Atkins Snacks as a way to get Low Carb? (Reprinted from Aug 12, 2016)

Walking down the Sam’s Club aisle (or the Pharmacy Aisle at Walmart) you can spot the Atkins snacks. This was my favorite.

I was eating those for lunch before I started the IF. I would typically eat two during the day. They didn’t send my sugars super high, but they didn’t let them drop down either. And I quickly found that I couldn’t use the net carbs of 3 grams listed on the label. It was just way too low when I was using the Insulin pump. I had to set the pump to the total carbs minus the fiber count to not have them mess me up. Trust your body over any label.

I think the reason is sugar alcohols. Atkins, likes other low sugar snacks, replaces sugar with sugar alcohols. Picking my favorite bar as an example, the Atkins Caramel Chocolate Nut Roll, they show the nutritional information as:

On the face of it this looks great. Let’s do the math.

  • 7g (Protein) * 4 cals/gram = 28 cals from Protein
  • 2 g carbs * 4 cals/gram = 8 cals from carbs

(My guess is Atkins doesn’t list the fat number on the front since most people still believe in Low Fat diets.)

Where are rest of the calories? Here is the detailed chart.

Fat presents 13 grams or 52 calories. Still short on calories. Turns out there are different numbers between Atkins and the nutritional label (forced by law). Atkins doesn’t count sugar alcohol as a carb in the Atkins Diet. They also don’t consider fiber as a carb. So from Atkins perspective the bar is only 3 net gram of carbs.

Atkins nutritionist writes (Ask the Nutritionist: The Scoop on Sugar Alcohols):

Sugar alcohols are not fully absorbed by the gut, which means they provide roughly half the calories that sugar does [ed: per weight]. Thanks to this incomplete and slower absorption, there is a minimal impact on blood sugar and insulin response. Because of this, sugar alcohols don’t significantly interfere with fat burning, which makes them acceptable on Atkins.

To calculate Net Carb count with sugar alcohols, simply subtract grams of sugar alcohols (including glycerin), as well as fiber, from total grams of carbs.

But I can tell you from my own experience the Sugar Alcohol used in these particular bars doesn’t act like that in my body.

Is it the fiber? The FDA estimates the amount of caloric contribution due to bacterial degradation of fiber at about 1.5 calories per gram of fiber. That would correlate to 1.2 calories from the fiber. Not enough there.

This article does a good job of analyzing the idea that Sugar Alcohols provide no net carbs (Can You Really Exclude Sugar Alcohols, Glycerin, Polydextrose, and Fiber?).

According to the article, the type of sugar alcohol matters. The label has two pieces of information with respect to sugar alcohols. This particular label lists 0 grams of glycerin. The sugar alcohol is hidden in the list of ingredients as Maltitol Syrup.

Some of the Atkins products use glycerin as the sweetening agent which the site says isn’t a problem. But this particular product uses Maltitol Syrup and the article says that is not a good sugar alcohol to use. The site states:

The glycemic index of one of their primary ingredients — maltitol — is higher than that of pearled barley or kidney beans.

Is there a solution?

The other ingredient glycerin had no glycemic load. The article concludes with:

You need to check which sugar alcohols are used in any low-carb products you buy. Just like different carbohydrates affect blood glucose to different degrees, so too do some sugar alcohols.

So, the other bar I would eat listed 5 grams of sugar alcohol and they were all glycerin.

Another article (Sugar-Free Labels Can Be Deceptive) reaches the same conclusions.

A Recommendation

I have also had the (Chocolate Peanut Butter Bar) and didn’t have a problem with my blood sugar rising. It also didn’t taste nearly as good. 8 of the 11 grams of sugar alcohol are glycerin. So the secret with Atkins bars is to look at the sugar alcohols and at the number from glycerin.

Is Low Carb Unhealthy?

There was a study done to determine the safety and effectiveness of a Low Carb (LC) diet vs a Calories Restricted Low Fat (CR-LF) diet (J Clin Endocrinol Metab. 2003 Apr;88(4):1617-23. A randomized trial comparing a very low carbohydrate diet and a calorie-restricted low fat diet on body weight and cardiovascular risk factors in healthy women. Brehm BJ1, Seeley RJ, Daniels SR, D’Alessio DA.).

The study was on fifty-three healthy, obese female volunteers.

The LC diet was more than twice as effective compared to the LF diet.

The very low carbohydrate diet group lost more weight (8.5 +/- 1.0 vs. 3.9 +/- 1.0 kg; P < 0.001) and more body fat (4.8 +/- 0.67 vs. 2.0 +/- 0.75 kg; P < 0.01) than the low fat diet group.

OK, so the Low Carb diet lost more weight and fat but was it safe? The study looked at the cardio risk factors and concluded.

Mean levels of blood pressure, lipids, fasting glucose, and insulin were within normal ranges in both groups at baseline.

Their conclusion?

A very low carbohydrate diet is more effective than a low fat diet for short-term weight loss and, over 6 months, is not associated with deleterious effects on important cardiovascular risk factors in healthy women.

So no, not only is Low Carb more effective than Low Fat, but it is also not any less healthy.

 

McDonald’s $1 Breakfast Burritos

Here is the nutritional information for McDonald’s $1 Egg and Sausage Burrito:

  • 300 Calories
  • 16 g Total Fat 25 %
  • 12 g Protein
  • 26 g Total Carbs 9 %

Up until 2 weeks ago (today) was eating two of these for breakfast. Not a bad deal at $2. Tasty, too.

Let’s double the numbers and see what we get:

  • 600 Calories
  • 32 g Total Fat 50 %
  • 24 g Protein
  • 52 g Total Carbs 18 %

A couple of observations here.

  1. Removing the 600 calories a day would result in under one pound a week of weight loss. I should have only lost 2 lbs in the past two weeks. But I’ve lost 14 lbs. Calorie counting doesn’t work.
  2. The claim that the two burritos are half my day’s fat is based on the old “low fat” diet model.
  3. No recommended daily amount of protein. Interesting.
  4. Most disturbing is the suggestion that I should eat more than 250 grams of carbs a day.

The Recommended Daily Allowance (RDA) numbers are (The Recommended Daily Intake of Calories, Carbs, Fat, Sodium & Protein).

Carbohydrates – 45 to 65 percent of your total calories
Saturated fats to no more than 10 percent of calories
Protein 0.8 grams of protein per kilograms

So if you eat 2000 calories a day they are recommending 900-1300 calories from carbohydrates. That’s 225 – 300 grams of carbs a day. This is deadly advice and the government should get it by now. There’s more than enough evidence that this level is just way too high. And telling Americans to get their carbs from non-refined sources doesn’t match what they see in the supermarket. Substituting wheat bread for white doesn’t do it.

 

How to tell if you are burning fat (Reposted from Aug 2016)

If you are on Intermittent Fasting you are burning fat. The same chart from before shows why.

Carbs pass through quickly, Protein less intense but longer and Fat even longer. But what is the significance of the vertical (height) of the curve? Let’s add another line to the graph to try and explain.

What is missing from the chart is scale on the time axis. The red line shows the energy needs of your body. If your energy input is greater than you energy needs then the body stores that energy. If your energy input is less than your body needs the body releases that energy.

In the chart above calories consumed as carbohydrates are consumed quickly but get stored in the body since they exceed the need of the body for energy. Protein is the same, but much less. Fat is below the curve. This is why the Low Carb High Fat diet works so well.

Dr Fung describes the means of storage as being in one of two compartments. There’s a short term storage (the refrigerator) andd a deeper term storage (the basement freezer). The body can more easily access the short term storage. To move from the shorter term to the longer term requires fasting.

This points out what’s the problem is with just Low Carb High Fat as a means of dieting. If you don’t do intermittent fasting you are only getting the benefit of the dinner to breakfast fast.

If you ate breakfast at 8 AM, lunch at noon and dinner at 6 PM you are keeping the energy level up with food you eat for 10 hours of the 24 hours. Worst than that the 10 hours is extended by the time if takes to digest the food from dinner. If it was a largely carb meal then it might be a few hours until you go to consuming what you stored in excess during the day. Your fasting might only be 8 hours and you spend most of that time working off the day’s excess.

Is there a simple mathematical model for this? Should be easy enough to figure out one and then calibrate it for a particular person. Two of the curves are parabolic or could be simulated with a sine wave.

 

Intermittent Fasting and Type of Diet (Reposted from Aug 12, 2016)

I think Dr Fung is often misunderstood. He appears on a lot of youtube videos with Low Carb High Fat (LCHF) diet folks. This has led people to believe that he is a backer of LCHF. From what I see he does support LCHF as a safe way of dieting but his actual advice is more nuanced than that.

Dr Fung’s position seems to be that the main point is to get to where your body is burning fat and they way he gets people there is to use Intermittent Fasting. To his way of thinking the type of diet matters much less than the Intermittent Fasting.

That doesn’t mean eat anything you want. He clearly says (How to Reverse Type 2 Diabetes, The Quick Start Guide):

The first step is to eliminate all sugar and refined starches from your diet. Sugar has no nutritional value and can therefore be eliminated. Starches are simply long chains of sugars. Highly refined starches such as flour or white rice are quickly broken down by digestion into glucose.

As long as the diet eliminates simple sugar and refined starches things are good.

Intermittent fasting allows time for the body to move from processing the last meal and into consuming stored fat from the body. Yesterday I did a 20/4 fast. I ate dinner at 5 PM and drank my last beer by 9 PM.

Status Aug 12, 2016 (Reprinted)

I had some good news this morning when I stepped onto the scale. My weight had dropped another 5 lbs. 10 lbs in 2 days. Looks like a switch got thrown to get rid of water weight. Plus, it’s been hot and humid here.

My insulin use was way down, too. Two days ago my insulin use was 42.0 and yesterday my insulin use was 29.2. My waking blood sugar was up a bit at 132 and it bounced up to 140 by a couple of hours later but that’s not abnormal for me.

My meal yesterday was satisfying. In fact, I ate until I felt sick of eating. Sick to my stomach of eating.  My total calorie count was too low at 1146 cals. I tried hard to eat Lower Carb and Higher Fat but only got to (% cals from source)

Carbs 11.6%
Protein 22.6%
Fat 42.3%
Alcohol 23.5%

I had less Craft beer than the day before (2 vs 3). However I did feel the effects a lot more than the day before. I attribute this to having less carbs to flatten out the response to the beer.

 

Intermittent Fasting – The Science (Reprinted from Aug 2016)

Looking at the science supporting Intermittent Fasting (IF) as it relates to Insulin Resistance/Sensitivity. Here’s  a study which has great information (J Appl Physiol 99: 2128 –2136, 2005. Effect of intermittent fasting and refeeding on insulin action in healthy men. Nils Halberg, Morten Henriksen, Nathalie So¨derhamn, Bente Stallknecht, Thorkil Ploug, Peter Schjerling, and Flemming Dela). They formed the study on:

… eight healthy young men [25.0 ± 0.1 yr (mean ± SE); body mass index: 25.7 ± 0.4 kg/m2] by subjecting them to intermittent fasting every second day for 20 h for 15 days…

What happened to their body weight? The paper continues…

Subjects maintained body weight (86.4 ± 2.3 kg; coefficient of variation: 0.8 ± 0.1%).

So on an every other day 20/4 fast over 2 weeks these eight healthy men did not lose weight. Not a big surprise there. Not a great diet for healthy young men to lose weight on. (Looking closer at the chart shows that they lost a couple of pounds.)

What were the results for Insulin Sensitivity? This is where it gets good.

Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03), and insulin-induced inhibition of adipose tissue lipolysis was more prominent after than before the intervention (P = 0.05).

I am not a scientist by any stretch of the mind, but I think the phrase “Insulin-mediated whole body glucose uptake rates increased from 6.3 ± 0.6 to 7.3 ± 0.3 mg·kg−1·min−1 (P = 0.03″ means they got better at using glucose, ie, their cells became more glucose tolerant. That’s the goal we are after for T2D like myself.

Seems like a change in 2 weeks of the glucose uptake rate from 6.3 to 7.3 is a significant response. When I do the math, that’s a 15% increase. And all these guys did was skip breakfast and lunch every other day.

 

Glycemic Index vs Glycemic load (Reprinted from Aug 2016)

The ADA site has an interesting study listed. The conclusions state:

No association was observed between glycemic index and SI, fasting insulin, AIR, disposition index, BMI, or waist circumference after adjustment for demographic characteristics or family history of diabetes, energy expenditure, and smoking.

This is a bit hard to accept but I have to question the results. How do they adjust for a family history of diabetes? I get the other categories but how does the American Diabetes Association (ADA) adjust for diabetes? Isn’t this what they are supposed to be figuring out?

Associations observed for digestible carbohydrates and glycemic load, respectively, with SI, insulin secretion, and adiposity (adjusted for demographics and main confounders) were entirely explained by energy intake.

This is true at least in part. The LCHF diet is most just LC and not so much HF. It’s easy to eat meats and miss the high fat sources. The end result of cutting out carbs is a lower energy intake than not dieting. Lower energy intake leads to lower body weights.

So this finding does in fact support a LC diet. It’s easier than counting calories.

Here’s the next interesting point:

In contrast, fiber was associated positively with SI and disposition index and inversely with fasting insulin, BMI, and waist circumference but not with AIR.

Fiber continues to look to be a good thing but if you are not eating a lot of plant roughage then you need to take it in supplement form. I think Dr Atkins recommended psyllium husk. But that would be another BLOG post…

 

Drinking Alcohol (Reprinted from Aug 2016)

This was originally a multi-part series from Aug 2016 where I explored the possibility of drinking beer and doing Low Carb.

Remember the food metabolism curve (Only Three Things in What We Eat)? That graph is only missing one thing. Alcohol.

The conventional wisdom (which seems to be repeated from Atkins) I have heard but now question is whether or not the body only burns alcohol if there are choices between alcohol and other things in the body. Alcohol is the best choice of all for the body in terms of ease of access so I wrongly concluded that the body puts off dealing with proteins, carbs and fats until the alcohol is metabolized.

The Atkins site (Q: Can I drink alcohol now following Atkins 40??) puts it this way:

The body burns alcohol for fuel when alcohol is available. So when it is burning alcohol, your body will not burn fat. This does not stop weight loss; it simply postpones it. Since the alcohol does not get stored as glycogen, you immediately get back into fat burning after the alcohol is used up.

Take careful note. They say that the body won’t burn fat but they don’t mention carbs or protein.

The truth is that the body burns all of the sources as best it can in some blended way. Some are more easily accessed than others and burn more quickly. Some are burned slower but all burn at the same time. Alcohol has it’s own curve for blood concentration (implicitly related to metabolism):

Also, Atkins can’t be right with the word “immediately” since this is such a long and smooth drop. What does make sense is that there are overlapping times when the alcohol level has reached a low enough point that the body has to start drawing energy from the stored energy sources. This isn’t a like a flipped switch at all.

Here’s some information on the interaction of Alcohol and other foods (Science here).

The concomitant ingestion of various foods with alcohol resulted in a decreased area under the blood alcohol concentration curve, a lower peak concentration and an increased time to reach peak. Michaelis-Menten kinetics indicated a decreased alcohol metabolism rate after the ingestion of carbohydrates or fats.

I think everyone who drinks realizes this (at least about carbs). If you eat food you get less drunk for both slower and longer. If you drink on an empty stomach you will get drunk faster but sober up more quickly. (PSA: Use those facts to whatever advantage you personally choose as long as you don’t drive. Find another way to stumble home than your car.)

However, that study does implicitly contradict the claim by Atkins. The study demonstrates that alcohol metabolism is reduced after the ingestion of fats. That implies to me that the body processes both at the same time. At least the dietary portion of the fat is still being burned. It’s not like the body puts the fat off into some corner and says that it won’t burn it until the alcohol is done. It does both at the same time. The alcohol acts slower but so do the other sources (Carbs, proteins and fats) just like they would in any other blended situation.

It is true that the body isn’t burning stored fat during that time, but that’s true of anything that a person eats. The body isn’t burning stored fat if it is getting enough energy from what you are digesting.

In fact the real story may be quite different. Take a look at the pathology of Alcoholic Ketoacidosis – a pretty serious condition (What Is Alcoholic Ketoacidosis?).

Cells need glucose (sugar) and insulin to function properly. Glucose comes from the food you eat, and the pancreas produces insulin. When you drink alcohol, your pancreas may stop producing insulin for a short time. Without insulin, your cells will not be able to use the glucose you consume for energy. To get the energy you need, your body will start to burn fat.

This is directly opposite of what Atkins says. At least for the alcoholic he has reached the point where his body is eating itself up by burning its own fat. That’s the exact goal of Atkins – to burn the body’s fat. The downside is that the blood glucose increases during that time. Note that this seems to take a lot of alcohol over an extended period of time but it does suggest that the alcohol itself does not prevent the body from burning fat.

Craft Beer

My drink of choice is craft beers. I am particularly fond of the higher octane varieties like Southern Tier’s 2X IPA. The nutritional data for that beer is:

Note that the summary below doesn’t get it right since it doesn’t include the alcohol as part of the calorie count.

This can be shown from the math:

Calories from carbs are 4 cal per gm.
Calories from protein are 4 cal per gm.
Calories from far are 9 cal per gm.
Calories from alcohol are 7 cal per gm.

So 12 ozs * .082 (percent alcohol) * 7 (cals per gram) * 28 (grams per oz) = 165 cals from alcohol. Calories from carbs are 21.4 * 4 = 85.6 cals. Cals from Protein are 2 * 3 = 8. This is 250.6, a bit more than the earlier table but close enough.

How Can I Keep Drinking?

So what’s the best strategy for drinking and losing weight/lowering insulin levels? The best approach is the “cut it out approach” but let’s look at the other choices.

First. seems like it would depend upon the type of alcohol. Craft beers, like the 2X IPA, have a pretty good carb count to begin with. That’s partly why they last longer in the body than say Jack Daniel’s Whiskey. Add to that the sheer volume of downing a 12 oz beer vs a 1.5 oz shot. Eating carbs lowers the metabolism of the alcohol and craft beers would have a slower effect than liquor.

Can it be explained by alcohol amounts? A 12 0z craft beer like the 2X IPA at 8.2% alcohol and 12 ozs has about one oz of alcohol in it. Except a person drinks it over an hour instead of 5 seconds it take to down shot.

If the goal is getting drunk then a few shots are a more effective way to get there. If the goal is to enjoy a few drinks over an evening than craft beer is a good choice.

I am convinced that there’s a dual effect of drinking carbolicious drinks like Craft beer with a meal. The carbs in the beer are one effect and the carbs in the food are another and they do add together. The LC treatment says both of these are bad and just cut them out.

If the goal is decreasing Insulin Resistance then it is believed to be helpful to drop the carb consumption. Carbs increase blood glucose levels requiring a quicker insulin response from the body than other sources of food (protein and fats).

The next question is then is it better to drink Craft Beer with dinner or wait a couple of hours and then drink. Certainly delaying alcohol gives the likelihood of drinking less which means less total carbs. Drinking a craft beer every hour or so from 5-11 would mean 5-6 beers which in this case would be 21 grams of carbs per beer. Basically a pretty decent carb load over an evening.

Delaying drinking until a couple of hours then has the effect of less drinking and less carbs combined with the advantage of letting the meal start to digest. If there are carbs in the meal they are then spread out and less bunched together.

So that is what I tried yesterday with success. I started dinner at 5 and ate for a short time. I then waited till 7 and drank beer at 7, 8, and 9 PM. I went to bed at 10 AM and work up at 5 AM to a fantastic blood sugar number of 111.

One thing I have noticed is that Rye Pale Ales do not blow up my Blood Sugar levels like other IPAs (wheat based Ales) do. Not quite sure why.

The carb levels look comparable. Hard to find anything out there on the difference and I’ve never met a diabetic to share the information with. I do remember that My grandfather had a wheat allergy of some sort and could only eat Rye bread due to some unknown digestion problems.

Is there an analogy to bread? The key may lie in the glycemic index/load. According to (The Glycemic Index of Rye Bread):

One slice of rye bread has a glycemic index of 41 and a glycemic load of 5, according to the Linus Pauling Institute at Oregon State University. In contrast, one slice of white bread, made from refined grains, has a GI of 73 and a GL of 10. A high glycemic index is considered 70 or more, and low is 54 or less; a high glycemic load is 20 or more, and low is 10 or less.

So if beer is really just liquid bread and the carb/alcohol numbers are the same, then it makes sense that Rye beer has a lower glycemic index and load over other Pale Ales of similar alcohol and carb counts.

I did a completely unscientific study and measured my BG at 111 and then drank a Rye Pale Ale beer. I then waited an hour and measured my BG and got 114. When I drank the beer I did not take a bolus like I normally would have in the past. I did the same thing a beer without a bolus and an hour later measured my BG at 112. The taste in my mouth tells me that I am out of ketosis. An hour and a half later my BG was 116 and I was solidly in ketosis.

This has been a disappointing year to find Rye Pale Ale. I bought one or two 12 packs and have not seen them at all over the year. Last year I could find Rye of the Tiger and other brands in the local beer distributors but not this year.

Beer can be healthy in moderation.