Case Study: Overcoming the Fear of Carbohydrates in Type 1 Diabetes (Video)

 

In this article I’d like to share the journey of Behrouz Farsi, a 43 year old man who has been living with type 1 diabetes for the past 9 years. This case study is important mainly because all the changes you see below happened within 2 months, due to hard work, determination and a willingness to succeed.

Frustrations with Nutrition

Behrouz first approached me in November of 2014, frustrated with a number of issues related to nutrition and blood glucose control that he had been struggling with for many years. His problems included the following:

  • Erratic blood glucose values throughout the day
  • A fear of carbohydrates (especially fruits)
  • Emotional eating
  • An unsuccessful attempt at being a vegan (for 1 year)
  • Frustrated with frequent fasting to control blood glucose values
  • Unsure of the health benefits of his favorite foods

For the past few years, Behrouz found himself attracted to the idea of following a plant-based diet. Having read a barrage of books on nutrition and diabetes, he attempted the vegetarian lifestyle for 2 years as well the vegan lifestyle for 1 year. Even though he inherently understood the benefits of following a plant-based diet, understanding the mechanics of what to eat, when to eat and how much to eat became overwhelming quickly. And as a result, he sought my assistance to implement a guided strategy for optimal nutrition and blood glucose control.

In a recent interview with Behrouz, he recounted the following:

I was left feeling tired, starving, hollow and weak at times. I knew that I was not eating adequately at times, and then I would end up emotional eating, which I knew was only making my ability to control blood sugar that much more difficult. Behrouz Farsi
recounting his frustrations with nutrition

Low Energy

Behrouz works a fast-paced job in a stressful medical setting, and must be alert, energized and able to process information quickly. In addition, he is a dedicated father that enjoys spending time with his family in the evening hours.

Behrouz struggled to eat in a way that kept him energized, insulin sensitive and mentally focused throughout the day. He felt low energy at times, and despite his desire to eat a fruit and vegetable-dominated diet, he struggled to implement a strategy that kept his energy levels high and enabled him to partake in work, family and a demanding exercise regimen.

Frustrations with Exercise

Behrouz grew up as an avid athlete, and has played every sport under the sun except rugby and golf. He has always loved playing sports and staying active, however in recent years chronic left hip pain forced him to limit the length and intensity of his workouts. Despite this, he maintained a consistent approach to exercise, making sure to workout between 5 and 7 days per week, circuit training on several different machines at the gym.

Despite this consistent approach to exercise, Behrouz was not able to lose weight, increase his flexibility or increase his sensitivity to insulin. Understandably, his frustration grew as time went on, as his approaches to nutrition and exercise were not yielding either weight loss or performance results.

The Specifics of Behrouz’s Individual Program

When it comes to nutrition and exercise, you’ve probably heard the sayings “everyone is different” and “there is no one-size-fits-all approach to wellness.” I couldn’t agree more.

Given Behrouz’s health status as a person with type 1 diabetes, repeated diligent attempts at eating as a vegetarian and vegan and a consistent approach to both cardiovascular and resistance exercise, we constructed an individualized program that differed from the programs of Larry Gershon, Cynthia Bronte and Maggie Crawford, clients I have written about in previous articles.

Behrouz’s Nutrition Regimen Before the Program

Old Breakfast

Breakfast was the smallest of all his meals, and generally included the following foods:

  • Some fruits
  • A slice of toast
  • 2-3 whole eggs
  • A few medjool dates
  • A small handful of walnuts
  • An omelet (weekends only)
  • Pancakes (weekends only)
  • Waffles (weekends only)

Old Lunch

Lunch was a medium sized meal that usually contained some combination of the following foods:

  • A green salad
  • A sandwich
  • A serving of pasta
  • A serving of meat
  • A serving of beans
  • A serving of potatoes

Old Dinner

Dinner was his largest meal, often influenced by the stress and fatigue he experienced at the end of the working day. Sound familiar? His dinner meals often consisted of the following:

  • A serving of meat
  • A serving of potatoes
  • Bread or tortilla chips
  • A serving of beans or lentils
  • A serving of cheese
  • A side serving of vegetables
  • A serving of pizza or pasta (once per week)

Old Dessert

Dessert was by far the tastiest of all meals, and included comforting foods that helped sooth his nerves after a long and stressful day at work. Dessert foods often included:

  • Chocolate
  • Pumpkin pie or apple pie
  • A few cookies
  • An occasional serving of fruit

Analysis of Old Diet

I helped Behrouz identify two fundamental aspects of nutrition which made a significant difference to his energy and blood glucose control in a short period of time.

Observation #1: Every meal contained at least 1 serving of refined or processed carbohydrates

This observation is critically important because a frequent intake of fake carbohydrates can cause significant metabolic defects, including the following:

Observation #2: His diet contained approximately 35% fat

Even though Behrouz thought that his diet was low in fat, more than 35% of his calories came from fat. Saturated fat predominantly came from meat and cheese while unsaturated fat came from avocadoes, oils, nuts and seeds.

In case you are new to this blog, one of the most important things you will learn is that eating fatty acids in excess of 30 grams per day can significantly impair blood glucose control and set the stage for insulin resistance.

Behrouz’s Nutrition During the Program

New Breakfast

His new breakfast was significantly larger than his old breakfast, and consisted mainly of a fruit smoothie which contained many servings of fruit, including the following:

  • Apples, bananas and pears
  • Hemp protein powder (15 grams)
  • Turmeric root (master antioxidant)
  • Chia seeds (omega 3 fatty acids and fiber)

He ate this meal directly after his morning workout, which served as his breakfast and high-energy workout recovery meal. This meal is by far the most important meal of the day.

New Lunch

We made sure that lunch was the largest meal of the day. Why? Because during the middle of the day Behrouz was both physically and mentally active, meaning that the bulk of his calories were being used for energy on-demand. This is a very important concept that easily gets overlooked in our dinner-dominated society.

His new lunch consisted of some combination of the following:

  • A bowl of lentil soup
  • A sweet potato or yam
  • A large serving of squash (any variety)

New Dinner

Dinner used to be the largest meal of the day, but on this program we made it significantly smaller. Why? Because at the end of the day both is mind and body are sedentary and preparing for sleep. Therefore eating many calories does not make sense from a physiological perspective.

His new dinner consisted of the following foods:

A large green salad, with:

  • Tomatoes
  • Garbanzo beans or black beans
  • A small serving of avocado
  • Carrots

New Dessert

His new dessert consisted predominantly of fruit, given that he now understood the metabolic difference between real and fake carbohydrates. No more cookies, brownies, pies and cakes. Instead he ate the following:

  • Medjool dates
  • Mangoes
  • Grapes
  • Oranges
  • Pumpkin pie (occasional)
  • Chocolate (occasional)

Results

Behrouz’s results were not atypical. By concentrating on eliminating refined, packaged and processed foods from most of his meals, he immediately gained physical and mental energy throughout the day, and was able to increase the intensity of his workouts significantly.

Changes in Fitness

Following 1 month on the program, Behrouz recounts the following:

I was able to steadily push myself during exercise, alternating between an intensive series of floor exercises and swimming. I increased my workouts to 7 days per week which resulted in 10 pounds of weight loss, increased aerobic activity, increased muscle tone and strength as well as a means of managing the pain and stiffness that had limited my workouts before. I also became much more aware of how high intensity interval training (HIIT) made me supremely insulin sensitive. Behrouz Farsi
on the benefits of plant-based nutrition for exercise

For more information about the benefits of high intensity interval training click here.

Behrouz further commented the following:

My 30 minute high intensity morning exercise routine turned my muscles into glucose vacuums for the 3-4 hours that followed, which is why my fruit-heavy post-workout meal didn’t budge my blood sugar values one bit. Behrouz Farsi
on experiencing the glucose vacuum

Behrouz made sure that part of his daily routine was to benefit from the post-exercise state in which glucose can enter muscle tissues free of charge (otherwise known as insulin-independent glucose uptake).

Insulin-Independent-Glucose-Uptake

Impact of Fitness on Body Image

By increasing the intensity and frequency of his workouts, Behrouz developed a mantra which helped him through the process, “be mindful, dedicated and welcome the pain and the muscle microtears.”

Increasing my workout intensity has been transformative, and has yielded breakthrough results in terms of mental and physical well-being. Having struggled with chronic pain in addition to diabetes, having a breakthrough in the ability to expand and intensify my workouts has helped me in indescribable ways. Behrouz Farsi
on increasing workout intensity

Insulin Sensitivity

By significantly reducing his intake of fake carbohydrates, Behrouz’s insulin sensitivity increased significantly.

Behrouz Insulin Sensitivity

I was reminded time and again how much of a negative impact fat consumption truly had. Anytime I consumed fat, it would create a ripple across the next few days in terms of raising my insulin resistance, resulting in elevated blood glucose levels. Behrouz Farsi
on the impact of dietary fat on insulin sensitivity

Intermittent Fasting

Behrouz also practiced intermittent fasting as a means of increasing his insulin sensitivity. Although it was not easy for him to execute, he did find that even a short 24-hour intermittent fast was sufficient to significantly increase his sensitivity to insulin.

I was introduced to the concept of fasting, which I am gradually integrating into my diet plan as a way of depleting glycogen stores and effectively hitting the metabolic "reset button,” when tweaking diet and exercise alone aren't enhancing my insulin sensitivity. Behrouz Farsi
on the immediate benefits of intermittent fasting

Eliminating a Fear of Fruit

What was the most profound impact that the Mangoman Nutrition and Fitness plan had on Behrouz?

The program transformed my relationship to fruit. I had been afraid of fruit since being diagnosed with type 1 diabetes which made consuming vegetarian and vegan type cuisine very challenging. Behrouz Farsi
on reintegrating fruits into his diet

Behrouz has found that eating a wide variety of fruits has significantly improved his ability to recover from strenuous exercise, and as a result he is now capable of exercising to his heart’s content.

Changing from the Inside Out

Behrouz offers up the two following statements to sum up the past two months of experience.

I became less judgmental of myself and more engaged in the conversation of how can I make a positive difference to my overall mental and physical wellbeing. Being actively coached provided me with an opportunity to have a different (and more positive) relationship with diabetes. Behrouz Farsi
on mental and physical change
Diabetes is a crucible through which I am meant to grow, flourish and in the process, I share this process with friends, family and acquaintances, because it humanizes and enriches me.
About The Author

Cyrus Khambatta

Diagnosed with type 1 diabetes at the age of 22, I have spent over a decade learning the fundamentals of nutrition at the doctorate level. My goal is to share my knowledge of practical nutrition and fitness with people with prediabetes, type 1 and type 2 diabetes. Diabetes is an OPPORTUNITY to attain excellent health. Reversing the effects of insulin resistance can be a fun and enjoyable process if the right system is in place. That's why I've spent over 10 years developing a rock solid system that can minimize blood glucose variability and insulin resistance.

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