GI index money-maker. Cynical, moi?

Indy51 wrote:I suspect it's because it would cut into the profits made by Brand-Miller's GI index money-maker. Cynical, moi?

Wouldn't it be nice to have a data-driven basis for determining which foods are ideal for different people so we don't have to rely on 'authorities' that are often polluted by the (appearance?) of a conflict of financial interest?

Eddie, what do you reckon? I reckon you could get behind and promote something like that hey?

martykendall wrote:

Indy51 wrote:I suspect it's because it would cut into the profits made by Brand-Miller's GI index money-maker. Cynical, moi?

Wouldn't it be nice to have a data-driven basis for determining which foods are ideal for different people so we don't have to rely on 'authorities' that are often polluted by the (appearance?) of a conflict of financial interest?  

Eddie, what do you reckon?  I reckon you could get behind and promote something like that hey?  

Hi Marty I will come back to you on your other long post but can you tell me about the financial side of the GI index and insulin index. Is this data subject to copywrite? If the work is printed in books or appears on packaged foods etc or in advertising are fees or royalties payable?

http://www.glycemicindex.com/testing_research.php

Price list available via email only.

“Bernstein calls it the power of small numbers, the less the carbs the less the insulin equals greater control and insulin predictability, less margin for error and absolute minimum insulin requirements.”
Exactly! Bernstein also talks about protein requiring insulin but I don’t think he quantifies it that well. He also doesn’t talk about fibre that much. He just says to go with 6, 12, 12 and have similar meals each day to refine the insulin dose. Most people don’t eat exactly the same thing as him every day. To understand the similarities and differences between my application of the insulin index and Bernstein please read https://optimisingnutrition.wordpress.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes”

I follow Bernstein because I believe him to be the world's leading expert on blood glucose control as do many others. I agree not everyone follows his strict regime, but almost all well controlled diabetics are following a Bernstein type diet. A stiff reduction in carbs and more fat.

“BTW an insulin injecting type two diabetic has up to three times the mortality rate (dose dependent) as a non-insulin using type two, there are various reason for this, but are scientifically proven.”

“But they still don’t control their blood sugars at optimal levels and they have way too much insulin. The aim is to reduce the insulin load of your diet.”

I agree but the members here do control their diabetes very well, they do not have too much insulin sloshing around their systems hence they have and do lose weight, control BG, and many on nil or minimal meds. How do we fix something that is not broken? other than our metabolisms of course.

“Please read https://optimisingnutrition.wordpress.com/2015/03/22/ketosis-the-cure-for-diabetes/ for an explanation of insulin load. It’s a lot like carb counting but with fibre and protein also considered. I’m not trying to reinvent the wheel, just refine it and quantify it.”

In the early days I carb counted weighed food etc. took loads of blood tests. I dumped the foods that took BG to unacceptable numbers. Unsurprisingly all the starchy carbs and sugar had to go, end of. No problem with protein and fat, I have never ever even considered fibre other than to know I have no problem with all the low carb vegetables I eat.

“No well controlled low carbing T1 diabetic has high and lows.”
Type 1 is still as massive challenge even if you are low carb, particularly due to gluconeogenesis of protein. I see some people who have had type 1 for a short amount of time with some pancreatic function getting HbA1cs of less than 5, however for people who have had the disease for a lot longer and lost their pancreatic function they often find it much harder to achieve optimal blood glucose numbers. Please read https://optimisingnutrition.wordpress.com/2015/08/02/standing-on-the-shoulders-of-giants/”

Some diabetics will always have problems for many reasons. The so called “honeymoon period” you refer to is usually a very tough time for T1’s because of the erratic natural insulin output. It seems to me they are better off when natural insulin stops completely. As far as predictability is concerned and predictability is the name of the game for all of us diabetics.

“They do not need a large amounts of bolus insulin or large amounts of basal insulin to hold constant safe BG numbers.”
Quantifying the insulin load rather than simply carb counting enables us to refine the diet to minimise the insulin load of the diet (i.e. Bernstein’s law of small numbers). I’m an engineer and like to be able to quantify things, whether it is insulin or micronutrients.
It seems you know everything you need to know, however I think that quantifying the benefits of a Bernstein like approach is helpful for people who want to follow it as well as to defend it to people who say that it’s unhealthy or non-nutritious.”

I am an ex Aerospace Engineer (Bernstein is an ex Engineer) I like to be able to quantify, but human beings are not machines, and therefore the variables for every situation and every diabetic are beyond a certain level of calculation and predictability. And thank God we are otherwise we would all be robots.

“With respect page views does not mean “the concept being used” I have had over 700 hundred readers read a blog post in a couple of days, that sort of post often goes onto thousands of reads, but tells me nothing regarding how many people are using my recommendations.”
Please see https://optimisingnutrition.wordpress.com/feedback/
“the benefits to the majority of diabetics is minimal”
Eddie, you are obviously well grounded in Bernstein and good diabetic practice that suits you as a type 2 to give you adequate control. That’s great.
There are however heaps of people who are still getting told that even if they are obese / type 1 / type 2 / insulin resistant that they should just eat the diet that is promoted by the USDA”

No one is more aware than me regarding the totally ludicrous dietary guidelines for diabetics. It is the very reason why our crew have worked so hard to change the greed, corruption and madness.

I hope I have answered your questions, your post was lumped together in one lump, including your quotes and mine, and has been hard to sort out in the time I have today. Look forward to more chats.

Regards Eddie

Indy51 wrote:http://www.glycemicindex.com/testing_research.php

Price list available via email only.

Thank you Indy for the GI link, so this GI index malarkey is a money making scheme, if the insulin index is the same, I am beginning to see the wood through the trees. Money eh, I should have realised.

Problem for Syd Uni is that you don't need labels on real food - so no money in promoting the insulin index. Can't imagine veggie grower's associations paying to have an insulin index label on their products. I'm surprised the chick's PHD thesis was even approved since the outcome would affect their nice little money spinner. They probably wish it'd fade into the woodwork like most other inconvenient academic research.

Indy51 wrote:Problem for Syd Uni is that you don't need labels on real food - so no money in promoting the insulin index. Can't imagine veggie grower's associations paying to have an insulin index label on their products. I'm surprised the chick's PHD thesis was even approved since the outcome would affect their nice little money spinner. They probably wish it'd fade into the woodwork like most other inconvenient academic research.

As I said on the 102 thread, we learn nothing by playing nodding donkeys, I am learning so much today. So the bottom line is we are talking about earners, but Sidney University may have shot themselves in the foot with the insulin index, there seems to be a lot of that about on this forum today.

The GI index was complete garbage, as Barry Groves video GI Blues clearly demonstrated, perhaps that's why the "chick" came up with another earner.

Eddie said... "I'm targeting the thought leaders of the diabetes scene" I have noticed that, how many are in it for money?”

None of the ones that have taken an interest. Ted Naiman (BurnFatNotSugar) is a doctor. Ivor Cummings (FatEmporor.com)is an engineer. RD Dikeman from TypeOneGrti is a theoretical physicist with Lockheed Martin. Troy Stapleton is as radiologist. All of these guys I now call friends who have been very supportive and encouraging and all have day jobs.

“Because people are lied to morning noon and night, so many held in the vice like grip of junk food and big pharma.”

There’s also not good research out there to support low carb because there’s no money in telling people to eat low carb whole foods. The money is on the side of big pharma and big food. I have the FII data and the USDA food nutrient database which I have found very useful to demonstrate the optimal / ideal.

“Good luck Marty anyone that gets people thinking is great, but my experience is people want the info as plain and logical as possible, they want to get sorted and get on with their lives.”

I am trying to create simple applicable tools and lists that you can apply without going into the detail too much. The discussion and community on the Facebook group is also building really nicely. Seems some people are getting it and excited. One starfish at a time.
In the end though I’m just doing it for me and my family and maybe the people in the community that I see struggling to manage their diabetes in the TypeOneGrit group (https://www.facebook.com/groups/660633730675058/) that I’m a part of and have learned so much from over the past year.

If it helps a wider audience then that would be great. If it’s useful info people will share it. If it’s an indulgent intellectual waste of time I will have enjoyed myself and helped myself and my family and a smaller group of people. That’s the beauty of the democracy of the internet.

Eddie said “…can you tell me about the financial side of the GI index and insulin index. Is this data subject to copywrite? If the work is printed in books or appears on packaged foods etc or in advertising are fees or royalties payable?”

There seems to be a little industry built around the GI (http://www.glycemicindex.com/) with low GI endorsements going on various products, even low GI sugar! http://www.csrsugar.com.au/csr-sugar/our-products/better-you/logicane-low-gi-sugar/

The FII data is just published research that I’ve done my own interpretation and analysis of that makes sense to me. I have talked to a few people about the copyright issues on this and, given that it’s published data that I’m completely acknowledging the source of, then there’s no issue. I think it might get a bit more complex if I tried to set up a FII stamp that https://optimisingnutrition.wordpress.com/ would sell to food companies to put endorsements on their packaged foods.

I see that you’re trying to say that the FII data is guilty association with the GI which has been commercialised, however:

1. I think the data stands on its own as valid and useful, and
2. I can’t see that they’ve made an effort to commercialise the FII data, it’s just published research.

Eddie said “No problem with protein and fat, I have never ever even considered fibre other than to know I have no problem with all the low carb vegetables I eat.“

Agreed. Sounds like your system is working great for you as a type 2. However for a type 1 who is living on a high protein high starchy veggies diet and trying to calculate their insulin dose these things become more relevant.

Same goes for people aiming for therapeutic ketosis trying to minimise their insulin load the combat cancer or epilepsy. https://www.youtube.com/watch?v=4WitYoTGeno

I can’t say that I understand Einstein’s theory of relativity or apply it to my everyday life, but it doesn’t mean it’s not valid or irrelevant to me. Just because Eddie doesn’t need the FII to control his diabetes doesn’t mean it’s irrelevant.

Eddie said “In the early days I carb counted weighed food etc. took loads of blood tests. I dumped the foods that took BG to unacceptable numbers. Unsurprisingly all the starchy carbs and sugar had to go.”

So you’ve basically done the FII testing empirically in yourself. The FII data is useful because it helps to connect the dots to understand the relationship between macros and the blood sugar and insulin response.

Eddie said “The so called “honeymoon period” you refer to is usually a very tough time for T1’s…”

At least they have some endogenous insulin. Once that’s over and you’re injecting all of your insulin it becomes more challenging to achieve stable blood sugars. The primary aim of this is to find foods that will give my wife (who has had type 1 for 30 years) stable blood glucose levels without the rollercoaster.

Eddie said “I am an ex Aerospace Engineer (Bernstein is an ex Engineer) I like to be able to quantify, but human beings are not machines, and therefore the variables for every situation and every diabetic are beyond a certain level of calculation and predictability.”

But don’t you want to find and use relationships where they exist and could be helpful? If you could find the universal formula to solve all the diet debates and confusion, to provide clarity though the commercial conflicts, wouldn’t you want to be a part of that?

@martykendall I have followed your discussions here and at the other place. Thank you. As a T2 who struggles with insulin resistance I find the subject interesting (if a little difficult to follow at times)

zand wrote:@martykendall  I have followed your discussions here and at the other place.   Thank you.  As a T2 who struggles with insulin resistance I find the subject interesting (if a little difficult to follow at times)

Cheers. https://optimisingnutrition.wordpress.com/the-insulin-index/ is a good place to start for a primer on the food insulin index data and the implications in bite sized chunks.

Eddie! Where'd you go? I was looking forward to your feedback on my 'elevator pitch'!

I want to make sure the message is concise for my LCDU presentation!

martykendall wrote:Eddie!   Where'd you go?  I was looking forward to your feedback on my 'elevator pitch'!  

I want to make sure the message is concise for my LCDU presentation!  

Hi Marty!

I believe Eddie is visiting family currently and away from the computer and will be back in the next day or so to answer your recent posts.

Kind Regards

Paul

Obviously all my information on Type 1 is secondhand, but I know a significant number of Type 1s who have been majorly disappointed by the DAFNE and similar courses available in the UK. One thing they strongly discourage is postprandial testing. Yet there's research that shows that while A1c is linearly related to cardiovascular risk (EPIC-Norfolk and a large New Zealand study to name but two), it is mainly related to microvascular risk while postprandial glucose spikes are related to MACROvascular risk. Hence the benefits of 1 hour(or whenever your glucose peaks) postprandial testing.

I have been told (but haven't looked myself) that the insulin users course from Bournemouth Department of Diabetes and Endocrinology (BDEC) is far superior and actually world class.

IMO anything that controls postprandial BG is a Good Thing.

The elephant in the room is the glucagon response from the pancreatic alpha cells. With IR within the pancreas the alpha and beta cells stop listening to one another, and insulin may fail to stop the pancreas emitting glucagon and this leads to the damaging combination of high insulin and high glucose. I suspect the insulin response to protein may be involved here.

I have your website bookmarked but I expect there's a lot more material there now than there was when I last visited, so if you already covered this, well just colour me stupid . . .

Money, money, money. Superstarch pales tesco s cauliflower cous cous into insignificance.

@Baruney 

I noticed on the other forum you stated that your surgery were no longer including trigs in your cholesterol blood tests, if you still get total, HDL and LDL this site will calculate your trigs and all your ratio's  http://www.hughcalc.org/chol-si.php 

I now only get total and HDL included but not to bothered as trigs have always been < 1.00  mmol/L, and though my TC at 5.91 is high with a HDL of 2.26  and a TC/HDL ratio of 2.6 I don't consider it a problem

Thanks Graham. That's correct though I think it's more a case of never have rather than no longer included. The issue was that the doc wanted me on stating cos of high total cholesterol which as I said to the diabetic nurse I wasn't interested in as not the full picture so they are pushing people down this route on outdated advice. So dismissing that and having a non diabetic hba1c result they still want to push statin route on me due to liver results. Don't have figured on me now but fan pull up when back in the office.

When 1st diagnosed, just over a year ago now, seems to me that HCPs just want to treat the issue with drugs. Which is such the wrong answer.

Thanks for the link will look into further.

Baruney wrote:Thanks for the link will look into further.

As long as you have any three of TC/HDL/TC/trigs it will calculate, I'm buggered now with only two to go on