Sunday, January 20, 2019

Type 2 Nutrition #468: Drink SuperBeets® for a “boost”?

SuperBeets®? Have you seen the TV commercial? Dana Loesch, a radio and TV host, pushes a powdered beet juice concoction that promises to make you “more healthy.” “Beets contain a nutrient that increases your own natural energy,” she says, but she doesn’t say what it is. It’s sugar. Fact: the body can only get its energy from either sugar (glucose) or fat (fatty acids and ketones from triglycerides), plus protein by gluconeogenesis. But you can bet your sweet bitty that the “natural energy” you get from beets is sugar, not fat or protein.
Don’t you think it’s curious that the TV commercial doesn’t even mention “sugar”? Neither energy source (fat nor sugar) is mentioned in the 1-minute TV commercial. Instead, the commercial extols the alleged benefits of the “boost” you’ll get from “increasing your nitrous oxide level.” It suggests, by inference, that this compound is one that your body lacks and needs more of to be healthy. Did you know that? No? It’s news to me, too.
I did some research, however, and discovered that 20% of the world’s sugar production is derived from beets. Sugar beet production is mostly from temperate climates. Russia, France and the U.S. are top producers, with the U.S. accounting for about 12%. The remaining 80% of world sugar production is from cane sugar, grown in tropical places like Brazil, India, China and Thailand. The U.S. produces about 1.5% of the world’s sugar cane.
Nitrous oxide (N20), known as “laughing gas,” is an analgesic and a weak anaesthetic. The inhaled gas has a half-life of 5 minutes. I was unable to learn how long a “nitrous oxide level” persists in the blood, but glucose persistence in your bloodstream, a much more important fact, depends on your degree of Insulin Resistance.
With normal blood sugar metabolism, the pancreas will produce insulin as needed to convey glucose (the “sugar” in the blood) from the food you eat to the cells. Insulin receptors are supposed to open up to receive the glucose. This quickly produces a spike of energy, and your blood sugar level soon returns to normal.
If, however, you have any degree of Insulin Resistance, the receptor cells will resist opening. The pancreas will then send more insulin until the cells eventually open, your blood sugar crashes, and you need a “boost.”
So, if you have insulin receptors that have been conditioned by a lifetime of eating processed carbs and sugars – both cane and beet, and you drink SuperBeets® for a “boost,” your blood sugar will go and stay high for a long time. But with SuperBeets®, who cares? Your nitrous oxide will be high for 5 minutes. Woo hoo!
“Within 30 minutes of taking it, I felt the difference,” one online testimonial said. That makes sense. That’s the sugar, stupid! Sugar IS a source of quick energy. It gets into your bloodstream in minutes. And with Insulin Resistance, it will cause blood sugar to “boost.” You will feel “the difference” You’ll also feel the crash!
Thus, Dana says she takes SuperBeets® multiple times a day: “in the morning, at the gym, in the afternoon as a pick-me-up.” Can you imagine? If she has any Insulin Resistance at all – and most of us do – her blood sugar curve would be a rollercoaster of ups and downs all day long. Spike, crash, spike, crash, spike, crash…endlessly, for so long and as often as she gets a concentrated hit of beet sugar “as a pick-me-up,” and for whenever she wanted to “feel the difference.” Is that what you want? To be more of a “sugarholic” than you already are?
If not, you could try a “lifestyle modification” and give your pancreas a rest. If you eat less “sugar,” your pancreas will not need to send a double dose of insulin to make the receptor cells work. This will help preserve the pancreatic capacity for years to come, and your energy level will not fluctuate as much. It will remain stable and flat while your body burns fat for energy. Fat doesn’t need insulin to give you energy. It’s actually absorbed through the lymph system and then into your blood to keep your energy level high and level.
If you feel the need for a “boost,” ask yourself, am I already addicted to sugar? If you answered “yes,” then, ask yourself, why on earth would you choose to add more sugar to your diet? Think about that.

Sunday, January 13, 2019

Type 2 Nutrition #467: It’s not fair!

It’s not fair. It’s not fair that, “The weight reduced individual will be requiring about 20% less (sic) calories per day relative to somebody of that weight who’s never lost weight would eat…in order to keep at that weight.” That’s what Rudolf Leibel, MD, Co-Director of the New York Obesity Research Center at Columbia University Medical Center said in “Choices,” one of 4 hour-long videos in the 2014 PBS series, “Weight of the Nation.”
“Individuals losing weight are not metabolically the same as they were before they lost weight,” Dr. Leibel said. I know. It’s not fair, but that’s the way it is…if you believe “a calorie is a calorie,” as Dr. Leibel apparently does. You will be consigned to accept this depressing fact and live with it. Worse still, you must be resigned to either 1) be fat because you will naturally want to eat as much as the person “who’s never lost weight” (because they don’t have to), or 2) you will eat 20% fewer calories and be hungry all the time. Your choice!
Dr. Leibel’s example: “Consider two individuals – same gender, same age, exactly the same body weight – one of whom is at that body weight as a result of let’s say a 10 or 15% weight reduction, the other who’s been at that weight for their entire adult life. If that reduced weight individual goes out to lunch with her friend, and they both order the same meal, that will represent 20% overeating for the weight-reduced individual, and be quite normal for the individual who’s not in that state. Twenty percent might seem like a little, but 20% excess calorie intake a year will account for the inexorable weight gain.” There, he said it again: “excess calories.”
But what if “calories don’t count”? I’m not joking. If you haven’t heard this before, just Google it. I got 20 million hits, many, on the first few pages, from sites that I respect. But I don’t need to search the Internet to know that I don’t need to “count” calories (or eat 20% fewer) to keep the weight off or not regain the weight I’ve lost. I know I can do that by changing the foods I eat; by eating fewer processed carbohydrates; by eating high quality proteins and fats instead. They will be more satiating, and I will naturally eat less without hunger.
Sound too good to be true? Well, if you don’t want to accept this, then you are welcome to wallow in self-pity and eat the “balanced diet” that the USDA and BIG PHARMA and the medical establishment dictate. You can ignore their conflicts of interest. You can also ignore your glucose meter and what is best for YOUR health. You can follow the HHS/USDA Dietary Guidelines for Americans, which continues to closely mirror the catastrophic “diabesity” epidemic trendline since they were first published in 1980, following the “Dietary Goals” of 1977. 
You can also rely on the American Heart Association’s exhortation since 1961 that you avoid saturated fat and dietary cholesterol and instead eat their recommended highly processed vegetable and seed oils produced by the same USDA-subsidized AGRIBUSINESSES that made the trans-fat laden Crisco and corn-oil margarines.
It’s your choice. So, whom are you going to believe, me or your heart doctor? ;-) Okay, THAT’s not fair either. If you already have heart disease, I won’t blame you for following your specialist’s advice, even if he or she doesn’t know sh*t about nutrition. But, just for laughs ask if they know 1) that in 2014 the Dietary Guidelines Advisory Committee declared “dietary cholesterol…is no longer a nutrient of concern for over-consumption” and 2) that Ancel Keys, the author of the “diet-heart hypothesis,” said later in life “we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”
Then there’s this quote of “updated findings” from Dr. William Castelli, Director of the famous Framingham Study, published in Archives of Internal Medicine: “In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol. . . we found that the people who ate the most cholesterol, ate the most saturated fat, and ate the most calories weighed the least and were the most physically active.” Confounding, isn’t it? Whom are you going to believe?

Sunday, January 6, 2019

Type 2 Nutrition #466: Want help getting into a size 10?

A year or so ago a friend who’d noticed how much weight I’d lost asked me how I did it. I told her, “Very Low Carb.” Like virtually everyone, she admitted she didn’t have a clue about the fine points of what a carbohydrate is and asked for a little guidance. Totally unaware of how much travail it would cause us both, I unwittingly jumped at the opportunity to mentor her…and we succeeded.
I saw her at a garden party last summer. When she asked if I had noticed how much weight she’d lost, I replied, “No, but I noticed how good you look in that dress.” She smiled. “I’ve lost 26 pounds, 1 dress size,” she said. “It’s a size 10.” “I would like to lose another couple of pounds,” she continued, “so a fitted dress would be a little more comfortable through the waist. I’m not shooting for a size 8” though,” she chuckled…which brings me to the subject of this post: MODERATION.
I hate the concept of moderation. Too often it is used as an excuse by those who reject a more radical lifestyle change. “Moderation” is an ideology in itself, but it’s often used as a response to importunate demands for radical change. Just because I lost over 180 pounds and kept most of it off is no reason to think that is the only way to lose weight. This is also true if 1) you don’t need to or want to lose so much weight and 2) you are cut from a “different cloth,” as my friend and perhaps the majority of the overweight people in this nation are.
My friend taught me this lesson. She of course is happy that she lost 26 pounds. She would be happier still if she lost another 6 or 7, which she now knows how to do. In her case, 26 pounds was over 20% of her starting weight, so that IS a singular achievement. Another 6 or 7 pounds would be 5% more of her current weight!
Why the opportunity to mentor my friend was so vexatious is that, to adopt a MODERATE approach to eating LOW CARB (rather than the extreme approach of VERY LOW CARB that I used), required a lot of education and a lot of negotiation. My friend leads a very intense, edgy lifestyle, constantly creating lots of “on the edge” situations as part of her work as a novelist. As a result, she’s inured to living somewhat “on the edge” herself.
A lifestyle that is fraught with anxiety and risk-taking is bound to be a strain on one’s psyche. For balance, such a lifestyle likewise requires rational thinking and counter measures to deal with the day-to-day exigencies. And to deal with this lifestyle, eating becomes both a driver and a crutch. Comfort food is an integral part of her lifestyle, and snacks are an integral part of her eating pattern. Therein lay the challenge.
Snacking is antithetical to a sound Low Carb Eating Plan, but giving snacks up was off the table – not negotiable! It was integral to her modus operendi. Therefore, all that remained was the Low Carb part. Beyond that, the education was pretty simple: She told me what she ate, and I gave her a basic education about which things she ate were the bad choices: both the “complex” carb type and the simple sugars. And that was it!
I’ve always scoffed at the concept of negotiating with a patient as the ADA’s clinical practice guidelines counsel. But in this case, I learned first-hand with my “patient” – with snacking being a part of her working lifestyle, which I totally understood and had to accept – a workaround would be necessary. And it was.
It took dozens of emails over several weeks, including countless recitations of the same principles to refute the same “scientific” articles she sent me which advocated for another Way of Eating or against the Low Carb way. But eventually we modified her “Eating Plan” sufficiently to where she started to see a difference on the scale.
The back and forth ended one day when I gave up on repeatedly defending the science of Low Carb eating. We didn’t “talk” for months afterwards, so I was delighted when we met at the garden party and she asked me if I had noticed her weight loss. That’s when I said, “No, but I did notice how good you look in that dress.” I think we both felt pretty good about that. I think her doctor did too. Of course, I would like to see her go for that size 8 dress. She knows how now and could get there by simply going back and doing “more of the same.”

Sunday, December 30, 2018

Type 2 Nutrition #465, Diabetic neuropathic complications

If the subject matter of this post turns you off, good! I’m going to get personal, and I’m not especially fond of the idea of your reading about my bladder dysfunction. But the truth is, my urologist thinks, and my internist agrees, that as a 32-year type 2 diabetic, I may have begun to show a sign of diabetic neuropathy. His Dx: that I have a neurogenic bladder that appears to be responsible for a worsening eGFR. What’s that, you ask?
An eGFR, “estimated glomerular flow rate,” is a lab test of kidney function. It is a common marker for Chronic Kidney Disease (CKD) and is evaluated on a scale of declining kidney function (5 stages ending with end-stage kidney disease, and renal dialysis. That “complication” is called nephropathy, the second of three possible microvascular complications  of long-term type 2 diabetes. The third is retinopathy (leading to blindness).
So, what is a normal eGFR? According to Wikipedia, the National Kidney Foundation defines, “a normal GFR for adults as greater than 90 mL/min/1.73m2.” “Because the calculation works best for estimating reduced kidney function, actual numbers are only reported once values are less than 60. Normal GFR values are largely over 60 in healthy subjects, at least before the age of 70 years. However, we know that GFR physiologically decreases with age, and in adults older than 70 years, values below 60 could be considered normal.”
My doctor began to request eGFR tests for me in 2011, one month before I turned 70. For three years, the next nine tests were all ≥60. Then, starting in 2015, 5 of the next 7 were below 60 (mostly low 50s); then, last summer I had a 43, which repeated at 47 and 45 (average of 3 = 45). I also wanted to know why I peed a lot and so little, so my urologist undertook a series of tests and examinations. We think we now know the answer.
I have a very large bladder – over a one-liter capacity – and it doesn’t completely empty despite the urethra having a clear passage through the prostate. The reason, apparently, is neuropathy: the muscle that normally contracts the bladder to make me “void” isn’t getting a signal to contract from my nervous system. Hence, the enlarged bladder and the frequent urge to urinate small amounts that I’ve observed since the beginning of the year. The urologist ordered a prescription to relax the muscle in the neck of the bladder, but it didn’t help.
As a result, his thinking goes, when my enlarged bladder is really full, and not emptying much, urine backs up the ureters to the kidneys; and this back pressure on the kidneys is beginning to cause the reduced kidney function (lower eGFRs). My internist concurred and added that back pressure affects both kidneys, and I only have two! He also stressed that I must drink plenty of fluids because dehydration also causes kidney damage.
My urologist has now twice suggested that the best option for me at this point is self-catheterization. I have reluctantly come to the same conclusion. Ugh! My plan is to live to be 100, and to do that I’ll need my kidneys, such as they are. When I was in my 40s, the idea of taking a pill every day for the rest of my life was anathema. Now, I take a handful twice a day. So be it. At least I can say I am “otherwise healthy,” knock on wood.
The “plan” (the urologist’s ploy to get me to start) was to have me catheterize myself three times a day for a few weeks and then do another eGFR. If my kidney function improves, that is, if my eGFR increases, as he thinks it may, then I will have to continue with catheterization from that point forward (until I get to 100 or otherwise expire), to preserve the benefits. Apparently, no other remedy is available for a neurogenic bladder.
Two subsequent eGFRs, performed at two-week intervals after catheterization began, were improved (53 and 55). A third, 2 months later, was, alas, back down to a disappointing 47. So, now we’ll just have to “wait and see.”
In the meantime, the message here is to take notice of changes in your daily habits (like frequency of urination) and discuss it with your doctor(s) before you too have no choice but to “siphon the python.” Happy New Year!

Sunday, December 23, 2018

Type 2 Nutrition #464: “She was only 75.”

Penny Marshall died at age 75…of “complications from diabetes.” A commentator lamented, “She was only 75.” Nobody explained, which was correct, I suppose. An obituary is about a person’s life and accomplishments. Penny Marshall was brilliant in “Laverne and Shirley” and as a director. “A League of Their Own” is one of my favorite movies, but when I saw a recent picture of her, I knew she was probably diabetic. She was fat.
I don’t want to blame her for that, although I regularly hector and cajole my readers for the very same thing. I do that because, like the rest of us, she probably followed “doctor’s orders,” especially when she knew she was sick and presented with unmistakable markers. But when we simply gain a little weight over the years, and have no symptoms, we (including the doctor!) mark it up to eating too much and moving too little. We are told “diet and exercise” is the way to drop the weight. We try it again and again, and we fail, again and again.
So, it’s our fault. We heeded the doctor’s advice and we tried. We went to the gym (maybe) and tried to eat less of the foods the doctors and the medical associations and government told us not to eat, and we lost some weight. We were always hungry, and eventually we lost resolve and gained it back. We failed. We did as we were told to do, and we failed. Over and over again. Is anyone thinking of the famous Einstein aphorism?
Einstein said, apocryphally, “Insanity is doing the same thing over and over and expecting different results.”
That’s why, I suppose, there are so many different diets out there. It’s so we don’t see ourselves as doing the same thing over and over again. But, don’t you see, we are, really. We are getting the same result! It’s insane.
All these diets have different names and other things that make them seem different, but they are really much more similar than we think. They are mostly “balanced.” What does that mean? They include the ratios of fat, protein and carbs (the “macronutrients”) that government and the medical establishment have recommended, without solid scientific evidence, for over half a century.
These ratios are on the Nutrition Facts panel on every box and bag that we buy at the supermarket. The daily amount recommended for every adult woman is 300g of carbohydrates, 50g of protein, and +/-65g of fat, mostly polyunsaturated fat (PUFA), from “vegetable” (seed and grain) oils. That translates to 1,200kcal of carbs (@4kcal/g), 200kcal of protein (@4kcal/g) and 600kcal of fat (@9kcal/g).
Here’s the truly shocking Percent Daily Value (%DV) of that 2,000kcal diet that “women of a certain age” are counseled to eat: 60% carbohydrate, 10% protein and 30% fat. Did you know that? That’s 60% percent carbs! And for men the percentages are the same; it’s just that we’re allowed 2,500kal a day, as follows: 375g carbs, 62.5g protein and 83g fat. That’s still 60% percent carbs, men! Is that insane, or what?  Bonus trivia: this is an excellent recipe for fattening livestock. No, I’m not joking.
That’s why Penny Marshall was fat. Not because she ate too much and didn’t exercise enough. Her obituary didn’t say that. It didn’t have to. The simple statement “complications from diabetes” said it all. Let that sink in. Then, ask yourself, was it a Microvascular complication? Neuropathy (with amputations), retinopathy (with blindness), or more likely nephropathy: end-stage kidney disease, with dialysis. Or perhaps a Macrovascular complication (stroke, heart failure, or old-fashioned MI (heart attack), increasingly common with diabetics.
In any case, Penny had, and you still have, a choice. Type 2 diabetes is a dietary disease. It is the result of eating a “balanced” diet of way too many processed carbs and foods with added sugar and processed vegetable oils. What does that have to do with being fat? When you greatly reduce the amount of carbs in a meal, starting with “breakfast,” you allow your body to burn its own fat for energy…so you won’t be hungry all the time. You won’t eat as much and put on the extra pounds. In fact, you will start to lose them, quickly. Just have coffee with heavy cream for breakfast, or bacon and eggs. No cereal, no toast, no fruit, no yogurt!

Saturday, December 15, 2018

Type 2 Nutrition #463: “You eat healthy, take statins…”

The TV commercial begins, “You eat healthy, take statins…” and then goes on to describe a new class of drug designed, “to lower LDL-C when added to a high-dose statin” (my emphasis). That’s what gets me riled. Folks, if you’re “eating healthy,” unless you have a very rare condition called “familial hypercholesterolemia,” you shouldn’t need to take a statin, much less another drug in addition to a high-dose statin. Geez…
Of course, this claim all revolves around what you (or they, the drug maker) call “eating healthy.” The drug maker will claim, rightly, that their “eating healthy” is what you have been told to eat by All the Powers that Be in our culture: The USDA/HHS Dietary Guidelines for Americans, from 1980 through 2015, with only minor modifications,  ChooseMyPlate.gov, and the entire medical establishment – the AMA, the AHA, the ADA, etc.
So, if you “eat healthy” in the way they prescribe, you very well may need to take a statin. And if it doesn’t lower your LDL-C sufficiently to satisfy the Total Cholesterol and LDL-C Standards of Medical Practice for a lipid profile, established by the corrupt practices of those government/medical entities, you’re going to be cajoled relentlessly to start taking a statin, and if a high-dose statin doesn’t “do the job,” to start taking this new drug.
In 2002, I had been a diagnosed a T2D for 16 years and was still eating the Standard American Diet. I was on 3 classes of oral antidiabetic drugs (maxed out on 2), and still “out of control.” To help me to lose weight, my doctor suggested I start eating Very Low Carb (VLC), i.e. 20g of carbs a day. The first day I had a hypo, and 2 more that week. He took me off 1 drug and cut the other 2 in half TWICE. And in 9 months I lost 60 pounds.
Then in 2003, following the prescribed standard, my doctor started me on a high-dose statin and in no time got my LDL-C down to “target” (<70mg/dl). In 2006 I rededicated myself to VLC and lost another 100 pounds in a year. By 2008 I had lost 170 pounds total and lowered my blood pressure to 110/70 (on the same BP meds).
But I also transformed my lipid panel. While my Total Cholesterol (TC) and LDL-C remained about the same, I doubled my HDL-C and lowered my triglycerides (TGs) by two-thirds. When my doctor saw these outcomes, he used his clinical judgment and took me off statins completely. That was 2008, 10 years ago. I still basically eat VLC most of the time, and my latest lipids were TC 189; LDL-C* 83; HDL-C 92; non-HDL 97 and TG 56mg/dl.
* Calculated by Quest using Martin/Hopkins; previously Quest calculated LDL-C by the Friedewald method.
A chart below illustrates my TC and LDL-C while off, then on, then off again a statin, from 1980 to the present.

So, I think it’s reasonable to ask, “Is your ‘eating healthy,’ (the way the USDA/HHS and the AMA, AHA and ADA have been telling you to do all your life), the reason your doctor has you on a high-dose statin and is now twisting your arm unremittingly to take yet another drug to lower your LDL-C?” I think so. And my doctor apparently agreed. Do you suppose if you changed the way you eat, you wouldn’t “need” to take a statin?

Tuesday, December 11, 2018

Type 2 Nutrition #462: The TG/HDL-C ratio and Insulin Resistance

Dr. Jay is Jay Wortman, MD, a Canadian clinician, Very Low Carb and political activist who I first found in 2012 at Franziska Spritzler’s Low Carb Dietitian. Both he and I are among a very good list of links and resources there. That was only two years after I had started blogging, so when I visited Dr. Jay's Blog, I left a comment on his “The Story So Far….” And, as shameless self-promotion, I also left a link to my blog’s website. It has since garnered several hundred hits. I also get lots of page views originating from Franziska’s blog list.
Jay Wortman has become very active on Facebook. A while ago when I offered wishy-washy advice to a newly diagnosed type 2 looking for help on a popular Facebook group, Dr. Jay intervened with a reply comment to mine. He blasted my lame advice, telling the hapless newbie to face facts. The newbie had Insulin Resistance and was therefore Carbohydrate Intolerant. I was embarrassed by my half-baked input, but very grateful he is lurking, or more likely, following the group. Dr. Jay is both passionate and selfless, and dedicated to helping. 
Dr. Wortman also keeps up with the most relevant medical research. He recently posted on Facebook this PubMed Central (PMC) mouse study, “The Failing Heart Relies on Ketone Bodies as Fuel,” which concluded, “These results indicate that the hypertrophied and failing heart shifts to ketone bodies as a significant fuel source for oxidative ATP production.” Translation: the ketogenic diet is good for the failing heart, in mice.
Another Facebook post by Dr. Jay is this study from Malaysia appearing in PMC. Looking for “an easy to use, precise and low-cost diagnostic test to predict Insulin Resistance,” 271 overweight and obese children were “stratified by tertiles using the homeostasis model assessment (HOMA), a good surrogate for the gold standard for measuring IR, the hyperinsulinemic euglycemic clamp.” “The children were analyzed for fasting glucose, lipids, insulin and waist circumference. The children were then stratified by tertile of TG:HDL-C ratio.”
The study’s conclusion: “the odds of having IR was about 2.5 times higher (OR=2.47, 95%CI, p=0.01) for those in the highest tertile of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.” Dr. Jay’s endorsement/imprimatur of this conclusion was, “I calculate this for all my patients.”
Below is a chart of my 82 TG/HDL-C ratios since 1980. The first 17 ratios were while I was eating a Standard American Diet (SAD) and, since dx in 1986, treated for type 2 diabetes with antihyperglycemic drugs. The last 65 ratios are since I began to eat VLC in 2002. A TG/HDL ≤ 1.0 is ideal, a ratio of ≤2.0 is good, anything over 3 is “indicates significant risk of heart attack and stroke.  Note almost all of mine since #17 are ≤1.0.

This metric has been in use by non-cholesterol-phobic physicians for years. I wrote about in 2011 in my #27 “...the strongest predictor of a heart attack.” I hope more physicians, like Dr. Jay, start to routinely use it.