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.

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:

Blood glucose spike after a meal

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.