Wednesday, 14 September 2011

Wheat and obesity

I've been reading on Tu diabetes of a new book that appears to claim that the wheat consumption in the US and their obesity levels are associated. I decided to look out some figures . As I couldn't work out how to post the relutant graphs I've put them here.

I managed to find this graph of wheat consumption in a set of countries
(as the print doesn't show up clearly, they are in order:


China,India ,USA ,Russia ,France,Canada,Germany,Turkey,Pakistan ,Australia,Ukraine, UK,Iran ,Argentina ,Kazakhstan,Poland ,Egypt ,Italy,Romania ,Uzbekistan .



I used data from the WHO to show the obesity levels in those countries


I really can't see any correlation at all.









Wednesday, 1 June 2011

Souvenirs of the London Marathon




A bit of an introspective post here.

It's taken over a month to get round to writing it and that's because it's taken that long to really want to think about it.
I had been looking forward to the VLM for a long time. I first entered within a few weeks of diagnosis and it's taken all that time to get in. The experience was a bit diasapointing.
Quite a lot of it was my fault. You have to put in the training and over the winter I didn't do enough. OK I can blame the weather, trotting backwards and forwards from the UK etc etc but basically I left it too late to build up the mileage. I managed some long runs in the month before the event but probably far too late and too big an increase in distance. The result was yes, I finished and I ran most of the way but in a desperately slow time. I knew I was running slowly but had hoped the event itself would help me to run a bit quicker, my fasted mile in recent years was done in the New Forest Marathon.

As for the event itself .
I really enjoyed the immediate build up.
We had a good day out at the Marathon Expo where you have to go to register . It was good knowing that my OH , daughter, son-in-law and grandchildren would be on the route to cheer me on.
The night before the marathon we spent in a Premier Inn near Tower Bridge. I'd booked it a year before. The hotel was full of runners and even served a carb loading pasta meal if you wanted it. I went for the normal menu. Next morning it was quite disapointing to be the 'healthy runner' and stick to muesli, red fruits and my nod towards extra carbs, a slice of wholegrain toast. OH had the full English cooked breakfast and very nice it looked.

I left early for London Bridge station and the train to Greenwich. Stupidly we followed advice and OH didn't come with me. The wait at the start was exciting but a bit lonely as most other people seemed to have someone with them. I almost spoke to a lady wearing a DUK vest but was a bit she, I wish I had now because I've now read her blog elsewhere and realise she was also wearing a pump. I tested BG whilst waiting and as I thought was fairly low, even though I'd had the extra toast at breakfast so I ate a cereal bar. I was determined to keep BG up during the run. The start of the race itself was a bit strange,. I was on the blue start, which isn't the one shown on the tele. After walking for a while I suddenly realised that I'd reached the start but it was hardly marked so it was a bit of an anticlimax.

I'm not going to go through a mile by mile analysis. Some things were great, the crowds as everyone tells you are fantastic, and a lot of them wait for the slower runners. I had the shock of my life when the first personyelled out my name, then I realised it was printed on my vest! It was great to see some of the character's There was a dinosaur . At one time I couldn't understand why sometimes a rhino overtook me and then I seemed to catch him up and overtake, there were several rhinos ! The man carrying a fridge, passed me somewhere on the course. He deserved far more than a medal. I passed the marching band, they were playing well at about 5 miles . I was glad to come across the centipede whilst they were taking a loo break, getting past a chain of 50 people cannot be easy!

It was fun running over Tower Bridge and great seeing the Houses of Parliament and brilliant running past Buckingham Palace with only a few yards to go but you see all the sights a lot better on the television than from the course.

Much of the course though goes through surburban London or Docklands and some of it is pretty boring. Also because so many bottles and gel packs are thrown down slower runners like me are surrounded by a sea empty bottles and the road gets wet from the spilt water and sticky from the gel. It's unpleasant.
The strangest part was I found it lonely. I've got used to running by myself, I don't even run with my OH much now. (and that's a mistake I think I was running faster when I ran with him). I also run in fairly isolated places, normally I might see a couple of tractors and the odd car but not much else. I think in consequence I run very much within myself , having lots of other people around me I just retreated into myself even more. Every 'official' photo of me has me with my eyes looking downwards. It didn't help when I missed seeing my husband , daughter and grandchildren. They weren't at the JDRF spot as I thought they'd be. I 'd been looking forward to seeing them and was really disappointed that they weren't there. (they had been at either end of Tower Bridge, OH had missed me when he tried to phone daughter. They saw me at that moment, but I didn't see them). For the next few miles my speed was really really slow , so it obviously affected me. I cheered up when I eventually saw OH at Docklands with about 8 miles to go and again when I at last heard the 'Go Granny' and saw everyone else about 4 miles from the finish.

Incredibly after the finish and a sandwich in St James's park. I felt fit enough to walk to Waterloo . My glucose levels were fine, I'd run with a reduced basal for the whole time and had taken in a lot more carbs than usual (about 100 including the cereal bar at the start) The lowest level was 5 and the highest reading was 7.8, though I doubt it was that high for long. So I really could have done better, I wasn't even sore the next day, just a bit down. In fact I was almost tempted to enter again for next year... but never again, I've done enough marathons. We have entered for the New Forest half though, it's my aim to get a bit quicker.





The fantastic thing about the London was the reaction of other people when I asked for donations for the JDRF. I was a bit reluctant to attempt to raise any money. I don't know many people so I didn't think I could raise much. I set up a just giving page and asked people. I was astonished by peoples generosity. When I saw the first few donations I cried, I was shocked! I managed to raise just over £400.


To all those people who gave can I again say thankyou.


To my anonymous donor, if s/he reads this thankyou also. I may not have totally enjoyed the event but knowing I was sponsored made it very worthwhile.

Saturday, 28 May 2011

Diet Transforms Canadian Community or there's more than one way to skin a cat

A little local trouble on a diabetes forum caused me to look the blog of a Canadian doctor. This particular blogger advocates the low carb/high fat approach. He has been working with groups from the Canadian First Nations.
On this blog I also noticed a favourable account of a doctor helping large numbers of people in his small community to loose weight. Stefan du Toit,a South African doctor now working in rural Canada is using a diet that is low carbohydrate, but at the same time not high in fat .The blog told me that he has so far helped over one hundred of his patients to, between them, loose over 3000lbs . Some have lost over 90lbs and many have managed to reduce medicines. Success indeed.

I thought I'd investigate this diet a bit more.
http://www.youtube.com/watch?v=EKOWp-GlH1A
and second shorter video from CBS adds a bit more information
http://www.cbc.ca/video/#/News/TV_Shows/The_National/Health/1244506052/ID=1778824999

Looking elsewhere ,I found a short article on the British Columbian Medical Journal. The results are impressive and there was a chart for one man with diabetes. It showed an HbA1c dropping from over 10% in January 2009 to about 5.4% in November 2010. His total cholesterol/HDL ratio dropped from over 6 to about 3.5 and his blood pressure also fell..
I learned that the diet had 1100 calories allocated for women and 1500 calories for men. Apparently, in spite of the fairly low calorie intake there is only about a 10% drop out. And it appears that some people at least have stuck to it for 2years.

The details of the diet are rather sparse , the doctor deliberately doesn't reveal very much . He stresses that it needs to be followed under medical supervision and of course that's really important if people need to reduce medications. He also suggests that the changes of diet may lead to electrolyte imbalances in some people
Nevertheless, as an exercise I had a go at working out what the diet might 'look' like.

From the info in the article and videos
it's a healthy eating programme
It's a low GI/low carb diet
Avoids processed /refined carbs
Its not a high protein diet or a' ketosis' diet.
It's a balanced diet that conforms to the Canada Food guide. Therefore can't be high in sat fat
Exercise isn't included whilst the person is losing weigh.(The doctor claims this is because it stimulates appetite but when the person has lost weight exercise is started. I assume this may help with maintenance.)
There may be some sort of induction, the man interviewed talks about the first month
In the original blog the author said he thought that people are started off with 80g carb per day.
It has a high success rate and seems sustainable for up to 2 years
I found an article that said it included 3 meals and no snacks..no confirmation of that though
.


The Canadian recommended dietary intakes are very much the same as elsewhere in the world
:http://www.hc-sc.gc.ca/fn-an/alt_formats/hpfb-dgpsa/pdf/nutrition/dri_tables-eng.pdf
Carbohydrate
Recommendations for macronutrients for people over 19
45-65% carbohydrates
estimated average requirement is 100g .
The RDA and AI ( adequate intake) is 130g
Protein
10-30% protein
The EAR for protein is .66g per kilo,
the RDA and AI is 0.80g per kilo
Fat
25-35% fat
men should eat 45g unsaturated fat, women 30g.
Saturated and trans fats plus dietary cholesterol should be kept low.

I did some figure juggling, using the woman's calorie intake example.
I tried 80g carb
80g carb = 320 calories : 29% of 1100 so already below guideline minimum, to get the rest of the calories would require either protein or fat to be above the levels of the guidelines: it wouldn't be a balanced diet. The figures don't work. So if the diet does start at this low level it is perhaps only for a short time.




A bit more juggling comes up with a distribution that seems to fulfil the criteria I found. (aprox figures)
130 g carb = 47% of 1100 calories = 520 calories
34g of fat = 28% of 1100 calories = 306 calories
68g protein = 25% of 1100 calories = 272 calories
That (if I haven't made a mistake) works out at 1098 calories and conforms to the guidelines and is low carb, low fat and not high protein..
(though protein is higher than that often suggested for people with reduced kidney function as it would work out at more than 0.8g/k of most women's ideal weight)

The Canadian guidelines also include advice on eating lots of fruit and veg , some grain with a preference for whole grains, plus fish/meat/alternatives ...it's suggested that pulses replace meat/fish for some meals, dairy and unsaturated fat (oil dressings)
It wouldn't be too difficult to work out the types of meals that you could eat. (my guess is that it will include lots of veg, some fruit, smaller portions of meat/fish and that he might make good use of low GI beans/lentils ) .

The difficulty with dieting; whatever the diet is sticking to it, to be honest I think a 1100 calorie would be hard for many people . Some people can stick with diets by sheer determination, you meet many such people on diabetes forums, the risks of high blood glucose levels forms the motivation. Not all people are that 'strong' though . I'm sure a charismatic doctor and the group sessions play a prime role in helping people maintain their diet. If a lot of people in a small community are following the diet, then this type of eating pattern becomes the norm. It must be much easier to stick t
Actually if I've got the type of diet right,(and this is only a paper and pen exercise to examine what it might look like.. Don't try it , I'm not a dietitian!), it doesn't seem that different to many commercial low calorie diets with support for example weightwatchers or Rosemary Conley.There are also lots of similar diets on the internet including one by Amanda Ursell, a well known member of the BDA, writing in the Times

Dr du Toit deserves big credit though, getting his community on board and been instrumental in improving so many of his patient's overall health. It would be great to see this sort of approach being tried elsewhere.
(I'm still not sure about the lack of exercise element though)







Friday, 12 November 2010

Monday 13th September 2010Day 3, Puivert – Espezel 9.72 miles climb 1783 ft descent :513 ft

(Garmin says 3102 calories)
Awoke to a blood glucose of 4.8mmol, again not too big a drop. OH went into the village for croissants and bread . We had some boiled eggs with bread for breakfast, I saved my croissant for elevenses.
At last we were on the Cathare trail proper. Puivert nestles at the very edge of the Pyrenees; the way forward was clear, round the lake, across the fields and upwards towards the higher ground.








The lake and castle at Puivert




Thats where we were going


The first 1.9 miles had only 121 ft of climb so was a gentle start. Then it got tougher. As we started to climb I became very conscious of the weight of the rucksack, it was one thing of the flatter ground but going uphill it slowed me quite a bit .The trouble is I’m not one of those people who can get by with the bare minimum of luggage. We took it steadily with frequent stops for tiny jellies and choc apricots, glucose levels were on the low side but not too low . I soon discovered that if my right shoulder was beginning to feel sore my levels needed topping up. It was almost as reliable as using the meter.


We spotted this newborn just before we started to climb up through the woods



The trail went gradually upwards though because it was through woodland it was more enclosed than I like with few long vistas. We saw more people today including some mountain bikers riding hell for leather down the hill.
The woodland trail eventually lead to the village of Escale, our lunchstop.


The village like so many others in the area helped provision the local Maquis. In August 1944 it was totally destroyed, set alight by Nazi troops .It wasn’t rebuilt until the mid fifities and there is a display showing the harsh temporary living condtions suffered by the locals during the early post war years.
After lunch we regained the trail which continues further upwards, past the PC du Masquisards, the stone hut which was the base of the Maquis. This was also set alight by the Germans but the resistants had already fled. It was restored in 1993.
The path eventually stopped climbing. We had started in Puivert at about 1550 ft and had climbed to about 3,200ft. We had started out walk amongst cultivated fields, it was really odd to have climbed so far and to be again in an area of very flat, cultivated fields. This was the Plateau du Sault and we were able to speed up for the last few miles to Espezel where we were going to camp.



In spite of the flatter terrain, we were quite shattered when we arrived, we eagerly anticipated putting up the tent and a shower .
The campsite was on our way into town, but our faces dropped when we saw it; long grass, a few ancient caravans, no sign of life. We went in, found a building and pushed the door open. It was the sanitation block, one door opened to show a loo au Turque, in the corner was a sink that didn’t look much more modern than the lavoir in our village, and much dirtier. We don’t mind camping, but this was more like slumming it.
We walked out and wandered into town We met a young French girl, she and her boyfriend were also doing the Cathare Trail, they had decided to bivouac outside the village. We felt we were too old for that so investigated other possibilities. We soon found the gite d’etape, actually an Auberge . Yes they had room and we were soon installed in a comfy double room complete with shower. We were going up in the world!



If you want a fun evening, stay at the Gite at Espezel. Its owner sporting a typical French beret is a fabulous mine host. The food is good and in available in huge quantities, no one would leave hungry. The wine flows very freely. There is no choice, but it was all good, charcuterie, duck, salad, sauté potatoes, cheeseboard, tarte aux myrtilles. Our fellow guests at the gite were a group from Denmark on a week’s organised trip (the type where your luggage goes from place to place, (I sometimes got a bit envious) They spoke good English and we all got along well. From them we learnt that there was an English/Australian group staying at the hotel. We also met an older French couple. The two groups and the 2 couples were to become our companions on the journey, overtaking them, being overtaken and meeting up in the evening. I really enjoy this aspect of long distance walking in France. Mine host decided to initiate our Scandinavian friends into the intricacies of drinking from a poron (none of them seemed to have spent youthful holidays in the Costa Brava). I ended up impressing him by joining in with the chorus of the Occitan anthem . We rather staggered to bed, my meter tells me I remembered to test, it was 4.9 thought fortunately had risen slightly when I tested during the night. Meals like that take a fair time to digest!
The graph shows reasonable control during the walk, so far but I was still skirting the lows a bit, its difficult to realise just how much you need to reduce the insulin when you are using so many calories each day. The mountain at the beginning, well it was certainly odd, perhaps something on my fingers from packing, or perhaps raised adrenalin levels as I started the walk. Who knows?
.

Thursday, 11 November 2010

Sunday 12th September 2010 Day 2 Ste Columbe sur L’Hers- Puivert 9.14 miles

Great morning, reading, it dropped just a bit and was 5.3mmol.
After a breakfast of boiled eggs and bread we took down the tent. We had arranged to buy some croissants from the little shop but neither of us felt like venturing into the village before breakfast.. We picked them up on the way and they made a very satisfactory 2nd breakfast later in the morning.
Unlike the the first day we had to rely on out map reading skills, the route followed footpaths but not any official route. We met no other walkers all day so it felt a bit remote and off the beaten track. The path started on the green way

but soon turned into the woods to climb through the woods

Then sharply down into the valley to out lunchtime stop of Rives, a sleepy place with a tiny village square to have our lunch in. During the morning, my pump had been firmly down at 20% , every now and then we stopped checked levels and I ate a few chocolate apricot bits ( OH put them in at the last moment and they were excellent fairly low gi carb nibbles. Lunchtime though glucose was just below 4mmol so very much time to refuel. We ate what was to be a typical lunch of bread soft cheese, tomatoes and peaches washed down with water.


After lunch, having gone down we went up again. The path was at times even more difficult to follow than in the morning. At one time it had been ploughed up and moved to the other side of a field. Fortunately OH map reading skills came to the fore and we worked out where we were.

It wasn’t the most scenic route since for a lot of the time we were enclosed by trees but occasionally we got glimpses of the mountains ahead.


Puivert castle came into sight, to our left. It was a little strange realising that this was one of the Cathar castles but we wouldn’t be getting any nearer.

Puivert itself was a busy little village . The municipal campsite was beside the lake and for once we weren’t the only people on site. We were given a large pitch for our tiny tent but had the luxury of our own electricity to recharge the garmin and mobile phone. (on other campsites we used the plugs in the sanitary blocks)
Tent up we collapsed for a while, unused muscles were beginning to protest but not for long as we had to find food. Glucose levels with the reduced basals, extra breakfast and the odd handful of chocolate apricots had been reasonable all day but a good dinner was a welcome prospect....Tonight it was at an Afghan restaurans , a rather odd thing to find in this part of France. Sadly we were a bit conscious of expenses so didn’t go for the specialities and I went for the menu fixe of salade with lardons (OK but not as good as the night before) and steak frites. OH went for a curry which was much better than they usually are in France. It was just light when we got back to the tent but it wasn’t long before darkness fell One thing about this walking is to remember to cut the bolus insulin with evening meals, the first night was a bit low considering the large meal and it had been a less hilly day. So I reduced the bolus by a couple of units. It didn’t make much difference as when I checked at bedtime, only about an hour after the meal but it was almost dark so it had to be bedtime it was 6.3mmol. Hoping that it wouldn't drop to far during the night I slept.

Wednesday, 22 September 2010

Day 1 Lavelanet to Ste Colombe sur L'Hers (8.29 miles.)

When we picked it as base we knew nothing about Lavelanet It was simply central and on some major footpaths.
We found it’s not a particularly beautiful town but seems like a good place to live with lots of things going on , some good shops and what seems to be a lot of communal/regional investment. We noticed two sports stadiums, a little theatre, a gym, outdoor pool, even the judo club had dedicated premises. The municipal campsite had a really good new, clean sanitation block, absolutely vital for making camping a reasonable experience. The site was managed by a very helpful lady who agreed that we could leave our car inside the site for the week.
The town used to be a centre of the textile industry. It grew up alongside a fast river. In early times the water was important for washing and dyeing the fabrics; later the water was used to power the looms. Many of the old factory buildings still exist and when we peered through the windows of one near to the textile museum we realised that it was still equipped (or reequipped for display?) with looms.






We slept the night in the ‘monstrosity’ , a tent that gives us loads of space but offends my artistic sensibilities , tents should be nice quiet colours not loud orange and reds. Unfortunately neither of us had a good night as we both felt a bit cold.



It took us forever to pack up the tent, pack and repack rucksacks trying to make sure we didn’t leave anything behind and then get going. It was 11.20am by the time we walked out of the campsite. As soon as I was out of the gate I realised I hadn’t checked glucose level, stop take off backpack; check. ...11.4mmol. I’ve no idea where that came from but decided not to correct Because it was so late we decide to stop for a coffee when we got into town but on arrival the cafe is shut with a , notice on the door ‘en greve’ .(.on strike), momentary panic...what if we get to our first stop and everywhere is shut because of the strike, will we get anything to eat? A quick look around reassures us as the cafe is the only business closed. About 20min later we find an open cafe (Lavelanet is a long town) and check glucose level which had descended to a more reasonable 7.4mmol. In fact at this point I lower my basal rate on the pump to 50%.
Restored (we’d done less than 2 miles!) we shouldered our packs and found our way out of Lavelanet onto the Voie Vert; an old railway track.


We were sensible to choose this route for day 1. It was a fairly easy, flat walk but with a backpack it took us far longer than it would do normally.





We went through a number of small towns once industrially important, now merely sleepy. It astounded me to learn that one industry horn working was big enough to necessitate the importation of horns all the way from New Zealand. I was a bit nervous as we approached a long tunnel, but I had no need to be,it contained movement activated lighting!





By lunchtime I knew that exercise was working it's magic on the glucose levels and I was in the high 3s by the time we sat down on the grass to eat. I cut the insulin for lunch in half and reduced the basal to 20% (0.1unit per hour). Even so I was sub 4 later and needed to stop for a snack before we got to our days campsite.
The site, just next to the track was basic but that didn't matter, we had it to ourselves. We set up camp and went out in search of food. First we found a little shop and checked they would be open the next morning so no worries about picnic for the next day.


We found a very unassuming looking restaurant and booked a table, then back to the site to rest a bit.

The restaurant was a brilliant surprise, A la Bonne Table was a cafe at the front , but at the back, a huge dining room. Since there were no windows the room was dark but was heated by a huge open fire (rather incongrous after the hot day) Later on we noticed it was used to grill steaks.
The meal was fantastic value for money. The portions were generous and everything was beautifully presented. To start a salad with lardons , this was big enough for a main course on it's own, a mixture of leaves topped with a mountain of crisply cooked lardons. To follow I had trout. It came scattered with almonds and accompanied by mussels, prawns and a creamy sauce...with a large number of slightly spicy baked potatoes (sans skin)...my glucose levels were good and I knew I had no fears about the amount of carbs but I couldn't manage all of them. After that a local sheeps cheese and to finish a thin slice of 'Opera', a gateau filled with a chocolate mousse.
A brisk walk home and to bed in our lightweight tent. A structure altogether more tasteful than the monstrosity


and whether it was the food and wine, or the temperature both of us felt very much warmer than the night before. Glucose level was 5.9 mmol, just a little worried that it might be too low.

Friday, 10 September 2010

Hi Ho, Hi Ho, It's Off To Walk We Go.

All packed including the kitchen sink.

This is my first multi day walk since the pump, hopefully fewer hypos than last time on MDI. Being able to reduce background insulin is my main reason for having it.

And meanwhile, here is one of the ups on our journey.

Montségur *this photo was taken by User:Gerbil from de.Wikipedia in August 2006 Category:Montségur)