Saturday, June 6, 2020

Retrospective #476: Martin/Hopkins, “a better LDL calculation method”

In mid-2018 I noticed that Quest Laboratories had changed their method of calculating low-density lipoprotein (LDL-C) on my lab report. For more than 40 years the method used to calculate it was the Friedewald formula (LDLC = TC – HDL – TG/5), where TG/5 (TG<400mg/dl) was a surrogate for VLDL cholesterol. The method Quest uses now is the Martin/Hopkins method. Quest says that this “novel” method is “more accurate than the usual method.”
Of course, the most accurate method to measure LDL-C is a DIRECT assay, not a calculation. Dr. Michael Eades explains this on his website and I discuss it here. It requires another test – a special test which is expensive and generally not done unless you request it and your doctor and insurer agree.
I’m writing about this change because, based on what Dr. Eades wrote, and from my own affirming data, I assumed that Quest changed to the new method because the new method reported a lower LDL-C. To my surprise, while doing some research recently, I discovered that the new method actually shows a higher LDL-C.  I found the story here in MEDPAGE TODAY, under Cardiology > Dyslipidemia. The sub-title of the article is, “Friedewald lowballed lipids; Martin/Hopkins was on par with lab reference” [for patients with stable CVD].
“According to an analysis of the FOURIER trial, the median Martin/Hopkins LDL cholesterol level was 2mg/dl below the reference standard of preparative ultracentrifugation – a statistically similar result, whereas the Friedewald method underestimated LDL cholesterol by 4mg/dl (P<0.001)” (all emphases added by me). So, relative to Friedewald, Martin/Hopkins yielded an LDL-C that was closer to “reference” (assayed value) and 2mg/dl higher than Friedewald.
“While 22.9% of Martin/Hopkins LDL cholesterol values were at least 5mg/dl different from reference and 2.6% were off by more than 10mg/dl, these proportions were 40.1% and 13.3% with Friedewald estimation.” Noto Bene: “The difference between methods was more pronounced when triglyceride levels exceeded 150mg/dl.”
While the MEDPAGE TODAY article did not give the whole Martin/Hopkins formula, it did reveal that “the Martin/Hopkins method ‘uses the same standard lipid measurements of total and HDL (high-density lipoprotein) cholesterol and triglycerides as the Friedewald equation does, but it uses a personalized rather than a fixed conversion factor in calculating LDL cholesterol levels,’ Martin and colleagues noted.” This is “the nut” of it.
But, I wondered, does this apply equally to low triglycerides? If Quest’s use of a personal conversion factor usually results in an LDL-C higher (even if only 2 mg/dl), I find it intriguing that on the three lab reports I’ve had since Quest switched to the Martin/Hopkins method, my personal LDL-C values have all been lower than they were before. This is why I presumed, based on what Dr. Eades had said about a DIRECT measurement, that my own values would probably be lower, not higher, using the new method as it was intended.
For the 3 tests before the switch from Friedewald to Martin/Hopkins, my LDL-C values were 101, 114 and 100mg/dl. Then, using Martin/Hopkins, the Quest reports for my last 3 labs were 87, 79 and 83mg/dl. Of course, my labs were for different samples, but I have not changed my Way of Eating. So, then, I wondered, why are my LDLs lower?

Cholesterol 198 201 196 184 173 189
HDL 85 74 74 83 81 92
Chol/HDL ratio 2.3 2.7 2.6 2.2 2.1 2.1
LDL (calc.) 101 114 100 87* 79* 83*
non-HDL 113 127 122 101 92 97
Triglycerides (TG) 60 67 108** 56 53 56
* calculated by Martin/Hopkins method   ** first TG > 100mg/dl in 12 years

And here’s the answer: The JAMA article explains: Martin/Hopkins uses statistics for 3 stratifications of TGs from 100 to 399mg/dl, which resulted in higher LDLs. My lower LDLs are because my 3 most recent TGs have all been in the mid-50s. Martin/Hopkins does not account for low TGs. They’re “off the chart,” so to speak!

Friday, June 5, 2020

Retrospective #475: The “Fast Mimicking” Diet

A WebMD Health article on the Fast Mimicking Diet (FMD), written awhile back for a “consumer audience,” was, I thought, a little too “thin” on substance. The paper that WebMD referenced in Cell, however, was a little too “thick.” Still, it was interesting, so I wrote about it here in #382, “Can fasting ‘wake-up’ the pancreas?”
Still, my editor thought I could do better, so she sent me this BBC piece, “Behind the Headlines – Health News from NHS Choices.” This time the porridge was neither “too thin” nor “too thick.” I thought it was just right!
The BBC lede jumps right to the conclusion: “‘The pancreas can be triggered to regenerate itself through a type of fasting diet, say US researchers.” Now, that’s an inviting prospect! Here are key excerpts, for your elucidation:
“Mice were fed for four days on a low-calorie, low-protein and low-carbohydrate but high-fat diet, receiving half their normal daily calorie intake on day one, followed by three days of 10% of their normal calorie intake.”
“Researchers repeated this fast on three occasions with 10 days of re-feeding on their usual high-carbohydrate diet in between to ensure they regained their body weight before the next fasting cycle.”
“They then examined the pancreas. They found, in mice modeled to have both type 1 and type 2 diabetes, insulin production was restored, insulin resistance was reduced, and beta cells could be regenerated.”
“Researchers also recruited healthy human adult volunteers without a history of diabetes, who underwent three cycles of a similar four-day fasting regimen. Their blood samples were applied to the cultured pancreatic human cells. The results in the human cell samples suggested similar findings to those seen in mice.”
The BBC summed it up: “The researchers concluded that, ‘These results indicate that an FMD promotes the reprogramming of pancreatic cells to restore insulin generation in islets from T1D patients and reverse both T1D and T2D phenotypes in mouse models.’” “This is good science,” a professor at Cambridge commented.
The Fast Mimicking Diet (FMD) employed in the study and reported on in Cell was conducted at the University of Southern California (USC) and the Koch Institute at MIT, plus in Italy. It was funded by grants from the US National Institutes of Health and the US National Institute on Aging. It was high fat, low carb, low protein and, okay, very low calorie, especially in the last 3 of the 4 days. In that sense, the FMD “mimics” a “water-only” fast; that is, the biomarkers had the same physiological effects on the body as the more extreme “water only” fast.
The FMD is a way to eat that tricks the body into thinking that a person is fasting. The 3 salient biomarkers that the body produces are 1) lower levels of IGF-1, a hormone with a molecular structure similar to insulin, 2) lower levels of glucose and 3) an increase in ketone bodies.  The hypothesis is that a more extreme “water-only” fast would produce the same effects, but is unnecessary if you’re unwilling to go there, yet.
The effect of the HIGH FAT, LOW CARB and LOW PROTEIN FMD used in the USC/MIT study on mice and men was to “reboot” the pancreas to help the insulin-producing cells repair themselves and start producing the hormone (insulin) again. The study in Cell said, “During periods of fasting, the cells go into ‘standby’ mode. When feeding begins again, new cells are produced that have the potential to become insulin-producing.
From an evolutionary standpoint, the ability of animals to survive food deprivation is an adaptive response accompanied by the atrophy of many tissues to minimize energy expenditure. Thus periodic cycles of fasting, leading to the oxidation of pancreatic fat cells, the removal of impaired tissue (autophagy) and the death of other cells by apoptosis (pre-programmed death), “induced by the stepwise expression of certain genes,” are regulators of cell metabolism which enable the pancreas to reprogram itself to restore insulin production and regenerate stem cells similar to those observed during pancreatic development.
Read that last paragraph through again, and if you get it, ask yourself, might a Fast Mimicking Diet be worth a try?

Thursday, June 4, 2020

Retrospective #474: “Taking aim at belly fat”

Most people are more motivated to lose weight than to control their type 2 diabetes (T2D). We’ve come to think 1) that being overweight or obese is a personal failure best addressed with self-discipline, aka “diet and exercise,” and 2) that T2D is a medical condition that is best left to doctors to treat. In my opinion, both ideas are wrong. Why?  Because 1) T2D is a dietary disease, and 2) obesity is also a “dietary disease,” as will be explained, both the result of Insulin Resistance developed over a period of many years from eating the “wrong” foods”!
Has “diet and exercise” worked for you? If not, is it because the diet and exercise program you followed didn’t result in permanent weight loss? Could it be that the “healthy eating” patterns recommended by the USDA/HHS, and endorsed by the AMA, AHA and ADA, are the same ones that got us fat in the first place? Their solution is to “eat less and move moreusing the same BALANCED diet, loaded with simple sugars and other refined carbs.
Did you really expect to permanently lose weight without hunger eating a high-carb diet? And did you think exercising more would not make you hungry? Exercise is healthy, but exercise is not a good weight loss strategy.
Maybe the composition of your diet is where the problem lies. Did you realize that, just by changing the macronutrient proportions of your diet, you could lose weight EASILY, and WITHOUT HUNGER? And keep it off, just so long as you continue to eat that way. By now you surely must know that I am suggesting you eat a Very Low Carb diet. If you do, you will lose weight. And you can do it without hunger, and without exercise (if you want to).
Likewise, treating type 2 diabetes as a condition that is within the purview of the medical profession is a surefire way to assure that you remain (metabolically) sick. Consider this: The Standard of Care goal of the American Diabetes Association (ADA) is that your A1c be ≤7.0%. That means the ADA’s goal is for you to always be “diabetic” since the threshold for diagnosis of type 2 diabetes is ≥6.5%. Your doctor will consider that you’re “in good control” if, with quarterly tests, and more meds as needed, you have an A1c of ≤7.0%. Wahoo! You’re permanently sick, but in “good control.”
That’s all your doctor can do in a clinical setting. Besides, most doctors know zilch about nutrition, and what they do know is mostly wrong. It is guided by USDA/HHS’s and ADA’s Create Your Plate. They just want to be paid the maximum reimbursement (w/o penalty) under Medicare and other insurance rules, and to do that they must advocate for the USDA/HHS “lifestyle formulary” to eat a “plant-based diet,” “move more” (and take a statin).
Do you see what’s wrong with this picture? Do you see that YOU, BY MAKING JUST ONE CHANGE, CAN ADDRESS BOTH OBESITY AND TYPE 2 DIABETES? Type 2 diabetes and obesity are both dietary diseases! YOU can treat them both YOURSELF. Your doctor only sees you from time to time in the office, but YOU can manage both diseases EVERY DAY, by what you eat. You have a choice: your doctor can monitor your diseases, or YOU can take control of them.
The “dietary solution” for weight loss (eating Very Low Carb) is the same “prescription” for T2D management. You will both 1) lose weight generally but specifically visceral fat in your liver and pancreas, thereby improving their function and 2) lower your high blood sugar (caused by Insulin Resistance) and improve your A1c and type 2 diabetes.
If you’re a man, take a look at these pics (Type 2 Diabetes #355, Before and After), for how I managed to lose my “beer belly” and recently achieve an A1c of 5.0%. By the government’s clinical standard, I am now “non-diabetic.”
If you’re a woman, read this Harvard Women's Health Watch article.  Belly fat creates serious health risks, but if you follow the advice to eat a Low Carb Diet (not the same-old, same-old establishment advice that Harvard still dishes out), you can achieve the same result (without hunger), and TAKE AIM AT YOUR BELLY FAT.
If you go Low Carb, your doctor will be very happy the next time the nurse weighs you in and takes your blood. The scale and lab tests will show you made a good decision. You lost weight, improved your blood sugar and your cholesterol in the same way, and YOU did it YOURSELF, without hunger…and even without exercise (if you want).

Wednesday, June 3, 2020

Retrospective #473: IT’S THE VISCERAL FAT, STUPID!

What if you’re a type 2 diabetic who doesn’t need to lose a lot of weight but is very motivated to get off daily basal insulin injections? You’ve been recently diagnosed a type 2 but weren’t able to tolerate Metformin or a DPP-4 inhibitor (Januvia) and a SGLT2 is counter-indicated.  I am interested in this question since, at the moment, I am mentoring such a person.
Only about 80% of type 2 diabetics are seriously overweight or obese. If you’re overweight or obese and a type 2, success in remediating both conditions can be achieved by eating Very Low Carb (VLC). If you eat VLC (+/-20g of carbs a day), you will lower your blood glucose to non-diabetic levels, and you will enable your body to burn fat when your blood insulin level also drops. Your body will naturally switch to burning stored fat for energy.
But my mentee has a concern, since he’s not really fat to begin with, that his body will turn to breaking down muscle for energy (in true starvation mode). Not a problem, I told him, so long as he continues to eat protein (with fat) every day. While he’s a non-obese type 2, he definitely has a “pot” belly to lose.
But, my mentee wants to know, since he’s not seriously overweight, what accounts for his being a diagnosed type 2 diabetic? Clinically speaking, it’s the convenient symptom, a high blood sugar! If your fasting blood glucose (FBG) is ≥ 126mg/dl or your A1c is ≥6.5%, you definitely are a type 2. And if your A1c is ≥5.7% and <6.5%, or your FBG is between ≥100 and <126mg/dl, you’re pre-diabetic! But the cause of type 2 diabetes is Insulin Resistance.
But WHY does VLC work, he asks?  The answer is that by losing weight in this very specific way – Very Low Carb – while maintaining your energy level at a high metabolic rate, you burn body fat in a way that repairs your impaired, dysfunctional glucose metabolism. Your insulin receptors (which had become Insulin Resistant) become more insulin sensitive and you slowly restore insulin production by your pancreatic beta cells. How?
By burning VISCERAL fat – that not-so-little “pot” belly which is really the INTERNAL fat around your organs.
I first read about this etiological hypothesis a while ago in the blog of Dr. Jason Fung, a cutting-edge Canadian nephrologist. In the opinion of many (including me), he is the leading “non-establishment” thinker in the field of obesity and type 2 diabetes. He blogs weekly and is co-founder, with Megan Ramos, of the Intensive Dietary Management (IDM) program. He is now also the author of 3 books, including my favorite, “The Obesity Code.”
There are basically two types of white body fat: 1) subcutaneous fat, fat just below the skin, generally everywhere but especially in women around the butt, thighs and midriff, and 2) visceral fat, internal body fat within the peritoneal cavity and around and within the organs, especially the liver and pancreas. It is also referred to as “central obesity” and (by me) as “omental adiposity.” In a man, it’s his high, hard pot belly.
Fatty liver, or Non-alcoholic Fatty Liver Disease (NAFLD), is a serious inflammatory condition that is increasing at alarming rates. Fatty pancreas is much less studied and understood, but it is Dr. Fung’s hypothesis that fat around and within the pancreas interferes with the function of beta cells in secreting the hormone insulin. And that eating Very Low Carb, with Intermittent Fasting (IF), forces the body to burn body fat for energy. As the fat within the pancreas dissolves to be used for energy, normal function of beta cells is restored.
Thus, the body restores its ability to produce (secrete) sufficient insulin when needed. And by eating a Very Low Carb diet, with Intermittent Fasting, the body will need less insulin to transport and facilitate glucose uptake and will become less resistant and more sensitive to insulin at the cellular uptake level.
Thus, the two joint and related dysfunctions of type 2 diabetes – 1) insulin resistance, interfering with glucose uptake, and 2) insulin production, in the pancreatic beta cells – are resolved. IT’S THE VISCERAL FAT, STUPID!

Tuesday, June 2, 2020

Retrospective #472: Is the Vedda Blood Sugar Remedy Credible?

A friend of 40+ years, who used to follow my blog,, recently emailed me to ask, “Does the Vedda Blood Sugar Remedy have any credibility?” I’d never heard of Vedda before so I looked it up. It’s a Sri-Lanka herbal product and diet program that’s being promoted here (in the U. S.) in a new book.
The website Contra Health Scam says the Vedda Blood Sugar Remedy is a scam. Quoting from their conclusion, “Vedda Blood Sugar Remedy is nothing but a well-produced scam, complete with paid actors, stock photos, stock videos, twisted scientific studies and outright lies.” So, I sent the link to my friend and suggested instead that he look up the Virta Health program (note the clever name similarity?) for managing his weight and blood sugar.
My friend thanked me and later emailed me, “The Keto rage sure evidences your research! The weight loss results are phenomenal. This is totally counter to the food pyramid we grew up with, or Michelle Obama’s new school she tried to promote.” I replied, “Yes, that’s all true,” and asked if he would like to be added back to my distribution list.” He replied, “Yes, I am definitely still struggling to get to my goal weight. Thanks.”
Later, while working in the garden I got to thinking about this “conversation.” I found it very depressing. I’ve been proselytizing about how to manage weight and blood sugar for about ten years and have written almost 500 columns (472 published with this one), and even my long-time friends (and my own wife!) pay no attention to me. How frustrating is that? So, I told my wife about the conversation and she said, “You have no bona fides.”
I understood what she meant, of course. I’m not a medical doctor or “certified diabetes educator.” But, with exasperation, I replied, I have personally lost 170 pounds (and maintained most of the loss) BY DIET ALONE, WITHOUT EXERCISE, AND WITHOUT HUNGER. Not only that but I HAVE TURNED MY DIABETES HEALTH AROUND, FROM A PROGRESSIVELY WORSENING DISEASE TO THE POINT WHERE, FROM A CLINICAL STANDPOINT, I AM “CURED,” AND IN COMPLETE REMISSION.
In addition, my lipid (cholesterol) profile is also completely reversed, I’m no longer on a statin, my blood pressure is “normal” (with meds), and my “chronic systemic inflammation” non-existent (hsCRP ≤1.0). I am so full of energy and so much healthier and happier than I was 18 years ago WHEN MY DOCTOR FIRST SUGGESTED I TRY A VERY LOW CARB DIET to lose weight. He didn’t call it LCHF or Keto, but that is what is was and IT WORKS!
So, perhaps, you’re thinking, my personal example only works for me. “You’re not like other people,” my wife says – until your long-time friend reads about “the Keto rage” with “weight loss results [that] are phenomenal.” And then you realize that it’s “totally counter to the food pyramid we grew up with,” the one our government has been promoting for more than half a century – a “food pyramid” that is completely turned upside down. Completely wrong!
My wife said I should be grateful that my friend has come back into the fold. I said I was, but still, I was stunned at the resistance of some people…by which I mean most people, not my friend in particular…to rational change. We just don’t want to change, until perhaps we reach a tipping point in our personal life. For me it was the shock of learning, when I weighed myself on a commercial scale, that I weighed 375 pounds. My doctor’s scale only went to 350. I thought I was going to die. I looked around and I didn’t see any really fat, old people. I didn’t want to die.
What will it take for you? What combination of fear, courage, and a glimmer of a chance that changing your diet could save your life? That it might be easy to lose weight and improve all the markers associated with morbidity and death?
What will it take for you to realize you became overweight because of what you ate? To realize the way to reverse that condition is to change what you eat to eat in a way “totally counter to the food pyramid we all grew up with,” that we’ve been following our whole lives. I food pyramid that got us into this mess in the first place. Think about it. If that’s what it takes, then maybe you’ll become a follower too, and we can grow old together…

Monday, June 1, 2020

Retrospective #471: “You mean, sugar is a carb?”

I was sitting at the bar of a local fine-dining establishment, having dinner and chatting with the co-owner about nutrition, when she said, earnestly, “You mean, sugar is a carb?” I’m not kidding. This woman, who is seriously obese, blames her obesity on her “lack of discipline” and being “married to a chef.” “I work in a restaurant,” she said. Sheez…
“I know sugar is the enemy,” she continued. But for someone in her position – she clearly has an influence on the menu– to know virtually nothing about nutrition, is shocking. I’m tempted to go into another rant about how we got into such a state of affairs, but you’ve read enough of those. Instead, let me illustrate the point with further evidence of her thinking, and how that influences her and their business.
I hadn’t been to this neighborhood restaurant in a while, so I took a good look at the menu: Two soups, seven appetizers, and eight or nine entrees. One soup was a creamed squash, the other a chowder, the latter by definition loaded with potatoes. I was interested in the creamed soup so the wife checked to confirm that it contained no flour. It was not, but I wasn’t hungry enough for such a filling starter, so I passed.
Then, to my surprise, the first appetizer listed was a plate of fried potatoes. Five of the other six appetizers were salads. The seventh was calamari, dredged in flour, dipped in cornmeal and deep fried – three good reasons for me (or you) not to order it. Some of the salads looked good though, especially hearts of artichoke and a burrata.
Several of the entrees were also appealing: two fish entrees, an osso bucco, and a pork chop. All the entrees were accompanied by a vegetable and a starch, which of course could be switched out for extra vegetables. However, since I was not hungry, I settled on just the artichoke salad…and it was very good.
The young amiable bartender made me a good drink and I settled in. That’s when the co-owner joined me and we got into conversation about nutrition. I told her about how I had lost over 170 pounds, starting in 2002, and was still down 150. She said that was very good, but she didn’t ask how. It was a sign she didn’t want to change her way of eating. I told her anyway: VERY LOW CARB, I told her. I started on Atkins INDUCTION, which is just 20 grams of carbs a day.
She told me she did Weight Watchers. When I asked her, rudely, why she was not successful, she explained that she was married to a chef. I let that pass and instead mentioned that she and I – both of us – were at a disadvantage to many in the population, like the bartender, who was skinny.  She and I were victims, I said, thinking that would appeal to her. We, like millions of others among us, had a bundle of genes in our makeup that had been “expressed” over the years by our eating too much sugar and other processed and refined carbs.
Her response was, “I think that’s up for debate.” She averred that a meal had to be “balanced.” Her problem, she said, was “discipline.” I countered that when you eat mostly carbs, you’re always hungry. With protein and fat, your hunger is satisfied. She responded that a large serving of broccoli satisfied her for hours. We were going nowhere.
“Potatoes have a lot of fiber in them,” she continued. “I like potatoes.” I now understood why the potatoes were the first item listed on the menu, offered as an “appetizer.” And I now also understood why the seat I took at the bar had a half-finished plate of potatoes in front of it that the bartender removed. I had taken the co-owner’s seat and had interrupted her dinner of fried potatoes.
I had another drink and another salad, the burrata – which was also very good. That was all I could salvage from the night’s foray into re-educating the world, one person at a time.
But I did get subject matter for another blog on the state of nutrition in this world, and my fasting blood sugar next morning was 87mg/dl. That’s good.
But what’s going to become of us if we’re not even interested in knowing and learning about nutrition. If we’re so fixated on a “balanced” diet, getting lots of “fiber,” and blaming others for the food choices we make?

Sunday, May 31, 2020

Retrospective #470: A Tale of Two Paradigms

Sitting next to a good friend – waiting for a memorial service to begin – I asked her if she was pre-diabetic. Huffily she replied that she was not! Her fasting blood sugars were all in the “low hundreds,” she said, which her doctor told her was okay. She’s happy because she thinks she’s avoided the dreaded T2 diagnosis and the drugs. But she’s “a little” overweight, like most of us, so I supposed she might also be a little Insulin Resistant. And, of course, she was pre-diabetic.
Tragically, this is how the Medical Treatment Paradigm for Type 2 Diabetes works, historically and for the most part as it exists today.  The doctor might have told a patient with a blood sugar in the “low hundreds” to “lose weight and move more.” But my friend is in her mid-eighties, still working hard, and no doubt very glad to be alive and declared “well.” A good doctor might also have counseled my friend to take Metformin and eat fewer carbs, but given her age and the new, very lax ADA Standards of Medical Practice for older people, she probably didn’t.
Doctors are taught to diagnose disease and treat symptoms by prescribing medicine. But almost all of us are “a little” overweight, and everyone is getting older, so what’s a doctor to do? Prescribe Metformin for every one? Ironically, that’s not a rhetorical question. There’s evidence that Metformin extends longevity even in a non-insulin resistant population. It's been suggested in this peer-reviewed article that maybe everyone should take Metformin. It’s cheap and, except for brief intestinal distress in about 20% of those who start on it, it has no other side effects.
But even in the best of circumstances, in our 40s when we start to develop Insulin Resistance and put on a few pounds, a doctor today would still just counsel “diet and exercise,” and when that fails – as it invariably does – initiate drug therapy. And Metformin is the first line of pharmacotherapy recommended almost universally. In the clinical world the debate these days is what should be the 2nd and 3rd course of oral medications, before the doctor begins a more advanced drug like an injectable GLP-1 incretin mimetic, or an SGLT-2, and finally, insulin therapy.
This is how the Medical Paradigm dominates the treatment of Type 2 Diabetes. We all wait too long to start taking it seriously, and consider treating Type 2 Diabetes) as something doctors do. Ironically, it is totally lost on us (and the doctors) that the reason we gained weight was a due to a medical condition called Insulin Resistance, whose best MEDICAL treatment is a Lifestyle Change: a change in our DIET. Weight gain and Type 2 Diabetes both arose because for years we ate way too many refined carbohydrates and simple sugars. That’s why we got fat and sick.
The Dietary Treatment Paradigm for Type 2 Diabetes is rarely suggested in the doctor’s office. There are many reasons for this, but suffice it to say it is both “safe and effective.” And so long as YOU follow this dietary “treatment” (eating Very Low Carb), you will lose weight (a lot of it, if you want) and your blood sugars (e.g, your A1c) will get much better. Many people report A1c’s below the pre-diabetic threshold (5.7%). My first A1c, taken by an endocrinologist more than 25 years ago, was 8.9%. Last December it was 5.0%, rock solid normal…and clinically, non-diabetic.
So, the question arises: What will it take to bring about a revolution in the basic principles and practices of medicine to make this Paradigm Shift, a shift from the Medical to the Dietary Treatment for Type 2 Diabetes? It does not require a shift in all the “principles and practices of medicine.” It is only because TYPE 2 DIABETES IS A DIETARY DISEASE that a change of diet is needed. Until doctors make this shift, patients must learn that TYPE 2 DIABETES IS “REVERSIBLE” THROUGH DIET and then take responsibility for their own health at every meal. Treating an elevated blood sugar with drugs, because “that is something doctors do,” is “old school.” Until that day comes, the protocol for diagnosing Type 2 Diabetes and treating it with drugs will continue to be the Medical model.
Doctors likewise need to be reminded that Hippocrates, the Father of Medicine, said, “Let food be thy medicine and medicine be thy food.” If you have fasting blood sugars in the “low hundreds,” you have Insulin Resistance. You’re “Pre-diabetic.”  And if you want to avoid the clinical diagnosis, and the complications, now is the time to change what you eat. Don’t wait before you graduate to finger sticks and a cocktail of drugs…and worse.