Diabetes 102

@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

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!  

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

Marty I am flattered by the thought you feel I could supply meaningful feedback on your ‘elevator pitch’ With the time and work you have put into the insulin index, I can’t think of anything I could add to your presentation, especially when I have made it abundantly clear, I feel the insulin index is of limited use to a very small group of people.

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

I think your message is the same as my message, the control of diabetes is best achieved with a very hard cutback in carbohydrates, and protein must not be overdone, and must be accounted for, and the shortfall in calories made up with healthy natural fats. Clearly we both believe the least the medication the better, for many reasons.

I have had another look at your excellent website and the foods and recipes shown are exactly what low carb diabetics have been eating for a long time, including most here I reckon. It seems to me we are both singing from the same hymn sheet, but on one line, on one of the verses, you are using different words. What difference that makes regarding the performance, is for the audience to decide.

I think Mark Siisson’s sums up the insulin index very well in his article here.

“In short, while the insulin index raises some intriguing points, I don’t think it undermines the Primal Blueprint or unravels existence as we know it. It’s another bit of research that illuminates the natural interaction of our body’s systems with the diet we feed it. The index highlights the need for responsible food choices based on our inherent physiological functioning.
Now, pass the bacon.”

Read more: http://www.marksdailyapple.com/insulin-index/#ixzz3lUtqewr1

It certainly does not unravel, what countless people have used as a method of diabetes control, for a very long time, namely low carb higher fat. I think we can take as read, for diabetics and nondiabetics, the way to go, is to consume the highest quality, highest beneficially nutrient foods we can get and afford. With this in mind, I have placed up a post on the low carb diabetic blog re. the world's healthiest foods, it has been my main reference for some years, I cannot recommend it highly enough.

http://thelowcarbdiabetic.blogspot.co.uk/2015/09/the-worlds-healthiest-foods-book.html

Marty, the truth of it is, I am only too pleased to continue our debate, but some people are giving me flack, both on the open forum, and behind the scenes. Evidently I am argumentative, I can live with the grief, and it is true, I am argumentative. I would like to minimise the upsetting of some members, perhaps it would be good if other members got involved, and I back away on the forum, possibly we could carry on our debate in private via email, what do you think?

Regards Eddie

Eddie

Earlier in this thread you mentioned that sometimes topics can become overcomplicated.

Well the dumb down department is back in the land of WiFi after his recent paleo glamping experiment and will soon be publishing his pictorial lowbcarb index.

Picture. Red cross or green tick next to it. This is the test section.

Sneak preview......

Baruney wrote:Eddie

Earlier in this thread you mentioned that sometimes topics can become overcomplicated.

Well the dumb down department is back in the land of WiFi after his recent paleo glamping experiment and will soon be publishing his pictorial lowbcarb index.

Picture. Red cross or green tick next to it. This is the test section.

Sneak preview......

Sounds cool to me, but please don't try and flog me any kind of index.

Can we just flog you then? I've heard the rumours.

From where I'm standing, it looks like Eddie, as a T2, has got himself to where he wants to go with BG control. End of story.....for him!
Marty (and others) havent been able to get to where they need to (possibly due to the T1/T2 divide) and have had to look further and gone down the Insulin index route for further route.
Good luck to both camps for trying to find the best control!
Eddie, just don't diss others for trying avenues you don't need to explore to get control! If it works for others, even "a very small group of people" Rejoyce that it works for them!

Yep I agree @Two Collies. We all need to do whatever we need to do to control our own BGs. LCHF and exercise is most of the answer for me, but I'm still not where I want to be (after 4 years) and I don't suppose I am the only one either. Any advice that helps a little more is gratefully received by me. If it doesn't work, I've lost nothing by trying.

Two Collies wrote:From where I'm standing, it looks like Eddie, as a T2, has got himself to where he wants to go with BG control. End of story.....for him!
Marty (and others) havent been able to get to where they need to (possibly due to the T1/T2 divide) and have had to look further and gone down the Insulin index route for further route.
Good luck to both camps for trying to find the best control!
Eddie, just don't diss others for trying avenues you don't need to explore to get control! If it works for others, even "a very small group of people" Rejoyce that it works for them!

Thank you for your comment and your opinion.  This is how I see it, but as I have said I may have got it all wrong. Hopefully Marty can put me straight.

Maybe my back was put up by the over the top sell job that has been the insulin index pitch. The GI index was pushed the same way, anyone who has taken the time to watch the Barry Groves video GI Blues, will have no doubts whatsoever, the GI index is a complete crock, not only for all diabetics but all people full stop. If you have watched you must agree.

It seems to me the insulin index has similar shortfalls. We all know carbs require the most insulin to control, then protein, then fat. Below is a partial chart of the insulin index for various foods, most of the information comes as no surprise, but check out some of the foods. The insulin score is based on the consumption of 1,000kJ of the given food. Check out beef at 51 + or - 16 and fish at 59 + or -18. White pasta is rated at 40 + or - 5 and All Bran cereal at  32 + or - 4.

So. if I have got this right (please correct me if I am wrong) according to the insulin index, I can eat a 1000kJ of white pasta and it will have less effect on bg than a piece of white fish, never in a million years. A piece of white fish has only a small effect on my bg a couple of points at most and returns to base level with an hour or so. A 1,000kJ portion of white pasta drives my bg through the roof and takes many hours to come down. The same applies to eating cereals compared to beef.

It seems we have one of two situations. 1. I am completely missing the point as to how the insulin index should be interpreted. 2. The insulin index is no use to me, and by definition, the vast percentage of type two diabetics (94% of all diabetics according to DUK information in the last week) Let’s look at insulin using diabetics. Why would the likes of Dr. Richard Bernstein have no problem with meat and fish (but must be accounted for in insulin dose calculations) but regard pasta and cereals as a total no no for obtaining maximum control and insulin predictability by way of low carbs and less injected insulin.

I could list the anomalies and variables all day long, that for me firmly places the insulin index in the same light as the GI index. But then again, perhaps someone can tell me where I am going wrong.

chris c wrote: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 . . .

Thanks Chris

Seems I need a log in to the BDEC website... I would be interested to see what they have to say.

See these two links my summary of learnings on the best of dosing for type 1s.

https://optimisingnutrition.wordpress.com/2015/08/02/standing-on-the-shoulders-of-giants/

https://optimisingnutrition.wordpress.com/2015/08/10/insulin-dosing-options-for-type-1-diabetes/

Basically, it involves minimising the total insulin load of the diet (while still trying to maximise nutrient density as much as possible). This enables you to stay off the blood glucose roller coaster.

The second part is the calculation of insulin for the reduced insulin load of the diet. This looks a lot like carb counting but with further consideration of the effects of protein and fibre. Some people (particularly if they still have some pancreatic function) can benefit from dosing for the protein component of their meal separately.

Again, your choice of approach depends on how much effort you want / need to put int.

Cheers

Marty

[quote="Eddie"]

martykendall wrote:Marty, the truth of it is, I am only too pleased to continue our debate, but some people are giving me flack, both on the open forum, and behind the scenes. Evidently I am argumentative, I can live with the grief, and it is true, I am argumentative.

I'm not offended by the discussion mate. I have learned a heap from 'arguments' like this online as well as seeing the issues the people continually struggle with and trying to come up with a tool that would solve it quantitatively or explain things clearly.

I have been suprised that that the majority of the traffic to my blog has been on the one page of my blog that explains my take on the FII, but I'm very glad to get some critique on how this is irrelevant for some people or how I could make it clearer.

Sure, some people will do fine on their current low carb / Banting / Atkins / Paleo approach, but for others it will be helpful to refine, for others it might be a proof text of the low carb approach to diabetes is better another approach for different people with different goals.

I'm impressed to see you referencing Mark Sisson. I was largely immersed in paleo land more than low carb before I stumbled onto the FII data. I am enamored by the nutrient density / whole food component of paleo, however think it needs to be sometimes nuanced for the user based on their insulin resistance.

Also chuffed to see you referencing George Mateljan's The World's Healthiest Foods list. Along with Joel Fuhrman's ANDI and Mat Lalonde's nutrient density his was one of the inspirations behind my trying to quantify nutrient density to compelment the FFI data.

Overall, I appreciate your time and discussion and understand your reaction to an outsider crashing your forum as an outsider.

Thank you Marty, re. my last post on this thread, what say you? have I got it all wrong?

Eddie wrote:Thank you Marty, re. my last post on this thread, what say you? have I got it all wrong?

I say no, it's just that Type 1 is complicated in different ways from Type 2.

Eddie wrote:Thank you Marty, re. my last post on this thread, what say you? have I got it all wrong?

Eddie

I wrote a response to that but it doesn't seem to have posted.  I feel like a learner driver when it comes to this forum thing…  

GI versus FII…  GI shows the maximum rise in blood glucose in which is important, however I think the insulin response to a food (rather than the glucose response) is fundamentally more useful as it is excess insulin that drives diabesity.  

I’m also not aware that the FII has been commercialised.  And I’m not sure if the FII will take off in the same way because it is harder to commercialise.  To verify the insulin response to a specific food requires not just a blood glucose finger prick, but rather regular blood draws to calculate the area under the curve of the insulin response for a group of people after ingesting a particular food.  

I agree that the short list of the insulin responses to different foods is confusing, but with the extended list of foods we can start to statistically understand the relationship between insulin, blood sugar, carbs, fat, protein and fibre (see charts in the elevator pitch above).  

This relationship isn’t perfect (there are probably still confounders like fructose which don’t require insulin but still are counted as a carbohydrate) but understanding the relationship is useful, especially if we can express it as a formula that we can apply to all foods that we have macronutrient data for (i.e. more than 8000 foods in the USDA foods database).  We can then quantify and rank foods based on their blood sugar and insulin response without needing to test it in vivo.  

For people like you who are already having success with a low carb / Banting / paleo / Atkins / Bernstein / ketogenic approach this knowledge and understanding will help support and reinforce why this approach is successful.  There is no need for people to make it more complex than it needs to be.  Eating shouldn’t ideally be rocket science, especially if it’s working for you.  

For people who aren’t getting the results or who need a more refined approach (e.g. type 1s and people aiming for therapeutic ketosis such as people fighting cancer or epilepsy) I think the ability to better quantify the insulin response to food is an exciting refinement.  

From a public food policy point of view, I think the improved understanding is an exciting way to make a clear decision about which foods are more ideal than others.  If we agree that people who are struggling with insulin resistance should eat food that don’t cause an excessive blood sugar spice, don’t require more insulin than their pancreas can produce, has lots of fibre and are nutrient dense, the quantification using this improved formula can help to demonstrate that what we’re being told to eat (i.e. lots of ‘healthy whole grains’) might not be the ideal approach.  There are so many conflicts of interest in food.  I think it would be ideal if people could be informed by a data driven approach that is free from bias and conflict.  

I hope this will help people make a more informed and confident chose about what they should be eating for optimal health.  As someone who likes to see the proof in numbers rather than just having faith in someone else’s advice I know it’s been useful for me and my family and it’s nice to see it impacting the lives of others for the better too.

I think I'm starting to sound like a broken record, so I'll stop now.

Cheers

Marty

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

Huh?!?!?!?

Please explain.

I don't get it Baruney.

martykendall wrote:

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

Huh?!?!?!?  

Please explain.

I don't get it Baruney.  

You're not the only one

Eddie wrote:

Two Collies wrote:From where I'm standing, it looks like Eddie, as a T2, has got himself to where he wants to go with BG control. End of story.....for him!
Marty (and others) havent been able to get to where they need to (possibly due to the T1/T2 divide) and have had to look further and gone down the Insulin index route for further route.
Good luck to both camps for trying to find the best control!
Eddie, just don't diss others for trying avenues you don't need to explore to get control! If it works for others, even "a very small group of people" Rejoyce that it works for them!

Thank you for your comment and your opinion.  This is how I see it, but as I have said I may have got it all wrong. Hopefully Marty can put me straight.

Maybe my back was put up by the over the top sell job that has been the insulin index pitch. The GI index was pushed the same way, anyone who has taken the time to watch the Barry Groves video GI Blues, will have no doubts whatsoever, the GI index is a complete crock, not only for all diabetics but all people full stop. If you have watched you must agree.

It seems to me the insulin index has similar shortfalls. We all know carbs require the most insulin to control, then protein, then fat. Below is a partial chart of the insulin index for various foods, most of the information comes as no surprise, but check out some of the foods. The insulin score is based on the consumption of 1,000kJ of the given food. Check out beef at 51 + or - 16 and fish at 59 + or -18. White pasta is rated at 40 + or - 5 and All Bran cereal at  32 + or - 4.

So. if I have got this right (please correct me if I am wrong) according to the insulin index, I can eat a 1000kJ of white pasta and it will have less effect on bg than a piece of white fish, never in a million years. A piece of white fish has only a small effect on my bg a couple of points at most and returns to base level with an hour or so. A 1,000kJ portion of white pasta drives my bg through the roof and takes many hours to come down. The same applies to eating cereals compared to beef.

It seems we have one of two situations. 1. I am completely missing the point as to how the insulin index should be interpreted. 2. The insulin index is no use to me, and by definition, the vast percentage of type two diabetics (94% of all diabetics according to DUK information in the last week) Let’s look at insulin using diabetics. Why would the likes of Dr. Richard Bernstein have no problem with meat and fish (but must be accounted for in insulin dose calculations) but regard pasta and cereals as a total no no for obtaining maximum control and insulin predictability by way of low carbs and less injected insulin.

I could list the anomalies and variables all day long, that for me firmly places the insulin index in the same light as the GI index. But then again, perhaps someone can tell me where I am going wrong.

Marty when you came over here the first time, you failed to answer my direct questions, I let it go. You have pontificated and waffled during this recent visit to this forum. You have completely failed to answer the points I raise above. As I said I could talk at length about very serious anomalies in the insulin index. It is clearly no more use than the GI index. I am amazed with all the time you have studied the insulin index, you have not realised it is riddled with serious faults and inaccuracies.

Good luck with your endeavours to establish this very shoddy piece of work into the mainstream, I look forward to commenting at length on our blog re. the insulin index in due course.

Regards Eddie