Interesting Links – 1/2020

Interesting articles I’ve read over the last month

Diabetes & Quantified Self:

Health & Aging:

  • Fisetin – a nice review of the history and recent clinical trials on Fisetin as a senolytic agent for general improvement of health and blood sugar control in diabetes.

Cooking:

  • Cream Cheese: A Homemade Ice Cream Miracle Worker – Never would have thought of this, but between the slightly sour taste and stabilizers that reduce ice crystal nucleation and growth, cream cheese can be a great substitute for heavy cream or yogurt in ice cream. I tried it out and really enjoy it in ice creams with a Philadelphia base.


Chemistry:


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Recipe #3 – Keto Snickerdoodle Custard Ice Cream

Keto Snickerdoodle Ice Cream

Continuing my series of low-carb ice cream recipes (first two here and here), here’s one for Snickerdoodle with a custard base. I can’t find a record of what I adapted this from, so if anyone recognizes it, please let me know and I’ll add an attribution.

This one’s a custard base, so it’s a bit more work than the Chai Tea (Philly base). That said, it’s only an extra 5-10 min. and the creaminess off the egg yolk is totally worth it if that’s what you’re in the mood for. 

In the recipe below, I give two different options for the stabilizers. If you use the ice cream stabilizer mix, it will stay scoopable even when frozen. If you use the alcohol + xanthan gum, it will freeze solid, but return to an ice cream texture if allowed to warm for 10 min. or so before eating.

Hope you enjoy it,


– QD

Keto Snickerdoodle Frozen Custard Ice Cream

QD
Snickerdoodle ice cream using a custard base
Prep Time 5 minutes
Cook Time 40 minutes
Total Time 45 minutes
Servings 6 3/4 cup
Calories 228 kcal

Equipment

  • Ice cream maker

Ingredients
  

Instructions
 

  • Set up an ice bath in a large bowl and set aside.
  • In a saucepan, whisk together allulose, cinnamon, salt, and stabilizer. If replacing the stabilizer with vodka + xanthan gum, don’t add them here. Instead add with the vanilla.
  • Add cream and almond milk and heat over medium to medium-low heat until the temperature is 170 °F, stirring frequently to prevent scorching.
  • Using the hot mixture, temper the egg yolks, then return the tempered mixture back to the saucepan and continue heating until ~175 °F and the mixture is thick enough to coat the back of a spoon. 
  • Strain the thickened mixture through a fine mesh sieve and into a bowl set in an ice bath. This removes lumps and rapidly cools down the mixture to stop further cooking of the eggs.
  • Refrigerate for at least 4 hours and preferably overnight, then freeze in an ice cream maker according to its instructions

Notes

Nutrition information calculated by adding up macros of the individual ingredients. Allulose not included in the Total or Net carbs.
To reduce the calorie content, you can replace part of the heavy cream with additional almond milk (1:1 by weight). I’ve gone as low as 160 g heavy cream and it’s still good, though less rich. Even lower might be possible, but I haven’t tried.

Nutrition

Serving: 0.75cupCalories: 228kcalCarbohydrates: 2.3gProtein: 3.3gFat: 26gFiber: 0.1g
Tried this recipe?Let us know how it was in the comments

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Recipe #2 – Quick, Customizable Keto Frozen Yogurt

Keto Frozen Yogurt

My last recipe for Keto Chai Tea Ice Cream got requests for more ice cream recipes on Reddit. Since people are interested, I thought I’d put up the rest of my ice cream recipes. They’re in various states of development, so with each recipe, I’ll note what I plan to do to improve and then update once I’ve tried.

This next recipe is for frozen yogurt. It’s adapted from a recipe in Genius Desserts, with allulose swapped for sugar and vodka added to reduce the freezing point and improve texture.

What I like about this recipe is that it’s extremely simple and customizable. You just mix a quart of yogurt with sweetener, your favorite flavorings, and some alcohol, freeze and you’re done.

For yogurt, Two Good brand is my favorite for taste and texture, but any low-carb yogurt will work.

Unlike the Keto Chai Tea Ice Cream, this one does freeze solid and you need to let it warm up before eating if you want a good texture. Next time I make it, I’m going to try swapping ice cream stabilizer for vodka to see if I can reduce the freezing point.


– QD

Keto Frozen Yogurt

QD
Super-simple low-carb frozen yogurt
Prep Time 2 minutes
Cook Time 20 minutes
Total Time 22 minutes
Servings 6 3/4 cup
Calories 80 kcal

Equipment

  • Ice cream maker

Ingredients
  

  • 900 g full-fat yogurt I use Two Good brand, but pick your favorite
  • 30 g vodka
  • 2 tsp. vanilla or any other flavoring you like (I really liked crystallized lemon)
  • 200 g allulose (or other sweetener)
  • 0.25 tsp. salt

Instructions
 

  • Mix all ingredients until fully incorporated.
  • Cover and refrigerate for at least 4 hours. Note: This step is optional with vanilla or if the flavor is already incorporated in the yogurt. It was necessary when I used solid flavorings, like crystallized lemon.
  • Freeze in ice cream maker per manufacturers instructions.

Notes

Nutrition calculated by adding up macros of the individual ingredients. Allulose not included in the Total or Net carbs.
This recipe is really flexible. You can swap in your favorite full fat yogurt with whatever flavoring you like. Vanilla can be omitted or replaced with other flavors (I particularly liked adding crystalized lemon).

Nutrition

Serving: 0.75cupCalories: 80kcalCarbohydrates: 3gProtein: 12gFat: 2g
Tried this recipe?Let us know how it was in the comments

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Recipe of the Week #1: Chai Tea Ice Cream

Keto Chai Tea Ice Cream

In addition to self-tracking, I also like to cook. I thought it would be fun and hopefully of interest to people to post some of my favorite recipes. All are low-carb, often modified from regular recipes I’ve found.

I’ve recently gotten into making homemade ice-cream. This first recipe is my favorite so far. I adapted it from the book Hello My Name is Ice Cream: The Art and Science of the Scoop. I used the author’s recipe for cream cheese ice cream, combined with her procedure for infusing a Philadelphia base with tea, and swapped allulose for sugar. The cream cheese and stabilizer give it a fantastic texture. It doesn’t freeze solid and remains scoopable (one of the biggest challenges in keto ice cream).

I used Chai Tea from Oaktown Spice Shop, which is near my house, but you can use whatever tea you’d like. The ice cream takes on the same flavor as that tea with milk, cream, and allulose added. 

You can also tune the calories up or down by swapping almond milk for heavy cream, with the expected affect on taste and texture.


– QD


Keto Chai Tea Ice Cream

QD
Low-carb, keto friendly Chai Tea ice cream
Prep Time 15 minutes
Cook Time 30 minutes
Total Time 45 minutes
Course Dessert
Servings 8 3/4 cup servings
Calories 180 kcal

Equipment

  • Ice cream maker

Ingredients
  

  • 200 g allulose
  • 3 g ice-cream stabilizer
  • 400 g almond milk
  • 380 g heavy cream
  • 20 g cream cheese
  • 10 g chai tea blend , I use a custom blend from Oaktown Spice Shop, which is near my house. It's fantastic, but you can substitute another tea that's cheaper or more readily available.

Instructions
 

  • Whisk together allulose and stabilizer in a small bowl. Set aside.
  • Add almond milk, heavy cream to a saucepan and heat over medium heat until boiling. Whisk occasionally to prevent scorching.
  • Add allulose mixture, reduce heat to a low simmer, cook for 2 min., then whisk in cream cheese until melted and homogeneous.
  • Remove pot from the heat, add tea, and steep for at least 30 min.
  • Strain through a fine mesh sieve into a bowl, cover, and cool in a refrigerator for at least 4 hours, preferably overnight.
  • Churn in an ice cream maker according to the manufacturers instructions.

Notes

Allulose is not included in the carbohydrate total.
Possible substitutions & modifications:
  • Chai tea can be replaced with whatever tea you like. The ice cream takes on the same flavor as that tea with milk, cream, and allulose added
  • The ice cream stabilizer can be replaced with xantham gum, glucomannan, or other stabilizers, but the ice cream will not stay as soft in the freezer and texture won’t be as smooth. Still tastes good, though.
  • Ice cream stabilizer can be reduced by up to 50% and still get a good texture.
  • Cream cheese can be replaced by milk powder, but you might have to increase the amount of stabilizer to compensate.
  • You can tune the calories by swapping more almond milk for heavy cream, with the expected affect on taste and texture.

Nutrition

Serving: 0.75cupCalories: 180kcalCarbohydrates: 2gProtein: 2gFat: 19g
Keyword Chai, Ice cream, Keto, Low-carb, Tea
Tried this recipe?Let us know how it was in the comments

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Experiment #2: 48 hours of Blood Sugar Tracking

Figure 1. Measured blood glucose concentration vs. time for both days. Reference bands and lines show target range and high/low thresholds.
Table 1. Summary statistics of blood glucose concentration over 48 h. 

I don’t have enough data yet to analyze my food & exercise experiments (see next experiments), so for this week I decided to look at how my blood sugar varies over the course of a day.

Normally, I only check my blood sugar at key times (waking, going to bed, before injecting insulin, before eating, and 1 & 2h after eating). To see if there was anything to be learned from what’s happening the rest of the time, I decided to spend 2 days checking my blood sugar every 15 minutes.

Since I have Type 2 diabetes, my insurance won’t cover a continuous glucose monitor (CGM). Plus, blood glucose meters (BGM) are more accurate, even according to CGM manufacturers. So, for this experiment, I used my Freestyle Freedom Lite and just measured by blood glucose every 15 minutes.

This ended up being way more useful than I expected. There was a lot more going on between the times I usually measure than I realized. Here’s a most important things I learned, my new questions, and ideas for next experiments.


Key Learnings:

  • Shorter testing intervals around key times is extremely informative. My normal routine of testing blood sugar before and 1 & 2h post-meals is not sufficient. There’s a lot going happening on both shorter and longer time-scales that will be useful for understanding the effects of different interventions and for optimizing medication. 
  • I’m spending far more hypoglycemic than I had realized, most notably when I exercise. 
  • My peaks in blood sugar from breakfast and lunch occur >3h post-meal and persist until my next insulin dose. This is way longer than I expected and indicates that I need to switch to a longer acting insulin or change something about the meals.
  • My blood sugar drops significantly during cardio exercise (MMA, biking), then returns to normal over 30-45 min. I need to find a way to mitigate this to prevent my blood sugar from going dangerously low.


Questions:

  • What is happening to my blood sugar between waking and breakfast? Any risk of hypoglycemia while driving to work?
  • Is the long-duration peak in blood sugar after breakfast and lunch real & consistent? If so, what causes it and can it either be shortened by modifying the meal or mitigated using a longer-acting insulin?
  • What is the effect of different types of exercise? How can I mitigate or offset the initial drop in blood sugar during cardio without causing high blood sugar after the recovery?
  • What is the effect of dinner, disentangled from exercise?


Next Experiments

I’m always interested in ideas for new experiments, so please leave a comment if there’s something you’d like me to try.

  • Exercise studies: Measure blood glucose at 15 min. intervals for different duration and intensity bike rides and weight lifting. Also try varying time since last insulin dose and food eaten before exercising.
  • Long peak from breakfast & lunch: Measure blood glucose at 15 min. intervals a few more times after breakfast & lunch. Try varying protein and fiber content to see if those are the causes. Try normal-acting insulin to mitigate.
  • Food & medication studies: It’s proving difficult to disentangle the numerous effects going on at any given meal by adding or subtracting particular foods (data too noisy, too many measurements required to observe a statistically significant effect). Instead:
    • Skip meals and medication to measure background trends.
    • Consume individual ingredients (glucose, protein, fiber, etc.) or take individual medications to measure their direct effects.
    • Measure combinations of ingredients and medications to measure interaction effects.
    • This will require more experiments, but I think in the end it will require less time & effort to get reliable results.

Details

Purpose

To better understand trends in my blood glucose over the course of a day and determine if there are trends or events that I should investigate further.


Design/Methods

General. Blood glucose was measured approximately every 15 min. using a FreeStyle Freedom Lite glucose meter and FreeStyle lancets & test strips. No special precautions were taken to clean the lancing site before measurement. To take a sample, the lancing devices was used to pierce the skin at an ~45 deg. angle from the finger. Blood was then squeezed out by running the thumb and pointer finger of the opposite hand from the first knuckle to the lancing site of the finger. Blood was then wicked into a test strip that had been inserted into the meter and the glucose reading was recorded.

Medication and meals were kept as normal, with the exception of an additional 2 g of glucose eaten with breakfast on the first day as part of an experiment on the effect of glucose on my blood sugar.


Data

Link


Results & Discussion

Overall. The full set of data is shown in Figure 1 with summary statistics in Table 1. Major insights:

  • I had far more hypoglycemic events than I expected, 13% overall and 21% in day 2, with a low of 41 mg/dL. This was extremely disturbing, as hypoglycemia can be extremely dangerous. A closer look at the data (see Evening section), shows this to be from riding a stationary bike, which I hadn’t noticed before because my sugar returns to normal levels after 30-45 min. 
  • Other than the low episodes in the evening, and factoring out time spent high due to eating extra glucose as an experiment, my control was pretty good. 
  • Clear dips and spikes were visible from eating, exercise, and insulin, many of which occurred at shorter time scales than I normally test.

To really see what’s going on, though, let’s zoom in different times of the day.

Morning:

Figure 2. Measured blood glucose concentration vs. time from 4a-12p, with annotations for key events. Reference bands and lines show target range and high/low thresholds.
  • Waking to breakfast: 
    • The first morning, there was a 10 mg/dL rise, followed by an identical drop over the next 45 min. My normal routine of measuring up arising and before dosing for meals would completely miss this. 
    • The second morning, the rise was the same magnitude (10 mg/dL), but slower, so there was time for it to fall back down before my breakfast insulin. Either way, looks like there’s some timing variability here. Need to investigate further.
  • Breakfast:
    • The first morning, I ate an extra 2 g glucose as part of my food & exercise experiments (see next experiments) and saw an immediate rise in sugar, reaching peak after about 1.5h. Very interestingly, the peak persisted for >5h, much longer than I usually test for. 
    • The second morning, I saw an 18 mg/dL drop in the first 45 min. after taking insulin, which then stayed steady for the next hour. This is larger than expected given the only difference from Day 1 was not eating the 2 g glucose, but may be within natural variation. 
    • More significant was the effect of a one hour mixed-martial arts (MMA) class. Since my blood sugar was low, I took 4 g glucose (expected to raise my blood sugar by ~20 mg/dL). From the start to end of exercise, I saw an ~25 mg/dL rise. While this could be accounted for by the 4 g glucose, based on Day 1, I would also expect an ~20 mg/dL rise from breakfast. All together, this suggests a possible 20 mg/dL drop from the MMA class (very speculative, needs more study). On top of that, I saw a brief 15 mg/dL drop after the MMA class finished, which then came right back up. Not sure what this means, but it’s consistent with other exercise effects (see evening section)
    • Lastly, the breakfast on Day 2 showed the same long duration peak as day 1, with blood glucose peaking 3.6h after breakfast and persisting for 5 h, until I took my insulin for lunch. I use a rapid acting insulin at breakfast. However, since I made the switch to the rapid-acting insulin, I added additional protein and fiber to the meal. Need to investigate whether I should switch to normal-acting insulin.    

Afternoon:

Figure 3. Measured blood glucose concentration vs. time from 10a-5p, with annotations for key events. Reference bands and lines show target range and high/low thresholds.
  • The afternoon was a lot less eventful. On both days, I saw a 10-15 mg/dL drop in the 40 min. between taking insulin and eating lunch, followed by a continued drop over the next 30 min., then a, ~15 mg/dL rise. On Day 1, the rise almost exactly offset the drop, while on Day 2, the drop was ~10-15 mg/dL larger and therefore wasn’t full offset. This may be due to the morning exercise on Day 2, or some other source of variation. Need to keep an eye on this.
  • Either way, lunch medication plus food seems pretty well calibrated, which is a bit odd since my breakfast and lunch are identical. Hypotheses to test:
    • There’s some other factor causing a drop in the afternoon, offsetting the long peak seen in the morning
    • The long peak at breakfast is related to the dawn phenomenon (additional glucose from liver and/or reduced insulin sensitivity)
    • To test these, could try skipping meals and their associated insulin, which should have different effects depending on the cause of the discrepancy.

Evening:

Figure 4. Measured blood glucose concentration vs. time from 4-11p, with annotations for key events. Reference bands and lines show target range and high/low thresholds.
  • The fact that I both eat dinner and exercise in the evening makes analysis difficult. Need to run experiments where I do one or the other to better disentangle the effects.
  • Dinner:
    • On both days, my blood glucose increase slightly after taking my dinner insulin. This suggests my blood sugar may still have been rising from after lunch, however, this is a very long time for food to be having an effect. Since my breakfast and lunch are high in protein and fiber, I tried to find information on their direct and indirect effects on blood sugar. However, the information I found was both spotty and ambiguous (especially for fiber, for which I found a lot of articles on using it for diabetes prevention, but no well controlled studies of its immediate effect on blood sugar). Need to test this directly.
    • After the immediate drop, exercise prevents any meaningful analysis of the effect of dinner except to say it doesn’t appear to significantly raise my blood sugar. 
  • Exercise:
    • I did ~30 min. of weightlifting on Day 1. During that time, I saw a ~12 mg/dL spike, which came back down immediately after. My blood sugar typically increases at the start of exerciseand this is consistent and small enough not to worry about.
    • The effect of biking was more significant. I typically to 2×15 min. stints on a stationary bike in the evenings and previously hadn’t noticed any major effects on my blood sugar at my normal 1h and 2h post-meal checks. By testing every 15 min., I can see that, even with taking glucose before starting, these bike rides are dropping my blood sugar by 10-20 mg/dL over the course of the ride, after which it comes back up to baseline over 30-45 min. 
    • On both days, even with taking glucose before hand, the bike rides sent me into dangerously hypoglycemic territory. Notably, I didn’t notice any symptoms of hypoglycemia, possibly because they were overshadowed by the effect of the exercise itself.
    • This drop during biking is very worrisome and something I completely missed with my normal testing routine. A few takeaways:
      • I need to run more experiments to figure out the exact details and how to mitigate this effect.  Bike further away in time from peak insulin
      • Use a faster acting and/or better timed glucose to offset drop
      • Since blood sugar can drop then rise quickly with physical activity, I can’t rely on just testing before and after meals. For any physically significant activity, I need to test before and after until I’m sure I understand it’s effect.

Overnight. I saw a 5 mg/dL drop overnight between Day 1 and Day 2. That’s within the normal variance of my meter, so I’ll check over a larger number of days to see if it’s real. Either way, not significant relative to the other effects I observed.


Conclusions & Next Experiments

See summary section above


– QD


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