Low-Carb Diets and Cycling

[Dianyla]

When you cut down on carbs, I hope you didn't cut down on protein too. If anything you want more protein, like at least 1 g per lb of lean body mass. You want your fat at about half that, and your carbs to be all you want of NON-STARCHY veggies, period.

I do have problems consuming enough protein. I've been off of the calorie counting wagon for a while, but when I was tracking daily consumption I had a very hard time just getting 50g of protein daily. Granted, I was not attempting to go low-carb at that time, I was trying to do more of a "Zone" 40/30/30 split. Just doing an offhand estimate, I think I can safely say I'm at least 30% body fat (my tanita usually says anything from 32-37% depending on dehydration). At 155 lbs, this means I've got ~110lbs of non-fat body mass, so I should be getting about 110g protein? Yeah, that's gonna be hard to adjust to.

[Triskeliongirl]

You can order the glucose monitor here: http://shopcart.shopmash.com/manu/10...5/product.aspx
The test strips are expensive, but if you get your doctor to write a prescription they are cheaper (I pay $40/100 with UTselectPPO). The meter will come with 10 to get you started. You can also order the strips from the same supplier.

This is the test. Its a home-made glucose tolerance test. Don't eat after you evening meal. Next morning, measure you blood glucose per the instructions with the meter. Then eat a breakfast of 3 pancakes with syrup, coffee, etc. if you like. Then call t=0 when you take your first bite of food. Measure the values at the following points: 30 min., 60 min, 120 min, and hourly thereafter until it comes to a value less than 100. Also, when you are feeling sleepy after a meal, take a measurement. You can PM me the results and I'll tell you what they mean. The 1 hour reading should be less than 200, and the 2 hour reading should be less than 140.


Interpretation of OGTT results (from: http://en.wikipedia.org/wiki/Glucose_tolerance_test )

Fasting plasma glucose should be below 6.1 mmol/l (110 mg/dl). Fasting levels between 6.1 and 7.0 mmol/l (110 and 126 mg/dl) are borderline ("impaired fasting glycaemia"), and fasting levels repeatedly at or above 7.0 mmol/l (126 mg/dl) are diagnostic of diabetes.

The 2 hour glucose level should be below 7.8 mmol/l (140 mg/dl). Levels between this and 11.1 mmol/l (200 mg/dl) indicate "impaired glucose tolerance." Glucose levels above 11.1 mmol/l (200 mg/dl) at 2 hours confirms a diagnosis of diabetes.

If you have impaired glucose tolerance, follow the diet in this book, Dr. Bernstein's Diabetes Solution. You can also order it from amazon, etc. http://www.diabetes-normalsugars.com/ (although I do eat tomatoes which he doesn't recommend).


Even if you don't have impaired glucose tolerance, but you would like to use these hormonal tricks to lose fat, follow the diet in this book, Protein Power Lifeplan: http://www.amazon.com/Protein-Power-.../dp/0446678678

The protein will protect your lean body mass, and diminished carbs will promote fat burning and curb apetite.

[Triskeliongirl]

I forgot to add, don't exercise when you perform the test, as exercise improves glucose tolerance.

[Dianyla]

Thanks for the wealth of information, Triskelion. I will let you know how it goes!

[Triskeliongirl]

Good luck! And YES, work on increasing your protein. As you eliminate strachy carbs, just replace them with more lean protein and non-starchy veggies.

My impaired glucose tolerance also went undetected for years since the screen is usually the fasting glucose measurement, and since I ride my bike to work, I'd always stop off for the test on the way, altering the results (its funny, they always tell you to fast, but they don't tell you to not exercise). Also, if you are a 'pre-diabetic' often it shows up much better in a glucose tolerance challenge, than a fasting measuremnt. In my case, I am fine when I don't eat starchy carbs, so my fasting measurements were only ever slightly elevated.

There does seem to be links between hypothyroidism and type 1.5 diabetes. Both can be autoimmune. I had a series of tests taken for that last week, but it takes 3 weeks for results. One idea is they can be triggered by grain allergies. Lectins in the grains resemble antigens on our pancreas and thyroid, so if we make an antibody to the grain lectin, it can then attack our thyroids and pancreas, reducing the cell numbers and therefore the output of both thyroid hormones and insulin. That is what we are suspecting is the underlying route of my problem (I already know I have autimmune thyroid - Hashimoto's - now checking for autoimmune diabetes. That is why even when I do eat a tiny bit of sugary carbs on the bike, I avoid grain sources.

GOOD LUCK DINANYLA AND KEEP US POSTED!

[Triskeliongirl]

One last thought about low carbing on the bike. When I stopped drinking gatorade or sugary drinks, I started putting electrolytes in my water. I don't both for rides under an hour, but do on longer rides.

[amymisk]

Thanks for all your updates. It sounds like you have put a lot of effort into solving your issues! Way to go, I am sure your body thanks you!

[onimity]

Wow, interesting post; thanks for sharing this.
I've read a bit about type 1.5 and assume that your doctors are testing to confirm that you are indeed producing insulin and that you also have Islet cell antibodies? Are you taking any medication, either insulin or something to help you produce more?

Carbs are important fuel, especially if you are active, but you are right to be keeping your blood sugars down. My sister is type 1 and we ride together so I've seen firsthand the ups and downs of balancing insulin/carbs/exercise; she's learning to do a great job with it. We've both been reading a great book called The Diabetic Athlete by Sheri Colberg that is really wonderful. It covers both type 1 and type 2, but it primarily deals with type 1 with some discussion of how type 2 medications can cause some of the same insulin/carb balancing issues that type 1 athletes have to deal with. It does a great job of explaining nutrition for athletes and how you have to adapt to that with diabetes. You might want to check it out.

Also, there was a great article on type 1 athletes in the NYT yesterday.
I would love to see tt1 in the TdF!

Anne

[Dianyla]

I'm baaaack with some updated information. It just gets curiouser and curiouser. I picked up a glucose meter at my local pharmacy and played around with it all weekend. I was all emotionally geared up for a premeditated pancake sinfest on Sunday. It would have been doubly sinful due to the fact that I've been off gluten for the last 6 months and I was really looking forward to an intentional indulgence. All in the name of research, right? Anyway, I got to my favorite cafe and they were out of pancakes! Who runs out of pancakes?!?!??!

Fasting plasma glucose should be below 6.1 mmol/l (110 mg/dl). Fasting levels between 6.1 and 7.0 mmol/l (110 and 126 mg/dl) are borderline ("impaired fasting glycaemia"), and fasting levels repeatedly at or above 7.0 mmol/l (126 mg/dl) are diagnostic of diabetes.

So I didn't yet do the glucose challenge, but I took quite a few blood sugar readings over the course of several days. My glucose level after fasting or sleeping is consistently 130-135 mg/dl. My post-ride "starving shakey shivery feeling like I've bonked" level is around 100-110 mg/dl.

The 2 hour glucose level should be below 7.8 mmol/l (140 mg/dl). Levels between this and 11.1 mmol/l (200 mg/dl) indicate "impaired glucose tolerance." Glucose levels above 11.1 mmol/l (200 mg/dl) at 2 hours confirms a diagnosis of diabetes.

In spite of the high fasting levels, my post-food numbers only climbed as high as 170 mg/dl. Most of these meals had a goodly amount of complex carbs and a small amount of refined sugars, with fat and protein. It took about 3 hours on average for my blood sugar to get back down to it's "normal" premeal value of 130 mg/dl. Sugary snacks (dark chocolate with whole hazelnuts, mmmm) failed to provoke anything higher than 160 mg/dl, though I didn't actually consume pure sugary stuff without fat or protein to balance it out. I'm hoping that the glucose challenge test will be more revealing.

So... verrry interesting. The biggest question in my mind is the 4 mcg of cytomel that I've been on for the last 4 weeks. I have no idea what my glucose levels were like before starting on this medication. I've been reading around and all the information I can find in the drug handout info, etc. is that cytomel can change blood sugar levels in diabetics, so one should monitor very carefully. I couldn't find much information about how exactly it changes levels. Might it raise or lower them, depending on the person and the condition? Could this just be a temporary adjustment effect of the medication?

I guess I'm a little stunned because I've never thought of myself as being at risk for diabetes. However, that Type 1.5 that you mention is very intriguing to me because I am intolerant to gluten and soy, both of which I consumed heavily until the last 6 months. In general I've never experienced the more common symptoms of diabetes, except during a long walking trip I did three years ago. On that trip, I had horrible edema, constantly infecting blisters on my feet, and neuropathy in most of my toes. I figured it was all because of the difficulty of walking 500 miles in 30 days, and just chalked it up to that. Now... I wonder. Plenty of other people who did the same trip had problems with blisters and sore feet, but not to the degree that I did.

FWIW, right now I still feel more on the hypothyroid side of things, being tired, sluggish, needing lots of sleep, low body temp. I don't feel overmedicated to the point of hyperthyroid with racing heart, hot/flushing, etc. In fact, other than being slightly less lethargic, I actually don't feel much different on the cytomel compared to before I started taking it. My next followup with my doctor is next week, I'll be interested to see what he says about this.


ETA: I did calibrate my meter with the provided glucose situation, and all that. I subjected my sweetie to a few random tests and his numbers all looked pretty good. So I think the meter is giving accurate numbers.

[Triskeliongirl]

Dianyla, the measurements you have taken so far are consistent with impaired glucose tolerance. First of all, your fasting numbers really should be under 100. I used to be ~110 but now I am 70-80. The post-prandial numbers you indicate are also too high (although you don't say how long after eating). You didn't mention you are gluten sensitive. You don't have to eat pancakes. The idea is to challenge yourself with ~100g of carbs. Another way is to just eat the equivalent in cycling gels. Feeling like you are bonking at 110 is exactly what happened to me. You are not bonking when your blood sugar is 11o, but you FEEL like you are because your blood sugar got so high during your ride that you felt like you were bonking due to the rapid change in blood sugar as it fell back to normal. Cytomel will not cause this problem. For years I blew off my symptoms as being due to my thyroid, but it was only when my endo asked me to measure my blood sugars that I realized what was going on. There is some connection I think. My body temp goes down when I eat carbs too, which is a thryoid thing. PLEASE BUY YOURSELF A COPY OF DR. BERNSTEINS DIABETES SOLUTION. I thought it wouldn't work for cycling, but I was amazed how much better I could cycle once I got my blood sugars under control.

A blood sugar of 130 is NOT NORMAL. Even though your post-prandial numbers may not be high enough to be classified as a diabetic yet, they are high enough to be classified as having impaired glucose tolerance which is a pre-diabetic state. Getting your insulin levels measured will tell you if you don't make enough insulin like me, or if your cells are not as sensitive to insulin as they should be. Do the test with gels and bring the results to your doctor to speed up your diagnosis and treatment, or bring what you have and ask him to order a glucose tolerance test.

[Dianyla]

OK, I called my mom up today to ask her about diabetes in the family and told her about the numbers I've been getting all weekend. She mentioned that she actually happened to have a nice quality glucose meter (OneTouch Ultra2 from LifeScan) with some nifty bells and whistles and she offered to loan it to me for a while to try out. I picked it up from her tonight on my way home from work and did some side-by-side tests. The cheap-*** meter I got last Friday is would give readings about 30 points higher (in mg/dl) than her meter. Before eating dinner her meter said I was at 95 mg/dl and my meter read 120 mg/dl. Pretty big difference, geez. I'm going to continue to monitor and track using her meter for the next week until I see my doctor to rule this in or out as a possible issue.

Cytomel will not cause this problem. For years I blew off my symptoms as being due to my thyroid, but it was only when my endo asked me to measure my blood sugars that I realized what was going on. There is some connection I think. My body temp goes down when I eat carbs too, which is a thryoid thing. PLEASE BUY YOURSELF A COPY OF DR. BERNSTEINS DIABETES SOLUTION. I thought it wouldn't work for cycling, but I was amazed how much better I could cycle once I got my blood sugars under control.

It is really hard to separate all of these issues. The more I read the more I'm getting confused. One minute it seems that hypothyroidism can cause glucose/insulin problems, the next it seems that diabetes can cause low thyroid function. I think I just sprained my brain. I will definitely check that book out, thanks for the recommendation.

ETA: PS: I know it doesn't have to be pancakes. I was just looking for a legitimate excuse to be naughty.

[Torrilin]

Even a cheap meter should give consistent results with other meters. It's pretty easy to get your meter calibrated incorrectly, so I'd recalibrate *both* meters. If your mom's meter is right, you're still getting spikes. And well, if your meter is right, those are scary spikes. That's part of why most diabetics trust their A1C numbers more than their daily numbers.

Even if you turn out not to have diabetes, the book Triskeliongirl is suggesting is good. Our endocrine systems are complicated, and a tiny change in the function of one part can have very large effects. So yes, if your thyroid doesn't work right, it can affect your pancreas, and your ovaries, and your pituitary gland... Thankfully most of us are old enough that the pituitary gland is off .

Note: Even with the meter error, you may *still* be looking at impaired blood sugar regulation. The high spikes you're getting are a lot higher than the high spikes my sister, dad, brother and I would get when we acted as Mom's normal guinea pigs while she was learning to use her meter. A "spike" on us would be around 110 (even for sugary stuff), and most random tests would have us in the 90-110 range. Mom uses any handy normal person as a quick way to check meter calibration after all that testing.

[Triskeliongirl]

Hi Dianyla, obvioulsy you need a reliable meter. The meter I recommended, while cheap to mail order, costs a lot in the store and is rated as very reliable (my doc gave me mine, same model). Technique is important too, be sure you wash your hands first so no food residues contaminate the results. Its harder on the bike, try to wipe the sweat off your finger or it can dilute the blood.

I also suggest that you arrive at you doctors appt. fasted and ask to have your fasting glucose measured in a lab, since a lab test will be most reliable. A real glucose tolerance test may also be indicated because of the problem described losing weight when you eat carbs. Again, a lab test removes the meter error. Knowledge is power.

I think you are getting confused because you are trying to put disease labels on things. That is why I am careful to use the word impaired glucose tolerance vs diabetes. Diabetes in fact is not a single disease. Type 1, 1.5 and 2 all have very different causes, although the end result in all 3 is impaired glucose tolerance. While of course thyroid disease is separate, sometimes the symptoms can overlap. For example, in the past when I complained about being tired all the time, falling asleep after lunch, etc., and my TSH was high I was given synthroid, or my dosage was raised. BUT, when these symptoms reappeared and my TSH was low, these symptoms were intially ignored (anti-depresssants were even suggested which I refused because I knew I wasn't depressed). It was only when I complained a year later that these symptoms continued, and I was gaining weight despite extreme diet and exercise that my internist referred me to an endo. He picked up right away on my only slightly elevated fasting glucose measurements. BUT, I was also put on a combo of T3/T4 (cytomel/synthroid) to be sure my thyroid was being treated optimally, and asked to start measuring my blood glucose response to food, which for me was much more problematic than my fasting levels. My new thyroid meds I know are helping, because my body temp is now higher (used to always be 96s-97s, now its 97s-98s), but even on the new thryoid meds, I still have impaired glucose tolerance, but I can control it by my diet, and keep my blood sugars always in the 70-120 range (even after a meal) by being careful what I eat. You may also want to start tracking your body temp. as a separate indicator of how well your thyroid meds are working.

You mentioned taking cytomel, but do you also take synthroid? If so, what are your dosages? What is your TSH now that you are on thyroid meds? If this is all too personal send a PM. Whether you do or don't have impaired glucose tolerance, you need to get your thyroid meds optimized.