The challenge - My story + How does one choose the best approach to Type 2 Diabetes Remission?

12. Recovering and managing diabetes or high blood pressure, has to be a priority, demanding an investment in time, effort, courage, money, discipline. No one else will do this for you. The doctors will do their best, typically give advice, and drugs, but the hard grind is up to us, and no one else. We determine how far we will improve by our own actions.

13. Water - so far it still is not clear how much water one should drink. 6 to 8 cups on the NHS means nothing, Cos cup sizes are not constant. This should have been expressed in a known quantity - so for a body based on science to omit this specificity, I deduce they also do not know. Based on everything I have studied that has been specific, I think 2 litres a day is the minumum for a man of my size, and I am willing to go to 2.5 litres per day if I am exercising a lot and sweating on any day. That is already a huge jump from sometimes no more than 1 litre a day, of all fluids including water, a poor habit I now realise that I had sustained for maybe decades. And good to spread the drinking over the day, in equal amounts. e.g every hour a bit. I have a hunch that water is a key factor, that is largely ignored in most of the advice given.

Like most changes, I think this should also be gradual, if one is increasing water intake, so the body adapts easily.

14. I now use iodized salt, albeit in very small quantities. 1/4 of a teaspoon per day. And the use of salt in cooking in the home is far better controlled. I realised that my wife who has been responsible for much of my meals in the past never measured how much salt she was adding to her cooking, and had done this for the approx. 30 years of our marriage. That's a whole lot of salt, that could be solely responsible for much of my high blood pressure. I now try to do as much of the cooking as possible, to more tightly control my salt intake. Avoiding ALL processed food with any salt added, goes a long way to managing salt intake. Low salt intake is supposed to lower blood pressure.

TBC
Over time, one adapts, and all of these changes become a way of life, we get used to doing things the better way. Sadly we live in a world of huge commercialism.

I did not eat ice cream every week when I was a teenager, so why must I have an ice cream every month, as an adult? All the confectionaries, biscuits, cakes, if these were occasional treats, like once a month, the impact would be negligible. But we now have all these things in huge quantities, everywhere, pastries, pies, ice creams, yoghurts, pizzas. I do not recall having a single pizza until I was 25 or older, so pizza is not needed in my diet. Yes I have cut out ALL bread, and that was a major change. Bread has too much salt, and questionable fats, and sugar as well as processed flour which turns into glucose, and the caloric density is high. So easy for me to eat 6 slices of bread at a sitting, cos bread does NOT fill me up. So bread is gone, for life.

When I think of it, our carbohydrate choices are pretty limited - Bread, Potatoes, Flour based products (and this includes pasta), Rice, and maybe Grains are another category of carbs. There really is very little variety in carbs. 4 main carbs that the entire western world eats. And only one of them has any real taste - potatoes. The others are made tasty by adding salt, fats, or sugars. The nutrient content of most carbs, in my estimation, is pretty low. So why are we eating them, especially on a regular basis? Much better, to fill up on vegetables, and a bit of fruit, which are far more nutrient dense, than carbs, and lower daily caloric intake.

The lack of variety in the major carbs, should also give us a clue. How come we are so limited in the choice of carbs?, in comparison to vegetables, fruits, and proteins. I think variety has to be a positive thing, for a more balanced diet, to give opportunity for a more complete set of nutrients. Our carb choices, severely limit that variety. Mashed, cooked, fried, whatever - it is still a potato - same thing.

Besides the glucose issue, a carb dominant diet, leaves us with reduced variety in macro nutrients, and micronutrients. Now that is a thought.
 
How carbohydrates are prepared is significant. Mostly, they (potatoes, rice, pasta, bread) are a source of starch when cooked. Starch is mostly broken down in the small intestine by maltase and salivery amylase, to glucose, which is easily absorbed straight to the bloodstream. There is a proportion of the starch that is so-called resistant starch. "Resistant Starch" is a terrible term really, because it suggests a substance that is resistant to being converted to starch. Its resistant to being broken down by maltase and amylase, and thats essentially through the formation of double bods in the polymer, changing how its folded, and therefore accessible by these enzymes. Double bonds are generally pretty stable. This form of starch is not broken down to glucose at all. Instead, its fermented in the large intestine by microbiota, to generate a range of short term fatty acids. These fatty acids are oxidized by muscle cells to Acetyl Co-A.

Cooling these cooked food to fridge temperature promotes the conversion of starch to resistant starch. Freezing the food increases that content. There's more than one type of RS though. RS4 doesn't occur in nature; its the type of polymerisation that occurs after gelatinisation of the food (ie cooking in water), followed by a rapid cooling cycle (put the food into the fridge).

Not all the starch is converted; though estimates seem to range widely, which I suspect is down to how the investigators measured starch content.

The RS content is a combination of the RS already in the food, and RS created through preparation process. Rice cooked in a rice cooker and chilled, will have a higher RS content than rice cooked in a pressure cooker. In fact the latter approach removes all variation in RS between rice varieties (Jasmine rice has the highest native content, short grain the lowest. The Chinese are looking at strains combining elements from Basmati-type rice with Japonica rice, to promote increased RS content). RS4 formation appears irreversible, so the content is not changed by warming the rice. though thats not necessary if you are spooning curry on top of chilled rice warmed to room temperature.
 
How carbohydrates are prepared is significant. Mostly, they (potatoes, rice, pasta, bread) are a source of starch when cooked. Starch is mostly broken down in the small intestine by maltase and salivery amylase, to glucose, which is easily absorbed straight to the bloodstream. There is a proportion of the starch that is so-called resistant starch. "Resistant Starch" is a terrible term really, because it suggests a substance that is resistant to being converted to starch. Its resistant to being broken down by maltase and amylase, and thats essentially through the formation of double bods in the polymer, changing how its folded, and therefore accessible by these enzymes. Double bonds are generally pretty stable. This form of starch is not broken down to glucose at all. Instead, its fermented in the large intestine by microbiota, to generate a range of short term fatty acids. These fatty acids are oxidized by muscle cells to Acetyl Co-A.

Cooling these cooked food to fridge temperature promotes the conversion of starch to resistant starch. Freezing the food increases that content. There's more than one type of RS though. RS4 doesn't occur in nature; its the type of polymerisation that occurs after gelatinisation of the food (ie cooking in water), followed by a rapid cooling cycle (put the food into the fridge).

Not all the starch is converted; though estimates seem to range widely, which I suspect is down to how the investigators measured starch content.

The RS content is a combination of the RS already in the food, and RS created through preparation process. Rice cooked in a rice cooker and chilled, will have a higher RS content than rice cooked in a pressure cooker. In fact the latter approach removes all variation in RS between rice varieties (Jasmine rice has the highest native content, short grain the lowest. The Chinese are looking at strains combining elements from Basmati-type rice with Japonica rice, to promote increased RS content). RS4 formation appears irreversible, so the content is not changed by warming the rice. though thats not necessary if you are spooning curry on top of chilled rice warmed to room temperature.
You've been reading my Nutritional Sciences text book.
I also depends on the individual's gut microflora as to what actually happens in their gut.6
 
How carbohydrates are prepared is significant. Mostly, they (potatoes, rice, pasta, bread) are a source of starch when cooked. Starch is mostly broken down in the small intestine by maltase and salivery amylase, to glucose, which is easily absorbed straight to the bloodstream. There is a proportion of the starch that is so-called resistant starch. "Resistant Starch" is a terrible term really, because it suggests a substance that is resistant to being converted to starch. Its resistant to being broken down by maltase and amylase, and thats essentially through the formation of double bods in the polymer, changing how its folded, and therefore accessible by these enzymes. Double bonds are generally pretty stable. This form of starch is not broken down to glucose at all. Instead, its fermented in the large intestine by microbiota, to generate a range of short term fatty acids. These fatty acids are oxidized by muscle cells to Acetyl Co-A.

Cooling these cooked food to fridge temperature promotes the conversion of starch to resistant starch. Freezing the food increases that content. There's more than one type of RS though. RS4 doesn't occur in nature; its the type of polymerisation that occurs after gelatinisation of the food (ie cooking in water), followed by a rapid cooling cycle (put the food into the fridge).

Not all the starch is converted; though estimates seem to range widely, which I suspect is down to how the investigators measured starch content.

The RS content is a combination of the RS already in the food, and RS created through preparation process. Rice cooked in a rice cooker and chilled, will have a higher RS content than rice cooked in a pressure cooker. In fact the latter approach removes all variation in RS between rice varieties (Jasmine rice has the highest native content, short grain the lowest. The Chinese are looking at strains combining elements from Basmati-type rice with Japonica rice, to promote increased RS content). RS4 formation appears irreversible, so the content is not changed by warming the rice. though thats not necessary if you are spooning curry on top of chilled rice warmed to room temperature.
Thank you for your excellent contribution to this thread.

I heard about resistive starch, many many years ago, long before I was diagnosed with TD2. I never really paid it that much attention, cos I could not evaluate how significant the opportunity was. I'll give an example - it is accepted that Vinegar (or the more well known example - Apple Cider Vinegar) helps to alter the absorption of food, and helps to lose weight.

In the case of vinegar, the challenge for me was - how significant is the benefit, vs the cost and effort. I did put ACV on my salads once upon a time, for about a year. Later on, and now I think the main benefit is the salad itself, while the ACV, is a booster. So now I do not bother about the ACV, and just focus far more on getting a good portion of vegetables, and some fruit daily.

So that is the challenge with the topic of resistive starch - how relevant is this?, for the effort. How much more does one get out of this.

Are we solving the real problem, which is a predisposition to carbs. After several weeks of abstaining, I had a few biscuits recently, and I did not like them anymore, they were so obviously too sweet, I did not want to take any more. My taste buds alone told me - not good for me, and I stopped, and did not have any more.

I've already reduced the amount of carbs I eat, from the simple reasoning that :

1. The body can make glucose from proteins, and fats

2. It makes sense that - it is NOT sensible for a diagnosed T2 Diabetic, to be dosing heavily on carb dominant meals, kinda counter intuitive to be doing that, makes sense to reduce a primary source of "glucose".

My point being, if one has already weaned themselves off any carb dependencies, or sugar addictions, and the "dose" of carbs is already low, is there any benefit in investing the effort in resistive starch?

When I was 1st diagnosed as T2D, I had a long list of do's and dont's, and it became somewhat complex, to establish a routine. Now I've broken it down into the important things, and everything else is simply an optimisation.

The basics being - A low carb diet, with some fruit(small amount) and varied set of vegetables as the priority, and get as much activity as regularly as possible, and get enough sleep, and drink enough water or fluids, with anything else being incremental, a further enhancement to these basics.

Simplifying this lifestyle has helped make it sustainable, and also observe that I continue to lose weight, albeit somewhat slowly, even though I really do not do any significant portion control.
 
You've been reading my Nutritional Sciences text book.
I also depends on the individual's gut microflora as to what actually happens in their gut.6

Not at all. I had no idea you have written a text book. I found Chen et al's review (Food Chemistry: X, Volume 21, 30 March 2024, 10111) a good start to reacquainting myself with this part of microbiology.

1-s2.0-S2590157524000051-ga1_lrg.jpg


Microflora will vary within individuals, with diet. For instance, an excellent preparation for a trip to India (I do many working trips there) is a couple of spoonfuls of freeze dried Lactobacilli. Most upset stomachs in India are not due to food poisoning, but due to an inability to properly digest different kinds of food. And note, eliminating sources of resistant starch leads to changes in that large intestine biota. Consuming RS rich food enriches the Bacteroidetes and Firmicutes spp/ populations, which are thought to produce butyrate (butyric acid, the smell of rancid butter), which might be important for colonic health. But these fatty acids also stimulates production of GLP-1, which increases insulin sensitivity.

But does the presence of RS4 (the form generated by cooling/freezing) have any significance to T2Ds? Probably not. The conversion of starch to RS4 is nowhere near 100%. But it seems nutrition scientists might be looking in this direction:

 
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Not at all. I had no idea you have written a text book. I found Chen et al's review (Food Chemistry: X, Volume 21, 30 March 2024, 10111) a good start to reacquainting myself with this part of microbiology (FYI, my grad studies were in industrial microbiology more than 30 years ago, before segwaying into a PhD in marine microbiology, followed by many years looking at threat agent detection, before eventually ending up in more broad medtech work).

1-s2.0-S2590157524000051-ga1_lrg.jpg


Microflora will vary within individuals, with diet. For instance, an excellent preparation for a trip to India (I do many working trips there) is a couple of spoonfuls of freeze dried Lactobacilli. Most upset stomachs in India are not due to food poisoning, but due to an inability to properly digest different kinds of food. And note, eliminating sources of resistant starch leads to changes in that large intestine biota. Consuming RS rich food enriches the Bacteroidetes and Firmicutes spp/ populations, which are thought to produce butyrate (butyric acid, the smell of rancid butter), which might be important for colonic health. But these fatty acids also stimulates production of GLP-1, which increases insulin sensitivity.

But does the presence of RS4 (the form generated by cooling/freezing) have any significance to T2Ds? Probably not. The conversion of starch to RS4 is nowhere near 100%. But it seems nutrition scientists might be looking in this direction:

The wrong turn of phrase, I meant the book on my bookshelf, I'm not that clever to write a book.
Love your presentation of the gut.
 
My point being, if one has already weaned themselves off any carb dependencies, or sugar addictions, and the "dose" of carbs is already low, is there any benefit in investing the effort in resistive starch?

But does the presence of RS4 (the form generated by cooling/freezing) have any significance to T2Ds? Probably not.

My view would be that if it’s not a particulatly onerous process, it may help some people with diabetes (of any type).

If our aim is really blood glucose management, then finding tactics, strategies, hacks and workarounds that enable us to have as flexible and varied a menu as possible seems positive.

So if resistant starch is in a food someone has discovered the absolutely cannot tolerate, at any reasonable portion size, then yep, it’s probably not going to help much. (eg a large bowl of pasta)

But it might help tip the balance for a handful of pasta included for variety in a salad?

And if, say, freezing and defrosting eg a loaf of bread means that a slice of bread as an open sandwich or slice of toast is now a viable option because the absorption is slowed and BG response is satisfactory, then that seems a helpful addition?

It may be different for me as a T1, with the benefit of rapid insulin to throw at things… but over the years I have experimented with various foods and discovered some of them are just too difficult to get the dose/carb timing & relationship reliably ‘right’, so I've abandoned them. Others sit ‘on the edge’ of acceptable/reliable post-meal outcomes, and it’s that sort of thing where resistant starch may just tip the balance and make that food a viable option for me.
 
My view would be that if it’s not a particulatly onerous process, it may help some people with diabetes (of any type).

If our aim is really blood glucose management, then finding tactics, strategies, hacks and workarounds that enable us to have as flexible and varied a menu as possible seems positive.

So if resistant starch is in a food someone has discovered the absolutely cannot tolerate, at any reasonable portion size, then yep, it’s probably not going to help much. (eg a large bowl of pasta)

But it might help tip the balance for a handful of pasta included for variety in a salad?

And if, say, freezing and defrosting eg a loaf of bread means that a slice of bread as an open sandwich or slice of toast is now a viable option because the absorption is slowed and BG response is satisfactory, then that seems a helpful addition?

It may be different for me as a T1, with the benefit of rapid insulin to throw at things… but over the years I have experimented with various foods and discovered some of them are just too difficult to get the dose/carb timing & relationship reliably ‘right’, so I've abandoned them. Others sit ‘on the edge’ of acceptable/reliable post-meal outcomes, and it’s that sort of thing where resistant starch may just tip the balance and make that food a viable option for me.

The problem is you cannot predict that RS4 content. Peer reviewed papers give wide ranges/
 
The problem is you cannot predict that RS4 content. Peer reviewed papers give wide ranges/
may, might, could

Like many things D, it seems to work well for some people (though not all foods equally well necessarily), less well for other people, and not at all for yet others. As @Proud to be erratic frequently quotes D is complex, confusing and contradictory! We do need as always to experiment to find out how well it works for us, if at all.
 
My view would be that if it’s not a particulatly onerous process, it may help some people with diabetes (of any type).

If our aim is really blood glucose management, then finding tactics, strategies, hacks and workarounds that enable us to have as flexible and varied a menu as possible seems positive.

So if resistant starch is in a food someone has discovered the absolutely cannot tolerate, at any reasonable portion size, then yep, it’s probably not going to help much. (eg a large bowl of pasta)

But it might help tip the balance for a handful of pasta included for variety in a salad?

And if, say, freezing and defrosting eg a loaf of bread means that a slice of bread as an open sandwich or slice of toast is now a viable option because the absorption is slowed and BG response is satisfactory, then that seems a helpful addition?

It may be different for me as a T1, with the benefit of rapid insulin to throw at things… but over the years I have experimented with various foods and discovered some of them are just too difficult to get the dose/carb timing & relationship reliably ‘right’, so I've abandoned them. Others sit ‘on the edge’ of acceptable/reliable post-meal outcomes, and it’s that sort of thing where resistant starch may just tip the balance and make that food a viable option for me.
The challenge is discovering what works. As a recently diagnosed T2D - almost 3 months ago, I asked my doctor, when she gave me the bad news, do I need a blood glucose monitor, and the answer was no. So in my case, I do not know what my glucose response is to meals, and the only assessment is @ the next set of tests in about two weeks from now.

I absolutely agree that blood glucose control is pertinent, for any form of diabetes. In my case, I am also targetting weight loss, as the principal approach to T2D remission, and this has been my experience :

1. I made a lot of effort to cut out carbs, for about two months and went from 100 KG to 95.7 KG.

2. On a whim, I thought, maybe I have cut the carbs too low, then started to add back some more carbs and also have butter. Not sure which of these was the culprit. In 8 days I gained about 2 Kilograms, and my weight this morning is 97.55 KG.

So one caveat of the resistant starch option, is it will only apply to those who are monitoring their glucose levels, with some kind of meter, regularly, ideally before and after meals. Or are on a CGM - Continuous glucose monitor (which is a bit expensive for most).

So now I have no choice but to again cut out all carbs, as much as possible, and kick the butter habit. The butter will not raise my blood sugar, but it will definitely oppose any attempt to lose weight.

One lesson from this is - there is no replacement for regular monitoring, and I think, in spite of my doctor's advice, I would prefer to at the very least have some kind of device that I can use to measure and track my blood sugar, and also track my weight daily.

I can imagine that all this tracking is a bit of a hassle. But guess like medications that one has to take daily, this is the new lifestyle. Regular checks, of various things, some several times a day like blood sugar and blood pressure, some daily like weight in my case, some every few months - like HbA1c, some annually like eye checks, foot checks. And regrettably, medication is no substitute for all this personal responsibility, to keep on top of the personal efforts to track one's progress/condition.

I think this is the biggest step change, taking personal responsibility, and being fanatically disciplined. This is the only way one discovers what works and what is not working, by tracking and tracking and tracking in as much detail and regularity as possible. My thinking is that the more regular the checks, the earlier we can respond and intervene, and correct any untoward deviations.
 
We are all human. We forget things, we get tempted, we deviate, the check-ins, are good for us, to stay on track. The more regular the better.
 
Many people's response to being advised not to get a monitor is to ask would they drive their car without having a speedometer, you can't manage what you can't monitor.
Hence may ignore that and find a monitor an invaluable tool, alongside diet, exercise and any prescribed medication if needed.
 
Many people's response to being advised not to get a monitor is to ask would they drive their car without having a speedometer, you can't manage what you can't monitor.
Hence may ignore that and find a monitor an invaluable tool, alongside diet, exercise and any prescribed medication if needed.
Looking back, it is unfortunate that I did not challenge that opinion, and just go ahead to get my own blood glucose monitor, at my own expense. That I will now investigate and acquire, sometime over the next few weeks, considering my experience with weight loss/gain, where the only way to know where one is, is to measure.

Thanks for your comment.
 
Many people's response to being advised not to get a monitor is to ask would they drive their car without having a speedometer, you can't manage what you can't monitor.
Hence may ignore that and find a monitor an invaluable tool, alongside diet, exercise and any prescribed medication if needed.
One interesting challenge with a "free" health system, is what I would call an averaging. The health care system is aiming to define the best care at the lowest cost, on average. One never knows, but I consider that maybe if I went private, if that was something I could afford, I may receive a more attentive personalised, and more regular level of attention. Am thankful for what is available for free, but recognise that the NHS is in a perpetual battle with costs, to ration how much time, attention or effort to expend on anyone who needs help, and there obviously have to be compromises.

On the fantastically positive side, it was my relocation and the need to register with a new GP, which led to my T2D diagnosis, so there is a lot that is positive about the NHS. But I'm thinking, what if I had not relocated, how many more years, would my T2D have remained undiagnosed !!!!

It must be such a hard thing managing a health service, to do the right thing for everyone. Not a job I would envy, cos like being a politician, you never get it 100% right, damned if you do, damned if you don't. There will always be that one person, that remains underserved.

Clearly more testing, is needed, but of course this will cost money, and take time, and need more people.

The Labour Chancellor is setting out her 1st budget about now, or she may already have finished speaking, in the House of Commons, will try to listen to the speech, later today.

I am thankful for all the free testing, just had the results of my retinopathy test. So on a positive, a lot is already being done, only wish there was a way to have been alerted 10 years earlier, and taken avoidance steps, that much earlier. That would have been nice. I do miss being able to eat things like cake and biscuits. Or ice cream. Such is life. Have not had an ice cream in almost three months !!
 
Besides the glucose issue, a carb dominant diet, leaves us with reduced variety in macro nutrients, and micronutrients.
Are you able to demonstrate this?
 
This is what my local practice gave me (then refused to give me any more strips):


A fiver, given you don't pay vat. I ended up getting strips and lancets off Amazon, with free next day delivery, whereas the manufacturer is charging £5 for delivery.
There's another option. It involves paying more upfront, for the meter, but from there it's possible to get the strips at a much cheaper price...incl. Free UK delivery. I beleive there're also discount codes floating around, although I'm not sure if they're still applicable:



Screenshot 2024-10-30 at 16.01.46.png

Screenshot 2024-10-30 at 16.00.11.png
 
Are you able to demonstrate this?
When I used the word carbs, I'm referring to plain carbs like rice, potatoes, and pasta, or white flour, which are predominantly just glucose, when digested and absorbed.
 
This is what my local practice gave me (then refused to give me any more strips):


A fiver, given you don't pay vat. I ended up getting strips and lancets off Amazon, with free next day delivery, whereas the manufacturer is charging £5 for delivery.
Thanks.
 
There's another option. It involves paying more upfront, for the meter, but from there it's possible to get the strips at a much cheaper price...incl. Free UK delivery. I beleive there're also discount codes floating around, although I'm not sure if they're still applicable:



View attachment 32292

View attachment 32293
Thanks
 
Many of us reuse lancets and my box of 200 will last me at least 2 lifetimes. 😳
I am an avid member of the St Swithin's day club, where we change our lancet once a day on St Swithin's. (15th July) There were times when I used to test as much as 16 times a day and it still lasted a year, but since CGM, my annual lancet has a much easier life.

There are times at my stables when I have to choose the least dirty finger to test (usually ring or little finger on my left hand) as I have no quick access to washing facilities and I have never yet had an infection from a once a year lancet change. I do however always change it for a new one if I am testing someone else (friends or family) and then dispose of their lancet after one test and replace my old one to continue my testing for the remainder of the year.
 
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