Weekly Update & Health Statistics: 9/19/21

I’m always looking for collaborators for future experiments. If you’re interested in collaborating on scientifically rigorous self-experiments with low-carb foods, supplements, or other health interventions, please let me know in the comments or via the contact form on the right.


Two posts this week, Reader Requests and a literature survey and pre-registration of the effect of vinegar and other acids on blood glucose after meals.

Reader requests was really interesting. In every category, there was a Reader Request that either had a much lower BG impact than what I had found or gave significant insight into the BG impact of different ingredients.

I’m really excited about the vinegar/acid study, as well. There are three people participating so far, /u/genetastic, /u/kabong, myself. This should give us much more generalizable results and a decent shot of unraveling what’s going on with regard to effect size, scope, and mechanism (unclear from the literature). More collaborators would make the study even stronger, though, so if you’re interested, let me know.

Experiments this week focused the initial replication effort for the vinegar study and the last couple reader requests. Next week, I’ll shift back to the chocolate tests, though alternating those with the vinegar experiment will push back the final report on chocolate for a couple weeks (though I’ll have interim reports on the vinegar work).


Active & Planned Experiments

  • Blood Glucose Impact of Low-Carb Foods
    • Goal: Determine blood glucose impact of low-carb foods and ingredients
  • Blood Glucose Impact of Supplements
    • Goal: Determine blood glucose impact and mechanism of promising supplements
  • Methods of Sleeping Longer

Let me know in the comments if there’s any other experiments you’d like to see.


– QD


Observations & Data

Continue reading “Weekly Update & Health Statistics: 9/19/21”

Reader Requests: Blood Glucose Testing of Tortillas, Ice Creams, Breads, and Yogurt

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This week in my low-carb food study, I have Reader Requests!

For the past 6 weeks, I’ve been posting a series of studies on the blood glucose impact of low-carb foods (tortillas, cereal, ice-cream, bread). In the comments for each of these posts, I’ve been getting some great recommendations for other foods to try, so I decided to do a “Reader Requests” study where I measured the BG impact of the recommended foods.

The results were really interesting. In every category, there was a Reader Request that either had a much lower BG impact than what I had found or gave significant insight into the BG impact of different ingredients.

Here’s what I found:


Summary

  • Tortillas
    • The regular flour tortillas were much lower impact than I expected (30% peak BG & 70% iAuC vs. glucose), similar to that of the resistant wheat starch tortillas. This makes the resistant starch tortillas look even worse than I originally thought. Definitely never going to eat those again.
    • Neither of the recommended low-carb tortillas (Mr. Tortilla & A La Madre) beat out La Tortilla Factory for taste, texture, and BG impact, so I’m going to stick with La Tortilla Factory for personal meals.
  • Ice Cream
    • All three of the requested low-carb brands had lower BG impact than any of the brands I’d previously tested. The Two Spoons brand, in particular, was extremely good and has the only fruit-flavored low-carb ice cream I’ve seen. The Two Spoons Strawberry and Brownie Fudge flavors are my new favorite by a pretty wide margin.
  • Breads
    • The Julian Bakery breads were very low carb, but didn’t taste much like regular bread. They were interesting, but if I’m looking for a bread replacement, I’d pick something else.
  • Yogurt
    • Two Good Strawberry Yogurt had good texture and low BG impact, but the flavor was too mild and had a stevia aftertaste I didn’t like.
    • I would prefer to eat their plain yogurt and add my own mix-ins, maybe some nuts or chopped chocolate for a dessert.

Note: Readers also recommended several of the best breads that were included in the original bread post, including: Carb0naut (Can’t find the original request, sorry), Unbun Unbread (u/fawkesandholly, u/Impressive_Citron_84), Kiss My Keto (u/justjules83), and Base Culture (u/Spell_Chick).


If there’s anything else you want to see me test, please let me know in the comments.


– QD


Details

Tortillas

Tortillas tested. New requests in orange.
Blood glucose impact of tortillas.

Summary: Nothing spectacular here, but the Mr. Tortilla could be good if you prefer smaller size tortillas/soft tacos.

  • La Tortilla Factory Flour Tortilla (not low-carb, as a control) (Can’t find the original request, sorry)
    • Much lower impact than I expected (30% peak BG & 70% iAuC vs. glucose), similar to that of the resistant wheat starch tortillas. This makes the resistant starch tortillas look even worse than I originally thought. Definitely never going to eat those again.
  • A La Madre Low-Carb Corn Tortillas (Requested by u/ADifferentJason)
    • About the same BG impact as the regular flour tortillas (23% peak BG & 63% iAuC vs. glucose). Not great and not consistent with the claimed net carbs.
    • Taste was only ok, too. Will not use again.
  • Mr. Tortilla 1 Net Carb Tortilla (Can’t find the original request, sorry)
    • About the same BG impact as the best-in-class La Tortilla Factory tortillas (14% peak BG & 40% iAuC vs. glucose, or about half the LTF flour tortillas)
    • I didn’t like the taste as much as the LTF low-carb tortillas (bit too gritty), but they’re taco sized, which is very convenient for some recipes.
    • All-in-all, I found these to be ok, but will continue to buying the La Tortilla Factory low-carb tortillas going forward

Ice Cream

Ice cream tested. New requests in orange.
Blood glucose impact of ice cream per gram.
Blood glucose impact of ice cream per gram, zoomed in to only show low-carb ice creams.
Blood glucose impact of ice cream per cup, zoomed in to only show low-carb ice creams.

Summary: All three of the requested low-carb brands had lower BG impact than any of the brands I’d previously tested. The Two Spoons brand, in particular, was extremely good and has the only fruit-flavored low-carb ice cream I’ve seen. The Two Spoons Strawberry and Brownie Fudge flavors are my new favorite by a pretty wide margin.

  • Talenti Double Dark Chocolate (not low-carb, as a control) (Can’t find the original request, sorry)
    • BG impact was consistent with the carb count (peak BG 27% of glucose, total carbs 31% of mass), and way higher than any of the keto brands. Not surprising.
  • So Delicious Chocolate (u/alltheketoladies)
    • Lower BG impact than any of the original brands I tested (2.0% peak BG & 5.5% iAuC vs. glucose)
    • Much harder texture out of the freezer than heavy cream-based ice cream. Even after sitting out for 35 min., I had to microwave it to get to my desired softness.
    • Had a strong chocolate and coconut taste. A lot lighter/airy than the heavy cream based brands, but still had a “creamy” texture.
    • Overall, I didn’t like it as much as the other brands, but I could see some people preferring it.
  • Nick’s Coffee Karamell (u/milliondollarman2019, u/WakeOfTheFlood)
    • Lower BG impact than any of the original brands I tested (2.5% peak BG & 5.9% iAuC vs. glucose)
    • Softest texture of any of the brands. This and Two Spoons were the only keto ice creams that could be “scooped” straight from the freezer.
    • The Coffee Karamell flavor is more mild than I’d like, but it’s ok. I’d really like to try some of their other flavors, but this is the only one in my grocery that’s low-carb.
    • Way lower calories than other brands (240 kcal/pint vs. 470-680 kcal for other brands). Not sure why, though maybe it’s got a higher water content with more stabilizers & emulsifiers to soften.
    • Warning: The nutrition label on their website doesn’t match with what I found in the store. The BG impact matches up with the label, so if you’re buying this, make sure you read the label carefully.
  • Two Spoons Chocolate & Strawberry (u/Harleydemondog)
    • The lowest BG impact of any ice cream I’ve tested:
      • Chocolate: 1.8% peak BG & 4.2% iAuC vs. glucose
      • Strawberry: 2.0% peak BG & 4.9% iAuC vs. glucose
    • This has the most similar texture to regular ice cream of all the brands I’ve tried. Scoopable, but a bit hard straight from the freezer. 1 min. in the microwave at 30% power got it to my preferred texture.
    • The chocolate flavor was good, though I’d prefer a stronger flavor.
    • The strawberry was amazing. Extremely smooth, creamy taste and the strawberry mix-ins taste like firm strawberry jam. This is the only keto fruit flavored ice cream I’ve found. I’ve always preferred fruit-flavored ice-creams and this was a great example.
    • I also tried their Brownie Fudge & Coffee Toffee flavors, but didn’t do a BG test
      • Brownie fudge: My second favorite after strawberry. A stronger chocolate flavor than chocolate and the brownies gave a nice flavor and textural contrast (even stronger chocolate flavor & soft chewy texture).
      • Coffee Toffee: Very strong coffee flavor with a great texture contrast from chocolate chips and toffee. If you like coffee ice cream, I’d definitely recommend it.

Breads

Bread tested. New requests in orange.
Blood glucose impact of bread.

Summary: The Julian Bakery breads were very low carb, but didn’t taste much like regular bread. They were interesting, but if I’m looking for a bread replacement, I’d pick something else.

  • Julian Bakery KetoThin Bread (Can’t find the original request, sorry)
    • The lowest BG impact of any of the breads I’ve tested (3% peak BG & 8% iAuC vs. glucose)
    • This one was a bit odd. It was soft, moist, and tasted pretty good, but not at all like bread. You can really taste the cream cheese in it.
    • When toasted or fried, it became slightly crispy and the cream cheese taste was much less noticeable.
  • Julian Bakery PaleoThin Sandwich Bread (Can’t find the original request, sorry)
    • 3rd lowest BG impact, after Julian Bakery KetoThin & UnBun UnBread (6% peak BG & 10% iAuC vs. glucose)
    • The bread was a little wet when I opened it and tasted slightly sour. Taste was not that great, though maybe it was starting to spoil? I ate it right after opening the sealed package and 3 days after it arrived, so if it was spoiled, that’s not a good sign.

Yogurt

Blood glucose impact of Two Good Strawberry Yogurt.
  • Two Good Strawberry (u/ploddingdiplodocus)
    • Low BG impact (4% peak BG & 7% iAuC vs. glucose), a little higher than its net carb count (2% of mass)
    • Strawberry flavor is very mild and has a stevia aftertaste that I don’t like.
    • Texture is great, creamy and not chalky like some greek yogurts
    • I didn’t like this and would prefer to eat their plain yogurt and add my own mix-ins, maybe some nuts or chopped chocolate for a dessert.

Design/Methods

Foods. Full nutrient and ingredient info here. Key nutrition facts in the tables in above.

Procedure. At 5:00a, I took 4.5u of Novolog (fast acting insulin, duration of 2-4h), then drank a Ketochow shake (websiteBG 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 or caffeine-free tea). At 10:30am-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.

Separately, all breads were toasted using a Brava oven (wheat toast, setting 7). Taste and texture were recorded.

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, 1.5u) and 2000 mg of metformin and multivitamin each morning at 5am. I did not dose for the experimental food ingested.


Data


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Does Vinegar Really Lower Blood Glucose? If so, how? – Literature Survey & Pre-registration for an N=3 Community Experiment

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Summary

About a week ago a reader, /u/genetastic, reached out about collaborating on experiments to determine the effect of vinegar on blood glucose after meal consumption.

Like most of you, I had heard all the nigh-magical, pseudoscience claims about using apple cider vinegar to treat diabetes. However, when you dig into the literature, there’s a sizable number of peer-reviewed studies, including several decent meta-analyses, showing that consumption of vinegar with a meal can reduce the blood glucose impact in both diabetic and non-diabetic subjects (see background below for details). There’s also a lot of open questions, including:

  • Is the effect large enough to matter for practical meals?
  • What types of meals does vinegar affect?
  • What is the best protocol to get a large effect without unpleasant side effects?
  • What’s the underlying mechanism?
  • Is the effect specific to vinegar or do other acids work?

/u/genetastic, a third collaborator /u/kabong, and I decided to answer these questions with community self-experiment.

Below, I give more details on the background literature and pre-register our protocol and analyses.

It would significantly improve the study to have a larger number of participants. If you’re interested in collaborating on this or other scientifically rigorous self-experiments with low-carb foods, supplements, or other health interventions, please let me know in the comments or via the contact form on the right.


Details

Purpose

  • To replicate (or fail to replicate) the existing literature and quantify the effect of vinegar on blood glucose level after consumption of complex carbohydrates.
  • To better understand the underlying mechanism by determining how this effect varies with person/metabolic status, dose, source of calories, and type of acid.

Background

Link to list and summaries of literature reviewed

Over the past 20 years, several clinical trials have shown that consumption of vinegar with a meal can reduce the post-meal blood glucose concentration on both non-diabetic and diabetic patients. A meta-analysis of 11 high-quality studies showed a significant and systematic reduction in glucose and insulin area under the curve (see Figures 1 & 2).

Figure 1. Forest plot showing individual and pooled random effect standard mean difference (95% CI) of trials testing the effect of vinegar on glucose area under the curve. Test of overall effect: z = 2.42, p = 0.01.
Figure 2. Forest plot showing individual and pooled random effect standard mean difference (95% CI) of trials testing the effect of vinegar on insulin area under the curve. Test of overall effect: z = 3.73, p < 0.001.

Based on this, I believe that vinegar has an effect. However, there’s no clear consensus on how or why vinegar lowers blood glucose. Various mechanisms have been proposed, including:

  • Delayed gastric emptying
  • Increased glucose uptake by muscles
  • Inhibition of alpha-amylase, leading to slower breakdown of starches

I’m particularly intrigued by the work of the Le Feunteun group, that argues that the effect is not due to vinegar specifically, but rather reduced pH slowing the breakdown of starch by inhibiting the enzyme alpha-amylase. Supporting this claim:

One of the biggest challenges in the vinegar/acid literature is that all of the experiments were done with different meals, protocols, and doses, making it difficult to integrate data from multiple studies. To address this issue and answer some of the open questions about this effect, /u/genetastic, /u/kabong, and I decided to do a series of community self-experiments.

While we each have different motivations and interests, overall, the questions we’re looking to answer are:

  • Is the effect large enough to matter for practical meals?
  • What types of meals does vinegar affect?
  • What is the best protocol to get a large effect without unpleasant side effects?
  • What’s the underlying mechanism?
  • Is the effect specific to vinegar or do other acids work?

To answer these questions, we will be conducting experiments using the protocol below.


Methods

Materials

  • Meals:
    • white bread (starch)
    • dried dates (simple sugars)
    • tortilla with beans, salsa, & avocado (starch, fat, and protein)
  • Vinegar:
    • Apple cider or white vinegar
    • As large a quantity as comfortable, not to exceed 30g
    • Diluted in as little water as tolerable

Blinding

  • Vinegar supplementation will not be blinded
  • However, the protocol was established in advance and adhered to without modification once experiments started.

Procedure

  • Each participant is using a slightly different procedure
  • QD (u/sskaye):
    • Meals are eaten contemporaneously with vinegar or an equal amount of water at ~10:30a.
    • Blood sugar is monitored for 5h using a Dexcom G6, with calibration performed 15-30 min. before the start of each experiments.
    • Treatments are alternated daily V-/V+/W (V-: meal with no vinegar; V+: meal with vinegar; W: wash/no experiment.
  • u/genetastic:
    • Meals are eaten contemporaneously with vinegar between breakfast/lunch. CGM data is checked to make sure that BG is at baseline before a test.
    • Treatments are alternated daily with no wash period.
  • u/kabong:
    • Meals are eaten contemporaneously with vinegar.
    • Blood sugar is monitored for 3h using a Freestyle Libre, with calibration using a fingerstick meter.
    • Treatments are 3x per week, each at the end of a >24h fast.

Measurements

Analysis

  • Peak blood glucose, iAuC, and time to peak blood glucose will be calculated for each experiment
  • Student’s t-test will be used to test if the values for any of the above metrics were different with and without consumption of vinegar.
  • Additional exploratory analysis may be done based on the data, but will be noted as such

Data Processing & Visualization

iAUC will be calculated using the trapezoid method. Data will be visualized using Tableau.


Data

All data will be posted after analysis.


Results & Discussion

Results will be posted and discussed after the data is analyzed.


Conclusions & Next Experiments

Conclusions & next experiments will be posted after the data is analyzed.


– QD


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Weekly Update & Health Statistics: 9/12/21

I’m always looking for collaborators for future experiments. If you’re interested in collaborating on scientifically rigorous self-experiments with low-carb foods, supplements, or other health interventions, please let me know in the comments or via the contact form on the right.


I finally posted the results for low-carb breads this week. This was the most interesting of my prepared food studies so far. There was a huge variation in taste, texture, and BG impact and some mysteries that I’ll need to unravel (specifically, what’s going on with the resistant starches?).

Experiments this week focused on reader requests from the last few posts, including adding “control” foods for each category (regular, non-low carb versions). Some of the best tasting and lowest BG impact foods have come from comments, so please keep them coming!

Lastly, I’ll be kicking off a new study next week looking at the effect of acid on metabolism of macronutrients. Most readers have probably heard the BS around apple cider vinegar, but there’s a fair amount of peer-reviewed literature showing an effect of acids on blood glucose and metabolism (nothing magical, but measureable). There’s a fair amount of dispute around the mechanism, what types of macronutrients are affected, and whether it affects both diabetics and non-diabetics. A reader reached out to me about collaborating to test the effect, so we’re going to try to sort it out (keeping anonymous until/unless I’m given permission to name). We’re finalizing the protocol, after which I’ll post on our literature review, pre-registration of protocol and analysis, and then results when we have them.


Active & Planned Experiments

  • Blood Glucose Impact of Low-Carb Foods
    • Goal: Determine blood glucose impact of low-carb foods and ingredients
    • Approach: Protocol
    • Status:
      • This week: 4 commenter requests (Two Good yogurt, Julian Bakery bread, and “control” tortillas & ice cream (non-low carb, for comparison)) and 3 chocolates.
      • Reported:
      • Up next:
        • Commenter requests (9/18)
        • Chocolate (9/25)
  • Blood Glucose Impact of Supplements
    • Goal: Determine blood glucose impact and mechanism of promising supplements
    • Approach: tbd
    • Status:
      • This week: literature review, determining protocol
      • Reported:
        • Nothing yet
      • Up next:
        • Literature review (9/18)
        • Pre-registration of protocol and analyses (9/18)
  • Methods of Sleeping Longer

Let me know in the comments if there’s any other experiments you’d like to see.


– QD


Observations & Data

Continue reading “Weekly Update & Health Statistics: 9/12/21”

Low-Carb Bread: Blood Glucose Testing of 16 Varieties with a few Promising Results

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Photo collage of breads tested

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

This week, I have the results from low-carb breads. Next week I’ll be posting results from commenter requests, followed by chocolate.


Testing Queue:

  • Prepared foods:
    • Snack bars: in queue
    • Chocolate: in queue
  • Ingredients:
    • Flour replacements: in queue
    • Seeds & nuts: in queue
    • Vegetables: in queue
  • Supplements:

Bread

Summary

One of the most difficult foods to make low carb is bread. Flour imparts multiple functions to the final product: taste, texture, water absorption, cohesion (via gluten), browning, food for yeast, etc. There are numerous good substitutes for one or the other of these properties, but to get them all, you’d need a complex combination of ingredients.

Recently, there’s been an explosion of commercially available low carb products both on-line and at supermarkets, including a number of low carb breads. Although the net carb counts look good for most of these, I’ve become very suspicious of the blood sugar impact of some of the dietary fibers used (see evidence of blood glucose impact of dietary fibers here & here). 

To see if any of these low-carb breads would hold up, I tested them myself. I tested 14 breads from 4 different categories (resistant starch, protein & flour or fiber, and egg & nut), plus regular white bread as a control.

This was the most interesting of my prepared food studies so far. There was a huge variation in taste, texture, and BG impact and some mysteries that I’ll need to unravel (what’s going on with the resistant starches?).

Here’s my overall conclusions:

  • Lowest BG impact: UnBun UnBread
    • <10% BG impact of regular white bread; <50% of the next best
  • Best combination of taste & impact: Carb0naut White & Kiss My Keto Golden Wheat
    • ~25% BG impact of regular white bread
    • Very different taste & texture, but both really good
  • There’s a large range in impact from different resistant starches.
    • No idea what’s going on here, but I’m very curious. Maybe I should source/test different resistant starches and see how their BG impact varies.
    • Does anyone have any hypotheses? If so, please let me know in the comments.
  • BG impact is not easy to predict from the primary ingredients or nutrition label due to not knowing the ingredient ratios. Breads with actual flour can have the same impact as ones with indigestible fibers and two breads with the same total and/or net carb count can have wildly different impact.
    • The only way for me to know the impact of a food is to do a controlled test.
    • For someone without diabetes, this would probably require eating a large amount, as you’d need to induce an BG rise (since an insulin spike wouldn’t be measurable).

Does anyone know any other good low-carb breads or other low-carb foods I should try?

As always, please let me know if you have any thoughts, suggestions, or anything else you’d like to see me test.


– QD


Details

Continue reading “Low-Carb Bread: Blood Glucose Testing of 16 Varieties with a few Promising Results”