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Saturday, December 12, 2015

Small New York Baked Low Carb Cheesecake




I posted the recipe for a delicious Large New York Baked Low Carb Cheesecake based on one posted by Angie, Granny Red, on the ADA forum a couple of years ago. It is a rather big cheesecake which I cut into 16 portions of 6gms carb each. 

Since then I have experimented several times with a reduced size because I found the large cake was too big for our needs. This is the recipe for those who prefer a smaller cake. The size reduction not only cuts the cost in half but is a little easier to prepare and needs less cooking time. The slight increase in egg proportions also tends to make a creamier texture.

I have modified the Splenda and sugar proportions as a reasonable compromise between my wife's sweet tooth and my need to keep the carbs down. Feel free to adjust that to suit yourself as the carb count will be directly reduced as you reduce the sugar. The nutrition count is based on the listed details. 

Ingredients

Crust 

1 cup almond flour or meal
2 tablespoons(tbsp) Splenda
1 tbsp sugar
4 tbsp butter, melted 

Filling 

12 oz (375gm) cream cheese
1/3 cup Splenda
2 tbsp sugar
2 eggs
1 teaspoon(tsp) vanilla extract
1/2 tsp lemon extract or a good squeeze of lemon; orange can be substituted as a variation.
8 oz (300ml) sour cream

Note: the eggs, cheese and sour cream need to be at room temperature. If the cheese is too stiff to beat easily, sit the containers in warm water for a little while until the cheese softens. 

Method

Crust Base 

Use extra butter to grease an 8 or 9 inch (20-25cm) spring-form pan. I also put a circle of greased brown paper on the bottom to be certain the cake does not stick; this step may not be necessary if you use a non-stick pan. 
 
Mix the splenda and almond flour (sometimes I make my own coarse version from almonds in the blender; it works just as well) with melted butter, press evenly onto the bottom of the pan for a thin layer without holes and press any excess up the sides of the pan. If you don't have enough almond flour to go all the way up the sides don't worry; it's not really critical as long as the base is covered. Set the pan aside while mixing the filling. 

Filling 

Beat the cream cheese until light and creamy, keeping the mixer on a low-medium setting throughout the beating and mixing process. Add the mixed splenda and sugar a little at a time and continue beating until creamy.

Add one egg at a time and beat briefly after each egg. When the eggs have been mixed into the cream cheese add vanilla and lemon extract (or lemon juice) and mix briefly until just combined. Add the sour cream last and beat briefly until fully incorporated. 

Baking 

Pour the mixture into the springform pan. Bake at 300 F or 150C for about 40 minutes then check to see if it is set and starting to brown slightly on top. If not, let it cook for another 15 minutes. Try not to over-cook it as it may become too dry. When it is set and beginning to brown turn off the heat, prop open the oven door slightly and leave it in the oven for at least an hour. 

Remove it from the oven and allow it to cool in the spring-form pan to room temperature before placing it in the fridge until the next day. Don't try to serve it on the day of cooking; it will not be set properly if you do. Do not be disappointed if it sinks slightly in the middle. That is normal, or, at least, it was for the ones I made.

The result is 8-12 satisfying slices. I individually wrap some in clingwrap for the freezer; they freeze and defrost well.


Nutrition per serve: 8 12
Kcals 3000 375 250
Fat 275 34.4 22.9
Carb 100 12.5 8.3
Fibre 12 1.5 1.0
Protein 62 7.8 5.2

Bon appetit, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Monday, September 21, 2015

Fat: The New Health Paradigm

I have just read the opening summary of a startling document published by the Credit Suisse Research Institute.


I predict that this publication is going to become one of the most hotly debated documents in the fat vs carbs diet wars this year. The conclusions the authors arrive at are summarised very succinctly on the opening pages.

Their conclusions will not surprise many in the on-line diabetes community as most of us have been saying this for years (for example Eggs, Carbs and Cholesterol, Cholesterol, Fats, Carbs, Statins and Exercise) but they will cause consternation in many of the world's respected dietetic and diabetes authorities. This is not a journalist's article or a book by an organisation with an agenda or a diet to sell; it is a very well researched and supported scientific paper.

Below are abbreviated selections from the summary; these statements are well supported in the body of the document which I am still in the process of studying. I decided to post early to alert readers to the document and allow others to read it in full.

••
Triangulating several topics such as anthropology, breast feeding, evolution of primates, height trends in the human population, or energy needs of our various vital organs, we have concluded that natural fat consumption is lower than “ideal” and if anything could increase safely well beyond current levels.
••
Saturated fat has not been a driver of obesity: fat does not make you fat. At current levels of consumption the most likely culprit behind growing obesity level of the world population is carbohydrates.
••
A proper review of the so called “fat paradoxes” (France, Israel and Japan) suggests that saturated fats are actually healthy and omega-6 fats, at current levels of consumption in the developed world, are not necessarily so.
••
The big concern regarding eating cholesterol-rich foods (e.g. eggs) is completely without foundation. There is basically no link between the cholesterol we eat and the level of cholesterol in our blood.
••
Doctors and patients’ focus on “bad” and “good” cholesterol is superficial at best and most likely misleading. The most mentioned factors that doctors use to assess the risk of CVDs—total blood cholesterol (TC) and LDL cholesterol (the “bad” cholesterol)—are poor indicators of CVD risk. In women in particular, TC has zero predictive value if we look at all causes of death. Low blood cholesterol in men could be as bad as very high cholesterol. The best indicators are the size of LDL particles (pattern A or B) and the ratio of TG (triglycerides) to HDL (the “good” cholesterol).
••
Based on medical and our own research we can conclude that the intake of saturated fat (butter, palm and coconut oil and lard) poses no risk to our health and particularly to the heart. 
••
The main factor behind a high level of saturated fats in our blood is actually carbohydrates, not the amount of saturated fat we eat. Clinical trials show that a low carbohydrate diet is much more effective in lowering the level of saturated fat in our blood than a low-fat diet.

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter


Friday, September 18, 2015

I Think I May Have Diabetes...

"I think I may have diabetes....and I don't want to die..."

The wording varies but I see this question with increasing frequency on all the forums I read. I have written replies to these posts so often I felt it was time to archive a standard response.

The web is a wonderful source of information but too often people who really should be asking questions like this of their doctor are asking strangers on the net. 

My usual answer is very brief and says exactly that: see your doctor. I highlighted that because it needs to be emphasised.

Unfortunately that isn't always immediately possible for everyone. There can be many reasons for that.  The most common excuses are lack of money, lack of availability of medical support or simply fear of hearing bad news. 

For those with an urgent need and obvious hypo or hyper symptoms or who have tested repeatedly high on a glucometer the suggestion changes from "see your doctor soon" to "get to an ER (emergency room) fast". 

For others unable to see their doctor soon I urge them to at least make the appointment. Do what is necessary to find the money or time or courage but not seeing the doctor can turn out to be much more expensive in the long term. 

Another variant has appeared recently. Some doctors appear hesitant to diagnose if A1c is OK but fasting or casual blood glucose are just over diagnostic thresholds even when the patient has some symptoms. Too many doctors appear to have forgotten that A1c was only recently approved as a diagnostic tool because the patient can be diabetic if other indicators are high despite a normal A1c. I see an increasing number of posts from people in those circumstances who were told they are “borderline” - whatever that means - or “you are not diabetic yet, just eat healthy and exercise and you'll be fine” without a meter or other advice being prescribed.

At this point I will remind readers: I am a diabetic, not a doctor, and only a doctor can diagnose diabetes.

What follows are suggestions for people whose situation is not urgent, who have a long wait to see their doctor or who have seen their doctor but are still unsure. 

Part 1. Discovery

Obtain a home blood glucose test meter and an adequate supply of test strips. How you do that will vary depending on your local health support system. In the US cheap meters and strips are available from several sources; Walmart's Relion Prime was one of the first cheap meters but you may find others if you search. Note that the cost of test strips will be more important than the cost of the meter in the long term. In Australia you will have to pay full price until you are officially diagnosed, but check with the chemist because there are often discount specials.

When you get your meter read this (click on it): Painless Pricks.
 
Test four times a day for two or three days: immediately on waking (fasting) and one hour after your last bite of breakfast, lunch and dinner. The results you are hoping for are as follows:
  • Fasting: 4 to 5.5 mmol/l (Australia, Canada, UK or other millimole countries) or 70 to 99 mg/dl (USA and other milligrams countries).
  • Post-meal: 4 to 8mmol/l or 70 to 140mg/dl.
If all your tests are inside those ranges, relax. Diabetes is most unlikely to be your problem. Don't throw your meter away because it may be wise to occasionally test in future years to see if anything has changed. In that case be aware that test strips have an expiry date.

If any of your results are outside those ranges immediately wash your hands and re-test. If, after re-testing, it is still out of range just record it the first time. If a second test at another time is out of range make an appointment with the doctor for qualified diagnostic testing. 

Part 2. Action.

If your tests were outside the ranges read this while you wait for your appointment with the doctor: Getting Started
 
For those unable to obtain a meter, this may help while waiting to see the doctor: What to Eat at First

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter 
There is nothing I could eat I like more than my eyes

Saturday, August 01, 2015

Blood Glucose Targets 2015

Several years ago I investigated the different targets suggested by three major respected US diabetes authorities. As a result I wrote this: Blood Glucose Targets. My 2006 summary included this comparison table:











Over the years those have changed very little. The 2015 comparison noting significant changes in bold is:











Sources: ADA, Joslin, AACE.

The ADA and Joslin now agree on the looser 2hr post-prandial target of 180(10) and both have also lowered the threshold for fasting. The AACE guidelines are unchanged. If you read the details on the linked pages all add caveats concerning relaxation of targets in case of other medical conditions, age etc.

Thirteen years after diagnosis, thankfully still free of complications, I see no reason to significantly change my closing remarks originally written nearly ten years ago.

The AACE advise much tighter post-prandial targets. I doubt that anyone would consider the American Association of Clinical Endocrinologists, a professional community of several thousand physicians specializing in endocrinology, diabetes, and metabolism as a bunch of fanatical radicals. Nor would they be promulgating guidelines impossible to be attained by the majority.

Unfortunately, nobody but pro-active type 2 diabetics talks much about 1hr PP targets. My personal logic is that I treat their 2hr as my recommended max peak for any post-prandial, as I discussed in When To Test? Those AACE guidelines then agree very closely with Jennifer's Test, Test, Test advice. Make your own judgment on which of those guidelines you think will lead to fewer complications.

Sadly, it appears that only 1/3 of senior diabetics are achieving even the loose ADA targets, but that is a discussion for another topic.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Monday, June 15, 2015

Comments Allowed

I was a little disappointed to notice the lack of comments over the past year or so.

Recently a friend informed me she tried to comment and was blocked.

I had not checked my blog settings for years, as I didn't see a need to change them. I was surprised to find Google had changed my settings without my knowledge and comments were now restricted.

I have changed them back. I welcome comments from anyone, anonymous or named. My only restriction is to moderate them before publishing.

Cheers, Alan, T2, Australia.
Everything in Moderation - Except Laughter

Friday, May 01, 2015

Are Diabetes Complications Inevitable? Not necessarily...


This is a very personal post, reporting on my own recent reports on three aspects of my health: my eyes, my heart and my other affliction, leukaemia.

I am writing this partly to celebrate but also to motivate any newly diagnosed type 2 diabetics, shocked and scared, who have been warned by their doctors of the inevitability of their diabetes progressing to complications. I suppose some doctors feel they need to do that to scare new people into making lifestyle changes, but too often I find dire predictions of long term complications or heart attacks lead to loss of hope. That can lead to a 'why bother' mentality. 

Please, do not give up. I know managing type 2 diabetes can be bloody inconvenient. You will have to make some annoying changes to your life such as pricking holes in yourself, adding some activity to your day, forever watching what you eat and drink and possibly taking meds and insulin. 

Let me assure you: taking control of your blood glucose levels is worth the trouble. I am just one example of many I read on the better diabetes forums where pro-active type 2s are learning how to take control.

Possibly my continuing story will give you hope.

I was first diagnosed with leukaemia and type 2 diabetes in 2002 at the age of 55. I discovered early I could do nothing at all about the leukaemia; for that reason I concentrated on beating the diabetes. I was thirsty for knowledge. For the first couple of years I spent a lot of time learning from many wise people, mostly on usenet. Some were medical professionals but most were experienced diabetics. I learned something from all of them, even if the main thing I learned was how to tell good advice from bad because, unfortunately, a lot of it was bad. I still believe the best advice was Jennifer’s Test, Test, Test: “Use your body as a science experiment.” 

I tested and experimented to find what worked for me. On usenet over the next couple of years I gradually changed from reader and student to lay advisor, passing on information based on my experience. In 2004 I joined some online forums. In 2006 I started this blog. 

Eventually I wrote a book based on my experience to help any newly diagnosed people who might not be computer-savvy. Of course, as my suggestions for good type 2 management differ significantly from the mainstream there will always be critics. In part this is a response to the critics, describing the results of practising what I preached for the past decade.

Motivation

We each must find our own motivation for maintaining the discipline. For me, it is my sight. Since the day I first learned about the possible complications of diabetes my over-riding motivation has been my vision. I came to accept the possibility of death and I certainly don't want to lose limbs from neuropathy or kidneys from nephropathy, but the thought of living in darkness scared me silly. I have tremendous respect and admiration for vision-impaired people who successfully live with that daily. But I do not want to join them. I am a reader of books, an appreciator of beauty, a user of computers and above all I want to see my grand-daughter’s joy as she grows and learns.

The tests used by doctors to monitor our diabetes such as HbA1c, fasting blood glucose and post-prandial blood glucose are all important but they are really only surface indicators. I use those indicators to set my goals, but they don't directly alert me to dying nerves or optic cells. The acid test is whether complications eventually appear as the years pass. 

Limbs and Kidneys

So far neither blood tests nor physical symptoms, including filament tests by my podiatrist, have indicated any signs of neuropathy or nephropathy. I am hopeful that will continue.

Eyes

I had some good news last month. It is over thirteen years since diagnosis and I had not seen the ophthalmologist since 2010. I had a good report then after a scare in 2006 when he discovered minor scars from healed retinopathy. The scars had disappeared by then. This recent visit was almost identical to that 2010 consultation.

The waiting room was packed. After various eyesight checks on new strange machines by the assistant, then the anaesthetic drops, followed by the dilation drops, then another wait, then more tests on machines, I eventually saw the ophthalmologist. He did a very thorough inspection. He warned me that as I age (I am now 68) I may start developing cataracts but at this stage I had no problems apart from inevitably getting older. I wanted reassurance so I asked specifically about retinopathy, macular degeneration and glaucoma as there is some family history of the latter. He re-inspected carefully. He expressed no concern and no evidence of past damage. Then he complimented me on my "superb diabetes control with respect to eye health". I cannot express in the written word how happy that made me feel. Is there a cloud ten above cloud nine? At his request we then spent a few minutes of his valuable time discussing the Test, Review, Adjust technique.

OK, that covers the ‘opathies. None at all. But there is another lurking danger for diabetics: the heart. 

Heart.

I dropped Lipitor ten years ago; the more I read about statins the less I am convinced of my need for one. My doctor has been polite and patient with me when I have consistently refused a statin for the past nine years despite high cholesterol by official standards. My HDL and triglycerides are fine but my LDL is very high. He suggests that may be because of my low-blood-glucose-spike (which many interpret as low-carb) way of eating. He strongly recommended I have a stress echocardiography accompanied by ultrasound of my heart, mainly to reassure him I am not going to keel over tomorrow. I had those tests last September. First, the gooey preparation and the ultrasound, twisting to awkward positions. Uncomfortable but not painful. Then walking faster and faster on the treadmill, with wires hanging off me, having problems reaching the heart rate he wanted. Eventually we got there. As I cooled down it was fascinating seeing the movies of my own heart pumping away on the playback screen of the ultrasound. 

The cardiologist was very thorough and pleased with the results. It seems my heart and vascular system are in fine shape. No problems at all. I will continue to refuse the statin and eat low-carb, moderate fat, for good blood glucose levels. I no longer care at all what my LDL is.

Leukaemia
 
Finally, although I would like to, I cannot forget my Chronic Lymphocytic Leukaemia sitting in the background like the Sword of Damocles. I make no claims about my diet or lifestyle for that. I’m just lucky I suppose. All of my indicators have improved over the years until almost all are in normal range. I still have hypogammaglobulinemia associated with the CLL but one of the indicators for that, IgM, has crept back into normal range. The IgG and IgA are still low, but oddly I don’t seem to be catching anything despite wandering the far corners of the world since diagnosis. I saw the haematologist quarterly at first, then every four months, then every six, now I waste his time annually.

The haematologist, ophthalmologist, podiatrist (who displays my book at reception and has sold several copies) and my General Practitioner tell me to keep doing what I’m doing. 

That sounds like good advice to me. I will heed it.

Cheers, Alan
Everything in Moderation - Except Laughter