Monday, August 2, 2021

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




Saturday, July 31, 2021

Weekly Health Statistics: 7/18 - 7/24/21

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 two weeks into my sleep experiment 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. 
  • Blood glucose:
    • All stats looking good.
  • Body:
    • Still seeing steady drop in weight and waistline; still happy with my progress.  
  • Blood:
    • Total cholesterol and triglycerides were way higher than normal this week (90 & 276 vs. ~160 & ~70). Very likely an outlier, but will keep an eye on it.
    • Blood pressure back down to typical, so last week was probably an outlier. 

Active & Planned Experiments

  • Comprehensive bloodwork:
    • Goal: Establish baseline for a broad range of biomarkers and check overall health
    • Approach: WellnessFX Premium panel
    • Status: Got the results, need to analyze and 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:
      • La Tortilla Factory Low-Carb Flour Tortilla: Testing complete
      • La Tortilla Factory Low-Carb Whole Wheat Tortilla: In queue
      • Other low carb tortilla: In queue
      • Costco low-carb bread: In queue
  • 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 2 complete

Data:

Blood



Body


Sleep





Methods:

Measurements: See summary section above

Data Processing & Visualization. Data was visualized using Tableau.

Data: here


- QD

Saturday, July 24, 2021

Weekly Health Statistics: 7/11 - 7/17/21

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:
    • This was the first week of my sleep experiment, so in addition to the metrics automatically tracked by my watch, I'm noting down any time I wake up in the middle of the night.
    • Despite the fact that all the auto-tracked metrics looked good, I was waking up much more frequently in the middle of the night and feeling more tired. This suggests the auto-tracked metrics are not a great measure of overall sleep quality.
    • I need to do a more detailed analysis to figure out what's going on here...
  • Blood glucose:
    • All stats back to normal after last week's travel. 
    • Time 70-140 mg/dL still could be a bit better. Will continue to cut back on insulin at meals.
  • Body:
    • Still seeing steady drop in weight and waistline. I'm very happy with my progress here. 
  • Blood:
    • Switching to every other week measurement for cholesterol and hemoglobin to reduce tracking burden. Will increase frequency if I'm doing any experiments that might cause them to change.
    • Blood pressure was much higher than normal this week. I ate an unusual dinner last night and had higher than normal BG, so might just be an outlier. Will keep an eye on this and see if it persists.

Active & Planned Experiments

  • Comprehensive bloodwork:
    • Goal: Establish baseline for a broad range of biomarkers and check overall health
    • Approach: WellnessFX Premium panel
    • Status: Got the results, need to analyze and write up.
  • 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 1 complete

Data:

Blood



Body


Sleep



Methods:

Measurements: See summary section above

Data Processing & Visualization. Data was visualized using Tableau.

Data: here


- QD

Saturday, July 17, 2021

Weekly Health Statistics: 7/4 - 7/10/21

For those checking the dates, I'm posting these with a 1-week lag. 

Summary:

What I'm tracking

  • Sleep: 
    • Method: Apple watch + Autosleep app
    • Metrics: total time, heart rate variability, pulse (sleeping vs. waking)
  • Blood glucose:
    • Method: Dexcom G6 CGM
    • Metrics: fasting BG, Avg. BG, coefficient of variation, time 70-140 mg/dL, time <60 mg/dL
  • Body:
  • Other blood:
  • Urine:
    • Method: Vessel
    • Metrics: biotin, ketones, pH, vitamin C, magnesium, hydration, & cortisol


Observations

  • Sleep:
    • Sleep improved again this week, despite traveling Monday-Wednesday and I continue to feel much better/less tired than before I started going to bed at a consistent time.
    • Still noticing that I'm waking up earlier than preferred, though it's not always showing up in the data (probably b/c I stay in bed trying to go back to sleep). I'm starting an experiment this week to test ways to stay asleep longer, so I'll need to make sure I measure wake-up time correctly.
  • Blood glucose:
    • Fasting BG spiked up this week, likely due to travel Monday-Wednesday. I ate much later those days (8p vs. normally 5p), which led to a higher fasting BG. 
    • Rest of BG stats were ok, but not great, again likely related to traveling and less controlled meals.
  • Body:
    • Still seeing steady drop in weight and waistline. I'm very happy with my progress here. 
  • Blood:
    • Hemoglobin in dead center of normal. Starting to look like those high points were anomalies.
    • Cholesterol (total, LDL, and HDL) looks like it's holding steady. Numbers are decent, but could be better. I may target this for intervention after my sleep study.
    • Blood pressure seems to be trending down. Will keep an eye on.
  • Urine:
    • Nothing interesting in this data. My values for biotin, pH, & Vitamin C are outside of the "normal" range, but I haven't been able to find any literature indicating that this is even correlated with medical issues I would be concerned about.
    • In 6 tests, I've only gotten a reading on cortisol three times. That measurements seems to be extremely unreliable.
    • All-in-all, I'm not getting much value out of the vessel tests. I've finished out the pack I bought and won't be continuing these stop.

Active & Planned Experiments

  • Comprehensive bloodwork:
    • Goal: Establish baseline for a broad range of biomarkers and check overall health
    • Approach: WellnessFX Premium panel
    • Status: Got the results, need to analyze and write up.
  • Testing methods of sleeping longer:
    • Goal: Determine interventions that will enable me to stay asleep longer
    • Approach: Melatonin?, will ask in several forums to get suggestions
    • Status: posting in forums this week

Data:

Urine




Blood






Body


Sleep


Methods:

Measurements: 

Data Processing & Visualization. Data was visualized using Tableau.

Data: here


- QD

Monday, July 12, 2021

Melatonin to Stay Asleep Longer: Protocol & Pre-registered Analyses

Summary: I'm trying to sleep longer, but am waking up too early in the morning. I'm going to test if melatonin can help me sleep longer. Based on suggestions solicited from the ACX open thread, I'm going to try a 30 day, blinded, randomized trial of 0.3 & 3 mg melatonin, both regular and extended release. If I see anything promising from this initial test, I'll repeat the trial with the best condition to confirm and get a better measure of effect size.


Details:
Purpose
  • 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

Background

Over the past 5 weeks, I've been making an effort to get more sleep. I've been able to hit an average time asleep of ~7h and, qualitatively, I've been feeling a lot less tired and have been able to concentrate better in the afternoons.  

I'd like to see if sleeping even longer will result in further improvement. However, over the last week I've noticed that I've been waking up earlier and earlier (before my morning alarm). I stay in bed (eyes closed) until the alarm, but can't go back to sleep.

Based on my data so far, there's no clear correlation with time I fell asleep or total time asleep. Might be a correlation with heart rate variability, but I need more data to be sure.

I'd like to test some interventions to sleep longer. I already exercise in the evenings and for as long as I'm willing to do (~30 min. high intensity, 5-10 min. stretching), my last meal is 4h before going to bed, and my CGM does not show a consistent rise in blood sugar before waking up.

Given that, my next thought was to try melatonin. It's typically used to control when you go to sleep, but it last long enough in the bloodstream that it might impact time asleep as well. Based on suggestions solicited from the ACX open thread, I'm going to try a 30 day, blinded, randomized trial of 0.3 & 3 mg melatonin, both regular and extended release. If I see anything promising from this initial test, I'll repeat the trial with the best condition to confirm and get a better measure of effect size.


Methods
Materials

Blinding
  • Melatonin was placed in opaque, size 000 gel capsules (6 per type).
  • Dosages were randomly assigned to days using the excel random number generator and placed into a coded pill container by a second person (not me). 
  • Data will be unblinded after the completion of the experiment.

Procedure
  • At 9pm, I will take that days gel capsule with minimal water.
  • At 9:30pm, I will turn lights off and attempt to go to sleep.
  • I will record:
    • If I wake up during the night
    • Subjective tiredness (1-3 scale) upon arising and at 3p
    • If any other unusual events occur

Measurements

Analysis
  • Sleep time, wake time, total time asleep, number of times waking up before alarm, fasting blood glucose, time of morning blood glucose rise, pulse, and HRV will be plotted vs. dose and release type. 
  • p-values will be calculated for each comparison and corrected for multiple-comparison
  • Additional exploratory analysis may be done based on the data, but will be noted as such

Data Processing & Visualization
Data was exported from Autosleep, reformatted using a custom python script, and visualized using Tableau. Wake times were corrected manually using contemporaneous notes (see measurements, above).


Data
All data will be posted after it is unblinded.


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


Conclusions & Next Experiments
Conclusions & next experiments will be posted after the data is unblinded and analyzed.

Saturday, July 10, 2021

Weekly Health Statistics: 6/27 - 7/3/21

For those checking the dates, I'm posting these with a 1-week lag. 

Summary:

What I'm tracking

  • Sleep: 
    • Method: Apple watch + Autosleep app
    • Metrics: total time, heart rate variability, pulse (sleeping vs. waking)
  • Blood glucose:
    • Method: Dexcom G6 CGM
    • Metrics: fasting BG, Avg. BG, coefficient of variation, time 70-140 mg/dL, time <60 mg/dL
  • Body:
  • Other blood:
  • Urine:
    • Method: Vessel
    • Metrics: biotin, ketones, pH, vitamin C, magnesium, hydration, & cortisol


Observations

  • Sleep:
    • With my family back home, my sleep came right back up to normal. I'll have to tell my wife she's not allowed to go on trips anymore :)
    • I'm feeling much better/less tired during the day now that I'm going to bed at a consistent time. However, over the last week, I noticed I'm waking up earlier and earlier (total change ~30 min.) despite going to bed at the same time. I'd like to test out some interventions to see if I can stay asleep longer.
  • Blood glucose:
    • Fasting BG & average BG continue to improve and CV% is holding steady at ~13% (very good). 
    • TIR is low again, due to spending too much time below 70 mg/dL. I suspect this is due to increased insulin sensitivity from losing weight, so I'm going to try backing off on my insulin doses.
  • Body:
    • Still seeing steady drop in weight and waistline. I'm very happy with my progress here. 
  • Blood:
    • Hemoglobin continues to be on the high end of normal range. Still doesn't matter.
    • Slight trend down in cholesterol (total, LDL, and HDL). Will keep an eye on.
    • Cardiocheck PA continues to give reliable readings (and matched Quest blood work). 
    • Blood pressure continues to run slightly high. Need to check against the Dr's at my next appointment
  • Urine:
    • Nothing interesting in this data. My values for biotin, pH, & Vitamin C are outside of the "normal" range, but I haven't been able to find any literature indicating that this is even correlated with medical issues I would be concerned about.
    • In 5 tests, I've only gotten a reading on cortisol twice. That measurements seems to be extremely unreliable.
    • All-in-all, I'm not getting much value out of the vessel tests. I will finish out the pack I bought and then stop.

Active & Planned Experiments

  • Comprehensive bloodwork:
    • Goal: Establish baseline for a broad range of biomarkers and check overall health
    • Approach: WellnessFX Premium panel
    • Status: Got the results, need to analyze and write up.
  • Testing methods of sleeping longer:
    • Goal: Determine interventions that will enable me to stay asleep longer
    • Approach: Melatonin?, will ask in several forums to get suggestions
    • Status: posting in forums this week


Data:

Urine




Blood



Body


Sleep

Methods:

Measurements: 

Data Processing & Visualization. Data was visualized using Tableau.

Data: here


- QD

Sunday, July 4, 2021

Please Critique my Experiment Design: Self-Experiment to Sleep Longer

Summary: I'm trying to sleep longer, but am waking up too early in the morning. I'd like to test some interventions to sleep longer (including melatonin) and am looking for advice.


Over the past 5 weeks, I've been making an effort to get more sleep. I've been able to hit an average time asleep of ~7h and, qualitatively, I've been feeling a lot less tired and have been able to concentrate better in the afternoons.  

I'd like to see if sleeping even longer will result in further improvement. However, over the last week I've noticed that I've been waking up earlier and earlier (before my morning alarm). I stay in bed (eyes closed) until the alarm, but can't go back to sleep.

Based on my data so far, there's no clear correlation with time I fell asleep or total time asleep. Might be a correlation with heart rate variability, but I need more data to be sure.


I'd like to test some interventions to sleep longer. I already exercise in the evenings and for as long as I'm willing to do (~30 min. high intensity, 5-10 min. stretching), my last meal is 4h before going to bed, and my CGM does not show a consistent rise in blood sugar before waking up.

The only thought I had was to try melatonin. It's typically used to control when you go to sleep, but it last long enough in the bloodstream that it might impact time asleep as well.

Plan:

  • Self-blinded study using melatonin placed inside placebo capsules
  • Concentrations: 0, 0.3, 3 mg (random assignment)
  • Duration: 4 weeks
Questions:
  • Anyone else have the same problem? What has worked for you to sleep later?
  • Any other suggestions for interventions to try?
  • Any comments or critiques on the melatonin experimental design?
    • Is random assignment by day sufficient or do I need to block by a longer time period, use washout days, etc.?