The Hazards of Low-Carb Dieting

This morning I ate a cheddar, mushroom, and tomato omelette and a cup of decaf with cream.

It’s now 12:00 pm, the time when normal people go to lunch because they ate shredded wheat with skim milk for breakfast and they are, consequently, starving.

I, however, am not hungry, and probably won’t be until 1:00 or 1:30.  While in theory I can take my lunch break whenever I want , in practice people often schedule meetings at 1:00 or 1:30 because by then they’ve all had lunch.  Today is such a day.

I guess I’ll go get a salad now while I can get away from the office and eat it later when I’m actually hungry.

Recommended Reading 1: Big Fat Lie

It was Gary Taubes’ landmark article in The New York Times Magazine in 2002 that persuaded me to start on this whole adventure. (Free, but registration required.)

If, like me, you weren’t all that heavy when you were younger, and you ballooned out like the Michelin Man during the 90s when They (the agricultural-industrial complex and its shills in the USDA and Congress) were recommending that everyone, even healthy people with normal weights and no risk of coronary artery disease, even tiny little two-year-olds for Christ’s sake, should follow low-calorie, low-fat, high-carbohydrate diets; if you spent two or three days eating a lunch consisting of a sandwich made of whole wheat bread, skip the butter, skip the mayo, with two or three skimpy slices of sliced deli turkey (a substance that tastes like death marinated in chemicals), a handful of Snackwells, and a big baggie of veggies, only to be so hungry by 3:00 that, to combat the shakes, you pumped something like $5 into the vending machine to get a sugar fix to stabilize your blood sugar until the next dry-bread sandwich, and after 2 or 3 days you gave up the low-fat lunch in defeat and binged on a pint of super-premium ice cream; if you watched yourself go from a 110-pound waif (BMI=19.5, at the low end of normal) to a 165-pound fat girl (BMI=a near obese 29.5) even as you kept a box of “healthy” low-fat, whole-grain breakfast cereal at your desk for snacks - this article will undoubtedly make you as angry as it made me.

I didn’t see Taubes coming, that was for sure, as I ate yet another Sunday breakfast of dry toast with jelly (all healthy, low-fat foods) while I read the NYT magazine on that lovely day in July, shortly before my 33rd birthday. Halfway through the article, I set the magazine aside for a moment, walked to the fridge, defiantly slathered my dry whole-grain toast in butter, and fried up a couple of whole eggs in more butter, and, ultimate sin against the establishment, I ATE THE YOLKS. I wasn’t hungry again for hours, and unlike a typical weekend day, I did not feel the need to go right back to sleep after breakfast, a real problem when I used to eat bagels or pancakes or toast or muffins for breakfast. Taubes, I was convinced, was onto something.

The next day I bought the Atkins book, learned that even the whole-grain toast wasn’t the greatest idea, fed the rest of the bread to the ducks, and, in spite of many, many detours from it over the years, I have never questioned that low-carb was the right thing for me and a lot of people like me.

Letter to My HR Department

It’s weird how things happen - I start a blog about migraines, and several months later I am tilting at the windmill that is the American Diabetes Association.

Here’s the letter I sent to my HR department regarding its support for the ADA.  I have omitted the name of my company and our HR SVP for privacy reasons.  Next I plan to find out the name of the chief fundraising officer at the ADA and explain why s/he’s getting no money from me.

___________________________

Dear [names of HR SVPs],

As the grandchild, child, niece, sister, and sister-in-law of diabetics, and as someone at risk of developing diabetes myself, I applaud [name of company]’s effort to fight this devastating disease.  However, after careful consideration, I have decided that I simply cannot support the American Diabetes Association, and I hope that, when this event rolls around again next year, [name of company] will consider withdrawing its support as well.  If [name of company] is really serious about reducing diabetes-related medical claims costs and supporting employees and their families, it is counterproductive to fund an organization that promotes a lifestyle that leads to increased use of medication rather than one that reduces the health care costs of diabetes sufferers.

In spite of its stated mission to provide “diabetes research, information, and advocacy,” the ADA is no friend of the diabetic.  After many years of independent reading on the causes and treatments of insulin resistance, pre-diabetes, and diabetes, as well as general nutrition, I have concluded that, if you wanted to deliberately devise a diet that would cause a diabetic to die a slow, painful death, you couldn’t do better than the diet currently recommended by the ADA.  The organization’s insistence on a high-carbohydrate diet, in the face of mounting evidence that diabetes is better managed by limiting carbohydrate consumption, would be laughable if it was not endangering the health and the very lives of the people it claims to advocate for.  In the nutrition section of the ADA website at http://diabetes.org/nutrition-and-recipes/nutrition/starches.jsp, the ADA says, “Yes, foods with carbohydrate — starches, vegetables, fruits, and dairy products — will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you.“

If it sounds unconvincing that a food that raises blood glucose quickly is the “healthiest” food for a diabetic, perhaps this is because the ADA itself does not believe it.  At http://diabetes.webmd.com/news/20060616/do-low-carb-diets-help-diabetes, WebMD reports that ADA spokesman Nathaniel Clark admits that, while a low carbohydrate diet results in reduced reliance on medication, the organization does not promote a low-carb lifestyle for diabetics, because the ADA believes carbohydrate restriction is too hard to stick to.

There are so many things wrong with this reasoning, it is hard to list them all.  First, there is no evidence that the current low-fat diet recommended by the ADA is any easier to stick to than a carbohydrate-reduced diet; in fact, several of the low-fat participants in the study defected to the low-carb camp before the study’s end, but none of the low-carb participants switched to the low-fat diet.  This suggests that the low-carb diet was preferable and easier to stick to than the low-fat diet.  Secondly, in spite of what the ADA spokesman says, the study in question showed that blood lipids remained stable on the low-carbohydrate diet. In fact, 3 out of 5 participants in the low-fat group actually developed cardiovascular disease, while none of the participants on the low-carb diet showed any evidence of cardiovascular disease.  You can see the study, published in the journal Nutrition and Metabolism, by clicking on the following link: http://www.nutritionandmetabolism.com/content/3/1/22)

But the most important problem with the ADA’s reasoning is that it flies in the face of its role as an advocate of the diabetic.  As a counter example, it is very hard to quit smoking, but both the American Heart Association and the American Lung Association continue to encourage smokers to quit, and both have advocated for stronger restrictions against smoking in public, stronger bans on advertising cigarettes, and stronger enforcement of laws forbidding the sale of cigarettes to minors.  The ADA’s responsibility is similar:  educating diabetics on the benefits of a low-carbohydrate diet, organizing and providing low-carbohydrate support groups, and advocating with food producers, restaurants, school and office cafeterias, vending machine companies, and other providers of prepared food and snacks to provide more healthy, natural, lower-carbohydrate food choices.  For the ADA to fail to recommend the right course because it is too difficult is not only defeatist, it creates a situation in which research-savvy diabetics who would like to try a health-promoting low-carbohydrate regimen have nowhere to turn for expert advice and support, exactly the kind of service that the ADA should be providing.

I have focused on this single study because the ADA has commented publicly on it, but please be assured that there are myriad additional studies that show that a low-carbohydrate diet is beneficial to patients.  The following study is a meta-analysis of many, many studies into the effects of a low-carbohydrate diet on weight, blood sugar control, cholesterol, insulin resistance, blood pressure, and inflammation in diabetics.  The study authors conclude, “Based on our examination of current evidence, we find concerns about LoCHO diets to be unsubstantiated and we see no problem in recommending them, at least as a means of caloric reduction. …. We believe from the evidence presented here that replacing fat with carbohydrate is deleterious and caloric restriction should be carried out by removing carbohydrate in preference to removing fat. “  (Study at:  http://www.nutritionandmetabolism.com/content/2/1/16)

In short, rather than encouraging diabetics to make simple, inexpensive lifestyle choices that result in reduced need for medication and reduced numbers of doctor visits, the ADA is promoting a diet that increases reliance on medication, increases the number of doctor visits, and increases costs for [name of company].  I hope you will reconsider your decision to support this organization until it reconsiders its position on what constitutes a healthy lifestyle for diabetics.

Just When I Thought I Couldn’t Get Any Angrier

I was going to log off, then I found this:

http://lowcarbdiets.about.com/od/news/a/adalowcarbdiabe.htm

Absolutely infuriating!  Is a low-fat diet any easier to stick to than a low-carb diet?  My experience, and I am very sure I am not alone, was that I could stick to a low-fat diet for about one day before I became ravenous and bought a pint of Ben and Jerry’s, but after the first two or three difficult days of low-carb, I can stick to it for weeks or months without difficulty.

How can one explain why an organization that lists “advocacy” as part of its charter refuses to recommend a diet that it admits is helpful for managing diabetes because it’s too “difficult” to follow?  If they were truly advocates, wouldn’t they help make it easier to follow?  By, for example, educating nutritionists, providing tips for diabetics in food preparation, and most important, advocating with restaurants, food manufacturers, schools, vending machine companies and convenience stores, to provide more healthy, naturally low-carb food choices?  Because, in my experience, if low-carb is hard to stick to, it’s primarily because, outside my own kitchen, starch and sugar reign free, and finding a nice protein snack that isn’t loaded with chemicals is nearly impossible.  If the ADA put pressure on restaurants to serve more delicious meats, fish, and fowl with a side of veggies, hold the potato; and if there was a good low-carb choice in the vending machine besides that stinky little bag of peanuts; and school cafeterias served something other than pizza and french fries and you could actually order whole milk instead of skim; and the salads at fast food places actually tasted good and the meat on them were not shot full of weird flavor-”enhancing” chemicals - maybe it wouldn’t be so hard to stick to low carb.

Definitely going to write that letter to the ADA, the bastards.  What kind of goddamn advocates are they, anyway?

A Quandary

This year my company is offering to sponsor any employee who wants to participate in Step Out to Fight Diabetes by contributing $100 per participant.

On the one hand, diabetes is rampant in my family and contributed significantly to the death of my mother.  Furthermore, I have enough risk factors for diabetes (excess weight, family history, PCOS, and probably insulin resistance, though I’ve never been tested) that I have a very personal interest in research into the causes, prevention, and treatment of diabetes.

On the other hand, I am no big fan of the American Diabetes Association.  I have said it before, and I’ll say it again:  if you wanted to devise a diet that would cause a diabetic to die a slow, miserable death, you couldn’t do better than the diet currently recommended by the ADA.  In fact, as more time passes since my mother’s death nearly four years ago, I am more and more haunted by the suspicion that the ADA diet, with it’s “carbs are the healthiest thing for you” nonsense, hastened her death, especially in her later years, when she was dependent on public agencies, like Meals On Wheels and the nursing home where she spent her final months, for all her meals.  The public agencies stuck to the party line dished out by the ADA, and fed my mother a non-stop stream of carbs, with little fat and protein to balance them out.  And not only do I believe this hastened her death, I think that it caused her undue psychological distress.  I remember numerous occasions when my mother was in tears because she had to follow some complex insulin dosing schedule and her blood sugar was still wildly out of control!  The routine was, a finger stick four times a day before each meal and a bedtime snack; some variable amount of insulin based on the blood sugar reading, and then the meal or snack, which was usually something like 3 skimpy ounces of low-fat turkey breast on white bread with mustard, hold the mayo, 8 oz of skim milk, 6 oz of juice, and a little pile of overcooked vegetable, which was often a starchy one like carrots or peas or corn with a teaspoon of some horrifying trans fat laden margarine.  (Sometimes, and I wish I were lying, she’d get an actual donut in her Meals On Wheels lunch bag!  You know, a donut - a little wad of starch and sugar fried in trans fat.  I’m not sure why they didn’t send her a cyanide capsule, too.  But the ADA said an occasional donut was OK, so it must’ve been OK.)  Repeat before next meal or snack.  It was extremely complicated, and it didn’t work.  My mother’s blood sugar levels were all over the place, either soaring over 200 (and sometimes over 300) or dropping so low that my local siblings felt the need to call her several times a day in case she passed out.  (This happened many, many times.  It’s a miracle she never hit her head or broke a bone.)  The most insane part of this, other than the fucking donuts, is that they actually gave her skim milk and juice at the same meal, two liquids that are so high in sugar that they are given to diabetics whose blood sugar has dropped too low due to excess insulin dosage.  Or maybe the most insane part of this was that her recommended bedtime snack was two Graham crackers and 8 oz. of skim milk.  In retrospect, there were so many insane things that it’s hard to decide which is craziest.  Do you feel, as I do, like you’ve gone down the rabbit hole?

Four finger sticks and four insulin shots a day (”I feel like a goddamn pincushion,” she used to say), and she still lived in fear of passing out and not being found until it was too late, or being hospitalized with a blood sugar higher than the Hancock Tower.  She was scared and very frustrated.  And like many people of her generation, she was a very compliant person and considered her doctor (who was an ass, but that’s another story) to be an authority figure.  She did she was told, and her diabetes will still raging out of control.  If I had a nickel for every time I heard my mother wail, “What am I doing wrong?” I could buy Microsoft outright.

If this diet is the best thing for a diabetic, why did my mother spend her last years in physical and psychological misery?  And why, in the 70s and early 80s, when the ADA diet was much more sensible and balanced, with a moderate fat and protein content and a lower carb content, did she manage her diabetes pretty well with a single daily insulin shot of a dose that seldom varied?  And this in spite of the fact that insulin delivery technology wasn’t as advanced, we didn’t have a distinction between slow- and fast-acting insulin, and people monitored their sugar by testing their urine instead of their blood?  She wasn’t exactly the picture of health then, but she did a lot better than she did in the last decade of her life.

The worst part for me is that I played along with the expert recommendations.   At the time, I didn’t know any better, didn’t know how carbs and insulin interact, didn’t know protein’s regulating effect on blood sugar, didn’t know that natural fats are good for virtually everyone, and had never heard of trans fats but thought margarine was healthier than butter and Crisco oil was better than olive oil.  I’ll always feel some guilt about this.  But how could I have known?

I’m not a scientist, just a layperson who takes an interest in nutrition; and I know that to blame my mother’s problems solely on her diet would be inaccurate.  I know that everyone’s metabolism slows with age, and the diet that worked for her when she was 50 would’ve needed some adjustment when she was 70.  And I know that her stubborn insistence on smoking (the doctor never told her to give it up, and I’m convinced that if he had, she would’ve - one of the many reasons that I think he was an ass) also contributed to her untimely demise.  But I can’t help thinking that, even if she had died at age 73, she might have suffered less from the physical and psychological symptoms of unstable blood sugar.

So … while I’m sure the ADA is doing some fine things with its money, research into genetics and insulin delivery systems and so forth, I just don’t think I can, in good conscience, raise money for them while they are telling diabetics that carbohydrates are “the healthiest thing for you.”  I’m considering borrowing a tactic that is used by tenants who have disputes with their landlords - write a letter to the ADA saying that I am escrowing my contributions to them, to be released when they devise a more sensible set of dietary guidelines.  If this does not happen before my death, the money will be willed to another charity.  (Or heck, maybe I’ll skip the escrow and just give the money to the Weston A. Price Foundation.)  And I’m considering sending a similar letter to my HR department, thanking them for their interest in helping address this devastating disease, but suggesting that their choice of charity should, perhaps, be thought through more carefully and explaining that, while I applaud their efforts, I simply cannot participate in a fundraiser for the ADA and I will be contributing $100 of my own money to some other charity instead.

 The saddest thing for me is that we need an American Diabetes Association, need an organization that can marshal a lot of resources toward research and education about this sticky, sugary, killer disease.  But if they can’t even get the education part right, who knows how much they are fucking up the research?

One Pound Down

The scale was at 154 this morning!  Woo hoo!

On Friday our department had its “summer” outing - a cruise to one of the Harbor Islands, where we played softball and ate grilled things.  (Unlike most publishers, we have our busy season in summer.)  I had been looking forward to the cruise but dreading the softball game.  Scott, who is my office neighbor and our department FunGi (get it?), spent the two weeks prior insisting that I was playing on his team, even though I was picked last in gym class every week, had never hit or caught a ball in my life, and was extremely unthrilled to show up at a company event in athletic wear.  (In fact, I wore jeans and, screw my heel fissures, Tevas.  Oh, and a shirt with the Jolly Roger and a head scarf and big hoop earrings and a name tag that said Deadeye Dot - did I mention that the cruise had a pirate theme?)  Talk about trepidation - I spent the whole cruise wondering why these ships don’t serve booze.

I didn’t score any runs, and I didn’t catch any balls (though I did scoop up a grounder and miss tagging a runner by a mere fraction of a second).  But I didn’t strike out once, and I ended up running for Scott, who recently had surgery on his ankle, and I made it to third base at least once.  And our team, the sad sacks and losers, the Bad News Bears all grown up, was ahead by several runs until the very last inning when the other team, coached by a very competitive project manager and composed of all the most athletic people in the department, scored like 5 runs.  Final score - we lost 13-12.

Scott pointed out that we had more fun than they did - and I think we did, too.

After the cruise, I walked back to the office to work on an overdue document - probably a 40-minute walk on a gorgeous fall day.

Saturday I woke up with a very silly farmer’s sunburn (like a farmer’s tan, but red and sore) and extremely sore muscles - and the scale was UP a pound and a half.  How could that be?  I spent all day Friday, you know, exercising.  How could I gain a pound and a half overnight?

On Sunday my husband and I went to the Boston Folk Festival, where I worked on getting my shoulders equally burned as my lower arms.  We forgot our folding chairs, so we sat on the ground, which, given how sore I still was, made me feel about 75.  Well, OK, sitting wasn’t that bad, but getting up was a chore.  And I got up A LOT - I drank only about a half a liter of water throughout the day (usually not enough), and I probably had to pee at least a half a dozen times.  I never thought I’d say this, but the Port-o-Potties actually seemed inviting. 

Now I’ve lost the 1 1/2 pounds I gained, plus 1 more.

My hypothesis is that the sore muscles were evidence of inflammation, and one symptom of inflammation is edema, which is a fancy word for water retention.  As the muscles healed, the edema went away, and all that water had to go somewhere.

I like to think that, on Saturday morning, my weight was not 156.5 pounds.  I like to think it was 154 pounds, plus 2 and a half pounds of excess water.  And if you know some scientific reason why that could not possibly be true, please don’t tell me, OK?

4 Weeks

Just a quick one.

 My weight is still at 155, where it’s been for two weeks.  In spite of sticking very closely to the low-carb diet.  (I solemnly swear that the highest carb food I’ve eaten in the last two weeks was a tomato.)  In spite of my daily 4 to 5 miles of walking.

Is it the bloody Inderal?

It’s hard to avoid being discouraged, so here’s my list of good things about the  low-carb diet:

• I haven’t regained any of the weight I lost.
• My waist is down an inch, from 33 inches to 32.  (Maybe someday my waist will be under 30 inches again!)
• Those jeans that Land’s End sent that were a little too small fit a bit loosely now.
• Those jeans that Land’s End sent that fit just right are rather loose now.
• Those jeans that Land’s End sent that were a little loose are almost embarrassingly loose now (think plumber butt). 
• I think the neuropathy in my hands is totally gone now.  At least, I don’t find my hands falling asleep for no apparent reason.
• My knees hardly hurt at all.

OK, so it’s still a pretty good thing, isn’t it, this low-carb lifestyle?  And the food is amazing!

Oh, Really?

The American Diabetes Association has managed to lose all credibility with a single sentence:

Some people even thought that eating sugar caused diabetes, an idea that we now know isn’t true.

Isn’t it?  Hasn’t the American Diabetes Association caught up to the idea of insulin resistance?  What do they think causes insulin resistance, if it is not excess intake of carbohydrates?  A virus or something?

Oh, I guess they haven’t caught on yet:

Yes, foods with carbohydrate — starches, vegetables, fruits, and dairy products — will raise your blood glucose more quickly than meats and fats, but they are the healthiest foods for you.

I’m having trouble with the idea that a food that will raise blood sugar quickly is the healthiest thing for a diabetic to consume - but what do I know?  I am not the Oh-So-Esteemed American Diabetes Association.

Jesus Christ.  What is the matter with these people?  If you wanted to kill off a nation of diabetics slowly and miserably, you couldn’t devise a better diet than the one recommended by the ADA.

How Do I Make This Decision?

The Dilemma:

On the one hand, I have a dozen or so health problems, major and minor, that seem to be related to a futzed-up insulin/endocrine system:  PCOS, excess weight (though with a BMI of 27.5, I am not clinically obese), neuropathy, joint pain, acne, and apparently even my cracked heels.

On the other hand, Inderal, that fabulous, fabulous drug that has kept my migraines completely in check for the last 99 days (99 migraine-free days!  after having a migraine 2 to 6 times a month for several months, this is like a miracle) has as one of its side effects increased insulin resistance.

I know that insulin resistance that is induced by a high-carb diet can be treated with a low-carb diet.  I wonder - can insulin resistance that is induced by a drug also be trated with a low-carb diet?  Because if it can, there’s no dilemma - keep taking the Inderal, keep avoiding sugars and starches, and all will be well.

But if it cannot, how on earth do I decide between the misery of migraine and the misery of insulin-related disease?  Diabetes is rampant in my family, and I have seen first hand its ravages.  Truthfully, I’d rather have migraine, even several attacks a month, than lose a foot, a finger, or a kidney.

I hope it won’t come to that, though.

As If It Weren’t Hard Enough …

… for me to buy shoes …

I have had this problem with cracked heels for several years, but this summer it seems to have gotten quite a bit worse.  I bought a tube of Flexitol, which is apparently the gold standard for non-prescription foot creams, and it seems to be helping some.  But today, during a meeting, I was bored, so I searched on “cracked heels” and discovered two extremely disconcerting things.

1.  Being overweight can contribute to heel cracking - put too much weight on that natural pad of fat that cushions the heel bones, and it’s gonna have to go somewhere.  The ripe tomato analogy on this site is a bit gross, but it definitely gets the point across.

(OK, after I got done being mad about how the medical profession blames everything on being overweight, I took a deep breath and said, ”I’m taking care of my weight problem as fast as I can.”)

2.  Open heeled shoes can aggravate the problem because there’s nothing to support the squashed cushion of fat.

Auuuggggggggggghhhhhhhhh!

You see, my feet are short (size 6 1/2) and very, very wide.  I mean, like, they’re practically perfect squares; you could use my feet to teach geometry.  Furthermore, because of a couple of bad toe-stubbings, the ligaments on both my little toes are sprung a bit, which means there are these bumps on my little toes that do not like having leather, heavy fabric, or anything else even remotely stiff rubbing against them.  (Seams are particularly bad and often land exactly on the little bumps.)  One day, several years ago, I was at DSW and I noticed that - gasp! - Tevas are the same shape as my foot!  And the straps don’t rub against my pinkie toes!  So I decided to try them, and I have to tell you, they are literally the only comfortable shoes I’ve ever owned.    I can wear Tevas for 18 hours straight and find them utterly comfortable.  I start wearing them as early as possible in the spring, and I often don’t put them away until temperatures drop below freezing.  (Yes, I’m one of those dorks that wears socks with sandals.)  I have quite fair skin and don’t tan very obviously, but I wear Tevas so much that I have Teva-shaped tan lines on my feet.

So WTF am I supposed to do for shoes?  If I wear Tevas, my heels will crack.  If I wear closed shoes, I’ll get bunions, calluses, and all manner of other foot problems, and my little toes will get blisters, calluses, and corns and scream at me all day long, “You bastard!  Set us free right now!”

I just went to Teva’s web site to see what they have besides sandals, and they do have a few closed heel shoes, though I have to say the soles don’t look as wide as the ones on their sandals.  These might be great in cooler months (if my pinkie toes don’t complain too loudly), but what am I going to wear in the summer?

Just what I needed - another consumer research project …

Maybe the Flexitol and weight loss will solve the problem?

A girl can hope, can’t she?