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How To: Deal with the Stress of a Newly Diagnosed Child

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This section is for any newly diagnosed type one families or anyone who would like to understand more about the emotional issues that arise. Grandparents or family friends may want to help and not know how. Often people under stress close in and don’t ask for help when they need it.

If you are not in this situation please proceed to the How To: Create Emergency Information Pack.

This section is for everyone.

It may help you to know that even in medical families the diagnosis of a child with diabetes can come as a profound shock. Most people know something about diabetes.  But this may not be accurate. Having to have lots of  painful jags, being likely to need a guide dog and amputations before old age are some of the  catastrophic things things that can go through a parent’s mind.

When any life changing event happens what people have been accepting as their likely future changes too. Life is full of pathways where doors open and close to various opportunities. The diagnosis of diabetes can even feel like a death has occurred in the family. The reality is that life has certainly changed for everyone in that family and it usually does take some time to adjust to the different expectations that come with the diagnosis.

The BC (British Columbia) Children’s Hospital in Canada has produced an excellent series of handouts that will benefit not only children and their carers but type one and two diabetics of all ages. This is partly due to effort that has gone into the carb counting and insulin adjusting sections but also the more general sections. They also give addresses of diabetes organisations and sites.

This is how they suggest you help yourself and your family through difficulties that surface at the time of diagnosis.

Join a Support Group

The Juvenile Diabetes Research Foundation at www.jdrf.org has a link to “Life with Diabetes”  and then “One-to-One Support”.

There is a chat room at www.childrenwithdiabetes.com/chat/.

If you look in the presentations section there is a very good series of slide shows from diabetes health professionals and parents to help you understand more about managing the condition and the effects on your child in the home and at school.

At Dr Bernstein’s Diabetes Forum at www.diabetes-normalsugars.com  the Bernies are  there to help people who are considering or who are doing a lower carbohydrate diet to help themselves or their child.

Look After Yourself

You can’t let diabetes rule your life to the point where your own emotional and mental health suffers. How can you help your child as much as you want to if you are in a poor state?

Find babysitters and relatives you trust and teach them all they need to know about diabetes care. Here are links below with advice on this.

Canadian Diabetes Association

www.diabetes.ca/Section-about/ChildrenIndex.asp

American Diabetes Association

www.diabetes.org/for-parents-and-kids.jsp

If you have a teen with diabetes who you think could be experimenting with alcohol or drugs educate yourself about how these can affect diabetes.

Keep or make a supportive network of friends to help you. These can be in person or you can meet online.

If You are Separated or Divorced

Both parents should educate themselves as much as they can about diabetes management so that your child feels comfortable in either home.

Keep your child’s diabetes separate from any ongoing disputes you may have.

Either both go to the child’s medical appointments together or alternate so that you both are confident about dealing with your child’s diabetes. Communicate freely about any regime or dietary changes that have been agreed.

Keep Optimistic

Focus on what CAN be done about diabetes.  Reading about diabetic people who have enjoyed life to the full and achieved remarkable things in all walks of life can inspire you.

Consider joining a local network for your national diabetes association for company, support, to help educate others, and fundraise.

If you are just not coping or you are nearing the end of your tether see your doctor or social worker or the diabetes teams psychologist for help.

Quick Quiz:
There is no quiz for this section.

 

Reference Info:
Acknowledgements to the BC Children’s Hospital for this section.

Where to Next?
Proceed to the How To: Create Emergency Information Pack

.

 

How To: Keep Healthy with Type 1 Diabetes

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This section is for everyone – who is still here!

DIAGNOSIS of TYPE ONE DIABETES

For most children or young people they will find out very quickly after diagnosis that they will need to be on injected insulin for life. Perhaps they will have had symptoms of weight loss, drinking a lot and passing urine a lot.  Others will have become very ill with diabetic ketoacidosis and will have been hospitalised.

More and more often younger people are being diagnosed with metabolic syndrome and type 2 diabetes. This is usually related to being overweight, sedentary and genetic influences.  Women with type 2, gestational or type one diabetes may find themselves being intensively treated with insulin during the planning or carriage of a pregnancy. Outwith pregnancy most people with type 2 diabetes will remain on diet and oral medications to control their diabetes. After about six years around half  of type 2 diabetics will have needed to add insulin to their medication regimes to maintain good control. Diabetics who use certain drugs to stimulate the pancreas to produce more endogenous insulin from their own pancreatic beta cells are more at risk of beta cell failure.

Type one diabetes results when the pancreas can no longer make enough insulin to prevent high blood sugars.  For early onset patients it is an autoimmune disease that used to be a death sentence.  Now that insulin is widely available for most people it is rarely as rapidly fatal. But until a real cure can be found and made available it can still feel like a life sentence.

Insulin is a drug that needs to be used very carefully.  It can rapidly lower blood sugars and cause hypoglycaemia which can cause death if it is very severe and is untreated. Lower levels of hypoglycaemia may not be obvious to drivers or their passengers and yet can cause impaired reaction times and judgement which can lead to accidents.  High blood sugars are less of a worry on the short term but on the long term damage accumulates that can severely affect the nerves, eyes, kidneys and heart.

Pancreatic beta cells start to die in tissue culture at sugar levels of 6.1 or higher. This is not a threshold effect and if blood sugar levels are brought below this level soon enough the cells can start to recover.

At the time of diagnosis and for up to decades afterwards type one diabetics still produce a small amount of insulin. The remaining beta cells are still subject to attack by autoimmune antibodies but can be nursed along for many years if high blood sugars can be avoided.

The more of your own pancreatic beta cells that are still active the easier it is to control your diabetes as the pancreas can still fine control sugar levels in a way that injections cannot. This is a major reason for all new diabetics to strive for normal blood sugars so they can prolong the “honeymoon” phase of diabetes.

Even the most rapidly effective injected insulins eg novorapid and humalog cannot replicate the immediately effective blood sugar lowering effect of the stored insulin from a normal pancreas beta cells. This means that blood sugars will be inappropriately high for at least some time after even small amounts of very fast releasing carbohydrates are eaten in eg bread or fruit. Over the long term these sugar spikes can add up to a lot of damage to body tissues.

We have already discussed what level of control you already have and what level of control may be optimal for certain groups of people in the Type Two Section. Please take a moment or two to review this.

This Type One section aims to give you more specific information on the use of insulin and other information to help you achieve the best health you can.

The insulin users section tends to lean heavily towards younger type ones. I will give some guidance about when older type twos can skip.

Quick Quiz:
1. For insulin users it is safe to go straight onto a low carb diet as long as you have…
a Thrown out all your crisps, breakfast cereals and biscuits.
b Bought a good low carb book to help you.
c Bought in plenty of meat, vegetables and olive oil.
d Planned out a gradual reduction of carbohydrates and appropriate reduction in your insulin.

2. Type One diabetics…
a Make plenty of their own insulin from beta cells in the pancreas.
b Can be sure there will be a cure within the next five years.
c Rely on carefully measured and timed amounts of injected insulin to keep well.
d Can eat whatever they like, when they like.

3. You are an insulin user going into hospital for a planned operation. You need to do three of these….
a Speak to an anaesthetist well before your operation to let them know how you manage your blood sugars.
b Speak to the dietician about your meal choices from the Healthy Diabetic section of the menu.
c Bring in your insulins, testing kit and any special foods or drinks you may need.
d Arrange for a friend to provide, transport, supplies and to liase with clinical staff.

4.Type ones can do three of these things…
a Get other autoimmune diseases.
b On first diagnosis go through a honeymoon period when pancreatic function improves for a period of time.
c Use inhaled insulin to control blood sugars.
d Die rapidly from severe hypoglycaemia.

5. Tests type ones should be having regularly include three of these…
a Amylase which is raised in pancreatitis.
b Thyroid function tests.
c Tissue transglutamase for coeliac disease.
d Albumin creatinine ratio which is a kidney test.

Have you got it?
1. D is correct. You MUST plan and change your diet and insulin doses GRADUALLY. This means more freqent blood sugar testing till you are stable on your new regime.

2. C is correct. If only we could be certain of a widely available and affordable cure within the next five years then we possibly could eat what we want, when we want without paying too much for the consequences. Unfortunately for the forseeable future most certainly DO have to live with the consequences so the tighter the control the better for most diabetics.

3. You need to do ACD. You don’t need to speak to the dietician. You decide yourself from the entire menu.

4. ABD are correct. Inhaled insulin is available now. It comes in 3 unit increments though and this is likely to make it less precise than is required for really tight blood sugar control for type ones. It may have a place for type twos who are still producing some of their own insulin.

5. Tests type ones should be having regularly include three of these…

Thyroid tests, coeliac tests, and kidney tests are all needed. Blood pressure, eye examination or retinal photography and foot examinations are other necessary tests.

Reference Info:

Where to Next?
Please proceed to the section How To: Deal with the Stress of a Newly Diagnosed Child section.

How To: Know the Truth About Carbohydrates

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This section is for everyone.

What “they” say:

When referring to carbohydrate the terms sugars, starch and fibre are preferred to the terms simple sugars, complex carbohydrates and fast acting carbohydrates as the latter are not well defined.

Carbohydrate exchange systems based on 10g portions do not improve glycaemic control and are no longer used.

Many factors including the type of sugar, nature of starch, method of food processing and cooking, food form, other food components, blood glucose levels, severity of glucose intolerance, can affect patient’s glycaemic response to foods.

The total amount of carbohydrate in the dietary intake seems to be more important than the source or type.

Intake of foods with a low glycaemic index has not been shown to improve glycaemic control in type 2 diabetics but may improve the lipid profile.

Consumption of the sugar sucrose does not increase glycaemia more than isocaloric amounts of starch.

Fibre containing foods such as whole grains, fruit and vegetables, provide vitamins, minerals and other substances important for good health. However both diabetic and non diabetic individuals would need to consume very large amounts of fibre to produce metabolic improvements to glycaemia and lipid profiles.

Intake of foods that contain naturally occurring resistant starch (corn starch) may modify post prandial glycaemic response and reduce more extreme fluctuations in blood glucose levels but there is no published evidence of long term benefits to diabetics.

When calculating optimal intake, greater attention should be paid to the total amount of carbohydrate than to its source or type.

Food with carbohydrate from fibre rich foods, wholegrains, fruits and vegetables and from low fat milk should be included in the diet. There is no evidence to support increasing fibre intake in diabetics above the levels recommended for the rest of the population.

Sucrose or sucrose containing foods should not be restricted for diabetics, but can be used in substitution for other carbohydrate sources in the context of a healthy diet with appropriate hypoglycaemic medication cover.

The expert consensus is that carbohydrate and mono-unsaturated fat together should provide 60-70% of intake, but precise and relative proportions may vary according to individual factors, such as age, activity levels and weight.

What they got right:

Quite a lot of what is said in this carb section is factually correct.

The terms sugar, starch and fibre are better than simple sugars or complex carb or fast acting carb.  The latter terms do tend to confuse people.

Carbohydrate exchange systems on their own do not improve glycaemic control.

Many factors do affect how an individual will respond to a given amount of carbohydrate.

The total amount of carb is indeed a more important consideration than the source or type.

The intake of low glycaemic foods versus high glycaemic foods is insignificant in getting good control when high amounts  of total carb are consumed. I do o not know whether the lipid profile will be better or not on a high total carb/low glycaemic diet.

Sucrose, which is the usual table sugar is certainly no worse than many starches in raising blood sugar levels.

Fibre eaten in palatable amounts has indeed no proven health benefits in diabetics or anyone else.

The consumption of corn starch may indeed result in less post prandial blood sugar drops if a high carb diet is consumed.

The total amount of carb is indeed a more useful consideration than type or source when it comes to glycaemic control.

What they should have said:

Sugar and starch have about the same effect on raising blood sugars. They both raise blood sugars quickly, often within 15- 30 minutes.  Fibre tends to retard the process somewhat.   In addition fibre is remains undigested and does not contribute to the total effect on blood sugar or on calories taken in.

The term complex carbohydrate tends to confuse people the most. Many would assume that brown bread is a complex carb and it is often described as such but most versions of brown bread are made into sugar just as fast as white bread or sucrose.

The truly complex carbs are non starchy vegetables such as celery, broccoli or cauliflower that have a cellulose structure that is more difficult for humans to digest so sugar release is quite slow.

Exchange systems can work well if the total amount of carb consumed at each meal is kept moderate to low. Dr Allen and Dr Lutz’s 70g carb diet is an example of this.

Many factors affect an individual’s response to a meal.  Charts and guides can offer some help but experimenting on yourself is the only way to really find out.

The total amount of carb consumed is certainly more important than the type or source when high amounts of carb are consumed. When you lower the amounts it becomes more obvious what the relative glycaemic effects of different carbs are.

Low glycaemic index foods when consumed in moderate to low amounts do tend to produce lower sugar spikes than higher glycaemic foods in equivalent amounts.

Consumption of sugar and starch raises blood sugar fast and predictably high. This can be very helpful when dealing with hypoglycaemia but is less useful when planning meals that are aimed at keeping blood sugars within the normal non diabetic range.

Strictly scientifically no carbohydrates are required to be consumed by humans whatsoever.  Essential fatty acids – Yes.  Essential amino acids – Yes.  Essential carbohydrates – Well, no actually.

In real life, if you are on injected insulin you can’t rely on getting it perfect 100% of the time. So, fast acting sugars such as glucose to deal with hypos IS necessary.

Many people enjoy eating carbohydrates even though their body can function fine without them.  These days we don’t eat the lightly cooked or raw organ meats that our ancestors ate. We therefore could become deficient in certain nutrients eg vitamin C if we did not eat exactly as they did.  Lightly cooked liver has more vitamin C than an apple weight for weight. But what would you rather have in your lunch box?

For a diabetic you would certainly have a lower effect on your blood sugars if you ate the raw liver compared to an apple. So what is the best of both worlds?

Fortunately nature has provided us with a wide variety of non starchy vegetables.
These generally grow above ground.

There is no nutrient present in whole grains, fruit or milk that is not available from either a meat/ egg source or non starchy vegetable. Usually the nutrients are present in much greater quantities too.

And there is no adverse effect on your blood sugars that often occurs with fruit, milk and wholegrains unless consumed in very small quantities, and preferably with a lot of fat added.

Sucrose and starches should be regarded by diabetics as poisonous until proven otherwise.  You can probably get away with eating small quantities of these infrequently. But you are kidding yourself if you think you can eat these as in a five year old’s birthday party and get away with it.

What the ADA and Diabetes UK say about sugar and starch is just plain wrong.  You may not want to believe this. It may be tough.

But do you know how much funding the food and drug industries give national diabetes associations such as the ADA every year? I’m not talking about the organic vegetable and free range chicken farms. I’m talking about sugar, confectionary, soft drink, breakfast cereal, bread , cake,  biscuit and other processed food suppliers give in donations and for endorsement of their products.

You can try to cover high carb/glycaemic items with insulin. Because of the 30-50% injection to injection variation in glycaemic effect you do put yourself at a rather high risk of overly low or overly high blood sugars. This is if your insulin matching and carb ratios are perfect.

Expert consensus about anything just means that a lot of people with common interests agree on something.   I call this “over the garden fence” opinions because they are just as scientifically valid.

They may be right. They may be wrong. But we just don’t know.

We don’t know what evidence they examined.
We don’t know what evaluation process they went through.
We don’t know what evidence they did look at.
We don’t know what evidence they didn’t look at.
We don’t know if they are bright or not.
We don’t know if they are going a bit batty-bat or not.
We don’t know if they took their medication that day or not.
We don’t know what they were offered for agreeing to someone else’s agenda or not.

We don’t know nuthin’ about that decision.

If you are happy to accept consensus decisions that is okay. Please give some tolerance to others who are a bit worried about accepting those decisions.

What is a typical NHS  dietary and insulin regime?

Your advised diet should you be a diabetic in Britain’s National Health Service is us usually something like this:

Consume plenty of starches at each meal.
Try to have wholegrain versions when possible.
Eat sugary foods in low to moderate amounts.
Eat at least 5 portions of fruit and vegetables a day.
Avoid diabetic products.
Drink diet versions of soft drinks.
Fruit juices may be consumed in moderate amounts.
Eat your usual amount of protein especially white meat such as chicken and fish.
You may eat eggs and red meat but only in small amounts.
Eat some oily fish each week.
Avoid saturated fat.
Avoid fried foods.
Avoid butter or lard. Use margarines instead.
Use olive oil in low to moderate amounts.
Drink alcoholic drinks sparingly.

A typical “healthy eating” day could be:

7.30 am

Breakfast cereal, semi skimmed milk.
Toast thinly spread with marmalade.
A glass of tropicana.
Tea.
A banana.

10.30 am

Small scone with small quantity of margarine and jam. (optional)
Coffee

1pm

Tinned cream of tomato soup.
Tuna sandwiches with margarine and wholegrain bread.
An apple.
Diet coke.

4pm

A small quantity of raisins and mixed nuts. (optional)
Coffee.

6.30 pm

Spaghetti Bolognese.
Tea.

9.30pm

Wholemeal toast and margarine.
A glass of semi skimmed milk.

The insulin regime to cover this could be:

Novorapid at breakfast, lunch and dinner and possibly before snacks.
Lantus at bedtime.

No carb counting is usually taught.

Dose adjustments are made on the trend in the blood sugars.

Blood sugars are preferred to be 4- 8 before meals and on rising.
Blood sugar is preferred to be over 5.0 at bedtime.
If blood sugar is 10 or over three days running at the same time of day the insulin to cover that period of time needs to be raised.

If 7.30 am bs is over 10 raise night Lantus.
If  1pm bs is over 10 raise breakfast insulin.
If  6.30pm bs is over 10 raise lunch insulin.
If  9.30 pm bs is over 10 raise evening meal insulin.

This sort of dietary and insulin regime is commonly used for type ones.

For insulin using type twos simple basal Lantus or other long acting insulin such as Levemir is commonly given on its own. No meal insulin is usually started unless the hbaics are over 8.

Twice daily mixed insulins such as Mixtard, Humalog Mix or Novomix may then be given.

Sometimes type 2s are given separate basal and rapid acting insulins to cover all meals.

The results of following this regime tend to be blood sugars set at a considerably higher points throughout the day and night. This is needed to reduce hypoglycaemia which can occur due to unpredictable absorption and action which is worsened by high amounts of insulin given at each injection.

The amount injected is whatever you have worked out works best and it is given in a single injection. When high carb diets are consumed high amounts of insulin are needed to cover this.

There is usually not enough fat consumed to reduce the speed of digestion of the carbohydrate. Snacking due to hunger results in a need for more insulin injections to cover the snacks. This can still be active when the next meal insulin is given.

This can increase the chances of hypoglycaemia.  Hypoglycaemia can often be overtreated and so blood sugars before the next meal are high.

No strategies such as correction doses, limiting the amount of insulin injected in one shot, using different types of  bolus insulin, timing the insulin injection so it is optimally effective are taught.

No wonder the results that insulin users get are so far away from what your pancreas would do if only it could.

Quick Quiz:
There is no quiz for this section.

Where to Next?
For type twos who don’t use insulin you may have mixed feelings now. The good news is that you have completed the course. Well done!

The more difficult news is that if your diabetes is not managed tightly enough or simply due to having the condition for a long time, you may need insulin in the future and have to come back and do the insulin users section that follows.

Its now time for type twos to start the course from the beginning again. I know. I’m a slave driver! This time you will be familiar with the sections most relevant to you. You can even take lots of time to browse the internet sites available.

Create a good action plan and be consistent and persistent.
We hope you reach your personal diabetes solution very soon.

For type ones and insulin using type twos its not over yet!

Insulin is a very dangerous hormone in overdosage. This is why there has been such an emphasis on waiting till you have completed the whole course and in a particular order before you low carb.

The sections ahead are very detailed. There aren’t many fun sections. It is very serious stuff. I’ll be really narky if I catch you laughing at anything.

Are you ready?  Got your meter steady?  Now Go to the How To: Keep Healthy with Type 1 Diabetes section.

How To: Know the Truth About Fats

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This section is for everyone.

What the supposed “healthy eating” guidelines say:

Saturated fat is the main dietary determinant of LDL “bad”cholesterol.

Intake of saturated fat in most European countries is above the 10% limit recommended.

Diabetics appear to be more sensitive to dietary cholesterol than the rest of the population. Eggs, offal and shellfish are particularly high in cholesterol.

Trans-unsaturated fatty acids (often found in manufactured confectionery products and some margarine) and N-6-polyunsaturated fatty acids raise plasma LDL cholesterol.  Trans fatty acids also lower HDL “good” cholesterol.

Diets low in saturated fat and high in carbohydrate or enriched in mono-unsaturated fatty acids with a cis-configuration lower serum LDL. eg cashew nuts, hazelnuts, almonds, herring, salmon, pilchards, mullet, peanut butter, olive oil, rapeseed oil, goose fat and avocado.

N-3-polyunsaturated fatty acids are found in foods such as oil-rich fish such as mackerel, herring, sardines, pilchards, trout, and mullet. N-3-polyunsaturated fatty acid supplements have been shown to lower plasma triglyceride levels in type 2 diabetics but they raise serum LDL levels.

Reduced fat diets  when maintained over the long term, can help to bring about a modest weight loss and an improvement in dyslipidaemia.

Regular use of foods with fat replacers or substitutes is safe and may help to reduce saturated fat and cholesterol intake, but will not reduce total energy intake or weight.

Less than 10% of energy should be from saturated fats. If the serum LDL is greater than 2.60 mmol/litre this should be reduced to less than 7%. If weight loss is desirable or replaced with either carbohydrate or mono-unsaturated fat if weight is to be maintained.

Dietary cholesterol intake should be less than 300mg/day. If the serum LDL is greater than 2.60 this should be reduced to less than 200mg/day.

The intake of trans-unsaturated fatty acids and N-6-polyunsaturated acids should be minimised.

What they should say:

Well they got one thing completely right.  Trans and N-6 polyunsaturated fats should be minimised.  Well done!

Trans, hydrogenated, partially hydrogenated, refined vegetable oils and margarine should not be used for cooking and baking. You can use lard, butter, macadamia nut oil and extra virgin olive oil instead.

As correctly stated these oils are extensively used in processed food products. They are cheap, taste bland and prolong the shelf life of food.  In baked goods they also give a lighter texture than butter and lard for instance. The safest way to avoid them is to make your own food from ingredients that you know are safe.

Hydrogenated oils have been found to increase inflammation in the body and are one of several causative factors in metabolic syndrome and the development of diabetes, heart disease and cancers.

The most important lipid markers for the development of cardiovascular disease are having low HDL, high fasting triglycerides and a high amount of very low density lipoprotein.

It is true that high saturated fat intake increases LDL but it is the most dense particles of this that are the problem as they are easily oxidised. This is the process that is involved in atheroma formation in blood vessels.  Just plain LDL levels are irrelevant to the formation of atheroma.

High saturated fat intakes are associated with higher HDL levels.  This is the protective “good” cholesterol.

Saturated fats also promote the absorption of vitamins from vegetables and fruit which are natural anti-oxidants. Saturated fats themselves are chemically stable and are  not prone to oxidation.

The formation of superoxides is one of the major contributors to the aging of blood vessels and thus the complications of diabetes. High blood sugars, wide blood sugar swings,  free radicals given off from heated polyunsaturates, overheated monounsaturates and hydrogenated / ttrans fats are major causes of superoxide production. Superoxides cause direct cell damage, weaken cellular repair functions and cause vasoconstriction.

Saturated fat seems to act like a natural antidepressant.  It is a source of the vitamins A, D, E and K in its own right.
Some low carbers feel best with saturated fat intakes as high as 80%.  About 50% of calories from fat which is mainly from saturated and animal sources is common in a “typical” low carbohydrate diet as described. Some of the healthiest people in the world are the Masai Mara tribes in Kenya. They drink cow’s milk mixed with cow’s blood and a small amount of beef. Cardiovascular disease is almost unheard of.

High fat/moderate protein/ low carb diets are adhered to better than low fat/low protein/ high carb diets.  Weight loss from fat stores tends to be better in low carb /high fat than in high carb/low fat diets.  Low carb diets have a greater effect on fat loss from the spare tire area in the abdomen than high carb diets.  This is the metabolically active fat that drives insulin resistance.  In addition the low carb diets improve lipids levels, inflammatory markers and blood pressure independent of weight loss.

Diabetics are particularly sensitive to dietary carbohydrate because both types one and two have do not have a type one insulin response to deal with the rapidly high blood sugars from digested sugars and starches.  Diabetics either lack insulin or the insulin they do make is much less effective than in non diabetics.  90% of ingested carbohydrate becomes sugar in the blood starting at 15 minutes and peaking  anything from 30 to 70 minutes.

Quick Quiz:
There is no quiz for this section.

Reference Info and Acknowlegements:

  • Anthony Colpo’s The Great Cholesterol Con is a good source of the published but rarely promoted research that has been done on the fats, cholesterol and cardiovascular risk issues.
  • Malcolm Kendrick has recently published a book of the same name, The Great Cholesterol Con.  This deals with similar issues. I have not read it and would be pleased to have your opinion on it if you have.
  • A free online book by Uffe Ravnskov is also available The Cholesterol Myths – Uffe Ravnskov

Where to Next?
Please all continue to the  How To: Know the Truth About Carbohydrates section.

What can you expect as your diabetic child goes through the teenage years?

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What can you expect when your child with diabetes becomes a teenager? I will discuss the physical effects, the psychological effects and the effects on blood sugar control.

 

Puberty starts in girls around the age of 10 due to the secretion of growth and sex hormones. This is all carefully coordinated between the brain and sex glands. The growth in these hormones peaks at the age of 14 and then gradually subsides. Menstruation starts around the age of 12 or 13.  For boys puberty starts around the age of 12, they generally overtake their mothers in height at the age of 14. The hormonal peak for boys is at 17 and then there is the gradual reduction. The bones of humans fuse at the age of 22 and from then on no more growth in height occurs.

 

The change in appetite around puberty is extremely pronounced. Instead of pleading with your children to eat their dinner, you have to plead with them not to eat yours as well.  They will all snack. They will develop a taste for high carb/high fat foods and Greggs, Krispey Kremes or Hortons will be their favourite.   Some may get quite tubby and then sudden shoot up six inches over the summer. You will have a hard job keeping up with shoes and clothes that reach their wrists and ankles.

 

Inside their brains a lot of pruning is going on. Brain pathways that they don’t use get lost and ones that they do firm up. Moodiness can be expected due to the changes that go on. Teenagers tend to stay up later but need a lot more sleep and need to sleep in late when they can.

 

For 14 year old teenage girls who have diabetes the natural rebellion they feel against their mothers could hardly come at a worse time.

 

Socially teenagers are both trying to fit in with their peer group and define their sense of self by exploring their differences. They want to take decisions for themselves but often lack self organisational skills and perspective. They may make utterly daft decisions. They don’t want to be babied but they need you help to almost the same extent, just in a different way.

 

Parents are a great resource for teenagers. In a study of type two diabetic teenagers the hbaic of those with good parental support was 7% compared to 11% for poor parental support.   In a study of type one UK 16 year old teenagers girls had a hbaic 2% higher than the 16 year old teenage boys. There is a menstruation effect here with girls too, but a strong difference was that 16 year old girls tended to deal with their diabetes management themselves and didn’t want their mum to interfere. The boys however were happy to have their mums help them and it didn’t affect their self esteem at all.

 

It seems to me that parental support is discouraged in the diabetic clinic that my son attends.  Parents are excluded from diabetic clinics once our offspring turns 14. This is rather silly of the doctors because the parents are the ones who have to pick up the pieces when things go wrong.  When Steven turned 14 I was informed that this would be my last sit in with the doctor at my son’s clinic.  I was informed by the dietician that she would now be educating my son whose hbaic was then 5.3% how to eat properly. I told her that she certainly would not.

 

The average hbiac for Ayrshire teenagers is 9%. The true level is probably more like 9.5% to 10% because they are mainly using capillary blood tests that underestimate hbaic. The average for Scotland is around 9.5-10%.  Steven reached the peak of his growth spurt bang on 17 and a half. His highest hbaic was 6.7% and it has come down over the last year to 6.0%. We are now finding ourselves cutting back on insulin instead of relentlessly increasing it.  In a few years he should be easily able to stay in the fives for hbaic and for parents with daughters they should by their late teens and early twenties be able to hit the sixes easily. So let’s go back a bit to what you can expect from all this eating, growing and stressing when it comes to blood sugar management.

 

The first thing you will notice about puberty is that blood sugars will increase. The next thing you will notice is that you will need more insulin to cover the same meals as you used to and that you need more insulin to correct high blood sugars than you used to. These are the easy bits.

 

The hard bit is dealing with the dawn phenomenon. This is the rise in blood sugars you get in the morning due to all the hormones that are secreted during the night. Why is this hard? Because whereas the other two are predictable and consistent, the effect of the dawn phenomenon is unpredictable and inconsistent.

 

In all cases you are going to end up giving more insulin. For the meal insulins you simply gradually increase the amount of insulin you give for a given amount of carbohydrate. From looking at  old blood sugar books I used to give Steven one unit of novorapid to cover 14g of carb. At his most insulin resistant this was one unit of novorapid to cover 8g of carb.  The complex thing is that your carbohydrate/insulin ratios vary according to the time of day. You usually have to give a lot more insulin at breakfast compared to lunch and dinner for instance.  In a short while I will show you how to work this out.

 

For correction doses you are doing a similar thing. A general rule of thumb is that one unit of novorapid will drop you 2.5 points UK. This is for a non insulin resistant  10 year old kid. As you get smaller in size you need less insulin to get the same drop. As you get more insulin resistant such as, you get bigger, your blood sugars are higher, you are ill, it is early in the morning, it is just before your period the amount will generally increase.  You have to find out what correction factors work for you. There is no short cut for experimentation.

 

The problem with blood sugar management with even the easy stuff like carb/insulin ratios for meals and correction doses is that you are aiming to shoot at a target that is moving all the time. Almost as soon as you’ve got it nailed they are off growing again. You can expect this to go on till their peak age 14 for girls and 17 for boys. And then you have a whole new set of problems, which we will talk about later.

 

This is how you work out carb/insulin ratios. Every week I get hold of Steven’s meters and do a few things. I empty all the used test strips out, I put new lancet needles in and I put more strips and needles in if necessary. I then write down all the blood sugar readings in columns related to pre-breakfast, pre-lunch, pre-dinner and pre-bed. I add up the average of the week under all these columns. If the average is between 4 and 6 (UK) or 72 and 108 (US) I do nothing different about the ratios. If they are higher or lower than this I think about why this is and I consider altering the carb/insulin ratio. You handle the pre-breakfast blood sugars differently as I will explain later.  On your way up to the peak age you will be gradually giving more insulin and as you go away back down from the peak you will gradually give less insulin.

 

You also look at the number of hypos, for us 3.5 (UK) and 63 (US) or under and try to think why this is happening. It means that the meal / insulin matching is out in some way. It could be the result of unusual physical activity. It can also be due to eating less than expected. Steven has a habit of giving too much evening meal insulin so he can treat his hypos that seem to come on at 7.30-8pm with biscuits and sweets. As long as you know what is going on you can manage it. You do need to consider if you need to cut the insulin ratio, or revise your carb counting more accurately. Just in the last few weeks I noticed that Steven had been having a few hypos after breakfast. This was an unusual pattern for him. He was eating the same low carb breakfast. What was going on is that he is finally becoming less insulin resistant in the  morning and I showed him how to reduce his breakfast insulins accordingly.

 

The big problem with the dawn phenomenon is its unpredictablility. From my experience it was on most of the time but off about one day in ten. We never knew which day. Blood sugars could be 5 UK or 90 US at bedtime, 5 UK or 90 US at 3am and 15 UK or 270 US at 8am. We could not up the night basal because  this would have given him a severe night hypo one night in ten. We just had to sit it out. The dry mouth in the morning from the high blood sugars led him to having three fillings in six months. He had never had any before this. His sweetie guzzling 14 year old brother who still has no fillings certainly laughed about this. It is ironic that the teenager with probably the lowest sugar consumption in Scotland ended up with three fillings in 6 months. It is terribly frustrating dealing with this but my best advice is that you must sit it out.

 

When you are doing your blood sugar logs, you only bother about morning blood sugars when they are too low. If the 7am is too low or your 3am is too low you have to cut your night basal insulin. If the 3am is too high, and this is not due to what your kid has eaten, then you can raise the night basal insulin. If the morning blood sugar is too high, this is the dawn phenomenon and you have to sit it out.

 

Another factor for high morning blood sugars that you need to consider is a re-bound high if there is a hypo in the night. Dr Bernstein doesn’t think this phenomenon exists but after speaking to a lot of diabetics I think it does. A clue is if you wake up sweaty, or wake up after a nightmare. In this case you may need to decrease your night time basal insulin.

 

Blood sugar sensitivity varies according to the seasons. In general you get more insulin sensitive in the summer. You are exposed to more natural vitamin D in the summer and this could be one reason. Hbaics usually go up half a percent in the winter.  Minor variations in your basal insulin and carb insulin ratios are going on all the time.

 

So, this is what goes on as you go up the insulin resistance peak. What goes on when you go down?  I can’t fully say because Steven has just started going down and we still have a way to go.  Just as the dawn phenomenon blasting holes in my son’s teeth was the worst aspect of the upswing, there is a big problem with the downswing. This is unpredictable and sometimes severe hypos. I have read that although the climb to the peak is generally slow and progressive the downswing can be quite sharp. The vigilance that is required here is to keep a close eye on basals and low blood sugars, remembering to check at 3am occasionally. If you detect a trend towards low blood sugars reduce the appropriate insulin before it becomes critical. Even then you can still be caught out. I have been told that the insulin dose Steven will eventually need could be between 1/3 and 2/3 of what he is on at his peak. The amount will depend on his natural level of insulin resistance, body weight and dietary preferences.

 

Quiz 

 

Which one of these options is NOT correct:

 

At the onset of puberty:

Correct
Incorrect

 

Parents of teenage diabetics:

Correct
Incorrect

 

On the way up to age 14 for girls and 17 for boys:

Correct
Incorrect

 

On the way down from age 14 for girls and 17 for boys:

Correct
Incorrect

 

Helping diabetic teenagers optimise their blood sugars is a challenge for everyone in the family.  How have your family managed?

How To: Follow a Low Carbohydrate Diet

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This section is for everyone. No skipping!

Overview

Dr. Annika’s Diet

Meal Suggestions for Dr. Annika’s Diet

How to Follow the Life Without Bread Diet 

How many carbs and calories do alcoholic drinks have?

How to eat out in a restaurant?

Helpful low carb books

Myths about low carbohydrate diets

Overview

Most of the diets that I have chosen to discuss have three main structures:

1. Restriction in type or amounts of certain foods or both.
2. Carbohydrate counting which is important for metabolic control.
3. Calorie counting which can be important if additional weight loss or gain is needed.

In the metabolic syndrome part I will particularly discuss Dr Annika Dalquhist’s diet and Drs Allen and Lutz “Life without bread” diet.  Anna’s is food type restriction diet and Allen and Lutz’s diet is an easy “block” method of carb counting.

In the type two – insulin resistance – diabetes section I will discuss the Atkins diet and the “Eat to meter method.”  These both give you suggestions on outcomes and you manipulate your diet to achieve them. More advanced carb counting skills are needed for both methods.

In the type one – insulin dependence- diabetes section I will discuss Dr Richard Bernstein’s diet and Dr Lois Jovanovich’s diet.  Both these doctors have type one diabetes themselves.  Dr Bernstein is at the strict end of the scale and Dr Jovanovich’s diet is at the more liberal end. By understanding both concepts I hope you can find an eating plan that suits you.

All the dietary plans are suitable for all ranges of glucose metabolism disorders. What will be important is how much you need to control your blood sugars, how much weight you want to lose, how good your carb counting skills are and how much carbohydrate you feel you “must have.”

Dr Annika’s Diet

Carbohydrates are food items that contain sugar and starch.

Dairy products contain fat and variable amounts of carbohydrate and protein.

You may eat full cream milk, yoghurt, feta cheese, cottage cheese, creme fraiche, cream cheese, butter and mayonnaise.
Avoid low fat, lite, or sugar added products.

Meat contains protein with variable amounts of fat.

Eat beef, pork, lamb, chicken, fish and shellfish. You don’t need to remove the fat.

When eating ham, sausage and other processed meats be aware that they often contain sugar and starch as binding and fillers.  Choose items that are not more than 5g carbohydrate in 100g of the item.

Eggs are great. High protein and low in fat and carbs.

Herbs, spices, stock, salt, pepper and low carbohydrate sauces will help your food taste pleasant and exciting.

Most vegetables, olives and linseed are good.

Cold pressed oils can be used for dressing and cooking. Olive, rapeseed, linseed, coconut, palmoil and macadamia nut oils are good. Avoid commercial vegetable oils as they contain partially hydrogenated and trans fats.

Unless you eat a lot of fatty fish such as sardines, trout, salmon and herring you may benefit from an omega 3 oil supplement.

Foods to limit or avoid:

Potato and potato products such as chips and crisps.
Rice and rice products.
Corn and corn products eg cornflakes.
Grain based products eg pasta, bread, biscuits, breakfast cereals and porridge.
Sweets, cakes, pastries, non diet fizzy drinks and fruit juice and cordials.
All sugar and sugary products.
Margarines and processed oils contribute to cardiovascular problems, diabetes, weight gain, cancer and allergies.
Oils with a high omega 6 content eg corn oil, sunflower oil, soya oil, peanut oil.

You may be crying when you read this list but I promise you that you can soon get into the way of making much lower carb and healthier versions of many baked goods and desserts.

Many people have been brought up on potatoes and bread and find it particularly hard to let go. Reduce them gradually. Not too gradually!

You may eat a little of these foods:

Beans, lentils, nuts, sunflower seeds.
Fresh fruit.
Chocolate with a high cocoa content such as over 60%.

Avoid dried fruits and fruit juices as there is too much sugar in them.

When you are trying to lose weight the legumes, fruit and chocolate may stall your weight loss. Could you give them up for a while ?

What about alcohol? It also can add to the calories and more importantly can affect your judgement on portion sizes and will power.  Beer in particular contains maltose which is a very fast acting carbohydrate.  Dry red and white wines are somewhat healthier for you.  But only in small quantities.

MEAL SUGGESTIONS FOR DR ANNIKA’S DIET

Breakfast options:

Yoghurt with 1-2 tablespoons of linseed or sunflower seeds. Add wheat bran if you are prone to constipation.

Eggs, sausage, bacon, ham, black pudding, mushroom, tomato.

Omelettes with meat/fish/vegetables

Low carb baking eg cheesecakes, muffins with double cream and small quantities of fruit as desired.

Coffee or tea with cream or milk.

Lunch and supper options:

Mainly meat/fish/eggs/cheese based dishes with vegetables or salad vegetables such as celery and avocado.

Avoid low fat products. Many stews, soups and gratin dishes are naturally low in carbohydrate. You can adjust most recipies to give a much lower carbohydrate alternative.

Cooked cauliflower especially with cream, cheese and seasoning makes a great substitute for potatoes.

Grated cabbage and carrot with an oil and vinegar dressing makes a good base for a salad.

Quick snacks to tide you over till the next meal are cheese slices, ham, sausage, yoghurt, nuts, olives or boiled eggs.

Crisp breads can be loaded with butter, cheese, ham and other toppings.

At a buffet load up with the high protein and fat items and leave the carbohydrates alone.

Fruit does raise the blood sugar so avoid or take a lot less of the higher sugar tropical types such as bananas and grapes and eat moderate portions of the temperate grown fruits such as apples and pears.

If you do eat a high carbohydrate meal you are likely to feel hungry or get another carb craving after about an hour or two when the high blood sugar starts to drop.  Just take a low carb snack at this point. This will help your sugar and insulin levels get on an even keel again.

Low carb diets work because you don’t experience a raise in blood sugar after eating. You avoid the pancreas releasing excess insulin which lowers your blood sugar making you feel hungry again.

Insulin is a major fat storage hormone. It converts the carbohydrate you eat into fat.

Your body can make enough glucose and energy for essential processes all by itself from the protein and fat in your food. Your muscles and brain work just fine with a mixture of ketones and bodily produced glucose.  This steady production of sugar in the body is called gluconeogenesis and it can occur in the liver, kidneys and intestinal tract. Reliance on mainly fat and protein for energy mean that you don’t need to load your body with fast sugar releasing carbs that raise and lower your blood sugar and insulin levels causing unhealthy metabolic effects.

This low carbohydrate diet is very suitable for anyone who wishes to lose weight.

If you are on any medication or insulin to lower your blood sugar, for instance if you have type one or two diabetes, you must reduce the carbohydrate in your diet gradually and do more frequent checks on your blood sugar. This diet  very effectively reduces your blood sugar and to balance this you will need to have a progressive reduction in your medications and insulin.

 

HOW TO FOLLOW THE “LIFE WITHOUT BREAD” DIET

This diet is quite similar to the carbohydrate exchange method that was used for many years by diabetics.

The authors, Dr Christian Allen and Dr Wolfgang Lutz have counted out units worth 12g of carb each for most food groups.  They suggest that for most people eating six x 12g of carbohydate a  day will give around 70g of carb a day which is palatable and  helps weight loss, diabetes control and other autoimmune illnesses.

For people over 45 or heart or autoimmune problems they suggest starting at 9 x 12g a day and slowly reducing to 5 or 6 such portions. (60-70g carb a day).

This method gives a bit more flexibility over what foods you can eat compared to Annika’s diet. The basic diet free intake of fish, meat, eggs, cheese, dairy products, non starchy vegetables, moderate intake of nuts and alcohol remains the same.

All carbohydrate containing foods such as grain products and potatoes, sweetened foods, sweet and dried fruits must be accounted for.

For the full list of foods see their book, “Life Without Bread.”

For illustration purposes I will list a typical day that you may have on this diet.

Breakfast
3 egg omlette with onion and peppers
half a grapefruit one unit
Coffee with cream

Lunch
Cold roast chicken
lettuce, one medium tomato, half an avocado 1.2 units
1/4 cup of rice (before cooking and seasoning) 3 units
Tea with small amount of milk

Evening meal
Peppered steak with cream sauce and mushrooms one unit
Slices of danish blue cheese and brie with celery
Two glasses of wine 0.8 units

The trick is to fill up on a wide variety meat and fats and reserve your carbohydrates to give a bit of variety to your meals.  Instead of basing your meals on  the same old  bread, potatoes, rice and breakfast cereals  base them around meats/fish/eggs and cheese and non starchy vegetables.

For a lot of people it is harder to eat  low carb away from home and if this true for you allocate more of your allowance to these meals and make the effort to cook delicious low carb meals at home.

 

HOW MANY CARBS AND CALORIES DO ALCOHOLIC DRINKS HAVE?

For non insulin users alcoholic drinks are just a matter of carbs and calories to worry about. For insulin users however the issue of delayed hypoglycaemia needs to be understood.  For diabetics of both types one and two anything more than light or very modest alcohol drinking is not compatible with good control and safety. Many people have no idea what drinks contain and this list aims to give you relevant information on that point.

Beer one pint 13g carb 170 calories
Lager 500mls bottle 7.5g carb 146 cals
Stout 275 mls bottle 11g 100 cals

Cider dry one pint 15g 207 cals
Cider sweet one pint 25g 242 cals
Cider vintage strong one pint 42g 580 cals

Dry wine (red or white) 125mls trace carbs 85 cals (some say allow 5-10g)
Sweet sherry 50mls 3.5 carbs 70cals
champagne 125mls 2g 95 cals

Any spirit 25mls trace carbs 60cals

Bacardi Breezer 275mls 20g 170 cals

Soft drink 120mls 14g 50 cals
Tonic water 120mls 12g 45 cals
Gin and Tonic 245mls 16g 170 cals

Diet drinks and water have no carbs and no cals.

 

HOW TO EAT OUT IN A RESTAURANT

Doctors Mike and Mary Dan Eades are the authors of “Protein Power.”  This has an excellent section on eating in international restaurants both the dos and the don’ts.
It also gives clear scientific reasons for low carbing and the advantageous effects fo this diet on the metabolic syndrome.  There is also a good recipe section.

Here are a selection of what you can eat in restaurants.

Drink a single glass of wine as 5g
Drink mainly diet drinks, water, tea and coffee without sugar.
Dessert can be berries and double unsweetened cream, fresh fruit salad or cheese.

Bistro

  • Grilled meat fish or fowl, green salad, blue cheese or vinaigrette dressing.
  • Eat vegetables instead of potatoes, pasta or rice. No bread or crackers.
  • Chefs or caesar salad but no croutons.
  • Quiche but don’t eat the crust.
  • Tomato stuffed with chicken, tuna, crab or cottage cheese.

BBQ

  • Beef, pork, chicken, dry ribs, tossed salad, devilled eggs.

Fast Food Burger Restaurants

  • Eat the fillings of grilled chicken, burgers including cheese and bacon. No buns or chips.
  • Chicken salad but miss out the croutons.

Chinese

  • Hot and sour soup
  • Beef or chicken kebabs
  • Beef, chicken, pork, prawn dishes with broccoli or assorted chinese vegetables. No noodles, rice, or pancakes.
  • Dry ribs. Avoid sweet sauces.

French

  • Clear soups
  • Green salads
  • Beef, pork with butter or peppercorn sauce.
  • Roast lamb, duck or other poultry.
  • Grilled or poached fish.
  • Mixed vegetables.
  • Avoid sauces thickened with flour.

Indian Restaurants

  • Tandoori chicken or lamb.
  • Chicken, beef or lamb curry.
  • Chicken tikki or chicken masala.
  • Tossed green salad, tomato and cucumber salad, spinach, mushrooms.
  • Vegetable accomaniments are often good choices. Try cauliflower instead of rice with a meat curry.
  • Avoid breads and potato dishes.

Italian Restaurants

  • Cured meats and melon
  • Chicken or veal, grilled fish, pork. Avoid breaded items.
  • Salad and vegetables instead of pasta, risotto or bread.
  • Steak Diane.
  • Veal in cream sauce.
  • Cheese and a few grapes or apple slices for dessert

Japanese

  • Sushi but under eat the rice or order sashimi which has none.
  • Miso soup.
  • Terriyaki chicken, beef, fish, prawn.  No tempura as it is battered.

Mexican

  • Chicken or steak fahitas but miss out the tortilla. You can have the guacamole, sour cream and vegetables.
  • Meat and salad.

Pizza

  • Pizza toppings only.
  • Buffalo wings with the sour cream rather than bbq sauce.
  • No pasta, bread dishes or ice cream.

 

HELPFUL LOW CARB BOOKS 

Atkins for Life: The Complete Controlled Carb Program for Permanent Weight Loss and Good Health. Very good clear book for long term low carbers. Atkins is the standard text on which many other low carb diets are variants. This is the most flexible regarding what fat and what carb you can eat.

Dr. Atkins’ New Diet Revolution, New and Revised Edition.  The orange paperback. You can probably borrow someone’s. In every workplace or club someone has done Atkins or knows someone who has.

Atkins Diabetes Revolution: The Groundbreaking Approach to Preventing and Controlling Type 2 Diabetes.  More tailored to the type 2 diabetic.

Protein Power: The High-Protein/Low Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health-in Just Weeks! by Drs Mike and Mary Eades has been recommended by diabetics.

The Diabetes Diet: Dr. Bernstein’s Low-Carbohydrate Solution. A companion to Dr. Bernstein’s Diabetes Solution.

I find it hard to choose between Atkins for Life and Protein Power as a basic book for people with metabolic syndrome but due to a better cooking section and clearer reasoning of the scientific evidence in Protein Power I recommend the Eades book if you are only going to buy yourself one book on the subject.

For other Low Carb books that are recommended by our members ,please Click Here or check out the books recommended on D-solve .

 

MYTHS ABOUT LOW CARB DIETS

“Living the low carb life.” by Jonney Bowden gives lots of reference material throughout his book.  One thing that always comes up when you tell your friends that you are going to go on a low carb diet are what I call the “Oh. Buts”   Here are some of the commoner myths regarding low carb diets as explained by Jonney Bowden.

Myth One. Low carb diets induce ketosis, a dangerous metabolic state.

Dietary ketosis is not the same as diabetic ketoacidosis. The ketosis of a  low carb diet is also not the same as the ketosis of starvation. Many studies have demonstrated the safety of ketogenic diets even for children.

Myth Two. Low carb diets cause calcium loss, bone loss and osteoporosis.

Higher protein intakes do not cause bone loss or osteoporosis especially in the presence of adequate mineral intakes. In fact lower protein diets are associated with more bone loss.

Myth Three. High protein diets cause damage to kidneys.

Higher protein diets do not cause any damage whatsoever to healthy kidneys.

Myth Four. The only reason you lose weight on a low carb diet is because it is low in calories.

Calories count but so do hormones. Many studies show more weight loss on low carb diets than on high carb diets with the same number of calories.  Also more of the weight lost on low carb diets comes from fat. Better blood biochemistry occurs too. Lowering fat intake is not the only answer to obesity.

Myth Five: Low carb diets increase the risk of heart disease.

Low carb diets do not increase the risk of heart disease and in fact they improve blood lipid profiles.

Reference:  Scientific evidence for the erroneous myths have been gathered and presented in a paper by Anssi H. Manninen. High Protein Weight Loss Diets and Purported Adverse Effects. Where is the Evidence?  Sports Nutrition Review Journal. 1 (1): 45-51, 2004. (www.sportsnutritionsociety.org)

Manninen works at the Dept of Physiology, Faculty of Medicine, University of Olulu, Finland.

Quick Quiz:
1. Low carb diets…
a Cause ketosis which is a dangerous metabolic state.
b Lead to calcium loss so causing osteoporosis.
c Increase your risk of heart disease by adverse effects on blood lipids.
d Reduce the risk of heart disease by helpful effects on blood lipids and blood sugar.

2. In a Chinese restaurant the best single choice would be..
a Crispy duck with pancakes.
b Chicken chow mein.
c Prawns cashew nuts and assorted Chinese vegetables.
d Pork in batter with sweet and sour sauce.

3. In a French restaurant you could eat three of these. Which one is off the menu for you?
a Confit de canard.
b Chicken with peppercorn sauce.
c Sole meuniere.
d Crepes flamed with apple brandy.

4. In an Italian restaurant which one of these would you not consider eating?
a Risotto milanese.
b Melon with procuttio.
c Cheese and a few grapes and apple slices.
d Steak Diane.

5. In a Japanese Restaurant you could choose from three of these. Which one would you not eat?
a Sashimi.
b Miso soup.
c Beef Teryaki
d Sushi.

6. A good choice of vegetable to have with your meal could be one of these…
a Fat free pureed carrots.
b Green beans with butter and slivered almonds.
c Mashed potato with cream and butter.
d Baked parsnips.

7. A drink could be chosen from one of these…
a Bacardi breezer.
b Coffee with cream.
c Red wine.
d Gin and slimline tonic.

Have you got it?
1. D is correct. The others are common myths about low carb diets.

2. C is correct. The rest have a lot of starch included and the sweet and sour sauce is also very high in sugar.

3. ABC are good choices. The small amount of breading on the fish is not a concern as long as the vegetable choices are low carb.

4. BCD are good choices. The risotto is mainly rice and picking out a few mushrooms or bits of seafood to eat from these dishes is rarely worth the effort.

5. ABC are good choices. Sushi has a rice base. You would need to eat the fish toppings only to avoid this which makes this a very expensive meal. Sashimi is simply the raw fish without the rice.

6. B is correct. Ther rest are cooked starchy vegetables that will have your blood sugars soaring.

7. BCD are suitable. Mineral waters are also a good choice. Many pre-mixed alcoholic drinks are heavily laden with sugar.

Reference Info:
Dr Annika Dalqhist is a Swedish doctor who has had her low carbing blog made into a book. She has enthusiastically approved of my efforts to spread the word about what works with obesity and diabetes and has provided a translation for those of you who don’t understand Swedish. Thank you Annika.

Where to Next? 
I reckon many of you are now desperate to head off to your favourite restaurant to try out your new skills in meal choices. But it’s not all about eating on this course!

Whenever you are ready you may all now proceed to the  How To: Exercise section.

How To: Lose Weight and Keep it Off

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This section gives many tips on how to reduce and maintain a weight that you are happy with.

If you are happy with your weight you may wish to skip this section and move onto the How To: Follow a Low Carbohydrate Diet section.

How motivated are you to achieve a healthy weight and stay there?

Is it something that you have tried to do before and not reached a weight you were happy with?  Perhaps you did become slim again but somehow the weight gradually returned?

Here are some tips from fellow health minded people to give you some inspiration and help.

Have a clear picture in your head of how much worse you will look and feel if you keep on your current habits for the next year, five years or ten years.

Have a clear picture in your mind of what benefits you will have when you are a healthy weight or even a little slimmer than you are right now. How will you feel? How will you behave differently?

List the foods that you eat a lot of, that you know you can’t resist, and that you know are stopping you losing body fat. If you really cannot resist them perhaps it is best to decide not to buy them and not to eat them at all.

Keep an accurate food and drink diary.

Plan to eat or have a snack every 4 hours or so to prevent you overeating when you are hungriest.

What activities can you do to relieve stress and boredom?  List the sorts of things you can do indoors and outdoors, in company and alone that you are going to do instead of eating to deal with emotions.

Cut back on your portions.   Measure them.

Stop eating when you are not hungry any more. Not when the plate is empty.

Eat a good breakfast. High protein is best as it fills you up for much longer than carbohydrates. What sorts of high protein breakfast items are you going to stock up on to get your day off to a good start?

Avoid anything other than small portions of sugar and starch. They can be very addictive for some people.

Eat real food. Avoid the processed package meals that have lots of unhealthy fats, sugars and chemicals added.

Have a high protein or fibre afternoon snack to prevent you gorging at your evening meal.

Eat your evening meal early enough that you have time to digest it before bed. You will be less hungry with an earlier evening meal too.

Carry a small high protein snack with you. Boiled eggs? Cheese triangles? These are more filling than a danish pastry and will keep you out of trouble.

Eat enough protein at your main meals to stop you becoming ravenous before the next meal.

Shop for food on a full stomach. Your impulse buys are likely to be less.

At a buffet fill a small plate once.

If you have an indulgence get back on track right away. Not Monday and not tomorrow.

How can you reward yourself without using food?

Foods that fill you up include seafood, eggs, meats and  high calcium dairy foods.

Eat meals that contain a  fixed amount of calories or have a fixed portion size.

Think about how you are cooking your food.  Fried food and dressings can easily add a lot of calories.

Stick to your good habits once you are at a weight you are happy with.

Wear attractive neat fitting clothes.

Don’t allow yourself to go more than 5 pounds over your goal weight.

Exercise every day if you can and at least three times a week.

Think ahead about what healthy foods you need to buy so you don’t run out.

Weigh yourself or put on a particular close fitting outfit (eg trousers) once a week. You need to know when you are going off track.

Cutting calories one way or another is usually needed to lose weight. A typical weight loss programme for a woman will be 1,200 kilocals and day and 1,800 for maintenance. The type of food won’t change just the higher quantity you can allow yourself when you have stabilised at a weight you are happy with.

Look at the internet, books and speak to your friends about what works for them before deciding which plan to commit to. What sort of programme would suit you best?

Exercise during and after weight loss.

Change aspects of your life that have been making you unhappy. This can help your mood considerably.

Develop other interests in your life that don’t involve food and drink.

Low carbohydrate diets tend to cause more weight loss through better compliance than low fat/ calorie counting diets. Lack of hunger is a main advantage. For diabetics or people with metabolic syndrome there are are other benefits such as more predictable blood sugar control, lower blood pressure and healthier lipid patterns.

Some kinds of diet work better for different people. Do your research and once you decide on a plan stick to it consistently for best results.

Quick Quiz

A useful strategy to control your weight is...

Correct
Incorrect

You should eat...

Correct
Incorrect

A useful strategy to help you eat less is to...

Correct
Incorrect

Reference Info:
Dr Stephen Gullo’s book The Thin Commandments: The Ten No-Fail Strategies for Permanent Weight Loss discusses the common emotional and behavioural patterns that determine how successful we are likely to be in sticking to a food plan for weight loss and weight maintenance.

I have summarised some of his more important tips in this section. If you want to understand more about how your brain could work better FOR you instead of AGAINST you when it comes to dieting, this book is a good start.

Where to Go Next?
Now please continue onto the How To: Learn About Metabolic Syndrome