Dr. Davis,
would you please explain, in layman's terms, why chiceking blood glucose can be so important for not only keeping track of blood sugar but for weight loss? I think I get it, but my mother, who was recently diagnosed as "pre-diabetic", says she is going to return the glucosometer she based bought upon my suggestion, as she is going to eat low-carb and track calories, etc.  Help me help my mom out!  Thanks so much,
emily

Dr Davis, thanks for the site.

There's a history of Diabetes in my family.
My dad and his father were both Diabetics and they both died of Pancreatic Cancer in later years.
They never watched any of their habits though.
My dad's doctor used to call him a "food and lifestyle" liar. Dad shrugged it off.. and kept on lying.

Yes, I know about the genetic odds here.
I do watch what I eat, Vit D3, no cigarettes and I exercise and live life.

I've never seen a conclusive study relating Diabetes and Pancreatic Cancer.
Any thoughts on that ?
I'm not Diabetic. FBG today of 89.
But I still watch myself and I have started to use a BG monitor to watch post-prandial numbers.
It's interesting how different foods affect everyones's BG differently.
I'm continually learning.
Thanks again for the site.

I'm new to all this but have a question if anyone is willing to indulge me an answer...

I frequently fall to sleep after lunch and/or after dinner, just "nod off" type of thing.  Is this a result of high BG and then the insulin response driving sugar low?

I am not diabetic and try to eat reasonable healthy meals, moderates amount of lean meat, vegetable and starch like rice or potato.  I wonder if I have insulin insensitivity...guess I need a meter. Thanks

Thanks for explaining why.

Could you maybe elaborate a little?

Carbs cause blood sugar to rise. Indulge in excess carbs, and you can walk, run and bike till you drop and not lose an ounce.

Awesome post Dr. Davis. I check my post-prandial BG constantly and have eliminated many so called low glycemic foods. ALso, nice simple explanation Lori.

@ Larry said...
I've never seen a conclusive study relating Diabetes and Pancreatic Cancer.
Any thoughts on that ?
It's not a straightforward connection, they are still arguing about it.
This abstract suggests  
the development of diabetes in subjects prone to pancreatic cancer could be a red flag for malignancy.

And this full text article
Is Type 2 Diabetes a Risk Factor for Pancreatic Cancer? explains why it's difficult to definitively identify type 2 diabetes mellitus as a risk factor for pancreatic cancer.

Worth pointing out for those with Diabetes who are concerned about the threat of Pancreatic cancer that Metformin monotherapy carried the lowest risk of cancer. However that was comparing medical diabetes treatments, so didn't include people using Dr Bernstein's or similar approaches to controlling diabetes through diet, exercise.

I found this paper Cancer as a metabolic disease worth studying. It's not specifically about pancreatic cancer. It makes the point that Reduced glucose availability will target aerobic glycolysis and the pentose phosphate shunt; pathways  required  for  the  survival  and  proliferation  of many  types  of  tumor  cells.
Maybe it isn't just the risk of heart disease that is reduced by lowering circulating  glucose levels.

@  Emily
Please try to persuade your mum the glucose meter is an essential tool to understand which foods really raise BG levels.
I thought, a bit like your mum, that because I followed a Low carb eating plan I wouldn't have a problem with high glucose.
Only after readingTo get low-carb right, you need to check blood sugars did I get a meter and start checking.
Despite eating almost exclusively low carb I was regularly spiking up to 199.8 ~ 11.1.
Adding into my diet a variety of things to slow gastric emptying has reduced the height of 1hr after meal spikes and I've now gone a week under 133.2 ~ 7.4 and the trend is towards lower numbers mostly under 108 ~ 6

I've not restricted my calorie intake nor am I able to exercise much but I have, unintentionally, lost weight. A month ago I was 168lbs and am now 163 lbs.

I went out and bought a glucose meter yesterday.  I bought the one Dr. Davis recommended, the OneTouch mini purchased at Walgreens.

In hindsight though, it turned out to be an expensive choice.  I had to buy the OneTouch test strips as well, and they are fairly pricey.

For anyone considering buying a glucometer, buy the Walgreen's version.  I think it had a mail-in rebate, cost a bit less than the one touch, and also, the generic Walgreen's test strips are half as much as the One Touch.

And thank you Dr. Davis for this great blog.

Consumer Reports magazine recommended the ReliOn Ultima and their strips. The meter is, like, $9 and the strips are very inexpensive (compared to "branded" ones). (I'm pre-diabetic.) I don't have any hesitation checking my b.g. anytime, because the strips are cheap.  (No insurance, I have to pay for all my supplies.)  If you have insurance but they limit your strips (as with my nephew, a Type 1), you can use the  cheap one to fill-in your testing.

From my research and experimentation, the Accuchek Aviva shown in picture is the most accurate and precise meter currently available.  Over the long run, an accurate and precise meter will save you money and a lot of trouble, versus one whose results are not as reliable, and which forces you to test more.

btw, most precision issues are due to the strips, and cheap strips will simply result in lots of unnecessary holes in your fingers if you're serious about knowing what's going on with BGs.

thanks

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I wish that I can have all those weight loss tool. I am sure if I have all those my weight loss program is going to be more effective.

I keep hoping nutritional advice will get simpler, but it seems like to know what to have for dinner we need a lot of blood tests and a very savvy doctor to interpret them.

Dr. D,

Get the ldl-fructose connection but still confused about the small particle ldl/Lp(a) and eating fats.  Is it beneficial or not to include "good" fats like olive oil, coconut oil,butter, grass-fed meats, etc. when you have a the small ldl/Lp(a)pattern?  Being a woman and not the skinny male, I do think my pattern is genetic and I'm doing all of your recommendations for diet/supplements and want to be sure I am not making things worse by including fats in my diet.

Thanks.

Jan

~Peter

amen.

regarding fructose, maybe eating fruit instead of sugary junk for dessert and whatnot is the way to go. i can't bring myself to believe that, in the context of a truly simple whole-food diet, an amount of fruit each day is going to contribute to future ills.

~Dr Davis, i wonder if someone who eats a simple paleo diet free of sweetner, added fats and oils, dairy, legumes and grass seeds, and eats plenty of fruit, fatty grass fed meat, fish, greens, and some tubers has an increased risk of s-ldl compared to an average nutritionally ignorant patient who eats a typical SAD and is now trying to "clean it up" a bit.

just musing aloud.

Jan and Shel--

Yes, fats are good. We've just got to be selective in our fats.

My recent comments about "genetic small LDL" were not meant to scare everyone off of fat, but just to make the simple point that there is a subset of people with small LDL whose pattern responds somewhat differently than most other people.

...sorry. i meant to say "...has a 'lowered' risk of s-ldl compared to..."

I notice that you don't include actual measured TOTAL LDL cholesterol. If this is substantially different from the calculated total LDL cholesterol, then your point about the inaccuracy of the Friedewald calculation is proven. As it is, it seems to me that you've merely shown that it may not be very useful (because size, density, and degree of oxidation may be more important), rather than actually inaccurate.

the stanhope study is only useful for those who are already fat and getting fatter and considering supplementing their already excessive intake with fructose sweetened beverages.

self experiment 2 months ago lasting 5 weeks: as much fruit as i wanted and more (i wanted to make sure i got at least my normal intake of approx. 2300 cals) and whey protein to get about 100 g protein/day. my calorie intake per day came to averarge approx. 2700 cals. maybe if i account for fiber the actual calories would be closer to normal.  with that amount of fruit i was consuming i was constantly full (uncomfortbably so at times). i was basically force feeding. i didn't gain weight, i still have six pack so there was no undesirable body recompostion. pure fructose consumption may have no associated feedback mechanism  and induce hunger as stanhope study states, but we can't say fruit does the same thing. i think the addition of fruit to diet maybe helpful to those with weight issues as it could displace more calorie dense stuff sweetened with sugar and has added fat(eg doughnuts, cookies). did i screw up my lipids? don't know.  may be when a study comes along that induces bad things using only fruit as the fructose source i'll know. my point: may be we shouldn't worry about SOME fruit in the diet. may be if i continued experiment longer i would get fat. i'll never know because the diet was unsustainable. turds were monstrous, but passable with more effort than i'm accustomed to or desire.

Professor Lustig hates fructose yet claims that it`s toxic effetcs are blunted by fiber in fruits versus sweetened beverages. Obviously the speed of ingestion is somewhat critical in case of fructose.

I can't rememeber exactly when but several years ago a melting glacier uncovered a 5000 year old man in the Pyranees area. He was dubbed 'Oetzi'.  Since he carried a bow and arrow and kit with seeds he was certainly a hunter-gatherer.   It's logical that he was hunting and carried seeds to sustain him during the day.  But he died of an arrow attack so possibly he was killed for the game he had found, or perhaps by a tribe mate wanting to move up the social ladder.  Who knows.  

kevin

And what about 3-4 small high fat (Omega 6 free) low carbs (no glycemic) meals during the day? Its for example my case

Plus grazing would result in higher levels of digestive acid present in the stomach more often. More acid, more often.......This too is unhealthy...is it not?

Excellent data, doc.

I rarely eat anything big during the day, and almost never before 10am. It's now 12:00 noon and I'll be headed for an intense workout at 12:30 lasting for 30 minutes and will include a lot of pushing weight around. I may eat a bit in the afternoon, but most probably will have a large meal this evening.

This approach has worked wonders in terms of body comp and especially, hunger. I'm just almost never ravenous as I was with all the junk, which I think is the root cause of the grazing dysfunction.

Also, note that it's probably far easier for them to keep their minds off food when they're busy hunting and gathering it.

ting caught up on what meal frequency or timing is "best" and shift the focus toward ensuring an adequate micro and macronutrient intake that supports your goals and lifestyle?

If I am highly active and making quality food choices that fall in line with that activity level, it seems like there wouldn't be anything inherently wrong with eating 4-6 small meals/snacks per day .  That's not to say that 1 or 2 relatively larger meals wouldn't work as well, but I can't see there being much overall difference provided overall daily intake is roughly equivalent (if not the same) and and the focus is on undamaged fat sources, lean protein sources, plenty of vegetables, and a modest intake of fruit (especially things like berries).

Some folks find that various styles of intermittent fasting work best for them when it comes to controlling intake, and others have found that a higher number of smaller feedings work better. So while I do not dispute the wisdom in observing patterns from various hunter-gatherers, I don't feel that mirroring their patterns is something that fits my lifestyle and individual tendencies.

Of course I could be living with my head in the sand and the joke is on me, but I figured I'd just offer up my general thoughts.  I am far from being an expert on these issues.

In any event, thank you for sharing this post, Dr. Davis.

I'm against grazing (especially since it's usually crap that people graze on), but I do have a question about this.  I recently read that the rate of strokes increases during Ramadan, which mirrors this pattern - a large evening meal every day.  

http://www.thaindian.com/newsportal/world-news/does-ramadan-fasting-increase-risk-of-stroke_10038409.html

My father used to just eat one big meal a day at night.  He had a massive heart attack in his 50s.  He ate a lot of meat, butter, eggs, and bacon grease.  I doubt that all of that caused it - I think the primary cause was his two-pack-a-day unfiltered Camels habit.  But all of that didn't prevent it, either.

I've found going down to 2 main meals a day, and only eating between 11am and 6pm that my body fat has dropped considerably.  

I was stuck on about 70kgs for 12 months after starting a high fat, low carb diet, since I've started IF I've dropped nearly a kg of body fat a week for the past 6 weeks (you can see photos on my blog) And I know its body fat because I'm maintaining and even increasing the amount of weight i'm lifting at the gym.

I also feel great too

Then, why the insistence, heard over & over that breakfast is so important?  My body just doesn't seem to want something early in the day, & i've been trying to trust instinct.  But then i wonder if it is just a habit i've gotten into?  

I'm not eating a lot of calories & i eat no wheat (on rare occasion i break this, but have been 95% gluten-free for about 4 years or more).  But no weight loss.  I sometimes wonder if it is because i'm resistant to having breakfast.  

I really don't understand.

I borrow here from the Diabetes community. Blood sugar spikes may be the root cause of or a major contributor to Type 2 diabetes. The bigger the meal the bigger the spike. Most of us that have endured the SAD for most of our lives are well on our way to Type 2 (in my opinion) even after taking to the Low Carb WOE. Thus we are damaged goods and probably would be well advised that if we eat fewer meals per day, we should test the effects on our blood sugar. I do this. Blood meters are dirt cheap. Low carbing no doubt helps but does not assure "no spikes".

Kathryn, the answer to your question "then why the insistence" is because the people who are doing the insisting are basing their advice on little or no real evidence, just pseudo science and old-wivery. Don't confuse exposure with validity. Bad ideas very often get more air time than good ones and the world of medicine and nutrition is rich with examples.

I stress this point because I see that the notion of grazing has seized hold of many people's thinking. In my view, grazing is a destructive practice that is self-indulgent, unnecessary, and simply fulfills the perverse non-stop hunger impulse fueled by modern carbohydrate foods.

If the typical hunter-gatherer tribe eats only once a day and if humans can only absorb around 35g of protein at one time, this would mean that even H-Gs eating very high protein diets would ACTUALLY be on very low protein diets. This is huge no?