Diet Priorities

[apod]

As has been posted, he focuses on sdLDL and said that shellfish will actually clear sdLDL.

Does Gundry have any particular favorite kind of shellfish? Scallops seem like a fairly methionine-rich muscle meat low in omega-3 with a good amount of phosphorus and nothing too unique (potential toxin accumulation?), while squid is interesting in that you get more dietary cholesterol there than an egg provides. Maybe raw oysters (potential Vibrio related food poisoning?) Or mussels (potential toxin accumulation?)

[Tincup]

As has been posted, he focuses on sdLDL and said that shellfish will actually clear sdLDL.

Does Gundry have any particular favorite kind of shellfish? Scallops seem like a fairly methionine-rich muscle meat low in omega-3 with a good amount of phosphorus and nothing too unique (potential toxin accumulation?), while squid is interesting in that you get more dietary cholesterol there than an egg provides. Maybe raw oysters (potential Vibrio related food poisoning?) Or mussels (potential toxin accumulation?)

The Maatrix list without E4 mods is here https://www.apoe4.info/forums/download/file.php?id=635

The listed shellfish include shrimp, crab, lobster, scallops, calamari/squid, clams, oysters, muscles. He told us only wild caught shrimp. He has said the cholesterol in shrimp are not an issue. As to "methionine-rich", he limits consumption to 20 g/day (4 oz serving) of any animal protein, for this reason.

From our first call with Gundry https://www.apoe4.info/forums/viewtopic ... ldl#p16389, "Shellfish will also help sweep away oxidized LDL, so eat as often as possible. Likewise, polyphenols will help sweep away oxidized cholesterol, so consume a lot. Unfiltered extra virgin olive oil is a great source of polyphenols." also "• Shellfish are incredibly good for you. They have plant sterols that lower your absorption of cholesterol. Want 4’s to eat wild shrimp (not farmed – don’t go near farm raised he says), crab, lobster any time they can. Farmed muscles, scallops, clams are OK as they are not fed anything."

[LanceS]

Thanks for explaining the macro balancing art. So hard. I was only watching out for carbs but overlooked the over consumption of protein. When you say "Perhaps timing the carb protein consumption to one meal to the extent possible," do you mean I eat each meal with the correct macro balance? I have been looking at daily balance but often much of the fat (macadamia nuts etc.) were consumed as snacks and not with my two meals when I eat most protein and carb.

Good point to identify what proteins provoke a glucose response in me. I don't eat meat. I will compare varies seafood I eat. Maybe nuts too.

I am going to try that lipoid acid. Currently my doctor has me on Berberine and Noni for glucose control.

Hubbs,

There is an idea that everyone has a meal size (composed of protein and fat mostly with carbs less than 10g) that does not produce glucose and insulin enough to knock dieters out of ketosis. This meal size is thought to be dependent on body size as well as time of day / time in relation to last workout. I would hope that you may also have a meal size that doesn't provoke a glucose / insulin response. For instance, I found that a couple of eggs and cheese (i've traded the cheese for veggies now) weren't a problem for me to stay in ketosis and thus didn't spike glucose / insulin enough to knock me out of ketosis. My "glucose insulin limit meal" is probably bigger than two eggs, probably up to four eggs but I just don't intuitively feel like eating that many eggs is something I want to do. In some sense any protein consumed during this meal would be "free protein" in that it would allow you to eat part of your daily protein budget without having to worry about glucose insulin issues.

Unfortunately I don't know of any rules of thumb for how to figure out how exercise impacts the ability of your body to absorb glucose. There are GLUT4 transporters that work with insulin and work with exercise to take glucose from the blood. Would it be better to eat then exercise? Or exercise then eat? What exercise affords you the most ability to absorb protein / carbohydrate? (Aerobic, HIIT, resistance training etc?) I don't know the answers to these questions but there seems to be no shortage of experts with opinions. It does seem like there are enough reports that indicate that aerobic, HIIT, and resistance training have beneficial glucose insulin results that if you can work them in and enjoy it... getting a little bit of each over the course of a week is probably a good thing. I would guess that timing a significant meal around your workout may be the best way to get your daily protein while controlling your glucose / insulin. You should check with your doctor to make sure new exercise is ok especially if you have beta cell issues. Folks with beta cell issues can have hypoglycemic complications that I don't understand. If you are exercising already without issues, maybe just check with a doctor before you add something new and strenuous in.

Whether you have beta cell issues or not... you are making very good progress. Many folks with beta cell issues struggle with whether it was something they did. Usually it is an unknown immune system issue... some docs check to see whether there is an antibody indicating the body has attacked the beta cells. No one really knows why this happens. So focus on the progress you are making. We all want to have the best numbers have the best diet, etc., etc. But for those of us whose numbers are "evolving" all we can do is make positive incremental change and be happy for finding new things that work better. Many of the things you are doing are working. Over time I think you will make progress on the glucose issues.

Cheers,

Lance

P.S. After re-reading I have come to the conclusion I am a terrible communicator. Sorry. The idea of the "no/low glycemic insulinemic" meal is that it could be a tool to get the day's protein and carbs into the body with a minimal glucose/insulin excursion. Whether your day looks like 1 of these with a large meal, or a few of these spread out among the day, that is probably dependent on the person, their lifestyle, and if there are beta cell issues I think that answer becomes more important. Just a possible tool to help.

[Surfrank57]

Total caloric intake for sure, unless you keep losing muscle tissue. Can't control glucose or lipids if you dump enough muscle. A whole lot of skinny people still die of heart disease. A balancing act for sure, glucose control is key for either system. It is a nice carryover for brain/ heart health. Cause and effect for all of it however.

Frank

[Hubbs]

Lance, I am very thankful that you took time to explain all that to me!

If I just eat seafood or eggs and non starchy vegetables in a meal, no pp bg rise above 120mg. It is when I want to expend what I can eat and testing the limit, the spikes disappoint me. After following George's link to read " The Law of Small Numbers," I became much more careful with the size of each food item I eat - for brussels sprout I eat half cup instead of one cup, and I am safe with 6 blueberries but not 12... As much as this is crazy limiting, it gives me a little cheer to know that I can still have a taste of my favorite food. Initially it was depressing for me to see that all fruits except avocado are on Dr. Bernstein's no no food list.

I am still puzzled by one experiment to eat a small meal before a 40min hike and what happened after:
bg 88mg before eating at 9:20am, finished eating salmon veggie with 1/2 green banana covered by flax meal/hazelnuts/cinnamon at 9:45am, bg 124mg at 10:16am, 148mg at 10:34am, 40 minutes later atop of the hill my bg readings are 59mg, 69mg, 62mg at 11:14am. I was shocked to see those low bg readings but I felt still full and no desire to eat anything. Do those readings indicate hypoglycemic? Is it a good thing to drop from 148 to 62 so quickly?

I tried smaller meals with less than 20 carbs each and was able to keep pp bg under 110mg. But I was snacking nuts a LOT between meals to curb my hunger. I haven't be able to prove if actually eating breakfast would lower my bg throughout the day, as some say. I also wonder if cut back on carbs more and more, our body might be more sensitive or less tolerate of carbs?

[Silverlining]

Hubbs, my numbers are very similar. I have 100 plus point swings in a two hour period. The only time I had a glucose tolerance test I started in low 90's, spiked around 230 at the 45 min mark, ended up at 60. That was about six years ago. I don't see those lows anymore. I've been tested for most known type of diabetes, Type 1, Type 2 (I have low fasting insulin), LADA, MODY. All negative. I use rapid acting insulin now for some meals. My father is on metformin and so was his mother in her later years. All of my grandmother's siblings were diagnosed diabetic and her brother lost a leg due to poor glycemic control. Also, my grandmother, father and myself are and always have been thin. My point here is my family has a type of glucose dysfunction that does not fit in any diagnosed pattern. We have at least one other member LAC that has similar BG readings. I think Julie has also had similar swings? I think while apoe might be at play, there might be more. One last note, my endocrinologist has suggested metformin but I already struggle with gastro problems related to defective connective tissue (gastro discomfort is common side effect of Metformin), so I use insulin instead. My father was on both basal and rapid acting insulin as well for a short time during his colon cancer journey. He was exhibiting bg fasting readings over 300. He transitioned to Metformin within three months as his body healed from the surgery. He has no unpleasant side effects. Maybe metformin might be an option for you if diet doesn't work. You're doing well, and I'm sure you'll find solutions!

[Tincup]

Do those readings indicate hypoglycemic?

Could be insulin resistance (IR).

Some time ago, I noticed on one of the online blood test ordering sites (pay out of pocket), you could order an oral glucose tolerance test, with insulin testing as per Dr. Kraft (without Drs. orders). The test was done at LabCorp. If you are interested and can't find it or a doc to order it, let me know & I will search again. This test should really tell a story. As I recall it was in the $200-250 range.

My gut tells me you have IR rather than no beta cell function. My reason is you wouldn't have the hypoglycemia (by the way the "lower" numbers you posted aren't, by themselves, an issue unless you have brain fog symptoms - on my keto diet, fasting 22 hours/day, I can get down there), if you were producing no insulin. What usually happens in IR is that you produce insulin in response to glucose or protein intake. The cells aren't taking it in, so you blood sugar increases and your body makes more insulin. Finally the insulin overwhelms the cells and your blood sugar drops.

Dr. Bernstein's book is an excellent way to get schooled in all of this.

In any case figuring out whether you have IR or LADA or whatever would be a very high priority. If IR, it may be solved with very careful diet. If it is LADA or T1, then that is a whole other matter and insulin may be indicated (a LC diet is still part of the solution).

[Julie G]

(((Hubbs and Silver,))) I’m sorry that you’re both dealing with weird glucose swings. My presentation was different in that I NEVER had the prolonged highs… although my FBG crept from the 70s to almost 100 as I approached 50 y/o. During my OGTT, the highest reading caught was only 140. My biggest issue was crazy (call the paramedics!) lows. I was so metabolically inflexible that I couldn’t shift into ketosis.

George is so much more knowledgeable about this than I am, but I’m certain I would have been Dxed with a type of diabetes had the Kraft assay been used. I’m guessing my insulin was sky high. It was never tested . (My cortisol was very high.) I was badly insulin resistant despite being thin and having great lipids. The BG roller coaster with severe hypoglycemia, elevated BP & belly fat (both new for me!) and high FBG were my clues. When we present with a mixed clinical picture (like Hubbs, Silver & I) figuring this out is hard.

I agree with George that BG lows (without symptoms are NOT a problem.) I can be in the 50s or 60s now without symptoms now, whereas when I was IR, I was very symptomatic when my BG was low. I also agree with George that a LC diet is managing my symptoms. For me, controlling BG swings has been key.

[Hubbs]

Lance, I re-read your post and really appreciative your advice that “all we can do is make positive incremental change and be happy for finding new things that work better.“ Keep things in perspective with a pragmatic approach. Yes I understand now and strive to use meal as a tool to get needed protein and carbs “with a minimal glucose/insulin excursion.” I hope to be able to rule out whether or not I have beta cell issues. I started with Tri Sugar Shield today – for lunch 1/3 banana + 5 blackberries on flax pancake didn’t spike bg over 120; but for dinner ½ carrots + ½ kiwi in a large green salad got bg over 148. I hope over time it will help reduce bg spikes enough to allow me …

Frank, forgive my ignorance, what do you mean by “Total caloric intake for sure, unless you keep losing muscle tissue.” On average I eat about 1200kcal/day and chronometer says I burn 1500kcal/day. But I am not losing weight, staying at 112-114lb for weeks. I gain weight easily but not so much muscle. I can walk for hours but dislike going to weight training.

Silver, thanks for sharing your experience. Makes me feel better that after all you can manage your wild glucose swing with success. No body else in my extended family has glucose problem and everyone gets to eat what they like to eat. And I am the only one who ate a mostly low fat vegetarian diet for 25 years - that might have something to do with my current problem. I also wonder if my surgery (removing ovaries and uterus) 6 months ago has something to do with my current glucose problem. But my A1c was 5.9 last May. Thanks for your encouragement and I sure hope to make some progress with all my effort and so many of you here helping me!

George, at this point I would feel so lucky if I have IR but not no beta cell function. I hope you are right, George! Yes I agree that figuring out whether I have IR or LADA or whatever would be a very high priority. I am waiting to hear if my primary care doctor would order the glucose insulin test for me. (I have had no luck to get a appointment with a good endocrinologist in Portland Oregon – every one seems overbooked for months ahead.) If not, I will get a test without a doctor. Google shows a LabCorp service a few miles away. I also found Bob Briggs’s a blog on “Kraft Prediabetes Bloodspot Profile Test” from Meridian Valley Lab. It's a 4hr test with blood spots provide at home, and his result matched Kraft’s Pattern 5. What do you think of taking the test this way?
http://www.buttermakesyourpantsfalloff. ... e-insulin/

Julie, I am inspired by you and many here working to find solutions to difficult problems, with success! Yes so far I feel LC diet and controlling BG swings is the right direction for me. In the last month or so I have dropped carb intake from 130+g to under 75g per day. I learned about flax meal pancake from George’s food posting. This week I baked a bread for the first time with almond flour. Those are helpful to fill in for my carb craving, and I look forward to making tasty new items to make my diet enjoyable again.

Update: I have since gotten a glucose/insulin tolerance test order from my primary care doctor. I just need to schedule it with a better lab in Portland so nothing gets messed up during the long test. I wonder if I should up my carb intake to 100g/day a few days before the test to make the test more accurate???

[circular]

Hubbs I think this is the thread where a week or two ago I had the thought of posting a suggestion that what we eat early in the day may influence BG reactions to later meals. At least I think this is the case. Anyone know? That is, your first meal was higher carb and your reaction not too bad, while the next meal was lower carb with a higher reaction. I'm not sure we want to assume that the second reaction was based only on the content of the meal just eaten and had nothing to do with the earlier meal. I just think I've read in the past (not on this forum) where, for example, eating certain things (was resistant starch one?) blunted BG reactions not just at the time but also after subsequent meals. The opposite may also be true?

Sorry I'm not being too clear. Really tired.