Pre-registration: Sleep Study Extension

My initial sleep study finished this past Sunday. During the course of the experiment, I noticed that I was waking up in the middle of the night more often than I remembered doing before the study started. My hypothesis/concern is that the process of noting down when I woke up during the night was disrupting my rest and causing me to be more aware of it.

To check this hypothesis, I’m extending the sleep study by one more week, this time taking no melatonin and only noting down the number of times I remember waking up after I finally get up for good in the morning. This is, of course, not blinded, but will at least test whether the initial observation was correct.

This will push back the final analysis of the sleep study to this weekend and posting of it to 8/21/21.

– QD

Weekly Update & Health Statistics: 7/25 – 7/31/21

For those checking the dates, I post these with a 1-week lag. 

Summary:

What I’m tracking

  • Sleep: 
    • Metrics: total time, heart rate variability, pulse (sleeping vs. waking)
    • Method: Apple watch + Autosleep app
    • Frequency: daily
  • Blood glucose:
    • Metrics: fasting BG, Avg. BG, coefficient of variation, time 70-140 mg/dL, time <60 mg/dL
    • Method: Dexcom G6 CGM
    • Frequency: continuous
  • Body:
    • Metrics: weight, waist circumference, BMI, waist/height
    • Method: scale + Renpho tape measure
    • Frequency: weekly
  • Other blood:
    • Metrics: hemoglobin, cholesterol, blood pressure, pulse
    • Method: Hemocue 801Cardiocheck PAOmron 10
    • Frequency: weekly for blood pressure & pulse, every 2 weeks for hemoglobin & cholesterol

Observations

  • Sleep:
    • I’m three weeks into my sleep experiment (1 to go!) and still seeing significant discrepancies between the auto and manually tracked metrics. I’m going to hold off on analyzing the data until the experiment is complete so as to minimize any impact on data collection. 
    • Significant drop in sleep this week due to a couple bad nights. Nothing to act on yet, but will keep an eye on.
  • Blood glucose:
    • Coefficient of variation was much higher this week. Could be due to the new food effect study I’m running. Will keep an eye on this.
  • Body:
    • Surprisingly steady drop in weight (1.1 lb/wk, R2 = .95) and waistline (1 cm/wk, R2=.99); still happy with my progress.
    • I’ve got time, but need to think about how to change my diet to stabilize my weight. I’m about at my limit for what I can eat for dinner without feeling too full and causing overnight BG spikes. I’ll probably need to add to breakfast…  
  • Blood:
    • Off week for cholesterol and hemoglobin
    • For blood pressure, no obvious trend over time. Slightly higher than I’d like (~125/82), but won’t know if that’s real or measurement error until I calibrate against another instrument.  

Active & Planned Experiments

  • Comprehensive bloodwork:
    • Goal: Establish baseline for a broad range of biomarkers and check overall health
    • Approach: WellnessFX Premium panel
    • Status: Complete, need to write up.
  • Testing blood glucose impact of low-carb foods
    • Goal: Check blood glucose impact of new low-carb foods I’d like to incorporate into my diet
    • Approach: Follow the same protocol from my previous study
    • Status:
      • Baseline:
        • Glucose re-test: In queue
      • Low-carb foods:
        • Meal replacements: 2/3 complete, (Ketochow previously reported)
        • Flour replacements: 1/4 complete
        • Tortillas: Reported
        • Bread: 1/8 complete
        • Snack bars: 0/8 complete
        • Ice cream: 2/11 complete
        • Cereals: 4/7 complete
      • Supplements:
  • Testing methods of sleeping longer:
    • Goals:
      • To determine if taking melatonin supplements in the evening extends the duration of my time asleep and subjective fatigue given a consistent bedtime.
      • To determine if taking melatonin supplement and/or sleeping longer affects subjective fatigue, blood glucose, heart rate variability, or pulse
    • Approach: here
    • Status: Week 3 complete

Data:

Blood

Body

Sleep

Methods:

Measurements: See summary section above

Data Processing & Visualization. Data was visualized using Tableau.

Data: here

– QD

Recipe: Bacon, Pork, & Brussel Sprout Tacos (plus other variations)

Left – Bacon, pork, & brussel sprout taco. Right – Chicken, shredded cabbage, and salsa taco.
Bacon, pork, & brussel sprout taco filling.

I’m doing a series of tests on low-carb prepared foods and finally found tortillas that taste good and don’t spike my blood glucose. The La Tortilla Factory flour tortillas, in particular, are shockingly similar to regular tortillas and I only need an additional unit of insulin for two tortillas. 

Excited to have something I can use for tacos & wraps, I started playing around with different recipes. I wanted something really quick and simple that I could use for weeknight dinners and that incorporated both meat and vegetables. 

I first just tried ground pork with shredded brussel sprouts, but the pork was too lean and the overall mixture was dry and not too flavorful, even with added seasoning. To add both fat and flavor, I added bacon, first rendering out the bacon fat, then using that to cook both the ground pork and the brussel sprouts.

The end result was fantastic and extremely customizable. I’ve since tried it with a variety of meats (turkey, beef, chicken, and pork, both ground and cubed), vegetables (brussel sprouts, cabbage, broccoli), and sauces (salsa, crema, etc.). 

To make it ultra simple, I’ve also made them directly from frozen ground meat and vegetables. Doing that, you can’t get browning on the meat, so it doesn’t taste as good, but works in a pinch.

Recipe below if you want to try them yourself.

Hope you enjoy it!

– QD

Low-carb Tacos

Yield: ~10 tacos

Author: QD

Prep time: 5 MinCook time: 15 MinTotal time: 20 Min

Ingredients

  • 10 Low-carb tortillas (La Tortilla Factory is my favorite and has the smallest effect on my blood sugar)
  • 4 slices thick-cut bacon, chopped into ~1 cm (~0.5″) pieces
  • 450 g (1 lb) ground pork (can substitute with whatever ground meat you like)
  • 350 g (1 lb) shredded brussel sprouts (can substitute with whatever vegetable you like, but it works best with something that has a lot of volume, like shredded cabbage or chopped broccoli)
  • seasoning to taste (I like salt, pepper, garlic powder, and chili flake)

Instructions

  1. Add bacon to a cold skillet and heat on medium heat until the fat has rendered out and the bacon is crisp
  2. Transfer the bacon to a bowl, leaving the fat in the pan.
  3. Add the ground pork, season with salt and pepper to taste, and cook until browned, but not cooked through, ~1 min.
  4. Add the shredded brussel sprouts, remainder of seasoning (to taste) and continue cooking until the meat is cooked through and the brussel sprouts are at your desired texture. This takes 3-5 min. for me, but depends heavily on how soft you want your brussel sprouts.
  5. While the filling is cooking, heat the tortillas in a non-stick pan over medium heat until warm and browning begins to occur (~3 min).
  6. Serve

Notes:

This recipe is extremely customizable. I’ve tried it with a variety of meats (turkey, beef, chicken, and pork, both ground and cubed), vegetables (brussel sprouts, cabbage, broccoli), and sauces (salsa, crema, etc.).

To make it ultra simple, I’ve also made them directly from frozen ground meat and vegetables. Doing that, you can’t get browning on the meat, so it doesn’t taste as good, but works in a pinch.

Nutrition Facts (per taco)

Calories

251

Fat (grams)

13.8

Carbs (grams)

13.2

Fiber (grams)

7.3

Net carbs

5.8

Protein (grams)

17.4

Macros calculated per taco and using La Tortilla Factory Flour tortillas, Safeway thick-cut bacon, ground pork, and brussel sprouts.

Low-Carb Tortillas: How do Different Brands Affect my Blood Glucose?

This post is an update on my experiments measuring the effect of low-carb foods and dietary supplements on blood sugar.

Testing Queue:

  • Baseline:
    • Glucose re-test: In queue
  • Low-carb foods:
    • Meal replacements: 2/3 complete, (Ketochow previously reported)
    • Flour replacements: 1/4 complete
    • Tortilla: This post
    • Bread: 1/8 complete
    • Snack bars: 0/8 complete
    • Ice cream: 2/11 complete
    • Cereals: 4/7 complete
  • Supplements:

This week, I have the results from low-carb Tortillas.

Tortillas

 

Summary:

I tested 6 low-carb tortillas from 3 different brands. The winner on both taste and blood sugar impact was La Tortilla Factory, with about half the impact of Mission and Nutri-Rica tortillas (~13 vs. 25% of glucose for peak BG/g & ~30 vs. 60% of glucose for iAuC).

The key difference between the brands appears to be that Mission & Nutri-Rica use resistant wheat starch, as their main ingredient, which I’ve previously observed to have almost the same blood sugar impact as glucose. La Tortilla Factory, in contrast, uses oat fiber or cellulose fiber, which have essentially zero blood sugar impact.

Overall, I’m really happy with how this experiment turned out. The La Tortilla Factory tortillas have low enough blood glucose impact that I’ve started using them with meals (recipe here).

I looked for other low-carb tortillas that don’t use resistant wheat starch, but except for La Tortilla Factory and Mr. Tortilla (recommended by a commenter on the preliminary data), they all are either too high carb or high calorie (e.g. using almond flour) and I’d rather leave room for more fillings. I ordered the Mr. Tortilla ones, but UPS lost the package so I wasn’t able to test them before this post (will update once I get them).

Does anyone know any other good low-carb tortillas I should try?

Details:

Purpose

  • To identify low-carb foods that taste good and have minimal effect on my blood glucose.
  • To determine the effect of popular, literature supported dietary supplements on my blood glucose.

 

Background

I was in the supermarket recently and noticed that they’ve started carrying low-carb tortillas. The macros looked decent (2-5g net carbs/tortilla depending on brand and type).

I love tacos and wraps and it’d be great to have a convenient way to make them, but I noticed that some of the brands used resistant wheat starch, which I’ve previously observed to have a substantial impact on my blood sugar (33% peak BG & 76% iAuC vs. the same amount of glucose).

To see if any of available low-carb tortillas would hold up, I decided to test them.

Design/Methods

Foods

I tested 6 low-carb tortillas from 3 different brands. Full nutrient and ingredient info here & at the bottom of the post.

Procedure

At 5:00a, I took 4.5u of Novolog (fast acting insulin, duration of 2-4h), then drank a Ketochow shake (website, BG testing) at 5:30a. After that, no food or calorie-containing drinks were consumed and no exercise was performed. Non-calorie-containing drinks were consumed as desired (water, caffeine-free tea, and decaffeinated coffee). At 11am-12 pm, the substance to be tested was eaten as rapidly as comfortable and notes on taste and texture were recorded (before observing any change in blood sugar).

Blood sugar was monitored for 5h using a Dexcom G6. Calibration was performed 15-30 min. before the start of each experiment.

Note: I take a long-acting basal insulin (Lantus, 2u at 9pm each evening).

 

Data Processing & Visualization. iAUC was calculated using the trapezoid method (see data spreadsheet for details). Data was visualized using Tableau.

Medication. During these experiments, I took long-acting basal insulin each evening at 9pm (Lantus, 2u) and 2000 mg of metformin and multivitamin each morning at 5am. I did not dose for the experimental food ingested.

 

 

Data

Results & Discussion

Figure 1. Left – Change in blood glucose vs. time. Right – Change in blood glucose per g(food) vs. time
Figure 2. Left – Peak change in blood glucose per g(food). Right – iAuC per g(food). All values reported as % of the value measured for glucose.

Changes in blood glucose as a function of time are shown in Figure 1. The Mission and Nutri-Rica tortillas show a steep rise for the first 1-1.5h, similar to glucose, followed by a leveling off with a peak 2-3h after eating. This profile is similar to resistant wheat starch, their main ingredient (listed as “modified wheat starch”, but same thing). In contrast, the La Tortilla Factory tortillas show a slower rise and lower peak, consistent with their use of non-digestible oat fiber and cellulose fiber.

The difference between the brands can seen even more clearly by looking at the peak change and iAuC per gram, shown in Figure 2 and the blood glucose impact table. La Tortilla Factory tortillas have about half the effect of Mission and Nutri-Rica tortillas (~13 vs. 25% of glucose for peak BG/g & ~30 vs. 60% of glucose for iAuC).

Happily, I liked the taste of the La Tortilla Factory tortillas the best of all those I tested. The flour tastes like a real flour tortilla: chewy, not much flavor, and with a hint of sweetness. The wheat has a strong wheat taste and is slightly gritty, very similar to the taste of oat fiber (main ingredient). I really like the wheat taste by itself, but found it would overpower/obscure the taste of fillings when I used them in meals. The La Tortilla Factory tortillas are also the thinnest of those I tested, letting you put more filling in a taco or wrap.

The Mission tortillas were pretty good as well: thin, with decent texture, though not quite as good as La Tortilla Factory. The spinach and tomato basil were ok, but I prefer a neutral flavor so the tortilla pairs with any filling.

The Nutri-Rica tortillas had good flavor (flax seed), but were way to thick and chewy for me. I prefer a thinner & larger tortilla that can hold more filling.

Note: taste and texture observations were recorded when I ate the food. I.e. before I knew its impact on my blood sugar.

Thoughts & Next Experiments 

I’m really happy with how this experiment turned out. It reinforces my previous observation that resistant wheat starch is not really low-carb and I need to avoid it. But, the La Tortilla Factory tortillas have low enough blood glucose impact that I’ve started using them with meals (will post some recipes soon).

I looked for other low-carb tortillas that don’t use resistant wheat starch, but except for La Tortilla Factory, they all are either too high carb or high calorie (e.g. using almond flour) and I’d rather leave room for more fillings.

Does anyone know any other good low-carb tortillas I should try?

As always, please let me know if you have any thoughts or suggestions.

– QD

La Tortilla Factory – Flour

La Tortilla Factory – Wheat

Mission – Wheat

 

Mission – Spinach

 

Mission – Tomato

 

Nutri-Rica

New Study: Effects of Low-carb Foods & Supplements

Of the previous studies I’ve done, the most informative and useful for me was measuring the effect of different macronutrients and low-carb ingredients

I was especially fascinated, and disturbed, by the huge variation in blood glucose impact of fibers that are listed identically on nutrition labels. This makes me extremely suspicious of the so-called “net carb” count listed on most low-carb food. I suspect that there’s a wide variation in actual blood glucose impact for foods with similar nutrition labels.

To follow up on that, I’m going to test the effects of popular dietary supplements and low-carb foods to see if claims about them really hold up. For low-carb foods, I’m going to focus on the ones that I like or that are recommended by commenters here or on Reddit. For supplements, to avoid wasting a lot of time chasing after BS fads, I’m going to focus on those that are either reasonably supported in the academic literature or otherwise appear to have solid data backing them up. 

Lastly, it’s widely believed that the relative blood sugar impact of foods varies from person-to-person. If you’re interested in helping me to quantify that, let me know in the comments or send a via the contact form or to quantifieddiabetes_at_gmail.com. 

Testing Queue:

  • Baseline:
    • Glucose re-test:
  • Low-carb foods:
    • Ketochow: Reported
    • Carbquick: Complete
    • Tortilla: Complete
    • Bread: In progress
    • Snack bars: In queue
    • Ice cream: In queue
  • Supplements:

Week 1: Tortillas

Since this is going to be an on-going exploration, rather than wait for complete sets of data (which could take a long time), I’m going to post each weeks worth of data as I collect it in the hopes of soliciting feedback to guide later experiments.

As always, if you have any comments, suggestions, ideas for new experiments, or want to participate, please let me know in the comments or send a PM via the contact form or to quantifieddiabetes_at_gmail.com.


Ingredient Background

When I went to the supermarket recently, I noticed that they’ve started carrying low-carb tortillas. The macros looked decent (2-5g net carbs/tortilla depending on brand & type), so I wanted to give them a try. 

Procedure

At lunchtime (11a-12p), I consumed the specified quantity of food. No other food, drink, or medication was consumed except for water (ad libitum, but always less than 500 mL). Note: I take a long-acting basal insulin (lantus, 2u/day).

Blood sugar was monitored for 5h using a Dexcom G6. Calibration was performed 15-30 min. before the start of each experiment.

Results

As shown in Figure 1, all of the low-carb tortillas show a steep rise for the first 1-1.5h, similar to glucose, followed by a leveling off with a peak 2-3h after eating. This profile is similar to resistant wheat starch, their main ingredient (listed as “modified wheat starch”, but same thing). 

Most interesting is the difference between brands. La Tortilla Factory tortillas have about half the effect of Mission and Nutri-Rica tortillas (~13 vs. 25% of glucose for peak BG/g & ~30 vs. 60% of glucose for iAuC). They are thinner and have a, to me, better taste and texture as well, so a significant overall win. 

From looking at the ingredient list, the main difference seems to be that La Tortilla Factory uses cellulose fiber instead of Resistant Wheat Starch. I haven’t tested cellulose fiber, but Resistant Wheat Starch has a significant impact on my blood sugar, so that’s presumably where the difference is coming from. I’ll get and test some cellulose fiber to confirm. 


Interim Thoughts and Next Steps

From this preliminary data, it looks like there are meaningful brand differences for similar products with similar net carbs, justifying these experiments. 

I looked for other low-carb tortillas that don’t use resistant wheat starch, but except for La Tortilla Factory, they all are either too high carb or high calorie (e.g. using almond flour) and I’d rather leave room for more fillings. 

Does anyone know any other good low-carb tortillas I should try?

Next, I’m going to do a more detailed analysis of the tortilla results while starting testing on breads, ice creams, and snack bars. 

As always, please let me know if you have any thoughts or suggestions.

– QD

Nutrition & Ingredient Information


La Tortilla Factory – Flour

La Tortilla Factory – Wheat

Mission – Wheat

Mission – Spinach

Mission – Tomato

Nutri-Rica