Guest Editorial: Carb Addiction Part II: Controlling the Physical Aspect of Insulin ResistanceMonday, April 02, 2012
Last month I wrote about the strong, almost irrepressible urge to overeat carbohydrate-based foods, especially in people with metabolic syndrome, prediabetes, and type 2 diabetes. Once we start nibbling on our special favorite--whether it is freshly baked bread, potato chips, ice cream, chocolate, cookies--it becomes a struggle to stop. Here is a program to help stop these cravings and reverse the physiological effects of ingesting carbs.
By: Diane Kress, RD, CDE
In my last article, I focused on a physiological reason for carb addiction--an imbalance of the fat gain hormone, insulin. I mentioned the two classifications I give metabolism: Met A (normal insulin release), or Met B (imbalance of insulin that leads to insulin resistance and blood glucose aberrations). Those with prediabetes and type 2 diabetes have Met B.
For those with Met A
When a person with Met A eats carbohydrates, the carb-based food breaks down into blood sugar. Blood sugar is the preferred energy source for the brain and body. The brain senses the rise in blood sugar and signals the pancreas to release insulin. Insulin acts like a key to “open” receptors on muscle and fat cells. Once “opened” the cells can uptake sugar. Muscle cells refill sugar stores lost during exercise or physical activity. When muscle’s sugar supplies are refilled, blood sugar in excess of “normal circulating blood sugar” is stored in fat cells.
In addition to blood sugar rises from carbs, the body has a “self feeding” mechanism. If a person waits longer than about 5 hours without refueling with carbs, the brain senses a drop in blood sugar and signals the pancreas to release the hormone glucagon. Glucagon travels to the liver and requests a deposit of glycogen (stored glucose) into the blood stream to fuel the brain and body. Just as when blood sugar rises from carbohydrates, blood sugar rises from the liver prompting the right amount of insulin to open the right amount of fat and muscle cells and allows circulating blood sugar to return to normal.
For those with Met B
People with metabolic syndrome, pre diabetes, and type 2 diabetes do not respond with the correct amount of insulin when blood sugar rises from either carb intake or glycogen release. Over the years, apparently due to multiple factors including genes and stressors, they begin to release excess insulin. As a result, these people gain fat on the body and in the blood and suffer from roller-coastering blood sugar. 24/7 dips in blood sugar--from excess insulin--cause them to crave the very food that can make blood sugar rise again: carbohydrates.
The typically recommended low calorie, low fat diet for people with diabetes does not address the problem as this diet configuration is disproportionately higher in carbohydrates. This is one reason those with type 2 diabetes have trouble keeping lost weight off and controlling blood sugar.
Answering for the Uncontrolled Met B Dilemma
I promised I would return with an “answer” for the Met B dilemma, so here goes. When I meet a patient with Met B, the first order of business is to rest their overworking and overwrought pancreas and livers. When Met B is uncontrolled, the pancreas is producing (or trying to produce) excess insulin and the liver is being called upon to release excess glycogen stores. The person is living in metabolic mayhem--sometimes to the point of glucose toxicity.
The most effective way to stop the madness is to commit to an eight week period following a lower carbohydrate diet and more active lifestyle. Not just any low carb diet will do. Uncontrolled Met B is a metabolic disorder that requires special attention and accommodations. In the years of research that led up to my program, I found that every gram of carbohydrate is not created equally. Unlike other low carb diets, my program does not count every gram of carbs in every food and does not limit total carb intake for all foods to 20 grams/day. Why? Because that type of restriction is not necessary for our situation. It is very easy to learn the program and live the lifestyle as it is designed to quickly (within about four days) bring the pancreas and liver hyperactivity to a restful state.
After the first four days (the time it takes for the liver to release most of its glycogen), there are no more carb cravings, no ravenous hunger, no fatigue. Day five until the end of the eighth week is a period of fat loss, blood sugar control, energy, and improved labwork. There are three types of food that can be eaten liberally ( they are considered neutral as they do not require insulin release), those that must be temporarily avoided (these cause appreciable rise in blood sugar and insulin release) and “5 gram Counters” that are optional at meals, bedtime, middle of the night. (All these food types are listed in the yellow box below.)
Examples of “neutral” foods that can be eaten at any time in liberal amounts: chicken, turkey, beef, pork, fish, seafood, eggs, egg whites, tofu, soy, cheese, natural nut butters, nuts, seeds, avocado, olives, nut butter, olive oil, vinegars, and butter.
Also: veggies like broccoli, cauliflower, green beans, bell peppers, onions, mushrooms, zucchini, spinach, salad greens and lettuce.
Examples of “foods to temporarily avoid” as they will not allow the pancreas and liver to rest and rehab: Regular bread, cereal, potatoes, corn, peas, fruit and juice, pasta, rice, legumes, ice cream, cookies, cake, chips, snack crackers.
Examples of 5 gram “Counters” that are optional at meals, bedtime, and the middle of the night: These include a 5 gram portion of low carb bread, wraps, crackers, milk, yogurt, popcorn, shakes, and bars.
During this eight week period, along with the liberal intake of neutral foods and increased physical activity, the following items should be added: water/decaffinated fluid intake, green tea, omega 3 fatty acids, calcium with Vitamin D, and a multivitamin. Would you believe it is recommended to eat within an hour of wake up, an hour of bedtime, and have no gaps of over five hours without eating? If you awaken during the night, a little neutral snack actually encourages fat burning!
This program discourages frequent weighing. I ask the dieter to get a starting weight and body measurements and put them away for the entire eight weeks. At the end of the eighth week, he/she reweighs and remeasures and compares status to expected fat loss. Based on gender and starting weight and height, the dieter knows the pounds and inches that will be lost during each eight week period. It’s amazing because the pounds lost and inches lost are usually at the same place.
If a person has labs retested at the end of just eight weeks, he will find marked improvements in glucose, A1C, lipids, vitamin D as well as blood pressure and HDL. Physically he will have lost pounds and inches, and his quality of life will improve with such factors as more energy, clearer focus and concentration, increased libido, improved skin, hair, nails, less depression/anxiety, and decreased gastroesophageal reflux disease.
This style of carbohydrate rest and pancreas/liver rehab keeps peoples` carb intake low enough that the pancreas and liver are not stimulated--and instead of fat production, people are burning fat.
It is a very easy-to-live-with eight week diet/exercise program. Instead of weighing, measuring, counting out foods, a person quickly learns the foods that are neutral in terms of liver and pancreas ramifications.
At this time, a person can continue on Step 1 or may move to Step 2. The second step is the reintroduction of carbohydrate foods based on low glycemic index/low glycemic load, targeting a range of carb grams to prevent over-carbing or under-carbing, and timing of carb insertions. Using the type, amount, timing method of carb introduction allows for continued weight loss at the same rate as Step 1.
In my next editorial segment, I’ll talk more about Step 2 as it explains the importance of proper reintroduction of carbs after a period of low carb intake. This step is the time in a lower carb diet when people who have lost weight, often regain it and experience rising blood sugar levels. Step 2 is the missing link in the diet for the millions of people with Met B.