Happy Saturday! Or maybe not so happy if you’re dealing with the weight struggles that some of our readers are writing in about this week. Got the dieting blues? We hear you. Please take a gander at this week’s edition of Ask D’Mine, hosted by veteran type 1, diabetes author and community educator Wil Dubois. 
{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}
Debbie from Washington, type 2, writes: I’ve had diabetes for about 15 years. I maintained my weight fairly well, maybe 15 lbs. over ideal, until I eventually started insulin. I gained 40 lbs. in about 6 weeks and my weight just keeps going up as does my need for more and more insulin. I am 5’3” and weigh 250 lbs. I have bad knees and this extra weight makes it very difficult to walk or exercise. I went to Disneyland last year and had to be pushed around in a wheelchair for much of the time (devastating). I must lose weight!! Can you recommend supplements that may help in my endeavor? Diets, meal plans, anything that might help would greatly be appreciated. Please help me.
Wil@Ask D’Mine answers: Ohmygosh, that Disneyland story almost made me cry. That’s awful, and I’m so sorry to hear about your troubles. I’ve got a couple of ideas that might work, but first some background: Weight matters. Too much weight is hard on the heart, hard on the knees, hard on insulin resistance, and hard on the ego.
The medical types use something called the body mass index, or BMI, to classify the relative health risks of various weight-to-height ratios. It’s a far from perfect system, but it least it gives us a vocabulary to use when talking about how serious someone’s weight is. So I ran your BMI here and got a score 44.3. Now, anything above 30 is a red light when it comes to living long and prospering. So yeah… Umm… yours is pretty bad. In fact, you fall into the rudely named category of “extreme obesity.”
By the way, as a complete side note, I was stunned to hear how quickly you went from basically OK to disasterville. Weight gain is often seen with insulin starts, and the question of whether insulin causes weight gain, or if weight gain is a side effect of reigning in high blood sugar, or a combination of both, is a controversial hotly contended subject amongst insulinologists (OK, I just made that word up) and waaaaaaaay beyond the scope of today’s column. Today we’re just gonna focus on how to get the frickin’ weight back off of you; and to that end we need to understand how extra weight happens.
But first we need to talk about cars.
I drive a Jeep. I love my Jeep. It can go pretty much anywhere, regardless of whether there is even a road to anywhere or not. But my Jeep uses quite a bit of fuel to do so. Even out on the open pavement at 85 miles per hour… Uh… I mean 75 miles per hour, of course… I only get 22 miles per gallon. So I trade spectacular off-road performance for a hefty dent in the wallet. My tree-hugger friend (I only have one of those) drives a Prius and gets something like twice the gas mileage I do. Of course she can get stuck in a garden-variety mud puddle, too. And then she’ll need to be rescued by someone like me, in a Jeep.
Anyway, my point here is that the whole your-mileage-may-vary thing is true not just of cars, but of human bodies, too. In general, the human body gobbles up around 2,000 calories per day. But unlike cars, if you put too much gas in the tank, instead of dribbling out the excess fuel onto your feet, the extra fuel is converted to fat and stored for a rainy day.
So if you eat more than you burn, you put on weight. And it doesn’t take much extra, either. Consider this: If you eat 10 lousy calories more per day more than you need, you’ll put on one pound by the end of the year. 100 calories more per day buys you ten pounds. And so forth. It doesn’t take much more than you need to give you real trouble.
To lose weight you need to take in less than you burn. That forces the body to draw on those rainy-day fat reserves. So, in theory, cutting your calorie intake by 10 less than you need melts a pound in a year; 100 less than you need melts ten pounds in a year, and so forth.
So, how to go about cutting those calories?
Now, I haven’t seen any evidence to convince me that any of the “supplements” are really going to help you lose weight, so let’s talk diet. Yeah. I know, I know. The word “die” is in diet and it’s easier to change your gender than your diet. But, really, diets are just different approaches to reducing calorie intake; and that’s what we need to do to get the extra pounds off you.
So here are my favorite diets: the smaller plate diet; the turn-off-the-f*ing-TV diet; the bear-trap-in-front-of-the-fridge-at-night diet; the measure-the-damn-carbs diet; the exploding seconds plate diet; and the refrigerator-ectomy diet.
And yes. Of course. I’m writing a book on each of these diets in hopes of creating the next big fad, cashing in on it, and retiring to Aruba on my royalties. (Actually, I’ve never been to Aruba, and I don’t know if I’d even like it. But I digress…)
Bottom line: You need to eat less, and you gotta trick your mind into being happy eating less. So… Look at your portion sizes. You need to keep them smallish, and smaller plates can help you do that… Don’t let your mind be distracted while eating. It’s a proven fact that folks who eat in front of the TV eat more than folks eating at tables with the TV off… If you snack at night, make sure it is very low calorie. Think rice cakes or fresh veggies… Use the proper portions of high-carb sides. Did you know a “proper” portion of rice is only a third of a cup? Measure it… Wait at least 15 minutes before having seconds. And it would be better if you never had seconds at all. Ever. Oh, and no cheating and putting two servings on your plate in the first place!
It’s hard, especially at first. But to lose weight, you need to put less fuel in the tank. Just keep your eye on the prize. Think how much better you’ll feel when you are back down to 15 pounds over ideal!
Oh and one last thing: If you fall off the wagon, just get up, dust off your jeans, and jump back on again. Failure happens. Just don’t stay in a state of failure.
PS: of course there’s something in the medicine cabinet that has been shown to keep blood sugar in check and help you lose weight: The GLP-1 meds Byetta and Victoza. Neither of these popular injectables are magic bullets. They don’t melt excess fat. They simply reduce most people’s appetite, which causes them to eat less without being hungry, which causes them to reduce their calorie intake, which PRESTO! causes them to lose weight. Yep. They’re just a diet in a syringe. (OK, well, in a pen, actually. But you know what I mean.) You might want ask your doctor if a diet in a syringe is right for you.
Meanwhile, on the other side of the coin:
Mendell from Washington, type 2, writes: I have an unusual problem — I need to gain weight. I’ve had type 2 since 2005 and lost weight as soon as I began my medications (Metformin & Glipizide), and then kept losing more weight over the next few years. I am now down to about 130 lbs. and am 5’9” tall. Not Good. Do you know of any products that are good nutrition that can help? It has to be sugar free, of course. And please do not respond by telling me, “You’re so lucky to be thin . . .” I hear it all the time. (Sorry and my prayers go out to those who are trying to lose weight.)
Wil@Ask D’Mine answers: OK. I won’t tell you that you are lucky to be thin, ‘cause I’m not actually sure that you are. Well, more correctly, I’m not sure that you’re too thin, anyway. Like I did with our first reader, I ran your BMI and got 19.2, which is towards the bottom end of the “normal” weight range, and thus not medically underweight.
But that said, if you think you’re too thin, I guess that’s good enough for me. And I’m here to help you fatten up. But first some myth busting: Your diet does not need to be sugar-free. Anyone with diabetes can have sugar, that whole “no sugar” thing is an urban myth like alligators in the sewer and spontaneous human combustion. Of course, some kinds of sugar are worse than others. You should avoid drinking sugar, for instance. Liquid sugars tend to out-pace even our best meds. But you absolutely can eat some sugar or stuff with sugar in it.
Still, don’t get me wrong, I’m not advocating the Entenmann’s Doughnut Diet to fatten you up….
As a side note, both your meds together are technically weight neutral, so I’d be willing to bet that your weight loss was due to changes in eating habits after you were diagnosed. It’s got me wondering if fear of high blood sugar has you half-starving yourself to death. But that aside, you need to do the opposite of what our earlier reader has to do. You need to put more calories in the tank every day than you burn, so that you can gain weight. And you’re 100% right, this is not as fun, or as easy, as it sounds for this simple reason: most really high calorie foods are hard on the blood sugar.
Yes, there's a bar for that!
So to eat more, we need to look at how you eat now. If you eat three small meals a day, maybe we could add a fourth, or some snacks. Or maybe we can increase your portion sizes a little bit. We also need to look at high-calorie foods that are low on the glycemic index — foods that turn to sugar slowly in your body. Nuts and sunflower seeds come to mind as an example.
Of course, everything has a cost. Most foods that are high in calories and low in sugar tend to be high in fat. That’ll be OK, unless your cholesterol is high. But check out this list here for more ideas (50 to be exact) for foods to fatten you up.
You know, what we really need is some sort of Star Trek technology to move extra fat from those who don’t need it to those who do. But in the meantime, my prescription for you is to eat, drink, and be merry. In less moderation than you are doing now.
Disclaimer: This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.
How embarrassing, to have to use a wheelchair at Disneyland just because of a weight problem! Fortunately, we know that a low-fat (~10% of calories), high-fiber, high-carbohydrate (75% of calories) vegan diet enables people to eat as much food as they like while losing weight and curing their type 2 diabetes.
http://care.diabetesjournals.org/content/29/8/1777.long
You don’t need to “eat less” or “move more” to cure your type 2 diabetes. Simply eating the right kinds of food can cure the diabetes, even if the amount of activity stays stable. Of course, you could get better results even faster if you also start exercising.
As for the person who is thin with type 2, scientists have known since the 1930s that a high fat intake can cause insulin resistance, even if the person isn’t fat. http://wheredogorillasgettheirprotein.blogspot.com/2011/07/thin-diabetes-fat-diabetes.html
So…. the actual study was done in a mostly legit fashion (I just read the whole thing that Laurie posted), but it was a study on only 99 people, and all type 2s at that. So to extrapolate their findings/results to “everyone” isn’t fair or reasonable, given the tiny sample size of the study. Additionally, they screened out 90% of the applicants to the study, so even of people who are already type 2 and willing to be studied, 90% of them didn’t fit the necessary requirements of the ideal participant, which means if someone’s A1C, body weight, cholesterol or what-have-you isn’t within the ranges of those that were accepted into the study, it is again unfair to assume that this very small sample size’s results are applicable to everyone.
Additionally, weight loss and improved health on many fronts was found in BOTH groups, not just those assigned to the vegan group.
Most important to realize though, is that this study was not about a “low fat high carb” diet, it was instead looking at the effects of a “low fat VEGAN”diet, which is a hugely different beast . The focus in a high carb diet is to maximize the number of carbs eaten, regardless of their source (think carb-loading before a marathon). The focus of a vegan diet is to eliminate animal products. While a vegan diet may show an increased % of total calories coming from carbohydrates, thats a side-effect of eliminating animal proteins and when eaten in a balanced fashion (as I suspect these 49 people were as they received training and repeat follow-ups with nutritionists) , many vegans consume high amounts of fiber, which reduces to a large extent the effect of the carbs they’ve just eaten. High in total carbs, sure. High in net carbs, not as likely.
It is appalling that someone could misread this study such, and then have the nerve to post their poor understanding with a promise of good health and solved problems.
NOOOOO! The Law of Small Numbers states that “Big inputs make big mistakes; small inputs make small mistakes.” As diabetics we need to keep our carbohydrate intake down, therefore decreasing our need for insulin and thus reducing our swings in blood glucose.
I believe everyone, especially diabetics, could benefit from the Primal Blueprint or Paleo lifestyle. Basically this entails eating lots of vegetables, natural meats, and healthy fats, while avoiding sugar, processed foods, grains, and legumes.
One of the articles posted above states that for this vegan diet, people were eating “vegetables, fruits, grains, and legumes” and were asked to “favor low–glycemic index foods.” This is similar to primal/paleo other than grains and legumes, which are not vital for healthy bodies. Vegan diets usually include high levels of carbohydrates – I have noticed that grains really mess with my T1.
So YES, people do need to move more and eat less (but more naturally) to be healthy. A good dose of sleep and exercise really helps with weight loss – I can personally testify to that.
Please check out the link I posted (Mark’s Daily Apple) – there is so much good information there. Not an employee, just a 24-year-old, pumping T1 fan.
For the person looking to gain weight, a spoonful or two of peanut butter a day is a great option. If you don’t want to eat more, and you don’t want to eat carbs… Well peanut butter is the most calorically dense food out there, and it’s the perfect ratio of carbs/fat/protein. Give it a shot!
To the person with rapid weight gain – two things…
1. Get your thyroid checked
2. Yeah, it kind of sucks. When your blood sugar was out of control, you were literally peeing out the calories. Now your body – thanks to insulin – can process them. If your knees are in such terrible shape, consider other exercise options… for example, building muscle mass by weight lifting will eventually amp up your metabolism and help you shed pounds! Or something low impact, like cycling or swimming.
I was able to test the kids DNA 20 yrs ago (I am a type I veteran). The University of Florida advertised the testing and I took them in for a blood test. All three were negative. None have become diabetics.
Before the invention of insulin therapy, the only way to prolong the short, miserable lives of people with type 1 diabetes was to feed them an essentially zero-carb diet. That regimen allowed them to starve to death slowly over the course of about a year instead of going into ketoacidosis and dying within about a week. Within a few years after the introduction of insulin therapy, it became clear that a high-carb (low-fat) diet was actually beneficial for people with insulin-treated type 1 diabetes and people with type 2 diabetes because it improved their insulin sensitivity and reduced their risk of cardiovascular morbidity and mortality. A high-carb diet for type 1 patients has been shown to reduce their insulin requirements. Nutritional epidemiology studies have shown that adding even small amounts of animal-source foods to the diet increases the risk of death from chronic disease. Paleolithic people ate meat because they liked it and it could keep them from starving during the winter, not because it is part of a health-optimizing diet for human beings. Eating meat actually promotes diabetes.
Laurie – how in the world could a high-carb diet lessen insulin needs for type 1 diabetics? Those people were dying because they didn’t have INSULIN, not carbohydrates!! I feel much better physically and mentally when I don’t have tons of sugar and insulin rushing through my system. Fact.
Here’s how my insulin usage has been (all with the same amount of physical activity):
standard “healthy” American diet: 65-75 units per day
more restricted calories & less carbohydrates: 35-45 units
low-carb eating (Primal/Paleo): 25-30 units
Now tell me more carbs equals less insulin.
Also, type 1 diabetes can occur whether or not you are eating meat – the cause hasn’t been found yet, so you absolutely cannot say eating it promotes diabetes.
Please read Dr. Bernstein’s Diabetes Solution (here’s a link: http://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-Achieving/dp/0316182699/ref=sr_1_1?s=books&ie=UTF8&qid=1323032582&sr=1-1) and see if that changes your mind.
It is sad that there are so many people with D who have no idea how carbohydrates and insulin interact. I think the medical community is doing their best to keep us ignorant and dependent on their drugs. I recommend that you all take the time to read this blog http://www.fathead-movie.com and also watch the Fathead Movie and Science for Smart People on youtube.
Disclaimer : I have no affiliation with Tom Naughton what so ever but as a type 1 D the insight I have gained from his articles has made a huge difference to my Diabetes management.
Cheers,
Bruce
Allison, fatty diets cause insulin resistance, which means that a person with type 1 diabetes would have to inject a higher dose of insulin to get the same effect on blood glucose levels. That basic fact has been known since the 1930s. Although an isolated starchy MEAL might necessitate a high dose of insulin, a low-fat starchy DIET tends to improve sensitivity to insulin, thus curing type 2 and leading people with type 1 to inject smaller doses of insulin. Eating meat has been shown to promote type 2 diabetes. The food that has been implicated as the main cause of type 1 diabetes is cow’s milk. The link between cow’s milk and type 1 is so strong that the American Academy of Pediatrics acknowledged it, despite pressure from the dairy industry.
I’m glad you put scare quotes around “healthy” in standard “healthy” American diet. It’s anything but. Please note that you can’t make conclusions about a low-fat, vegan diet from data on a comparison between the standard American diet and the “Paleo” diet. You didn’t provide any data on insulin requirements from when you were eating a high-fiber diet that was ~10% fat and ~75% carbs. Of course you would need less insulin on a low-carb diet than on a moderate-carb, still-high-fat diet. Your insulin sensitivity would still be relatively poor but the dose of sugar entering the bloodstream would also be low.
In general, I don’t read books that were written for a lay audience. I prefer to read the scientific studies, many of which are available for free over the Internet. I worked in medical publishing for many years and am appalled by the poor scientific quality of most of the health books published for the general public.
It can be overhwelming when you feel like you have a large hurdle to conquer such as weight loss. The best thing to do is to change your mindset from diet as a way to loose weight to diet is a way of life. What I mean by this is often how we eat is dictated by circumstances and our environment. If your mood, environment, etc dictate your eating habits, then you want to figure out what that is. Simply said in an ideal world, hunger alone should dictate when we eat. I realize this is a long answer and there is so much more that can be said about this topic. The good news is studies such as the Diabetes Prevention Program show that weight loss as little as 7 to 10% of your current weight reduces diabetes complications significantly. People in the study lost the weight through lifestyle interventions. When they were compared to folks in the meformin group, those in the lifestyle group (moderate carbs, low-fat and 30 minutes per day of physical activity) lost more weight and kept it off. So there is no magical supplement to weight loss, just a willingness to be patient as you change to healthier habits one small victory at a time.
Laurie – I understand the value of peer-reviewed, evidence-based material. I am very familiar with it due to pursuing my doctorate of audiology. However I haven’t read it for diabetes.
I really liked Dr. Bernstein’s book, and even though it may not be “scientific” enough for you, it has lots of scientific data as well as his and his patient’s personal experiences. He has been T1 since age 12 (in 1946) and followed his doctor’s orders for years as his bodily functions shut down. He switched from engineering to earn his MD and really worked at learning as much about diabetes as he could. He turned his complications around and has a lower A1c than many normal adults, now at at age 77 (average 83 mg/dl).
I guess at this point we should agree to disagree. I will see what I can dig up in regard to type 1 diabetes and these issues.
I’m sorry Laurie, a high carb diet simply does not work for type I diabetes. I would love to see the references that purport this to be a viable diet option for type I diabetes?
I intend to accomplish several goals in my diabetes activism. The first is to let people with type 2 know how easily they can cure (yes, cure!) their condition by shifting to a low-fat, high-fiber, plant-based diet. The second is to raise awareness of the role of cow’s milk in causing type 1 diabetes (a relationship acknowledged by the American Academy of Pediatrics in the 1990s) and of the role of dietary fat and cholesterol in contributing to the complications of type 1 diabetes (a relationship documented by Joslin as far back as 1927). The third is to persuade PWDs to pressure NCCAM to fund some proper clinical trials of benfotiamine (an off-patent, lipid-soluble thiamin analogue) for the prevention of blindness, kidney failure, and amputation in type 1 diabetics.
Here’s one study of high-carb diets for T1: Anderson, J.W. 1986. Dietary fiber in nutrition management of diabetes. In: G. Vahouny, V. and D. Kritchevsky (eds.), Dietary fiber: basic and clinical aspects. New York: Plenum Press. I haven’t read that study itself, but supposedly the T1′s total insulin requirements decreased by 40% and their cholesterol decreased by 30% after 3 weeks on a high-fiber, high-carb, nearly vegetarian diet. This is consistent with Dr. Joel Fuhrman’s observations of patients with T1 who go on a diet of unrefined plant foods.
“a high-carb (low-fat) diet was actually beneficial for people with insulin-treated type 1 diabetes and people with type 2 diabetes because it improved their insulin sensitivity and reduced their risk of cardiovascular morbidity and mortality. A high-carb diet for type 1 patients has been shown to reduce their insulin requirements.”
No where in your original post did you say high-fiber. Of course eating high fiber over low fiber will have blood sugar benefits: we are taught to subtract fiber when carb counting. High fiber is a far cry from high carbohydrate. Fiber is like a net-zero carb; thus also eating low carb would have the same if not better benefits.
Susan – do many T1s actually subtract fiber from their carb count? In my 14 years of carb counting and pumping I’ve never, ever done this and haven’t had problems due to it. I eat tons of vegetables and if I calculate 8 total grams of carbohydrate in my cucumber plus 9 from a clementine, I take insulin to cover all 17 grams. Just curious because everyone’s different. Thanks. (And thanks for supporting the low-carb side!)
Susan f, the experiments that were done on the relationship between macronutrient balance and insulin sensitivity (as measured by an oral glucose tolerance test) in the 1930s used test diets that were based on purified starch and fat and so on. Insulin sensitivity improved as fat intake decreased. It had nothing to do with the amount of fiber in the diet, which didn’t change. Although those studies were done on healthy, nondiabetic volunteers, other researchers have observed similar results in T1 diabetics who switched to a high-carb diet that also included fiber.
Here’s what Dr. McDougall says: “By changing to a low fat, no-cholesterol, starch-based diet, type-1 diabetics have a real chance of avoiding premature death and serious complications. The only people I have met with long-standing type-1 diabetes who still have all their parts working after 40 years of disease, have been those following a low-fat nearly vegetarian diet—the best example I know is of the few fortunate people who learned and practiced the Kempner Rice Diet from Duke University—oftentimes they remained in great shape for as long as 50 years following their diagnosis because of their very low-fat diet of primarily rice, fruits and vegetables.” http://www.drmcdougall.com/misc/2009nl/jul/strategy.htm
Whipping out Dr. Mcdougall, vegan diet advocate, but refusing to read Dr. Bernstein is pretty funny. Quoting him is not quoting a peer-reviewed study.
We are just going to have to agree to disagree.
The lower carb I eat, the better my a1c’s, blood sugars, energy, and stability of my glucose levels. Eating low carb allows me to do things like boot camp without crashing lows, and pretty much stay between 100-170. I average < 30 units a day, have perfect BMI, and am happy.
Susan, let’s be friends! I’m glad to know low-carb works for so many people.
Laurie, I knew not to take you seriously after I saw your website. You’re probably an “ADA minion” (see http://www.diabetes-warrior.net)…
Actually, Allison, I’m nobody’s “minion.” In fact, I’m a harsh critic of the ADA in particular.
Laurie, are you a diabetic? Honest question, just curious!