Saturday, 29 August 2009

Label Reading ( or the difficulty of choosing a savoury snack)

I don't actually eat many prepackaged foods but when I first developed diabetes, I spent hours studying the labels on those that I did, trying to make the best choice. I still do this when I go to the UK as there are always lots of enticing new products in the supermarket, though often they don't live up to the packet blurb. Like many people I'm a creature of habit so don't have to label read so much now and shoppings a lot faster.
That is until something I buy regularly is out of stock., then it's label reading time again.
Today it happened with the Palmiers, savoury cheeesy biscuts.
Now these are not a healthy food, they are a calculated indiscretion. Quite frequently I go for a run or swim in the late afternoon, then its time to cook dinner . By this time blood glucose is often low In the 20 minutes or so so before serving up its time to pour a glass of wine, and I 'need' a little 'something' to stop my BG going through the floor (well thats my excuse, my diabetologue doesn't agree ) This is where these little biscuits come in.The label tells me they are 46% carbs, (but they are very light), they'e a bit high in lipids and probably too much salt but all they contain is flour, cheese, butter, sunflower oil and some seasoning. They are similar ingredients to the cheese straws I used to make. Not that good, but not horrendous either.

So what to get when there are no Palmiers. It probably took me ten minutes. There were lots of packets to choose from.
The first one had 76%. carbs- a bit high ;
the next contained palm oil-don't want that;
a third hydrogenated and partially hydrogenated fat .(trans fat) -no thanks;
sirop de glucose fructose... I assume thats high glucose fructose syrup, definitely rejected.
Almost all had huge ingredient lists complete with chemical cocktails of flavourings and preservatives. I think I went through almost all the savoury 'snack items' and didn't think I could compromise on any. Just as I was going to walk away, I found a new product: petites tuiles aux 4 cereales: 60% carbs but a whole packet only has 75g, 22% fat but mostly unsaturated and 6% fibre.They contain corn, wheat oat and rice ;sunflower oil : fermented pasturised cream (sour cream?) cracked black pepper and salt. Are they any good, I don't know yet, they'll probably taste like cardboard. If I do like them and they don't cause blood glucose havoc they won't have any next time.

The horrifying thing was what was in most of the products. It's a tiny market here compared with the UK but a growing one.

Thursday, 27 August 2009

French Paradox?

Fruit and vegetables, locally grown and sold in large quantities

A variety of well made cheeses, from cows, sheep and goats

Meat, locally reared and killed. The notice shows the names of the farms from which the animals came.

Some fish, always lots to choose from.

Pain de campagne, low gi and eaten in large amounts

Something to finish the meal, not everyday and not too large or too sweet

But don't forget the wine!

So what do the people who according to the statistics are a part of the French paradox seem to buy and eat? Butchers sell all kinds of meat, beef, pork, veal, lamb, lots of duck and other poultry ,rabbit and occasionally goat and horse. Nothing is wasted, almost everything is eaten including parts of the animal usually relegated to pet food in the UK.
Though a long way from the sea, fishis extremely popular and far more plentiful and varied than in the UK. (even our local 'fast food ' restaurant Flunch always has at least 4 fish dishes every day). Dried, salted cod is used in traditional local dishes.
People struggle home with whole trays of fruit, it was melons and peaches this week. Seasonal fruit and vegetables are relatively cheap and people eat lots. Cheese selected carefully but eaten in fairly small portions. Bread, often pain de campagne (made with coarse flour and soudough raised ) rather than baguette is eaten at every meal.
French patisserie , often very rich, tends to be just for Sundays and special occasions, for everyday eating fruit is more common. And the wine, well people drink it,but I often get the impression that they drink less at any one time than the local British inhabitants.
My part of France has the highest life expectancy in France. Most of my neighbours are very elderly. One of the reasons I think they have such long lives is they have been active and remain active. Sadly, when I read the the local paper it often seems that the most common causes of death of the older farmers areagricultural accidents... often turning over the tractor on a steep hill. These men and women have lived hard lives,their youth was during ww2, a time rarely mentioned but I gather that times were hard. Market in the past was as much as anything a social occasion, much of the food was (and is) grown or reared at home. The market was a place to sell the surplus produce and to meet friends and relatives from other villages. Even today much of the chat between locals is in 'patois', here a mix of Occitan and French. Now they drive or are driven to market, but in their youth everyone walked; every week 15km there, followed by 15KM back again.
Whilst they still can, my neigbours continue to walk, perhaps only a few kilometres a day. I see them walking the quiet roads, stick in hand. Apparently the GPs say that they should walk a minimum of 3km a day but I don't think they need to be told, it's what they've always done. The terrain round here isn't easy, it's hard to to farm and you need to be fit to walk any distance. In the photo below I tried to show the hill outside our house . It goes down 250m and then straight up again. One tourist book calls it the land of the 1000 valleys. I'm sure that working and walking in such an area must develop good cardiovascular fitness.
I don't really think there is a paradox. The local diet includes a huge variety of foods, mostly local, fresh and homecooked. People don't count calories, carbs, types of fat or check their vitamin intake. Whats missing, at least in the diet of the older generation are biscuits, crisps, ready meals , sweets and fizzy drinks and snacking between meals. They've also had a lifetime of hard work and whilst they are still able, continue to keep themselves fit.

OF MICE, CVD and Forums

Actually its far too hot!
The various forum debates on this piece of research were fairly predictable, ranging from the thoughtful and valid questions about the use of animal models to potentially libellous statements about the scientists integrity. On reflection the most useful thing about this study maybe future reseach into whether there are better bio markers for artherosclerosis.
One poster did mention the French paradox. As it was market day I decided to take some photos to show my views on some of the reasons for this.

Tuesday, 25 August 2009

Diets and CVD

When I was first diagnosed I had an echograph on my arteries. My doctor was a bit concerned about the amount of plaque but the blood flow was fine. I more or less followed the French dietary suggestions, from various leaflets but took account of GI of carbs. My dietitians advice was directed this way and at the start I was far too afraid to vary my insulin by much so ate fairly prescribed amounts of carbs. At the end of the first year my HbA1c was down in the low fives and another echograph showed much less plaque. I now get scans every 2 years and my diabetologue is far less worried. What I do works for me.
On the other hand,there are lots of people on various diabetes forums who advocate a low carb , sometimes very low carb approach. They frequently decry mainstream science and like to claim that it is carbohydrates alone that are responsible for CVD and the current world obesity problems.
Their gurus are people like Drs Atkins and Bernstein, their hero is the science writer G Taubes .They love to cite certain high profile blogs.I'm sure most people reading have come across them.I have dutifully read much of the required reading, but I haven't been convinced. I feel that extremely low carb diets have not been shown to be either effective or safe in the longterm . ( I certainly don’t buy a high in anything diet either).
At times I have been really worried about the way they promote the diet., their woe (way of eating) as the only way, a diet to be embraced no matter what a person's lifestyle, activity level or medical history .
Recently these people have been able to quote limited studies, which suggest low carb diets as being effective in the short term for losing weight, and for lowering glucose levels in type 2 diabetes . These studies have suggested that LDL cholesterol and triglycerides fall whilst HDL rises.
(funnily enough quite frequently low carbers argue that cholesterol levels don’t matter, but thats another subject)
Its not surprising that this headline caught my attention this morning.
Low-carb diets linked to atherosclerosis and impaired blood vessel growth
It related to a study on arterial plaque and diet using mice model
The press release contained some background anecdote to the study.

"The study’s first author Shi Yin Foo, an HMS instructor in medicine and a clinical cardiologist in the Rosenzweig laboratory at BIDMC, first embarked on this investigation after seeing heart-attack patients who were on these diets – and after observing Rosenzweig himself following a low-carbohydrate regimen.
“Over lunch, I’d ask Tony how he could eat that food and would tell him about the last low-carb patient I’d admitted to the hospital,” said Foo. “Tony would counter by noting that there were no controls for my observations.”
“Finally,” said Rosenzweig, “I asked Shi Yin to do the mouse experiment – so that we could know what happens in the blood vessels and so that I could eat in peace

So the researchers from the Beth Israel Deaconess Medical Center devised a study. They used ApoE mice...... apparently normal mice don’t spontaneously develop artherosclerosis but this particular strain has been created in laboratories. When fed a western type diet the mice quickly develop very high levels of VLDL (very low density lipoproteins) and develop arterial plaque resembling human plaque . These mice have been used as a human model in a variety of studies on dietary interventions, pharmaceuticals and investigations into lipid metabolism. They are useful, but as with all animal studies the results may not be directly applicable to humans. (Meir and Leitersdorf 2004)
They fed the mice one of three diets: a normal mouse “chow” diet (65 percent carbohydrate; 15 percent fat; 20 percent protein), ; a “Western diet” (43 percent carbohydrate; 42 percent fat; 15 percent protein; and 0.15 percent cholesterol); or a low-carb/high-protein diet (12 percent carbohydrate; 43 percent fat; 45 percent protein; and 0.15 percent cholesterol). They observedthe mice at 6 and 12 weeks (growth is a lot faster in mice than humans!) Just as in recent human trials the ‘low carb mice’ gained less weight than the ‘Western diet mice’ but greater amount of artherosclerosis. The control group of ‘normal chow mice’ had ‘minimal
evidence of artherosclerosis’. When the markers for CVD such as cholesterol levels were investigated, mice on the low carb diet had similar or lower markers to those on the Western diet. So this didn’t explain things. However one finding was that these low carb diet mice had a 40% reduction in EPC ( endothelial or vascular progenitor cell ). What they don’t yet know is what the roles of these cells actually is.

So what was Professor Rosenzweigs reaction to the study?

these results succeeded in getting me off the low-carb diet......... This issue is particularly important given the growing epidemic of obesity and its adverse consequences. For now, it appears that a moderate and balanced diet, coupled with regular exercise, is probably best for most people.” (Prescott 2009(Augus24))

Meir, Karen S., and Eran Leitersdorf. “Atherosclerosis in the Apolipoprotein E–Deficient Mouse.” Arteriosclerosis, Thrombosis, and Vascular Biology, 2004: 1006-1014.
Shi Yin Foo, et al
Vascular effects of a low-carbohydrate high-protein dietPNAS published online before print August 24, 2009
Prescott, Bonnie. “Low-carb diets linked to atherosclerosis and impaired blood vessel growth.” online press release , Beth Israel Deaconess Medical Center, 2009 (August 24).

It will be interesting to read the various responses on diabetes' forums to this research

After the Fete:

A fantastic evening, 510 people fed and a packed dance floor from the start.
I love the way everyone joins in from toddlers to great grandparents with every age group in between cluding the hard to please teens. We did a fair amount of dancing though OH’ s legs were a bit stiff after the run in the morning.
As for blood glucose levels, I ate the melon , missed out on the charcuterie, bloused before the green salad , chicken and a bit of bread, ate the cheese but declined the flan. Because it was a relatively low carb , meal my bolus worked out at 3.2u. Even so, I probably over estimated a bit as was down at 3.8mmol (68.4mg/dl) when I got home. The red wine probably played a part. A cup of coffee and a biscuit called a fouree framboise. (a bit like a jaffa cake with raspberry jam and dark choc) This did the trick and my fasting level next morning was 4.4mmol (79.8mg/dl).
Clearing up
Next morning was the clearing up. About 35 volunteers did all the cleaning down, humping and dumping of chairs and tables necessary. By midi everything was ready for a meal of ‘restes’.. leftovers. There was a great debate as to the quality of the pate and the jambon this year.... pate excellent, jambon ‘moyen’. I decided to be on a regime to avoid the extra dish of a ragout made with the chicken livers and gesiers (gizzards) . Other half said they were very good...... but why did he bring home a carefully wrapped package for the cats?

Sunday, 23 August 2009

Our Village, En Fete (a bit about life in this part of France ... not much about Diabetes!)

Back home In England, you think of the school fete, the church fete , or the Red Cross fete. You know the sort of thing, cake stalls, tombolas and Mrs Jones’s class dancing round the maypole. Here the word applies to all sorts of feasts, festivals and partied but in this part of the world, this is the season of the village fete, much bigger events to their English counterparts. Originally, they were big parties held in the summer to welcome back the children on their holidays from work in Paris and other big towns. This still happens, relatives try to come back for the fete last year I met an elderly lady who had left the village 65 years ago as a GI bride. Every ten years or so she returns for the fete.
So what goes on? Each village has its own way of doing things, they don’t change much from year to year as it makes it easier to organise. Last night we travelled about 30km to a village for a Celtic night. This village (population 417) hosted an event with 3 music groups from Ireland and France, pipers from Scotland and Galicia, a barbeque and bar for well over 1000 people in a giant tent. (That was the first of several events including a large vide grenier and a huge meal to round it off)
Our village is a bit smaller; there are no more than 60 people, about 35 in the village, the rest in neighbouring farms. This includes several octo and nonagenarians and a handful of children. This morning we organise a 10km and 15km run. This is not for the faint hearted, it includes lots of climb and some quite rough terrain. This year the competitors won’t have to worry about the mud like last year, we’re in the middle of a heat wave and the temperature will be very high. My husband is running, but I’ve chickened out this year, though I have run in previous years.
The afternoon is gentler, though just as fiercely contested; a pentanque competition.
In the evening is the main event, a bal for up to 800 people. On the menu, melon with a slug of Muscat, charcuterie , pain de champagne, green salad, our famous poules a la broche, (chicken on a spit), cheese, fruit tarte, lots of vin rouge, oh and coffee with eau de vie to round it off. The whole lot accompanied by dancing to a top class accordeoniste, Sylvie Pulles with her band.
This is completely organised by the local people. The chickens are local. They arrive from neighbouring farms on Saturday morning.... still squawking. (Stop reading now, if you’re squeamish)
Everybody helps. The chickens are efficiently dispatched by a middle aged couple. An elderly man plunges them into a bath of hot water. Then they’re plucked , feathers flying everywhere, and then draw. All the edible innards are then washed and set aside for making into charcuterie. The chickens are trussed, with strips of lard tied to their breasts, seasoned with salt and garlic and are ready for cooking over a wood fire next day. About 250 chickens are prepared like this! The charcuterie comes from a local firm; this has to be cut up, as do the melons, the bread and the flan. The lettuce has to be washed. Tables collected from the main village in the commune and set up. ... I could go on. There’s a lot of work and for most of my neighbours the day job doesn’t stop for the fete. The cows still have to be milked.
My problem as a diabetic is just how to bolus for this very large meal strung out over 2-3hours. I’ll let you know tomorrow how I got on!