Saturday, August 11, 2007

Fats, Carbs, Sugar and Inflammation

My last day in the hospital last year, I spoke with a nutritionist about my new "diabetic diet."

For those of you unfamiliar with how diabetes works, a short general explanation: I have an autoimmune disease which was triggered by "who knows what" but likely some kind of virus that told my immune system that the cells in my pancreas that produce insulin were foreign cells and needed to be slaughtered ruthlessly. Insulin is the stuff that enables your cells to pull the sugar/glucose out of your blood and use it for energy. Everything you eat is converted by your body into some amount of glucose, but the amount of glucose depends on the type of food you eat. Vegetables, meat, eggs, cheese, any sort of protein, these foods all have a really, really low to 0 glucose conversion rate. I can eat cheese to my heart's content and not worry about my glucose levels.

I have to take a shot of insulin every time I eat a substantial meal (snacks like cheese, small amounts of nuts, some carrots, I usually don't bother, cause it doesn't affect my sugar by more than like 10 points or so). The insulin clears the glucose out of my blood by enabling the cells to process it; the cells sweep the glucose out of my bloodstream, and all is well. High blood sugar, or consistently having high blood sugar (particularly over 180/200 or so), means your body gets sluggish, you can't think properly, wounds take longer to heal, and your body slowly breaks down because it can't get enough energy from the food you're eating; all that sugar's still stuck in your blood, turning you into one big slushy. Being a slushy is very uncomfortable. Believe me, I know. Eventually, when you get over, say 700 or 800 or 900, you go into a coma and eventually die because your heart and brain can't get enough energy to survive.

Complex carbs like straight sugar, juice, donuts, bread, pasta, stuff like that, that's all pretty much pure glucose. Your body just immediately converts it all into sugar. Pizza is often the worst to deal with, because the absorbtion of glucose is slowed by the cheese, so by the time your insulin whot hits (30-90 minutes after you take the shot) and you think you've got it all covered, you get a slow spike overnight or during the day and end up with another high number. It's complicated and a pain in the ass. Anyway, high sugar foods tend to give me headaches for the hour or so I eat them before the insulin kicks in, so as a general rule, I avoid them. They also make my life miserable insofar as trying to calculate the right amount of insulin to take, cause I don't eat them all the time and so don't have a correct set amount (except for, say, pancakes, which I eat on weekends. Because I eat a pancake every weekend, I know the exactly right amount to take, and I use whole wheat flour, so the glucose is absorbed slowly, and doesn't give me that sugar-spike headache).

So, now, knowing all of this, you would think that the overwhelming recommendation for diabetics, then, would be to eat a low carb diet, right? I mean, that's what I do: it avoids sugar spikes and means I use less insulin and have less glucose in my blood at all times. Sure, there's the occasional splurge, but for the most part, living on tortillas instead of bread is a great idea if you don't want to feel like a sluggish lump all day. Surely, doctors recommend this kind of thig?

Wrong.

Well, wrong as of about 1940 or so. Prior to that, and especially prior to the advent of insulin in 1921, people realized that those t1 diabetics who ate a low carb diet and exercised vigorously lived longer than those who didn't.

What changed?

The food pyramid. Farm subsidies. Our American obsession with all things corn-related began, and we started ingesting high fructose corn syrup and filling stuff with carb-laden fillers. Suddenly, carbs were in and fat was out, and Americans started suffering from a lot of health problems like heart disease and diabetes that they hadn't seen much before. Some of that, of course, was due to the fact that we didn't use to live as long. But some of that was because high levels of glucose in your bloodstream will wear down your arteries over time; they create a higher level of inflammation in your arteries, which increases your body's resistance to insulin, which means your body pumps out more insulin, which means you become more resistant, and the more insulin you produce, the more weight you gain, the more insulin resistant you become, the more insulin you produce, the more weight you gain... and etc.

In this study out of Hamburg, Germany, researchers recently compared artery inflammation (which is correlated with the breakdown of said arteries) and how severe it was based on one of three kinds of fast food meals from McDonald's that they ate: high fat, medium fat, low fat.

They honestly thought that the low fat meal was going to have less of a damaging effect on arterial damage. I mean, less fat, less damage, right?

So there are big differences in the fat grams of each meal, but if you actually look at the carb count for all three meals: it's exactly the same.

The result?

All three meals damaged arteries in the same way.

As Jackie pointed out in the comments section to another post, inflammation and insulin resistance are linked. The more inflammed your arteries (which is what happens when they have to process a lot of glucose produced by ingesting lots of carbs), the more insulin resistant you are. I highly suspect that this is why taking a couple of vicoden for the past week has resulted in sugar numbers that have not once tested above 120. Even during a "good" week, I'll have a 130 or 150 number on occasion. The last number I saw that was over 120 (134) was on the 30th of July (have I also mentioned that that extreme hunger I've been experiencing all day has been totally nipped in the bud? I'm not hungry until lunch, am full before I finish eating lunch, and not hungry again until dinner: you know, like a normal person. I've been desperate to figure out why I was suffereing from this extreme hunger all the time, and living without it is... is... really nice).

As one response to the study says:

... eating is an inflammatory event just like breathing. We have to do both, but we pay the price. During inflammation the endothelial cells don’t function optimally. So getting rid of the huge load of carbohydrate and the accompanying inflammatory effect of the food (and, don’t forget, high glycemic carbs are the most inflammatory of all the macronutrients) inhibits the normal action of the endothelial cells. Anyone with half a brain and a rudimentary knowledge of the nutritional aspects of physiology would have predicted that the FMD would have declined about the same with all of these meals.

And another response to a wealth of other studies on inflammation:

What the nutritional research appears to conclude in the aggregate is that the processes involved in the things we worry about (e.g. cardiovascular disease etc.) are actually inflammation-based and linked to both existing levels of bodyfat (primarily visceral fat) along with insulin. Consumption of fats -- from plant sources, fish, and "good saturated" fats -- ameliorates much of these processes, and controlling carbohydrate intake does the rest. I even read a new study yesterday about the link between inflammation and cancer. Substances such as TNF-alpha and IL-6 are starting to look very nasty indeed, and these are definitely linked to visceral fat deposit and carbohydrate intake.

What I find stunning, then, is that 1) diabetics, like me, are still told to eat a high carb, low fat diet (what saved my numbers was reading Dr. Berstein's The Diabetes Solution, written by a t1 who's done a lot of study on the effects of low carb diets and diabetics) 2) never once told to, say, take a couple aspirin or ibuprofen every day to cut down on inflammation caused by eating and therefore even out my numbers cheaply.

Instead, my last endo wanted to give me blood pressure medication that made me dizzy (my blood pressure was already low to begin with), get me on metformin (which costs a shitload more than aspirin, let me tell you), and I've been searching desperately for some kind of anti-depressant cocktail that might in some way assuage my appetite.

Hundreds and hundreds of dollars worth of drugs....

You know how much I paid for my generic version of vicoden?

$4.96

Yeah.

6 comments so far. What are your thoughts?

Jackie M. said...

Guess what diet my they told my Dad to eat after his first open heart surgery? Low-fat, of course. No eggs, no cheese. Veggies were good. Pasta was supposed to be excellent.

And he stuck to it, to, for two decades... until lo and behold he was diagnosed with low-level type 2 diabetes. So they told him to cut out sugar--not starch, not carbs: sugar. And he struggled and struggled for most of a year, until finally he went to see a nutritionist (and, oh, was his cardiologist upset that he was taking advice from a quack nutritionist) and she set him on a low-carb diet. Et voila! Not only could he control his sugar--suddenly his cholesterol dropped.

Aspirin seems to be preferred over ibuprofen for once-a-day preventative purposes. Either way, make sure you take it with food.

I'm pretty happy with my SSRI's weight-management-wise. They're better than MAOIs or tricyclics, which typically cause weight gain... but because of my excessive daytime sleepiness/ seasonal affective issues, I'm thinking about switching to/augmenting with wellbutrin. Which has a really good track record for weight management.

But I don't like the idea of recommending antidepressants for simple weight loss... studies show that the more drugs you're on-->the more risk for interactions-->the shorter your lifespan. The magic number being something like 4 prescriptions.

Jackie M. said...

Sorry--I didn't originally see the bit where you mentioned the curbing of the constant hunger. I really, really hope that keeps up after you go off the vicoden... but it may be specific to the opiate.

Bad Decision Maker said...
This comment has been removed by the author.
Bad Decision Maker said...

I'm with you on the ridiculousness of diabetics, type 1's and type 2's, being told to eat low fat high carb diets. It's like what, American Diabetes Asoociation, did you really say that??? Healthy unsaturated fats like olive oil, nuts, avocados, etc. are our friends!! It definitely helps when I fill up on these instead of carbs.

And I definitely think that many doctors are doing a lot of unnecessary prescribing, and everyone and their mom is in bed with the big pharmaceutical companies. However, an ibuprofen a day is probably not the best idea for diabetics. It is hard on the kidneys, and people with any kidney issues are not supposed to take it. We're at high risk for kidney issues (probably why your dr. wanted you on the blood pressure meds, right?). They say it's fine for diabetics to take in moderation if you don't have kidney issues, this is what my endocrinologist and primary care provider tell me. However, my aunt that's a doctor was horrified when she saw me taking ibuprofen for cramps, and told me that I should never take it. So whoever you believe, taking it every day is probably not beneficial in the long run.

I'm struggling myself with the decision of whether or not to go on the blood pressure meds to protect my kidneys (my blood pressure is also in normal range).

If you are worried about your appetite, you might want to try the metformin. I'm on it, and it has helped a little with my blood sugars and changed my appetite a lot. I am less hungry and crave food less. My doctor had me try it because my blood sugars weren't where they needed to be and went especially crazy on any day that I didn't exercise over an hour, but also because she thinks I might have PCOS, which you mentioned before you thought you might have. It's still way more expensive than aspirin, but it's one of the cheaper prescription drugs if you have health insurance. Generic is $10-12/month at your local pharmacy, and walmart has it for $4.

And your appetite might not just be linked to antidepressants. They're learning more that diabetics don't just lack insulin, we're also deficient in amylin, a hormone that controls appetite and slows the rate at which food is emptied from the stomach. I'm mad they couldn't figure this out earlier (they missed an entire hormone?) because they were spending all the research $$ on things like far-fetched attempts to completely cure diabetes instead of concrete things to improve our lives.

Perpetual Beginner said...

Okay, I guess my insurance really is good. I take metformin (Insulin resistance rather than diabetes) - it costs me a whopping $1.04 a month.

I don't track my blood-sugar (actually it's really weirdly level when it has been tracked, between 75 and 85 no matter what I do), but the metformin has certainly straightened out my eating and appetite.

Kameron Hurley said...

Yeah, I've heard about amylin, and it's one of the things I'm going to ask my endo about. Metformin or symlin shots. Not too keen on more shots, but I'm not too keen at being starving-hungry from 8am-7pm with one short hour of post-lunch non-gnawing-my-arm-off hunger either...

Also, Perpetual Beginner, if you're between 75-85, you know you're in the normal blood sugar range, right? Are you in that range when you're *not* on meds? If so, you may not need those meds.