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Wednesday, March 16, 2016

Why I follow a low-carbohydrate meal plan

I would like to start off this post by explicitly stating that a low-carbohydrate diet has worked extremely well to help *me manage my blood sugar. However, this does not mean that I am going to try to convince *you to do anything. I am after all a libertarian – freedom of choice to do whatever you want is important to me, and I am not here to preach or to convince you to do one way or the other – simply relaying my experiences with different food choices. Nor am I going to partake in the stupid divide I have witnessed in the #doc when people have different opinions and can’t seem to accept that “to each their own” ;)

Now that I have gotten that out of the way, I must also point out that the dietary guidelines recommended for the general population as well as for PWDs are unfortunately not the best. Better than the food pyramid? Sure. However, still way outdated and not supported by research (saturated fat, anyone?) As a scientist I read primary literature. All. The. Time. Be it developmental biology (my current area of expertise), immunology and cancer (my graduate work), or simply for fun (read: nutrition). As a result of my background and constant need to read papers, I have realized that a low carbohydrate diet can be both “safe” and very sustainable. If you have specific questions, please feel free to contact me :)

Now, I realized many years ago that eating less carbs per meal helped me avoid post-prandial blood glucose spikes. However, at the time, I was not well-educated about fat consumption, and as a result of adhering to the low-fat advice, couldn’t maintain my weight, and thought to myself – hmm, I guess this is unsustainable and I need to eat more carbs. Fast forward to today, and I have learned a lot more about both metabolism, and also the terrible studies that produced the low-fat guidelines/craze (luckily, things are slowly starting to change – even the 2015 dietary guidelines have finally removed dietary cholesterol and saturated fats from the “nutrients of concern” list.) In any case, once I realized that fat (good fat!) is not the enemy, and also that there is absolutely no evidence that eating more protein causes kidney damage, I once again began my journey of diet experimentation in an effort to normalize my blood sugar. 

Here’s the caveat  - a majority of health professionals are not up-to-date on their continuing education and as a result are prone to continuing to misinform the public. Don’t get me wrong – I think the vast majority of physicians have the patient’s best interests in mind (after all, why wouldn’t they?) However, about 50% of what doctors learn in medical school is unfortunately wrong (we just don’t know which half). I whole-heartedly applaud those doctors (such as my paleo-eating endocrinologist, who holds both a D.O and a M.D., and has actually conducted research) who stay up-to-date and don’t just spend decades regurgitating information they memorized years ago. One of the reasons I never became a medical doctor was because I really didn’t want to deal with the ridiculous hours (residency and beyond), and also because I don’t really want to deal with the stress of getting sued. But – if you are a doctor reading this – I applaud you – and I hope that you are finding time in your busy schedule to attend conferences and read studies yourself. (My endocrinologist is appalled at how many docs are getting their CE from pharmaceutical reps. He is also appalled at how new drugs are pushed out today with pretty much no safety profile). But, I digress – that will have to be another post.

Anyway, back to my low-carb (moderate fat/ unlimited protein) diet. PROS: Amazing BGs. Fewer lows. More stability. As a result – improved mood. CONS: Learning to bolus for protein (this was the hardest for me), and spending a lot of time in my kitchen (some may consider this a con, but I personally do not :).  As an example, I am posting some CGM graphs from my “standard diet” days vs. today’s low-carb. The first set of graphs illustrate the difference (for me anyway) between eating a bagel vs. low-carb waffle + egg. The 24-hr. ones are representative of overall stability throughout the day (I am still working out all the kinks). Importantly, these graphs are not representative of effort (I tried really hard to have stable blood sugars on a “regular” diet just as much as I try to do it now), these graphs are reflective of diet. 

Now, I personally eat a lot more carbs than most people adhering to a low carbohydrate diet (e.g. Bernstein plan). I eat about 60g per day (on average), and I don’t actually have any foods that are “off limits”. If I feel like eating it, I will eat it. However, most of the time, I tend to prefer feeling good instead of “indulging”. What does indulging look like to me? These days, this would be a serving of popcorn and an ice-cream (together, at once). I had some last week, spiked to 150 mg/dL. Did I regret it? Not necessarily, but looking back, I wish that I had split up these “treats” into two occasions. What does a typical day look like? For breakfast, I have a two egg/ cheese (sometimes meat too) “sandwich” on a low-carb wrap. An alternate breakfast is a low-carb waffle (made with almond flour, plain yogurt, a bit of milk, and eggs, with Stevia) with a teaspoon of jam and 1 fried egg with a sprinkling of cheese. Another alternative is plain yogurt with berries. And coffee. ALWAYS coffee :) My favorite lunch is hands down a loaded Greek salad – lettuce, tomato, cucumber, olives, feta, green onion, with added avocado, or chicken, or tuna. I make my own dressing (1:1 EVOO/red wine vinegar with s/p, oregano, and garlic powder – so good). Alternately, I bring my leftovers from yesterday’s dinner – usually this is a protein source and lots of vegetables. For instance, last night I had cheeseburger casserole and bacon-fried French green beans. It is also my lunch today. This particular meal is quite high in protein and fat (and illustrates one of my lowest-carb meals), but not all my dinners are. I also enjoy blackened tilapia, ramen using shirataki noodles, Parmesan-crusted chicken (with a tiny bit of bread crumbs) with steamed spinach or broccoli, etc. I could go on and on and on (I will have to make a separate recipes-only post ;) And I am not afraid to throw some refined carb in there – be it about 1/3 – 1/2 serving or rice or French fries or whatever if I feel like it. My favorite “carby” thing to eat remains the occasional small serving of multi-grain bread from Costco with artichoke spread or smoked salmon and cream cheese. Alternately, I really like crackers and cheese J Oh and I loooove Kind+ bars as an on-the-go snack. I also love berry/plain yogurt smoothies.

Here is the fun part – since I now bolus for protein, I don’t have to wait 15-30 minutes after bolusing to eat my meal to achieve flat lines. So I bolus for my carbs and 30% of the protein up front and eat! 

And this is why I choose to eat low-carb. Here is this morning :)

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