Culture

13 Weeks: Sweet Release

shutterstock_108563738

Week 1 of my fourth 13 week season: a low glycemic load diet, tracking my weight and blood glucose. You can follow me at my 13 Weeks Facebook page for daily updates, and you can join Fitocracy (free!) and follow my daily exercise, and maybe even start tracking your own.

Diabetes mellitus, especially the type-2 variety that used to be called “adult onset”, is a serious problem that’s been growing along with people’s waistlines. The name comes from “diabetes” (διαβήτης in Greek, and more or less adopted whole into Latin) meaning “to pass through”, and “mellitus” from Latin, meaning “sweetened with honey.” So the name means “pees sweet.” In fact, the test for diabetes was originally to taste the patient’s urine; if it was sweet, that meant diabetes.

This is why doctors are glad they no longer do their own lab work.

Type 1 diabetes is caused when the pancreas stops secreting insulin, for reasons that aren’t completely clear; type 2 happens when the body stops responding to insulin normally. No one is quite clear why that happens either, although an interesting new line of research is suggesting that people with type-2 diabetes have abnormal populations of bacteria in the gut. (I’ll be writing more about this soon, I’ve got a stack of papers full of long Greek-root words to read.)

Whatever the cause, the effect is that your blood sugar goes too high. This has a lot of bad effects, including a greater risk of heart disease and strokes, pain and numbness in the limbs, and not to put too fine a point on it, peripheral body parts becoming gangrenous and falling off, leading to slow creeping painful death.

This explains why, when I was diagnosed as actually being type-2 diabetic (familiarly called T2DM in medical conversations) I took it somewhat seriously, leading me to the first of these 13 Week experiments last year. I’ve experimented with several different diets and exercise plans, and lost a little over 30 pounds — followed by a near plateau of very slow weight loss. I was rather more successful with controlling my blood glucose — a little too successful back in April, in fact.

So, at the end of this most recent experiment, I had an HbA1c test, which measures your average blood glucose level over the lifetime of red blood cells. (I explained that in more detail last January.)

For the previous 13 weeks, I changed the diet, adding more carbs and reducing my metformin dose to 500 mg/d to see if I could avoid the hypoglycemic episodes. I was successful; haven’t had another fainting spell. Last Friday I had another HbA1c, though, and it’s up to 6.4 percent, which still counts as good control of the T2DM, but lower would be better. So, after talking with my doc this week, I’ve made some changes in my meds: back up to 1000 mg/d of metformin, back down to 20 mg/d of Prozac, and I’ve cut out the simvastatin completely because my cholesterol is actually low. All this for this 13 weeks; I’ll have another set of blood tests at the end of this 13 week experiment, in December.

Aside: Just making it one thing after another, my current doc, who I really like, just told me that the effects of the Affordable Care Act, and the required changes in paperwork and all, have taken so much time away from doctoring, which she likes, and put so much of her time into doing clerical work, which she hates, that she’s hanging it up in February. I’m starting to look for a concierge doc in this area.

As well as changing the medications, I’ve changed the diet somewhat. I found it very difficult to maintain the “slow carb” diet. I just didn’t feel as good as I had (mostly) on the low carb diet, but I didn’t want to go back to that and have more hypoglycemic episodes. So this 13 weeks, I’m trying a low glycemic load diet.


2013-07-21 06.55.19

To explain this, we need to talk about glycemic load, and to do that we need to talk about the glycemic index.

Whenever you eat food, your body responds by doing several things: you start to salivate more, acid secretions in your stomach increase, and your pancreas starts to produce more insulin. As you digest the food, glucose goes into your bloodstream and your blood sugar increases; how much your blood sugar increases depends on how much sugar you absorb from the food.

The glycemic index works like this: someone measured how fast the blood sugar of an experimental subject increases after eating a measured amout of glucose. That’s set to 100 by definition. Then experimental subjects eat measured amounts of other food, and the blood sugar changes after eating those foods are measured. If the blood sugar increases half as fast as after eating glucose, then that food gets a glycemic index of 50.

Generally, a food is considered to have a low glycemic index if the glycemic index is less that 55 — so anything that increases your blood sugar only half as fast as glucose has a low glycemic index. Now, some years ago — pre-diabetes — I had quite a lot of success losing weight simply by eating only foods with a low glycemic index, which basically can be summarized as “never eat anything white.” No white bread, no white potatoes, no white rice. Okay, it’s not a 100-percent rule, as you can eat cauliflower and hearts of palm, but you get the point.

This works especially well if you load up on food that have a glycemic index of effectively 0, which is salads, greens, some fruits (bananas, as well as being radioactive, have a glycemic index of 52-60 depending on who you ask,) eggs, and meat. Cheeses are a little higher, with a glycemic index of a little less than 30. Peanuts are very low, and most beans are in the same neighborhood as cheese. (You can find the standard table of glycemic indices for many foods here.)


shutterstock_96468233

Of course, just because the glycemic index is low, that doesn’t mean it’s magic: if you eat a pound of digestible carbs, your body is still going to have to process a pound of glucose eventually. However, if the glycemic index is low, the body processes it more slowly; your blood sugar doesn’t spike, and before it can crash you’ve eaten something again. So eating a diet with a low average glycemic index is effective for helping avoid those blood sugar swings (and when I have a blood sugar crash, it’s a real crash.)

Controlling your actual blood sugar, however, means controlling the total amount of carbs you challenge your pancreas with. For that, nutritionists have defined a second number called the glycemic load. Glycemic load is defined to be the effective carbs consumed times the glycemic index over 100:

Screen Shot 2013-09-06 at 21.11.15

So for a simple example, 100 grams of glucose has a glycemic load of 100 (100×100/100=100). But there are lots of foods with a much lower glycemic index than that. Just — as an example of a favorite of mine — refried beans. Tia Julia’s frijoles refritos have a glycemic index of 38. A cup of refried beans has about 25 grams net carbs, so a cup of refried beans as a total glycemic load of around 10 (25×38/100=9.5).

It turns out that low glycemic load diets have been tested and have a number of good effects: they have been shown to be easier to comply with than other diets because they’re more satisfying; they seem to be more effective at controlling blood sugar levels than other diets in T2DM; they even seem to cure or reduce acne.

So, as I said last week, I’m adopting a low glycemic load plan for this 13 weeks. The basic plan is to keep my daily glycemic load below 30 on average.

So far, a whole week, it’s been great. I can eat some things I hadn’t been able to eat before — a medium apple, for example, has a glycemic load of 6, a cup of refried beans with eggs and cheese and salsa has a glycemic load of 10. I’m keeping a careful food diary again on LoseIt, and there’s another interesting effect: I’m hardly limiting my intake, anything but, but this is turning out to be calorie-restricted. Right now, after a week, I’m basically about 8500 kcal below what would be my historical “maintenance” level of 17,500 kcal a week. My blood sugar has also been somewhat lower, even before I upped the metformin.

If there’s anything I’ve learned after almost a year of this, it’s not to get too excited about any change. But so far, this one looks pretty good.

*****

images courtesy shutterstock / annyart / Olaf Speier / Glenn Price