Sunday, October 15, 2017

Type 2 Nutrition #402: IGNORANCE is the biggest problem…

I was at a gathering recently where I was having a tĂȘte-a-tĂȘte with Dr. Eric C. Westman, co-founder and medical director of the Heal Clinics. I’ve been a diagnosed type 2 diabetic for 31 years, eating Very Low Carb for the last 15 and writing about it here for the last 7, so when Dr. Westman asked me what I thought was the biggest problem in type 2 diabetes today, I responded, simply, “Ignorance.” He nodded his head in agreement.
I told Dr. Westman that I started this WOE after my doctor had read Gary Taubes’ July 7, 2002, New York Times Sunday magazine cover story, “What If It’s All Been a Big Fat Lie?” My doctor wanted me to lose weight, so he tried it himself first to see if it would be safe and effective. When he lost 17 pounds, he suggested that I try it too, to lose weight! As he walked me down the hall to schedule my next appointment, he said, “It might even help your diabetes.” He had no more than a vague notion about that. Turns out, he was spot on!
My doctor told me to start Atkins Induction after he returned from vacation so he could monitor me closely.
He had my blood sugar “under control” (FBG: 155mg/dl!!!) with 3 classes of oral hyperglycemic meds. He knew, however, that by this standard he would soon have to refer me to an endocrinologist to start an insulin regimen, probably a basal injection once a day and maybe mealtime bolus injections, 3 times a day, as well.
Like so many other clinicians, my doctor believed that my morbid obesity (I weighed 375 pounds) was a CAUSE (frequently hedged as a “risk factor”) of type 2 diabetes. But Taubes had not yet written his ground-breaking magnum opus “Good Calories – Bad Calories” (2007), in which he dispels that notion. In fact, in the Epilogue (page 454) he says, “As I emerge from this research,” 10 “certain conclusions seem inescapable to me.” Today, ten years later, every one of his conclusions is still right on point – as true today as the day he wrote them.
In #5 Taubes says, “Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behavior.” If this first part sounds like a tautology, it is not. It is fully explained in #6 thru #10. You really should read all 10 “certain conclusions” in the above link. I’ve read it a dozen times over the years.
6.      “Consuming excess calories does not cause us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger.
7.      Fattening and obesity are caused by an imbalance – a disequilibrium – in the hormonal regulation of adipose tissue and fat metabolism. Fat synthesis and storage exceed the mobilization of fat from the adipose tissue and its subsequent oxidation. We become leaner when the hormonal regulation of the fat tissue reverses the balance.
8.      Insulin is the primary regulator of fat storage. When insulin levels are elevated – either chronically or after a meal – we accumulate fat in our fat tissue. When insulin levels fall, we release fat from our fat tissue and use it for fuel.
9.      By stimulating insulin secretion, carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be.
10.  By driving fat accumulation, carbohydrates also increase hunger and decrease the amount of energy we expend in metabolism and physical activity.”
Gary Taubes’ hormonal explanation of the metabolic science of fat synthesis and breakdown totally refutes the “calories-in, calories-out” (CICO) hypothesis. CICO sounds so logical that it is now “accepted wisdom” without evidence. It’s like that other “truism” of establishment dietary thinking: “Eating fat makes you fat.”
Taubes’s “certain conclusion” #1, “Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization,” deals with that. Of course, he backs up this statement, and all his other conclusions, with 460 pages of convincing research and analysis, 45 pages of links to his sources, and a 66 page bibliography. “Good Calories – Bad Calories” is a bit of a slog, but it’s worth it.

Sunday, October 8, 2017

Type 2 Nutrition #401: “Improve your A1c with a non-insulin option”

Have you seen this diabetes drug commercial on TV? It always makes me laugh. I’ve been a diagnosed type 2 for 31 years, and my last A1c was 5.2%. That was a big improvement from 5.8% eight months ago. The only diabetes medication I took eight months ago and I take now is Metformin. I improved my A1c with another “non-insulin option.” I control my diabetes with Metformin, and I improved my A1c by eating Very Low Carb.
Of course, the TV ad had a different “fix” in mind for you. It was playing on the dread people have for the drudgery of daily insulin injections. Most insulin-dependent type 2s inject a slow-acting basal dose of insulin once a day and then many (most?) inject a fast-acting bolus with each meal. Thus, with this 1 to 4 injections-a-day routine, if you are very careful to avoid hypos, you can achieve “good” blood glucose control. It’s an onerous path to follow.
It doesn’t have to be this way. I weighed over 300 pounds in 1986 when an internist diagnosed me as a type 2 with a high fasting blood sugar (FBS). He started me on an oral anti-diabetic drug of the only class then available in the U.S., a sulfonylurea. Seven years later an endo gave me my first A1c test. It was 8.9%. My FBS was 197. Nine years later (2002) I was maxed out on both the sulfonylurea and Metformin and had started on Avandia.  My FBS was 81, so my doctor had my “progressive” diabetes under control with drugs. But we both knew that when the 3rd class of drugs was no longer effective, I would “graduate” to insulin. I weighed 375 lbs.
So, my doctor now turned his attention to my weight again. He had tried before. I had seen his staff dietician who advocated a “restricted-calorie, balanced diet and exercise.” It didn’t work. I lost weight but promptly regained it. Then, in July 2002 my doc read the New York Times Sunday Magazine cover story, “What If It's All Been a Big Fat Lie,” by the science writer Gary Taubes. He tried the diet described himself, and it worked. When he came back from vacation in September, he asked me to try it too. He wanted to monitor me closely.
The diet was Atkins Induction, which is VERY low carb, just 20 grams a day. On the first day I had a hypo. I called him, and he told me to stop taking Avandia. The next day I had another hypo and he told me to cut the other two drugs in half.  Later that week, when I had yet another hypo, he told me to cut them in half again. So, in just one week, by strictly following a VERY LOW CARB diet, before losing more than a few pounds of water weight, I had dramatically reduced my diabetes meds. My type 2 diabetes had gone into remission.
A year later, in August 2003, I had lost 60 pounds and my A1c was 5.4%. A few years after that, I regained 12 pounds over the summer, so I started on Richard K. Bernstein’s 6-12-12 program for diabetics (30 carb grams a day). Over the course of a year or so, I lost that 12 and another 110 pounds, reaching 205 pounds at the end of 2008. That was my weight when I completed Army Basic Training in 1960! And my A1c was still 5.4%.
Now, 15 years after beginning to eat Very Low Carb, and plenty of “misadventures” (“cheats” with ups and downs), I celebrate by dropping below 200 pounds (186 last week) for the first time since I was in my teens. And although 15 years ago, in 2002, my doctor’s motivation was to get me to lose weight, NOT to treat my so-called “progressive” type 2 diabetes, I have “improved my A1c with a non-insulin option.” Furthermore, I have forevermore avoided progressing to becoming an insulin-dependent type 2. AND MY LATEST A1C WAS 5.2%.
To his credit, although he suggested it to help me lose weight back in 2002, my doctor did have an inkling that eating VERY LOW CARB might help my type 2 diabetes. He said, as he walked me down the hall to schedule my next appointment, “Dan, this diet might help your diabetes too.” Boy, was that an understatement!
Would that more doctors had a similar understanding of the basic relationship between dietary carbohydrates and blood sugar regulation. Type 2 diabetes is, after all, a dietary disease, and the best treatment is self-management by carbohydrate restriction. Your doctor can’t write a prescription for that, BUT YOU CAN!

Sunday, October 1, 2017

Type 2 Nutrition #400: “Not half the man I once was,” my wife quipped

As you can tell from the number above, I have been posting a long time. I have also been a diagnosed type 2 diabetic for 31 years and probably pre-diabetic for a decade or more before that. At my doctor’s suggestion (to lose weight), I’ve been eating Very Low Carb since 2002. About 8 months ago, I added Extended Fasting.
In 2002 I started and stayed on Atkins Induction (20g/day) for 9 months and lost 60 pounds. Four years later I regained 12 and started and then stayed on Bernstein (30g/day) for a year and lost 100 pounds. Later I lost another 20+, reaching 205 in 2008. I regained some later but recently returned to 205 using consecutive 2 and 3-day fasting. This was possible because, while fat-adapted on VLC, I can easily go 2 or 3 days without hunger.
My weight has not been below 205 since I was a teen ager, maybe pre-pubescent! I’m 76 now. But, feeling as healthy and energized as I do, I am going for a new goal: To be half the man I once was. I began in September 2002 at 375. My goal is to get to half that weight, to 187, by end of September 2017, 15 years later. Here goes. (N.B.: If you want to skip the messy parts, don’t bother with the Weekly details; just jump down to Results.)
Week 1: I start this challenge at 207, so I need to lose 20 pounds in 8 weeks. The 1st 4 will be easy. I gained them overnight, literally, so this week I expect to lose at least 6, leaving 14 for the remaining 7 weeks, or 2 pounds a week. That’s very doable. Result: lost 5lb, after regaining 3 Sat. FBG aver: 81mg/dl. Wk 2 goal: 5 lbs.
Week 2: Three restaurant meals this week, including a birthday. Fasting only Mon & Wed. Result: took 3 days to lose the 3 pound gain, and the glucose shot up after the b-day; alas, I lost only 1 pound. FBG aver: 97mg/dl.
Week 3: Starting the week 2 lbs behind, but have no excuses. Should be a good week. Goal: lose 4 lbs to reach 197; Plan: fast Mon-Tue-Wed. Result: lost 5, then regained 2 Sat to 198, net lost 3 pounds. FBG aver: 82mg/dl.
Week 4: Starting week just 1 lb behind. Goal: lose 3 lbs to reach 195. Fasting Mon-Tue-Wed. Result: Small cheats every day, but I lost 3 lbs and reached goal of 195, a 180 lb total loss from 2002. FBG aver: 82mg/dl.
Week 5: Eight pounds to go in 4 weeks, 2 lbs per week. Goal 193. However, gained 4lbs both Sun & Mon, so strict fasting this week; I need to lose 10 lbs. Result: Lost 11, fasting 4 days; net lost 3 lbs. FBG aver: 79mg/dl.
Week 6: Now 1 lb. ahead, but goal is still 2 lbs. Eating ‘normally’ Sun & Mon (company); fasting thereafter. Results: Relaxed a bit and just lost 1 lb to 191, on target. 4 pounds to go, 2 each week. FBG aver: 71mg/dl!
Week 7: Doing a modified fast Mon-Tue-Wed, then Fri and/or Sat if required. Thurs: dining with visiting ‘kids.’ Results: Missed the mark; lost just 1. Too much fat, a little cheating, poor choices Thu. nt. FBG aver: 88mg/dl.
Week 8: Final week of challenge with 3 pounds to go. Very doable with a little discipline. Let’s see if I have it.
Results: A feast on Sunday added 4 lbs. to the challenge, but I “fasted” until I lost NET 4. FBG aver: 79mg/dl.
Results: Well, I did it! These words recall for me the line “We did it!”that Elle Woods squeals in her graduation speech at the end of one of my favorite films, the chick-flick “Legally Blonde.” Except in this case, I did it, all by myself! In the last 8 weeks, using a combination of Very Low Carb on days that I ate “normally,” and Very Low Carb on my so-called “fasting” days, I lost 17 pounds. That was my goal: to get to be “half the man I once was,” at 375 pounds, when I first discovered Very Low Carb in 2002. My doctor suggested I try Atkins Induction (20 carb grams a day) to lose weight. It’s been a long journey, with lots of ups and downs, but I finally reached my goal. Along the way, my health improved greatly, and I feel great. It’s wonderful not to always be hungry.
Next week my wife and I are taking a vacation. We’re going up to the Shaw Festival at Niagara on the Lake. Plans include dinner every night in a nice restaurant and one lunch and a tour of one of the many wineries in the area. When we return, I will begin one more weight loss challenge: To lose another 15 pounds (plus what I gain on vacation) to get down to 171. And then, THE FINAL CHALLENGE: to maintain the 200 pound loss. I will keep my weight between 171 and 175 by a combination of OMAD (VLC), plus Extended Fasting as needed. 

Sunday, September 24, 2017

Type 2 Diabetes, a Dietary Disease #399: WebMD and Walgreens, a new collaboration

While waiting in my wife’s doctor’s office the other day, I picked up a FREE magazine, “WebMD diabetes, at Walgreens.” I’ve been a type 2 for 31 years, and treating it as a dietary disease for 15, so I didn’t expect that the magazine would have much to offer me, but…was I in for a surprise! It was loaded with material for my blog!
The featured article was “Savor Summer,” with a recipe section: The subtitle was “New ways to bring sweet corn to your table” (my emphasis). But to a carboholic, the added emphasis is unnecessary. The brain sees “sweet” and translates it to “SWEET.  And the food photography was great! Really mouth watering stuff!
“You can almost taste sunshine when you bite into a freshly picked ear of corn,” the article begins, adding, “It’s also nutritious” because it’s “chockful of Carotenoids.” (No mention of sugar.) But then, unabashed, it says, “It’s also a starchy vegetable, easily rounding out your plate with more fiber than a refined grain.” Okay, so it’s not a refined grain. That’s good. But corn is starch. It is pure sugar and starch. For a diabetic, that’s just as bad as a refined grain. The sugar alone is 62% glucose (the rest is fructose) and the starch is 100% glucose.
And if that wasn’t enough, 2 of the 3 corn recipes added honey! Added honey, for diabetics! As if corn wasn’t sweet enough! The recipes had all been reviewed by the WebMD medical editor, an MD, and she could do it with a clear conscience because, by the U. S. Dietary Guidelines “MY PLATE, a healthy meal plan for everyone, even diabetics, – includes ¼ starches. Corn certainly fills the bill. But should a magazine for diabetics, intended to help both type 2 diabetics and pre-diabetics make healthy food choices, suggest and feature recipes that will assure that the pre-diabetic progress to diabetic and the diabetic remains in a diseased state? C’mon!
 Why would the medical community and Big Pharma encourage people who have “presented” with evidence of Insulin Resistance, which equates to Carbohydrate Intolerance, suggest, recommend, and even encourage people to eat a diet comprised three-quarters of carbohydrate (¼ starch and ½ non-starchy vegetables)? Why? One size fits all!!! For 37 years the “Dietary Guidelines for Americans” have ordained that one-size-fits-all. The Guidelines have gone through various iterations, from various food pyramids to today’s “My Plate,” but they all have one thing in common: by following them, you, the diabetic, most assuredly will get sicker and sicker.
Who benefits from this whack-a-mole recommendation? I know, I know. It’s easy to conclude it’s the doctor’s and the pharmaceutical industry, including retailers like Walgreens. And they certainly do benefit. We all get sick, and they take care of us. But that’s their business. They’re just doing what they are in business to do. Altogether, the 23 page Diabetes magazine included 4 pages of corn recipes, 8 pages of other content, and 11 pages of ads, 4 for Walgreens products and 4 for diabetes meds from Lilly and Pfizer, available at Walgreens.
But that’s not where the problem lies. It originated forty years ago when the U. S. government got into the nutrition business. In 1977 a U. S Senate select committee convened and held hearings. So-called “experts” testified. Later, the lay staff of the Committee produced the “Dietary Goals for the United States.” In 1980, and every five years after, HHS has produced the “Dietary Guidelines for Americans.” It’s been a disaster.
The Nutrition Coalition has proposed that the Guidelines be reformed. They say, “Americans have followed the Guidelines, but their health has not improved.” “The Guidelines have not always provided the best dietary advice.” “The science is not settled and in some cases has been reversed,” and “(T)he process of drafting the Guidelines needs reform.” I certainly agree. I have signed their petition and ask you to consider adding your name to the growing community of people like us who are in-the-know. We need Guidelines based on sound scientific evidence. And there will still be plenty of ways in which WebMD and Walgreens can collaborate. And then my wife’s doctor won’t have the shame of having this awful magazine in his waiting room.

Sunday, September 17, 2017

Type 2 Diabetes, a Dietary Disease #398: My Supplements

I haven’t written about supplements since…wow! I just did a search of almost 400 posts and discovered I have NEVER written about my supplements. I guess it’s because I consider it personal, not in the sense of private – I am transparent about my health – but in the sense of “individualized.” I think it is also because I have read so much about how none of them are necessary or even helpful, like I’ve just been duped or sold a bill of goods.
So, why do I take supplements when there’s no real way to prove that they have helped me? A well designed experiment is impossible; there are just way too many confounding factors. I guess the best answer is that they are “insurance;” besides, most of them are vestigial, that is, I began them before I was initiated in the ways – or the concept anyway – of eating a low carb diet of whole, real food…and I just continued with them. That’s my construct anyway. Besides, some of them I do believe in. So, which would I eliminate and why?
I am prompted to write about this now by a presentation made at Keto Fest in New London, CT last July by podcast meister Ivor Cummins, the “Fat Emperor.” Near the end – maybe his very last sentence – as though it were a hurried, throwaway line, he said: “Don’t forget to take supplemental magnesium and potassium.” No time for an explanation. It was just a given, like everyone knew! Fortunately, I do take them both.
Here’s a complete list of my current supplements. Bear in mind, I am/have been a Type 2 Diabetic for 31 years and eat a Very Low Carb (VLC) or LCHF (Low-Carb, High-Fat) or Ketogenic Diet, with frequent full-day fasting.
With COFFEE with HEAVY CREAM and POWDERED STEVIA, early in the MORNING
     1g fish oil, containing 300 EPA and 200 DHA, and 5 IU of vitamin E
     1 tablet high potency men’s multi-vitamin, with vitamin D3, lutein and lycopene
     100mg capsule of CoQ10, the active form (Ubiquinol)
     200mg magnesium glyconate, chelated for absorption
     200mcg of elemental chromium (chromium picolinate), with 18mg L-leucine + 2mg vitamin B6
     100mg biologically active R-Lipoic acid (alpha lipoic acid), with 150mcg D-Biotin
In addition, I take 2 prescription meds: 750mg metformin Hcl and 25mg HCTZ, a diuretic (for hypertension)
With 6oz RED WINE & 8oz SELZER, about 12 hours later, if FASTING, or with FOOD (my supper meal).
     1g fish oil, containing 300 EPA and 200 DHA, and 5 IU of vitamin E
     200mg magnesium glyconate, chelated for absorption
     99mg potassium, a multi-source blend
     1 capsule homocysteine modulators: 50mg B6, 400mg folic acid (B9), and 500mcg B12
In addition, I take 3 prescriptions: 750mg metformin Hcl, and 20mg Enalapril & 240mg Verapamil (BP pills)
Candidates for deletion: 1) chromium picolinate, 2) R-Lipoic acid and 3) homocysteine modulators.
Possible additions: 1) a small (250mg) Vitamin C tablet with supper, to help with protein uptake, and a calcium supplement, to help with magnesium uptake. First I need to learn more about their interactions.
My labs are very good. My last A1c was 5.2%. My Vitamin D and B12 are high and very high respectively. My TC is below 200mg, my HDL-C is averages about 80, my LDL-C averages about 100 and my TGs still average around 50, even though I don’t eat a can of sardines for lunch any more. When I do eat lunch, I prefer a can of kippered herring in brine. It’s fewer calories and much less fat, and I’m trying to burn endogenous fat, not exogenous fat! My fasting intake is about 300kcal/day and my feasting intake paradigm is still about 1,200 (15g carbs, 60g protein and 100g fat, mostly saturated/monounsaturated). Finally, my inflammation markers are very low. Now that I have laid it out for everyone to see, what do you think? I invite comments.

Sunday, September 10, 2017

Type 2 Diabetes, a Dietary Disease #397: If an A1c of ≥6.5% is defined as diabetic…

If an A1c of ≥6.5% is defined as diabetic, and the goal of the American Diabetes Association (ADA) is to manage your blood sugar such that it does not exceed 7.0%, then it follows ipso facto that the ADA’s guideline to MDs is to maintain you, if you are a type 2 diabetic, in a perpetual disease state. What do you think about that?
Two explanations are possible. I’m not so cynical that I would buy into the easy one: that your doctor, and the health care world that comprises about 1/6th of the entire U. S. economy, needs to keep you sick for them to prosper. I understand why it’s easy to go there, but I really don’t think there is such a sinister conspiracy. There has to be another, probably much more complex and difficult, explanation for this conundrum.
The other explanation for the low expectation (≤7.0%) of the healthcare community is that, in their clinical experience, it is difficult under the terms of the ADA’s Standards of Medical Care to achieve the “reasonable goal” of an A1c of ≤7.0%, even with all the pharmaceutical options, both oral and injected, that are and come on the market. Big Pharma has expended vast resources over the last half century to manage type 2s health.
Insulin, discovered in 1921, can achieve that goal, but most patients do not want to inject themselves multiple times a day while monitoring and counting everything they eat to maintain “tight control.” Besides, the ADA and most clinicians do not advocate or practice it because there are serious dangers in some situations (coma and death).They are content to let their diabetic patients remain in a perpetual disease state rather than risk having them pass out and be transported to the hospital with life threatening hypoglycemia or ketoacidosis.
The confounding and mitigating factors for the terms of the ADA’s “Standards of Medical Care” include the  American Heart Association (AHA), starting in the 50s, and the U.S. public health establishment, including foremost, beginning in 1977, Government Dictocrats. In that year the Senate Select Committee on Nutrition and Human Needs, aka “the McGovern Commission” produced the “Dietary Goals for the United States.”
Starting in 1980 it was followed every 5 years by the “Dietary Guidelines for Americans to “govern” what we eat. We followed it, the food manufacturers followed it, and so did the media and medical associations. We ate low fat, low cholesterol, low salt, lean meats, and low-fat cheese and yogurt. A mostly plant based diet.
Simultaneously starting in 1980, we got sicker and fatter and started to develop insulin resistance and type 2 diabetes at increasing rates. A little of this reflects an aging population, but this cannot explain the soaring rates of childhood diabetes. And just look around you on the street, or maybe in a mirror.
The “ship of State,” however, has begun to change course. In 2015 the Guidelines dropped the limit (30%) on total fat and the limit on dietary cholesterol (300mg/day). Eggs and butter, even bacon, are healthy again. Margarine, made from partially hydrogenated vegetable oils (trans fats) is taboo.
But these little known changes, while really significant – seminal, really – are in themselves not sufficient for the type 2 diabetic to reverse his or her disease state and achieve an A1c of less than 6.5% much less the 5.7%, threshold for a diagnosis of pre-diabetes. To reach this goal, or lower, the pre-diabetic needs to change the foods they eat. They need to limit carbohydrates, and not eat the same, one-size-fits-all diet that the government still insists everyone should eat. They need to follow a Low-carb, High-fat (LCHF) Way of Eating.
When you start to eat Low Carb, you will feel better. You blood sugar will stabilize. You will feel less tired and less hungry. You will lose weight. And your A1c will come down. I’ve been a diagnosed type 2 for 31 years and have been eating LCHF for 15. On LCHF I’ve lost 180 pounds and my A1c has gone from 8.9% to 5.2%. With no CVD. It’s still a challenge, but if I hadn’t made this lifestyle change, I wouldn’t be here today to write about it.

Sunday, September 3, 2017

Type 2 Diabetes, a Dietary Disease #396: “Intransigent Resistance”

An acquaintance called me recently to say she had been talking to a mutual friend who had said that I had helped her lose 30 pounds (and 2 bra sizes!), by eating low carb. LOL. She (the acquaintance) wanted to know how to do it? Well, my friend suggested, she should call me and ask. So, she did, and I was glad to help.
I am always pleased when my low-carb, moderate-protein, high, healthy-fat message is heeded. I offered to lend her my favorite books to learn the physiology of low carb eating, suggested the best websites for a neophyte to visit, and offered to mentor her, answering any question she had, as I had for our mutual friend.
It turns out that the acquaintance – let’s call her Pam – is a very busy woman and doesn’t have time to learn about the science. She just wants to know what to eat, and what not to eat. Apparently Pam had read that I had lost 60 pounds in 9 months 15 years ago, by following “Atkins Induction” (20 grams of carbs/day). Then, a few years later I had lost another 110 pounds following Dr. Richard K. Bernstein’s “6-12-12 Program,” in which you eat just 30 grams of carbohydrate a day. For some reason, Pam decided she wanted to try Bernstein.
So, I loaned her Bernstein’s “The Diabetes Diet” and his encyclopedic “Diabetes Solution.” I also told her I had recently become an acolyte of Dr. Jason Fung, fasting advocate and author of “The Obesity Code,” about Intermittent and full-day fasting. I had unsuccessfully tried 16-8 for about a year, in which I ate basically just one meal a day, or a small lunch and then supper within an 8 hour window, thus fasting 16 hours a day.
More recently, because I eat Very Low Carb and am therefore FAT-ADAPTED, I transitioned to full-day fasting. So far I have lost about 50 pounds since early February. Concerned that I would be hungry or lacking in energy, I started off with alternate day fasts (Tuesday and Thursday). But because I am FAT-ADAPTED, I was neither hungry nor lacking in energy. My body transitioned easily from fed to fasting states, using glucose from the fed state and then fatty acids from body fat and ketone bodies, the by-products of fatty acid breakdown, for brain food during the fasting state. Because of that smooth and natural transition, my metabolism continued to run at full speed. In fact, my sense is that I am actually more “pumped,” more energized, in my fasting state.
I then described what I put in my mouth on my 300 kcal/day Fasting Regimen: Coffee with heavy cream for “breakfast” and a wine spritzer at the supper hour. Pam asked, “Don’t you drink more water during the day?” I said, “Only if I am dehydrated from working outside on a hot day.” “You should, you know,” she admonished. I said, “I also drink some brine from the pickle jar” (to maintain my electrolyte balance). Pam was apoplectic.
In a later email exchange, I told Pam that she would have to cut way back on fruit to eat Low Carb. To eat Very Low Carb, she’d have to virtually eliminate fruit. Fruit is basically just sugar. Fruit juice is worse.  It’s nature’s candy. Pam replied she had a serious problem with constipation and didn’t want to give up fruit on that account. I replied that that was a rationale that I did not understand, but she didn’t explain how they were associated. I suggested it was an irrational justification, a rationalization, if you will. The subject was dropped.
I then suggested taking magnesium as a mild laxative and sleep aid. Most older adults are deficient in magnesium and should probably take a supplement. Pam then said she currently takes 400mg a day and her cardiologist doesn’t want her to take more. Her cardiologist! That’s new information to me. I replied that I take a full gram a day: 400mg morning and night plus 200mg in a multivitamin. And I had never experienced constipation on a Very Low Carb diet, even before I added a magnesium supplement morning and night.
Finally, I suggested increasing her fat consumption to ease her bowels. She said, “Thank you” and signed off. I guess she, and maybe her cardiologist, think the US Dietary Guidelines still limit dietary fat to 30%, or worse, cause CVD. Not true! Change is a slow process, starting with curiosity and intrigue, with a lot of resistance throughout. Sometimes intransigence shuts down the process completely. “Intransigent Resistance” (IR).