It's about time!!! BMI = Bull$hit Mass Index

[Bill Glasheen]

Let me remind people that these screening tools are for man cows anyway. The smarter and more active people don't need to be told when they're in or out of shape right?

Yes and no.

Last winter/spring I experienced the kind of multidimensional stress that happens maybe a couple of times in a person's life. Most people gain weight under such stress; I lose it. Or as my friend Vicki joked, "I found the weight you lost." In any case, I've found now that my body "rebounds" in weight in much the same way that yo-yo dieters ultimately fail in their quest to shed blubber. Body senses severe body mass loss and goes into lower BMR to conserve weight. Stress goes away and WHAMO!!! Body overshoots weight. So when these changes happen, I have to monitor myself very carefully.

The good news is that I ultimately end up in one of those rare periods where it's actually easy for ME to put muscle mass on in the weight room. So if I manage the rebound right, monitor myself carefully, and eat correctly, I can turn lemons into lemonade. If I put the weight on as more muscle than fat, the BMR self-corrects.

Or not - if I ignore it all and let life happen.

- Bill

[IJ]

Wait, wait... you're saying you needed some sort of a score or calculation to realize what was happening and what to do about it?

[Bill Glasheen]

Wait, wait... you're saying you needed some sort of a score or calculation to realize what was happening and what to do about it?

I know my body. You have no idea. I'm like the princess with the pea under a hundred mattresses.

- Bill

[IJ]

This is all I'm saying. I weigh the same and have the same measurements as a week ago, but after working too much and travel and missing exercises in the process, I felt really different doing my workout. I was only a pushup behind my pace each set, too, but I knew what was up. Math didn't factor in.

[Glenn]

Somewhat related to this BMI discussion, Men's Health online has a lengthy but very eye-opening article on prediabetes and diabetes among people not falling within the usual stereotype for being at risk for type 2, as well as on the causes of diabetes in general. I've heard over and over about the need for a low-carb diet after being diagnosed with diabetes to help control it, but never before about high-carb diets causing diabetes in people who aren't overweight, and thus using a low-carb diet to prevent diabetes (in ways other than preventing weight gain that might lead to diabetes).

There is a quiz at the end to see if you might have signs that you need certain testing for prediabetes, and what tests can be run to detect prediabetes (and why results on the standard diabetes tests indicating no diabetes can be misleading).
http://www.menshealth.com/spotlight/dia ... abetes.php

[Bill Glasheen]

The thing to remember here however is that not all carbohydrates are created equal. The same is also true of fats and to a lesser extent true of proteins.

We all need soluble and insoluble fiber. The more the better. These are carbohydrates.

The key with carbs is the glycemic index. That is the the degree to which any volume of said carbohydrate spikes your insulin levels.

The other thing to remember is what you eat in addition to said carbohydrates. Any time you screw around with mother nature (concentrate sugars), you're in for trouble. You're better off getting your carbs naturally from the fruits and vegetables you need for balanced nutrition. And combining your carbohydrates with proteins and good fats is also helpful.

- Bill

[IJ]

"But too much of it coursing through your blood vessels, for too long, is ultimately deadly. "It's kind of like dynamite," says Mary Vernon, M.D., president of the American Society of Bariatric Physicians. "The body realizes it's dangerous, not to be left lying around." That's why people with diabetes are frequent bathroom visitors."

Eh, yes and no, and no. Glucose is reactive, and the body does have a cap on desirable levels, pushing out more insulin when the level is higher than needed. But it's not dynamite. And the frequent urination is totally unrelated. That happens because blood's liquid component and smaller proteins get filtered at the kidneys. Good stuff (most of the salt, sugar, etc) is reabsorbed and the rest is allowed to pass to form urine. There's a limit on how much sugar the kidney can reabsorb (no evolutionary need to deal with sugar levels that were probably almost never reached) and over a threshold sugar spills out. It carries more water with it = lots of urine.

I'll go look around for evidence that a high carb diet is linked to diabetes apart from the obesity effect. "Recent research" doesn't do it for me. Meanwhile, don't rush to the Atkins side; there was an interesting article in JAMA recently about how in study rats, low carb high fat diets failed to change traditional markers of atherosclerosis for the worse--but the atherosclerosis was substantially worse anyway, perhaps because of usualy unmeasured risk markers like circulating repair cells which went way down.

Even the low salt diet I've championed is something of a question mark. Last week I read, again in JAMA, about associated undesirable biomarkers that accompany low salt diet's lower blood pressure (signs of stress and attempted compensation like higher aldosterone and sympathetic nervous activity). The author concluded that having a national experiment on salt lowering without good outcome data first, and only having surrogate markers like BP, was premature.

[IJ]

Continued...

He makes a plain error in arguing that ADA diet recommends that you eat tons of carbs then gives you insulin releasing drugs to combat the problem they created; the med he'd just finished talking about was metformin, and in the context of prediabetes. THAT drug doesn't raise insulin levels, it makes insulin work better, and induces weight loss, and reduces the risk of progression to diabetes.

And what the heck is this:

"You might need an Oral Glucose Tolerance Test if...
You often wake up with a headache
You often wake up in the middle of the night
You had acne, numerous cavities, and hair loss in your teens/early 20s
You feel cranky or forgetful after a high-carb breakfast"

Nonsense. Waking up with headaches for diabetes? Huh? Insomnia? Zits? Puhlease. Everyone in the country would need OGTT at this rate. And yet no one advocates broad screening like that. Must not be a good idea.

He goes on to claim that anyone with A1c of 6+ DEFINITELY needs the test (ie, all diabetics therefore do), as does anyone who's obese, most people who are over 45, etc. Gosh, where are the references? How is he justifying many many millions of OGTT across the nation? It sounds like he found a doctor with a different opinion than most and feels qualified as a layperson to recommend altering the course of national health policy in opposition to large and thoughtful groups like the ADA. Don't buy it. The whole theory he espouses, that fluctuating sugar levels cause diabetes in the absence of overweight, is a bit of a reach, although of course it's wise to avoid carb binges and crashes.

Men's Health advises, in related pages, that their diet will lower blood pressure so much that you'll need to consult your doctor first if you're on BP meds. ORLY? There are a bunch of other unfounded suggestions like consuming 64 oz of water a day, limiting veggie intake to 4 servings, cheese and egg ok (limited / until full, respectively)....

I can't police all this stuff but it's all pretty sketchy from what I've seen so far. I wish people who have this stuff proofed before printing it.

[IJ]

"Pre-diabetes

Before developing type 2 diabetes, most people experience blood sugar levels that are higher than the average non-diabetic population, but not as high as individuals with type 2. Usually that means their blood glucose is between 140 and 200 micrograms per deciliter. This condition is known as pre-diabetes, and it affects roughly 57 million Americans."

--http://www.menshealth.com/spotlight/dia ... abetes.php

OR

"Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[10]

Fasting plasma glucose level at or above 7.0 mmol/L (126 mg/dL).
Plasma glucose at or above 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
Symptoms of hyperglycemia and casual plasma glucose at or above 11.1 mmol/L (200 mg/dL).
Glycated hemoglobin (hemoglobin A1C) at or above 6.5. (This criterion was recommended by the American Diabetes Association in 2010; it has yet to be adopted by the WHO.)[28]"

http://en.wikipedia.org/wiki/Diabetes_mellitus

I'll forgive them for getting the units wrong (mg vs mcg) but to imply that prediabetics run around with sugars 140-200 is plain wrong. Those are their sugars AFTER a huge glucose load! If they were fasting they'd be diabetics with sugars just of >126, far lower. This gives the impression a normal sugar is far higher than in reality.

(NB: diabetes doesn't have a bright line for definition in the real world; risk is graded with increased sugar, but humans have created arbitrary limits of normal, impaired glucose tolerance, and diabetes)

[Glenn]

Thanks Ian, that helps a lot. We have a type 2 diabetic in the family (currently being controlled by a combination of Actos, metformin, and lisinopril along with diet and exercise) and had not come across a lot of that info mentioned in that article, but I was assuming it might represent newer info than I had seen before.

One aspect I did think strange when reading the article was how much emphasis he was placing on factors such as diet and exercise and how little he was placing on genetics. His grandfather and father had it, but the article seems to focus on a desparate hope that he has contol over his genetics and can avoid diabetes in spite of already showing signs of being prediabetic. There is a lot to be said for diet and exercise, but you can't ignore the genetics. Heck my dad's mom had it and my dad's sisters all had/have it, and even though my dad and his brothers have not had it I make sure to periodically have my blood tested to make sure my blood glucose levels are where they should be.

metformin...induces weight loss

Unfortunately Actos has the opposite effect (much to the dismay of a couple of people I know who are on Actos only), so the Actos + met combo seems to cancel each other out in this respect.

The thing to remember here however is that not all carbohydrates are created equal

Unfortunately there is a hazard with making carb control more complex. The more difficult something is the greater the chance of failure. I know from our experience that simply counting all carbs is a challenge, to try to factor in good carbs versus bad carbs might be more than many can handle.

[Bill Glasheen]

The thing to remember here however is that not all carbohydrates are created equal

Unfortunately there is a hazard with making carb control more complex. The more difficult something is the greater the chance of failure. I know from our experience that simply counting all carbs is a challenge, to try to factor in good carbs versus bad carbs might be more than many can handle.

Well that doesn't make it any less important!

Newsflash - CARBOHYDRATES AREN'T EVIL
Without fiber (carbohydrate) in the diet, you're asking for long-term gastrointestinal trouble. Your body NEEDS low glycemic index carbohydrates. And someone who has just finished an intense weight workout needs a sugar fix (high glycemic index carbohydrate) to restore the glycogen reserves and facilitate the action of insulin as an anabolic hormone.

Newsflash 2 - FATS AREN'T EVIL
Eicosapentanoic acid is good for your heart, good for your joints, and stops inflammation. Docosahexanoic acid is good for brain development. Hormones are lipoproteins

This isn't MY fault, Glenn. Atkins isn't the patron saint of diets. He really really IS wrong now and then.

Throw the Atkins diet book in the trash where it belongs.

- Bill

[IJ]

Carb health isn't "complex" and it isn't "hard" for someone that's committed. You simply don't pursue the processed ones, and everything in moderation. Since I'm mostly the cook at home this means we hardly ever have bread or pasta or mashed potatoes or rice with meals. It's mostly the lean protein and veggies. Occasionally there is a bun and due to the rarity I don't try to force what carbs we do eat to be whole wheat. People WILL stop eating junk carbs if they're simply not purchased, which is the best place to start.

Glenn, those friends on Actos alone probably need a new doctor. I'm being a bit harsh here, but why on earth would you start someone on a new, branded medication that costs 10x as much or more as metformin, and has less outcomes data, and causes weight gain rather than loss, and has a relative increased risk of fluid retention and comes from a class that's been implicated in liver failure (troglitazone, now off market) and possibly more heart attacks? There are only two good reasons: renal failure (metformin dangerous if present) or GI intolerance (gets easier with time so really should be just slowly titrated up). As a second choice I'd probably use a sulfonylurea because they've been around longer.

Diabetes medicines, it is worth pointing out, do not cause weight gain (sorta). People with diabetes pee out the extra sugar in their blood, losing calories; controlling the diabetes prevents this, and the calories stay inside. So really they just limit a symptom of diabetes. More to the point, they don't make calories. If you don't eat more than you need, you do not gain fat.

I think the author is right not to focus on genetics. You need to acknowledge this, but you can't change it, so.... it's always best to make the most of your situation, bad or good. My father and grandfather ALSO had diabetes. I do not intend to join them. They were fat and inactive. If later in life I learn I'm headed to diabetes, I will go Food Nazi and you will find me being insanely proper on my intake. Now it's just mostly good I just found the authors excessive focus on sugar variability as a CAUSE of diabetes in otherwise normal weight people a bit sketchy. People's sugar doesn't skyrocket post-meal unless they're insulin resistant already, and that usually means: fat and inactive, at least in degrees. We do know that post prandial hyperglycemia is bad for you, and there are plenty of good reasons not to eat junk food, but we also know that obesity and inactivity explain the large majority of the diabetes we see. In susceptible people, even if the cause is hopeless, lifestyle improvements delay and ameliorate the coming diabetes. So I guess they're not hopeless?

Bill, do you support the idea of under repleting glycogen post workout to remain ketotic longer, for those who need to shed fat pounds? If you don't force the body to run on fat at some point, it'll never go.

[Bill Glasheen]

Bill, do you support the idea of under repleting glycogen post workout to remain ketotic longer, for those who need to shed fat pounds? If you don't force the body to run on fat at some point, it'll never go.

That works... The problem however is getting the body to burn fat as opposed to slipping into catabolism.

If you can increase muscle mass, then your raise the basal metabolic rate. I've very rarely had problems with excess weight, and my high metabolism is my ally. Now that I'm older, I do everything I can to keep it where it was in my youthful years. Part of that effort revolves around avoiding the natural 10 percent loss of muscle mass per decade.

Lots of voodoo there.

I personally used to have problems "bonking" after hard workouts before I stopped treating carbs as evil. There's a time and a place for sugar, and the hour after a weight training session is it.

- Bill

[Glenn]

Throw the Atkins diet book in the trash where it belongs.

We've never had one, but have several diabetes books (plus had consultations with nutritionists) and I suspect the Atkins diet is based on the diabetes diet (although Atkins seems to go further in reducing carbs from what I know of it). Ironically though, it has been the popularity of the Atkins Diet that has made carb-conscious options appear at restaurants, no one cared to offer them when it was just diabetics needing them

Our diet is anything but carb free, carbs are OK but have to be monitored and only a certain number of grams of carbs are recommended a day for someone with diabetes. When you have to limit the number of carbs you eat, the emphasis of course is on getting them from better sources like certain fruits and vegetables. Splenda has certainly helped with the avoidance of processed sugar.

Well that doesn't make it any less important!

Agreed, but in general doctors and nutritionists seem to try to make it as simple as possible for people to track and reduce carbs. Take this from the American Diabetic Association:
( http://www.diabetes.org/food-and-fitnes ... rates.html )

Did you know there are three main types of carbohydrate? There are
•Starches (also known as complex carbohydrates)
•Sugars
•Fiber
You'll also hear terms like naturally occurring sugar, added sugar, low-calorie sweeteners, sugar alcohols, reduced-calorie sweeteners, processed grains, enriched grains, complex carbohydrate, sweets, refined grains, and whole grains.

No wonder knowing what kind and how much carbohydrate to eat can be confusing!

On the nutrition label, the term "total carbohydrate" includes all three types of carbohydrates. This is the number you should pay attention to if you are carbohydrate counting.

They provide more detail on each type and which ones are better, but the focus is still on a single total-carb count.

[Bill Glasheen]

Glenn

I don't like that. Not all complex carbohydrates are good, and not all simple sugars are bad. Furthermore... we need to get people thinking more about whole foods and not about processed foods.

Fiber IS good though, so keep that in your list of things to consume.

This is simple, and it cuts to the chase.





Remember though... For the athlete wanting to put muscle mass on (which is a good thing in ANYBODY'S book), a high GI snack or drink (like Gatorade) within one hour after pumping iron is a rare treat. So if you like an occasional treat, go for it within that window of time because your body will do good things with that blood sugar spike. Over time as you put on a few more pounds of muscle mass, your body will be able to process more calories without putting fat on. In other words, you get to enjoy food rather than constantly stay in the denial mode.

- Bill