I just learned that my piece on low-carbohydrate diets for management of T1 diabetes has been published in the International Diabetes Federation's Diabetes Voice magazine.  My pro-carbohydrate restriction article is published below, followed by my opponent's. It's interesting that she argues that restricting carbohydrates to less than 100 grams per day will make blood glucose control more difficult when research and the anecdotal experiences of thousands of people with T1 diabetes have demonstrated otherwise. I'm interested to hear thoughts from everyone, especially T1's.

I'll preface this post by saying that it was written with my female readership in mind. Guys, you're welcome to read as well, of course, but I have a feeling most of you will want to pass on this one. 

At 46, I'm well into perimenopause and have noticed several changes ranging from amusing to annoying. Almost every woman finds growing older challenging to some extent,  be it physically, mentally, and/or emotionally.  Many tend to put on weight as they age, and the standard explanation is that our metabolism slows down as we get on in years and decrease our physical activity. But it's more complicated than that, and hormonal regulation plays a very large part.

Menopause and perimenopause, the 5-10 year period preceding it, often result in decreased insulin sensitivity, particularly in those predisposed to endocrine imbalances. Recent research indicates that decreasing levels of estrogen lead to insulin resistance and impaired carbohydrate tolerance even among nonobese menopausal women. Weight gain during perimenopause and menopause is  an obvious result; it's difficult to ignore your pants getting tighter even if you're not weighing yourself regularly. What many  women are less aware of (unless they're testing with a glucometer) are elevated blood sugar levels after eating.

While the aging process is inevitable and to some extent dependent on your genes, there are ways to make the transition easier in terms of weight management, loss of muscle mass, and blood sugar control. My advice is to cut back on carbs to a level that allows you to achieve a healthy weight and optimal glycemic levels, keeping in mind that this is highly individualized and may change over time.* Some women at this stage may be able to continue the same moderate-to-high-carb diet they've always consumed without any issues, but after looking into the research and hearing many anecdotal accounts, I know that many are simply not. It saddens me to hear about  ladies in their mid-40s to mid-50s eating low-fat diets and continuing to struggle with food cravings and weight. I feel many would benefit from the hunger-reducing, hormone-altering, blood-sugar-stabilizing effects of carb restriction.

Another problem women in or approaching menopause often experience is hot flashes, along with sensitivity to temperature changes. Neurosurgeon Dr. Larry Mc Cleary writes in his excellent book, The Brain Trust Program, that the decline in estrogen during this period reduces the action of glucose transporters that deliver glucose to the brain, resulting in release of norepinephrine from the adrenal glands in an attempt to increase blood sugar and provide the brain with energy. He states this process is similar to what  children with epilepsy and other seizure disorders experience, although on a much smaller scale. Dr. Mc Cleary recommends a very-low-carbohydrate diet in order to provide the brain with ketones as an alternative source of fuel, thereby eliminating or greatly reducing hot flashes. What types of food, specifically? Meat, fish, poultry, eggs, cheese, nuts, greens, nonstarchy vegetables and small amounts of low-sugar fruits like berries -- exactly what I eat. He also provides a recipe for a "ketogenic cocktail" which contains MCT oil, flaxseed oil, and EPA.

I have to say that after 10 months of continuous ketosis/near ketosis, I feel terrific. Blood sugar swings are a thing of the past, my weight is  easier to maintain, and energy levels are better than they've been in years. Will this change as I get older and become postmenopausal? Perhaps, but I can honestly say I think eating a very-low-carb diet gives me better odds for keeping things under control.

I don't think I've mentioned the importance of exercise in any of my blog posts yet, which is surprising given how important it is in my life. Physical activity is vital it is for feeling good and preserving muscle mass as we age. However, I'm not a cross-fitter, runner, or jogger. I like walking and try to get 30-60 minutes in every day, but I also feel that resistance training, stretching, and strengthening are extremely beneficial. I hate gyms; in fact, I can probably count the times I've worked out in a gym  or taken a class on one hand. I prefer working out on in my own home and enjoy routines that make me feel graceful , strong, and energized. Enter Ellen Barrett.

Now, Ellen is not a low-carber; judging by her tweets, she may be vegetarian  or even vegan. But the way she eats makes no difference to me because she is simply an amazing fitness instructor. Her routines are not only extremely effective at toning, tightening, and increasing energy; they're also very enjoyable, easy to stick with until the end (They range from 30-45 minutes in length), and set to upbeat, fun music. Her enthusiasm, pleasant voice, and genuine smile complement the light weights, Pilates, ballet, yoga, and dance sequences. She always has someone demonstrating the movements at a lower level of intensity for beginners.  I love the way Ellen encourages women to really tune in to their bodies and feel graceful and beautiful while exercising.  After one of her workouts I feel highly energized, never fatigued.  Now, if you  love cross-fit or running , that's wonderful -- keep it up! But if you really don't like exercising and aren't big on working out at a gym, I highly recommend getting one or more of Ellen's DVDs.* I own seven (she has even more!), and they're all fantastic.  Check out the Amazon descriptions and reviews at the links below: 

Grace + Gusto
Fusion Flow
Slim Sculpt
Super Fast Body Blast
Sleek Sculpt Express
Power Fusion
Fat Burning Fusion

So my advice in a nutshell is to accept aging as a natural part of life but do your best to provide your body with the type of nourishment and activity that gives you the best chance of remaining healthy, strong, mentally engaged, and full of vitality.

* Consult your doctor prior to starting a low-carbohydrate diet or engaging in physical activity


References:
1.Lindhelm SR, et al. A possible bimodal effect of estrogen on insulin sensitivity in postmenopausal women and the attenuating effect of added progestin. Fertil Steril 1993 Oct:60(4):664-7 
2.Whitcroft, et al. Insulin resistance and management of the menopause: a clinical hypothesis in practice. Menopause Int 2011 March:17(1)24-28