Tuesday, June 30, 2020

Retrospective #500: Many, many thanks, especially to my intrepid editor.

With this column (#500), I will cease publication on Blogger of the Retrospective Series of “The Nutrition Debate,” renamed at some point, “Type 2 Nutrition.” The daily Retrospective Series posts were edited versions of my original posts begun in 2010. The Retrospectives were begun in anticipation of a possible book.
None of this endeavor would have been possible without my intrepid editor, Laurie Weakley. From the very beginning, she has been there for me and my faithful readers. Of the original 500 weekly posts, she never missed a timely, thorough and professional review of even one – and she did it entirely pro bono. Laurie recognized, without my ever mentioning it, that 1) my writing skills left much room for improvement and 2) my motivation was purely educational outreach (not a commercial enterprise). She wanted to help with both.
Laurie was formerly a university librarian. She is smart and highly skilled in computers, very well read in the physical sciences (and otherwise), and extremely well organized with a vast library of saved hyperlinks. She also has the skill to improve a writer’s message without changing it. She’s flexible to adapt to a writer’s style, a very good communicator and has a soft touch when making corrections and suggestions. In case I haven’t made myself clear, I highly recommend Laurie Weakley to anyone looking for a highly qualified editor.
I originally began writing this column at the invitation of the editor/publisher of a local weekly newspaper. He published my columns as “content” to fill space between ads. He published about 20 columns and then lost interest in “all the low-carb stuff.” A few years later, he ceased publication of the weekly newspaper too,
On the other hand, interest in “the low carb stuff,” has increased exponentially. For me it began in 2002 with The New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie,” by the heralded science writer Gary Taubes. Taubes based his story on research but fundamentally vouchsafed for Robert Atkins, MD. I’m very glad to say, it got my doctor’s attention. He just wanted to lose weight, and he wanted me to as well. So did I. He tried the diet recommended and lost 17 pounds in 6 weeks. My doctor then suggested I try it too.
And the rest, as they say, is history. By the time the local newspaper publisher asked me to write a column for him, I had lost 170 pounds, first on Atkins Induction (20g of carbs a day), 60 pounds over 9 months, and then another 110 on Dr. Richard K. Bernstein’s 6-12-12 program for diabetics. I also learned a lot by lurking on Bernstein’s on-line “Diabetes Forum.” And in the first week on Atkins Induction, I had 3 hypos, and he took me off virtually all 3 of my oral anti-diabetes meds (all except 500 Metformin), putting my diabetes “in remission.”
My doctor knew he was going “off label” by prescribing “very low carb” for weight loss, so he monitored me monthly for a year. In that time, and in the 18 years since, I never had a hypo again. In addition, my HDL more than doubled, my triglycerides dropped by more than 2/3rds and he took me off the statin he had prescribed.
My column’s focus these last 10 years has remained the same: Type 2 Diabetes is a dietary disease. It is best treated with a Very Low Carb diet. Since 2010 I have had about 425k page views on Blogger, plus with the daily Retrospective Series, an unknown number on Facebook and Twitter. But that pales in comparison to the giants, many of whom arose after I began. Dietdoctor.com, I think, now gets about over 400k hits a day!
Andreas Eenfeldt, MD (dietdoctor.com), and Jason Fung, MD (The Jason Fung Fan Club – Fasting Support) are today two of the brightest stars in the nutrition firmament and among my favorite places to visit. They deserve our profound gratitude and thanks for their pioneering work and courage. But for me, personally, I am hugely indebted to my intrepid editor, Laurie Weakley, who stayed with me for almost 10 years in my weekly foray into the blogosphere.
Thank you, Laurie. I don’t know how I can ever repay you for your support and encouragement…and help. 

Monday, June 29, 2020

Retrospective #499: Lose the Fat, Save Your Life

This column, #499, will be my next-to-last post on Blogger. I started to write on Blogger about type 2 diabetes and nutrition in 2010 because a friend, who was following “doctor’s orders,” died of heart disease, a Macrovascular complication of type 2 diabetes. He was a pharmacist, and as his condition worsened through medical mismanagement of his disease, he became an insulin-dependent type 2 diabetic.

Why did this educated man follow “doctor’s orders”? Why would he not? Don’t we all, generally? Aren’t doctors trained to treat disease? Like high blood sugars, a type 2 symptom? The answer to these questions is, of course, “Yes.” So, you might suppose that a pharmacist would too. Pharmacists are trained in pharmacy and pharmaceuticals, and that is how doctors treat type 2 diabetes. With drugs. They treat type 2’s primary indication: a high blood sugar.

So, Dick continued to eat the one-size-fits-all, “balanced,” very high carbohydrate diet to which he, and the rest of us, sadly, have transitioned during our lifetimes, and especially since 1980: The Standard American Diet (SAD). This diet, if you didn’t know, is +/-60% carbohydrates. Check out the Nutrition Facts panel on processed food. And it is not the healthy, whole-food carbs we used to eat. They are highly processed boxed and bagged food products and sugars.

Knowing what I learned on my own, and from online forums, I was motivated to help others treat the cause, not the symptom of type 2 diabetes, and reverse the course of the disease. But it didn’t start out like that. From the time I was diagnosed a type 2 in 1986, I followed my doctor’s advice too. To control my blood sugar, my doctor started me on one oral medication and over the course of 16 years I graduated to where eventually I was maxed out on 2 classes of oral meds and starting a 3rd. I was, to be sure, on a certain path to becoming an insulin-dependent type 2 too.

Then my doctor turned his attention to my weight. He had read, “What If It’s Been a Big Fat Lie,” the cover story of The New York Times Sunday Magazine on July 7, 2002. He tried the diet himself, to lose weight. When it worked for him, he asked me to try it too, just to lose weight. It occurred to him, though, as we walked down the hall to schedule my next appointment, he said, “It might even help your diabetes. The diet was Very Low Carb (20g of carbs a day). We know now how well that works, but doc didn’t learn it in medical school, and Dick didn’t learn it in pharmacy school.

In the next week, strictly eating just 20 grams of carbs a day, I had 3 hypos (hypoglycemic episodes). Each time I called the doctor and each time he cut my meds. The first day I stopped taking the 3rd class and by week’s end had cut the other two classes of meds in half twice. I later stopped one of those, a sulphonylurea, and today just take Metformin.

In the course of 9 months, strictly followed the Very Low Carb regimen, I lost 60 pounds. Four years later I slipped a little and regained 12, so I started Very Low Carb again and over a year and a half lost another +/-120 pounds.

Of course, copious health benefits (and cost savings) followed. Besides the diabetes drugs, my doctor too me off statins. Why? My Total Cholesterol and LDL remained about the same, but my HDL more than doubled from borderline (39mg/dl) to 84 average. And my triglycerides (TG) dropped from 135mg/dl to 49 average. On this Very Low Carb diet, my TG/HDL ratio, “the strongest predictor of a heart attack” was always less than 1.0 (“a very low probability”). And so was my chronic inflammation, and my blood pressure dropped to 110/70 on fewer meds.

When I started out to eat Very Low Carb, it was just to lose weight, as both my doctor and I wanted. I had followed his weight loss “prescription,” before, including when he employed a Registered Dietitian in his office. I did it then and in 2002 because, like most of us, I trusted my doctor. I was positively inclined to “follow doctor’s orders.”

But my doctor didn’t learn how to lose weight in medical school. He learned it from a newspaper story. He did it just to lose weight, and he did. And when he suggested that I try it, he thought – almost as an afterthought, channeling something he remembered maybe from a pre-med course in physiology – that it might help with my worsening type 2 diabetes – no matter how many drugs he prescribed for it. By accident you might say, my doctor saved my life. Today, 18 years later, I am in tip top health, still 150 pounds lighter that when I started, and I think I may live forever.

Sunday, June 28, 2020

Retrospective #498: Save Money on Food and Meds Too

For almost 500 columns I have been harping on the health benefits of adopting a Low Carb or Very Low Carb Way of Eating. I have been trying to cajole my readers into acting in their own best interests. I’ve been telling you that you will lose a lot of weight, easily and without hunger, you will normalize your blood sugar regulation, and by strictly following a low-carb diet, you will put your Type 2 diabetes in remission…and with it reduce your risk of all the co-morbidities, both Macrovascular and Microvascular. By now, I hope, you have been persuaded…
However, just in case, if you need a little more push, there’s another very good reason to eat a Very Low Carb diet:
Let’s start with medications. If you are overweight (from chronic hyperinsulinemia), you are probably on blood pressure medications. At one time I was on 3 classes of BP meds. As you lose weight and your BMI returns to “normal,” your doctor will be able, in all likelihood, to titrate you off one or two or even all three BP meds.
If you’re a diagnosed Type 2 diabetic, you may be on as many as 3 classes of oral anti-diabetic meds. I was, and within the first week of going “cold turkey” on a Very Low Carb diet (20g of carb a day), my doctor had to take me off one and reduce the other 2 meds in half twice. And a while later, he eliminated a 2nd med altogether. I still take a very inexpensive Metformin, but many very low-carbers have stopped taking that medication as well.
In addition, the new classes of diabetes meds that are still on patent are very expensive. The 20% Medicare co-pay for the SGLT-2 class, that makes your kidneys excrete glucose, is $300 for a 60-day. That’s a $1,500 prescription!
And it you’ve been following “doctor’s orders” and eating a “balanced” diet of 55% to 60% carbohydrate, the Standard American Diet (SAD for short) of processed carbs and simple sugars (as in fruit), you may already be injecting insulin in your body…so I don’t have to tell you how expensive injected insulin (and other injectables) have become recently.
Then, if you’ve been eating the SAD, you probably have “high cholesterol,” a Total Cholesterol (TC) of 200mg/dl and an “elevated LDL-C,” so you’re taking a statin. But it’s low HDL and high triglycerides that are the real risk to your cardiac health. My HDL doubled and my triglycerides dropped by 2/3rds on VLC, and my doctor took me off statins. Eating a Low-Carb or Very Low Carb diet will fix non-alcoholic fatty liver disease (NAFLD) too. It will burn visceral (abdominal) fat around and within the liver and pancreas too, returning them to “normal” function. All of these medications (7 or 8 so far) cost a passel of money, and you can save virtually all of it…while improving your health!
Saving money on food is also a huge opportunity. People say protein and fat are more expensive than carbs, but have you looked at the price of a box of cereal or a bag of chips recently? And those “foods” are not nutrient dense. In fact, they are empty but addictive calories. And they’re totally non-essential. That right. There are no essential carbs.
Proteins have certain “essential” amino acids (that your body can’t make), and fats contain certain essential fatty acids (Omega 3’s and 6’s). And without fat, there is no way to take up the essential fat-soluble vitamins A, D, E and K.
And fat is satiating and protein digests more slowly, so you will eat less real food when you eat just protein and fat because you’ll be less hungry. In a restaurant, I frequently order just an appetizer. That’s a big way to save money.
And then there’s fasting: the 16:8 type, where you skip one meal a day, and there’s the OMAD way, where you skip two meals every day and eat just one-meal-a-day, again because you’re not hungry. Now, that saves a lot of money.
Finally, there’s extended fasting (EF), where you fast all day, taking just water, coffee or tea. When your body is fat-adapted, it switches back and forth easily between eating VLC and fasting, while maintaining a high energy level because it has access to your body fat for fuel. When you are in this state of nutritional ketosis, you can full-day fast on alternate days, or even 2 or 3 consecutive days, all the while feeling pumped no matter what your activity level.
And you feel great, because you are full of energy, but also because of all the money you saved on food and meds.

Saturday, June 27, 2020

Retrospective #497: How to Transition to a Low-Carb, Fat-Adapted Life

A few years ago, Andreas Eenfeldt, MD, founder of dietdoctor.com, the world’s most widely viewed source of information on the health benefits of a low-carb lifestyle, produced a New Year’s video with these 5 guidelines:
This prescription works. I lost altogether 180+ pounds, put my Type 2 diabetes in remission (in the first week!), and dramatically reversed “high cholesterol” (stopped taking a statin) and lowered my “chronic inflammation level.”
How you transition from “here” (where YOU are NOW) to “there” (how you WANT to be) is what this post is about.
To strictly follow a low carb diet, you need to know what a carb is. No joke! Most people don’t know. There is not room here to describe a carb in detail, so suffice it to say: IF IT IS NOT PROTEIN OR FAT, IT IS A CARB. Think about that. Then make the time to learn about carbs, because to be successful in this Way of Eating, you need to know.
Then, when you strictly follow a low-carb diet, you will soon discover that you eat a lot less because you are never hungry. That’s because when you eat low-carb, your blood insulin level is low and your body can access stored fat whenever it needs it for energy balance. Your body is adapted to burn its own fat for energy, so you don’t need to eat.
When I first thought about the Diet Doctor guidelines, I wanted to reverse the order of guidelines 1 and 2 above. Then, I realized it’s nonsensical to follow the “eat only when you’re hungry” guideline if you’re always hungry! And if you eat a “balanced” diet (typically 55% to 60% carbs), you WILL always be hungry, or at least every 2 or 3 hours. So, that’s why you have to “strictly follow a low-carb diet” before you can, “then, eat only when hungry.” Got it?
Then came along Jason Fung, MD, the Toronto nephrologist whose book, “The Obesity Code” was a blockbuster. Fung has a way with words, and his writing style is very “accessible.” You will see that, when you’re not hungry, fasting becomes much easier. So, Fung and Andreas Eenfeldt are kindred spirits and now frequently collaborators in fasting.
The two IF methods Eenfeldt described a few years ago were 5:2 and 16:8. I suggest you use them both to transition to a low-carb, fat-adapted Way of Eating. Once you start strictly eating low-carb, and you start skipping breakfast (except for coffee with heavy cream), because you’re not hungry at breakfast, you’ll already be fasting 16:8.
Then, you might also sometimes transition to skipping lunch, or to eating a very light one (one or two hard boiled eggs). And voilĂ , you’ll be in a mildly ketotic state – a mild form of nutritional ketosis – for most of the day.
The other form of IF that Eenfeldt describes is 5:2. I have instead adopted, from time to time, as needed for weight loss, intermittent 42-hour fasts 2 or sometimes 3 times a week. Instead of eating 5 days and fasting 2, I eat 4 days (Tue-Thu-Sat-Sun) and fast the 3 alternate days, M-W-F, fasting from supper one night to lunch the second day after.
Guidelines 4, to get a good night’s sleep, they say is important. Just make sure your bladder is empty before retiring, and if you have trouble falling off, take a magnesium pill or even a glass of wine. Guideline 5, weighing yourself daily, is a good idea for motivational reasons. I keep a written record and set a weekly weight loss goal.
The essential thing is, when you eat, eat Very Low Carb. In 2002, I started “cold turkey” on 20 grams of carbs a day. I saw immediate results. Within the 1st week, my doctor took me off virtually all the oral antidiabetic medication I was on to avoid hypos (hypoglycemia or low blood sugar); I had three hypos the 1st week, but not one since (in 18 years).
The other two macronutrients (protein and fat), besides carbohydrates, are important to understand, but are secondary in importance to weight loss. Protein is important to eat, every day when you’re not fasting, but if you’re fat-adapted (from strictly eating very low carb), and you want to lose body fat, you don’t have to eat extra fat beyond that which comes with the protein. Give your body a chance to burn body fat, not food, to make up the energy deficit, whether you’re fasting, or eating less because you’re not hungry, even of “feasting” days. Your body likes to burn fat.

Friday, June 26, 2020

Retrospective #496: Maintaining “Half the Man I Once Was”

In The Nutrition Debate: Type 2 Nutrition #400, I related how after years of eating Very Low Carb, with ups and downs and many misadventures, and finally with an excursion into Extended Fasting – both alternate day and consecutive day – I achieved a weight loss result I could never even have imagined at the start: I was just half the man I once was.

It all began with my doctor’s suggestion in 2002 that I begin a program of eating Very Low Carb (20g of carbs a day), to lose weight!  I weighed 375 pounds. After 15 years of on-again, off-again compliance – even some periods of outright cheating – I finally weighed in at 187 pounds. My BMI went from 54 to 27, and I was just half the man I once was.

As everyone who has lost a lot of weight knows, the challenge at that point was to maintain that loss, or at least most of it. Alas, I failed. In the ensuing months, I regained and then lost some of the weight. Along the way I thought a lot about my attitude toward food, including the cultural influences and the emotional drivers that influenced the eating habits and patterns that I had acquired over a lifetime. That’s a lot to know, and my introspection was not perfect.

One thing was certain though: Carbohydrates drove my weight gain and regain. I had been diagnosed a type 2 diabetic in 1986, at age 45. I had probably begun to develop Insulin Resistance in my early teens (I remember when and how and why.) By the time I reached middle age, I was Carbohydrate Intolerant, Insulin Resistant and a full-blown type 2.

Reading Gary Taubes’s New York Times seminal piece, “What If It’s All Been a Big Fat Lie,” gave my doctor and them me the confidence to try Very Low Carb. Reading Taubes’s tome, “Good Calories, Bad Calories” (“The Diet Delusion” in the UK), gave me an understanding of the science of insulin resistance, type 2 diabetes and obesity (“Diabesity”). It also explained Metabolic Syndrome and Gerald Reaven’s associated Unifying Theory of Disease. When I started to write about type 2 diabetes on Blogger in 2010, Gary Taubes was the subject of The Nutrition Debate #5.

An important factor in my early adoption of eating Very Low Carb was the online community. I became a regular at The Bernstein Forum, first as a lurker, then as an active participant to learn more, and later as a sort of mentor to others. I had lots of questions, and members of this community were very supportive of Very Low Carb eating. In no time at all (it seems), I had lost 170 pounds. Seriously, support in a friendly environment is very conducive to learning.

Another influence, long before he (they) became the blockbuster enterprise they are today, was Andreas Eenfeldt at DietDoctor.com. It was Andreas who, in a timely January post some years ago, available as an inducement to becoming a monthly subscriber (which I recommend), suggested a 5-point manifesto. Rule #1 was, “Eat only when you are hungry.” This was so valuable on so many levels: a) think before eating, b) question cultural norms and habits, and c) remind yourself of the primary purpose of eating: nourishment to maintain energy balance (if required by eating).

That last point became clearer when I thoroughly understood the role of the hormone insulin in energy management: If your body has access to stored energy (body fat), possible only when you have a low level of circulating blood insulin, in turn made possible by a low level of glucose in the blood, your body will be both nourished and in energy balance.

So, returning to where I began this post, my goal now is to be forever in ONEDERLAND. Onederland is the world in which, when you step on the scale, the first number you see is a “1.” Does that sound like fantasy to you? It did to me, at one time. But when eating Very Low Carb worked, for losing weight easily and without hunger, it was just a matter of one-day-at-a-time, then one-week-at-a-time, and with every passing month, the goal became closer to reality.

In my case, my goal for the rest of my days on this planet is to maintain my weight between 195 and 199 pounds. I will do this with a combination of generally following the principles of Very Low Carb (VLC) and One Meal a Day (OMAD). I will include protein every day, including whatever saturated fat is inherent in it. In fact, I will choose fatty cuts and always eat full fat dairy, including heavy whipping cream in my morning cup of coffee. I will otherwise eat only a moderate amount of fat, to allow my body to burn its own fat, and I will avoid as much possible all unnatural PUFAs.

Finally, I will use full-day fasting, as often as needed, to keep my weight within my Onederland range. Wish me luck!

Thursday, June 25, 2020

Retrospective #495: “A Very Low Insulin Diet”

I’ll bet you’ve never heard of this diet! Am I right? Well, if you haven’t, it’s because there isn’t a diet as such. It’s an outcome actually, of eating a certain way that achieves a low blood insulin level.  And that is a very good outcome, as I’ll explain. It’s also the natural outcome, as I will show, of eating the way our ancestor ate. The problem is there’s no way yet of knowing, objectively, from a simple (inexpensive) blood test, that you’ve achieved that desired outcome.
As a consequence, once you have achieved this outcome – until a cheap blood test is available – you will have to rely on a surrogate marker to know if, how and when you have achieved your goal: a low blood insulin level.
To understand “how,” we’ll need to delve into a little basic human physiology. Insulin is a hormone that has multiple roles in metabolism and fat partitioning. It is secreted by the pancreas, a small gland near the stomach, in response to eating carbohydrates. And as carbs are digested into glucose, insulin accompanies them into the bloodstream and acts to “open the door” of the cells where the glucose is taken up for energy.
So, when you eat carbs, your blood insulin level naturally rises. And the glucose from the carbs you ate are in excess of your energy needs, they are stored or, when storage is full, by a process called de novo lipogenesis, the liver converts them to fat and stores them in your fat cells. Then, as the circulating glucose is absorbed and burned or stored or converted to fat, your blood insulin level drops. And that is what a normally functioning glucose metabolism does.
Then, in that normally functioning glucose metabolism, when you blood insulin level goes low between meals, when you body calls for energy for whatever purpose (basal metabolic or activity), your low blood insulin level signals the liver to take energy from those recently refilled or other fat cells. Your fat cells cycle the triglycerides back into your blood stream (broken down as free fatty acids), and you get all the energy you need from your stored fat. Again, that is what a normally functioning glucose metabolism does. A low blood insulin level allows your body to continuously access stored body fat to maintain energy balance, including any level of energy required by your activities.
But what happens if for years and years, to avoid “saturated fat and cholesterol,” you have eaten – as you’ve been told – a diet very high in carbohydrates? And what happens if that diet, for your “convenience,” is mostly processed carbs from prepared foods or products sold in boxes and bags? And what if, to make the food more “palatable,” sugar (a simple, easily digestible carb) is added to virtually all processed foods, e.g., store-bought bread or peanut butter?
What happens is that for many people the body resists the unnaturally high level of glucose in the bloodstream. The transport hormone – the insulin accompanying glucose in your blood, it unable to open the cell that needs the energy. Those cells have developed Insulin Resistance. Well, the glucose and the insulin, continue to circulate, the cells don’t get the glucose energy they need, and because your blood insulin level is still high, your liver can’t access your stored body fat for the needed energy. So, your metabolism slows, and you feel tired… and sluggish…and hungry.
If you are one of those who has developed…over many years…a degree of Insulin Resistance, your doctor has no direct measurement to find out. He doesn’t have an affordable or insurance reimbursable test that he can use to measure your blood insulin level. But she, and you, have a few good surrogates: 1) you body fat level. The cause of obesity, or “overweight,” is not sloth or lack of activity. It is Insulin Resistance. If you have a “touch” of Insulin Resistance, your elevated blood insulin is being transported back to your liver where it converts it to fat, and your elevated blood insulin is blocking body fat from being used for energy when your body needs it, so you’re hungry and you eat for energy.
Another surrogate is an elevated blood glucose level. Your doctor can easily test for this, either with a hemoglobin A1c test which measure the glucose on your red blood cells over 3 months. This is a good surrogate because, as we say, if you have an elevated blood glucose, it is because you have an elevated blood insulin because of Insulin Resistance.
If you have Insulin Resistance, the precursor condition for Type 2 Diabetes, you can treat it yourself by not eating the foods that make your body produce and transport insulin to help your body take up glucose: CARBOHYDRATES.

Wednesday, June 24, 2020

Retrospective #494: My Simple Food Rule

My “food rules” haven’t changed much since I started eating Very Low Carb in September 2002. At the my doctor’s suggestion, to lose weight, I began with Atkins Induction: 20 grams of carbs a day. It worked in the way my doctor intended. I lost 60 pounds in 9 months. It also worked in another way that was unintended, or at least not anticipated. In the 1st week I had to come off nearly all 3 oral diabetes medications that I was on.
As best I can remember, the Atkins protocol only addressed carbohydrates at the time . That’s worth noting. It’s only – okay, well largelyonly carbs that matter. To lose weight (lots of it – I eventually lost 180+ pounds), you only need to restrict – severely, I’ll admit – CARBOHYDRATES.
So, if all you need to know, to lose lots of weight and greatly improve your health, is to severely limit the carbs you eat, the first thing you need to learn is: what foods contain carbs. Today, there are many ways to go about doing this: 1) You can “count carbs.” That’s what I did. From the start, I estimated portion sizes, used on-line sources for carb counts and recorded everything I ate in an Excel chart I created; or 2) You can use an on-line service to do the work for you, but be careful; many of these sources are much too lax in their allowed foods. They think you “can’t” or want to eat in a way that severely limits your carb intake. They’re too friendly to the weak-willed or insufficiently motivated, or 3) Once you know what foods are carbs, you can just totally (or mostly) avoid them, in most meals or by fasting. Whichever way you choose, once you learn about carbs, remember: you just have to stick with Very Low Carb.
I learned what I needed to know, and then I ate (mostly) in compliance with this new knowledge. The foods I ate, were primarily protein and fat – saturated fat that is an inherent component of animal protein. If you aren’t prepared to do that, you will have a tough row to hoe. Artificially manufactured vegetable oil (polyunsaturated) fats are inherently unhealthy, and you must eat fat with protein. Protein has primarily cellular and hormonal functions. And you need healthy saturated fats, and some monounsaturated fats like olive oil, to absorb the fat-soluble vitamins: A, D, E and K.
As I lost weight by eating mostly protein and good fats,, I discovered I needed less food to feel full.  I wasn’t hungry most of the time. My body was in mild ketosis, just ketotic enough to burn body fat as an energy source. Fat and carbs are the only two sources of energy.  I didn’t need to eat carbs for energy. My body fat provided all the energy needed.
That’s when I started to ask myself: If I’m not hungry, why am I eating 3 meals a day? My body runs well on its own fat (and some ketones), so, if I’m not hungry, why eat just because it’s a certain time of day. I started having just coffee with heavy cream for “breakfast,” and skipping lunch or just being sure lunch was only protein with some fat so I could stay mildly ketotic and not be hungry. At supper, just eating a small meal of animal protein (with saturated fat) and a portion of low-carb vegetables tossed in butter or roasted in olive oil, was always enough for me.
But I sometimes snacked. My snacking was always just before supper (happy hour). When I was on anti-diabetes meds (sulfonylureas) that was always the time of day when my blood sugar was lowest. My snacking may be cultural as well. I have always enjoyed a glass of wine, or two. (I only drink spirits in a restaurant or when we have guests for dinner.) And with wine I might have radishes with salt and butter or celery with anchovy paste, or stuffed olives.
My cheats are 1) once in a while I’ll steal some of my wife’s ice cream from the freezer, or 2) in a restaurant, eat a roll with butter or olive oil. Rarely, I’ll share a dessert. These are indulgences. Simple pleasures, from a previous life almost forgotten. The best part of eating Very Low Carb almost all the time, besides the stellar labs, is how well I feel. I am often “pumped,” almost euphoric. The mood difference is palpable. It’s not just knowing I am no longer fat!
Oh, and did I mention...I have saved a lot of money on drugs and food. And my blood pressure is lower. And my HDL doubled and my triglycerides dropped by 2/3rds. And I don’t have to take a statin. And my chronic systemic inflammation blood marker (hsCRP) is way lower. And I did it without exercise (and saved lots of time and gym costs).
And all it requires is that I eat Very Low Carb most of the time. That’s VERY Low Carb. It’s all you have to do.