Sugar Alcohols Update: Maltitol

Back in March, I wrote an entry about sugar alcohols; what they are, how they're used and how someone following a low-carbohydrate diet can enjoy sweets without the carbs or guilt. Since then, I've had to do a litle more research on the topic because I've noticed that one of the sugar alcohols in particular - maltitol - has quite an effect on my blood sugars, despite it being a "low-carb, low-sugar" alternative. Here's what my experience has been:

The nutrition information on the Russell Stover Assorted Fruit Hard Candies say they have 17g of total carbohydrate, 0g of dietary fiber and 17g of sugar alcohols per 3 pieces. Based on the information we know about sugar alcohols (subract them from total carbohydrates), this would mean that 3 hard candies would have no carbs. Right?

So then after having 3 candies with my dinner, giving the correct doses of insulin (plus a correction if needed) and maybe a unit extra for the candy just in case, why are my blood sugars sky high? I thought maybe it was something I had eaten and forgot to bolus for, but I get the same effects when I have Atkins bars or any other brand of sweet with maltitol.

I conducted a little experiment the other day. I checked my fasting blood sugar and it was 14.2. I had just an Atkins bar (with maltitol. Not all of them have it) and gave my bolus for it (1 unit) as well as a correction dose (3 units). 2 hours later, I checked my blood sugar again and it was 17.3. 3 points higher than my fasting blood sugar after giving 4 units of insulin!

I did some reading on maltitol and it turns out it does have an impact on blood sugars and it's recommended that diabetics and low-carbers stay away from it as it will raise blood sugars, increase insulin needs, and stall weight loss. It turns out that maltitol has a glycemic index of 52 (table sugar is 60). A potato is 57.

Here are the gycemic values of the most common sugar alcohols:

• Maltitol syrup, intermediate: 53
• Maltitol syrup, regular: 52
• Maltitol syrup, high: 48
• Polyglycitol / hydrogenated starch hydrolysate: 39
• Maltitol syrup, high-polymer: 36
• Maltitol: 36
• Xylitol: 13
• Isomalt: 9
• Sorbitol: 9
• Lactitol: 6
• Erythritol: 0
• Mannitol: 0

Most Atkins bars don't have maltitol, but there are a few that do - mainly the Endulge bars. As for Russell Stover, I e-mailed them asking if they have any products without maltitol or if they plan to make any in the future, and they said that unfortunately all their products are sweetened with it. The second question went unanswered, so I'm assuming we won't be seeing any maltitol-free products from Russell Stover in the near future.

In the meantime, I found this awesome website that is very useful for people with food intolerances. It allows you to create a profile where you can select which ingredients you don't want in your diet, and from there you can search through their database and see what exactly is in your food. It'll tell you which foods to avoid based on the ingredients you selected.

To learn more about the negative effects of maltitol, check out this article. Remember to always check ingredient labels as well as the carb and fiber content in foods to be sure you know exactly what you're eating. Hopefully getting rid of the maltitol in my diet with help bring my blood sugars back down to a reasonable level. We'll see - I'll have to update at a later date.

Andie

Stalls, Struggles, Frustrations and Inspiration

Since my last experience at the hospital, I've been under a constant state of stress. My high blood sugars in the hospital had me feeling tired, achy, moody and emotional and the symptoms have continued into my second week at home. Although no longer in the mid to high 20's, my sugars keep fluctuating from an 8 to about 19 despite adjusting my insulin appropriately, and these major fluctuations have me feeling worn out, tired and extremely frustrated. To make matters worse, my ketones haven't gone back up to the level they were at before - which in a sense I guess is a good thing because ketones and high sugars can only mean more trouble than good - and my weight loss has stalled, making me feel like, "well what's the point?"

The point is, stalls happen. Life happens. Unfortunately for me the affects of that hospital stay have continued for longer than I had expected, but it was something that couldn't be avoided. Other people struggle with giving into cravings or have to take medications that can stall the progression of ketosis and put them into a plateau. No matter what the individual situation is, everyone's been there, and in a lot of situations, it's something that's completely out of our control.

The other day was a particularly horrible one. My blood sugar was above target, I wasted my morning running from hospital to hospital trying to get some blood work done (which no one would do in the end), dropped half my lunch on the floor, and by mid-afternoon I was completely fed up. I ended up doing something I really regret - I skipped one of my rapid acting insulin doses and binged on all the yummy cold-cuts in our fridge. I knew my blood sugars were going even higher because I could feel the headache and thirst coming on, and I felt extremely guilty and upset with myself. This was the first time in four months that I've even thought about skipping my insulin, let alone act on it. (I bet a handful of you are probably extremely disappointed in me for skipping my insulin, but let me reassure you, it's never going to happen again!). After that little meltdown, I decided to call up my mum and go for a long walk. Get out of the house - away from triggers, and get a little exercise in there. Of course, my breakdown wasn't over until I had a really big cry about everything, but I drank a big bottle of water and went on my walk with mum. Afterwards, I tested my sugar and noticed it hadn't even gone up that much despite missing my insulin.

I know, I know, you're probably thinking, "what does all this have to do with Atkins?" Well, remember what I said before - life happens. Okay, so we have bad days, we have stalls, we stop losing weight, but what are you going to? I've been told I tend to overreact a lot, but is that the way to handle things? Are you going to give up and sabotage all your efforts? Are you, like me, going to say, "what's the point?" Well, you might feel like doing all that, but what you really have to do is remind yourself why you started on the Atkins journey, why you've worked so hard, and why you want to keep working. I know, it's way easier said than done, and in a moment of crisis or panic you're not really thinking about the positives, and that's okay. Sometimes you need to have that meltdown to realize what's important. I know that if I hadn't skipped that dose of insulin, I wouldn't have realized how horrible it makes me feel and that it's not worth it.

So how do we cope? Well first off, if you've had a slip up, don't keep fretting about it. Pick yourself up, dust yourself off, and start again. Remember, tomorrow is always a new day and you don't have to keep feeling miserable. Secondly, have a plan ready for the days you feel you really can't take it any more. Make a list of things you enjoy to do and have them on hand for those times when you need to forget about your day and relax. Something that mum and I have done in the past few weeks is to cut up all our veggies and have everything prepared in advance so we're not tempted to go out to eat all the time because we're too lazy to prep our food (which is one of our biggest triggers). The most important thing though, is to remember that even slow progress is still progress. Don't give up just because the number on the scale isn't going down. It'll happen. Just have patience and trust your body to do it's thing.

I'm going to end my rambling post with a little inspirational quote by Winston Churchill. Have a beautiful day everyone :)

Andie

A Hospital Stay Keeps Ketosis Away

When I was 15 and my eating disorder was at it's worst, I would spend almost every weekend in the hospital. I would go days without insulin or food, go into DKA, be admitted, get better, go home and the whole cycle would start all over again. I couldn't tell you how many times I was admitted with DKA during my teens, but it was enough that I practically became a joke on the ward and all the nurses knew me well. In the last two years however, I can count the number of times I've been admitted with DKA on one hand (3), and only one of those times was for deliberately missing my insulin.

Since starting Atkins, I constantly worried about what I was going to say to the doctors if I ever ended up in hospital. Do I tell them I'm on a ketogenic diet? What if they tell me to stop? How am I going to cope with the weight gain with all the fluids and insulin they give me? What about the high-carb meals served in hospital? These things were always on my mind, but considering I've had pretty good blood-sugar control, I wasn't worried about ending up in the hospital. Until last Saturday, that is. I was admitted because I had another pancreatitis attack which triggered another episode of DKA. This admission was different though; and here's why:

When I went to the ER, my blood sugars were completely normal - around the 5-7 range - but the issue was my stomach pain, vomiting, and ketones. I told everyone who saw me that I'm on a ketogenic diet to control my blood sugars, and it was okayed by both my family doctor and endocrinologist. I also told them about my past; how I used to manipulate my insulin to lose weight, but that it isn't an issue for me any more. The ER doctors believed me and seemed to understand that I would have normal blood sugars with ketones if I was truly following this diet, and the blood work proved it. However, once I was admitted to the ward, everything changed. I saw new doctors and everyone was confused, and telling me different things. One of the residents said he suspected this was a case of "non-compliance" on my part, and so I went into DKA first which then aggravated my pancreas. The ward doctor first told me that considering the course of events (stomach pain, then vomiting and normal sugars) he thought the pancreatitis came first which then triggered the DKA, but he then changed his story to match the residents'. The endocrinology team just kept asking me "are you SURE you gave your basal insulin?" This was frustrating, not because they were asking me (obviously with my past of abusing my insulin I would expect that) but because they had the proof that when I came in, my blood sugars were normal.

As the days went by, the doctors didn't seem to have things under control. I was being given sugar tablets and juice when my blood sugar was fine, and then I had to eat the dreaded meals they served me. I was having probably about 50 carbs per meal which not only freaked me out, I could see the effects it had on my body right away (swelling in my legs and feet, fluid retention, feeling tired and sluggish). Not only was I gaining weight, but whenever I asked for an insulin bolus for my meals, they refused to give it to me, making my blood sugars rise into the high 20's. I was feeling worse in hospital than I was at home and my good blood sugar control went out the window. It wasn't until about the third day that I was there (and some calls to my diabetic nurse) that they finally decided to give me some insulin, but yet I was the one getting in trouble for having high sugars. Even after the pancreatitis cleared up, they wouldn't let me go home because my blood sugars were still high. I kept telling them, "my blood sugars are going to stay high because I don't eat this way at home." Some of the doctors didn't believe me when I said I ate about 20 carbs a day at home, others were interested in the concept, and I had one who said she wanted to learn more about "this diet". They still didn't listen though, and my insulin was increased to match the carbs I was eating in hospital. I was getting increasingly frustrated with the doctors, the meals, the weight gain; it almost didn't seem worth it. I knew I'd have better glucose control at home while following Atkins, but they refused to let me go home until my blood sugars were back to normal.

I spent a week in the hospital, gained 21 pounds and am in excruciating pain in my feet from the swelling and fluid retention. I was out of ketosis and extremely hungry. The whole time I was there, all I could think of was food and when my next meal was coming. I tried snacking on celery and radishes in between my meals, but all I wanted was crackers, bread, doughnuts, you name it. I was about ready to eat my own hand. I've been out of the hospital for 3 days now and I'm slowly getting back into ketosis. It's difficult because I'm going through all the symptoms again, and having all the cravings but I'm doing my best to tough it out. I know it'll take a few days to get back into the swing of things, so in the meantime I'm just staying home, away from temptation and trying to get back into a routine. The only issue is that with pancreatitis, I'll have to watch my fat intake, as well as not have too much meat or caffeine. I'll really have to tweak my diet so I don't end up in the same situation again.

This whole experience has eliminated any doubts we still may have had about the diet. The carbs are what make us unhealthy. The proof is all in the sugar-free pudding.

Andie

Happy Diaversary

Today is a bitter-sweet day in the Sola household. 12 years ago today, I was diagnosed with type 1 diabetes; a condition that would forever change our lives. We don't "celebrate" that this happened of course, but we're extremely grateful that it's been 12 years without any major complications, and things are getting better and better each day.

I don’t have many memories of what life was like before I started getting sick. I was eight years old when I was diagnosed but I had been struggling with the symptoms for several years prior to diagnosis. Despite living with diabetes for several years now, that fateful day is engraved in my memory like it was just yesterday.

I woke up that morning needing to use the bathroom for the umpteenth time, which I was used to by now. My mouth was dry, my stomach hurt, and I felt very weak. Grandma had breakfast ready for me downstairs as usual, but it wasn’t a typical day; I had to go to see my doctor to get some tests done and hopefully, after so many years of feeling sick, they could tell me what was wrong. I finished breakfast in record time and asked for more. My body was so small, so thin, and fragile despite all the food I would constantly eat. I snacked all morning trying to fill my stomach which seemed to be a bottomless pit. I took a big piece of garlic bread and juice for the road.

At the doctor’s office, Grandpa held my hand as I watched a little machine draw my blood and count down from twenty. When the machine beeped, the nurse looked very surprised. She asked me if I had eaten anything sweet before coming in because my breath smelled very fruity. I remembered the juice I had on my way to the clinic and was scared that I'd be in trouble, so I said no. She turned to face my grandpa, “your granddaughter’s blood sugar is extremely high which means her body isn’t producing any insulin,” she explained. “She has juvenile diabetes and will have to go to the hospital immediately.” I didn’t know what any of this meant but I smiled anyway because I’d never stayed in the hospital before and I thought it might be fun.

My grandparents took me to the hospital where we met up with my mum. I was put on an insulin infusion right away to keep my blood sugar from going higher. My mom and grandma cried while I jumped around excited to be in the hospital. I turned to my mom and saw the sadness and fear in her eyes and it broke my heart. I sat in her lap and gave her a hug. “It’s okay mommy,” I said, “I’m in the hospital now. Everything’s going to be okay.”

The next few days in the hospital were tough. Mom and I had a lot of new information to process in the week that I was there. I was most excited to play with "the fake food" that the dieticians usually brought in, but I never actually got to use it. We were handed lots of information sheets, pamphlets, phone numbers, and forms (I found a lot of them the other day when looking through a box of old stuff at my grandma's house. It's pretty funny how much things have changed since then). I had fun playing with the toys they brought me and going to the play room, and I was very excited when my teacher and all my classmates sent me "get well" cards, but it wasn't all fun and games as I thought it would be. The doctors wanted me to go for walks everyday which I hated. Mum would have to drag me outside to get some fresh air, and I would throw a tantrum. I also couldn't eat what I wanted when I wanted anymore and this made me upset. Mum was getting frustrated and depressed; seeing how upset and miserable I was at such a young age must have been extremely difficult for her.

In the years since, we've been through quite an ordeal. I had some control of my blood sugars when my mum was home and doing everything for me, but when she returned to work and school, and I started becoming more independent things started getting worse. I also met a diabetic girl at school who taught me that "it was okay to have candy and chocolate and not give insulin". She convinced me that "it wouldn't hurt". It's definitely been a difficult 12 years, with times of absolute chaos, followed by short-lived promises of "starting fresh". I never really took my diabetes seriously, I guess in a sense just hoping it would go away on it's own or just pretending it wasn't actually there. It wasn't until this February that I finally decided that I've had enough of pretending and being sick all the time and had to get serious about my illness unless I wanted to suffer extreme consequences. I've been lucky to have survived several scary episodes of DKA as well as some other issues, and I've only got the beginning stages of neuropathy which can be reversed if I do something about it now. It's not easy trying to figure out exactly what I need to do to help keep everything in control. It's a [re]learning process really, almost like being diagnosed all over again.

So when I say, "Happy Diaversary," I'm not celebrating the fact that I have diabetes, but the fact that I have yet another chance to start over. I'm celebrating that despite all the stupid, dangerous games I played with my diabetes, I'm alive and still relatively healthy, and things are really looking up. Here's to another 12+ years!

Andie

Feeling Empowered

Life has a way of always surprising you.  One of the last things I expected back in January of 2012 when my daughter said she wanted to start "doing Atkins" was that I was about to embark upon one of those life-changing experiences that revolutionize everything around you.

No sooner had the words come out of her mouth, than I said (shouted, really, if we're going to be honest) a categorical "NO!"  I was not going to be supporting such madness.  After all, we had at that point endured countless hospital stays, complications with her diabetes and a chaotic series of complications stemming from her eating disorder (diabulimia).  I was not about to start supporting a silly diet that would land her in the hospital yet again.   My prejudices were not completely without foundation.  I had seen several acquaintances claim that they were on the diet in the past, and for the most part these were folks who started eating an enormous amount of meat and fat without much research, and soon either grew tired of the diet or got sick.  My reaction was, much like their attempts, unresearched and premature.  Once I settled down enough to listen to her reasons and I did some reading on it, I was open to have her explore this as a possibility, as long as she did it responsibly and involved her health care team in the decision.

It didn't take for me to realize that this diet might turn out to be useful in controlling her  diabetes.  After all, she had been counting carbs for about ten years as part of her diabetes care, and we knew that eating fewer carbs was overall a good strategy, as the trigger for her eating disorder was the massive amounts of insulin she required to cover her carb consumption, resulting in the usual weight gain from insulin overload.

So, having decided that she would be eating this new way for a while (at first the idea was to see what would happen and if there were no adverse effects we would proceed) it became evident that I'd best start eating this way too.  It is just too difficult to be cooking two completely different types of meals.  I usually end up making two different meals anyway because my DD does not like much of what I eat, but this was different.  This was two entirely different ways of eating.  We needed to ensure that we had everything she would need on hand, so we weren't left scrambling, so the first thing we did was to throw out everything in our pantry that we would no longer be consuming and replace it with induction-friendly items.  It was odd to note that while we had been conscious of sugar-laden fare when she was diagnosed with diabetes at age 8, we had slowly added so much stuff to our diet that no self-caring person with diabetes would have around.  We threw out everything from maple syrup, regular ketchup and bags of sugar to boxes and boxes of pasta, several types of potatoes, frozen corn, countless tins of legumes and beans, etc.

The next step was to go shopping to stock our new pantry.  And here was the revelation that really startled me.  In all the years of "trying to eat well," that is, following the advice of the experts, eating according to the food pyramid, I had never gone to the grocery store armed with a list I thought I understood or felt confident about.  I always wandered through the isles hoping not to be putting something in my cart that was considered to be bad for me this week or this hour.  The advice on what foods will give you cancer and which ones will give you energy; which ones you should eat before or after exercising; which ones contain gelatin and which contain other additives you should try to avoid is extremely long and confusing and it seems to change by the minute.  And it is not a list that is limited to the processed foods isles either.  Everyday you hear claims about different fruits and vegetables having this or that property that should be added to the diet or avoided or eaten with caution, and fish, poultry and red meat having high levels of this metal or that hormone of some other problems that make them dangerous to consume.  It feels as though you're taking your life in your own hands every time you head out to do your grocery shopping.  You wonder if you're going to become another statistic because of something you eat that they'll discover in five years was bad for you all along.  It's madness!

The other issue is that in spite of all the years that I tried to eat well, I never felt any closer to really understanding the principles of good nutrition.  I always felt out of my depth.  We would go to the dietitian at our family doctor's practice and she would tell us my daughter should be eating one thing.  We would be sent to the dietitian from the endocrinology clinic at the hospital and she'd tell us the exact opposite.  And they were never able to admit that maybe they might be wrong.  We just knew that they couldn't both be right.  I remember a family friend whose daughter also has type 1 diabetes telling me that her daughter's blood sugar would rise noticeably when drinking diet pop.  The doctors laughed at her and told her it was impossible.  She didn't care.  She assured me she had tested it enough to know that it was true, and I believe it.  That's another thing I've learned - every body is and reacts differently to different foods, and the docs and dietitians should take that into account, but don't.

Now, however, I waltz through the isles resolutely knowing what is good for me, how much of it I need to consume, and why I'm eating it.  I feel empowered, and I feel that I am making intelligent, informed food choices.  I can get my grocery shopping done in record time now.  In fact, at the Farmer's Market, I know which stalls I need to visit and I go only there.  I go to the fishmonger first.  Two stops over is my cheese lady - we buy a number of cheeses for variety and interest.  Our favourites are Gouda, Gruyère, Asiago, Parmesan and Feta.  Whatever else we might try, we're never without those.  One stall over I purchase my eggs, lots of them, fresh from the farm.  A couple of steps over, and I purchase my salad ingredients, including spinach, lettuce, cucumber, scallions, cilantro, avocados.  You can't beat that kind of fresh, honest food.  And knowing that it's good for you, well...  we should all feel that way about the things we eat.

Susana

Why I Decided to do Atkins

It wasn't so much a decision as it was a cry for help. But I'm getting ahead of myself; let me give you some background story.

I don't think my body has ever known what it was like to be satiated. I remember being in the first grade and feeling the need to binge. My mum would get me ready for school, feed me my breakfast and drive me to daycare. There, I would lie and say I hadn't eaten yet, so I'd have another full breakfast before being sent off to school. Once at school, I would go to the "breakfast club" and gorge down another breakfast which would make me late everyday to class. And that was just when I was about 5 years old! My pancreas was probably already killing it's own insulin producing cells by this point, so maybe that explained my hunger, but we'll never really know.

When mum went back to school and we moved in with my grandparents, I felt like I was in heaven. See, my grandma loves buying lots of sugary treats, breads, desserts - basically anything my mum wouldn't want me to eat - so I loved living with them. I remember prior to my diabetes diagnosis I would sit at their pantry and eat whole jars of Nutella, packages of cookies, basically anything I could get my hands on, and then I'd chase it down with a jug of juice (those frozen cans that you just add water to... Yeah...). Of course, I'd do all this in secret because I couldn't let anyone know I was eating so much. But everyone knew of course, especially when my mum would find whole packages of deli ham under my bed, or a giant loaf of bread, or a bunch of hard boiled eggs went 'missing'.

After I was diagnosed, my mum worked really hard to try and feed me according to what the dieticians said I had to eat: 1 starch, 2 fruits and vegetables, 1 dairy, 1 extra, etc. Although she kept feeding me nutritious meals, I was ravenous and decided to eat my favourite sugary treats behind her back and not give insulin for them. People were confused about my blood sugars and why they were high if I was doing everything right. Eventually my mum went back to work, and my grandma was in charge, which I liked because I could manipulate her and my grandpa into giving me all the 'bad foods' I wasn't allowed to have. I was only eight years old when I was diagnosed with diabetes but by the time I finished middle school, I had my grandparents tied around my little chubby finger and I was feeling pretty crumby most of the time. My blood sugars were high, I was eating whenever I wanted, injecting insulin whenever I felt like it, and I was tired, and always had stomach aches. The problem was, I was never full, and all the nasty carbs I was eating just kept making me feel hungrier (but I didn't know this yet).

High school added a whole bunch of other issues. Of course, being a teenager isn't easy, but being a diabetic as well made it ever more difficult. I started worrying about my weight and began dieting. At first it was okay; I cut out junk food and pop and was feeling really good. My mum encouraged me and was happy I wasn't eating so much junk. Then I gave up eating meat, which my mum was okay with as well since she's a vegetarian. Eventually it got too far and I gave up dairy, followed by fruits, and that's when my mum realized that this wasn't dieting any more - this was something major. This was an eating disorder. Of course, I was starving myself so food was always on my mind. I even dreamt about food. I remember once dreaming that I had taken a bite out of a hot dog and I woke up in a sweat because I was scared I had gained weight from that bite. I was scared to eat, but I wanted to so badly. Eventually my mum got me to eat small, nutritious meals and I wasn't as afraid of food any more, but this is when I realized that I could manipulate my insulin so I could still eat as much as I wanted and still lose weight. It seemed like the perfect solution for a food addict like myself, but if I could go back and change one thing, I would never have started doing that. It's an addiction and once you start it feels impossible to stop.

So it's been a long five years of going to so many different professionals asking for help with my diabetes and food addiction, but no one has been able to give me a straight answer. Everyone like giving out a prescription for a different kind of med that might help, but nothing does. My endocrinologists have refused to give me an insulin pump for fear that I'll just manipulate it and make myself sick, my dieticians have given me advice according to Canada's Food Guide and the Canadian Diabetes Association Guidelines for Healthy Eating, but I've never felt satisfied with the portions or the foods I'm supposed to eat. In the last two years I've noticed that when I eat carbs and take my insulin, my legs and feet swell like you wouldn't believe, and it's extremely painful. When I confronted my nurse about this, she just said it would go away eventually when my body got used to getting regular insulin and nutrition. But how soon is eventually? They don't experience the agonizing pain so it's easy to just give me a prescription for the pain and say the swelling will go away, but when you're living it, you want a solution - fast.

Early last year I started doing some research on low-carb eating and diabetes. As a diabetic, I know I have to be eating a healthy, low-carb diet to maintain normal blood sugar levels, but I didn't know anything about Atkins. I read a little more into it, just enough to learn about Induction pretty much. I was very worried about eating so little carb and didn't think it was safe for a diabetic to go into ketosis, but I figured 1) I'm already in a constant ketotic state without my insulin, and 2) I'm desperate for something to help with the pain. I didn't really have anything to lose, so that's when I decided I was going to do something about my diabetes and food addiction. It wasn't until a year (and a lot more research) later, during a huge breakdown about my weight and uncontrolled diabetes, that I finally asked mum if we could do Atkins together.

Mum was skeptical at first, but listened to my arguments and decided that it if would help my diabetes control, there was nothing to lose. It's been almost three months and I gotta say, starting Atkins was probably the best decision I could make for my diabetes and my sanity. I'm thankful to have a really supportive mum who decided to go on this journey with me because without her, this would have been impossible and I would have failed at Atkins almost immediately.

To anyone who's on the fence about Atkins or who's wanting to start but doesn't know how, I say, really really really do your research. Read as much as you can about it, throw out everything in your pantry and start fresh. Your body will thank you for it.

Andie

Table Talk

Last night was an interesting night at the Sola household.  When we are alone at home we don't usually spend a long time sitting at the table after our dinner, just talking.  That is a ritual that is well observed at my parents' house, but not mine.  At our house, meals are usually something to be got over as soon as possible and the lingering at the table has traditionally been associated very negatively will over-consumption of food.  We have often considered this to be a particularly Hispanic ritual - this sitting at the table for hours talking and, inevitably, munching on goodies; but I'm told by friends of many cultures that it is so at their tables too, so it would seem that lingering at the table is a common human bonding experience.  That makes me wonder why we Sola Girls have never done that.  Maybe it's the fact that there's just the two of us, but I don't think so.  Even when we have guests, I tend to herd them back to the living room pretty soon after the victuals are done.

But last night we started reviewing the journey we've been on for the last seventy-four days.  Because we're not together during the week, we have not much of a chance to catch up on the changes we have both experienced.  We have both made some sort of progress, though very differently, since starting on Atkins.

I have lost a lot more weight, simply because I was much heavier to start with, but also probably because I don't have diabetes, so my pancreas releases just the amount of insulin needed to deal with the food I just ate.  There's not much surplus insulin circulating around, and therefore a lot less fat storage is going on for me.

We're both looking forward to finding out Andie's next A1C results.  We've never been looking forward to that in the twelve years that she has had diabetes.  It's always been kind of a scary, disappointing, frustrating thing for us.  Now we are actually looking forward to it, and it seems kind of special.  Sort of how "good diabetics" (you know, the ones who follow the rules) must feel all the time.  We just never had a chance to experience that feeling before.

Discovering some of the great resources available to us for support from those who've gone on this journey ahead of us has been surprising and has made us feel supported by those trailblazers.  There's a special bond that happens when people share their experiences of this particular way of eating.  I think it has to do with the fact that the Atkins Nutritional Approach is generally maligned and misunderstood, and there's a general sense that we're in this together.  Some superb blogs we've found are Adele's Lead with the Diet, and Linda's Low Carb Index.

We talked about my mom's attempts to "help" us with our diet effort.  At first she was not supportive.  Then she got used to it and she started to buy us things that we might enjoy eating, though she has not yet caught on that either we can't or won't have it at this point in our diet, or she buys us such huge amounts, that we couldn't possibly have it all.  The other day she brought me two bags of spinach.  I eat spinach just about every day, but it was still too much for me since I already had two bags in the crisper.  One of the bags inevitably went to waste.  She'd done the same with big containers of mushrooms that I've had to throw out without even opening because they went bad before I could get to them.  We had a good laugh about it.  We appreciate her efforts to help but we kind of wish she would get a clue.

Struggling with invitations to dinner and restaurants has been another challenge.  Actually, this has always been a struggle; it's just gotten a lot worse recently.  Since Andie was diagnosed with Type 1 diabetes at age 8, we have sort of suffered through dinner invitations by well meaning friends who didn't serve much that she could eat.  There always seems to be an over abundance of pastries and absolutely no diet pop.  In fact, people have said things to me such as "I wouldn't let my kids drink that stuff - it's poison"  and all I can think is thanks a lot, that's all my kid CAN drink.  Anyway, we have a friend who always takes us out for dinner on our birthdays and we reciprocate on her birthday.  Normally this has not been an issue but now it is.  Since December she has been reminding us that she owes Andie her birthday dinner.  We've been debating which restaurant would be most amenable to our diet.  We've considered the Mandarin, for it's large selection of foods.  We feel pretty confident we could find really good things to eat and feel satisfied.  The problem is that their huge selection includes a lot of sweets and fruits that could be triggering.  We also feel that we would have to limit ourselves to foods without any sauces as it's difficult to determine just how foods have been prepared.  For the last three months we've been eating mostly things we've cooked ourselves and it's a big step to jump into eating things that we have not prepared.  I don't think we can keep stalling much longer.  Sooner or later we'll have to take the plunge.  It may seem funny to someone not doing this diet, but to us, it's a real life struggle.

By the time we decided to get up and go watch some TV we had actually been sitting at the table for about an hour or longer.  It felt kind of nice to do that.  And the best part was while we sat there and talked we weren't hungry and looking for something else to munch on.

Susana

The Joy of Satiety

satiety \suh-TY-uh-tee\ , noun:
The state of being full or gratified to or beyond the point of satisfaction.
Carbohydrates, especially the starchy ones like pasta and potatoes, provide a feeling of satiety, both physiologically and psychologically.
-- Marian Burros, "Eating Well", New York Times, October 19, 1988

A quick internet search for the term Satiety revealed the above entry on Dictionary.com - the word of the day for July 1, 2001. You can see it for yourself here.

I found it particularly interesting and ironic that the quote from Ms. Burros is so very, very far from being true, at least for me. Carbohydrates are responsible for the fact that I spent the better part of my 48 years in a constant state of deprivation, feeling hungry, preoccupied with the thought of my next meal, constantly searching for something that would satisfy me. In other words, the reliance on carbohydrates as my main source of fuel is what kept me as far from satiety as East is from West and made my life a miserable hell of food obsession.

I will not speak about this as though I had years of low carb experience under my belt. Anyone who has read through this blog will know that I started my Atkins experience on February 8, 2012. I would not do that dishonour to the hardy souls who have lived this new lifestyle for decades. However, I can tell you that in the last three months I have not had a day of being hungry or worried about what time I can eat again except once. That was the morning that I decided I just wanted my "normal" everyday breakfast of two eggs and toast with a bit of ketchup and a cup of coffee. Yes, this is what I used to eat every morning, except that the toast was probably twelve grain and the cup of coffee contained about six teaspoons of sugar. This was the breakfast that had me ravenous by about 10:30 and had me cruising the kitchen at work looking for ANYTHING that one of my colleagues may have dropped off at the kitchen table and yellow-dotted. And invariably there are various treats such as cupcakes someone was thoughtful enough to pick up for the rest of us on their way to work that morning, or maybe some chocolates they had left over from the weekend, or some salt water taffy they brought back from their trip to Florida or the remnants of a decadent cake they baked for their family.

And after eating the chocolate or the cake or the leftover bagels from yesterday's meeting, I would go back to my desk and continue to obsess about lunch. I was NEVER satiated.

But all that changed on Wednesday, February 8, 2012. All of a sudden I had the ability to concentrate on my work without once thinking about my next meal and without once raiding my friend's chocolate stash. Except for the morning of April 13, when after my "normal" breakfast I wrote to my daughter in desperation by mid-morning:

So I had two eggs and a slice of toast for breakfast, some ketchup and a cup of coffee.
Now, I haven't been hungry between meals in two months but today, I'm ready to eat my fist.
Not sure if it's the fact that I ate bread or if it was just not enough bread. It's very upsetting. I think I'm going to have to dash home and get myself a bar, as I'm covering reception today and it's going to be a long morning.

And dash home for an Atkins bar I did. I had to. My feelings of hunger were so intense that they scared me. I thought at that moment I might even consider eating some chocolate or some leftover cake or some other ghastly thing. Lucky for me, I live across the street from my office, so I had the option of quickly running home and getting something that I could trust to have the right balance of fat/protein/carb. Had I not had that option, it would have been a case of running to the pharmacy and hoping that they had some bars or something else appropriate for me to eat in induction.

To me, this illustrates clearly the principle that you have to pay attention to the nutritional balance of each meal. The protein and fat have to be in the right proportion to the carbohydrate. I have eaten the toast before without any ill effect. I have also eaten low carb tortillas from La Tortilla Factory and yummy linguine from Dreamfields pasta, and done ok with both. Those were meals where the carb did not take centre stage, but played a minor role around the fat and protein and where the calories from fat were about 65% of the diet. As an example, my typical breakfast in the last three months has been an omelet made with a cup of spinach, two eggs, one ounce of shrimp, two ounces of cheese, cooked in a tablespoon of butter, with a cup of coffee sweetened with one packet of splenda and containing exactly one tablespoon of whipping cream. The total breakdown of fat/protein/carb for that meal is about 33g/15g/4g or roughly 65%/30%/5% of calories from each of those nutrients. The problem with this morning's meal was that I didn't have enough fat to provide satiety. I was asking the carbohydrate to provide something it was never meant to. Between the (low sugar) ketchup and the toast (which is made with a mixture of flours, including wheat) I had let the carbs and protein hijack my diet and revert me back to the hungry, obsessive days of yore. The breakdown of this morning's breakfast was 34/32/14. As you can see, the increase of carb relative to the fat and protein was enormous, and the protein ratio was more than double that of one of my normal low carb meals. The fat was no longer providing the fuel and keeping me satiated, but instead, my body reverted right to carb burning for fuel, and as a result I was "ready to eat my fist" by 10 am.

Interesting to note, I ate one bar on my dash home, and brought another one along anticipating that I'd be hungry all day. I discovered the bar in my pocket the next day, as I did not have a need for it at all after eating my properly balanced emergency bar.

Susana

Sugar Alcohols

Maltitol, sorbitol, xylitol, isomalt... Unless you're a low carber, you probably have no idea what I'm babbling on about. These words and a few others have become well known in the Sola household since starting on Atkins. I had seen them listed on nutrition labels before, but I had no idea what they were, and I wasn't really interested in learning. So I guess I should get on with it and explain what they are. Sugar alcohols.

Well, since I'm not very good at explaining exactly what a sugar alcohol is, I'll just provide you with a Wikipedia snippet (click here for the full article):

sugar alcohol (also known as a polyol,[1] polyhydric alcohol, polyalcohol, or glycitol) is a hydrogenated form of carbohydrate, whose carbonyl group (aldehyde or ketone, reducing sugar) has been reduced to a primary or secondary hydroxyl group (hence the alcohol). Sugar alcohols have the general formula H(HCHO)n+1H, whereas sugars have H(HCHO)nHCO. In commercial foodstuffs sugar alcohols are commonly used in place of table sugar (sucrose), often in combination with high intensity artificial sweeteners to counter the low sweetness.

We started Atkins in early February and I was worried about how I was going to survive Valentine's Day with my boyfriend. He knows my mum and I are on Atkins, but he keeps asking me, "can you eat this? Can you eat this?" So when he told me that his mum bought me candy for Valentine's Day, I almost died. I was freaking out wondering how I was going to cope with having a bunch of candy in the house. Of course, I knew it was diabetic candy (his parents know I'm a diabetic, so they would never get me a pound of regular candies) but I had seen these candies at the pharmacy before, had looked at the carb count and since I was only used to deducting fiber, according to my calculations I still couldn't have these. "Some day... Maybe in the later phases of the diet," I thought to myself.

While looking for some recipes online, I stumbled upon a lot of people mentioning that they were eating low sugar candy and they were so thankful that they could subtract the sugar alcohols and the total carb count was basically nothing. I couldn't believe this was true, so I did a little investigating. I was surprised to see how many people ate these candies on induction and it had basically no effect on blood sugar or ketosis (of course it does affect different people in different ways).

When my boyfriend gave me all the goodies for Valentine's Day, I checked the nutrition facts, and sure enough, if you deduct the fiber AND the sugar alcohols, the carb count is negligible. Now, this doesn't mean that one should go on a low-sugar candy binge. Although it's nice once in a while, the sugar alcohols in these treats can cause some stomach symptoms, which most companies warn about on their product. These symptoms include bloating, diarrhea and flatulence. This doesn't happen to everyone; like I said, sugar alcohols affect different people in different ways. When my mum ate some of my candy she said she gained some weight the next day and was out of ketosis, but it didn't affect me either way.

Everyone is different. I know some people who are highly sensitive to sweeteners and sugar alcohols that these products would produce a sharp blood sugar spike even though they have very little or no carb at all - but they don't seem to affect me in the least. It's best to just try it out yourself.

The Wikipedia article I posted above has a list of all the sugar alcohols and how much they sweeten a product; this may give you a little insight on just what you're consuming. We've tried a few brands and flavours out there but here are a few of our favourites:

Baskin Robins Sugar Free Hard Candy - Cookies N Cream
Russell Stover No Sugar Added Toffee Squares
Russell Stover No Sugar Added Hard Candy - Assorted Fruit
And I can't wait to try the sugar free Twizzlers!

Just one little word of advice before I conclude this post: Please don't use sugar alcohols as an excuse to just fill up on candy and sweets. I've seen way too many people posting about how they ate a whole package of candy just because it's low carb (and I gotta admit, I did this once too). But remember, you're obviously doing Atkins for a reason, whether it be weight loss, better diabetes control or just to be healthy overall and although sweets have their place in every diet, let's not get crazy here. Sugar alcohols and other sweeteners have definitely made things easier for us, so let's be thankful and enjoy them in moderation. (Plus, you don't want to have a serious case of gas or other symptoms leading to an awwwwkwaard situation. You'll thank me later for this little warning :-D)

Andie

The Patient Experience

Being a type I diabetic on Atkins is a little tricky simply because of the confusion around ketosis. When I first mentioned to mum that I wanted to do Atkins for my diabetes control, she was very concerned about the carbohydrate count, and once she heard about ketosis, I didn't hear the end of it. Like a lot of people my mum just thought Atkins = meat and eggs, and didn't think it would be healthy for a diabetic to do. After a lot (and I mean a lot) of research, she calmed down and finally believed that this could actually be good for us.

Now, that was my mum. I could talk to her for days, send her websites, give her books, argue with her endlessly about Atkins, but when it comes to your health-care professionals, what are you supposed to do? You only have about an hour with them - probably less - and you're not going to argue with what they say, right? I'm lucky that my family doctor only kinda-sorta cares about what I do with my condition, so when I told her I was starting Atkins and wanted some blood work done, she didn't think twice before signing the requisition. She told me she'd send the test results to my endocrinologist who I was seeing in the next two weeks.

When I saw my endocrinologist, I asked him about my blood work and he said my doctor hadn't sent him any test results. I showed him my blood sugar log and he was okay with the numbers; although not perfect, they're a heck of a lot better than they have been in the past. He asked me what I was taking for insulin, and when I said about 6 units of fast-acting a day, he thought I was misusing again. I told him about Atkins and that I'm taking all the insulin I need according to my carb intake, and he agreed that if that's what works for me, then that's great. He didn't seem concerned at all, which made me think that he probably has a lot of patients who are following the same plan.

Right after seeing the endocrinologist, I saw the dietician, and that was a whole other story. She told me that my A1C level has been coming down steadily, but that it's impossible for anyone to sustain their energy on "this kind of a diet". She started giving me recipes, and telling me to eat yogurt, berries, flavoured soy milk. She showed me food labels of things that had about 15 carbs per serving, and I'm thinking to myself, "if I have this, I can only have another 5 carbs and I'm done for the day..." She was not very supportive of going the Atkins way, and I can understand that because she's a dietician and she's going by the Food Guide. Of course she's not going to agree to eating 20 carbohydrates a day, when she's supposed to be teaching diabetics to eat around 300 grams a day! It does make my relationship with her difficult though because this is where she gives me advice that I know I'm not going to take. It's not that I want to be difficult, but professionals need to take into consideration what the patient wants and needs. I know for a fact that if I eat more than 20 carbs a day, I'll swell, feel bloated and horrible, and will end up in the diabulimia cycle all over again.

I have a follow-up appointment with the dietician in May, as well as with my nurse (who I'm hoping will be supportive), and a kinesiologist. Hopefully my next appointment will go better, and I'm hoping to see my A1C drop even more. We'll see.

Andie

Pancake Tuesday

We really wanted to have pancakes for Pancake Tuesday so we purchased a package of Bakers Deluxe Pancake and Waffle Mix and a bottle of Joseph's Sugar Free Maple Syrup from the Low Carb Grocery the week before, and were very excited to get our package and try it out.  

Susana's Review

I followed the instructions exactly, as we had been warned that we had to be careful how much of the mix we used.  The  instructions were confusing, to say the least.  The instructions on the package are for the entire contents of the package, which is supposed to yield 16 pancakes.  Since we were not sure we could eat that many, we had to do a LOT of math to try to figure this out.  Once the mix was prepared they cooked the same as any other pancake.  They were a little bit flimsier and difficult to flip, but that may have just been me because I was getting more and more frustrated.  

Not only that, but because we were both in induction, we had pretty much consumed the majority of our daily carb ration by the end of breakfast, once we added the syrup.  I felt that as a meal this was a waste because nutritionally it didn't really provide anything.  Moreover, I was pretty hungry so I ate more carb than allowed that day.

The pancakes themselves were fine.  They were not special in any way.  I have since made pancakes using almond flour, flax meal, whey isolate powder and cream and they are a lot better, so I personally would not buy the mix again.  The syrup is extremely thick, more like molasses than syrup and very dark with a definite hint of maltitol to it and not a little bit like maple syrup.  We have most of the bottle still, as I've learned that it's a lot better when diluted with a bit of water.  Perhaps that's because I'm used to having real maple syrup which is not very thick.


Andie's Review
Like a lot of people, it took me a while to actually start on my Atkins journey because I kept making excuses about holidays, special events, you name it. So when I discovered the Low Carb Grocery, I was super excited to buy some products that would help make the transition easier. We had only been on Atkins about two weeks and I was already thinking about Pancake Tuesday and how I was going to manage. Luckily, we had found the bakers mix and pancake syrup mentioned above, so I wasn't worried - I was really excited to have pancakes on Atkins!


The directions on the package are extremely confusing. The night before, mum and I stayed up pretty late trying to figure out how to make the recipe for two people. The carbohydrate count on the package was for the whole package, but the instructions were for one serving, and since there are two of us... Well, I'm sure you get what I mean. And the Solas are not fans of such complicated mathematics ;-)


Waking up to the smell of pancakes after not having any such treats in so long was like being in heaven. I was so excited to see a nice stack of pancakes on my plate, but I had to remind myself that these were low-carb and therefore weren't going to taste exactly the same. They weren't fluffy by any means, but they looked and smelled like the real thing, so I poured my syrup on top and dug in. I absolutely hated them! They tasted gritty, a little nutty, and kind of dry. I thought maybe I'd get used to the taste, so I took another couple of bites, but I got through about one pancake and couldn't finish the other ones. The syrup tasted okay; it wasn't too sweet, but it was very thick.


Overall, Pancake Tuesday wasn't as great as I thought it would be. It was nice to be able to have the pancakes, but I think I'd like to try them with a different bake mix or something. For a first attempt, I guess it was okay, but we'll definitely have to experiment with another bake mix. The carb count was a bit high anyway so maybe we'll have more success with a different brand.


Final Review/Recommendations
The Solas give the Bakers Deluxe Pancake and Waffle Mix two thumbs down. Not only for the taste, but being very confusing with their instructions. And we give the Joseph's Sugar Free Maple Syrup two thumbs up, but we think it does need to be watered down a bit since it is very thick.

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The Sola Girls