Low-Carb Diet

Why ‘Controlling’ Blood Sugar Shouldn’t Be the Goal

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No person with diabetes, no matter how many years they’ve had it, has achieved absolute control of their blood sugar. In fact, I would argue that “control” is not possible at all.

It has to do with the word control itself, but more on that later.

Even people who use the latest technologies – including insulin pumps, continuous glucose monitors (CGM), smart insulin pens, and hybrid closed loops – won’t have perfect levels every day. Most will see an improvement in their time in range, but not control.

I saw this firsthand at the 2023 EASD conference in Hamburg, Germany, where many of my fellow diabetes advocates wearing hybrid systems had their alarms go off frequently.

It may feel disheartening, but understanding that “full control” over blood sugar levels is not possible can be liberating and empowering. If you think of it as a process of managing with the goal of improvement, it can free you from chasing the impossible goal of perfection, easing the stress, frustration, disappointment, guilt, and self-blame that can come from feeling like you failed.

I’ll explain below how to better work with the constant fluctuations of blood sugar and share some of my practices for navigating (as opposed to controlling) it.

The complex science behind blood sugar management

Our heartbeat, blood pressure, gut and brain signaling, digestion, liver processes, nervous system, and more all interact and influence blood sugar levels. So does living in an unpredictable world.

Personally, every morning I deal with the “dawn effect.” I need to take 1 unit of rapid-acting insulin immediately or I’ll go up 30 points in minutes. The stress of presenting at a conference, even though I feel relaxed, releases hormones that raise my blood sugar.

Adam Brown’s 42 Factors that Affect Blood Glucose is always worth sharing to remind us how many factors, biological and environmental, impact blood sugar.

Instead of using the verb “control,” I prefer “manage.” To manage comes from the Italian maneggiare, meaning to handle and train horses. It suggests a mutual adapting to, respecting, and evolving between two complex entities: the horse and rider. Or, in this case, the complex dance between humans, the environment, and blood sugars.

Even after living with type 1 diabetes for 51 years, I cannot, for example, see 142 mg/dL on my CGM, decide I want to be 102 mg/dL, and make it happen. Yes, I’ll take some insulin or go on a walk, but I cannot guarantee exactly where my blood sugar will settle.

This was much to the chagrin of my husband who early in our marriage thought there must be a few root causes I could manipulate and the effect would be absolute control. But one evening, 15 minutes after I’d ordered my meal in a restaurant and pre-bolused, the waiter came back to say, “There’s been an accident in the kitchen, your meal will take another 20 minutes.”

That’s when the husband saw that managing blood sugar is not a cause-and-effect task but a complex one that relies on constant sensemaking. Sensemaking is the act of trying something and seeing what happens. We do it all the time but we don’t recognize it.

You may think what I’m saying is obvious, but the word “control” is used so often in the language of diabetes that on some level we have absorbed it as true and possible. We hold ourselves responsible for our numbers thinking we should be judged on them. This causes a lot of unnecessary suffering.

Why do we believe we can ‘control’ blood sugar?

During the industrial and scientific revolutions, the idea of machine efficiency was brought into medicine. The human body was widely viewed as a machine. This can be useful for acute care but fails miserably for chronic care, as is the case for managing diabetes.

But machine thinking seeped into diabetes care with control-like, statistical formulas: insulin-to-carb ratio, insulin-on-board, pump algorithms, and carb-counting. Don’t get me wrong: these are enormously helpful, but they don’t turn us into machines.

Improving time in range

Success in managing blood sugar and spending more time in range is knowing how to influence your numbers and sensing what to do with any blood sugar number you see.

This requires you to have a general knowledge of how things affect your blood sugar and a familiarity with your patterns. That said, because so many variables are involved, any action may take some trial and error.

Here are steps that help me spend, on average, 90% time in range.

Influencing your blood sugar

  1. Wear a CGM: I recommend wearing a CGM to anyone with diabetes, particularly if you use insulin. You need to be able to see your numbers to know where you are and where you’re going. A CGM is also an easy way to see your patterns: check your blood sugar before and two hours after a meal or physical activity to see its impact on your blood sugar. If you don’t use a CGM, you can check for patterns using a meter. While the 2-hour check is a mechanical rule, it will give you a sense.
  2. Routine: I eat the same breakfast of plain Greek yogurt, a spoonful of tahini and almond butter, and a slice of a flaxseed muffin every morning when I’m home. My lunches and dinners are similar day to day in quantity and carbs, and I follow a low-carb diet. Eating and exercising consistently also helps my numbers be more similar day to day.

Nudging: small pushes back into range

I follow Dr. Richard Bernstein’s “law of small numbers.” If I’m too high, I take a small amount of insulin to nudge my numbers down, wait, watch, and repeat if necessary.

When I need to raise my blood sugar, if it’s not dangerously low, I’ve learned to take one or two glucose tablets and watch what happens rather than eat everything in the refrigerator like I used to.

Practicing patience and forgiveness

Managing blood sugar takes vigilance. You’ll have more energy to do it when you flow with your numbers, rather than fight them. That means staying calm and seeing the big picture. It means knowing that many variables, not just your decisions, affect blood sugar.

That said, I’m far from perfect. I certainly have times I feel overwhelmed or frustrated by my numbers and my mind shouts, “How could I let that happen again? Why didn’t I wait before I took that extra shot?”

But the temptation to think why didn’t I do this instead of that is useless since I can only know which decision was better in hindsight.

To help my nervous system stay calm, I practice this simple exercise – sometimes during the day or when I’m tempted to rage bolus.

I stand with my knees unlocked, feel my feet on the floor, let my arms rest by my side or hold them over my chest, and slow my breathing. I acknowledge this number is not my fault. My actions alone didn’t cause it. Then I reflect as best I can on what might have created it so I might do better in the future. I think, what do I do now, and do it; I don’t dwell on the number.

In closing

It’s important to mention that managing diabetes is not easy. If it was, more than 50-60% of people with diabetes would reach the time in range recommendation, which is 70% of the time (the equivalent of 17 hours a day).

This past summer at Camp Nejeda I presented this myth of “control” to adults who have been living with type 1 diabetes for decades. They all knew it instinctively, but hearing someone say it caused one woman to sob, releasing years of blame she had been carrying.

It’s time we realize that it’s more accurate and helpful to tell people to “manage” their blood sugar instead of “control” it. Our numbers emerge from dozens of factors, some within our sphere of influence, many not. As such, we’re responsible for our efforts but not our outcome.

Rest in this understanding and see if giving up the idea of perfect numbers helps you spend more time in range with less stress.

7 Low-Carb Breakfast Recipes to Start Your Day

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After a more relaxed summer schedule, it’s time to get back into the routine of things. If you tend to do more meal planning during the school year, here are seven low-carb breakfast recipes to put on your radar.

Blueberry Protein Smoothie Bowl

From Sugar-Free Mom: “What exactly is a smoothie bowl? Basically taking your traditional smoothie in a glass to another level. Instead of sipping it, you enjoy it like soup and add some delicious toppings! It’s taking your smoothie to another level, and it’s a whole lot more satisfying for a meal.”

Bacon Breakfast Enchiladas

From 24-7 Low Carb Diner: “Egg wraps stand in for the standard tortilla. A cream cheese sauce goes over the top instead of a chili based enchilada sauce. No one would stop you from adding some green chiles or jalapenos. They are far easier to make than you would suspect.”

Coconut Porridge

From Low Carb Yum: “A high fiber low-carb coconut porridge that’s easy to make on the stove top or in an electric pressure cooker. It’s a perfect hot keto cereal.”

Vanilla Ricotta Pancakes

From Sugar-Free Mom: “When all you need is just four ingredients to make a quick and easy breakfast, you never have to feel deprived on a sugar-free, low-carb diet. Simple recipes like these are what can keep you feeling satisfied and happy and ready to take on the day ahead!”

Egg Muffins

From Butter Is Not a Carb: “I was determined to make some zero carb egg muffins for breakfast that I can bring with me all week for lunch at work, too. These muffins are extremely easy to put together and have the perfect low-carb, high-fat, moderate protein macro ratio.”

Fat Head Dough Bagels

From Low Carb Yum: “If you haven’t been making your own Fat Head dough because of the almond flour, you need to give this coconut flour version a try. One advantage of coconut flour over almond flour is that you use less. A little bit of coconut flour goes a long way as it seems to expand like a sponge when absorbing the liquid.”

Glazed Donuts

From Caroline’s Keto Kitchen: “If you miss Krispy Kreme, you’re in luck. This morning I made glazed donuts that look just like the real deal, and they are light, fluffy and delicious.”

The Evening Meal

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Mix-and-match dinner components for healthy, relaxing meals, featuring slow-roasted salmon, rotisserie chicken, zucchini spaghetti, and more!

Dinner is a mystery to me. It is definitely my favorite meal to eat – but being in charge of getting it on the table can be kind of dispiriting. It just comes around and comes around, and even though you just made dinner last night, it is time to make more of it, to make it again and again, whether or not you are out of ideas and whether or not you have family members milling around like a school of hungry sharks.

Dinner prep can be especially tricky if you’re trying to lower your overall carb intake since easy, comfortable favorites like spaghetti and meatballs, mac and cheese, or even breakfast for dinner have to be tinkered with. That’s why my recipes are meant to be the meal equivalent of practical wardrobe separates: you can make them as stand-alone recipes, or you can mix and match them into complete meals. They are generally low-carb, nutrient-dense, and also fairly straightforward and quite delicious. Plus, you can add whatever seasonings you like to make them even more interesting for yourself or the people you’re feeding – in other words, you can dress them up, dress them down, serve them with jeans, etc. Or that’s the hope.

I want to say here, in the interest of full transparency, that lots of people at diaTribe, including our own Adam Brown and me, are increasingly convinced that lowering carbohydrate intake substantially helps stabilize blood sugars and makes people feel better. But then we’re not completely avoiding carbs, and we don’t want to assume that you are. (Although if you are, that’s great!) We are thinking of some of these foods – the quinoa, for example – as better options than the ones like bread or pasta that have lots of carbs that go in fast. But please feel free to tell us what you’re thinking, what you’re wanting to cook more or less of at home. Because we really want to know!

Click to jump down to a recipe:

1 Store-Bought Rotisserie Chicken / 10 Meals

Okay, that’s a kind of inaccurate headline because you’re not really making 10 entire meals from a single chicken. It’s more that I’m giving you 10 different meal ideas for when you’ve bought a rotisserie chicken from the supermarket, but you don’t really want to have just the plain chicken (again). I love supermarket rotisserie chickens because they’re inexpensive and they’re tasty – and because they lend themselves to such a lovely range of meals, without the fuss of first prepping and cooking the chicken. (Plus, nobody will know that you peeled off and ate the entire bronzed chicken skin while you were cooking. Chef’s prerogative!)

(Serving size and carb counts will depend on individual preparations, but I’m indicating what the source of carbs is below)

  • Lettuce Wraps (The carrot will add up to 3 grams of carbs per serving)

Butter or Boston lettuce leaves + shredded chicken + slivered carrots and/or cucumbers + basil and/or mint + a simple peanut dressing made by whisking together 2 tablespoons peanut butter (try to get the no-sugar ones), 1 tablespoon balsamic or rice vinegar, 2 tablespoons soy sauce, ½ teaspoon garlic powder, ¼ teaspoon cayenne, and enough warm water by the spoonful to make it creamy and drizzle-able

  • Chicken Caesar (The chickpeas will add up to 15 grams of carbs per serving; feel free to omit them)

Cut-up Romaine lettuce + shredded chicken + grated parmesan + Caesar dressing + chickpea croutons (below). Adam’s Brown shared his Caesar dressing recipe, one he’s modified from The Keto Diet book: In a blender or food processor, whiz together 1 cup olive oil, ½ cup mayonnaise (use full-fat; look for Best Foods or Hellmann’s; otherwise, check that there are 0 grams of sugar per serving), one small tin of anchovy fillets, 6 tablespoons lemon juice, 2-3 tablespoons Dijon mustard, 4 cloves of garlic (or 2 teaspoons garlic powder) and a grind of black pepper until creamy and smooth. This makes enough to dress 10 large plates of salad.

  • Green Noodles with Chicken (The red pepper will add up to 3 grams of carbs, the zucchini noodles around 6 grams)

Sautéed zucchini noodles (see below) + pesto + shredded chicken + red bell pepper + toasted pine nuts + grated parmesan cheese

  • Ginger-Miso Chicken Salad (The miso will add 2 grams of carbs, the almonds or peanuts up to 2 or 3 grams)

Cut-up Romaine lettuce + shredded chicken + sliced celery and/or cucumbers + toasted sliced almonds or roasted peanuts + miso-ginger dressing made by whisking together ¼ cup white miso + ¼ cup rice vinegar + 2 teaspoons finely minced ginger + 1 teaspoon soy sauce + 1/3 cup vegetable oil + 1 tablespoon warm water

  • Chicken Burrito Bowl (The beans will add up to 10 grams of carbs, the avocado up to 3 or 4 grams)

Shredded chicken + black or pinto beans + shredded cheddar or Monterey Jack cheese + sour cream + salsa + diced avocado

  • Buffalo Chicken Salad (The blue cheese dressing might add a gram or two of carbs)

Cut-up Romaine lettuce and/or mixed greens + shredded chicken + sliced celery + blue cheese dressing + a few shakes of Frank’s Red Hot or Louisiana hot sauce

  • Mexican Chicken Soup (The tomato will add up to 5 grams of carbs, the avocado up to 3 or 4 grams)

Chicken broth + shredded chicken + canned tomatoes + sautéed onion and garlic + oregano and chili powder + lime juice + avocado + sour cream

  • Cobb Salad (The tomato will add up to 4 grams of carbs, the avocado up to 3 or 4 grams)

Cut-up Romaine lettuce + shredded chicken + hard-boiled eggs + cooked bacon + diced avocado + chopped tomatoes + crumbled blue cheese + vinaigrette dressing

  • Chicken Quesadizza (detailed recipe here) (The tortilla will add up to 3 grams of carbs, the broccoli 3 grams, the salsa 1 gram)

Low-carb tortilla + grated Monterey Jack cheese + salsa + shredded chicken + leftover roasted broccoli (below)

  • Vietnamese Chicken Salad (The carrots will add up to 3 grams of carbs, the Sriracha or hot sauce up to 1 gram)

Slivered napa cabbage + shredded chicken + grated carrots + chopped mint and/or cilantro + lime vinaigrette made with 3 tablespoons lime juice + 3 tablespoons fish sauce + 3 tablespoons vegetable oil + 1 clove minced garlic + Sriracha or other hot sauce to taste

Zucchini Spaghetti

Makes: 2 servings

Total carbohydrates: 6 grams per serving

Hands-on time: 5-15 minutes (depending on whether you’re spiralizing yourself)

Total time: 5-15 minutes

So, yes, oodles of zoodles and all that – it’s true that spiralizing vegetables, i.e. slicing them into spaghetti-shaped strands, is kind of a food trend. But zucchini noodles are light and delicious, naturally low in carbohydrates, and naturally high in fiber and nutrients. Plus, if you give them the spaghetti treatment – sauce and cheese, a spoonful of pesto, or even simply a little pat of melting butter – you just might convince any squash-wary family members that they’re worth tasting.

A note on gadgets: I have a super-simple double-sided pencil-sharpener type spiralizer, and I find it quite easy to use. I would also recommend the SpiraLife Vegetable Spiralizer ($13.99), a hand-held no-bells-and-whistles model that I like because it’s a) relatively inexpensive and b) entirely mechanical, which means you don’t need to plug it in and it won’t break.

However, you can invest in a more efficient gadget if you anticipate eating this a lot (Adam really likes this one) or you can even buy your veggies already-spiralized in some places if you want to pay a little more.

Ingredients

1 tablespoon olive oil

1 pound zucchini noodles (also called zoodles) or 1 pound zucchini (about 2 medium), spiralized

Salt

Instructions

  1. Heat the oil in a wide skillet (ideally nonstick) over medium-high heat.
  2. Add the zucchini and sauté, tossing gently with tongs as it cooks, until it is just barely tender. This will take around 3 minutes, and you should stop before you think it’s completely cooked because it will keep cooking and you don’t want it suddenly sitting in a flood of water. Likewise, don’t salt it until you’re done cooking it, since the salt also will pull water from it.
  3. Salt and sauce as you like.

Perfect Slow-Roasted Salmon

Makes: 4 servings

Total carbohydrates: less than 1 gram per serving

Hands-on time: 5 minutes

Total time: 20-30 minutes

This is my very favorite way to cook salmon (or cod or striped bass, for that matter): the fish ends up meltingly tender, with a velvety texture and a very fresh, mild flavor. Don’t expect it to brown (alas), and don’t expect it to look the way you might expect cooked fish to look, since it won’t turn pale pink and opaque. It’s perfect as a regular main course, or atop a salad for a leafier meal.

Ingredients

1 ½ tablespoons olive oil (divided use)

Grated zest of 1 lemon (quarter the lemon after zesting it)

1 clove garlic, smashed, peeled, and minced

1 teaspoon fresh thyme leaves, chopped, or another herb of your choosing (optional)

4 pieces of thick salmon fillet (ask for center-cut), 1- 1 ½ pounds total

Salt and freshly ground black pepper

Simple tartar sauce, below (optional)

Instructions

  1. Heat the oven to 275° F. Cover a baking sheet with foil, then brush or rub it with the half tablespoon of olive oil.
  2. In a small bowl, stir together the lemon zest, garlic, and remaining tablespoon of oil.
  3. Put the fish on the baking sheet, skin side-down. Sprinkle it with salt and pepper, then drizzle the lemon-garlic oil evenly over the fillets.
  4. Roast for 15 to 25 minutes, until the flesh is just beginning to flake when you press a fork into it, and you can separate the fish from its skin. It might look different from the way you’re used to cooked fish looking – rosier and less opaque. That’s okay!
  5. Serve with the lemon wedges, warm, at room temperature, or cold.

Simple Tartar Sauce

Whisk together ½ cup mayonnaise (use full-fat; look for Best Foods or Hellmann’s; otherwise, check that there are 0 grams of sugar per serving), 1 tablespoon coarsely chopped capers, 1 tablespoon chopped parsley, 1 tablespoon lemon juice, and ½ teaspoon salt. Feel free to add finely chopped cornichons (mini sour pickles) or dill pickles, and/or chopped dill.

Quinoa

Makes: 6 servings

Total carbohydrates: 20 grams per serving

Hands-on time: 5 minutes

Total time: 20-30 minutes

Quinoa is a wonderful grain… or seed… or superfood of the Andes. Whatever it is, it’s somehow simultaneously tender and crunchy, and also nutty and delicious. Plus, it’s gluten-free, high in fiber, and super-high in protein. Try swapping it into any dish or meal that you’d typically use rice for, since it offers so much more nutritional value. And if you’re serving the quinoa as a plain side dish, try stir in the juice and grated zest of half a lemon. Yum. (But also, if you’re aiming for fewer carbs, try making something like cauliflower “rice” instead, which you can find in some frozen vegetable aisles – Trader Joe’s has great options.)

Ingredients

Salt

1 ½ cups quinoa

3 tablespoons butter or olive oil

Instructions

  1. Bring a medium or large pot of water to a boil over high heat and salt it heavily. It should taste as salty as the sea, so we are talking a fair amount of salt.
  2. Add the quinoa and stir, turn the heat down to medium-high and cook it for 10-15 minutes, uncovered, until it is just tender and the grains have spiraled open a bit. It will continue to cook as it steams, so don’t cook it until it’s soft at this point – just fish a little out with a fork to test.
  3. Drain it really, really well in a fine sieve – I mean, really shake it around to get the water out – then put it back in the pot, stretch a doubled dish towel over the top of the pot, and put the lid back on. Leave it to steam for 5 to 10 minutes.
  4. Stir in the butter or oil and serve.

The Best Roasted Vegetables

Makes: 4 servings

Total carbohydrates: around 10 grams per serving

Hands-on time: 15 minutes

Total time: 25-35 minutes

Ingredients

1 large head broccoli or cauliflower, or 1 ½ pounds Brussels sprouts

3 tablespoons extra-virgin olive oil

1 teaspoon kosher salt (or half as much table salt)

Optional: ½ teaspoon of sugar

Note: If you feel weird adding sugar to your vegetables, please feel free to leave it out. That seems completely reasonable to me, and the vegetables will still be totally good! However, because it helps the vegetables brown, because it only adds only a 1/2 gram of carbs per serving, and because this has, for years, been the best recipe I have for getting vast quantities of vegetables into the bodies of my children, I include it.

Lemon wedges, for serving

Instructions

  1. Adjust an oven rack to the lowest position, place a large rimmed baking sheet on the rack, and heat the oven to 500 degrees.
  2. If you’re using broccoli, peel the thick stems with a sharp paring knife as best as you’re able. Then cut the stem into long ½-inch-thick pieces and the rest into long, narrowish florets. If you’re using cauliflower, trim out the core with a sharp paring knife, then cut it up into florets, ideally cutting each in half so there’s a flat side. For Brussels sprouts, trim off the bottoms and any discolored leaves, then cut them in half.
  3. Put the vegetables in a bowl, drizzle with the oil and toss well until evenly coated. Sprinkle with the salt and sugar, and toss to combine.
  4. Remove the baking sheet from the oven, then dump on the veggies, spreading them in an even layer and placing flat sides down wherever possible.
  5. Return the baking sheet to the oven and roast until the stalks are well browned and tender and the vegetables are lightly browned: about 10 minutes for broccoli; 15 minutes for cauliflower; 15-20 minutes for Brussels sprouts. Transfer to a serving dish and serve immediately with lemon wedges.

Chickpea Croutons

Makes: 1 cup (4 servings)

Total carbohydrates: 15 grams per serving

Hands-on time: 5 minutes

Total time: 25-20 minutes

I love these so much more than traditional croutons and they are better for you! They’ve got all the crunch, flavor, and saltiness you expect, but then they also add a ton of protein, fiber, and vitamins to your Caesar or green salad. Use a nonstick or well-seasoned pan, if you’ve got one.

Ingredients

2 tablespoons olive oil

1 (15-ounce) can chickpeas, drained and spread to dry on a double thickness of paper towels

Salt to taste (use plenty)

Garlic powder (optional)

Instructions

  1. Heat the oil in a medium pan over medium heat until it is medium hot.
  2. Add the chickpeas in a single layer, salt them liberally, and leave them for a few minutes, unpestered by you and your spatula, so they can start to turn a bit golden on the bottom. Now start flipping and turning them every so often, shaking the pan around, until the chickpeas are as crisp and brown as they could be without burning. This will take 10-15 minutes.
  3. Add a sprinkle of garlic powder, if you’re using it, then taste for salt and remove the chickpeas to a paper-towel-lined dish to cool a bit before their introduction to the salad.

The 5 Necessities of an Effective Weight Loss Diet for People With Diabetes

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weight loss for people with diabetes

This is not just another general “eat salad and completely avoid carbs” article. I’m tired of seeing generalized diet information that, to be brutally honest, is pointless and inapplicable to most people’s lives. This article is aimed to help the diabetic community focus on and prioritize what works.

Weight loss is science, not magic or voodoo or luck. There is a specific set of requirements needed to lose weight efficiently as a person with diabetes (type 1 or type 2). Yes, you may have heard of your friend’s cousin’s mother doing a no carb detox cleansing bath scrub to lose belly fat who lost 10 pounds, but I highly encourage you to check in with that person who does every fad diet possible in a few weeks or months. Chances are they gained the weight back and then some.

That’s because while some diets cause people to lose weight initially, they don’t employ the basic principles of continued effective weight loss. Whether it’s water weight loss, weight loss from severe calorie deficit, or avoidance of food, a lot of diets promise and sometimes produce acute results — that is temporary or short term results.

From helping hundreds of diabetics lose weight on social media, I was nicknamed the “T1D Fat Loss Coach” and now help people with all kinds of diabetes and chronic illnesses get on effective diets.

I have a 3 “E” rule for an effective diet before you continue on in this article. A diet must be all three of the following for you for it to be effective:

  1. Easy to adhere to long term
  2. Enjoyable or at least not miserable and affecting quality of life (socially or mood related)
  3. Effective in producing results long term (any diet change can produce short term results)

So, in deciding on a diet, make sure you have these rules in mind. These next five components of a diet will determine your success.

Optimal Weight Loss Blood Sugar

Blood sugar management is more important than exercise and diet combined for weight loss. Why? Because chasing blood sugars involves ruining your diet and training effectiveness.

You can’t optimally lose fat, build lean muscle, or get a healthier physique while mismanaging your blood sugars.

When your sugars are low, you are likely to (or at least more at risk to):

  • Overeat to correct lows
  • Overcompensate the overeating with medication that could lead to another low
  • Experience another low in the next 24-48 hours (“lows beget lows”)
  • Reduce intensity of exercise
  • Experience increased hunger and cravings which can be hard to fight

When your blood sugars are high, you are likely to (or at least more at risk to):

  • Overtreat with insulin which could lead to another low
  • Reduce nutrient absorption necessary to increase or preserve lean muscle mass
  • Decrease effectiveness of a workout
  • Experience a false sense of scale weight loss when in reality, you could be losing lean tissue which means reducing your metabolic rate and storing more body fat

In order to improve your metabolic rate and your body’s fat burning capability/processes, blood sugar management has to be a priority. In order to reduce cravings and hypo and hyperglycemic events that negatively affect diet and training, blood sugar management must be a main priority that isn’t overlooked.

Talk to your endocrinologist and diabetes management team as you decide on what the best approach is in conjunction with your changing diet and exercise habits. Then, you can get into specifics on calories and the makeup of those calories for fat loss optimization.

Specifying Calorie Intake

In order for you to lose weight, you have to be in a calorie deficit — that means burning more calories than you take in. You can do this by eating less, burning more calories through activity, or, ideally, a combination of both.

But first, you have to determine what is the appropriate number of calories you should be intaking based on your personal stats and goals. But can’t I just eat “healthy” and lose weight? You can and leave it to chance but even if you eat healthy foods in the wrong quantities, you will gain weight.

There is no universal fix to an individual problem.

That means what works for me doesn’t optimally work for your mom or for you. Specificity is optimal. To figure out how many calories you need to consume, you can find any TDEE calculator online like this one. This determines your Total Daily Energy Expenditure, or the calories you need to eat to maintain your current weight.

IIFYM TDEE calculator

Now if you want to lose weight, you need to be in a caloric deficit which means you need to eat less than what you expend daily. My personal, general rule of thumb is:

  • If you want to lose 5 lbs/2 kg or less, subtract 250 calories from your TDEE
  • If you want to lose 5-15 lbs/2-7 kg, subtract 500 calories from your TDEE
  • If you want to lose over 20 lbs/10 kg, subtract up to 750 calories from your TDEE

This is a general rule that has helped hundreds of my type 1 and type 2 online weight loss clients lose between 5-60 lbs/2-25 kg but always be sure to consult your doctor before starting a new diet and training program.

Once you have your daily caloric limits, you can be more specific and determine your macronutrient goals.

Identifying Your Ideal Macro Balance

Calories determine weight change, but macronutrient balance determines the kind of weight change. Macronutrients are your proteins, carbohydrates, and fats.

  • Protein has 4 calories per gram
  • Carbs have 4 calories per gram
  • Fat has 9 calories per gram

Why is macronutrient balance important? Take two people eating a 1500 calorie diet based on the advice above. Person A is eating 90% fat, 5% carbs, and 5% protein while person B is eating a balanced macronutrient diet of 35% protein, 30% carbs, and 35% fat. Who will get better results?

Person A is eating far too little protein and far too much fat. Higher protein diets are effective in helping people lose body fat, reduce hunger and cravings, and manage blood sugars. That little protein intake would increase risk of lean muscle loss which is the exact opposite goal. High protein diets are also proven to not be dangerous or harmful to the kidneys as long as there is no pre existing kidney damage.

That high of fat intake might make person A more hungry too as fat is more calorie dense meaning less total food intake. More hunger = more of a chance to fall off the diet when faced with opportunity to cheat.

The goal is to preserve or even build lean muscle while losing body fat. Losing muscle decreases your metabolic rate and lowers your body’s ability to burn fat. Keeping your protein around 30-40% of your total caloric intake is key for long term fat loss.

What about carbs?

Given that protein is 30-40%, carbs I leave up to my clients’ personal preference. Some people choose a moderate carb intake, some choose a lower carb intake, and some even choose to follow a ketogenic approach.

I personally don’t care as long as you are managing your sugars, eating the right protein amount, and hitting around your decided macronutrient intakes.

In terms of pure weight loss science, hundreds of studies have compared low-carb, high-fat diets to high-carb, low-fat diets and found no significant difference in weight loss when calories and protein are equated.

There may be some instances where clients with insulin resistance or hormonal issues (Type 2, PCOS, Hashimotos, post menopause, etc.) might be encouraged to be on the lower side of carb intake but, for the most part, it is a personal choice.

Carbs and fats usually have an inverse relationship — if one is higher the other is lower. If your protein intake is at 30% and you decide you want to do a moderate carb approach at 30% carbs, then you know your fat intake will be 40% (the remainder).

Some of my preferred macro percentages with my clients are:

  • Low-carb: 40% protein/20% carbs/40% fat
  • Moderate carb: 35% protein/30% carbs/35% fat
  • Moderate carb, high activity level: 40% protein/30% carbs/30% fat

These are just a few of the many possibilities and strategies to elicit fat loss. Simply download a calorie counting app like My Fitness Pal to track these numbers discussed above.

Navigating My Way Through a Food Heavy Culture

Food Choices

It is not necessarily the choices of food that affect us as much as the quantities of food in terms of weight gain and weight loss, directly speaking. Indirectly, food choice can be a major indicator of adherence to a diet.

Eating processed foods is shown to decrease satiety (feeling of fullness), increase cravings, and increase guilt. These repercussions of not eating healthy can slow or even reverse progress. I like to take an 80/20 approach with my diabetic clientele and myself.

80% of the food eaten should be whole foods. 20% can be your personal indulgent. That means if you are alloted 1500 calories a day, 20%, or 300 calories, can come from your craving foods. I believe this helps people cheat within the diet so they stay on track for longer and get far better results than being extremely strict.

An interesting note, a Kansas state nutrition professor ate twinkies and protein shakes for 10 weeks and lost 27lbs/12kg and improved his metabolic profile in the process. He wanted to show that quantity of food is extremely important when it comes to weight loss. Obviously, I don’t recommend doing this and neither does he, so please don’t replicate his experiment.

Meal Timing & Frequency

One of the biggest myths in the dieting world is having to eat every two hours to “stoke the metabolic fire.” There is no metabolic fire or fire inside of your body — I promise. Daily macronutrient & caloric totals matter most not meal timing or frequency. When you add diabetes to the mix, that’s when these variables become more relevant.

Meal timing prior to cardio or exercise can determine if you are going to have a great workout or diabetic emergency. Both hypo- & hyperglycemia can ruin a workout so timing meals according to your activity level can greatly improve blood sugar management, which indirectly improves your ability to adhere to your diet and training.

Meal frequency is a personal preference but some people with diabetes find it easier to minimize glucose variability with smaller, more frequent meals. Ultimately, that is your decision. Whatever fits into your lifestyle best is what you should do.

Effective Weight Loss With Diabetes

Blood sugar management, proper caloric intake, and macronutrient balance will help you lose body fat long term, the right way. There are tons of advanced strategies I’ve used to help people with diabetes transform their bodies but all progress stems from these basic principles. Yes, it takes some work. Yes, you have to type some stuff and do some math. Yes, it takes conscious, daily effort just like diabetes management. But, in doing so, your body will thank you.

Study Shows Keto Diet May Reverse Metabolic Syndrome

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ketogenic diet

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 December 28th, 2017

A study tried to find out if a ketogenic diet could reverse the pathological processes that lead to metabolic syndrome.

Researchers looked to see if fasting triglycerides, BMI (body mass index), BFM (body fat mass), and weight could be lowered and to see if A1c levels could be lowered or normalized. They looked for increases in RMR (resting metabolic rate) and ketones.

They studied a group of 30 individuals who had been diagnosed by their primary care provider as having metabolic syndrome and randomly prescribed them one of three protocols. One group sustained a ketogenic diet with no exercise. The second group ate a standard American diet with no exercise and the third group was asked to eat a standard American diet but include 3-5 days of 30 minutes of exercise.

What is a Ketogenic Diet?

In the study paper, they explained that “Ketogenic diets are characterized by a reduction in carbohydrates (usually less than 50g/day) with a relative increase in the physiological proportion of dietary fat with adequate protein to feed individual lean body mass.”

They add that ketosis is an energy state the body uses when glucose availability is low whereby ketones are made by the liver. The researchers state that recently, evidence has shown that a ketogenic diet can help conditions like “diabetes, polycystic ovarian syndrome (PCOS), neurological degeneration, cancer, as well as marked improvement of respiratory and cardiovascular disease risk factors”.

Why Are These Results Notable?

The results showed that over the course of 10 weeks those who ate a ketogenic diet had reductions in weight, body fat percentage, BMI, and A1C levels.

The researchers wrote in their study paper that “All variables for the ketogenic group out-performed those of the exercise and non-exercise groups, with five of the seven demonstrating statistical significance.”

The two groups eating a standard American diet did not see any significant changes in any of the five main biomarkers for metabolic syndrome.

These findings are of interest because modern countries like the U.S. are enduring a growing epidemic of metabolic syndrome. Metabolic syndrome increases the likelihood of obesity, pre-diabetes, type 2 diabetes, and “numerous degenerative diseases”, write the researchers.

According to the study authors, based on their results–their statistical data, “the null hypothesis that a ketogenic diet has no effect on the five principle biomarkers of metabolic syndrome can be rejected.” These researchers say that “nutritional ketosis is a noteworthy modality of preventative and restorative care”.

They hope more studies can be done for the sake of developing a standard of care surrounding a ketogenic diet that results in a safe and effective practice.

ADA’s 2018 Standards of Medical Care Released

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Standards of Medical Care in Diabetes 2018

Every year the American Diabetes Association (ADA) puts out an updated Standards of Medical Care approved by their board of directors which is their official position and provides all of their current clinical practice recommendations.

In this year’s Standards they state that “To update the Standards of Care, the ADA’s Professional Practice Committee (PPC) performs an extensive clinical diabetes literature search, supplemented with input from ADA staff and the medical community at large.” they update it each year or as needed online based on incoming evidence or regulatory changes.

It should be noted that most current Standards supersedes all previous ADA position statements.

Citing the way the field of diabetes moves quickly, the 2018 Standards of Care reveals the following major revisions:

Limits of A1c and Diagnostic Recommendations

Since recent evidence shows limits to A1c measurements because of hemoglobin variants among individuals, conditions that affect red blood cell turnover, and assay interference, recommendations have been “added to clarify the appropriate use of the A1C test generally and in the diagnosis of diabetes in these special cases,” states the ADA.

The ADA now recommends pre-diabetes and type 2 diabetes screening in children and teens who are overweight or obese and have one or more additional risk factors.

Comprehensive Medical Evaluation and Comorbidities

Components of a comprehensive medical evaluation now includes “information about the recommended frequency of the components of care at both initial and follow-up visits.”

The ADA added information about “the importance of language choice in patient-centered communication.”

They also now recommend healthcare providers consider checking serum testosterone levels in men with diabetes who have signs/symptoms of hypogonadism.

Dietary Clarification

The ADA stresses a clarification regarding nutrition: the ADA states that “there is no universal ideal macronutrient distribution and that eating plans should be individualized.” They have also included text to “address the role of low-carbohydrate diets in people with diabetes.”

low-carb diet for people with diabetes

On this point the Standards state, “The role of low-carbohydrate diets in patients with diabetes remains unclear,” They write that some of this confusion is due to different definitions of low-carb diets. “While benefits to low-carbohydrate diets have been described, improvements tend to be in the short term and, over time, these effects are not maintained,”

They concede that some studies show “modest benefits of low-carbohydrate or ketogenic diets” which entail under 50 grams of carbohydrate per day and say that ” this approach may only be appropriate for short-term implementation (up to 3–4 months) if desired by the patient, as there is little long-term research citing benefits or harm.”

The ADA does recommend children and adults with diabetes to reduce their intake of refined carbohydrates and added sugars and to get carbohydrates from vegetables, legumes, fruits, dairy, and whole gains. They write that the “consumption of sugar-sweetened beverages and processed “low-fat” or “nonfat” food products with high amounts of refined grains and added sugars is strongly discouraged,”

CGM Recommendation

Considering the latest data, the ADA now recommends the use of CGM (continuous glucose monitoring) in adults with type 1 diabetes to all adults ages 18 and up who are not meeting their glycemic targets (recommendation was previously for age 25 and up).

Drug Recommendations for Blood Sugar Treatment

Recommendations have been added due to data from the recent cardiovascular outcomes trial (CVOT) which shows that people with atherosclerotic cardiovascular disease should start with lifestyle management treatments plus metformin and “subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.”

Managing Blood Pressure from Home

All patients with high blood pressure are now recommended to monitor their blood pressure at home to find out if they have “masked or white coat hypertension” and to help motivate patients to take their hypertension medication via awareness of elevated blood pressure.

Caution in Older Adults

New recommendations have been added to indicate how important individualized drug therapy is in older adults in order to lower the risk of low blood sugar episodes and to avoid over-treatment, as well as simplifying complicated regimens if at all possible while keeping the A1c target.

Pregnancy and Diabetes

A new recommendation emphasizes that insulin is “the preferred agent for the management of type 1 and type 2 diabetes in pregnancy.”

Citing new evidence, the ADA now recommends that pregnant women with type 1 and type 2 diabetes take a low-dose aspirin beginning at the end of the first trimester for the purpose of lowering the risk of developing preeclampsia.

Diabetes Care in Hospital

Insulin degludec (Tresiba) has been added to the insulin dosing for enteral/parenteral feedings.

For all the revisions visit the Summary of Revisions. For the pdf of the 2018 Standards of Care go here.

Low-Protein and Low-Carb Diet May Slow Alzheimer’s Disease

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Low-Protein Diet

Story at-a-glance

  • A deficiency of healthy fats, combined with too many carbs may be at the heart of the Alzheimer’s epidemic
  • A growing body of research suggests there may be a powerful connection between the foods you eat and your risk of Alzheimer’s disease and dementia, via similar pathways that cause type 2 diabetes. In one recent animal study, researchers were able to induce dementia by disrupting the proper signaling of insulin in the brain
  • Previous animal research has shown that calorie restriction protects against aging, oxidative stress and neurodegenerative pathologies, and that reduced levels of IGF-1 mediate some of these protective effects.
  • Recent research has also shown that intermittent fasting triggers a variety of health-promoting hormonal and metabolic changes similar to those of constant calorie restriction—including reduced age-related brain shrinkage

Alzheimer’s disease is the sixth leading cause of death in the U.S. This fatal and progressive condition destroys brain cells, resulting in memory loss and severe thinking and behavioral problems (aggression, delusions, and hallucinations) that interfere with daily life and activities.

The cause is conventionally believed to be a mystery. While we know that certain diseases, like type 2 diabetes, are definitively connected to the foods you eat, Alzheimer’s is generally thought to strike without warning or reason.

That is, until recently.

A growing body of research suggests there may be a powerful connection between the foods you eat and your risk of Alzheimer’s disease and dementia, via similar pathways that cause type 2 diabetes. Some have even re-named Alzheimer’s as “type 3 diabetes.”

Top Dietary Factor Now Implicated in Skyrocketing Dementia Rates

Faulty insulin (and leptin), signaling caused by a high non-fiber carb diet is an underlying cause of insulin resistance, which, of course, typically leads to type 2 diabetes. However, while insulin is usually associated with its role in keeping your blood sugar levels in a healthy range, it also plays a role in brain signaling.

In a 2012 animal study,1 researchers were able to induce dementia by disrupting the proper signaling of insulin in the brain.

All in all, it seems clear that your diet plays a tremendous part in Alzheimer’s, and the low-fat craze may have wrought more havoc than anyone could ever have imagined. It was the absolute worst recommendation possible, limiting the nutrient you, and your brain, need the most in your diet.

The disease is currently at epidemic proportions, with 5.4 million Americans — including one in eight people aged 65 and over — living with Alzheimer’s disease. By 2050, this is expected to jump to 16 million, and in the next 20 years it is projected that Alzheimer’s will affect one in four Americans. If that comes to pass, it would then be more prevalent than obesity and diabetes is today!

How Carbohydrates Can Activate Disease Processes

Dr. Ron Rosedale, a prominent expert in the low-carb, high-quality fat approach to improving your health, was possibly the first person to advocate both a moderate protein (and therefore high fat) and low-carb diet. Most low-carb advocates were very accepting of, if not promoting, high protein, and protein was, and still is, often recommended as a replacement for the carbs.

However, a high-fat, low-carb diet is very different than a high-protein, low-carb diet and this is a major source of confusion by both the public and researchers when doing studies and publishing conclusions as if all low-carb diets are the same.

You cannot live without protein, as it’s a main component of your body, including muscles, bones, and many hormones. We also know that protein was instrumental in advancing our intelligence. However, most people today are indulging in hormone laced, antiobiotic loaded meats conveniently available at fast food restaurants and processed meats in grocery stores.

How Much Protein is ‘Enough?’

Dr. Rosedale believes the average amount of protein recommended for most adults is about one gram of protein per kilogram of LEAN body mass, or one-half gram of protein per pound of lean body weight. (As an example, if your body fat mass is 20 percent, your lean mass is 80 percent of your total body weight.

If your total weight is 200 pounds, you would divide 160 by 2.2 to convert pounds to kilograms and come up with 72.7 grams of protein. If you are doing vigorous exercises or are pregnant you can add up to another 25 percent or another 18 grams in this illustration to increase your total to 90 grams per day.)

This is something that makes sense to me and something I seek to apply personally, but this is partly because I foolishly had my amalgam fillings removed 20 years ago by a non-biologically trained dentist that caused serious kidney damage, so I can’t tolerate high levels of protein anyway. However, it seems obvious to me that most people consume too much low-quality protein and carbohydrates, and not enough healthy fat.

So it would make sense that the majority of your diet should be comprised of good fats, followed by good proteins like whey protein concentrate from grass-fed cows, and organic grass-fed beef, pastured organic eggs and chicken, and fish like wild caught salmon.

Your healthiest option is to ensure your carbs come primarily from fresh, organic vegetables, high-quality protein, and eat primary a high fat diet. Depending on the type of carbs (high fiber or not), most people need anywhere between 50-75 percent fat in their diet and sometimes even higher for optimal health.

Another Brain-Boosting Alternative: Intermittent Fasting

Recent research has also shown that intermittent fasting triggers a variety of health-promoting hormonal and metabolic changes similar to those of constant calorie restriction — including reduced age-related brain shrinkage. According to Professor Mark Mattson,2 head of neuroscience at the U.S. National Institute on Ageing:

“Suddenly dropping your food intake dramatically — cutting it by at least half for a day or so — triggers protective processes in the brain.”

He likens the effects to those from exercise, stating intermittent fasting could help protect your brain against degenerative diseases such as Alzheimer’s and Parkinson’s. Constant calorie restriction typically includes restriction of protein, and as discussed above, some of the beneficial effects of calorie restriction may actually be due to the reduction in protein. Likewise, intermittent fasting, where meals are either restricted to a small window of time each day, or calories are restricted on specific days of the week, will also typically lead to a reduction in the amount of protein you consume.

Again, going back to the featured study, the animals were only given a protein-restricted diet every other week for four months — essentially, they were on an intermittent fasting-type diet. So we’re not promoting going vegan here. Just cutting your protein back to what your body really needs, and no more. The science on this is relatively new and there are many different protocols but I personally have evolved to the point where I do it on most days. I will make exceptions a few times a month.

Alzheimer’s Might be ‘Brain Diabetes’

No discussion of brain health can be complete without emphasizing the need to dramatically cut down on the sugars in your diet. It’s becoming increasingly clear that the same pathological process that leads to insulin resistance and type 2 diabetes may also hold true for your brain. As you over-indulge on sugar and grains, your brain becomes overwhelmed by the consistently high levels of sugar and insulin and eventually shuts down its insulin signaling, leading to impairments in your thinking and memory abilities, and eventually causing permanent brain damage.

You may already know I have become passionate about warning of the dangers of fructose. There is NO question in my mind that consuming more than 25 grams of fructose regularly will dramatically increase your risk of dementia and Alzheimer’s disease. Consistently consuming too much fructose will inevitably wreak havoc on your body’s ability to regulate proper insulin levels.

Additionally, fructose has other modes of neurotoxicity, including causing damage to the circulatory system upon which the health of your nervous system depends, as well as profoundly changing your brain’s craving mechanism, often resulting in excessive hunger and subsequent consumption of additional empty carbohydrate-based calories. In one study3 from UCLA, researchers found that rats fed a fructose-rich and omega-3 fat deficient diet (similar to what is consumed by many Americans) developed both insulin resistance and impaired brain function in just six weeks.

More Tips for Avoiding Alzheimer’s Disease

The beauty of following my newly revised Nutrition Plan is that it helps treat and prevent all chronic degenerative diseases, from the common ones like heart disease, cancer, diabetes, obesity and Alzheimer’s to the ones you have never heard of or can’t even pronounce. It is divided into three helpful sections, Beginner, Intermediate and Advanced to help you start at the right level.

The plan is the first step in addressing Alzheimer’s disease. In spite of how common memory loss is among Westerners, it is NOT a “normal” part of aging. While even mild “senior moments” may be caused by the same brain lesions associated with Alzheimer’s disease and other forms of dementia, these cognitive changes are by no means inevitable! People who experience very little decline in their cognitive function up until their deaths have been found (post-mortem) to be free of brain lesions, showing that it’s entirely possible to prevent the damage from occurring in the first place… and one of the best ways to do this is by leading a healthy lifestyle.

  • Limit fructose. Most people will benefit from keeping their total fructose consumed below 25 grams per day.
  • Only use moderate amounts of protein. The featured studies provide compelling evidence that in most cases you will want to limit your protein to the levels discussed in the article. Most people consume 200-300 percent more protein than their body can use and the altered metabolism and metabolic breakdown products can be pernicious to human health.
  • Improve your magnesium levels. There is some exciting preliminary research strongly suggesting a decrease in Alzheimer symptoms with increased levels of magnesium in the brain. Unfortunately most magnesium supplements do not pass the blood brain barrier, but a new one, magnesium threonate, appears to and holds some promise for the future for treating this condition.
  • Optimize your vitamin D levels with safe sun exposure. Strong links between low levels of vitamin D in Alzheimer’s patients and poor outcomes on cognitive tests have been revealed.4 Researchers believe that optimal vitamin D levels may enhance the amount of important chemicals in your brain and protect brain cells by increasing the effectiveness of the glial cells in nursing damaged neurons back to health.Vitamin D may also exert some of its beneficial effects on Alzheimer’s through its anti-inflammatory and immune-boosting properties. Sufficient vitamin D is imperative for proper functioning of your immune system to combat inflammation that is also associated with Alzheimer’s.
  • Keep your fasting insulin levels below 3. This is indirectly related to fructose, as it will clearly lead to insulin resistance. However other sugars (sucrose is 50 percent fructose by weight), grains and lack of exercise are also important factors.
  • Vitamin B12. According to a small Finnish study recently published in the journal Neurology,5 people who consume foods rich in B12 may reduce their risk of Alzheimer’s in their later years. For each unit increase in the marker of vitamin B12 (holotranscobalamin) the risk of developing Alzheimer’s was reduced by 2 percent. Very high doses of B vitamins have also been found to treat Alzheimer’s disease and reduce memory loss.
  • Eat a nutritious diet, rich in folate, such as the one described in my nutrition plan. Vegetables, without question, are your best form of folate, and we should all eat plenty of fresh raw veggies every day.
  • High-quality animal-based omega-3 fats, such as krill oil. (I recommend avoiding regular consumption of most fish because, although fish is naturally high in omega-3, most fish are now severely contaminated with mercury.) High intake of the omega-3 fats EPA and DHA help by preventing cell damage caused by Alzheimer’s disease, thereby slowing down its progression, and lowering your risk of developing the disorder.
  • Coconut Oil may offer profound benefits in the fight against Alzheimer’s disease. One of the primary fuels your brain uses is glucose, which is converted into energy. When your brain becomes insulin resistant, atrophy due to starvation can occur. However, ketone bodies, or ketoacids can also feed your brain, perhaps better, and prevent brain atrophy. It may even restore and renew neuron and nerve function in your brain after damage has set in. In fact, ketones appear to be the preferred source of brain food in patients affected by diabetes or Alzheimer’s.Ketones are what your body produces when it converts fat (as opposed to glucose) into energy, and a primary source of ketone bodies are the medium chain triglycerides (MCT) found in coconut oil.
  • Astaxanthin is a natural pigment with unique properties and many clinical benefits, including some of the most potent antioxidant activity currently known. As a fat-soluble nutrient, astaxanthin readily crosses your blood-brain barrier. One study6 found it may help prevent neurodegeneration associated with oxidative stress, as well as make a potent natural “brain food.”
  • Eat plenty of blueberries. Wild blueberries, which have high anthocyanidin and antioxidant content, are known to guard against Alzheimer’s and other neurological diseases.
  • Gingko biloba: Many scientific studies have found that Ginkgo biloba has positive effects for dementia. Gingko, which is derived from a tree native to Asia, has long been used medicinally in China and other countries. Sixteen years ago, in one of the first issues of my newsletter, I posted the results of a 1997 study from JAMA that showed clear evidence that Ginkgo improves cognitive performance and social functioning for those suffering from dementia. Research since then has been equally promising. One study in 2006 found Gingko as effective as the dementia drug Aricept (donepezil) for treating mild to moderate Alzheimer’s type dementia. A 2010 meta-analysis found Gingko biloba to be effective for a variety of types of dementia.
  • Alpha lipoic acid (ALA) can help stabilize cognitive functions among Alzheimer’s patients and may slow the progression of the disease.
  • Avoid and remove mercury from your body. Dental amalgam fillings, which are 50 percent mercury by weight, are one of the major sources of heavy metal toxicity, however you should be healthy prior to having them removed. Once you have adjusted to following the diet described in my optimized nutrition plan, you can follow the mercury detox protocol and then find a biological dentist to have your amalgams removed.
  • Avoid aluminum, such as antiperspirants, non-stick cookware, vaccine adjuvants, etc.
  • Exercise regularly. It’s been suggested that exercise can trigger a change in the way the amyloid precursor protein is metabolized,7 thus, slowing down the onset and progression of Alzheimer’s. Exercise also increases levels of the protein PGC-1alpha. Research has also shown that people with Alzheimer’s have less PGC-1alpha in their brains8 and cells that contain more of the protein produce less of the toxic amyloid protein associated with Alzheimer’s. I would strongly recommend reviewing the Peak Fitness Technique for my specific recommendations.
  • Avoid flu vaccinations as most contain both mercury and aluminum, well-known neurotoxic and immunotoxic agents.
  • Challenge your mind daily. Mental stimulation, especially learning something new, such as learning to play an instrument or a new language, is associated with a decreased risk of Alzheimer’s. Researchers suspect that mental challenge helps to build up your brain, making it less susceptible to the lesions associated with Alzheimer’s disease.
  • Avoid anticholinergic and statin drugs. Drugs that block acetylcholine, a nervous system neurotransmitter, have been shown to increase your risk of dementia. These drugs include certain nighttime pain relievers, antihistamines, sleep aids, certain antidepressants, medications to control incontinence, and certain narcotic pain relievers.Statin drugs are particularly problematic because they suppress the synthesis of cholesterol, deplete your brain of coenzyme Q10 and neurotransmitter precursors, and prevent adequate delivery of essential fatty acids and fat-soluble antioxidants to your brain by inhibiting the production of the indispensable carrier biomolecule known as low-density lipoprotein.

AUA: Low-Carb Diet Quells ADT Effects

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Trial misses insulin-resistance endpoint but may have potential.

A very low-carbohydrate diet failed to prevent insulin resistance in men taking androgen deprivation therapy for prostate cancer, but led to significant weight loss and preserved bone health, a small trial showed.

The dietary intervention led to a significant reduction in homeostatic model assessment (HOMA) of insulin resistance at 3 months, as compared with a control group, but not at 6 months, the primary endpoint. Men on the very low-carbohydrate diet had significant reductions in weight and percent body fat and stable bone mineral content (BMC) versus weight and body fat increases and a reduction in BMC in the control group.

Though the trial missed its primary endpoint, a follow-up study has already begun to test the oncologic benefits of the very low-carbohydrate diet, Stephen Freedland, MD, of Cedars-Sinai Medical Center in Los Angeles, reported here at the American Urological Association (AUA) meeting.

“Carbohydrate restriction is a promising tool to prevent androgen deprivation therapy (ADT) -induced metabolic side effects,” said Freedland. “Given that weight loss is generally anticancer, coupled with animal data that this diet slows prostate cancer growth, studies evaluating oncological efficacy and safety are ongoing.”

The diet would pose an adherence challenge for many men, but the challenge has to be weighed against the reality of the disease, said Benjamin Davies, MD, of the University of Pittsburgh.

“These are men who have recurrent cancer,” said Davies, who moderated an AUA press briefing where Freedland discussed the study. “If you tell them that there is preliminary data that this may help them with their physiology and their health, you might be more apt to induce them to follow a proactive approach to change their lifestyle. Whereas if this were just a regular guy without the kind of medical challenge, you can see where there might be some reluctance.”

“Usually, people are more apt to change their lifestyles when their health is at risk,” he added. “I think that gives me some hope that we could actually do that for patients. Obviously, it’s challenging. I don’t know that I could do it … actually, I know that I couldn’t.”

For decades, hormonal therapy, or ADT, has represented standard of care for advanced prostate cancer. Multiple studies have demonstrated survival benefits with ADT. However, recent investigations have documented major side effects, especially metabolic effects (weight gain, insulin resistance, dyslipidemia), in addition to hot flashes, loss of libido, erectile dysfunction, memory loss, and bone mineral loss and osteoporosis.

“Hormonal therapy for prostate cancer increases the risk of diabetes by 40%,” said Freedland. “Diabetes is a problem controlling blood sugar levels. We wondered, what happens if you don’t eat sugar?”

Low-carbohydrate diets have demonstrated the potential to achieve significant weight loss and improve diabetes control, he continued. In animal models, low-carbohydrate diets have been associated with slowing of prostate cancer growth. Such a diet has never been evaluated in a randomized trial involving patients with cancer.

Investigators hypothesized that a very low-carbohydrate diet could prevent insulin resistance and other metabolic side effects in men initiating hormonal therapy for advanced prostate cancer. To test the hypothesis, Freedland and colleagues conducted a prospective, randomized trial, comparing a very low-carbohydrate diet versus usual diet in men initiating ADT.

Men randomized to the intervention arm followed a diet that limited daily carbohydrate consumption to 20 g, similar to the Atkins diet, said Freedland. They also were instructed to exercise 30 minutes a day, 5 days a week. Men assigned to the control arm continued their usual practices regarding diet and exercise.

Investigators randomized 42 patients, and 40 completed the baseline assessment. Subsequently, 14 men in the intervention arm and 20 in the control group completed the 6-month trial. Complete data were available for 11 men in the very low-carbohydrate group and 18 in the control group, and those 29 patients formed the basis for data analysis.

The primary endpoint was change in HOMA at 6 months. The intervention group had a mean change in HOMA of -4 compared with an increase of 36 in the control group (P=0.127). The 3-month values showed a significant difference in favor of the intervention arm (-19 versus +7, P=0.015).

The dietary intervention was not expected to affect PSA values, and the change from baseline (in response to hormonal therapy) ranged from -97% to -99% in both arms at 3 and 6 months. Men in the very low-carbohydrate arm had weight loss that averaged about 15 lbs at 3 months, increasing to 20.5 lbs at 6 months. In the control group, men had gained almost a pound at 3 months and almost 3 lbs at 6 months (P<0.001 versus intervention group at both time points).

Bone mineral content remained unchanged at 6 months in the intervention group as compared with a reduction of 2.3% in the control group (P=0.025). Percent body fat decreased by 16.2 % at 6 months in the intervention group and increased by 11% in the control group (P=0.002).

This Low-Carb Diet and Workout Will Blast Body Fat

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For individuals trying to improve body composition — more specifically reducing body fat — carbohydrate depletion has proven to be the most effective approach. 

First, it’s important to explain the effects of carbohydrates on your body. When you eat carbohydrates or sugar, it causes a spike in blood sugar to a degree largely determined by the food’s glycemic load.

ruigsantos/iStock/Getty Images

In response to this elevated blood sugar, your body secretes the hormone insulin to encourage the storage of nutrients and reduce the amount of glucose (sugar)  in your blood.

But while insulin is critical to our health, paradoxically, this response also promotes energy storage (or fat accumulation) of any extra macronutrients you’ve eaten. For this reason, it’s important to avoid high-fat foods when consuming carbohydrates or sugars.

If you consume both in significant quantities, you’re creating an environment ripe for energy storage (fat accumulation from elevated blood sugar, thus insulin secretion) and providing the body the supplies (fat and extra carbohydrates) to do exactly that.

In my meal plan below, I keep carbohydrates low while encouraging fat and protein consumption as an alternative.

Both carbohydrates and sugar act to replenish glycogen levels in the body (liver and muscle tissue) — our body’s primary source for energy production. If you have adequately “filled” glycogen levels, your body has ample resources to meet energy demands, so it won’t need to burn extra energy that your body has stored.

Bottom line: High glycogen levels, while useful for high-intensity exercise, prevent substantial fat loss.

I’ve developed a plan that has been overwhelmingly effective across a wide spectrum of my clients. I found this approach to offer transformative results while incorporating techniques that are sustainable in the long-term.

I do find some value in carbohydrate consumption for people who do high-intensity resistance training. When performance goals are the primary driver, we time carbohydrate consumption around a sufficiently intense workout.

This is simply to optimize workout intensity (energy) and muscle recovery. What you’ll find is the amount of carbohydrates needed to support pre- and post-exercise demands is surprisingly low. When you are consistent about eating a low-carb diet your body becomes more efficient at burning fat for energy, and a small amount of carbohydrates will simply act as a primer.

We want to keep this to approximately 25 to 35 grams of carbohydrates before and after exercise; an apple, mixed berries or sweet potato would be some good examples.

No matter your fitness goal, a well-developed weight-training program is critical to sustain weight loss and improve health, muscle tone and metabolic efficiency.

Here is a sample workout plan I’ve developed. It combines strategies I’ve found optimally effective at burning body fat and improving body composition while building muscle and developing strength:

1. Dumbbell squat, curl and press: 3 sets of 20 reps
2. Elbow planks push-ups: 3 sets of 10 each way
3. Walking lunges: 3 sets of 20 reps
4. Straight-leg raises: 3 sets of 20 reps
5. Squat with cable row: 3 sets of 20 reps

It’s important to understand that your body will eventually adapt to the workout, likely causing weight loss to plateau.

There’s a simple solution: Supplement fat intake. In order to avoid this plateau, we provide just enough fat to avoid metabolic shifts and negative hormonal responses, while further encouraging fat burning.

Beyond the clear physiologic benefits, a diet that’s moderate in fat intake is considerably easier to sustain than one without any fat or carbohydrates. Choose fat over carbohydrates and sugar when you have limited options.

Here are two examples of a low-carbohydrate daily meal plan, taking into account a weight workout in the evening (option 1) or morning (option 2). If you don’t lift weights, simply replace the carbohydrates with green vegetables.

Carbohydrates: 75 grams
Protein: 1.5 grams per pound of muscle tissue (not body fat)
Fat: 70 grams
Total Calories: 2,200

Sample Day (Evening Weight Training)

MEAL 1
1 whole egg and 3 egg whites (1/3 cup)
1/2 avocado
Mixed peppers and greens (combine with above to make an omelet)
1/4 cup all-natural salsa (low or no sugar)

MEAL 2 (snack)
1 scoop whey protein
1 tablespoon almond butter
3/4 cup almond milk (unsweetened)
Ice cubes
1 to 2 cups spinach or kale
Blend all ingredients; sprinkle with cinnamon

MEAL 3
Chicken or turkey breast (palm-size)
Mixed greens and vegetables

MEAL 4 (snack, pre-workout)
1 apple
1/2 scoop whey protein in shake (optional)

MEAL 5 (meal, post-workout)
5 ounces of sweet potato, sprinkle of cinnamon and pepper
6-ounce tilapia filet

Sample Day (Morning Weight Training)

MEAL 1 (consume either before or after your workout; if doing cardio, consume this meal after)
1 scoop whey protein
3/4 cup almond milk (unsweetened)
Ice cubes
1 banana
2 tablespoons powdered peanut butter
Blend all ingredients.

MEAL 2 (post-workout snack)
Celery sticks
2 tablespoons hummus or all-natural almond butter

MEAL 3
Chicken or turkey breast (palm-size)
Mixed greens and vegetables

MEAL 4 (snack)
Homemade tuna salad (palm size)
2 tablespoons all-natural almonds (roughly 16 almonds)

MEAL 5
6 ounces of tilapia or salmon
Broccoli, spinach or any green vegetable (unlimited)
1/2 avocado

Here are some fun and delicious recipes you can cook while staying on the low-carb plan:

SPAGHETTI SQUASH
You’ll love this healthy spaghetti squash recipe. It’s easy and filling. And, with squash replacing the noodles, it’s hearty, delicious and fun to make.

razmarinka/iStock/Getty Images

Start off by poking holes in a spaghetti squash and bake in the oven for one hour at 350 degrees. (Poking holes in the squash prevents it from exploding). Short on time? Microwave the squash for 10 to 12 minutes, then let stand for five minutes or so afterward to finish steaming.

While your squash is cooking, it’s time to make your sauce: Here is quick recipe for a simple, light — and vegan — tomato sauce, with the option to make a meat version:

Ingredients
* 1 tablespoon minced garlic
* 3 Roma tomatoes, quartered
* 1/4 cup fresh oregano, chopped
* 1/2 teaspoon sea salt
* 2 tablespoons of olive oil
* Freshly ground pepper to taste
* 1/2 package of lean ground turkey (optional)

Directions
1. Blend all ingredients (except for the turkey) on low. A few pulses will give you that chunky, rustic consistency. Warm over low heat for a few minutes. If desired add cooked turkey. On the go? Use sauce from the grocery store. Be sure to look for one with little to no added sugar, no preservatives and made with olive oil.

2. Now it’s time to make the “spaghetti.” Cut the cooked squash in half. Grab a fork and scrape through the flesh to create noodle-like strings. Keep going until you hit the rind.

3. For a fun dish, serve the spaghetti squash inside the hollowed-out rind. Garnish with fresh basil and edamame.

MEDITERRANEAN CHICKEN LETTUCE-WRAP TACOS

 Ingredients
* 12 ounces boneless, skinless chicken breasts cut into four-inch-long, one-inch-thick strips
* 2 teaspoons Mediterranean spice
* 1/4 cup balsamic vinaigrette
* 4 romaine lettuce leaves, shredded
* 1 tablespoon thinly sliced red onion
* 1/4 cup red-wine vinaigrette
* 4 Roma tomatoes, chopped
* 12 butter lettuce leaves
* 1/2 teaspoon dried basil
* 1 teaspoon chopped parsley
* 1/2 teaspoon dried oregano
* Tzatziki sauce for garnish (if desired)

Courtesy Evan Shy

Directions
1. Preheat a grill pan over high heat. Season chicken with one teaspoon Mediterranean spice and place on grill.

2. Cook about two minutes per side, basting with balsamic vinaigrette and turning once, until cooked through. Season cooked chicken with remaining teaspoon of Mediterranean spice and remove from grill; set aside.

2. Place shredded romaine lettuce and red onions in a medium bowl; drizzle with red-wine vinaigrette and toss to combine. Divide mixture evenly among butter lettuce leaves and drizzle each with one teaspoon of tzatziki.

3. Top each taco with one piece of chicken and garnish with chopped tomatoes and Greek yogurt (if desired). Season with parsley, basil and oregano before serving.