Pre diabetes symptoms - scary!

I surf a lot on the web about low carb diets, ketogenic diets, etc. The reason is clear: I need the positive reinforcement (besides the need for information) for continuing a diet that is very often tough, as I love sweets and cookies and chocolate and all those delicious treats. Those treats are my comfort food and it is really hard to be deprived of them. Yesterday was a classic example: I had a dinner with my boyfriend's company and the restaurant had no alternatives for my dessert. And the raspberry sorbet was too tempting. I ate it. I just could not resist, specially with all the wine I drank... So there you have it. I will pay dearly for my sorbet: it takes at least 4 days to go back to normal ketosis, and this means I will have 6-7 days of water retention and inflammation. It will probably show in the weight chart.

But this is not what I intended to discuss in this post. The scary part of the pre-diabetes symptoms is that I looked at them and could immediately recognize my complaints. Even scarier: I raised those complaints to my doctor and she did not do anything. Nobody stopped to check if my insulin levels where normal. I suppose if you do that it is too expensive for the dutch health system, but it is my health we are talking about!
I put the symptoms list below, noting that I took it from the blog Healthy Eating Politics.

1. Heartburn, especially during sleep; a diagnosis of GERD – Gastroesophageal Reflux Disease.
2. Digestive issues. You get frequent stomach aches, and are constantly dealing with gas pain, bloating and stool issues, cycling between diarrhea and constipation.
3. Headaches and a sore throat that comes and goes.
4. Breathing issues, especially at night; you may have been diagnosed with sleep apnea.
5. Dizzy spells, and a feeling of being lightheaded sometimes, especially after having sweets. (This indicates reactive hypoglycemia.)
6. Unexplained weight gain. Your eating habits haven't changed, but suddenly you've put on 10 pounds. In addition, you are having difficulty losing it, even when you exercise and eat less.
7. Blurred vision that seems to be worsening, and trouble seeing at night.
8. A constant feeling of being tired. No matter how much you sleep, or exercise to gain strength, you feel fatigued.
9. Frequent bouts of depression for no reason. You’ll be fine, and then you feel sad all of a sudden, without any cause.
10. Constant joint aches, and muscle and joint stiffness when you wake up in the morning. You may even have been diagnosed with some form of arthritis.
11. Your feet burn and your toes feel numb when you stand for long periods of time.
12. Swollen ankles, and a general feeling of puffiness or water retention, especially if you sit for long periods of time.
13. If you don’t eat, you get really grumpy. You may also feel nauseous and shaky.
14. Waking up in middle of the night with your heart pounding. Often you also feel nauseated or cold. It happens more often if you've been eating high sugar meals. This again indicates hypoglycemia or low blood sugar.
15. Constant hunger, no matter how much you eat. You often think, "How can I be hungry? I just ate!"
16. Frequent yeast infections, and cuts or bruises you get don’t seem to heal quickly.
17. After every meal, you really crave something sweet, even if you are already feeling full.
18. You have elevated blood pressure and blood tests indicate you have high triglyceride levels, and low HDL cholesterol levels.
19. The dentist tells you that have gingivitis, even though you brush and floss every day. You often wake up with a nasty taste in your mouth, even though you brush before bed.
20. A groggy, sleepy feeling after meals, even when you have plenty of rest. You may have been embarrassed because you fell asleep at your desk at work, or during a meeting. 

How many of these symptoms did I have? (note the past tense): 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 17 and 20. I had a "yes" for 15 of these symptoms. You only need 4 or 5 "yes" to suspect you are becoming a diabetic.
Right now, after starting with the LCHF diet I can say that the symptoms have almost all disappeared (except one or two). But it came from me, the doctor did nothing to help me. It is infuriating. The worse part is that I told the doctor that my parents are diabetic and I had more danger for such a problem. I was ignored.

LCHF diet week 5

I am satisfied. The weight is still going down and I feel better and better everyday. Apart from losing weight, my mood has improved greatly and I feel that I am more energetic and lively. It also has improved my work life: it is much easier to focus than before, and I am not distracted by being hungry. This week the weight went down to 72 kg...
I decided to take up walking as an activity to help the weight loss and feel healthier. I take now a brisk 30 min walk everyday at lunchtime, and it is really nice because I get to be out and enjoy the weak winter sun. It is low impact exercise, but I do get warmed after the walk, and I feel already it helps my circulation. I decided to do this walk in the moment of the day I am the least productive, after lunch, because I feel sleepy from eating and it is tough to start working again. It had been almost impossible to arrange a schedule to exercise before, it is so difficult with a long traveling time from work to home. I put some fast beat songs in my mp3 player and walk in the sunshine every midday. It feels wonderful actually. I recommend it!

Low carb diets and cancer

Amazing story about ketogenic diets beating cancer.

The theory side of the LCHF diet

The idea is to give a hint of why the diet works. I am no doctor, therefore this post is sort of a concoction of things I've read, wikipedia articles and plain speculation.
There is a very extensive and interesting article on wikipedia on low carb diets. A extract of what is written there:
^"The body of research underpinning low-carbohydrate diets has grown significantly in the decades of the 1990s and 2000s.Most of this research centers on the relationship between carbohydrate intake and blood sugar levels (i.e. blood glucose), as well as some related hormone levels. Some evidence suggests blood sugar levels in the human body should be maintained in a fairly narrow range to maintain good health. The two primary hormones that regulate blood sugar levels are insulin, which lowers blood sugar levels, and glucagon, which raises blood sugar levels. These are both produced in the pancreas: insulin from beta cells and glucagon from alpha cells.
In western diets (and many others), most meals are sufficiently high in nutritive carbohydrates to evoke insulin secretion. The primary control for this insulin secretion is glucose in the blood stream, typically from digested carbohydrate. Insulin also controls ketosis; in the non-ketotic state, the human body stores dietary fat in fat cells (i.e., adipose tissue) and preferentially uses glucose as cellular fuel. Diets low in nutritive carbohydrates introduce less glucose into the blood stream and thus evoke less insulin secretion, which leads to longer and more frequent episodes of ketosis. Some research suggests that this causes body fat to be eliminated from the body, although this theory remains controversial, insofar as it refers to excretion of lipids (i.e., fat and oil) and not to fat metabolism during ketosis."

So, the main idea it to reduce the amount of insulin secretion (that is the low carb part). This will induce a state of ketosis, where instead of using glucose, the body will use ketones to get its energy. The higher fat intake is necessary to have enough energy from the food and to ban the hunger from the diet. The body feels sufficiently nourished and does not lower the metabolic rate to accommodate for lower energy intake (i.e. starvation mode). Then you become an efficient "fat burning machine". I really recommend to read the wikipedia article on low fat diets. It outlines well the ongoing scientific debate about nutrition.
Another interesting wiki-article is about insulin release. These diets eventually aim for lowering the insulin release from the body. So it is most natural to want to know the insulin response to food. What is surprising from the article is the sometimes disproportionate insulin release to the carb content of some food, for example beef. But I think it would be very hard to know the insulin release of combined foods, like a soup. It anyways gives a good indication.

The insistence on the ban of trans fats is hardly surprising (what it is surprising is that they still manufacture it to give it to people) as those fats are really bad for health. The insistence on eating saturated fats is controversial.

The practical side of the LCHF diet

The theory is simple enough: no "man-made, unnatural" products are allowed. This means no trans fats (margarine is one of them) as they are really bad for your health. This has implications: no fast food (fries are fried in these trans fats), no foodstuff where these fats are used, this means you have to read the labels and find out if there are any trans fats used to make the product. Most products that you know if made at home should be in the fridge but are outside in the shop have either loads of salt, sugar or trans fats.
Which fats are allowed then? Natural saturated fat, like the ones present in butter and cream, animal fat (found in meat), and all the "good fats", olive oil, avocado, etc.
Also this ban involves "fake sugar", so all the artificial sweeteners are also prohibited. No diet coke, sorry.
So, what is the "carb" that you set to "low": sugary and starchy foods. Sugar is completely banned and the starchy foods, depending on the amounts of carbohydrates and the level to which the person desires, are also banned.
So, how do you "put into practice" the LCHF diet? I will talk about this diet to go down on weight only, not as a permanent lifestyle choice.
There are several steps to follow.

1. Clean your fridge and pantry: remove all sweet things like cookies, spreads, jams, marmalade and fruits (yes, fruits). Remove also all starchy things like rice, pasta, cous-cous, quinoa, bulgur, breakfast cereals, polenta, potatoes, sweet potatoes, carrots, legumes, paprika (this will depend on how strict you want to be). If you are super strict, then things like ketchup are not allowed (contains sugar), or soy sauce (also contains sugar or starch). Check up things like sausages, mayonnaise or sugo, they should not have carbs but very often they do. Be wary of all the sauces and things you use that are already made (pesto, salad dressings, sauces, etc). There are gray zones, and depending how strict you want to be, if you allow them in your diet or not. Lentils are rich in carbs but also rich in protein. Same with quinoa. Paprika can have a lot of carbs per 100 gr (10%), but it also comes with loads of fiber, so treat with care but allow it in the diet. What I did myself (because I don't want to throw anything away) is to put all those non-perishable foods in a box, for when the diet is over.
2. Shop often, because the food will be fresher. What can you eat? Eggs, meats, fish, nuts, cheese (full fat versions of it) and vegetables. The biggest problem is to have something to eat the meats with (you cannot have salad all the time!). The Internet is full of suggestions to fake the missing pure, rice, pasta. Chef William (link on the left) is an inspiration for me. The mashed cauliflower recipe is just delicious.
3. Add fat to the food to make it filling and satisfying. This was the hardest for me. After years of listening to the "fat is bad" advice, I had become a fat-phobic. You need to add fat to the diet, otherwise you end up eating way too much proteins, and a protein-rich diet is not good for your health. So you have to get used to make sauces to go together with your meat (gravy, cream and cheese is one of my favourites). Salad made with avocados are a good idea. Add fat until you are satisfied and not hungry.
4. With care and aware of your own response to it, a very moderate amount of (dry, not sweet) wine and berries is allowed. I respond well to wine, but if I eat a handful of berries, I get crazy for more sugar. I cannot eat (at least for now) anything remotely sweet. 
5. Treat fruit like you would candy. Not very often. I cannot eat any fruits now myself (and therefore I am taking a vitamin supplement) but I am hoping my insulin levels will go to normal and later be able to enjoy an orange without going out of ketosis.
6. Most important: eat only when hungry. Tweak your fat intake to end up hungry at the right moments (here in The Netherlands people are rather strict with times for the lunch pause). And never go hungry. It is counterproductive, as then the body goes into starvation mode and then you cannot lose weight. The whole idea is that you are happy and satisfied, but forcing the body to process protein and fat mostly, and going into ketosis.

I follow this diet without looking for the carb content of every thing. I would get crazy like that. I also don't want to get quotas to fill on each type of nutrient (there are apps for knowing how many carbs, protein and fat you eat per meal). I have a busy life as it is. I have banned all starchy foods (grains, potatoes, carrots, legumes) but I eat paprika without worry. I take it easy with the fat, I just cannot drink "bullet coffee" (coffee with butter), I find it gross. And also take it easy with nuts. That's it. It is actually a quite simple diet, as you don't count portions, calories or anything else. And it works.
After 4 weeks, I have gone down 7 kilos already (a lot of water though) and my boyfriend has gone down 4 kg (no water there, guys are lucky on weight issues). I think of those kilos we lost, 2 kg each is probably the real weight loss. The rest is the water retention part caused by the sugary things we used to eat.

LCHF diet week 4

Today I weighted myself and the scale showed the needle (it is old fashioned indeed) slightly below 73 kg. The rate I was hoping for, 1/2 kilo per week, has slowed down. I did have some influence to it though: last couple of weekends I really overdid it with the wine. I drank waaay too much wine (like a whole liter) in the course of the evening. And as I have been learning recently, the body metabolizes ethanol in pretty much the same way as fructose. This means you get these fatty liver problems that sound so nasty. The weirdest thing about the wine was that it didn't feel (at the moment) like a lot. So it seems this diet helps me to not get so tipsy and so hangover the next day. My boyfriend did not have the same luck though.

I suppose it is time to admit it: I will have to "help" the weight reduction with some exercise. Actually more than my weight it is my size and my health I am most concerned. The thing is, until very recently, I felt so heavy and sluggish that I couldn't exercise. And the moment I started moving, I got joint pain right away. I am hoping it is not the case now. And I was hoping I could delay this exercise issue till it was warmer and nicer outside. To go to the gym and feel like an idiot surrounded with other idiots moving like lunatics at some musical tune is really not appealing. But even less appealing is to hook myself on a machine to pull weights and grunt and sweat. It is so stupid! I have never been able to play or enjoy group sports, as my asthma really is an impediment. I need some aerobic type of exercise, or I get an asthma attack right away. Perhaps swimming?

The books about LCHF: Hjärnkoll på vikten

Disclaimer: I read this book a long time ago, so there may be loads of things I just don't remember from it. It is not a good review from that perspective.
My journey to a LCHF lifestyle began a few years ago, actually. I went to visit my friend Nina once more and she had a book lying around her place. I started to read the book and got immediately hooked. The book is in Swedish, and its name is Hjärnkoll på vikten (a loose translation is "brain control of the weight"). What I loved of this book were two things: it was written by doctors (no health gurus) and every claim was supported by a reference to a publication in peer reviewed medical journals. In other words: science. I believe and understand science.
The book had a few novel ideas that struck me: the first one was that saturated fat is not that bad for you. The usual dietary advice is that saturated fat is a very bad type of fat, promoting cholesterol and therefore atherosclerosis and therefore heart problems. Well, the authors claimed in the book that the most recent research indicated that saturated fat was neither good not bad for you, and some studies suggested that it could be even beneficial. I was astonished. My thought was: "but surely the other claim had to have a scientific basis as well?". Well, the saturated fat story is far from finished and wikipedia actually shows the ongoing debate with snippets from different articles. This story is not over, but most importantly, not as a closed case as I came to believe earlier. The authors from the book go even further: they claimed that unsaturated fat was excellent when raw, but when cooking it, even at kitchen temperatures, you would start the process of hydrogenation of the oils, and therefore creating the evil trans fats in your own food. The natural consequence is that you should use saturated fat (butter) for cooking, because this fat cannot change its composition when heating it up. I didn't know what to make of such claims, as it was the total opposite of what I had been told all my life.
The other claim is that the brain loves sugar and it becomes addicted to it. Well, that wasn't so surprising. Years ago I had tried to quit putting sugar in my coffee (I took ridiculous amounts of it) and it took me several weeks of slowly reducing the amount to quit it. It was impossible to quit cold turkey. I knew then that sugar had an addictive quality to it, and that probably I was a sugar junkie.
Other idea the book gives is to work with the brain's reward system to go down on weight, not against it. It goes on to show that the usual "eat less, exercise more" dietary advice is actually going against the machinery of the body and that's why it is so hard to follow that advice and to maintain it.
The authors don't give dietary advice per se, but they praise the GI type of diets. This is the reason I bought myself two more books about GI diet and Patrick Holdford GL diet. I will review these in another post.

I recently re-read this book so below I discuss more "recent" memories.

The book starts with a discussion that sort of supports the paleo movement of eating: our body and brain evolved millions of years to adapt to a particular lifestyle (paleo) and agriculture and extensive farming made food available that otherwise would have been really scarce. The consequence is that our bodies are really "old" in a new environment, so all our instincts guide us to wrong habits when it comes to food.
Then it follows to explain that the main function of the body is to keep the brain working, and therefore, because the brain eats glucose, the brain loves sugar. Since early childhood we associate sweet taste and sugar with food to be eaten. We are programmed to be sugar junkies. It is actually the brain that makes you eat so much short chain carbs.
It claims that the way our body metabolises sugar makes you hungry for more very quickly after eating: that's why you can have a whole 1/2 liter cola and still be hungry afterwards. The reason for this is the central role insulin has on the control of blood sugar and feelings of satisfaction and hunger. When sugar is released in the blood stream (apparently is even earlier, when sweet taste is perceived by the mouth), a hormonal chain reaction triggers the release of insulin. This insulin reduces the amount of blood sugar. The release of ghrelin, the hormone responsible for the  feeling of hunger, responds to the negative gradient of the blood sugar. This means that if you eat something really sweet and rich in short carbohydrates, the amount of blood sugar will go very high, to be later whipped out by insulin, and therefore have a substantial drop. This will trigger the feeling of hunger once more, and hunger for something that increases your blood sugar once more, therefore, more sweets.
The book continues with the fat apology that was what I remembered most: don't be so stingy with fat, avoid trans fats, eat more fish fats and meat fats of cows that are freely eating on the grass.
Afterwards the book focuses on what to do if you want to go down on weight. It tells you to listen to your body, to pay attention when and how you eat. In particular if you eat sweets of white breads (they call this hyper-foods): that afterwards you start your roller coaster of blood sugar and that like this is impossible to keep out from foods that make you fat. The policy they advise is that once you pay attention to your body, you can avoid the foods that make you go into the roller coaster to begin with. This is individual-based and there are no general recipes for anyone. Me, for example, is cookies. I cannot keep out, once I had one, I must have the whole package!
It continues to explain that traditional weight-loss strategies of eating too few calories go against the machinery of the body: that if your body feels undernourished, it will go into starvation mode and you will not spend any energy on anything. You will feel tired and sluggish, and cold, because the body will save energy on heating up the body. As most of our energy goes on heat, this is really counterproductive if you want to go down on weight. They argue the contrary: eat till you are satisfied (not full) and eat enough fats to keep you satisfied for longer. Don't eat hyper-foods (sugar, white breads, pizza, pancakes, quick pasta) and focus your carb intake in carbs with low GI index. Then the kilos will disappear, they claim. Afterwards they enter into the apology of exercising, and how good it is for the body's functions to move.That exercising should be incorporated into the daily routine, and preferably should be mild and every day of the week.
Then the authors analyze the social effects of obesity. That it is sort of "contagious" as it takes place into whole families. That children copy what they see, not what they are told, therefore good practises start at home and with the parents. It end with an analysis of the situation in the US and how it is correlated with Sweden.
It is a great book and was an eye opener for me.