Chinese Restaurant Effect

Alright, so there is this dude; he is a doctor dude, born in 1937 and he is a type 1 diabetic. He is a very smart man and I believe that at this point in his life – dude has seen some shit.
Please feel free to peruse his information and develop your own opinion about this guy. I respect him greatly, but I’m kinda still gonna eat carbs sometimes ’cause they taste so dang good. Anywhoodle – his wiki page is:
I shared all that ’cause I wanted to share one of his most famous theories:

Many years ago a patient asked me why her blood sugar went from 90 mg/dl up to 300 mg/dl every afternoon after she went swimming. I asked what she ate before the swim. “Nothing, just a freebie,” she replied. As it turned out, the “freebie” was lettuce. When I asked her just how much lettuce she was eating before her swims, she replied, “A head.”

A head of lettuce contains about 10 grams of carbohydrate, which can raise a type 1 adult’s blood sugar about 50 mg/dl at most. So what accounts for the other 160 mg/dl rise in her blood sugar?

The explanation lies in what I call the Chinese restaurant effect. Often Chinese restaurant meals contain large amounts of protein or slow-acting, low-carbohydrate foods, such as bean sprouts, bok choy, mushrooms, bamboo shoots, and water chestnuts, that can make you feel full.

How can these low-carbohydrate foods affect blood sugar so dramatically?

The upper part of the small intestine contains cells that release hormones into the bloodstream when they are stretched, as after a meal. These hormones signal the pancreas to produce some insulin to prevent the blood sugar rise that might otherwise follow the digestion of a meal. Large meals will cause greater stretching of the intestinal cells, which in turn will secrete proportionately larger amounts of these hormones. Since a very small amount of insulin released by the pancreas can cause a large drop in blood sugar, the pancreas simultaneously produces the less potent hormone glucagon to offset the potential excess effect of the insulin. If you’re diabetic and deficient in producing insulin, you might not release insulin, but you will still release glucagon, which will cause gluconeogenesis and glycogenolysis and thereby raise your blood sugar. Thus, if you eat enough to feel stuffed, your blood sugar can go up by a large amount, even if you eat something undigestible, such as sawdust.

The first lesson here is: Don’t stuff yourself. The second lesson is:
There’s no such thing as a freebie.* Any solid food that you eat can raise your blood sugar.

Okay, got it? That’s his theory and I don’t believe he is wrong – although I do believe that in addition to his theory that if you don’t have enough usable blood glucose in your body when you workout your body will attempt to fix that by releasing glucagon and thus raising your blood sugar.

Anywhoodle – this is the reason that quite a number of endocrinologists [including Dr. Bernstein] highly recommend and prescribe a GLP-1 drug for Type 2 diabetics and even prescribe them “off-label” for Type 1 diabetics. GLP-1 drugs are also known as incretin mimics and the most common drug names out there right now are Byetta and Victoza. Please know that a GLP-1 drug CANNOT replace insulin and a common way to adjust insulin with a GLP-1 is to keep basal the same and start with the assumption that mealtime boluses can be reduced.

Now, because there is another dude out there in the world who has already shared some great information about these drugs on a forum known as tudiabes; I’m totally copying and pasting:

[Victoza & Byetta] “…are both GLP-1 drugs, a class of drugs that mimic key incretin hormones. The GLP-1 drugs have a key action of inhibiting glucagon and stimulating insulin release in response to eating. For a T1, the insulin stimulation just won’t work, but the glucagon effect can be significant. When we eat, particularly if we eat something big, our bodies will release glucagon and insulin in response to simply the act of eating. Bernstein calls this the Chinese Restaurant Effect. This is different than insulin being released in response to a high blood sugar and instead is focused on enabling a complex dance of preemptive control of blood sugar in response to meals. That being said, even as a T1, when you eat you can and will release glucagon and that can result in a contribution to your mealtime blood sugar. So a GLP-1 may help a T1 get better mealtime control, perhaps using less insulin or just improving postprandial levels.

It is also true that the GLP-1 drugs lower both hunger and appetite and have been shown to help people lose weight. My observation is the GLP-1 drugs are mostly being prescribed to T1s for their effect on hunger, appetite and weight loss. That being said, the use of GLP-1 drugs for T1 is not FDA approved and while doctors can prescribe it off-label there is apparently lots of confusion. The prescribing information on Victozabasically says not to use it for T1 and provides absolutely no information on how to adjust insulin dosing with Victoza. There are ongoing studies on T1 use of GLP-1 drugs and I would anticipate FDA approval for their use in T1 in the near future….”

Forum Link:

Okie dokie, that was some diabetic learning for the day – if anyone has any questions, comments, concerns, stories, photos, whatever…..please feel free to comment.