Interview with an outspoken advocate of truth in diabetes

I stumbled onto Jenny Ruhl's Diabetes Update blog after I received several very insightful comments to this blog whenever I posted a discussion on diabetes or pre-diabetes/metabolic syndrome.

Who the heck was this commenter who clearly had deep insight into diabetic issues?

It turned out to be Jenny Ruhl, a woman who learned her lessons the hard way: by receiving a belated diagnosis of (an unusual form of) diabetes, then receiving plenty of mis-guided advice from physicians on diet and treatment. Reading her many blog posts and websites, you get the clear sense of how hard this individual worked to gain the depth of knowledge she's acquired, on a par or superior to most diabetes specialists.

And she minces no words in expressing her heartfelt and carefully considered opinions. But that's what I look for: people who are unafraid to voice opinions that may not be consistent with the flow of conventional thought, but ring true and prove effective.


Dr. Davis: From your blog and websites on diabetes, it is clear that you exceptionally knowledgeable in the world of diabetes, metabolic syndrome, and related disorders. Can you give us a little background on how you came to this quest?

Jenny: Though I was told I was a "classic type 2" [diabetic] by my doctors, nothing I read about diabetes corresponded to my own experience. I knew my diabetes had not been caused by obesity because I'd been a normal weight all my life until my blood sugars went out of control at which point I developed ravenous hunger and gained a lot of weight very quickly.

I also wondered at the huge gap between what Dr. Bernstein said was a normal blood sugar and what my doctors told me was a safe blood sugar for a person with diabetes. The people I met who followed Bernstein's very low carb diet had much better blood sugars and far fewer complications, but my doctors dismissed this as irrelevant. So I decided to do some research to find out who to believe. I plunged into the medical journal articles that had recently been made available on the web to see if I could answer two questions: What causes diabetes? and "What does science actually know about what blood sugar levels damage organs?"

The result was the information that became the basis for the Blood Sugar 101 site. Initially, I attempted to sell it as a book, but editors told me that though what I'd learned was "fascinating" it would be "over the head" of the typical health book buyer who wanted simple explanations and if possible, a simplistic slant towards "cure." Fortunately, the very strong response and high traffic volume to the web site proved that, as I had thought, there are a lot of people who do want more than an oversimplified overview and who, given the information they needed, were able to make huge positive changes in their health.


Dr. Davis: What do you think your life would be like if you hadn't pursued this unique course?

Jenny: Possibly a lot shorter.

People in my family die of heart attacks in their 50s, probably from undiagnosed high blood sugars. The pattern of the type of diabetes I have is to have a normal fasting blood sugar and an extremely high post-meal blood sugar after consuming very few grams of carbohydrate. When doctors diagnose using only the fasting blood test, they miss those highs, which research is now finding to be a primary cause of heart disease.

I also would have been a lot fatter. My doctors told me that I was packing on 20 lbs a year due to "normal menopausal changes" and that there was nothing I could do about it. Lowering my carbs significantly dropped all the weight I had gained and I still weigh a lot less now than I did in 1998.


Dr. Davis: You've been a keen observer of the diabetes scene for some years. Have you discerned any important trends in both the public's perception of diabetes as well as how diabetes is managed in the conventional world?

Jenny: The huge difference I see is that, over the last decade, the online diabetes community has learned the value of cutting back on carbohydrates and shooting for truly normal blood sugar levels. So people who put some time into researching diabetes online and talking with those of us who have succeeded in avoiding complications will learn that they do not have to settle for very high blood sugars and deterioration their doctors think inevitable.

Unfortunately, the media have put most of their energy into promoting the discredited idea that diabetes is caused by gluttony and sloth and to promoting the equally discredited idea that people with diabetes should eat a high carbohydrate diet and avoid fat.

So for now there is a huge divide in the quality of life of those people with diabetes who educated enough to go out on the web and educate themselves and those who get their diabetes information from doctors. Sadly most doctors still encourage patients to eat low fat/ high carb diets, and counter the very high blood sugars this diet produces with oral drugs of questionable efficacy, while assuring patients they will be safe if they maintain blood sugar levels that meet the American Diabetes Association's recommendations, though a mass of research shows these are high enough to produce every single diabetic complication possible.


Dr. Davis: I understand that you've released a new book, Blood Sugar 101. How is your book unique in the world of diabetes books? Who should read Blood Sugar 101?

Jenny: Blood Sugar 101: What They Don't Tell You About Diabetes differs from other books in that it gives the reader a much deeper understanding of what is really going on in their bodies as their blood sugar control breaks down and what sciences knows about how abnormal blood sugars cause complications. Then it gives the reader the tools they need to find what diet and/or drug regimen will brings their own, unique, blood sugars down to a truly safe level.

Unlike some books, this one does not present a one-size-fits-all solution, but recognizes that Type 2 diabetes is really a catch-all diagnosis that covers a lot of disorders that behave quite differently. That is why what works for one person with diabetes may not work for another.

Because this book provides details available nowhere else about the physiology of diabetes and the drugs available to treat it, readers will find the information they need to work with their doctors to craft a regimen that brings their blood sugar into the range that preserves and improves their health.


Dr. Davis: Before we close, tell us a little about yourself outside of your diabetes advocate role.

Jenny: I live in rural New England and am a passionate gardener. I've been online since 1980 when I was part of the team at IBM that developed the first commercial email program, PROFS. I got involved in online discussion groups in 1987 and have been messaging on bulletin boards ever since.

I was a professional singer/songwriter in Nashville in my youth and spent my middle years as a bestselling author of books about consulting. Right now a lot of my energy goes into managing the financial and software side of a family business that makes hand made pocket tools for collectors.


Dr. Davis: Thank you for your great insights, Jenny!

Comments (6) -

  • Anne

    4/2/2008 3:32:00 AM |

    I have learned more about diabetes from Jenny's blog and her 101 site than I have from any doctor, any diabetes program I have attended or any reading I have done on my own. She has organized this information so it is easy to read and understand. After reading the information she posted, I realized that my blood glucose was high enough to put my health at great risk. My doctors did not seem too concerned, but with the help from a meter and low carb eating, my BG is now so much better.

    Blogs and websites such as Jenny's and Dr. Davis' are invaluable. Thank you.

  • Anna

    4/2/2008 3:46:00 AM |

    So glad to see this post.  Finding Jenny's website nearly two years ago was a pivotal point for me.

    Despite my history with gestational diabetes, after my pregnancy my doctors didn't monitor my glucose control beyond an annual FBG, even when twice my dentist advised investigation because of the condition of my gums (my PCP said I was fine and not overweight enough for diabetes, even though after weaning I gained 5 lbs a year for 4 years).  

    Still, knowing my pregnancy history put me and my son at higher risk, I kept my eyes open for information that might be pertinent about future risk (thinking 50s, 60s, and 70s, not my current age in the 40s).  Periodically, I would spend an evening online learning about the current state of research into risk factors and outcomes for mothers and offspring with gestational diabetes.  That's how I found Jenny's site.  I was in shock, I think.  Maybe outraged was more like it.  I realized I needed to know more about my current glucose metabolism condition right away.

    Like Jenny, I am not nor have ever been obese, and my FBG is still (barely) in the normal range.  But I now know many carb-rich foods will give me diabetic level post meal BG.  And with even moderate sugar and starches in my diet, I will gain weigh easily.

    I credit Jenny's website for providing the insight I needed to tighten my glucose control for my health, not just my weight.  I am achieving fairly normal BG levels with a high fat/low carb diet and without medications.   Additionally, the knowledge and confidence I gained from Jenny's website enabled me to approach my skeptical PCP and insist on a GTT and insulin levels, which turned out to be abnormal.

    Of course, I have ordered Jenny's book and look forward to receiving it soon.  Knowing the high quality of her writing and website information, I am sure it will be a valuable book for people with diabetes, people who have family history of diabetes, and for those who have loved ones with diabetes.

  • Anne

    4/2/2008 7:04:00 AM |

    Dear Dr Davis,

    It's good to see an interview with Jenny. Her diabetes website was one of the first I discovered when I was trying to find answers when I was diagnosed with diabetes type 2 last year. I am not at all the typical type 2, I'm very slim and have never eaten junk or processed food. Her website was one that had answers for me, and it led on to Dr Bernstein and his book.

    I'm glad Jenny has a book out now....I'll be buying it !

    Anne

  • Anonymous

    4/2/2008 12:22:00 PM |

    Thanks!  The American Diabetic Association says 2 abnormal readings are grounds to label someone "diabetic."  The healthcare industry loves labels--perhaps because once there's a "disease" they can assign a code that insurance companies will accept which then generates a whole treatment plan, including pharmaceutical products.  A high carbohydrate diet defies common sense in my opinion.  It just seems like this would trigger yoyo readings.

  • Sarah

    4/2/2008 12:35:00 PM |

    Jenny's blog and website should be required reading/participation for anybody with diabetes. She speaks truth.

    Sarah, who credits a 5.1% a1c to the information provided by Jenny and others in the online community.

  • buy jeans

    11/3/2010 6:51:11 PM |

    So for now there is a huge divide in the quality of life of those people with diabetes who educated enough to go out on the web and educate themselves and those who get their diabetes information from doctors. Sadly most doctors still encourage patients to eat low fat/ high carb diets, and counter the very high blood sugars this diet produces with oral drugs of questionable efficacy, while assuring patients they will be safe if they maintain blood sugar levels that meet the American Diabetes Association's recommendations, though a mass of research shows these are high enough to produce every single diabetic complication possible.

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Gretchen's postprandial diet experiment

Gretchen's postprandial diet experiment

Gretchen sent me the results of a little experiment she ran on herself. She measured blood glucose and triglycerides after 1) a low-fat diet and 2) a low-carb diet.









Gretchen describes her experience:

Several years ago I received a windfall of triglyceride strips that would expire in a week or so. I hated to waste them, so I decided to use them to test my triglyceride and BG responses to two different diets: low carb and low fat.

The first day I followed a low-fat diet. For breakfast I ate a lot of carbohydrate, including 1 oz of spaghetti cooked al dente and ¾ cup of white rice. For the rest of the day I ate less carbohydrate but continued to eat low fat.

The second day I followed a low-carb diet. For breakfast I ate a lot of fat, including a sausage, mushrooms fried in butter, 2 slices of bacon, and ¼ cup of the creamy topping of whole-milk yogurt. For the rest of the day I ate less fat, especially less saturated fat, but continued to eat low carb.

Both days I measured both BG and triglyceride levels every hour until I went to bed. On the low-carb day I had 3 meals. On the low-fat day, I was constantly hungry, had 4 meals, and kept snacking.

You can see the results in Figure 1. On the low-fat diet, after a “healthy” low-fat breakfast of low-glycemic pasta with low-fat sauce, my BG levels shot up to over 200 mg/dL and took more than 6 hours to come down. My triglycerides, however, remained low, and at first I thought perhaps the low-fat diet might be better overall. However, after about 6 hours, the triglyceride levels started to increase steadily, and by the next morning, they were higher than they had been the day before.
On the low-carb diet, my BG levels stayed low all day. However, after meals, the triglyceride levels skyrocketed. After meals they came down, and by the next morning they were lower than they had been the day before.

As I interpret these results, the high triglyceride levels after eating the high-fat meals represent chylomicrons, the lipoproteins that transport fat from your meals to the cells of your body. The high triglyceride levels the morning after eating the low-fat meals represent very low density lipoprotein, which takes the cholesterol your liver synthesizes when your intake of dietary cholesterol is low and distributes it to cells that need it, or again, to the fat for storage.

There are several interesting factors to consider here. First, when you have a lipid test done at the lab, it’s usually done fasting, which means first thing in the morning after not eating for 8 to 12 hours. It tells you nothing about what your triglyceride levels were all day.

Second, the low-carb diet resulted in lower fasting triglyceride levels, but much higher postprandial triglyceride levels. Which are more dangerous? I’m afraid I don’t know. You should also note that the high-fat, low-carb breakfast was extremely high in fat, including saturated fat. I don’t normally eat that much fat but wanted to test extremes.

Third, although the low-fat diet didn’t produce the very high postprandial triglyceride levels that the high-fat diet did, it produced extremely high BG levels that persisted for 6 hours. Some people think that it’s oxidized and glycated lipids that are the dangerous ones, so high BG levels and normal triglyceride levels might be more dangerous than very high triglyceride levels and normal BG levels. Note that high BG levels also contribute to oxidation rates.

Fourth, this shows the results of an experiment with a sample size of one. My physiology might not be typical. If you want to know how your own body’s lipids respond to different types of diets, you should get a lipid meter and test yourself. Unfortunately, your insurance is unlikely to want to pay for this, so it will be an expensive experiment.

The main point of this is that the results of different diets are complex. We have to eat. And what we eat can affect many different systems in our bodies. Finding the ideal diet that matches our own physiology and results in the best lipid levels as well as BG levels is a real challenge.



This was a lot of effort for one person. Thanks to Gretchen for sharing her interesting experience.

Gretchen makes a crucial point: Some of the effects of diet changes evolve over time, much as triglyceride levels changed substantially for her on the day following her experiment. Wouldn't it be interesting to see how postprandial patterns develop over time if levels were observed sequentially, day after day?

The stark contrast in blood sugars is impressive--Low-carb clearly has the advantage here. Are there manipulations in diet composition in low-carb meals that we can make to blunt the early (3-6 hour) postprandial lipoprotein (triglyceride) peak? That's a topic we will consider in future.

More of Gretchen's thoughts can be found at:

http://wildlyfluctuating.blogspot.com
http://www.healthcentral.com/diabetes/c/5068

Comments (11) -

  • ET

    11/27/2009 5:10:43 PM |

    Interesting results.  I follow a low-carbohydrate (<60 g/day) eating plan and I recently had blood drawn and sent to a lab for glucose and cholesterol testing.  It was supposed to be fasting, but the sample was drawn 4.5 hours after I had gotten up for the day.  By then, I'd already eaten breakfast several hours earlier and my coffee with coconut creamer and  half-and-half which represents around 60 grams of fat and 9 grams of carbs.  Both my  glucose and triglycerides were 91.  My total cholsterol was unchanged.  My fasting triglycerides are usually around 45.  I did exercise prior to having the sample taken which could influence my triglycerides.

    On an earlier occassion, I also had a non-fasting cholesterol test performed by a lab and the sample was taken mid-afternoon.  I'd consumed around 150g of fat total that day, starting nine hours earlier and my triglycerides were 79.

  • DrStrange

    11/27/2009 6:07:28 PM |

    Having done similar myself though only testing blood sugar, I can say for certain that if you ate a truly low fat diet (<10% calories from fat) for 2 weeks prior to the test and then ate a truly low fat meal, your blood glucose curve would have been similar to that for the low carb meal.  The spike comes from insulin resistance, largely caused by dietary fat.  It takes about 2 weeks on a low fat diet for that component of IR to be reversed.  I have repeated this same experiment several times with identical results.

    There are two ways to keep a fairly flat sugar curve.  One is a very low carb diet, the other a very low fat diet.  For the low fat diet to work however it must be constant without cheating.  In my experiments I found that only one meal of "normal" fat content, increased IR and caused sugar spikes for many days after.  Over about 10-14 days, my post postprandial sugar curve returned to normal.

  • Nigel Kinbrum BSc(Hons)Eng

    11/27/2009 8:09:00 PM |

    Any chance of persuading someone (Oxford Group, say) to do a randomised crossover intervention trial with a suitable washout period and using different Carb/Fat percentages e.g.
    15P, 55C, 30F (Standard American/English Diet) alternating with:-
    15P, 5C, 80F
    15P, 15C, 70F
    15P, 25C, 60F
    15P, 35C, 50F
    15P, 45C, 40F
    15P, 65C, 20F
    15P, 75C, 10F but without adding extra sugar? The trial previously mentioned has received criticism on a board I post on for adding extra sugar to exaggerate results.

  • Gretchen

    11/28/2009 2:12:20 PM |

    DrStrange, perhaps it was not clear from the quoted material, but I am diabetic. My BG would go up on a low-fat diet. That's what I was on for about 6 months after diagnosis, and I certainly did not have normal blood glucose levels. My A1c was much higher than it was on low-carb, high-fat.

    However, it would be very interesting if nondiabetic people repeated my experiment. I think exaggerated TG responses may be caused by whatever it is that causes the diabetes.

  • Anonymous

    11/28/2009 3:01:50 PM |

    I think DrStrange illustrates that there must be momentum to physiological responses to what is a typical diet for any one person. A low carber's insulin levels may not be ready to handle an untypical (for them)carbohydrate load while a person with a low fat diet maintains higher insulin at all times.

  • Gretchen

    11/28/2009 3:32:59 PM |

    My experiment was flawed in several ways. I was not planning on publicizing the results, so I didn't weigh food or make sure the protein amounts were the same.

    And I didn't do the usual 3-day high-carb eating to make sure I was producing carb-producing enzymes. Not eating carbs can produce diabetes blood glucose (BG) levels in a nondiabetic: called "starvation diabetes" because starvation is the ultimate LC diet.

    However, I already knew I was diabetic. And people with diabetes have different lipid responses, so someone without diabetes would probably not see such a dramatic difference.

    A good experiment for a nondiabetic who has been on a LC diet would be the following:

    1. Measure BG and TGs for a day on your usual LC diet. Weigh the food so you can get exact nutrient levels. This would tell you what happens when you're adapted to the LC diet. Probably measuring every 2 hours would be enough.

    2. Eat a low-fat diet without preparation and follow BG and TGs for a day.

    3. Continue to eat the low-fat diet for a minimum of 3 days, maybe a week or 2 as suggested by DrStrange. Then repeat the experiment in No. 2, eating exactly the same thing.

    4. If you wish, repeat the experiment in No. 1, to see if your lipids went high when you weren't adapted to the LC diet.

    I do know someone else who was concerned that she might be diabetic, and while on a LC diet, her BG levels in a home "glucose tolerance test" approached diabetic levels. She then went on some kind of vegan diet, and on this diet, her BG levels stayed low on the GTT.

    So yes, not eating carbs and eating more fat (two different inputs) can produce a result that looks like diabetes. Which of these two factors is more important is not clear because when you reduce one nutrient you have to increase another to keep the calorie content constant.

  • DrStrange

    11/28/2009 3:45:39 PM |

    Gretchen, were you consistently at about 10% total calories from fat on your "low fat diet"?  Fat intake for most needs to always be not more than about 10% of total calories  for insulin resistance to be dramatically reduced. If someone is insulin dependent, the insulin they take will be maximally effective in that case but the fat intake must be at that low level for every meal ongoing.  One meal with excess fat and IR can shoot up and take many days to come back down.  This is what I found in my body.  Also, this is presupposing that all carbs are coming from very few fruits, vegetables, whole/intact grains (not flour, not sugar, etc)

    I really do not know which is healthier in the long run for someone who is insulin dependent, low fat/high carb or high fat/low carb.  There are studies showing increases, long term, of a number of health problems w/ high fat intake.  On the other hand, w/ the low fat diet you would need to use more insulin which is inflammatory.

  • DrStrange

    11/28/2009 3:59:33 PM |

    Anonymous, I do not have high insulin levels, in fact the opposite!  My A1c was creeping up a couple years ago (peaked at 6.4) so i tried low carb for 9 months and felt worse and worse the entire time.  More research and switched to low fat/high carb.  I have been on a very low fat, vegan (McDougall) diet for about 20 months now.  My A1c last tested 5.1 fasting insulin is <2.00 uIU/ml.  Recent glucose tolerance test with insulin values showed this after fasting ingestion of 75 gm glucose (I am only 5'3" 110 pounds:

    BG (mg/ml) fasting=82, 1/2 hour=114 1 hour=103, 2 hour=86, 3 hour=100

    insulin (uIU/ml) fasting<2, 1/2 hour 8.5, 1 hour=11.0, 1 1/2 hour=13.4, 2 hour=18.1

  • Gretchen

    11/28/2009 9:56:57 PM |

    DRStrange

    Maybe we should discuss this privately, as the best way to treat diabetes is really not the topic of this blog. There are so many variables. You can get my e-mail on my blogsite, which is at the end of the stuff that Dr. Davis cited. Use Wildly Fluctuating.

  • buy jeans

    11/2/2010 8:21:09 PM |

    Gretchen makes a crucial point: Some of the effects of diet changes evolve over time, much as triglyceride levels changed substantially for her on the day following her experiment. Wouldn't it be interesting to see how postprandial patterns develop over time if levels were observed sequentially, day after day?

  • Dharini

    11/13/2011 11:56:52 PM |

    De novo lipogenesis is almost non-existant in humans. Trigs being high the day following a high carb meal probably reflect the regular trigs levels for a particular person. This would be true for any macronutrient composition that is not low in carbs.

    Naturally after a low carb meal there is an increased turnover of lipids because the brain does not have any glucose or glycogen sources for fuel. Thus, triglyceride levels fall ad fasting triglyceride levels are low.

    More importantly, fasting triglycerides DO NOT independently predict risk of heart disease once you adjust for post-prandial triglycerides. (Bansal et al_JAMA 2007_Fasting Compared With Nonfasting Triglycerides and Risk of Cardiovascular Events in Women)

    The effects of a low carb diet on postprandial triglycerides has been measured over 4 weeks in a study by Natalie et al_Diabetes Care 2009. They also found a worsening of triglycerides post prandially.

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