Diet confusion - low carb or low fat?

[niggle]

Hi all, just registered. I was diagnosed with type 2 ten years ago and I had been doing reasonably well, taking 500mg metformin twice a day, plus simvastatin for moderately high cholesterol, no concerns generally at reviews up to previous one 18 months ago and had become a bit blasé TBH.

Fast forward to a month or so ago and the first sign of problems was when my eye test results for the first time showed some changes. Then came my review with diabetic nurse where my blood results came back with very high HbA1c (8.something) and very high cholesterol. Interestingly I was told the high cholesterol was probably due to the high blood sugar. GP has increased my metformin to 1.5g daily and replaced simvastatin with atorvastatin.

My basic diet was pretty good with no potatoes, pasta, rice etc., just either a couple of slices of whole meal bread or half a dozen oatcakes, lean meat, fish, lots of fresh green vegetables and a couple of pieces of fruit, but I was prone to giving in to cravings quite frequently and binging on very inappropriate things like a big bar of chocolate, cream cakes, tub of ice cream, plus was drinking a fair amount of beer on and off.

I decided to go full keto including increased oily and white fish, all types of meat regardless of fat, reduced vegetables & zero alcohol, fruit, bread or oatcakes. After a week I had my urine tested and there were high ketones as expected. There was also high sugar but the nurse explained that takes a while to come down. She also said that the keto diet was a really good move.

First thing I have noticed is that I have no cravings and I don’t seem to get hungry for many hours after eating.

My weight is about half a stone above recommended ideal and I am reasonably physically active due to dog walking at least 45 minutes a day plus walking about 7-10 miles about once a week.

I have another review scheduled in 3 months so it will be interesting to see what my results are by then. I will check with the health centre and post the accurate blood tests from my last test, then get back with the next results when I have them.

 

[niggle]

OK so my vital stats are:
Male age 59, height 5’6” (yes I’m a short @r$e lol)
28.2.23: HbA1c 89, total chol 6.52, HDL 0.93, total/HDL 7.00
5.3.23 weight 11st 8lb = BMI 26
12.3.23 weight 11st 5lb = BMI 25.5, waist 37.5” (tape measure reading at true waist, not trouser waist).

 

[niggle]

Good to know. I lost 26 lb doing low carb but it has plateaued for 6 weeks. So I reduced it to 1200/1300 calories the last 2 weeks to no avail. My body loves to fight back! So I will calorie count and see where 1200 calories goes....I will give it a month and if no good I am going to ask about the Newcastle diet because I think they have to monitor you in that and so if there are issues they will see them for once instead of thinking I am lying about my diet.The meds won't be helping of course for the fibro they cause weight gain all the clinical papers say so but yet the doctors still deny what is in black and white makes me so frustrated.

One unfortunate truth about weight loss is that the less you weigh the fewer calories you need daily, i.e. it takes less energy to maintain and move around a lighter body.

 

[niggle]

Its interesting because getting energy from protein costs the liver energy so not a straight forward situation, fat is more easily used. The saying a calorie is not a calorie seems to apply to keto diets particularly in that sense. But I remember doing a candida diet with the herbalist years ago and she said I would drop stone in a month it was lower in carbs but low sugar and had nuts and seeds and oils in it....I was suspicious it would not work....too high in fat for me and I was correct I only lost a couple of pounds so the next month I cut the seeds nuts and oil out then I dropped a little more weight and she commented I must be sensitive to fats...if you ask me my body is sensitive to anything at all....I swear if I ate fresh air I would still have a problem!

Or maybe you are sensitive to plant oils? You might get different results from animal fats. Proper keto needs to be <50g carbs a day, or even <20g

 

[niggle]

OK so my vital stats are:
Male age 59, height 5’6” (yes I’m a short @r$e lol)
28.2.23: HbA1c 89, total chol 6.52, HDL 0.93, total/HDL 7.00
5.3.23 weight 11st 8lb = BMI 26
12.3.23 weight 11st 5lb = BMI 25.5, waist 37.5” (tape measure reading at true waist, not trouser waist).

Ok quick update: as of today 11st 1lb, waist 37”, BMI 24.9 so just crept into the very top of a healthy weight according to BMI, but I think I need to get down a fair bit further, the waist size is still not great for my height, could do with getting down to below 33” to get recommended waist to height ratio below 0.5. However I am definitely headed in the right direction and still not getting hungry at all. Also starting to feel a bit lighter on my feet which is a bonus for the hillwalking.

 

[Deleted member 21371]

Ok quick update: as of today 11st 1lb, waist 37”, BMI 24.9 so just crept into the very top of a healthy weight according to BMI, but I think I need to get down a fair bit further, the waist size is still not great for my height, could do with getting down to below 33” to get recommended waist to height ratio below 0.5. However I am definitely headed in the right direction and still not getting hungry at all. Also starting to feel a bit lighter on my feet which is a bonus for the hillwalking.

Sounds good.
Keep doing it 🙂

 

[Callista]

ne unfortunate truth about weight loss is that the less you weigh the fewer calories you need daily, i.e. it takes less energy to maintain and move around a lighter body.

**

true, but if you increase, through exercise, your lean to fat ratio by building muscle mass (instead of fat!), then muscle uses more energy than fat (which is, I think, almost inert energy-wise??). So having a more muscular body does need more fuel which gives a bit of 'headroom' when it comes to calorie intake (ie, we can eat a bit more as we are fuelling our muscles, not depositing the unusued calories as yet more fat!)

As we know, our weight will increase if we build muscle but it will be healthy weight, not unhealthy. It's the reason BMI is only a rough proxy for 'healthy weight', and why it is controversial. (It's advantage is, of course, that it's very easy to calculate, compared with trying to work out our lean/fat ratio)

 

[Callista]

And that's even before we get to the even trickier-to-measure issue of visceral fat around our body organs, rather than deposited as spare tyres round our tums etc!!!

 

[niggle]

ne unfortunate truth about weight loss is that the less you weigh the fewer calories you need daily, i.e. it takes less energy to maintain and move around a lighter body.

**

true, but if you increase, through exercise, your lean to fat ratio by building muscle mass (instead of fat!), then muscle uses more energy than fat (which is, I think, almost inert energy-wise??). So having a more muscular body does need more fuel which gives a bit of 'headroom' when it comes to calorie intake (ie, we can eat a bit more as we are fuelling our muscles, not depositing the unusued calories as yet more fat!)

As we know, our weight will increase if we build muscle but it will be healthy weight, not unhealthy. It's the reason BMI is only a rough proxy for 'healthy weight', and why it is controversial. (It's advantage is, of course, that it's very easy to calculate, compared with trying to work out our lean/fat ratio)

Agree with all of that (but it’s important to use the muscle through regular exercise).

If you see my posts re my own case I am aiming for a sub 0.5 waist to height ratio. I have already achieved getting just inside the official healthy BMI range but still have a bit of a paunch, with waist to height ratio of 0.56, which is far from healthy IMO.

I don’t even know how to go about calculating lean/fat ratio, but waist to height is even easier than BMI and is IMO a much better indicator of how much body fat you are carrying (and doesn’t penalise females with bigger than average fat deposits on bust/backside/thighs which is said to be less of a health risk).

 

[niggle]

And that's even before we get to the even trickier-to-measure issue of visceral fat around our body organs, rather than deposited as spare tyres round our tums etc!!!

And of course that is very important as the visceral fat is reckoned to be the real problem. It is not really possible to measure on oneself but I think a clear indication of visceral fat is that bloated and rather firm, forward projecting tummy I have had, which to my thinking would indicate it is inside the muscle wall, unlike softer “flab”, the mobility of which indicates it (I think) is outside the muscle wall.

 

[niggle]

I have just seen that the NHS BMI calculator is not currently available:

“Changes to the BMI healthy weight calculator

The BMI healthy weight calculator is being updated and is temporarily unavailable.

If you're concerned about your weight, or the weight of someone you care for, speak to a GP.”

and if you scroll down the page they also have some information on waist to height ratio: https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/#:~:text=To calculate your waist to,type 2 diabetes and stroke.

 

[42istheanswer]

I have just seen that the NHS BMI calculator is not currently available:

“Changes to the BMI healthy weight calculator

The BMI healthy weight calculator is being updated and is temporarily unavailable.

If you're concerned about your weight, or the weight of someone you care for, speak to a GP.”

and if you scroll down the page they also have some information on waist to height ratio: https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/#:~:text=To calculate your waist to,type 2 diabetes and stroke.

Straight BMI is easy to calculate yourself on a calculator that has ( ) options.

Weight in kg ÷ (height in m X height in m) =

For example if you weigh 80kg and are 1.70m then your BMI is:

80 ÷ (1.7 x 1.7) = 27.7 (rounded up to the first decimal place).

You can find conversions for weight in stones/lbs and height in feet and inches online.

Although if it means the NHS calculator is going to include adjustments to BMI to show what is normal for cis women (who naturally carry more fat than cis men) that would be nice!

 

[niggle]

Straight BMI is easy to calculate yourself on a calculator that has ( ) options.

Weight in kg ÷ (height in m X height in m) =

For example if you weigh 80kg and are 1.70m then your BMI is:

80 ÷ (1.7 x 1.7) = 27.7 (rounded up to the first decimal place).

You can find conversions for weight in stones/lbs and height in feet and inches online.

Although if it means the NHS calculator is going to include adjustments to BMI to show what is normal for cis women (who naturally carry more fat than cis men) that would be nice!

The original NHS BMI calculator made you select male or female. As for calculating, the ideal waist to height ratio is something you can do in your head instantly: waist needs to be less than half your height, simples! At 5’6” = 66” I need to get my waist below 33”.

Also as I said it seems a better indication of fat:lean ratio, body builders don’t bulk up their waists, quite the opposite; plus it is cis female friendly: a slim waist is healthy regardless of the size of the curves elsewhere.

 

[Docb]

If I might intervene to suggest that looking at ones BMI has much in common with looking at the readings from a blood glucose monitor. You have got something to think hard about when they are clearly above or below what might be expected under a given set of circumstances.

Interpretation of the nuances of variability within the normal range is mostly for the argumentative. As usual all involved in the argument usually have some merit in the point they are making but nobody is right or wrong and there is little point in getting wound up about it. It is easy to pick out some groups (like boxers referred to above) which, for understandable reasons, do not fit the general pattern but it does not invalidate the overall picture.

 

[Callista]

An even simpler method of judging if one is overweight is just to see what wobbles! It's perfectliy obvious to me that my wobbly tum is excess fat.

Really, we shouldn't be talking at all about people being 'overweight' - it's 'over-fat' that counts.

Physique can vary a lot - I have 'big bones' (for a cis-woman, which I think means 'natal', as in XX etc?), and that puts extra weight on. Even if I had a very lean, low fat body, I'd still weigh more for my height.

The issue of visceral fat around organs which is 'invisible' (and intangible - doesn't wobble!) is far more insidious I think.

But overall, BMI is a starting point at least, so in that sense it's helpful. But it's not always the end of the story.

PS - I think there used to be an advert for something like Special K or whatever (some form of diet food), that used the mantra 'if you can pinch an inch' - that's another pretty basic indicator of whether one is carrying too much fat.

 

[Sarahp]

Yes, a low fat plant-based diet can improve insulin resistance dramatically. Here’s some information and reference to one of a number of studies:

https://nutrition.org/plant-based-diets-and-diabetes/

“a plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment.”

The author of the book you refer to is Type 1 and has done amazing things to his insulin sensitivity - extremely impressive. He eats a lot of carbs per day but takes a tiny fraction of the insulin that the average Type 1 would need to take to eat that many carbs. It’s incredible.

So, yes, the diet can work. There are also other proponents of a similar way of eating and you can see personal stories of Type 2s who’ve lost huge amounts of weight and eliminated or greatly reduced their insulin resistance, eg on the Forks over Knives website.

It’s up to you which diet you choose. There are various diets followed by members here 🙂

I am finding this is helping especially as I have epi as well but I can’t have processed plant based foods due to hidden salt and fats, I batch cook wholefood based meals using recipes off the DUk site and few others that I have adapted along the way. Plus batch cooking has worked out so much cheaper for me.

 

[Sarahp]

Hi, I've been working on a low carb diet with moderate results but I've been introduced to the 'mastering diabetes' book which seems to take a different approach but claims good results.

Basically it seems to be eatr as much fruit and veg as you like but avoid eggs, dairy, meat.

Has anyone tried it? how did it go?
Their explanation seems legit (although they are also trying to sell the diet and 'support').
is it that they key thing is actually weight loss and how you manage that doesnt matter?

I started to look into this diet but for me fruit triggers my cravings and other GI conditions hugely so stopped plus didn’t like the sales pushing the plan and couldn’t see anything on the nhs website supporting this sort of plan. My Dietican has always promoted low GI so certain complex carbs in moderation and it helps to an extend when my other conditions are behaving, I managed remission with it and have a stable weight, still a long way to go but keeping trying but scratch/batch cooking has been the only way I can manage it as processed food (even healthy options) make me so sick.

 

[Sarahp]

Or maybe you are sensitive to plant oils? You might get different results from animal fats. Proper keto needs to be <50g carbs a day, or even <20g

Can I ask how your kidneys are doing? Seen a lot of concerns around keto but mainly seems to be around type 1 and others on insulin, I am interested in it but scared as have kidney issues and now the nurse only checks once a year it’s made me very wary of trying keto v my current low GI plan .

 

[everydayupsanddowns]

Yes, a low fat plant-based diet can improve insulin resistance dramatically. Here’s some information and reference to one of a number of studies:

https://nutrition.org/plant-based-diets-and-diabetes/

“a plant-based eating pattern is associated with a reduced risk of developing type 2 diabetes and is highly effective in its treatment.”

The author of the book you refer to is Type 1 and has done amazing things to his insulin sensitivity - extremely impressive. He eats a lot of carbs per day but takes a tiny fraction of the insulin that the average Type 1 would need to take to eat that many carbs. It’s incredible.

So, yes, the diet can work. There are also other proponents of a similar way of eating and you can see personal stories of Type 2s who’ve lost huge amounts of weight and eliminated or greatly reduced their insulin resistance, eg on the Forks over Knives website.

It’s up to you which diet you choose. There are various diets followed by members here 🙂

A side conversation comparing different opinions on plant based diets has been split away to its own thread here:

https://forum.diabetes.org.uk/boards/threads/plant-based-menu-different-opinions.106273/