Re: T & Fat

[Guest guest]

So, , in order to control your diabetes, what do you eat? You may

have told us previously, but I've forgotten. Do you limit just fat? Or

carbs too? What works for you? I am interested in this idea of yours

that diabetes is caused by high fat values. I believe that we do not

fully understand the disease, but I believe that the genetic component

is very important.

Sue

On Monday, January 9, 2006, at 10:41 AM, Thornton wrote:

> He might have been ahead of his time! It is the

> " glucocentric " approach to diabetes that concentrates

> on blood glucose. The " lipocentric " approach lays

> the blame on high fat values, the high blood lipids

> being held responsible for insulin resistance. I am

> sure that is true in my case.

[Guest guest]

> So, , in order to control your diabetes,

> what do you eat?

I do not control my diabetes with food at all, I do not find that

there is much connection between the two. The 2 x 500mg

metformin/day reduces the effect of my insulin resistance when my

weight is up (90kg/198#), a nominal 250mg/day is enough when my

weight is down (75kg/165#), otherwise I eat 100% pyramid for my

general health, i.e. primarily vegetables, natural rice, salad,

fruit and whole-wheat cereals with a very little meat and olive oil

on the side to give it a taste. I do not eat processed food of any

kind except some cheese and two slices of whole-grain bread each day

and the occasional yoghurt.

Calculated out that gives me on average 50energy% carbohydrates,

25energy% protein and 25energy% fat. At 1400 kcal/day, that gives

170g CH, 81g protein, 38g fat averaged over 2 weeks or so. No

scientific basis for it, that is just what comes naturally to me, if

I tried to achieve any other proportions I would have to force

myself and I reckon that would be self-defeating. Generally, I have

about 100mg/dl FBG, 90-110 mg/dl before meals, 180mg/dl or less one

hour after eating, 110mg/dl two hours after eating. HbA1c

consistently around 5.5%, no detected hypos, lowest BG measured with

this regime: 70mg/dl after strenuous exercise and a missed meal.

My wife is completely different in her approach. At the moment, I am

ahead on points!

> I am interested in this idea of yours that

> diabetes is caused by high fat values.

Yes, the theory is that a high blood fat level hinders insulin from

initiating glucose take-up by the muscles and in the liver. It

sounds plausible to me.

> I believe that we do not fully understand the

> disease, ...

That's for sure! If it really is a disease and not just a symptom of

something else!

> ... but I believe that the genetic component

> is very important.

Many people believe that all diseases have a genetic component. But

considering that we are the direct product of " genetics " , I don't

see how the genetic component can ever be eliminated. Find some

other way to get born?

I suppose that scientists will eventually find some way to monkey

about with our DNA to improve on nature but diabetes could well be

the result of scientists monkeying about with the environment or our

food in the first place so who knows what else they will mess up in

the process?

Regards

T.

[Guest guest]

> ... 110mg/dl two hours after eating.

Make that " about 125mg/dl two hours after eating, about 110mg/dl 3-4

hours after eating " .

T.

[Guest guest]

> I do not control my diabetes with food at all, I do not find that

> there is much connection between the two.

This is a very odd statement. Most of us agree that YMMV when it comes to

diets. What works for one might not work for another. But there's very

definitely a connection between diet and diabetes. Food, especially

carbohydrates, makes BG go up.

> Yes, the theory is that a high blood fat level hinders insulin from

> initiating glucose take-up by the muscles and in the liver. It

> sounds plausible to me.

One has to remember that " blood fat " encompasses a wide variety of

chemicals.

In the short term, free fatty acids actually stimulate the pancreas to

produce insulin. Some fats stimulate the gut to release " incretin " hormones

that increase satiety. A synthetic incretin hormone is Byetta.

> Many people believe that all diseases have a genetic component. But

> considering that we are the direct product of " genetics " , I don't

> see how the genetic component can ever be eliminated. Find some

> other way to get born?

No. Choose different parents .

Gretchen

[Guest guest]

> This is a very odd statement. ... Food, especially

> carbohydrates, makes BG go up.

That is also a very odd statement, Gretchen. It is really stating

the obvious. Carbohydrates, ingested as food, are converted in the

duodenum into glucose and then enter the bloodstream in all mammals,

diabetic or not. It is what happens to them after that that

distinguishes a diabetic from a non-diabetic mammal, i.e. whether

they are taken up by the liver and the muscles in sufficient

quantity to limit the amount of circulating glucose effectively.

The proportions of macronutrients required for healthy nutrition is

determined by a number of factors, not just by diabetes.

My HbA1c remains the same whatever I eat (within reason) and that is

why I said that I do not find any connection between MY diabetes as

it now is and what I eat. Note that I said " I " , other people might

well have a different reaction, I am not monitoring them.

I have tried eating 40energy% CH and 65energy% CH for long periods

(2 months or so) and my HbA1c has not shifted so I settled on

50energy%. I also settled on 1400kcal/day since with that my weight

stays constant if I do not exercise intensively, goes down if I do.

50energy% of 1400 is 700kcal/day, divided by 4.1kcal/gram gives 170

grams CH/day average but moving to 40% (560kcal -> 136 grams CH) or

65% (910kcal -> 222 grams CH) makes no difference to me HbA1c-wise

so I stay in the middle of the range recommended by

various " nutrition experts " .

> One has to remember that " blood fat " encompasses

> a wide variety of chemicals. In the short term,

> free fatty acids actually stimulate the pancreas to

> produce insulin.

I was not writing about " producing insulin " but about glucose take-

up by the liver and muscles. And I am not in this for the " short

term " but for the long haul!

Different strokes for different folks!

Regards

T.

[Guest guest]

> That is also a very odd statement, Gretchen. It is really stating

> the obvious.

Correct. But you had said that food had no effect on your diabetes control,

and some people who are new to diabetes might have interpreted that as

license to eat whatever they wanted.

> My HbA1c remains the same whatever I eat (within reason)

I think the " within reason " is the crux of the problem here. As long as you

limit calories, which you seem to be doing, it is reasonable that eating a

small cracker or a small pat of butter wouldn't make much difference. You

may be in the early stages of DM, still with enough insulin production to

allow you to eat more carbs.

Gretchen

[Guest guest]

> Correct. But you had said that food had no

> effect on your diabetes control, and some people

> who are new to diabetes might have interpreted that

> as license to eat whatever they wanted.

Which is precisely the way it is taught in Germany, not " whatever

they wanted " but that diabetics in general can and should eat

exactly the same way that non-diabetics in general *should " eat,

repeat: " should eat " , there is no good medical reason to make a

difference. Healthy nutrition is healthy nutrition! There are always

special cases, of course - those are allowed for in the German

diabetic teaching - the principle is for the general case.

Nor am I at all sure that it is a good thing for patients to base

their nutrition on what they read on the Internet. I really did try

to make it clear that I was describing my own situation - I have

done a lot of testing to reach that conclusion in MY case, I feel

sure that this list will convince anybody new to diabetes that the

only way is to test thoroughly to see what works best for them and

not just take over somebody else's regime blindly!

> I think the " within reason " is the crux of the

> problem here.

I don't see a " problem " myself.

> As long as you limit calories, which you seem

> to be doing, it is reasonable that eating a

> small cracker or a small pat of butter wouldn't

> make much difference.

Whether I eat one very small cracker or a half a banana or a whole

plate of noodles, my BG rises by about the same amount, i.e. to

around 180 mg/dl after one hour. I did a check today to make sure

that nothing has changed recently. By " within reason " , I meant that

there are international recommendations on minimum and maximum daily

macronutrient intakes for a healthy nutrition and they usually give

a safe range, not just a single value. I would not go outside that

range without a good reason (or medical advice) on a long-term basis.

> You may be in the early stages of DM, still with

> enough insulin production to allow you to eat

> more carbs.

Not so early! I was diagnosed, first with metabolic syndrome and

then with full diabetes in 1999 with HbA1c of 13%. That is not

really " new " . I agree with you that a newly-diagnosed diabetic does

not usually have everything sorted out but after 6 years of good

control I feel that strict dieting can be relaxed considerably. I

was set on a strict diet at the beginning until my HbA1c stabilized

and after that, as I said, in my case there is a lot more freedom to

vary quantities above and below what the doctor ordered (minimum 55%

CH). Works for me but I have no reason to expect that it would work

for everybody (or anybody) else! It doesn't work for my wife, for

example, she has to take a different approach altogether.

Regards

T.

[Guest guest]

> Which is precisely the way it is taught in Germany, not " whatever

> they wanted " but that diabetics in general can and should eat

> exactly the same way that non-diabetics in general *should " eat,

> repeat: " should eat " , there is no good medical reason to make a

> difference. Healthy nutrition is healthy nutrition!

Not all of us agree with that philosophy. And " healthy nutrition " is a

matter of debate. There was an article in today's New York Times, by a

biochemist at a major medical center, who says low-carb diets are best for

people with type 2. He's the editor of the online journal I mentioned in

another post. You can read some research on diets in that journal.

> I have

> done a lot of testing to reach that conclusion in MY case

This is what a lot of people on the Internet are urging new patients to do.

Test and find out what works for you. Doctors and CDEs are less apt to take

this approach. They tend to tell you what they think you should eat.

> sure that this list will convince anybody new to diabetes that the

> only way is to test thoroughly to see what works best for them and

> not just take over somebody else's regime blindly!

Yes.

> Whether I eat one very small cracker or a half a banana or a whole

> plate of noodles, my BG rises by about the same amount, i.e. to

> around 180 mg/dl after one hour.

Some of us feel that's too high. Nondiabetics don't go over 120, and often

stay under 100, no matter what they eat. Would you also go up to 180 if you

ate some fish and some green salad?

If I ate some meat and some LC vegetables, my BG would not go up to 180.

Whether or not short spikes are dangerous is a matter of controversy.

Gretchen

[Guest guest]

> Which is precisely the way it is taught in Germany, not " whatever

> they wanted " but that diabetics in general can and should eat

> exactly the same way that non-diabetics in general *should " eat,

> repeat: " should eat " , there is no good medical reason to make a

> difference. Healthy nutrition is healthy nutrition!

Not all of us agree with that philosophy. And " healthy nutrition " is a

matter of debate. There was an article in today's New York Times, by a

biochemist at a major medical center, who says low-carb diets are best for

people with type 2. He's the editor of the online journal I mentioned in

another post. You can read some research on diets in that journal.

> I have

> done a lot of testing to reach that conclusion in MY case

This is what a lot of people on the Internet are urging new patients to do.

Test and find out what works for you. Doctors and CDEs are less apt to take

this approach. They tend to tell you what they think you should eat.

> sure that this list will convince anybody new to diabetes that the

> only way is to test thoroughly to see what works best for them and

> not just take over somebody else's regime blindly!

Yes.

> Whether I eat one very small cracker or a half a banana or a whole

> plate of noodles, my BG rises by about the same amount, i.e. to

> around 180 mg/dl after one hour.

Some of us feel that's too high. Nondiabetics don't go over 120, and often

stay under 100, no matter what they eat. Would you also go up to 180 if you

ate some fish and some green salad?

If I ate some meat and some LC vegetables, my BG would not go up to 180.

Whether or not short spikes are dangerous is a matter of controversy.

Gretchen

[Guest guest]

> Which is precisely the way it is taught in Germany, not " whatever

> they wanted " but that diabetics in general can and should eat

> exactly the same way that non-diabetics in general *should " eat,

> repeat: " should eat " , there is no good medical reason to make a

> difference. Healthy nutrition is healthy nutrition!

Not all of us agree with that philosophy. And " healthy nutrition " is a

matter of debate. There was an article in today's New York Times, by a

biochemist at a major medical center, who says low-carb diets are best for

people with type 2. He's the editor of the online journal I mentioned in

another post. You can read some research on diets in that journal.

> I have

> done a lot of testing to reach that conclusion in MY case

This is what a lot of people on the Internet are urging new patients to do.

Test and find out what works for you. Doctors and CDEs are less apt to take

this approach. They tend to tell you what they think you should eat.

> sure that this list will convince anybody new to diabetes that the

> only way is to test thoroughly to see what works best for them and

> not just take over somebody else's regime blindly!

Yes.

> Whether I eat one very small cracker or a half a banana or a whole

> plate of noodles, my BG rises by about the same amount, i.e. to

> around 180 mg/dl after one hour.

Some of us feel that's too high. Nondiabetics don't go over 120, and often

stay under 100, no matter what they eat. Would you also go up to 180 if you

ate some fish and some green salad?

If I ate some meat and some LC vegetables, my BG would not go up to 180.

Whether or not short spikes are dangerous is a matter of controversy.

Gretchen

[Guest guest]

I believe the most recent recommendations are no higher than 140 at 1

hour and 120 at 2 hours.

, with your numbers, I think you're courting complications.

Eventually.

Vicki

Re: Re: T & Fat

>> Which is precisely the way it is taught in Germany, not " whatever

>> they wanted " but that diabetics in general can and should eat

>> exactly the same way that non-diabetics in general *should " eat,

>> repeat: " should eat " , there is no good medical reason to make a

>> difference. Healthy nutrition is healthy nutrition!

>

> Not all of us agree with that philosophy. And " healthy nutrition " is a

> matter of debate. There was an article in today's New York Times, by a

> biochemist at a major medical center, who says low-carb diets are best

> for

> people with type 2. He's the editor of the online journal I mentioned

> in

> another post. You can read some research on diets in that journal.

>

>> I have

>> done a lot of testing to reach that conclusion in MY case

>

> This is what a lot of people on the Internet are urging new patients

> to do.

> Test and find out what works for you. Doctors and CDEs are less apt to

> take

> this approach. They tend to tell you what they think you should eat.

>

>> sure that this list will convince anybody new to diabetes that the

>> only way is to test thoroughly to see what works best for them and

>> not just take over somebody else's regime blindly!

>

> Yes.

>

>> Whether I eat one very small cracker or a half a banana or a whole

>> plate of noodles, my BG rises by about the same amount, i.e. to

>> around 180 mg/dl after one hour.

>

> Some of us feel that's too high. Nondiabetics don't go over 120, and

> often

> stay under 100, no matter what they eat. Would you also go up to 180

> if you

> ate some fish and some green salad?

>

> If I ate some meat and some LC vegetables, my BG would not go up to

> 180.

> Whether or not short spikes are dangerous is a matter of controversy.

>

> Gretchen

[Guest guest]

> I believe the most recent recommendations

> are no higher than 140 at 1 hour and 120 at 2 hours.

Not over here (German DDS) - don't forget: " Diabetes INTERnational " !

We have to take the complete picture into account unless we have a

BG fixation! This gives equal weight to glucose and lipids.

We get three values: Desirable / Upper limit / Bad

They are currently:

BG before meals: 90-120 / 126 / over 126

BG 1hr after meals: 130-160 / 200 / over 200

HbA1c: 6.5% / 7.5% / over 7.5% (Type 1, if frequent hypos, not under

6.1%, the majority maximum value for non-diabetics)

Total cholesterol: under 200 / 250 / over 250

LDL: under 130

HDL: over 40 / 35 / under 35

Triglycerides (fasting): under 150 / 250 / over 200

BMI men: 20-25 / 27 /over 27

BMI women: 19-24 / 26 / over 27

Blood pressure: under 140/90 / 160/95 / over 160/95

Smoking: never

These are all evidence-based recommendations. The values you quote

sound to me like " expert's opinion " and they are not the complete

picture.

Emphasis is placed on the setting of personal values taking into

consideration each patient's particular overall condition.

> , with your numbers, I think you're

> courting complications.

Then I have plenty of company over here!

> Eventually.

I should live so long!

Naturally, everybody striving for tight control is happy to get

the " desirable " values but does not lose any sleep if the " upper

limit " is not exceeded, the complete picture being considered more

important than the individual parameters.

I have a check-up every 3 months, particularly for complications.

Regards

[Guest guest]

> Not all of us agree with that philosophy.

Sure, Gretchen, I realize that by now but everybody gets to describe

their experiences!

> And " healthy nutrition " is a matter of debate.

My opinion is that it can be debated only with some kind of expert

knowledge, which I do not have. I go by the evidence-based findings

of our national nutrition organization which are clearly laid out in

a handbook, complete with sources. Everything else is anecdote as

far as I am concerned.

> There was an article in today's New York Times,

> by a biochemist at a major medical center, who

> says low-carb diets are best for people with

> type 2.

Interesting, but I haven't seen it yet. I doubt that I would follow

the advice of a single biochemist in a US medical center

published in a NY paper. The NY Times has published some dubious

stuff on other subjects too in its time!

> He's the editor of the online journal I mentioned

> in another post. You can read some research on diets

> in that journal.

That the guy is also a journalist does not exactly improve his

credibility for me but I would read it with an open mind. All I ask

is that such people provide some evidence and not just claim that

this is good for you, that is not and without saying where the

information comes from so that I can see for myself if he is

reporting or if he is drawing his own conclusions.

> Would you also go up to 180 if you ate some

> fish and some green salad?

No, not that I eat a lot of fish but normal mixed meals do not go to

180, they are a lot flatter.

> Whether or not short spikes are dangerous is a

> matter of controversy.

I have not seen any controversy on that subject; what I would like

to see is the evidence and I haven't seen any of that either! If you

can give me a couple of URLs and I will check them out.

Regards

T.

[Guest guest]

The recommendations you're getting in Germany are similar to the

recommendations of the ADA in America. Many people feel these

recommendations are not ideal.

For example, the ADA is still supporting 60% carbohydrate for people with

diabetes, and they don't accept the concept of the glycemic index. But the

Joslin Diabetes Center, one of the leading diabetes research centers in the

world, recently said that's too high and lowered their recommendation to 40%

and also recommended eating low-GI carbs.

The " experts " keep changing their minds. This is why many of us feel that

the best answer is to test and test and find out what works for you. This

means testing your BG and also having your lipid levels monitored.

For example, many people find that going on a LC diet improves their fasting

lipid profile. But about a quarter of people who try this find that their

lipids get worse. This is one reason to recommend a diet higher in

monounsaturated fat for such people.

I spent a year at a German university (University of Freiburg), and I found

that Germans tended to follow authority without question (I realize there

are always exceptions to any vast generalization like that). I remember one

time during Fasching (Mardi Gras), when we were all coming home semi-drunk

at 3 a.m. There wasn't a car on the road for miles. I started to walk across

the street and the German students gasped in horror, because the sign said

" Halt. "

So I can understand why you want to follow the recommendations of your

experts. We've also had Americans who kept citing the ADA recommendations

and insisting that they must know more than patients because they're

experts.

In Germany, I also learned how dietary perceptions depend on what you're

accustomed to. For instance, it seemed to me that the diet wasn't

particularly varied if you were a poor student: a lot of potatoes and some

sausage and cabbage. I missed the ethnic variety of American food: Chinese,

Italian, Spanish, Indian. One of my instructors had spent a year at Yale and

he said to me that he found American food boring. I asked him why, and he

said, " There was not a great deal of selection in sausages. "

For an Eskimo, a " balanced diet " might consist of some whale, some seal,

some salmon, and some caribou. Others would say it was all meat. For a

vegan, a balanced diet might consist of some whole oats, some whole wheat,

some whole barley, and a bit of salad. Others would call that mostly grains.

> LDL: under 130

Here the recommendations for people with diabetes is LDL under 100,

preferably under 70.

> HDL: over 40 / 35 / under 35

Here HDL levels differ by sex, as women tend to have higher levels than men.

> Blood pressure: under 140/90 / 160/95 / over 160/95

Here 120/80 is now considered borderline high.

What is health insurance like in Germany? Is it like in England? Or do your

employers have to cover you?

I read somewhere about diabetes care in India. It sounded good. They have

these " one-stop shopping " places where you start out at one station to have

blood drawn, then you go to the next one to have your feet checked, then to

another to have your eyes checked, and so on. It sounded great. The only

problem is that they said the cost of one complete checkup was a month's

salary, and the recipients didn't have insurance.

Gretchen

[Guest guest]

> The recommendations you're getting in Germany

> are similar to the recommendations of the ADA

> in America. Many people feel these

> recommendations are not ideal.

That is because those recommendations are international and not

exclusive to the ADA. I was a member of the ADA for some years.

Nothing is ideal in this world but the recommendations are based on

evidence and for me that is what matters.

> For example, the ADA is still supporting 60%

> carbohydrate for people with diabetes, ...

Well, not quite! The last I read from them was:

" As is the case for type 1 diabetes, there is no body of evidence

relating to people with type 2 diabetes to suggest changing the 1994

recommendation that 60–70% of total energy be divided between

carbohydrate and monounsaturated fat. In weight-maintaining diets

for type 2 patients with diabetes, replacing carbohydrate with

monounsaturated fat reduces postprandial glycemia and

triglyceridemia, but there is concern that increased fat intake in

ad libitum diets may promote weight gain and potentially contribute

to insulin resistance. Thus the contributions of carbohydrate and

monounsaturated fat to energy intake should be individualized based

on nutrition assessment, metabolic profiles, and weight and

treatment goals. "

> ... and they don't accept the concept of the

> glycemic index.

But they DO accept the concept! You really do seem to have it in for

them! They just do not find that there is any evidence that it

brings a significant benefit. I tried the glycemic index concept out

on myself (I have " The Glucose Revolution " ) and came to the same

conclusion when I used real meals and not isolated samples of single

foods.

" Although it is clear that carbohydrates do have differing glycemic

responses, the data reveal no clear trend in outcome benefits. If

there are long-term effects on glycemia and lipids, these effects

appear to be modest. Moreover, the number of studies is limited, and

the design and implementation of several of these studies is subject

to criticism. "

( " Evidence-Based Nutrition Principles and Recommendations for the

Treatment and Prevention of Diabetes and Related Complications "

Diabetes Care 25:148-198, 2002

http://care.diabetesjournals.org/cgi/content/full/25/1/148? )

> But the Joslin Diabetes Center, one of the

> leading diabetes research centers in the

> world, recently said that's too high and

> lowered their recommendation to 40%

> and also recommended eating low-GI carbs.

But weren't those new recommendations for overweight Type 2s only?

There does not appear to be any support for them over here.

> The " experts " keep changing their minds.

Yes, poor fellows, but so do I!

> I remember one time during Fasching (Mardi Gras),

> when we were all coming home semi-drunk at 3 a.m. ...

> ... I started to walk across the street and the

> German students gasped in horror, because the sign

> said " Halt. "

German students do all kinds of odd things when they are " semi-drunk

at 3 a.m. " ! You are lucky they didn't break off the sign

completely!

> I missed the ethnic variety of American

> food: Chinese, Italian, Spanish, Indian.

Ah, well things have changed a lot since then! Germany now has a

broad selection of ethnic restaurants in every town of any size:

Serbian, Chinese, Thai, Indian, Lebanese, Italian, Turkish, Greek,

Spanish, Mexican with a Macs and a Burger King in most places.

There is a list of 1,018 restaurants around Freiburg at:

http://www.schlemmerregion-freiburg.de/

There is even an American diner ( " Sam Kullman's Diner " ) in the

Engesserstraße 11 in Freiburg! See? So ethnic meals are now easier

to find!

> Here the recommendations for people with

> diabetes is LDL under 100, ...

> Here HDL levels differ by sex, as women

> tend to have higher levels than men...

> Here 120/80 is now considered borderline high...

Yes, those figures or similar are mentioned over here, too, but they

are generally held to be unrealistic for most patients, worth a try

but most are not going to make it - and they are not based on

evidence so far as I can make out.

> What is health insurance like in Germany?

In a terrible mess! There is no political consensus on what to do

about it but I suppose they will eventually settle on some kind of

compulsory insurance to which everybody contributes with no

exceptions according to their means and not according to how much

they use the services and those who cannot afford to pay will be

financed from taxes. There has recently been a proposal to charge a

premium that is based on the actuarial risk associated with age -

the older you are, the more you would pay under that setup but that

came from the doctors!

> Is it like in England? Or do your employers

> have to cover you?

I have no idea - the last time I went there was in 1972 on a short

visit.

> I read somewhere about diabetes care in India.

> It sounded great. The only problem is that they

> said the cost of one complete checkup was a

> month's salary, and the recipients didn't have

> insurance.

I lived in Iran (where there is also no health insurance) for a few

years and poor people just look around for somebody better off and

ask them to help out.

I was told when I went there that the thing to do is to ask beggars

how much they want, they would never have the nerve to ask for more

than a few cents and I always kept a pocketful of small coins so I

could keep them at arm's length.

One day, I made the mistake of stopping outside a pharmacy when a

woman came up to me, I asked her how much she needed and she pressed

a paper into my hand. I took it and went into the pharmacy with her

to pay for what I thought would be some vitamin C or some such

thing.

It turned out to be a list of the complete set of everything needed

for an operation to be performed on her daughter who was waiting in

the hospital, including anaesthetic, bandages, face masks, soap,

disinfectant, all kinds of tubes and needles and clips, and it set

me back the equivalent of US$248 which was a lot of money in those

days (I had just been paid and happened to have the cash in my

pocket!).

Once I had asked her " how much " and gone to the counter with her, it

was impossible to back out again! That, or something similar, is the

way it works out there. She took the things, mumbled something and

ran off to the hospital.

That is the way of the world; no matter how badly off you think you

are, somewhere in the world there are thousands or millions who

would be very happy to trade their problems for yours!

Regards

T.

[Guest guest]

> That is because those recommendations are international and not

> exclusive to the ADA.

No they're not. Most countries accept the concept of the glycemic index as a

way to improve BG control, but the ADA does not.

> " As is the case for type 1 diabetes, there is no body of evidence

> relating to people with type 2 diabetes to suggest changing the 1994

> recommendation that 60-70% of total energy be divided between

> carbohydrate and monounsaturated fat.

Yes, but they still permit 60% in people who want to lose weight.

> but there is concern that increased fat intake in

> ad libitum diets may promote weight gain and potentially contribute

> to insulin resistance.

Despite studies showing that low-carb diets result in greater weight loss.

> But they DO accept the concept!

Since when? If they do, this would be Big News. Please tell me where you

found this.

> They just do not find that there is any evidence that it

> brings a significant benefit.

That's what I meant.

> I tried the glycemic index concept out

> on myself (I have " The Glucose Revolution " ) and came to the same

> conclusion when I used real meals and not isolated samples of single

> foods.

Other people have found that it works for them, multiplying the GI by the

carb count (essentially producing glucose load) when calculating insulin

dosages. This is in mixed meals.

> > But the Joslin Diabetes Center, one of the

> > leading diabetes research centers in the

> > world, recently said that's too high and

> > lowered their recommendation to 40%

> > and also recommended eating low-GI carbs.

>

> But weren't those new recommendations for overweight Type 2s only?

First, most type 2s are overweight. Second, I don't understand what you're

saying. The ADA says overweight people should eat more carbs and less fat.

> There does not appear to be any support for them over here.

No support for Joslin or no support for overweight Type 2s?

> Yes, poor fellows, but so do I!

And so do I. But I don't expect people to do whatever I suggest .

> Ah, well things have changed a lot since then!

I'm sure. I was not criticizing German cuisine as much as I was pointing out

that we view balanced diets or varied diets within the context of our own

experience, so what is dull to one person is varied to another. Also, I'm

sure there was more varied cuisine even when I was there, but I was eating

at student restaurants that featured 1-mark meals (this dates me, of

course). The U of F was alleged to have the worst food in Germany and one

day the students went on strike. The university just reheated the food and

served it the next day. But one thing I liked was the fact that the soup was

always free, and it was fairly nourishing, so a truely impoverished student

could survive for almost nothing. Tuition was $50 a semester. There were no

exams.

> That is the way of the world; no matter how badly off you think you

> are, somewhere in the world there are thousands or millions who

> would be very happy to trade their problems for yours!

Yes. In some parts of the world there are children dying of type 1 diabetes

because they can't afford insulin.

Gretchen