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.

Sugar and social media

For the last one (or is it two?) weeks, I’ve been off all social media. For the last three weeks or so, until a friend baked a wonderful brownie on Wednesday, I was off sugars as well. And I find that my mind reacts similarly to sugar and to social media.

Essentially, the more frequently I’ve been consuming them, the more receptive my mind is to them. I’ve written this in the context of twitter recently – having been largely off Twitter for the last one month or so, I started enjoying my weekly logins less and less with time. Without regular use of the platform, there was no sense of belonging. When you were missing most of the things on the platform anyway, there was no fear of missing out.

So when I logged in to twitter two weekends back, I’d logged out within ten minutes. I haven’t logged in since (though this has since been coopted into a wider social media blackout).

It is similar with sugar. I’d written something similar to this eleven years back, though not to the same effect. Back then again (in the middle of what has been my greatest ever weight loss episode) I ran a consistent calorie deficit for two months, being strictly off sugars and fatty foods. After two months, when I tasted some sweets, I found myself facing a sugar high, and then being unable to have more sugars.

While I got back to sugars soon after that (massive weight loss having been achieved), I’ve periodically gone on and off them. I’m currently in an “off” period, though I’ve periodically “cheated”. And each time I’ve cheated I’ve felt the same as I did when I logged in to twitter – wondered what the big deal with sugar is and why I bother eating it at all.

Last Sunday it was my father-in-law’s birthday, and I broke my “no sugar” rule to eat a piece of his birthday cake. I couldn’t go beyond one piece, though. It was a mixture of disgust with myself and “what’s the big deal with this?” that I felt. It was a similar story on Tuesday, when I similarly couldn’t go beyond one piece of my daughter’s birthday cake (to be fair, it was excessively sweet).

On Wednesday, though, that changed. My friend’s brownie was delicious, and I ended up bingeing on it. And having consumed that much sugar, I continued thulping sugars for the next two days. It took some enormous willpower yesterday morning to get myself off sugars once again.

With social media that is similar. Whenever I go off it, as long as my visits back are short, I fail to get excited by it. However, every time I go beyond a threshold (maybe two hours of twitter in a stretch?) I’m addicted once again.

This may not sound like two many data points, but the moral of this story that I would like to draw is that social media is like sugar. Treat your social media consumption like you treat your consumption of sugar. At least if you’re like me, they affect your mind in the same way.

Peanut Butter

You can put this down as a “typical foreign-returned crib”. The fact, however, is that since I returned to India a little over a year ago, I’ve been unable to find good quality peanut butter here.

For two years in London, I subsisted on this “whole earth” peanut butter. Available in both crunchy and creamy versions (I preferred the former, but the daughter, who was rather young then, preferred the latter), it was made only of peanuts, palm oil and salt. It was absolutely brilliant.

The thing with Indian peanut butter makers is that so far I’m yet to find a single brand that both contains salt and doesn’t contain sugar! The commercial big brands all have added sugar. Some of the smaller players don’t have salt, and in case they have salt as well, they include some other added sweet like honey or jaggery, which defeats the point of not having sugar.

I’d ranted about this on twitter a few months back:

I got a few suggestions there, tried the whole lot, and the result is still the same. Those that have salt also have sugar. The consistency in the product (especially for the smaller guys) is completely off. And a lot of the smaller “organic” players (that play up on the organic factor rather than the nutrition factor) don’t add any preservatives or stabilising agents, which mean that in Indian temperatures (30s), the oil inevitably separates from the rest of the product, leaving the rest of the thing in an intense mess.

Finally, my “sustainable solution of choice” I settled on was to buy Haldiram’s roasted and salted peanuts, and then just grind them in the mixie (making it from first principles at home just hasn’t worked out for me). Except that now during the lockdown I haven’t been able to procure Haldiram’s roasted and salted peanuts.

So during another shopping trip to a supermarket earlier this week (not that much insight to write a full blog post on that), I decided to try one of the commercial brands. It was available in a big white 1.25kg box and had a fitness (rather than “goodness”) messaging on the cover. It had added sugar, but at 10 grams per 100 grams of the product it was less than other commercial brands. On a whim, I decided to just go for it.

And so far it’s been brilliant. Yes, it’s sweeter than I would have liked, but the most important thing is thanks to the “stabilising agent”, it has a consistent texture. I don’t need to endlessly mix it in the box each time I eat it. The taste is great (apart from the sweetness), and I must say I’m having “real peanut butter” after a long time!

It’s a pity that it took a year and a period of lockdown for me to figure this out. And I’m never trying one of those “organic” peanut butters again. They’re simply not practical to use.

Then again, why can’t anyone figure out that you can add salt without necessarily adding sugar?