Diet/exercise info for insulin resistance/type II diabetes/general overweight

Hi folks,

Here’s a medical update, with diet and exercise plan for those of you who’ve asked for it. I was diagnosed with insulin resistance in January after years of insisting to no avail that something was wrong. I probably have something in the Syndrome X range, with insulin resistance and polycystic ovarian syndrome as the major symptoms.

**I am not a medical doctor; this is an account of what I’m doing, not medical advice. **Now with that scope of practice disclaimer made–

Since mid-January, I’ve lost 25 pounds and my blood sugar, with few exceptions, is where it’s supposed to be (<105 fasting, <140 postprandial). I’ll see my doctor for another glucose tolerance test in May.

The diet I’ve been following is basically Whitaker, Reversing Diabetes, though I have modified it slightly. To the extent that I can while still working and having a social life, I have checked this plan against current medical research on insulin management and weight loss. You may find the diet similar in some ways to the “modified Mediterranean diet” based on the Five Country study, and to the Zone Diet. There are several good studies, some including crossover designs, that appear to show that the American Diabetes Association diet increases insulin resistance (perhaps because it doesn’t address glycemic index or quality of grains). Atkins Diet appears to be effective in the short term at least, but the long-term impact of a high-protein diet, especially on people with diabetes, is still being studied.

FOOD
Aim for a moderate daily calorie count (I’ve been generally 1400-1800).

Decrease pre-packaged and restaurant food.

Aim for 30-45 grams of fiber a day, preferably from food (not packaged).

Eat something with fiber before eating the rest of the meal.

Measure foods and record constituents (as below).

Drink lots of water (>64 oz.) and low to moderate caffeine.

Eat at least three meals and two or three snacks, spaced relatively evenly throughout the day and evening.

Each meal should include some protein, carbohydrate, and fat.

Snacks should not be high GI/GL (see below).

You should eat before you get very hungry.

Aim for a daily breakdown of 20% protein, 60% carbohydrate, 20% fat.
*Count by food’s actual constituents, not by the simplified categories into which diets such as American Diabetes Association or Atkins lump a food (e.g., “1 fat exchange”).
*Account for all foods–nothing is “free.”

Protein: Lean, emphasizing fish with omega-3 and vegetable proteins
*Not more than 4 oz. at a time.
*About 2 tablespoons of raw, unsalted nuts a day.
*Whitaker gives a formula for determining how much protein to eat based on your current weight.

  Carbohydrates: Heavy on vegetables, some fruits, light on grains and pastas. 
        *Breads: Whole grain, sprouted, or whole-grain crackers.
        *Rice: Uncle Ben's converted, no sticky/glutinous rice.
        *Pastas: Cooked al dente in unsalted water.
        *Vegetables: Raw or lightly cooked, low on glycemic index, high fiber.
        *Fruits: Low on glycemic index, high fiber.

  Fat: Monounsaturated or polyunsaturated.
        *Include fat from other foods in total count.
        *Use olive oil; use canola only if needed.
        *Use olive oil spray or Pam on frying pans.
        *Examine labels of "fat-free" products; they're often high in sugar.
        *Do not eat too *little* fat.

Keep a food diary listing food, amount, calories, protein, carbohydrates, and fat.
*Subtotal the grams of protein, carbohydrates, and fat by category.
*Total protein + carbohydrates + fat.
*Divide each subtotal by the total to determine what percent of your intake falls into each category.

Eat foods with a low glycemic index.
*“Glycemic index” and “glycemic load” refer to the effect of a carbohydrate-containing food on blood sugar.
*GL = (GI value of food x carbohydrates in a serving of the food)/100, if this matters to you. Either GI or GL will give you a sense of how quickly the food raises blood sugar.
*Higher GI/GL foods raise blood sugar more precipitously, causing a greater insulin response, leading to low blood sugar (hypoglycemia/food cravings).
**Canned beans and cooked root vegetables typically have higher GI/GLs than dried and raw respectively.
**Sugar- or flour-based desserts are high GI/GL.
*Read labels for added sugar in other guises (e.g., corn syrup).
*A higher-GI/GL food can be buffered by
**eating a smaller portion
**eating the higher-GI/GL food with other foods that include protein and fat
**eating 4 tablespoons vinegar at the same meal
**exercising after the meal
**eating higher-GI/GL foods earlier in the meal
**eating higher-GI/GL foods earlier in the day
**drinking a small serving of alcohol with the meal (e.g., 2 oz. wine or 1 oz. vodka)
****if you’re taking Glucophage or insulin, discuss alcohol use with your doctor. Don’t start drinking if you don’t drink already or if substance abuse is a problem for you or your family.
*Higher-GI foods may increase hunger and food craving about 1-3 hours later.
*Eating higher-GI/GL foods or grains at dinner and before bed elevates my morning blood sugar.

EXERCISE
Exercise aerobically for 30-45 minutes before breakfast (coffee before is okay).

Exercise aerobically for 10 minutes as soon after a meal as possible.

In addition, do anaerobic exercise (stretches, weights) several times a week.

Exercise after eating higher-GI foods.

SUPPLEMENTS
(that I’m taking based on reading/finances/number of pills I care to take)

AM
Multivitamin without iron
Omega-3
Flaxseed oil
Calcium
Magnesium
Chromium
C with bioflavinoids
B
Garlic
Beta carotene

PM
E
Selenium
Calcium

MY TYPICAL DAY
Excluding little activities like working

Test glucose
30 minute walk (1.1 miles on hills)

Breakfast
Water
Apple or 1/4 c unsweetened organic applesauce
Coffee with T vanilla Silk soy beverage
Egg or 1/4 c egg substitute
Slice Ezekiel Bread
(10-15 minutes aerobic exercise)

Snack
Green tea
Apple or orange
10 almonds

Lunch
Tea, coffee, or water
Bell pepper
Cucumber with peel
Tomato
1/4 c sprouted legumes (peas, lentils)
Carrot
2 oz. smoked salmon or cooked chicken
T vinegar
t olive oil
1 portion crackers (3 thin Kavli, 1 thick Kavli, or 2 Ry-Krisp)
15-30 minute walk

(Snack
Apple, pear, or orange or 2 T nuts or raw vegetables)

Dinner
Water
(2-3.5 oz. red wine)
1-2 c cooked green vegetable
4 oz. protein
Salad (composed or lettuce/spinach and vegetables)
t olive oil
Apple
(10-15 minutes aerobic exercise)
(10 minutes anaerobic exercise)

Test glucose at 2 hours from end of dinner
Calculate food totals
(Snack
3 c air-popped popcorn or piece of fruit or 2 T nuts)

NOTES
Before I did this, I saw doctors who checked my heart and eyes, and I switched from albuterol to Intal for asthma. I’m still taking BCPs to regulate my hormone levels.

I’m still not as consistent with post-meal exercise as I’d like to be. When I manage it, my glucose and weight go down.

I can’t stick to only 20% protein consistently. 25% protein and 15% fat works better for me at the moment.

If I don’t keep a food diary, I consistently underestimate my intake.

I want to emphasize that in the past I’ve spent up to 8 weeks at a time exercising more, with lower caloric intake, and have not lost weight or felt better. Of this plan’s major variables (timing of exercise, balancing foods at each meal, eating high-fiber foods before other foods, attending to glycemic index, taking supplements) I couldn’t say which one, or which combination makes a difference, but it’s working.

In 11 weeks, I’ve
*lowered my glucose to target range
*lowered my pulse
*lost 25 pounds (almost 12% of my initial body weight)
*decreased my waist size by about 2" and gone down 2 clothes sizes and half a shoe size
*decreased acanthosis nigracans
*decreased sleep apnea/snoring
*decreased fatigue (it’s now hard for me to take a nap unless I’m sick)
*decreased allergies and therefore asthma
*decreased vision blurriness
*increased immune response? (I haven’t gotten the major awful illnesses that all my students had)
*decreased muscle cramping and burning while exercising and at rest
**i.e., I can actually “warm up” rather than having muscle fatigue and constant pain.
*In addition, my hair seems to be growing in more thickly.

This is actually pretty simple, but I wouldn’t characterize it as easy. Just buying, cutting up, and chewing all those vegetables takes a fair amount of time, and I loathe getting up at 6:00 AM in order to exercise before breakfast. For that matter, you may recall that I loathe making breakfast in and of itself. The diet has occasioned many irritable outbursts about the superiority of metric versus English measurement, but I have finally learned how many teaspoons are in a pint.

USEFUL TO HAVE ON HAND
Kashi Go Lean cereal
Ezekiel bread
Ry-Krisp, Kavli, and Wasa crackers
Raw almonds, filberts, and pistachios
Wheat berries, bulgur, and pearl barley
Popcorn and air popper
Dried garbanzos, peas, and lentils
Frozen fruits and vegetables (unsalted/unsugared)
Fresh vegetables cut into snack-sized pieces and kept in the refrigerator
Apples
Small containers of unsweetened applesauce

First press, virgin olive oil
Cold expeller-pressed canola oil (keep refrigerated)
Ghee
Low-salt chicken broth (doesn’t have to be low fat)

Chicken, salmon, tuna, shelled shrimp, scallops, divided and frozen in 2-4 oz. servings
Chunk white fancy albacore tuna packed in water
Vegan Boca Burgers (other varieties may have cheese that’s not indicated on label)
Flavorful cheese (e.g. chevre) to use sparingly
Egg substitute (compare labels for calories, chemicals)

Vinegar
Flavored teas and infusions
Stevia (sweetener)

RESOURCES WITHOUT EXCLAMATION POINTS
Brand-Miller, J., Wolever, T. M. S., Foster-Powell, K., & Colagiuri, S. (2003). The new glucose revolution: The authoritative guide to the Glycemic Index (rev. ed.). New York, NY: Marlowe & Co.

  Has a good Q & A section.

Challem, J., Berkson, B., & Smith, M. D. (2000). Syndrome X: The complete nutritional program to prevent and reverse insulin resistance. New York, NY: Wiley.

  Written as though you’re not too bright, but has few exclamation points and does cite research.

Mendoza, R. (accessed 4/3/2003). The Glycemic Index. Available: http://www.mendosa.com/gi.htm

  Under "Other Resources" you’ll find a link to a downloadable file of the GIs of 750 foods.

The NutriBase nutrition facts desk reference (2nd ed.). (2001). New York, NY: Avery.

  Lists more than 40,000 foods, including constituents, vitamins and minerals, and fast food/restaurant items.

United States Department of Agriculture. (accessed 4/3/03). Nutrient data laboratory. Available: http://www.nal.usda.gov/fnic/foodcomp/

  While not complete, this is a huge, easily-searched compendium of nutritional information (click "Search the Nutrient Data Base" in the upper left quadrant of the screen). 

University of Sydney [Australia]. (accessed 4/3/2003). Glycemic Index website. Available: http://www.glycemicindex.com/

  Another useful GI website listing different foods.

Whitaker, J. M. (2001). Reversing diabetes: Reduce or even eliminate your dependence on insulin or oral drugs. New York, NY: Warner Books.

  The basic source for much of what I’ve described above.

I hope that’s useful–enjoy!

Read “Neanderthin” by Ray Audette.

Good luck. It sounds like you’re doing well, but that level of record keeping would wear me out in about 8 hours.

Looks like a very healthy plan. I was just reading an article about something called “Fat Flush.” The thing that attracted me was something about the liver and making it healthier. The “fat flush” system looks like a healthy plan, too. I tried a search for info. on SDMB, but haven’t found anything.