The current issue of Performance Menu, a journal devoted to hard core nutrition and strength training, has an interview with Yours Truly.
Many of our readers are coaches and trainers and are constantly facing a scenario of working with a type 2 diabetic or pre-diabetic. What are your basic guidelines for introducing a nutrition and exercise program? What have you found to be a safe rate of carbohydrate restriction in the type 2 diabetic? Do drugs such as Glucophage and Avandia increase the likelihood of an event of hypoglycemia or ketoacidosis?
MRE: In my medical experience I’ve found that with type 2 diabetics, the more carbohydrate restriction the better. We usually start diabetic patients on diets containing about 30 grams of available carbohydrate per day. When I first started treating diabetic patients with these low-carbohydrate diets I really pussy footed around with it. I would put these patients on the diet and wait to see what happened with their blood sugars. If they were on an oral hypoglycemic drug I found out in a hurry because their blood sugars cratered. After a couple of these experiences I began taking these patients completely off all oral meds when starting the diet. I watched them closely and would add a small amount of an oral agent back in if sugars didn’t respond, which wasn’t very often. Most patients, if they followed the program as they should, never had to go back on the meds. I went up this learning curve before the advent of metformin (Glucophage). Once metformin came along, it was the only medication I ever used in type 2 diabetics. To this day I have never used Avandia. I use Metformin only if I can’t get a patient’s blood sugar controlled with diet alone. I’ve never had a problem with ketoacidosis or with lactic acidosis with metformin.
I’ve set it up so that readers of this blog can download the issue of Performance Menu containing the entire interview free.
Click here, then request issue #22. You might want to consider subscribing because the journal is full of interesting info on diet and training written from a Paleolithic perspective. And it’s very reasonably priced. I read every issue.
Robb Wolf, the publisher, arranged a debate between Loren Cordain and T.
Colin Campbell, author of The China Study, a book recommending a low-protein, low-fat diet based on the authors study of the Chinese. The topic is the role of protein in degenerative disease. Apparently the debate is a real blood bath…Loren just destroys this guy. Robb is going to make the transcript available to readers of this blog. As soon as I get it, I will post it.