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Another great resource for those with type I or II diabetes, LADA diabetes or low carb dieters interested in the peer-reviewed research is created and maintained by Janet “Jenny” Ruhl at http://www.phlaunt.com, and is called “Blood Sugar 101.”

Jenny explains the reason the site exists:

After losing 30 pounds with a low carb diet, I have maintained that weight for many years. My current BMI is within the normal range for my height. At one point I exercised daily for a year and got my body fat down to 24%, which put me into the “Fitness” category for a woman my age. Despite what my doctors had told me, weight loss and intense fitness didn’t do a thing for my blood sugars, which got worse.

This raised my curiosity. I started tracking through the research articles available for free on the web. (many of them, now, alas, are no longer free, but I was lucky that I started my research back in 2004 when they were.)

The information I found, much of it differing dramatically from what doctors were telling patients about what caused diabetes and how it should be treated, became the kernel of this web site. My goal was to answer these questions: What do scientists actually know about Type 2 diabetes? Why do doctors miss diabetes diagnoses until long after people already have diabetic complications? And what blood sugar levels are truly low enough to prevent further damage to the organs and beta cells?

The site is a treasure trove of information. While Low Carb Age attempts to provide the latest news chronicling the end of the low fat craze, Jenny’s site provides a wide and expansive view of the research spanning back decades. Under the general heading of blood sugar control, Jenny ventures into nearly every area a low carb dieter is concerned about. The site is extensive enough to have been put out in book format:

Jenny maintains a blog also at Diabetes Update where new information is presented.

Both the blog and the Blood Sugar 101 website are highly recommended.

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Chris Dikmen has some great advice on staying on plan during a cruise:

So when preparing for a low-carb cruise, there are really two things that you have to keep in mind:

1. Define a plan for limiting the carbs during your cruise.

2. Accept that cruising without carbs can be enjoyable. You don’t have to have the pies, cakes and breads to have a great time on a cruise. Look at it this way, it is better to be on a low-carb lifestyle and on a cruise than on a low-carb lifestyle and be at home!

He has specifics in the post, and you can tell he’s a pro at this; he has had more than 15 cruises since starting a low carb lifestyle back in 2002.

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I’ve avoided the show The Biggest Loser on purpose, but Dr. Doug McGruff happened upon it in the break room between patients in the emergency ward:

I have never watched this show, as I assumed it would be ridiculous. I was shocked how much I had underestimated. I could not believe the amount and types of exercise these poor people were being put through. They even showed one contestant collapsing on a treadmill and being spit off the back of the machine by the spinning tread. Then there were multiple scenes of the contestants being screamed at by that Gillian lady in the tank-top/midriff shirt (talk about narcissistic) and some sadistic guy with tattoos all over his arms. The instructors’ contempt for the obese was obvious as they spewed insults (and saliva) in the faces of the contestants. I don’t care how fat or desperate I was, if someone did this to me I would punch them in the face and storm off the set. I checked in on the show between patients. The diet and exercise shown were prescriptive for ravenous hunger and ultimate failure. As I continued to work, I kept thinking about the importance of biologic signaling, and why it does not have to be this hard.

Dr. McGruff graduated from the University of Texas Medical School at San Antonio in 1989 and studied Emergency Medicine at the University of Arkansas in Little Rock, where he served as Chief Resident. He is one of the “smart guys” I like; not a researcher in some academic office running computer queries to do some fancy meta analysis, but a practicing physician who sees real people with real problems every week.

Every person who has struggled with a “diet and exercise” program to lose weight knows the problem Dr. McGruff identifies:

Overtraining (especially in the obese) triggers cortisol and other stress hormones. A low fat, high carbohydrate diet signals insulin release. These signals defend a high level of stored fat and drive huger…a true prescription for misery and failure.

Theories abound in what passes for dietary science. The ones based on science rather than just observation appeal to me the most. Dr. McGruff explains why a short high intensity workout is better than the Biggest Loser’s cardio-based workouts:

The key to turning around these sorts of metabolic disasters is to send the correct biologic and hormonal signals. If the correct signals are given, there is a disproportionate improvement in the metabolic state and body composition. This disproportionate response is courtesy of a second messenger system. Most hormones do not act directly on their target organ or tissue.

The cell wall protects the cell; most hormones cannot pass through the cell wall easily. Instead, the hormone’s fat soluble receptors bind the hormone on the outside of the cell wall and transmit the signal to a messenger inside the cell itself. I always think of the way an amplifier can take the puny signal from an iPod, process it, and play it through big, power hungry speakers. And in this case, amplification does indeed happen. The second messenger, on the inside of the cell, amplifies the signal:

The unique thing is that the second messenger then activates a chemical cascade that multiplies the signal at the target. This way a single molecule of primary messenger can produce thousands of second messenger signals at the target.

In other words, your cellular stereo amplifier is set on “10″ (or “11″ if you are a This is Spinal Tap fan).

This is why a proper signal is so important…the beneficial effect is hugely magnified. A brief, but intense workout that fatigues the musculature activates growth hormone, testosterone and adrenaline which all signal to empty glycogen and fat, both short and long-term. A hunter-gatherer diet creates a low insulin signal which triggers the body to defend a lower body fat set point.

The fact is, you don’t need a skinny person who has never fought a weight battle yelling at you to lose weight or become healthier. And chances are, even after that ordeal, your weight problems will return:

On camera, Zwierstra seemed giddy and brash, interrupting host Caroline Rhea, hollering at her friends in the audience, tipsy on her 3-inch heels. Secretly, she was woozy, having dehydrated herself by avoiding liquids, baking in a sauna and fasting for days to skim off those last few pounds.

The studio audience went wild as the cameras panned in. Zwierstra stepped on the scale. Rhea hollered, “Your current weight is …”

The scale heightened the tension: Beep. Beep. Beep.

144 pounds!

She’d lost 45 percent of her body weight.

But it wasn’t enough.

In the end Erik Chopin, a New York deli owner, took home the big check, losing more than 200 pounds from a starting weight that topped 400.

In January he appeared on Oprah to describe how he’d gained half of it back.

The top two contestants of The Biggest Loser’s third season have not solved their problems. The impossible standard set by the program’s extreme exercise program won’t work for them, or for many people. At its heart, The Biggest Loser uses the “calories in / calories out” principle, comparing the human body to a gas engine rather than to a metabolic organism. It is rooted in the 19th century science that measures food content in how much heat it gives off when burned in a furnace, rather than using modern science to understand how the human body actually works.

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Johns Hopkins has been doing research and clinical trials on ketogenic diets for seizure disorders in children for years. The diet they use is much more carb-restricted than we find in PP, and probably higher in fat content. The article in Diabetes in Control describes it this way:

The ketogenic diet, consisting of high-fat foods and very few carbohydrates, is believed to trigger biochemical changes that eliminate seizure-causing short circuits in the brain’s signaling system. Used as first-line therapy for infantile spasms and in children whose seizures cannot be controlled with drugs, the diet is highly effective but complicated and sometimes difficult to maintain. It can temporarily raise cholesterol, impair growth and, in rare cases, lead to kidney stones, among other side effects.

The Hopkins Children’s Hospital used the diet for 16 months to 8 years to reduce or eliminate the seizures. The study being referenced is a follow-up to see if any lasting health problems from the diet are revealed.

There don’t seem to be any long-term effects:

Only two of the 101 patients reported kidney stones after stopping the diet, the same rate found in the general population not treated with the ketogenic diet, the researchers say.

None of the 25 patients who had liver and kidney function tests had abnormal results. Among the 26 patients who had their cholesterol tested, the average level was 157 milligrams per deciliter of blood (less than 200 is considered normal), with three of the 26 having abnormal levels. Most patients’ cholesterol levels go up while on the diet, but are believed to return to normal thereafter. The Hopkins study now confirms that this is the case.

In 2008, Johns Hopkins Children’s Hospital described the results on cholesterol this way:

While most children developed high cholesterol after starting the diet, in half of them, cholesterol gradually improved returning to normal or near-normal levels, with or without modifications to their diet to reduce fat intake.

Interestingly, efforts to reduce saturated fat saw no greater decrease in cholesterol levels. In other words, doing nothing and reducing saturated fat had the same effect over time. That might be good news for low carbers that are worried about an increase in cholesterol in the early years of the new way of eating.

Since 2005, Hopkins has noted that a modified Atkins low carb diet plan has nearly the same benefits as their more restrictive ketogenic diet for children with seizure disorders. In effect, any diet that puts the patient into ketosis restricts the seizure activity.

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These are a great, soft cookie with under 2 grams of carbs per 2″ cookie. The cookie is moist, chewy, and the sweetness can be controlled easily if you so desire. The flavors blend well, and neither the pumpkin, coconut, apple filling or pecans overpower the other flavors. The recipe makes about 24 cookies 1 1/2″ to 2″ in diameter. Jan created these cookies by experimentation, and they are fabulous!

Cookie Ingredients:
3/4 Cup Almond Meal
1/4 Cup Flax Seed Meal
1/4 Cup Unsweetened Shredded Coconut
1/4 Cup Pecans, chopped
3 tsp Sweetner
1/2 Package Single Serving Apple Drink Mix (pictured)
1 Grade AA Large Egg
1/2 Cup unsweetened Pumpkin filling
1/4 Cup Butter
1 1/2 tsp Dark Molasses
1/4 Cup Shortening

Topping
1 tsp Brown Sugar
1/4 Cup unsweetened Shredded Coconut
1/4 Package Single Serving Apple Drink Mix (Pictured)

Heat oven to 325°F. Mix topping ingredients together and set aside. In a 2 quart mixing bowl, mix dry cookie ingredients well. Add egg, pumpkin filling, butter (allow to soften to room temperature first) and shortening and mix well. Form 1″ balls with cookie mix, and press down onto greased cookie sheet, flattening them to form 1 1/2″ to 2″ diameter. Sprinkle topping over cookies and bake for 12 – 15 minutes. Store cookies in refrigerator.

Total effective carb count (ECC) is 36 grams per batch of cookies.

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In the UK, the government sponsors the “National Child Measurement Programme”, an attempt to combat childhood obesity by assessing the height and weight of children. The program does the measurements in the schools, and then sends letters home to parents.

Lucy, a five year old, was measured and the letter warned she “may have an increased risk of heart disease, diabetes, high blood pressure and cancer as her body mass index (BMI) was outside recommended guidelines”.

The Daily Mail Onlline recounts the reaction of the parents. As the mother said:

I couldn’t believe what I was reading, Lucy is five-years-old and not fat in the slightest. She shouldn’t even be thinking about her weight at her age.

‘I want her to be running around playing and having fun, not worrying about what she looks like.

It would be easy to say mum is a bit sensitive about her daughter’s weight, and in denial about how she is setting her daughter up for medical problems by her poor parenting.

The problem with formulas to determine optimum weight for an individual is that they are often just plain wrong. A number doesn’t make you healthy. And in Lucy’s case, the number is obviously wrong, as anyone with any sense can see. But perhaps that’s more than we can ask from a government program. Here’s a picture of Lucy:

She looks like the picture of health, to me. Sounds like the bloated, overweight, tub-of-lard actor in this issue is not the kids in Britain, but the fat-ass government.

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A new “meta analysis” of existing studies purports to find no link between fat intake and coronary heart disease (CHD):

Conclusions: A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD or CVD. More data are needed to elucidate whether CVD risks are likely to be influenced by the specific nutrients used to replace saturated fat.

The problem with this study is that it is a meta analysis, which as Dr. Eades explains:

For those who don’t know, meta-analyses are compilation studies in which researchers comb the medical literature for papers on a particular subject and then combine all the data from the individual studies together into one large study. This combining is often done to bring together a collection of studies, none of which contain data that has reached statistical significance, to see if the aggregate of all the data in the studies reaches statistical significance. I think these types of meta-analyses are highly suspect, because they can lead to conclusions not warranted by the actual data.

Those same concerns apply to this study, of course. But one thing this study does is help counter the other meta analysis studies that purport to show a link between dietary fat intake and heart disease.

Meanwhile, we find another study that says butter ain’t so bad:

Now a new study from Lund University in Sweden shows that butter leads to considerably less elevation of blood fats after a meal compared with olive oil and a new type of canola and flaxseed oil. The difference was clear above all in men, whereas in women it was more marginal.

Seems that about 20 percent of the fat in butter consists of short and medium-length fatty acids which are metabolized for energy and don’t contribute to blood lipid levels.

Good news for me. Butter is one of my favorite foods.

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Dana Carpendar at Hold the Toast blog recaps the results of an interesting study in the Archives of Internal Medicine:

47% of the low carb group had their blood pressure medication discontinued in the course of the study, as compared to 21% of the low fat group. Dr. William Yancy, who ran the study, said the difference in the two groups might have been even greater had subjects remained on their blood pressure medication, but they instead took people off medications as their readings normalized.

The study started the low carb group at the true low carb level promulgated by the Atkins diet, 20 grams per day. Far too often, studies comparing low carb diets to low fat diets use 100 or more grams per day of carbohydrate. The study lasted nearly a year, long enough for true differences in the diets to be seen. For the low fat diet group, the study added a common diet drug, orlistat, a drug that sequesters fat so it can be eliminated before being absorbed by the body.

Weight loss for the two groups is statistically insignificant, even though some low carbers have pointed to the results proudly. The small sample size and small difference in the number of pounds lost between the two groups just doesn’t lend itself to proclaiming any victory for the low carb diet. But the study does show the low carb diet is the equal of a low fat diet in nearly every respect. The study’s Abstract points this out.

No matter what you read, the main benefit of a low carb diet in this study was that it matched the low fat diet in nearly all areas, and was superior in controlling high blood pressure:

Conclusion: In a sample of medical outpatients, an LCKD [low carb ketogenic diet] led to similar improvements as O + LFD [orlistat plus low fat diet] for weight, serum lipid, and glycemic parameters and was more effective for lowering blood pressure.

It would be interesting to see how the participants felt about their low carb or low fat diet. My experience has been that the low carb diet is much easier to maintain, as I rarely struggle with hunger even while losing weight.

And, I love bacon.

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Dr. James Carlson is a board certified family physician with multiple degrees … biochemistry and molecular cellular biology from Cornell University, an MBA from Regis University, and a Juris Doctorate from Concord University. And that’s in addition to his medical education at the NY College of Osteopathic Medicine. Dr. Carlson is one of those smart guys I like, one that, like Dr. Eades, has actually had a medical practice with real patients and real mysteries to solve.

His blog post today covers a subject that many low carb dieters wonder about: for some reason, they stop losing weight, even though they have not increased their carb intake. In forums, these people are often told they are “cheating”, perhaps without knowing it. But I’m always struck with how much this kind of “advice” resembles the justifications for the failed low-fat diet: if you can’t stay on the diet, its your fault.

Dr. Carlson does a good job of describing a situation where protein can be made into glucose:

Ok, so back to protein. Yes, one can definitely over consume protein, allowing the glucogenic amino acids to be converted to glucose, this can cause a sugar rise, subsequent release of insulin and that is what is causing your weight loss stall or possibly weight gain.

There’s a lot more there about a topic most low carbers have heard, gluconeogenesis, and one they probably haven’t, glyceroneogenesis. Follow the link to read it all.

So why would a careful low carber, who has been losing steadily and eating all the right things, suddenly stop losing? Nothing has changed, right? Wrong.

No, the dieter isn’t necessarily cheating. The dieter has lost 20 or 30 pounds. I have lost 30 pounds, about 13% of my pre-diet body weight. And when I started the diet, I calculated my protein requirement based in large part upon … my weight. That’s what has changed.

So, for the low carb dieter who has lost weight, its back to the tables and charts to re-calculate what their protein requirement is; for most people, it will be less than before. While weight lifters may have more lean body mass, most of us will have less calculated lean body mass. I don’t think we are actually losing muscle. And while I’m not absolutely certain on this point, I think the charts and measurements we use have a built-in variation that gets more and more accurate as we reduce our body fat percentage.

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I noticed when I adopted the The Protein Power Lifeplan
way of eating that I was finally able to eat regularly spaced meals without getting hungry between them. Prior to that, I can’t remember a time in my life when I wasn’t fighting the urge to snack between meals.

In dietary circles, the ability of food to satisfy your hunger is referred to as the satiety factor. Some researchers claim satiety is tied to the feeling of fullness you get from bulkier foods, but my experience is that high fiber foods do not necessarily satisfy my hunger. They make me feel full, but still hungry. There’s always room for another slice of that fiber-rich pumpkin pie.

Low carb advocates often cite the satiety factor of their diet, as I have done in the first paragraph. Some point to the higher percentage of fat in the diet than the typical low-fat diet emphasized by most doctors, making the claim that you cannot gain weight if you eat a low carb diet with plenty of fat. But some people do gain weight that way, so something else may be at work.

When I started Protein Power, I calculated my daily minimum protein requirement, as the book recommends. I was surprised at how much food I could eat. With 25 – 30 grams of protein per meal as a minimum, that meant a hearty bacon and eggs breakfast of 3 eggs (18 grams) and 3 slices of bacon (9 grams). My usual breakfast routine was a toasted bagel, then a snack before lunch because by 10 AM I was very hungry. But after eating the eggs and bacon mentioned above … I was full, and remained so until lunch time.

As the title of the book suggests, Protein Power is about getting the right amount of protein as well as reducing carbohydrates. It works for me. And it may be the protein that satisfies, rather than just the increased fat.

Nutritional ecologist Professor David Raubenheimer of New Zealand’s Massay University, recently conducted a study on primate eating habits in collaboration with other experts. Studying the Bolivian rainforest spider monkey, Professor Raubenheimer found the monkey’s food intake increased when low protein food sources were the only ones available.

The findings, published in the latest issue of the journal Behavioural Ecology, reinforce the theory that humans and other primates are physiologically predisposed to maintain a constant level of protein in their diets. But when the range of foods available to them is low in protein (yet high in fats and carbohydrates) they are compelled to eat greater quantities in order to maintain correct protein levels.

I think this explains the satiety issue better, and gives an indication of why some people experience weight gain even on a low carb diet. If they aren’t meeting their body’s protein requirements, they will be hungry. And hungry people eat more.