replacing carbs with protein for T2D
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cstehansen
Posts: 1,984 Member
I thought this was an interesting study to share.
https://www.ncbi.nlm.nih.gov/pubmed/14522731
It is fairly small and short term, but it has me thinking. It says that although protein can be converted to glucose, replacing carbs with protein has a positive effect in lowering FASTING BG over a 5 week period.
Personally, I have found high quantities of protein on a one off basis has given me higher PP readings, but not as high as if I had eaten carbs, but higher than fat. However, I hadn't tried over a longer period of time to see if there was a change in FBG.
That said, upon initial diagnosis, before I knew anything about LCHF, I cut carbs just because that made sense. I only cut to about 30%, but the calories were made up for fairly evenly between fat and protein, so my protein would have been considered pretty high by most in this group - averaging about 30% protein and 40% fat. During that first 4 months, my A1c did drop from 6.6 to 5.9.
In the last 3 months of keto, my A1c went from 6.2 (after spending some time more aligned with ADA guidelines) up to 6.3.
I wanted to share this as I have come to the determination that nothing works 100% of the time for 100% of the people, so perhaps for some people, the LC is more important than the HF.
One reason I took a look at this is because of the Dr appointment I had yesterday where he asked what I was doing different now than I was when I had that large drop. At first, all I could think was my carbs are lower now than then which didn't make sense. I can't imagine raising carb intake that much would be a good thing. Then I thought about the fact my protein intake was significantly higher then.
Anyway, off to do some more n=1 experimentation.
https://www.ncbi.nlm.nih.gov/pubmed/14522731
It is fairly small and short term, but it has me thinking. It says that although protein can be converted to glucose, replacing carbs with protein has a positive effect in lowering FASTING BG over a 5 week period.
Personally, I have found high quantities of protein on a one off basis has given me higher PP readings, but not as high as if I had eaten carbs, but higher than fat. However, I hadn't tried over a longer period of time to see if there was a change in FBG.
That said, upon initial diagnosis, before I knew anything about LCHF, I cut carbs just because that made sense. I only cut to about 30%, but the calories were made up for fairly evenly between fat and protein, so my protein would have been considered pretty high by most in this group - averaging about 30% protein and 40% fat. During that first 4 months, my A1c did drop from 6.6 to 5.9.
In the last 3 months of keto, my A1c went from 6.2 (after spending some time more aligned with ADA guidelines) up to 6.3.
I wanted to share this as I have come to the determination that nothing works 100% of the time for 100% of the people, so perhaps for some people, the LC is more important than the HF.
One reason I took a look at this is because of the Dr appointment I had yesterday where he asked what I was doing different now than I was when I had that large drop. At first, all I could think was my carbs are lower now than then which didn't make sense. I can't imagine raising carb intake that much would be a good thing. Then I thought about the fact my protein intake was significantly higher then.
Anyway, off to do some more n=1 experimentation.
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Replies
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I think the source of the protein matters too. High protein that comes mostly from red meat as opposed to coming from lean chicken or whey powders would probably be pretty different.3
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I was poking around the "related articles" for that study, and found one that was more recent:
https://www.ncbi.nlm.nih.gov/pubmed/23674159
It reaches the same conclusion, using more subjects over a longer period of time. What I found interesting was the emphasis on plant-based protein, since plants have carbs. I'm curious what the macros were for the high-protein and the control groups.3 -
MyriiStorm wrote: »I was poking around the "related articles" for that study, and found one that was more recent:
https://www.ncbi.nlm.nih.gov/pubmed/23674159
It reaches the same conclusion, using more subjects over a longer period of time. What I found interesting was the emphasis on plant-based protein, since plants have carbs. I'm curious what the macros were for the high-protein and the control groups.
I hadn't gotten to the related articles yet. I kind of enjoy going down those rabbit holes.
I am also curious about macro breakdown and what plant protein they used and proportion compared to animal protein.
One of these days I'm going to have to get a membership to some of these journal sites to see full studies.
I think one simple conclusion is cutting carbs is good for diabetics regardless if they are replaced by fat or protein. In other words, the ADA recommendation to eat low fat high carb to "manage" diabetes is wrong.3 -
It's a certainty that the ADA's recommendations for controlling BG are not a good OSFA for the entire population of T2Ds. (How's that for alphabet soup?)
Dr. Bernstein had interesting advice on raising BG in T1Ds - to slowly increase protein intake and monitor BG closely to adjust insulin. That is probably badly oversimplifyied. @Sunny_Bunny_ , @midwesterner85 - any thoughts?2 -
I didn't read the article, but yes, I have thoughts on macros. This is stuff I was first educated about in the '90s when diagnosed with type 1 diabetes and have noticed / confirmed through BG's over the past 2 decades.
First, let's be clear that not all proteins are the same. But let's keep things simple and assume they are.
The 3 primary macros (carbs, protein, and fat) are known to affect BG in different amounts and over different time periods.
Carbs start raising BG almost immediately and continue to do so for a short period of time (usually not more than 1 - 1.5 hrs. in even the slowest absorbing carbs.
Proteins do not convert to glucose as quickly as carbs, but faster than fat. And not all protein converts to glucose anyway. So you now have a time window of around 2-5 hours where that protein is converting to glucose. It happens slowly, but sometimes can be enough to appear as a mild BG spike (mild when compared to carbs).
Fat takes a very long time to convert to glucose (and not all of it does) - 10-14 hours in many cases. Because it happens so slowly and at such a small rate, the BG effect from fat consumption is hard to see.
So the carb effect on BG is obvious; the protein effect on BG is a bit less pronounced, but it is still measurable. Fat is just tough to even notice an effect on BG.
Finally, let's recognize that it is uncommon to eat just 1 of these macros at a time. The effect of combining these macros is really important. Restaurant pizza is the most extreme example. A lot of carbs and protein, covered in heavy fat. The carbs will provide a quick BG spike, and the protein will keep adding BG for a few hours after consumption. But because the carbs become so entangled in fat, it is quite common to have a 2nd carb spike several hours later as the fat is absorbed and carbs become separated from that fat. This is so common, in fact, that the Medtronic insulin pumps (they have probably 90% of the insulin pump market in the U.S.) have something called a "Dual Wave Bolus" in order for insulin pump users to more easily bolus with proper timing for these types of foods where some of the carbs absorb normally and some of the carbs are delayed by fat.4 -
@midwesterner85 gave lots of great info there. Especially the one about pizza and similar meals.
The TypeOneNation Summit I went to recently had a speaker (Gary Schiener, author of Think Like a Pancreas) that is considered to be one of the most influential people in the T1D community in a recent list I saw from JDRF. Though, I honestly don't think he knows all the science because he clearly has blinders on when low carb is concerned. So I was disappointed to see him on that list.
Anyway, I took a photo of this during his presentation.
He went on to say that low carb diets are a bad idea because 40-50 of your protein gets converted to glucose and since it's such a wide range it's impossible to bolus insulin correctly to cover it. You can see that he even has noted that this only happens if you eat a low carb meal. So, if you don't, then I guess your body doesn't use the protein that way. Ok. Sure.
First he said that the brain can ONLY use glucose for energy and then wants us to believe that as much as 50% of your protein becomes sugar whether your body needs it or not... riiiiiiight.
Again, the fear is always about low blood sugar. The concern over not dosing insulin correctly and causing a potential low. So they want blood sugar "safely" in a higher range. Makes "sense"
Just wanted to note at this conference they had areas set up as low stations where T1D's could get a juice box or bag of cookies to treat a low if needed. Great idea right? They sat in large buckets on tables filled with bananas, Sun Chips and different packages of cookies.... uhhhhhh. I think the entire conference was a low station.2 -
As for variance among proteins:
From what I have been able to fish up, protein breakdown rates are pretty consistent, until we start getting into concentrates, isolates, and the like. For example, when taken as a whole, milk protein is actually pretty slow to break down, due to being roughly 80% casein and 20% whey. Of course, once you isolate them, you start seeing their individual digestion characteristics become more prevalent. This is very clear in egg protein, which had an absurdly slow breakdown rate.
I have never been able to find any hard numbers comparing actual animal proteins (chicken vs. fish vs. beef, etc.) so I am fairly sure that if differences exist, they are likely minimal, and probably affected more by the other nutrients present in the different meats, than by anything specific to the proteins themselves.
Now of course, it would be possible to find the digestion and assimilation rates of all of the various amino acids, and then cross reference that with the amount of each present in each type of meat, but again, with those numbers always being "shooting distance estimates", I'm still more inclined to believe that the overall nutritient content will have a much larger impact.0 -
I went searching for some info from something I heard Adam Nally say about chicken specifically having a different rate of GNG (if I understood him right) on a recent Keto Talk episode.
Since I can't quite figure out how to search what I am looking for I am not having any luck finding anything. I will have to take a look at the last couple keto talks I listened to and try to find the exact phrasing he used...
Anyway, I did come across this great explanation how dietary protein is used from Mark Sisson. Ultimately, we already know the answer, that it varies from one person to another, and that it's not even fully understood.
http://www.marksdailyapple.com/dear-mark-how-much-protein-can-you-absorb-and-use-from-one-meal/
What we do know is GNG is a demand driven process and that the mechanisms that drive the demand vary widely from person to person. I also believe that taking in large amounts of isolated protein or significantly unbalanced, high protein foods with very little fat and carbs also consumed can overwhelm the body with so much that it just has to do something with it. I don't have any science to support that idea. It just makes sense to me. I do think it would have to be pretty large intake though. 2 to 3 times or more what macro calculators would suggest we need. Again, this is just an opinion on my part. It just doesn't seem natural to take in large concentrations of single macros, so I figure just like taking in large concentrations of carbohydrate over time negatively affects glucose metabolism the same could be true of the others ...??? Though, because of the idea that we evolved eating more meats that included all parts of the animal, I think what our bodies would consider large concentrations for protein and fat are waaaaay higher than anyone would be able to eat on a consistent basis. But, that idea is why I can't really get behind the fat bomb craze that you see some low carb groups going nuts over. It makes no sense to eat just fat for the sake of eating fat. Or as they seem to think, to burn more fat... lol
So concentrating on real, while food eating should provide a natural balance. And only when eating foods that lean heavily toward one macro, like lean skinless chicken, might there be a need to tweak the meal to get a balance more consistent with eating the chicken with the skin and fat like our ancestors did.
Anyway, I think I'm rambling now.
Edited to add the link. Oops2 -
Sunny_Bunny_ wrote: »@midwesterner85 gave lots of great info there. Especially the one about pizza and similar meals.
The TypeOneNation Summit I went to recently had a speaker (Gary Schiener, author of Think Like a Pancreas) that is considered to be one of the most influential people in the T1D community in a recent list I saw from JDRF. Though, I honestly don't think he knows all the science because he clearly has blinders on when low carb is concerned. So I was disappointed to see him on that list.
Anyway, I took a photo of this during his presentation.
He went on to say that low carb diets are a bad idea because 40-50 of your protein gets converted to glucose and since it's such a wide range it's impossible to bolus insulin correctly to cover it. You can see that he even has noted that this only happens if you eat a low carb meal. So, if you don't, then I guess your body doesn't use the protein that way. Ok. Sure.
First he said that the brain can ONLY use glucose for energy and then wants us to believe that as much as 50% of your protein becomes sugar whether your body needs it or not... riiiiiiight.
Again, the fear is always about low blood sugar. The concern over not dosing insulin correctly and causing a potential low. So they want blood sugar "safely" in a higher range. Makes "sense"
Just wanted to note at this conference they had areas set up as low stations where T1D's could get a juice box or bag of cookies to treat a low if needed. Great idea right? They sat in large buckets on tables filled with bananas, Sun Chips and different packages of cookies.... uhhhhhh. I think the entire conference was a low station.
Hmm... I disagree that protein doesn't raise BG when eating carbs.
As for lows due to insulin dosing errors... that is one of the primary benefits of eating low carb for both diabetics taking insulin and reactive hypoglycemics. I will acknowledge that dosing for protein is more difficult than dosing for carbs, but the solution is not to add another variable with risk of error.
The snack stations and the low stations are likely in the same place so that the people who ate snacks and made errors dosing will be able to easily find more carbs.1 -
midwesterner85 wrote: »Sunny_Bunny_ wrote: »@midwesterner85 gave lots of great info there. Especially the one about pizza and similar meals.
The TypeOneNation Summit I went to recently had a speaker (Gary Schiener, author of Think Like a Pancreas) that is considered to be one of the most influential people in the T1D community in a recent list I saw from JDRF. Though, I honestly don't think he knows all the science because he clearly has blinders on when low carb is concerned. So I was disappointed to see him on that list.
Anyway, I took a photo of this during his presentation.
He went on to say that low carb diets are a bad idea because 40-50 of your protein gets converted to glucose and since it's such a wide range it's impossible to bolus insulin correctly to cover it. You can see that he even has noted that this only happens if you eat a low carb meal. So, if you don't, then I guess your body doesn't use the protein that way. Ok. Sure.
First he said that the brain can ONLY use glucose for energy and then wants us to believe that as much as 50% of your protein becomes sugar whether your body needs it or not... riiiiiiight.
Again, the fear is always about low blood sugar. The concern over not dosing insulin correctly and causing a potential low. So they want blood sugar "safely" in a higher range. Makes "sense"
Just wanted to note at this conference they had areas set up as low stations where T1D's could get a juice box or bag of cookies to treat a low if needed. Great idea right? They sat in large buckets on tables filled with bananas, Sun Chips and different packages of cookies.... uhhhhhh. I think the entire conference was a low station.
Hmm... I disagree that protein doesn't raise BG when eating carbs.
As for lows due to insulin dosing errors... that is one of the primary benefits of eating low carb for both diabetics taking insulin and reactive hypoglycemics. I will acknowledge that dosing for protein is more difficult than dosing for carbs, but the solution is not to add another variable with risk of error.
The snack stations and the low stations are likely in the same place so that the people who ate snacks and made errors dosing will be able to easily find more carbs.
I totally agree! I was doing a lot of eye rolling at the conference. I was NOT impressed at all! I actually stated as much in my survey I got about it afterward.
This guy is thought to be a great resource for learning. I honestly felt very sad upon realizing this. Especially when I hit an email with the top influencers in T1D from JDRF. I think it was them. I'll have to check and share it.
I took some notes during his lecture when people started asking questions at the end. I started seeing a common theme that I recognized.
Some of the things people asked were
- A lady was seeking advice for her daughter on how to deal with always feeling hungry. The suggestion was to eat several small meals and snacks between meals....
Really? I mean if she's always hungry she's probably already eating more often than she wants to or she wouldn't find being hungry all the time concerning. It was clear that the underlying concern was weight gain and the several small meals idea is obviously calorie and portion control focused. So he was basically just spewing the standard "eat less" garbage we all know and despise.
- Someone else had trouble controlling blood sugar during exercise.
Again this was related to weight. This person was wanting to exercise in an effort to help control weight and found it difficult because of the crazy blood sugar swings. They expressed frustration with it just causing them to need to eat to correct a low that would inevitably come after correcting with insulin, the high they got after exercise. They really just got advise to make a smaller correction and allow the blood sugar to stay high for a while and watch it closely.
- Someone asked how to avoid post meal spikes after eating pizza.
Just about everyone in the room erupted in laughter at the question. There was talk about some pumps having the dual wave feature. Other than that the advice was to take only part of the insulin dose before eating and the other part a couple hours later and/or incorporate some light exercise to help.
- A lady asked how to manage extreme ups and downs. The said "My daughters BG is all over the place!"
Another big outburst of laughter. Followed by advice to work with medical team to adjust pump settings. No food related questions or suggestions AT ALL!
I also wrote down something he said at some point during the lecture when discussing how to determine how much carbohydrate a meal contains. I think it is very telling as to his overall idea of what it means to eat healthy.
"Restaurant foods tend to have a lot of fat. Even if you think you're ordering healthy, there's usually more fat than you realize"
This guy is operating under the same OLD ideas about fat, and he's thought to be a great resource for the T1D community.
Here's the article where they named the "Influencers To Know"
http://www.healthline.com/diabetesmine/type-1-diabetes-influencers-to-know2 -
As @Sunny_Bunny_ said, I think eating real food is the key. Looking back to that 4 months where my A1c dropped so much, that is what I was doing. Doing this is naturally going to be lower carb with the carbs eaten being real food I could grow in my garden.
How much and how quickly protein affects one's BG is going to vary. This could vary based on genetics, activity level/type, timing of eating, combinations of foods, types of protein, etc.
Our bodies were clearly not designed to take in 50+% of our calories from carbs as is the case in the SAD. We were also not designed to be eating processed carbs or fruit juices (apart from eating the fruit) at all.
I can understand having something to help with lows at a conference for T1, but the choices seem really dumb. Dr Bernstein said that a 4 gram glucose tab would raise is BG by something like 20 points, but that liquid was a better option. That juice box probably has 6-8 times the amount of carbs needed to prevent a low from anyone. Then things in solid form, like a cookie, will take just long enough to hit the blood stream to make the person panic and eat a second and just overshoot the target even further.2 -
"Better living through chemistry" has never looked so stupid as in that conference.2
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As for exercise, my experience has been that I don't have nearly as many lows now that I'm fat adapted. Sure, they still happen on occasion. But it used to be that at least 50% of the time I went running, I either had to start high (which affects performance and enjoyment), do a temp. basal of something very low or 0, or I would go low and have to treat (often, 2 or 3 of the above). I now go low when running in fewer than 10% of my runs. I know it is anecdotal, but we know that fat adapted athletes can use fat much more efficiently. If the primary fuel source is fat, supplemented with glucose (as opposed to the primary fuel source of glucose, supplemented by fat), then it just seems logical that T1D's who are fat adapted will have fewer lows when exercising than T1D's who fuel with carbs / glucose.2
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cstehansen wrote: »MyriiStorm wrote: »I was poking around the "related articles" for that study, and found one that was more recent:
https://www.ncbi.nlm.nih.gov/pubmed/23674159
One of these days I'm going to have to get a membership to some of these journal sites to see full studies.
@cstehansen Organizational memberships and/or journal subscriptions can be quite expensive. If you have an affiliation with a college or university (as a student, alumnus, family member of an alumnus, employee or former employee, etc.) you may have free or low cost access to the university library. Some schools also allow local residents to use the library services for a minimal fee. If the library does subscribe to the journal of interest, they can obtain copies from another library, and most if not all libraries, will send it to you electronically.1 -
cstehansen wrote: »MyriiStorm wrote: »I was poking around the "related articles" for that study, and found one that was more recent:
https://www.ncbi.nlm.nih.gov/pubmed/23674159
One of these days I'm going to have to get a membership to some of these journal sites to see full studies.
@cstehansen Organizational memberships and/or journal subscriptions can be quite expensive. If you have an affiliation with a college or university (as a student, alumnus, family member of an alumnus, employee or former employee, etc.) you may have free or low cost access to the university library. Some schools also allow local residents to use the library services for a minimal fee. If the library does subscribe to the journal of interest, they can obtain copies from another library, and most if not all libraries, will send it to you electronically.
Thanks. I'm definitely not made of $, but not afraid to spend some as I think it will save me in the long run by not having the medical expenses associated with following ADA recommendations.1 -
I second the library bit. University libraries have different policies though. Our local university, if you aren't a student or faculty, Interlibrary Loan (ILL) is off-limits to you even if you are an alumni, and you have to go to your local public library and make the request through them. ILL fees aren't usually too prohibitive, but if you're going to be making multiple requests frequently it might add up. It all depends on if the journal is owned by a library in your pub library's association/network. Loans from libraries outside their network are going to cost more. Again, that's variable and depends on the library. Picky librarians... (said by a former librarian.
) 0 -
cstehansen wrote: »MyriiStorm wrote: »Edited....
One of these days I'm going to have to get a membership to some of these journal sites to see full studies.
Check with your local library most have subs to many things that are cost prohibited for the casual reader. I use Ancestry, Medline, & Morningstar without subscriptions that way. If you don't have a membership to a library that is online, some larger cities (with greater resources) have a small yearly fee to "join."0
