low carb

How To: Do the Atkins Diet

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This section is for everyone. Even those of you who may have done the Atkins or lived with someone who has.

The easy way to do the Atkins diet is to buy one of Dr Robert Atkins books and do it.

The book I would particularly recommend is Atkins for Life the Next Level.

This is a simple introduction to low carbing and it covers all the basics you should know about.  The book discusses the research information, the relative importance of protein, fat and carbohydrate in the diet and gives you various meal plans and recipies that you can incorporate into various total daily carb plans.

What I like about it is its versatility between carb plans from 20-120g of carb a day.  Compared to the Zone diet it is more versatile about the amount of carb that may suit you and compared to the South Beach diet there is no unnecessary restriction on saturated fat.

When you do a traditional Atkins diet you start at 20g of carb a day and gradually increase your carbs as far as you can till your weight loss levels out.  For many people who are just plain fat and who are not on any medication that could affect their blood sugar this is usually fine.

For anyone who is on insulin or blood sugar lowering medication  such as sulphonureas which includes gliclazide or metaglinides this would not be such a good idea. In fact such a drastic reduction could be dangerous.

But the Atkins diet has in my opinion still a great deal to offer. For those people who have pre-existing heart disease or are otherwise at greater than average cardiac risk, or who are on medication or who perhaps are getting on a bit – over 45 – for instance why not do Atkins in REVERSE?

What I am proposing is to take things nice and slow.  If you have any glucose metabolism problem you are going to have to restrict your carb intake for the good of your long term health sooner or later. You have to face this sometime.

From my previous discussions about how to measure the carbohydrates you eat you can surely find some way that suits you to find out how much carb you are currently consuming.

Whatever this is you need to start here.

That’s right.

Start wherever you are and start to cut down.

Week on week. Day by day. Meal by meal. Carb by carb.

If you are over 120g a day that is okay. If you are already on say 90g a day that is okay too. Simply look at the weight loss and blood sugar goals you want to achieve for your future health and start right away.

Many people will get what they need at the higher ends of the Atkins range such as those following the Zone or perhaps Dr Lois Jovanovich’s guidelines at about 120g of carb a day.

Some will want to drop their carbs further such as those people who are following the Drs Eades Protein Power plan or the diet advocated by Dr Allen and Dr Lutz or Dr Jorgen Vestig-Nielsen or Barry Groves at around 70g a day.

Others will not get to what they want until they get to Dr Bernstein’s diet of between 30-42g of carb per day.

You decide.

What do you want to achieve?

What amount of carb restriction is likely to be necessary to acheive this?

How slowly must you go down for safety?

Whatever the answers are for you, I hope this internet course can help you get what you want with safety  and with the knowledge of companionship along the way.

Quick Quiz:
There is no Quiz in this section. All the questions in this section have been ones to ask of yourself.

Where to Next?
The last few sections may have been a lot tougher than you were expecting. Have you got an idea of the amount of food recording and sums that you are going to be doing from now on?

I think it’s time for a little change of scene.

It’s back to Home Economics 101 for your lessons on How To: Cook and Bake the Low Carb Way.

Even if you’ve never boiled an egg your life, the quality of food you will soon be able to serve to yourself your family and friends will greatly improve when you’ve taken the plunge.

 

How To: Do Dr. Morrison’s Carb Weighting System

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This section is for everyone who wants to “cheat” on their low carb diet and minimise the consequences.  If you can see yourself happily low carbing without the need to cover higher carb meals you may skip to the How To: Time Insulin Injections for Simple Insulin Regimes.

You need to wean yourself gradually off your high carb diet.

You need to be in a typical transition period at the very least.

You need to adopt the 7 unit per shot guidelines.  Every single shot.

Your need to find out which methods of carb counting work best for you and do them every meal.

You need to keep your basals, exercise, and fat and protein intake consistent over the testing period.

You need to be well and free of infection or undue stress so your meal profiles will be accurate.

You need to test at 3am on an experiment day to see you have not over done your insulin.

Ready?

What you are going to do is find out at what level your insulin stops working in a linear way.

You will recognise this by high blood sugars before the next meal compared to when you eat low carb meals. I don’t know when this will kick in for you. For Steven it was good bs at 30g and higher bs at 40g for the same carb insulin ratio.

The best meal to test on is your lunch. Your dawn phenomenon is not active. Your dusk phenomenon is not active. Your carb sensitivity is usually at its best. You are awake and can deal with any adverse effects on your blood sugars by correction doses before your evening meal.

It is too risky to experiement on yourself at your evening meal. Throughout this experimentation process the only sugars that were consistently perfect for Steven were the before bed ones for this reason.

You need to add a smaller incremental dose of insulin to the one calculated for your carb sensitivity for that meal.

Test yourself on items that are easy to calculate eg breakfast cereals that are easily weighed and bread slices that are listed on the package. Packaged processed food with carb labels are helpful for these experiments.

Decide on how many units of insulin extra you will give per 10g over the baseline figure.

Make this a very low amount. If you can change to a half unit pen. The novonordisk demi pens and junior pens have this facility and humalog has just become available in half units too.  Of course this is not a problem with a syringe.  For a child you may wish to consider extra accuracy from diluted insulin.

We started on 0.5 units novorapid for each 10g extra increase in carb.

If your figures are showing that this is giving sugars higher than your next pre-meal target you can up the amount of additonal carb weighting insulin by a small amount.

If your figures are showing that the next pre-meal bs is too low then up the amount of carb stages eg in 5 or 10g increments till you figure out what works.

This carb weighting method is accurate for Steven up to 90g of carb per meal. After this our levels are inaccurate.  They are usually lower than expected on this exponential weighting but sometimes are higher.

You could find that you need to start carb weighting at levels of less than 40g.

You could find that you don’t need to start carb weighting till levels of 50g or higher.

You may find half unit increments  need to be used at additional carb levels of  5g, 10g or 15g or 20g levels.

You will need to determine when this system stops being accurate for you. This could be at levels considerably lower than 90g or could perhaps be higher.

Remember to only do the experiments when conditions are optimal for this.

You are well.
Your carb levels are accurate.
You are starting at normal bs.
It is lunch time.
No unusual exercise is involved.
You are not particularly stressed.
You have help to figure out what you are doing.

By a slow process of guess and test you can find out how to extend the carb in your meals and still get normal bs levels before the next meal.

I would again stress that low carbing is the safest option.

Once you know how to deal with higher carbs at lunch safely you can test this out at other meals.

Once you have learned this method use it wisely. It is for emergency situations and special indulgences. If you use it day in and day out you may indeed have normal bs levels before your meals and at bedtime, but you will be spiking a lot more than any non diabetic will.  It is not only high blood sugars but widely fluctuating blood sugars that are causes of complications.

Quick Quiz:
There is no quiz for this section.

Where to Next?
Please continue on to the How To: Time Insulin Injections for Simple Insulin Regimes section.

Reference Info:

NOTE: the calculator is no longer available, but the methodology below may be of interest for those interested in creating their own app or tool (e.g. spreadsheet).

The insulin calculator in the download section of this site is a great help AFTER you have done your personal experiments and calculations.

It is a simple programme with three background tables that can be adjusted by you if your insulin sensitivities change.

The first factor which you adjust for are your insulin sensitivity at breakfast, lunch, dinner and bedtime. This has been covered on a previous module on the course.

The second factor which you adjust for is the carb weighting factor. This module shows you how to do this.

The third factor which you adjust for is your correction bolus for certain high blood sugars. For simplicitity I recommend that this is only done before meals. The module on how to deal with high blood sugars further on in the course covers this aspect.

The insulin calculator is useless and even dangerous if you rely on it for your insulin doses without having done the necessary background study, experiments and personal calculations.

What it does do however is make it unnecessary to do the same calculations every time you are about to eat a meal. Once up and running you only need to change it if any of the three factors need adjusted. The one most frequently changed is the carb sensitivity factors which can vary according to monthly cycles in women and seasonally im most other type ones.

Steven has a portable version on a palm top and we are hoping to put a downloadable version on this site very soon.

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.