diabetes – Pertinent Observations

Diabetes, sugar and insulin

Last weekend I finished off Jason Fung’s The Complete Guide to Fasting. Like his earlier book that I read (The Obesity Code), this book makes a very compelling case to fast as a means of reversing type 2 diabetes, lose weight and generally have a much better life.

I’m compelled enough by the book to have put its message into practice immediately. Apart from days when I go to the gym early in the morning, I’ve been making it a point to not eat breakfast (this isn’t the first time I’m trying this, I must mention). And while the weighing scales haven’t moved yet, I’m pretty happy.

In any case, in both his books, one thing that Fung rails against is the conventional medical practice of telling people suffering from Type 2 Diabetes to “eat 6 meals a day”, while most medical research shows that this leads to higher insulin resistance (and thus worse diabetes), and that what is better is to eat a smaller number of meals in a day.

So a few days ago, I came across this tweetstorm by this guy who installed a continuous glucose monitor in his blood. The tweetstorm is very instructive.

Finished a 14 day experiment with a continuous glucose monitor in my arm. Learnt a lot about how my body reacts to food!

?w graphs below. May be useful for folks with high blood sugar

All food in this thread was home cooked. I wrote some python to extract & clean the data pic.twitter.com/VwC9W5ZMoL

— Rishabh Srivastava (@rishdotblog) April 14, 2021

And this helped explain to me why despite research showing the contrary, eating “several meals a day” has been part of the treatment manual for diabetes, even if in reality (as per Fung’s book), it hasn’t helped.

This graph from the tweetstorm is instructive:

Look at how his blood glucose spiked immediately after a meal that he ate after a longish fast. The conventional medical wisdom has been that if a diabetic eats infrequently, every meal will spike his blood glucose, which then leads to a spike in insulin, and that is not good for the person.

Instead, the wisdom goes (I’m guessing here) that if you have several small meals, then you don’t have a single big jump in glucose levels like this. And so you don’t have single big jumps in insulin levels.

Moreover, the big risk with Type 2 diabetes is hypoglycemia – where your blood sugar drops to such a low level that you start sweating rapidly and come under the risk of a heart attack. And when you don’t eat frequently, your blood sugar can drop like crazy. And so several small meals works.

Logical right? I guess that’s what most doctors have been thinking over time.

The little problem, of course, is that if you eat too many meals (and small meals at that), your blood glucose doesn’t spike by a lot at any one point in time. However, that you haven’t given sufficient gap in your meals means that your insulin levels never drop below a point. And that means that your body becomes resistant to insulin. Which means your diabetes becomes worse.

So what do you do? How do you let your insulin level drop to an extent where your body is not resistant to it, while also making the spike in insulin when you finally eat not so much? Again, I’m NOT a medical professional, but seems like what you eat matters – fat spikes insulin much less than carbs or protein.

Maybe I should change the nature of my lunch on days I don’t eat breakfast.

PS: This entire blogpost is entirely my conjecture, and none of it is to be taken as any kind of medical opinion.

Concepts from The Obesity Code

Based on the recommendation of a friend who had once described his waistline as “changing more often than Britney Spears’s (?) bra size”, I read Jasun Fung’s The Obesity Code over the last couple of days. The book is stellar.

Here are my highlights from the book.

Anyway, fitness and nutrition is something I’ve been struggling with for a very long time in life now. I used to believe that I have my health numbers (primarily triglycerides) under control because of regular lifting of heavy weights, but a recent blood test called that assumption to question. Having got what I now think is bad advice about what to eat and what not to eat, getting better advice on food is something I’ve been fairly receptive to. And the book does a great job of it.

The basic idea is – your body weight is controlled by hormones. How much you eat and how much you exercise doesn’t really matter. Calorie counting just doesn’t work. Your body has a “natural weight”, and if you are above that the body will try to adjust it lower, and vice versa. And this “natural weight” is guided by the hormones, especially insulin. The higher the level of insulin in your blood, the more your “natural weight” will be.

So the idea is to keep the level of insulin in your blood low. The author builds up a stellar case with some rigorous presentation of research. There is NO RELATIONSHIP between the fat that you eat and risk of heart attacks. A high carb low fat diet will make you fat.

And what I liked about the book is the structuring – the first 220 pages is all about presenting the research on various topics, and not really “giving away” what you should or should not eat. And then in the last 20 pages, he puts it all together, with a broad plan on what is good to eat and what is not.

In any case, I’m not going to reproduce the book here. You can go read it (it’s very very well written), or just read my highlights. The reason I started writing this post is to document my learnings from the book. I think I’d already internalised a lot of it, but some of it is new. This is how I plan to change my diet going forward:

Sometimes in recent times I’ve noticed this “heady feeling” upon eating certain foods. I used to think it’s due to eating too much sweet. Now, after reading, I think it’s the feeling of an insulin spike in my head. I’m not going to have any fruit juices. Fruits need to be eaten whole
I’ve largely eschewed added sugars for a while now (sometimes on and off). This will continue.
Artificial sweeteners also cause a spike in insulin. I didn’t know this. So no more coke zero. No more Muscle Blaze Whey Energy powder as well (I now need to find a whey powder that doesn’t contain any sweet or any sweetener). No energy bars. No “no added sugar” biscuits.
This is maybe the most important concept in the book – NO SNACKING. Eat exactly two or three times a day (I used to eat two a day, but nowadays I go to the gym in the mornings, so breakfast is necessary). Eat as much as you want at each meal, but don’t eat in between meals. The body needs lots of periods of time when insulin levels go low – so it doesn’t adjust to a higher natural level of insulin, which means a higher natural weight.
Dairy products have a high “insulin index” (produce lots of insulin once eaten), but also have high satiety – they keep you full for a very long time after eating. After my last cholesterol test, after a fight with the wife, I largely gave up on cheeses. I’m reversing that now. I love cheese, and it’s good for me. Calorie counting just doesn’t work (the book does a great job of explaining this).
Not doing keto. It’s unsustainable. And I love my fruits too much. Oh, and I need to eat my fruits along with my meals. Not as “snacks”
Processed carbohydrates are not good. So no more bread for me. I need to figure out if fried eggs + milk will be enough for breakfast. Or find a decent substitute.
I also need to figure out how good or bad basmati rice is. Definitely makes me feel better than sona masuri (which we used to eat before). Need to figure out if this feeling is justified.
Peanuts are good. Peanut butter is good. Other nuts are good as well. But need to eat them for breakfast. Not as a snack.

The hardest part for me, with this new regimen I plan to start, is “no snack”. I’d gotten so used to snacking that I think I eat far less than necessary during my main meals. And that results in a vicious cycle. I’ve attempted to start breaking out of that by supplementing my chapati-paneer curry with some curd rice tonight.

So far I’ve been feeling great. Let’s see how this goes.

Health and fitness not a rural concern?

It is now well accepted among nutritionists that excessive consumption of cereals is actually harmful to to health and can lead to problems such as high cholesterol, triglycerides, diabetes and fatness. In response to this, we have a number of new-fad diets such as the paleo and the keto and the Atkins which restrict intake of cereals. Even though the number of people practicing such diets might be low, in general there seems to be a trend away from cereal consumption.

Anyway, yesterday Mint put out a set of charts on malnutrition in India and the relative success of the Public Distribution System (in terms of prices for the end-consumer and nutrition only – not in terms of efficiency). What caught my attention was the last chart – the one on per capita cereal consumption in rural and urban areas.

I wasn’t comfortable with the dynamic chart on the Mint website (they have a slightly better multiple-column chart in the paper this morning), so I redrew it using lines. I’m still not sure if drawing it using lines (since the X-axis is deciles which is ordered but strictly not numerical) is the most appropriate but haven’t been able to find a better way to draw it so here goes.

The Mint piece talks only about the ratio of consumption of top and bottom deciles in rural and urban areas and stop by saying that in urban areas the poorest consume more cereal than the richest. The “trends” in the above two lines tells me a different story, though.

As you see, as we go towards the right (i.e. richer people), consumption of cereal in urban areas (the red line) actually drops! I would put this down to greater health-consciousness among the richer people of urban areas who are cutting down on cereals (either voluntarily or following the discovery of a lifestyle disease such as diabetes or cholesterol).

The blue rural line doesn’t show the same effect though – in fact, the richer you get the more cereal you consume if you are in a rural area. It either means that rural people are immune to lifestyle diseases (unlikely), or their lifestyles means that they aren’t as affected by lifestyle diseases as urban people (rather more likely) or that their lifestyle diseases go undiagnosed (perhaps even more likely) or that they have no choice but to eat cereals (unlikely again) or non-cereal sources of nutrition are too expensive for even the rich in the rural areas because of which they just consume more cereal.

Nevertheless, the trend shown in this graph is extremely interesting, and definitely shows among other things the power of aggregation when it comes to analysing data!

The stigma about mental illness

It saddens me deeply every time I see someone rubbish mental illnesses as a fad, and as a wall behind which the mentally weak strive to hide. Having myself being affected negatively by delayed diagnosis and treatment thanks to prevailing orthodoxies, and having seen the kind of lift timely recognition and therapy can provide, it is frustrating to know that most of the world still attaches a stigma to any kind of mental illness.

Earlier today, someone I know reasonably well complained that she’s feeling way too depressed nowadays, and that she needs to seek a counselor. Knowing her, I know that this is a deeply informed decision, but before I can throw in my support, her mother interjects saying “all this therapy and counselling is bullshit. Just move in back with us and you’ll be fine”. I had half a mind to interject with “your similar stupid judgments not so long ago drastically delayed someone’s recovery, I know. So I don’t think your daughter should listen to you”. But not feeling particularly combative, I kept my opinion to myself.

Over the last few months, I’ve been trying to do my bit, though, to help clear the stigma of mental illness. I was talking to some aunts today and told them, “Look, there’s nothing wrong in being clinically depressed. It’s just unlucky. It’s like having diabetes”. They nodded, and seemed to understand. Perhaps using analogies like this one, where people can evaluate mental illness on par with an illness that they understand well, help.

The problem with mental illness, though, is that too few possible evangelists are “out” (while reading homosexual literature, I see several parallels between the difficulties faced by the sexually queer and the mentally ill). So many possible evangelists are involved in professions that sees “mental strength” as a necessary trait that they are afraid of jeopardizing their careers by “coming out”. The only solution, as I heard in an interview a couple of months back, is for this to be a gradual process. People with mental illness “coming out” is now a trickle, but if we sustain that trickle, perhaps it will become a flood sooner rather than later, and that might help erase the stigmas associated with this class of illnesses.

A couple of months back, I happened to listen to cricketer Iain O’Brien’s interview with The Cricket Couch, where he talked about his depression, and about why he “came out”. It was a truly inspirational talk, and there he mentioned about the trickle turning into a flood theme. He talked about Marcus Trescothick, who probably led the way among cricketers with mental illnesses “coming out”, and the effect that had on mentally ill sportspersons. He mentioned that his own coming out was a step in sustaining that trickle.

A month back, I read Trescothick’s autobiography, “Coming Back to Me“. That is again a story very simply written and well-told, and hopefully that helps educate the larger population about mental illness, and about the fact that it can strike just about anyone. In fact, Tresco makes an interesting point there that mental illness is more likely to affect the mentally stronger people, for being mentally strong, they try to fight against the tide that inhabits their mind, unaware of its presence, and in the process sink deeper into the illness. We surely need more such evangelists.

So today, on no particular occasion, I have decided to do my bit for mental illness evangelism, to make my little contribution to what is currently now a trickle and will hopefully turn into a flood. I suffer from more than one illness that gets categorized under the class of “mental illness”. For over six months now, I’ve been on anti-depressants, trying to combat my anxiety and depression. I also suffer from this condition called Attention Deficit Hyperactivity Disorder (ADHD) , but don’t take any medication for it.

For a while I was suffering from “second degree stigma”, and hence not “outed” myself, though in general I keep my affairs public. Because I’ve known that mental illness has stigma attached to it, I was afraid that outing myself might harm me both personally and professionally. However, I realize that by not sharing my story of incredible transformation in the past six months, I was doing a great disservice to the class of mental illness patients in general by not contributing to the trickle. Having convinced myself that I can work (for the first time in over six years I completed a couple of projects recently), and that I can work well despite my illness, I think it makes no sense holding this back any more. I thank Marcus Trescothick, Iain O’Brien, Freddie Flintoff, Lou Vincent et al for showing the way, and I think it’s my duty to join the band.

My psychiatrist informs me that I must have had ADHD for, like, forever, but lack of knowledge of the condition in India meant I was never diagnosed. Back in 2002, my parents took me to a psychiatrist because they thought I wasn’t performing up to my potential at IIT. I got administered the Rorschach Test and some questionnaires and was put on a mild dosage of sleeping pills, which I soon stopped taking without much impact. In hindsight, my ADHD should have been diagnosed then, and perhaps that might have helped me make better career choices than quitting four jobs in a bit over five years’ time.

As the more perceptive of you might have already figured out by now, this “coming out” means that I’ll probably be writing more about mental illness on this blog. I know it might make some of you uncomfortable, but it is indeed part of my effort to make people more comfortable with dealing with mental illness, and to try and erase the stigma attached to the class of illnesses. If you are a sufferer, too, I encourage you to come out, and join this trickle. And help turn it into a flood.

Mutter Paneer for Breakfast!!

So when our newly-recruited cook told us last week that she knows how to cook North Indian dishes, and when we bought Paneer and Frozen Peas at the supermarket yesterday, I assumed that we’ll be having Mutter Paneer for dinner tonight. The cook comes in around 6am, a little after I leave for the gym, so it’s usually the wife’s responsibility to tell her what to make.

And so I return from the gym and find out to my horror that we’re going to have Mutter Paneer for breakfast instead! I mean, who has mutter paneer for breakfast? Or even, who has chapati for breakfast? Isn’t it a dinner item? Well, that’s been one of the longest standing disputes the wife and I have had ever since we started living together.

She comes from a family of rice-eaters (she’s technically Gult, I’ve told you right?), without anyone in her immediate ancestry suffering from any lifestyle disease (heart/diabetes/cholestrol/etc.). And so, they’ve been used to having rice for meals. Rice for lunch, and rice for dinner. And occasionally chapati for breakfast.

I remember this being the case in my family, too, when I was a small kid, but things changed sometime in the 90s. My parents were both plump by then, and for a variety of other reasons, we switched to having oil-free chapatis (phulkas) for dinner. And now that chapati had become a dinner item, it automatically stopped being a breakfast item, and so for breakfast we restricted ourselves to the “traditional stuff” like dosa, akki rotti, uppit, avalakki, etc. (I hate homemade idlis so that was never a part of the menu). And for dinner, apart from chapati, we also started having ragi mudde (ragi balls, made world famous all over India by former PM HD Deve Gowda).

And so the battle begins. She, who has grown up always eating chapati for breakfast, and never for dinner. And I, having been looking at chapati as solely a dinner item for the last twenty years. Ok, chapati and onion-potato palya for breakfast is acceptable. But Mutter Paneer for breakfast? You gotta be kidding me!

Anyways, the Mutter Paneer was good, and I did need a high-calorie meal after the gym session, so this cribbing here is more for the sake of cribbing rather than a genuine crib. Also, it is possible that it’s healthier to reserve the high-density food for breakfast, and have something light for dinner (I admit mutter paneer for dinner isn’t that good for health). But mutter paneer for breakfast and then rasam rice for dinner?

I’m sorry but I’m not a big fan of rasam. I find it too low-density and not filling enough. And in order to fill myself I need to eat a lot of rice, and eating a lot of rice at night makes me sometimes feel gross as soon as I get up the next morning.

Ok I’ll stop cribbing now. And I guess I’m a CHoM.