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.




Sunday, December 2, 2018

Type 2 Nutrition #461: Very Low Carb is the Basic Precept


The best diet for a type 2 or pre-diabetic to control blood glucose is Very Low Carb (VLC). How many grams of carbs you eat will depend on your degree of Insulin Resistance (IR). Your meter will tell you. Then, the number of carbs you eat will be up to you. How much do you want to mediate your condition? Do you want to put your diabetes in remission, or do you want to let your doctor manage it as you go on with your old diet?
In the last 16 years I have tweaked how I eat a lot. My doctor started me on Atkins Induction (20 carb grams a day). I few years later I switched to Richard K. Bernstein’s 30 grams a day (6-12-12). I transitioned to LC-HF (low-carb, high-fat), then Very Low Carb (VLC) or VLCKD (“keto”), and finally VLC with lower protein and moderate fat, to allow my body to burn fat, while I fasted or had one-meal-a-day (OMAD) and was “fat-adapted.” This Way of Eating has been called many things, but the basic precept is Very Low Carb.
Besides always being fundamentally Very Low Carb, it has also always been Moderate Protein. It is not high protein as some would have you think. People who say “high protein,” are thinking negatively in two respects: 1) They think “high protein” is harmful to the kidneys and 2) they are afraid to call it or think of it as “high fat,” which it is, because they think high fat, especially saturated, is harmful to the heart, which it is not.
With respect to PROTEIN, a moderate level means from 15% to 30% protein, depending on the carb and fat calories. Mine has been 20% for many years. Second, only a diet that is higher than 30% protein, of total calories (including body fat burned), might be harmful to the kidneys and then only if you already have kidney disease. Third, fear of fat is not supported by sound science, as the world is just now coming to realize. We have all been unwitting subjects in a 60-year, world-wide, low-fat, public health experiment.
As for  FAT, I hope you’ve noticed that the 2015 Dietary Guidelines have quietly dropped the “30% and lower” target in their recommendations. You probably didn’t notice that the Dietary Guidelines Advisory Committee told the full committee that “cholesterol is…no longer a nutrient of concern for overconsumption.” You no longer are being guided to limit your CHOLESTEROL to 300 mg a day! Eat eggs! Eat shrimp! Enjoy!
Unfortunately, the Guidelines still focus – in fact they have doubled down – on the dietary recommendation against SATURATED FAT, found mostly in animal products but also in coconut oil. They – ahem, the United States Department of Agriculture, the co-authors of the Dietary Guidelines with another government agency, HHS – want you to “shift from eating solid fats to oils,” specifically the highly processed grain and seed oils grown, manufactured and “baked into” foods, literally and figuratively, by AgriBusiness. Anyone see a conflict?
Basically, a diet that is very low carb, moderate protein and high fat – or moderate fat if you are fat-adapted and need to lose more weight with fasting or just calorie restriction – is going to work for you to manage your blood sugar and to lose weight without hunger. When my doctor started me on Atkins Induction 16 years ago, for weight loss, it worked. But we were both surprised that I had hypos every afternoon for a week until I stopped all the anti-diabetic meds he had me on. And eventually I lost over 180 pounds!
My blood lipids also improved dramatically, doubling my HDL-C and cutting my triglycerides by 2/3rds. And, with weight loss, my blood pressure went down, as did my inflammation levels. I am so much healthier today than before, and I feel so much better. It all began with VERY LOW CARB. It is the basic precept for type 2s.
My apologies to my regular readers of this blog. I’ve told this story many times; however, since my columns cover a wide range of subjects and aren’t indexed, the majority of my readers find me through a “Google” search.  If that includes you, I hope you will return often and make this one of your favorite sites, or even become a “follower” and send a hyperlink to a friend. I accept no ads because I have no products to promote or sell – only nutritional advice and encouragement for type 2s and pre-diabetics.

Sunday, November 25, 2018

Type 2 Nutrition #460: The Blind Leading the Blind

No offence intended if this “microaggression” offends any blind person to whom this column is read, but that was my reaction to a “workshop” I attended a few months ago, conducted at a local hospital by two state- trained RDs. There were 13 attendees all looking for help to deal with their type 2 diabetes.
The workshop began with a brainstorming session in which each person was asked how they felt about being a type 2 diabetic. The moderators – I’ll call them Tweedledum and Tweedledee – dutifully wrote the feelings down on a mammoth 20 x 30-inch Post It. Virtually everyone expressed negative emotions, among them anger, confusion and frustration. I was last to be asked, and I said I had no such negative emotions because my type 2 diabetes was now under control. My last A1c was 5.0%, and the only medication I take is metformin.
I was then asked by Dee, reasonably, why I was attending the workshop. I explained that I had been diagnosed a type 2 thirty-two years ago, and my diabetes progressively worsened until I was taking 3 different orals meds – maxed out on 2 – and my fasting blood sugars were still out of control. Then, 16 years ago, to lose weight, my doctor suggested I try a Very Low Carb diet he had read about. The first day, to prevent hypos, he had to take me off 1 med and within the week he cut the other 2 in half TWICE. Over several years I lost 170 pounds.
Although I mentioned the name of the NYT Magazine cover story my doctor had read, nobody – neither Dum nor Dee nor anyone taking the workshop – expressed any interest in how I did it. Of course, they weren’t there to listen to me. They were in this group therapy session because their health-care providers had sent them to help them deal with their anger, confusion and frustration. The free book that everyone got said it all: “Living a Healthy Life with Chronic Conditions.” In other words, give up hope of reversing your T2D; just get used to it.
I really did feel sorry for the hapless participants, each with different issues but one thing in common, T2D. They are all victims of the current healthcare system. The course syllabus, from which the workshop facilitators READ VERBATIM, is based on the Chronic Disease Self-Management Program (CDSMP) developed by Stanford University. The homework assignment for workshop #2 was to read the “food guide” in the text and learn about “healthy eating.”  It is based on is the “Dietary Guidelines for Americans,” as illustrated in the book by ChooseMyPlate.gov, and the American Diabetes Association’s, “Create Your Plate.”
The Dietary Guidelines “Choose My Plate’ plan is ¼ fruits, ¼ vegetables, ¼ grains and ¼ protein, with dairy in a bubble. No fat. The ADA’s “Create My Plate” plan is ½ non-starchy veggies, ¼ starchy foods, and ¼ meat or meat substitute, with 8 oz non-or-low fat milk. Clearly the US Department of Agriculture and the American Dairy Products Association had a hand in developing these essentially identical plans, helped by Big Pharma and Big Food Producers. How all this corruption co-exists is explained in “Root Causes” by Jason Fung, MD.
The penultimate task of the workshop was to come up with an individual Action Plan for the coming week. Mine (I was last again) was two 36-hour total fasts, on alternate days, until I lost the weight I had gained since my last annual doctor’s visit. On the other 5 days I would eat Very Low Carb/One Meal a Day (VLC/OMAD). 
At the conclusion of class, we were all asked for our impression on how things had gone. I think Dum and Dee were hoping to get feedback that we all felt better after having attended our first group therapy session. Once again last to speak, I commented that I thought it odd that most people’s “Action Plans” were to exercise more. “After all,” I said, “diabetes is a dietary disease.” Tweedle Dum responded, “Well, everyone’s different.”
If you click on both “Plate” links above, you will get a visual image you won’t forget. Americans have been following these guidelines and the incidence of diabesity has skyrocketed. Ask yourself if anyone in this workshop will have any hope of self-managing their disease. I think the only thing that this “self-management” program is designed to achieve is acceptance of their feelings. That is truly sad.

Sunday, November 18, 2018

Type 2 Nutrition #459: My new favorite snack

I’ve been mentoring a recently diagnosed type 2 about what and when to eat, and not eat. I’ve told him that when you eat Very Low Carb (VLC), you won’t be hungry much, and you should skip meals if you’re not hungry. When you eat VLC, your blood glucose drops and your blood insulin drops too, so you can access and burn body fat. That’s why you’re not hungry. Your body is being fueled by your own stored energy.
So, in general you won’t need to snack for energy, but they are other reasons we snack. We all (most of us) do it, some of us habitually. I usually snack in the late afternoon, before supper, and when I do my favorite new snack is celery with anchovy paste. Celery is low calorie – just fiber and water – and filling. On each bite I add a dollop of paste, squeezed directly from the tube, for savor. But when my mentee tried it, he said, “It’s salty!”
It is salty, of course. Very salty. That’s why I like it. But to a newbie, salt is yet another “forbidden fruit.” For decades we were told to avoid fat, especially saturated fat. Now we know that government’s advice to avoid fat was a mistake. As a result, the Powers that Be in the 2015 Dietary Guidelines omitted the recommended 30% limit on fat. It’s now officially okay to eat more fat (and fewer carbs), just not SATURATED fat.
But from my POV that just takes us from the frying pan into the fryer (LOL). The alternative to saturated is unsaturated fat, either monounsaturated, the “good” fat found most commonly in olive oil and avocados, or polyunsaturated (PUFAs). PUFAs are highly refined and processed “vegetable” (seed) oils – corn oil, soybean, Canola, and sunflower, etc. – that easily oxidize when exposed to light and heat (the fryer). Think French fries.
Government is also slowly backing away from warnings about cholesterol, found in animal foods. Starting with the 2015 Dietary Guidelines, there is no longer a 300mg a day limit. However, the recommendation of the Dietary Guidelines Advisory Committee, that “cholesterol is no longer a nutrient of concern for overconsumption,” was largely ignored by the full HHS committee. They are, however, slowly coming to accept that our livers will make all the cholesterol our bodies and brains need, if we don’t eat it. Think vegans.
So, what’s wrong with eating salt? Nothing, unless you believe that the Public Health recommendation that everyone should eat less salt to protect the very few who have a rare genetic sensitivity to high levels of salt. The 2015 Dietary Guidelines have, however, also dropped the 2010 recommendation that Americans “reduce daily sodium intake to less than 2,300 milligrams (1 tsp salt) and further reduce intake to 1,500mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.” Think about half the U.S. population!
In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote an article, “The Dangers of Salt Restriction,” about a study in JAMA in 2011 that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day.” So, the lowest risk of death is associated with consuming from 267% to 399% more sodium than Type 2s or hypertensives or older adults were being “guided” to eat. I’ve been writing about salt since 2012. My column #74 cites Kresser and several other resources as well.
       Gary Taubes, “The (Political) Science of Salt,” and “Salt, We Misjudged You,” both also cited in #74.
       Eric Topol, MD, Editor-in-Chief of Medscape Medical News: “Dear Medscape Readers” (my #248)
       Then there’s this recent rant on the “salt scare” by Jason Fung, MD/IDM. It’s a no-holds-barred tirade!
       For “Tips and Tricks” on why Low Carbers should eat more salt to maintain electrolyte balance, Michael Eades, MD, has this link to his blog. Eades also explains the physiology. Please read these links about salt.
Losing weight and improving your general health and lipid profiles on a VLC diet will be more beneficial than living with mild hypertension. Ask your doctor if he or she doesn’t agree with this. Mine does, emphatically.

Sunday, November 11, 2018

Type 2 Nutrition #458: Is it time to clean out the pantry?


Of course, if you blame someone else for the food choices they made, by buying food you’re trying not to eat, you have another problem: taking responsibility yourself for the food you decide to put in your mouth. But we’re all human, as I’ve said, and I’ll have to admit it is sometimes hard for me not to eat the food I’m trying to avoid IF IT’S AROUND ME ALL THE TIME (especially in open boxes, containers and bags), or worse JUST SITTING ON THE COUNTER. Most of my neurotransmitters still work. Have you heard about the cephalic response?
But the fact is, “if you live alone…the only food in the house is the food you bought” includes a vestigial accumulation of “before” foods. In transitioning from eating the Standard American Diet (SAD) to eating Very Low Carb, you still have goods in your pantry (and frig) that remain from those halcyon days of yesteryear when you ate processed foods and sweets to your “heart’s content” (!!!), or more correctly to satisfy your brain’s addiction to foods developed and produced to addict you to them. When you blamed yourself for that, you called it a “craving.” It’ll be awhile before you’re weaned off them and realize you no longer want them.
Until that time you need to take steps to reduce the temptation to stray from the course you have set for yourself. The Way of Eating you have chosen may seem difficult at first, and confusing until you learn when and what to eat, and not eat, but you will eventually sort this out. When you follow a Very Low Carb (VLC) Way of Eating for a period of time (the length varies), and you lower your blood insulin and deplete your liver glycogen supply of stored glucose, you will transition to being a “fat burner.” You will not be hungry then.
But, if you’re like me, that doesn’t mean you won’t be tempted to eat carbs, both the highly processed ones and sweets. So, the best defense is a strong offense. You need to take charge. Clean out your pantry and frig of all things that might tempt you when you “raid” the kitchen looking for something to put in your mouth.
When you were a “sugar burner,” you were probably told you should eat 5 or 6 times a day, that you needed these infusions, or “snacks,” for energy.  That was true. When you followed the SAD, which is 55% to 60% carbohydrate, and you have Insulin Resistance (IR), your blood sugar goes up and down like a roller coaster, but your blood insulin level stays high (because of your IR). And because your blood insulin is still high, you don’t have access to your body fat for energy. So, you need to snack on carbs (or fat), for that “energy boost.”
But when you eat VLC, you’re not hungry. You have access to body fat for energy so you don’t need to snack. If you do snack, it’s just a bad habit. It’s time to face up to it. Eat only when you’re actually hungry, not caving to a bad habit when you’re not actually hungry. Eat only, at most, three small meals a day. Even two, or one (OMAD). EAT ONLY WHEN YOU’RE HUNGRY. Your body will feed itself (on you) the rest of the time. It works.
So, start with the pantry. It will be cathartic, and it will boost your confidence that you have finally crossed the Rubicon and there’s no going back. You can probably throw out almost everything. Think of the space you will create! I started with the “vegetable” oils. They’re all oxidized and rancid anyway. And the Crisco (trans fats).
If you have unopened jars of jelly or honey or boxes of sugar, donate them to a food bank. Virtue signaling will make you feel good.  Fill a garbage bag with open containers from the pantry and frig. That’s what all the sugar-filled, processed “foods” are anyway. Garbage. The exercise of clearing away the past and preparing to go forward into a future that you have envisioned for yourself is very Jungian. It’s the kind of self-therapy that supports the future you have chosen for yourself, a future in which you self manage your type 2 diabetes by treating this disease for what it is: A DIETARY DISEASE. You can eat your way out of it…by eating VLC.





https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

Sunday, November 4, 2018

Type 2 Nutrition #457: One foot in two lifeboats…

If you’re recently been diagnosed with type 2 diabetes (T2D), you may feel like you’re lost at sea with one foot in two lifeboats, each pointing in opposite directions. It’s time to make a decision: Which lifeboat do you take?
One lifeboat is occupied by others like yourself and is led by the ship’s captain, who brought you to this point. The other lifeboat has survivors as well…and just a boatswain’s mate to guide you safely to shore. But you can only take one lifeboat. Will it be the captain’s lifeboat or the boatswain’s mate’s lifeboat? How do you decide?
The captain has a lot of education and experience. He’s a commissioned officer and the ship’s master. He is “ultimately responsible for aspects of operation such as the safe navigation of the ship, its cleanliness and seaworthiness, safe handling of all cargo, management of all personnel, inventory of ship's cash and stores, and maintaining the ship's certificates…,” according to Wikipedia. We have confidence in our captain, right?
A boatswain’s mate has the rate of petty officer and also has acquired lots of knowledge and experience, but of a more practical nature. “Boatswain’s mates take charge of working parties; perform seamanship tasks; act as petty officer-in-charge of picket boats, self-propelled barges, tugs, and other yard and district craft,” Wiki says. In other words, a boatswain’s mate has the experience and navigational skill to coxswain a lifeboat.
Which “lifeboat” should you take? Well, the “ship” that brought you here…has sunk. It failed you and all those who followed the McGovern Committee’s Dietary Goals for Americans, published in 1977, and the first Dietary Guidelines for Americans in 1980. The “Titanic” (see my #12 here) first set sail in the 50’s with Ancel Keys’s infamous “Seven Country Study,” bolstered in 1961 when Keys joined the AHA board and was on Time’s cover.
You could get into the “captain’s” lifeboat. He will utilize all the skills he learned in medical school to diagnose and treat your symptom, an elevated blood sugar. He will counsel you to lose weight; he will suggest “diet and exercise” and his healthy fats.” And he will tell you to do what you have always done on this ill-fated “cruise,” just “eat less and move more.” And if that doesn’t work in a few months, (s)he will start writing prescriptions.
This “boatswain’s mate” will steer you in a completely different direction – one that deals not with a symptom (high blood sugar) but the cause of type 2 diabetes,  a dysfunctional metabolism. Instead of encouraging you to eat a “balanced,” “mostly plant-based” diet, high in refined carbs, sugars and “vegetable” (seed) oils, you will eat a Low Carb diet, with moderate protein and high fat, including saturated, to guide you safely to shore.
But as you can see, I have a bias. I lived the “high life” on the Titanic for 61 years. But I am among the lucky survivors who chose the “boatswain’s lifeboat.” After I made my decision 16 years ago in 2002, I lost 187 pounds) and recently had an A1c of 5.0%. I started my journey to remission and reversal of T2D by strictly eating just 20g of carbs a day. Within a week(!), I got off most of the anti-diabetic medications I was on.
My “coxswains” were mostly on on-line forums; I owe so much to them for their support. Today there are lots of special online support groups. I think the best is DietDoctor.com (subscription: $9/mo.); they get more visitors in 1 day than I’ve had on my blog in 8 years. My favorite books are "The Obesity Code," by Jason Fung, "The Art and Science of Low Carbohydrate Living," by Volek and Phinney, and "Blood Sugar 101," by Jenny Ruhl.
Of course, I’d like it if you decided to read my blog regularly. I publish once a week on Sunday mornings. I have a great editor who helps me make it readable and keeps me honest. She’s so much more qualified than I am, and in so many areas of health and wellness. I am so lucky to have had her help for all these years. As you can see, we do this without advertising. We don’t want or need ad revenues so we don’t sell or promote anything except an idea. After the disastrous voyage you’ve been on, we know that all YOU have to do now, to make it to shore safely, is to be in the right lifeboat and make smart, informed decisions about what to eat and when.

Sunday, October 28, 2018

Type 2 Nutrition #456: “Why am I taking insulin?”

You’re a newly-diagnosed type 2, and you’ve proved to be intolerant of a couple of oral prescription meds, so you’ve been prescribed a basal (once-a-day) insulin injection to lower your blood glucose levels. You know this, but it seems to contradict the advice you’ve heard that the dietary goal of eating Very Low Carb (VLC) to self-treat type 2 diabetes is to lower your blood insulin, so you ask, “How will this “lower your blood glucose?”
Treating an elevated blood glucose with injected insulin will lower your blood glucose, temporarily, but by continuously keeping your blood insulin level high, with a long-acting (24hr) insulin, 1) your insulin will “progress” to larger doses, 2) your Insulin Resistance will worsen, leading to the dreaded complications, and 3) you will gain weight – remember, “insulin is the fat storage hormone.” And that’s the establishment’s advice.
You reply, “So If reducing insulin according to this is the answer, then more sugar will be channeled into the bloodstream.” Do you see the fallacy? You’re making a logical error. “More ‘sugar’ [glucose] will be channeled into your blood stream only if you eat more ‘sugar’ [carbohydrates]. On a VLC diet, you eat far fewer carbs.
If you are eating far fewer carbs, your blood glucose and blood insulin will both naturally lower, because endogenous insulin (secreted by the pancreas) is the transporter of glucose in the blood. But if you are injecting a long-acting insulin, your blood insulin level will remain high all day and night, even as your blood glucose level comes down. Eventually, if you eat VLC at all meals, your blood glucose level will be so low that you will have to reduce the amount of insulin you inject to prevent hypoglycemia (too low blood sugars).
If you don’t eat VLC and continue to inject insulin (the establishment way), you will have all the consequences described above: 1) worsening IR, 2) higher insulin doses and later complications, and 3) weight gain.
So, you’re “taking insulin” now to lower your blood glucose because your doctor knows that untreated high blood glucose is very dangerous for your health, long term. She is treating your symptom (high blood “sugar,” caused by Insulin Resistance). By self-treating your disease at the cause, a diet high in “sugars” and refined carbs, your aim is to reverse the metabolic dysfunction caused by your diet and put the disease in remission.
And you can do it yourself.  Here’s how: 1) accept that you need to change your “lifestyle” (at least with respect to what and when you eat), and 2) learn about carbs and other things that raise your blood sugar, 3) commit to adopt this Way of Eating, and then, 4) #justdoit. This last is perhaps the hardest, but there’s lot of help out there: mentors, books, blogs, and Facebook pages and groups. For the last 16 years I’ve used them all, to great advantage.
Two of the very best websites are 1) Andreas Eenfeldt’s www.dietdoctor.com (500,000+ subscribers) and 2) the Intensive Dietary Management (IDM) program run by Megan Ramos out of Jason Fung’s Toronto office. Fung’s book, “The Obesity Code,” is one of my favorites. Another: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney. Another, Richard Feinman’s, “The World Turned Upside Down.” All good reads.
Two programs I can recommend are Eric Westman’s healclinics.com at Duke Health, and Phinney and Volek’s Virta program (virtahealth.com). Eenfeldt, Fung, Phinney and Westman are MD’s. Volek is a widely published PhD exercise physiologist, Feinman is a PhD researcher/activist, and Ramos started out as Fung’s patient.
Tweeters I try to follow include: Nina Teicholz (@bigfatsurprise), Franziska Spritzer (@lowcarbRD), Dr. Eric Westman (@drericwestman), Dr. Feinman (@DrFeinman), Dr. Zoe Harcombe (@zoeharcombe), Dr. Jason Fung (@drjasonfung), Dominic D’Agostino (@DominicDAgosti2), Andreas Eenfeldt (@DietDoctor1), Thomas Dayspring (@Drlipid), Tim Noakes (@ProfTimNoakes), Tom Naughton (@TomDNaughton), gary taubes (@garytaubes), Georgia Ede MD (@GeorgiaEdeMD), Adele Hite (@ahhite), Marika Sboros (@MarikaSboros), Dr. Jay Wortman (@DrJayWortman), Amy Berger (@tuitnutrition), Dr. Aseem Malhotra (@DrAseemMalhotra).