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    Finally called-
    barb10562 posted:
    My doctor. He put me on Metformin 500 mg 2 mos ago and my sugar has run 150-250 constantly. I am limiting my carbs to 8-10 per meal. Finally called him today and asked him what to do. He is upping the Met to 1000 twice a day and we will see how it goes. Wish me luck, I rally dont want to go back on Actos- am afrid it will make me gain weight.
    DavidHueben responded:

    Eating 8 - 10 grams of carbs for a meal is not enough.That is not even enough for a snack. You cannot simply eat your way into compliance. Have you seen a dietitian? I think you need some nutritional advice.


    We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm.

    - Winston S. Churchill

    barb10562 replied to DavidHueben's response:
    Hi David- your anjswer has bothered me all week-end. Isnt everyone eating our way into compliance by limiting our carbs each day? I have lost 23 lbs by cutting down on what I eat and try to keep my carb intake low. Trust me, I eat well- lots of salad and protein. Just not alot of breads or pastas.
    cookiedog replied to barb10562's response:
    I really don't understand your meal plan. A medium apple has around 25 carbs. You are not even eating the amount of carbs in an apple in two or three meals. Is that even safe?

    I do limit carbs - I think we all do here. But my goal is to eat healthy and to eliminate white carbs from my diet - not all carbs.
    DavidHueben replied to barb10562's response:

    Sorry if my answer bothered you. But, eating 8 - 10 grams of carbohydrates per meal is not going to "gir 'er done".

    Do you think you can survive on the equivalent of 1/3 of an apple for each meal?

    You should probably have at least 30 - 35 grams of carbs at each meal.

    We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm.

    - Winston S. Churchill

    nutrijoy responded:
    I mentioned in another thread that carbohydrates are not essential for human survival and used the Inuit as an example. The life span of the Inuit is shorter than most Americans and Canadians but that is due to disease and the harsh, environmental conditions in which they live. Adding carbs to the Inuit diet would do nothing to improve their health or extend their longevity. Our paleo ancestors also survived primarily on a diet of animal products. The only carbohydrates they consumed were the occasional berries and other wild fruits or edible plants that they were able to infrequently gather from time to time. Dr. Richard K. Bernstein, a type 1 diabetic for most of his life, has recommended very low carbohydrate intake to his patients for the last few decades based on the formula 6-12-12: 6 g for breakfast and 12 g each for lunch and dinner (he also allows an additional 12 g of carb for snacks). David Mendosa mentions Bernstein's carb recommendation in his overview of the good doctor's Diabetes Solution book.

    Quite frankly, Bernstein's recommendation is my own eventual goal. I'm not quite there yet but have been gradually reducing my carb intake ever so gradually during the past six months. As of two weeks ago, I even decided to drop ALL grain products from my diet after very disappointing results experimenting with sprouted grains. The net impact on my blood glucose levels wasn't that much lower with sprouted whole grains than with more highly refined grain products. And you can't consume healthier "whole grains" than the ones you germinate yourself from the various grass seeds (wheat, spelt, quinoa, etc.).

    Read the article, How Many Carbohydrates Do You Need? , and perhaps factor that into your own decisions for setting (or justifying) carb intake levels instead of worrying about it. In my view, your current level will definitely go a long way towards the goal of normalizing blood sugar, the hope of any diabetic. Your BG levels of 150 and higher are still too high but should continue to drop as your weight decreases and the metformin has a chance to fully kick in.
    teddybear200 responded:
    I was told by my endocrine doc that if we don't eat enough of the good carbs our sugars will rise. My dietitian also stated we need to eat at least 20 - 35 carbs per meal and no more than 15 for a snack.

    Did you ask your doctor about the amount of carbs you should be eating to each meal? He/she is the one who should be telling you how much carbs to be eating at meals.

    I could be totally wrong here but if your doctor has increased your Metformin to 2,000 a day and you are only taking in this extremely small amount of carbs I think you will go the opposite directions. I am thinking your are going to need to bumped up your carbs to handle the increase of Metformin.

    I was also told that in order to lose weight we are to cut down on the number of calories a day.

    I balance my carbs with protein at every meal - my meals are no more than 25 carbs and snack 15 carbs. I am not on meds any more and my sugars average 100 a day. I test 3 times a day.
    One day I will soar on wings of an Eagle.
    Want to know more about me - come join us at

    nutrijoy replied to teddybear200's response:
    Unlike the ADA, my endo has acknowledged that for some people (especially those who are insulin-dependent like me), a very low carb diet is the best path to good blood glucose control. However, he falls short of recommending it himself for liability reasons but doesn't condemn it either. He does feel that striving for blood glucose "normalization" (as Bernstein recommends) is truly a laudable goal but to accomplish that skates much too close to hypoglycemia for his taste and thus won't specifically recommend it because it does not comply with "protocols" (again, for liability reasons).

    In Barb's case, her BG levels are still too high (150 and above) so she has a ways to go before she has to start worrying about lows. My post was merely to reassure her that a low carb diet is not injurious to health as man has survived without carbs for millennia. If you accept the fact that the history of man dates back nearly ten million years and that agriculture did not begin until about ten thousand years ago in the fertile crescent (about one percent of our total existence), then the carb picture becomes much clearer. Studies of indigenous peoples also show that the "diseases of civilization" before the introduction of the western diet were non-existent when they were still on hunter-gatherer type diets.

    In Barb's case, she has already lost 23 pounds and is definitely headed in the right direction. Until her blood sugar levels reach the 100 (and under) category, I personally don't think she has anything to worry about. Metformin, unlike sulfonylureas, rarely cause patients to go hypo anyway and my personal take on the matter is that she is on a relatively safe course for the moment. It may require monitoring in the event things change in the future but I think that situation is still quite a ways off.

    Like you, I do balance my reduced carb intake with protein as well as fat. I include cheeses in my diet and have been doing a one-person study on the effects of dietary cholesterol on myself. I currently have elevated the consumption of eggs (often organic but not always) to the top of my food preferences and consume anywhere from two to five eggs per day. I have a complete blood panel test scheduled in two months and the results will be very interesting to say the least. I am also a staunch anti-statin crusader so if my dietary fats/cholesterol turn out to have a negative impact on my blood profile (and I don't believe that it will), then dietary modifications will be my only recourse.

    Since eliminating all grain products from my diet, almost all of my carbs come from vegetables, nuts and eggs (which contain nearly a gram per extra-large egg) but I do occasionally include small portions of fruit such as apple slices, tomatoes and avocado. I have been experimenting with almond flour (3 g net carbs per ounce) and oat fiber (zero net carbs) together with "riced" cauliflower to make normally forbidden dishes like "bread" and pancakes. I also supplement with a little whey protein before engaging in exercise (whey protein does contain some carb content but I use only whey isolate products that have smaller amounts). So far, I am making slow but gradual progress towards ever-lower A1c results (currently 5.0). Well, time to go on my walk.
    cookiedog replied to nutrijoy's response:
    I am curious where your body gets essential vitamins and minerals such as Vitamin C.
    teddybear200 replied to nutrijoy's response:
    I do not think and this is my opinion that eating an extremely low carb is healthy for anyone. I don't care what the people before us did we live in the here and now. Times have changed and so has people.

    You can eat the way you want and I will eat the way I have to in order to live. I follow my Doctors advice not that of others telling me what to eat. Barb's Dr. should be telling her how many carbs to eat not us.

    I hope your numbers come out good, mine are and I eat 100%whole grains on a daily basis and my sugars are controlled.
    One day I will soar on wings of an Eagle.
    Want to know more about me - come join us at

    laura2gemini2 replied to nutrijoy's response:
    I too am an insulin dependant diabetic. My endo has told me that extremely low carb diets could be detrimental due to the increased amount of keytones your body makes by breaking down pure fat instead of carbs. He's encouraged me to eat at least 60g of carbs a day in order to prevent keytones. The Adkins diet promotes having keytones because that means you are burning fat, and for someone without diabetes that may be all very well and good.

    I would say to each his own, but make sure that it's safe. If the doctor, dietician, or CDE say that severe low carb diets are safe then go for it. If they wont, then it probably isnt the safest route to have for your diet.
    nutrijoy replied to laura2gemini2's response:
    Cookiedog, I get plenty of vitamins and minerals via the vegetables that I do consume. Most of my veggies are eaten either raw (sometimes I even drink them by pulverizing them in a Blendtec or Vitamix), lightly steamed, or occasionally boiled when I'm making soups. I also use veggies in my omelets and frittatas. Although cruciferous vegetables are my favorites, I do include less popular veggies like Swiss chard and Kale. Of course, I take nutritional supplements as well to fill in any gaps but take them only with food spread out among all three main meals instead of ingesting them all in one sitting. My most recent passion is "ricing" cauliflower and using it as a base for a variety of interesting dishes including extremely low-carb "bread," fritters, pizza "dough," and pancakes. I don't use any wheat flour at all in my cauliflower-based dishes but substitute almond flour and oat fiber into my preps instead (I purchase most of my supplies from Honeyville Foods during their once-a-month sales).

    Teddybear, my numbers have been extremely good; not just in my A1c results but my entire blood panel tests. That's one of the reasons why I am increasing my consumption of eggs and other dietary fats and cholesterol to see (for myself) if ingested fats have any impact on my cholesterol numbers. From everything that I have been taught or read, it is our liver that produces the lion's share of serum cholesterol in the human body and that dietary cholesterol only contributes 15% or less to the total. In fact, cholesterol has been unfairly demonized because it is actually an important building block in our physiology. Even the much maligned LDL serves a valuable function. It is only when LDL gets oxidized that it becomes detrimental.

    Laura, I am definitely not planning to migrate to a ketogenic diet. My current carb intake is around 20-25 grams per meal due to the vegetables and nuts/seeds that are still mainstays in my diet. I am in the process of reducing portion sizes but will supplement with whey protein more frequently to ensure that I have the requisite amount of essential amino acids for proper health.

    The main purpose of my posts was to stimulate people to think instead of blindly accepting as fact the flawed information that we have been fed by government agencies (based on inaccurate studies that were often funded or heavily influenced by the large food and drug manufacturers). I just finished viewing "The Oiling of America ," a lecture-based presentation given by Sally Fallon, CEO of the Weston A. Price Foundation. Much of the information was based on data (published in 2000) gathered by Mary Enig . It is available both as a DVD (released 2008, linked above) as well as viewed as a free streaming video (do a search for it in Yahoo or Google). I think that William Banting had it right in his Letter of Corpulence that was published nearly 150 years ago. Banting's dietary advice was targeted primarily at weight reduction but it's just as applicable (perhaps even more so) to those of us with diabetes.

    (to be continued when I go for a full blood panel test in two months or so; will post the results together with additional commentary).

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