OSA and Sugar - Oh My!!!

[Todzo]

So I am reading an article in the Journal Sleep. “Intermittent Hypoxia Impairs Glucose Homeostasis”. The first statement is “Obstructive sleep apnea is associated with insulin resistance, glucose intolerance, and type 2 diabetes mellitus”.

Then, under Conclusions:
“ Intermittent hypoxia induces insulin resistance, impairs beta cell function, enhances hepatocyte glucose output, and increases oxidative stress in the pancreas. Cessation of the hypoxic exposure does not fully reverse the observed changes in glucose metabolism. ”

I recently finished reading “Fat Chance” by Dr. Lustig (see: http://www.amazon.com/Fat-Chance-Beatin ... 159463100X ). So it is now clear to me that eating much sugar for those with or even treated for OSA is not wise.

Please be careful this holiday season!

Take care!

Todzo

[Goofproof]

Eating excessive refined sugar is not or never has been healthy to eat. I wonder how much it costs to publish papers about the obvious. Jim

Your body runs on sugar, it's fuel, the only fuel your body uses. Food is digested and converted into fuel the body processes to operate.

Sugar isn't just the sugar you eat, it the food you eat. My sleep apnea is under control, I still require 200 units of insulin to even get my level close to normal.

[JohnBFisher]

WARNING!! Danger Will Robinson!! Danger!!

It's not just "sugar". It's carbohydrates. It's the pasta. It's the bread. It's the rice. It's the cakes. It's the ice cream. The more "refined" it is the worse it is for your body. So, beans and corn and such is better than bread and white rice and ... The more processing that's done, the easier it is for our bodies to absorb the carbohydrates.

As both Goofproof and I can attest, even when you do everything right after the damage is done ... it's not going to "reverse" itself. You need to use medication and/or insulin to help your body handle the permanent change done to our metabolic systems. While I don't need as high a dosage of insulin as Goofproof, I do now require an insulin pump to administer the extra insulin throughout the day. Even with that I need to watch what I eat.

And that because my sleep apnea was not all that well managed for years .. as I struggled to address the central apneas. Plus it led to some permanent kidney damage. Gee, thanks, doctors for not listening to me or my wife as we complained about my just stopping breathing. A note to medical personnel ... PAY ATTENTION to your patients. Failure to do so can and does cause them harm.

[Janknitz]

Your body runs on sugar, it's fuel, the only fuel your body uses. Food is digested and converted into fuel the body processes to operate.

Sugar is not the only fuel your body uses. If that were true we would not be here today, because our ancestors did not have an easy and reliable source of glucose--fruits were only available seasonally and were small and bitter compared to modern hybrids. Man only began to cultivate starches like cereal grains, tubers, and legumes relatively recently in our history. Humans subsisted on meat, fish, and greens if and when they were available. The primary fuel source was ketones, not glucose, just like many omnivores and carnivores. Have a dog? They don't use sugar as fuel. We don't have to either. There's a growing body of evidence that sugar in its many forms is toxic to us, and we all would be better off reducing the carbohydrates (sugars) in our diets--ESPECIALLY those of us at risk for diabetes or pre-diabetic or diabetic already. And maybe this article indicates that all of us with apnea should be watching our sugars.

Our brains function mostly on ketones from fat, but they do need a SMALL amount of glucose which we can make ourselves if dietary glucose is not available through a process of gluconeogenesis. I'm not claiming its necessarily ideal to rely on gluconeogenesis, but it illustrates that we can and do survive without "sugar as fuel".

Diabetics who keep their carbs (glucose) low need less insulin and suffer fewer diabetic complications (see Dr. Bernstein's Diabetic Solution, for example), children with seizures and other brain disorders and people with neurological and autoimmune disorders do very well with ketogenic diets, and there's a growing body of evidence that ketogenic diets are very helpful in stopping the growth of many cancers. There are many people having weight loss success on ketogenic diets--glucose is minimized while ketone bodies are relied upon for fuel.

Another interesting book for your reading list is Good Calories, Bad Calories by Gary Taubes. And a new book I haven't read yet, but the author has been giving good interviews promoting his book in Grain Brain by Perlmutter.

[Todzo]

WARNING!! Danger Will Robinson!! Danger!!

It's not just "sugar". It's carbohydrates. It's the pasta. It's the bread. It's the rice. It's the cakes. It's the ice cream. The more "refined" it is the worse it is for your body. So, beans and corn and such is better than bread and white rice and ... The more processing that's done, the easier it is for our bodies to absorb the carbohydrates.

As both Goofproof and I can attest, even when you do everything right after the damage is done ... it's not going to "reverse" itself. You need to use medication and/or insulin to help your body handle the permanent change done to our metabolic systems. While I don't need as high a dosage of insulin as Goofproof, I do now require an insulin pump to administer the extra insulin throughout the day. Even with that I need to watch what I eat.

And that because my sleep apnea was not all that well managed for years .. as I struggled to address the central apneas. Plus it led to some permanent kidney damage. Gee, thanks, doctors for not listening to me or my wife as we complained about my just stopping breathing. A note to medical personnel ... PAY ATTENTION to your patients. Failure to do so can and does cause them harm.

Hi John!

You are so right. It makes a hugh difference how many calories of various kinds are already in play before the sugar is added into the mix. On FB I monitor a “road runners” group. These guys think nothing of running 12 to 50 miles for fun (well, if it is 50 it is probably a competition – nobody does 50 miles for fun!). What Dr. Lustig says is that those long distance runners can eat anything they want. Even if it is fructose it will jump though the liver and into the cells because those calories are needed in a big way – they have a place to go.

But most of the food we eat has the even the fiber removed and if you are like me you do not run those 12 or so miles for fun most days. So the whole load of calories of various kinds pretty much flushes into our systems. Added sugar with extreme speed. Most of the fructose goes right into the liver – and – much will end up hanging onto the liver in the form of fat! The rest seems to enter the body in nefarious ways.

In about the past five years I have lost 40 pounds or so. What is left hugs my abdomen. I am not technically obese anymore but I think that if I do take in calories I do not immediately need they will end up in the abdomen fat pile with all the rest.

Regarding our breathing instability issues (centrals) I have recently come across the work of Dr. Stasha Gominak, Michael F. Holick, Ph.D., M.D., and the Vitamin D Council. After about a month of heavy supplementation I find it notably easier to breath eucapnically during the day and my breathing stability is improved at night. I think you would do well to view some YouTube – perhaps start with Lustig, see Gominak, and end with Holick.

And have a lot of fun!

Todzo

[2flamingos]

This whole sugar thing has me so confused.

My last blood work - A1c was great - 5.5. Insulin level on the other hand was a tad high - 45. These were fasting numbers - if that makes any difference.

Dr changed med from Metformin to Actoplus met.Two weeks into the new med and I had hypoglycemic episodes two days in a row. One was about 2-1/2 hrs after lunch and the other was less than 2 hrs after my morning snack. The second was bad enough I almost passed out, and "recovery" to feeling "normal" took several hours.

Not sure what or where we are heading with this now.

[Janknitz]

To reduce insulin you have to reduce carbohydrates in the diet--the corresponding blood glucose levels are what cause the excess insulin secretion. Another thing that causes insulin secretion are stress hormones like Cortisol--and that's exactly what we produce during apnic episodes, so good control of sleep apnea is another important component.

Now that you are having hypoglycemic episodes, they will tell you to INCREASE carbs to prevent hypoglycemia caused by the new med, and the cycle continues to spiral out of control. YOU can control your insulin levels by a careful, low carb high fat diet, by managing stress, and optimizing treatment of your apnea. No bad side effects from that, and the bonus is vastly improved health. High intensity interval training and/or lifting weights also increase insulin sensitivity of the muscles, whereas "chronic cardio" is a stressor that can increase cortisol and insulin levels.

[Goofproof]

This whole sugar thing has me so confused.

My last blood work - A1c was great - 5.5. Insulin level on the other hand was a tad high - 45. These were fasting numbers - if that makes any difference.

Dr changed med from Metformin to Actoplus met.Two weeks into the new med and I had hypoglycemic episodes two days in a row. One was about 2-1/2 hrs after lunch and the other was less than 2 hrs after my morning snack. The second was bad enough I almost passed out, and "recovery" to feeling "normal" took several hours.

Not sure what or where we are heading with this now.

I've had diabetes over 30 years, using insulin over 10 years. The first 20 years used pills, they did very little, finally went to insulin better control, but too many years of being out of control took its toll. I've had my A1C many times but no-one ever gave me a number on insulin in blood. Tests are always done fasting,or they arent any good. For me insulin control by pills. I might as well take M & M's.

I too have times when I go low, it's a fluke, the body reacts different at times, I run high to avoid the lows, especially at night, that's scary. Jim
I mix two kinds of insulin, depending on the test numbers, kind of like using a shotgun hunting, got to lead it just right. Sometimes they get away.

[Janknitz]

Goof Proof, out of curiosity, what type of diabetes do you have--I, 1.5 (LADA), or II?

[jamiswolf]

Our brains function mostly on ketones from fat

Janknitz,
When you get one fact wrong, it makes your other points look suspect too.

"Glucose is the only fuel normally used by brain cells."
is a direct quote from the following Franklin Institute resource for Science Learning website.

http://www.fi.edu/learn/brain/carbs.html

During starvation or fasting, the brain can use ketones but under normal metabolism...it's sugar. Our body has a normal blood sugar of 80 to 120 mg% so that sugar is regularly available to the brain and other cells. When the glucose level drops...brain function suffers and unconsciousness can occur.

And almost all animals use glucose to fuel body functions. They just don't eat it.

And you mentioned gluconeogenesis. Why do you think that metabolic pathway even exists but to provide glucose to the body?

Go ahead and knock processed sugar as a bad food...but recognise it's critical inside the body.
Jamis

[2flamingos]

I think my apnea is pretty well controlled - I use my PAP every time I sleep, and my AHI is consistently less than 5 and usually less than 3, and sometimes less than 1. My leaks are good and within range.

They haven't told me to increase my carbs, but rather to cut back on the med to once a day. For the first 1.5 years on Metformin my normal blood glucose was less than 120 - usually between 105 and 115. Then I began having high readings in the morning (fasting), but within 30 minutes to an hour back down to normal. The highest my A1c ever got was 6.4. This last test I referenced is the first time anyone has checked insulin. While the doc didn't make it sound like this level was an immediate threat, he was concerned (normal should be below 10). He also said that high insulin could be causing several of my other health issues.

[Todzo]

This whole sugar thing has me so confused.

My last blood work - A1c was great - 5.5. Insulin level on the other hand was a tad high - 45. These were fasting numbers - if that makes any difference.

Dr changed med from Metformin to Actoplus met.Two weeks into the new med and I had hypoglycemic episodes two days in a row. One was about 2-1/2 hrs after lunch and the other was less than 2 hrs after my morning snack. The second was bad enough I almost passed out, and "recovery" to feeling "normal" took several hours.

Not sure what or where we are heading with this now.

If your numbers were good why the change?

Dr. Lustig's book is not an easy read. Yet, I am going back in for a second read. Why? Because the understanding of the energy control processes in my body will enable me to make better decisions about how I care for my body and that I believe is well worth the time and effort.

The very basic recommendations, however, are quite simple. Eat a lot more fiber and move more. If you consume both soluble and insoluble fiber it forms kind of a "net" in your system which will tend to slow the speed at which such things as sugar can enter your system. It is kind of hazy in my mind but I do believe this helps insulin resistance to become less (probably less insulin resistance to form).
I think that “move more” should be a mantra for all of us OSA people who can. Whether it be OSA or UARS events it raises the stress hormones. Only one way to burn those off that I know of - Move it!

I remember doing only some 2000 steps a day when I started several years ago. At the moment my pedometer shows 6945 and will read over 10,000 (the recommended steps per day) by the time I make it back to my house for my evening nap – then it will be out for an errand (about 5000 steps) this evening. As well I spent about an hour on a cycle at the gym and did some very light “make the blood move in the muscles” muscle work. This will help burn off any stress hormones I made last night and will help with any insulin resistance I may have.

With exercise I have found, start slow, go slow, but keep it moving up to be a good plan.

Have a great holiday season!

Todzo

[Janknitz]

Jamis, you are correct. I was thinking of it from the dietary sources of sugar side. Yes, we do need a level of blood glucose to survive. But we can also function quite well on ketones--and maintain normal levels of blood glucose. We don't need to eat sugar (or other starchy carbohydrates) to survive. I'm not advocating a zero carb diet, or even a ketogenic diet for everyone, just pointing out that "sugar" is not necessary in our diets, whether it comes from what we normally think of as sugar or starches.

[jamiswolf]

Jamis, you are correct. I was thinking of it from the dietary sources of sugar side. Yes, we do need a level of blood glucose to survive. But we can also function quite well on ketones--and maintain normal levels of blood glucose. We don't need to eat sugar (or other starchy carbohydrates) to survive. I'm not advocating a zero carb diet, or even a ketogenic diet for everyone, just pointing out that "sugar" is not necessary in our diets, whether it comes from what we normally think of as sugar or starches.

I felt it was an important point...didn't mean to be a jerk.

This whole business of diet and insulin levels is so crucial since now it's known that somehow OSA is involved.

If anyone wants to research the worst case scenario, they should look up Metabolic syndrome...formerly called syndrome X. It's the ultimate conclusion to a lifetime of excessive carbs in your diet.
Jamis

[Todzo]

I think my apnea is pretty well controlled - I use my PAP every time I sleep, and my AHI is consistently less than 5 and usually less than 3, and sometimes less than 1. My leaks are good and within range.

They haven't told me to increase my carbs, but rather to cut back on the med to once a day. For the first 1.5 years on Metformin my normal blood glucose was less than 120 - usually between 105 and 115. Then I began having high readings in the morning (fasting), but within 30 minutes to an hour back down to normal. The highest my A1c ever got was 6.4. This last test I referenced is the first time anyone has checked insulin. While the doc didn't make it sound like this level was an immediate threat, he was concerned (normal should be below 10). He also said that high insulin could be causing several of my other health issues.

High morning sugar could mean events at night. Your machine will not pick up micro events and may not capture RERA events. My AHI has been well under 2 for a long time now - but - I still struggle with breathing stability and the daytime sleepiness I sometimes experience is likely related to arousals cause by excessive respiratory effort during those events. If an arousal occurs the stress hormones are ratcheted up. Higher stress hormones will cause the body to prime for a sugar release - which will have no place to go - so insulin is then released and so that may explain your high insulin as well.

I am glad that Dr. Lustig's book explains a lot about how to deal with keeping insulin resistance from getting worse. I do highly recommend his book! See: http://www.amazon.com/Fat-Chance-Beatin ... 159463100X

Have a great week!

Todzo