Sunday, April 23, 2017

Type 2 Diabetes, a Dietary Disease #377: My 10-week, 30-lb Challenge: Final Report

Executive Summary: Primary End Point: Achieved, lost 31 pounds in 10 weeks. Discussion: All day fasting (300kcal/day) – either alternate day or 3-consecutive-day fasting – is an effective way to break a weight loss plateau if you are keto-adapted to start. It is easy because you will not be hungry, and it is effective because you lose weight while your metabolism continues to run in “high gear” as you burn your own body fat. During fasting your fasting blood glucose will fall dramatically (while continuing a Metformin regimen), but not below 60mg/dl. There was no hypoglycemia. Gluconeogenesis from fatty acids and amino acids provided glucose. My FBG average dropped from 119mg/dl before to 81 (10-week average). A1c went from 5.8% to 5.3%. Lipid Panel: Total Cholesterol: 201mg/dl; HDL: 74mg/dl; LDL: 114mg/dl; Triglycerides: 67mg/dl.
Week 6: Lost 0 lbs. Annoying. I thought I might be in trouble when after my first day of fasting this week I had lost only 1 lb and my FGB was 83. The week before my FBG was 61. I also ate out on Friday (3/17), and while lunch was VLC, my supper was 3 Ultras and ad lib peanuts. So, Saturday’s FBG was 107 and my weekly average bumped up to 79 (4.3mmol/L). Still, not bad.
Week 7: Due to the less-than-desired results in Week 6, I decided to try a 3-consecutive-day fast this week (Tue-Wed-Thu). I’m never hungry on fast days, so I thought it would be easy…and it was. No hunger, even on Friday morning. I could have kept it up for longer, easily. I had lots of energy and low but consistent fasting blood sugars (60s & 70s), average 71 mg/dl, and I lost 2 pounds. It was successful so I decided to repeat the 3-day fast the next week.
Week 8: Once again, the 3-day fast was easy. No hunger. Very little thinking about food. When I wasn’t busy with projects, or needed to rest from pushing hard all day, I sat down and read for half an hour. This week I ended the fast with a seminar in NYC that included a talk by Gary Taubes and lunch. I had the salad (with candied walnuts!), a piece of chicken and a spinach side. For supper, I had a petite filet, broccoli rabe side, and a drink. FBG this morning was 87! That raised my weekly average to 74mg/dl. I also lost 5 pounds, bringing my 8-week loss to 25.
Week 9: All good things, as they say…slow down. My weight loss continued, but just 1lb, to 26. My FBG average jumped 15 points, to 89mg/dl (range 74 to 101). Explanation (excuse): I spent most of the week in Florida and on the road. It’s hard to stay on track with so many diversions. I cheated. “No dessert,” I said at the Charleston Grill, but then without thinking ate the offered petit fours. Etc. So, with only 8 days remaining in my 10-week, 30-pound challenge, I will need to employ “the nuclear option” again this week: a 3-consecutive-day fast; still 4 pounds to go.
Week 10: It worked, for the 3rd time. I lost 5 pounds, bringing my 10-week weight loss to 31. And my FBG average was 80mg/dl (4.4mmol/L) – higher than expected, due no doubt to the adjustment period the body needs to down regulate from the previous week’s excesses. The 3-day consecutive fast, I discovered, is just as easy as, and more effective than, the Tuesday-Thursday alternate day fast. You just need to be keto-adapted to avoid hunger altogether.
Conclusion: If you eat VLC (just 15-30 grams of carbs/day), and you are thus keto-adapted, and you reach a weight loss plateau, you can effectively employ full-day fasting (alternate day or consecutive day) to restart weight loss in a healthy way. I did and I lost 31 pounds in 10 weeks.

Sunday, April 16, 2017

Type 2 Diabetes, a Dietary Disease #376: “I have gone off carbohydrates almost entirely.”

A couple of columns back I told the story of a man I had met only once, and then only briefly, at a New Year’s Eve party. I was, shall we say, sort of “juiced”, and probably rattled on a bit about my Way of Eating (WOE). I related how I had lost a lot of weight, and improved many other health parameters, on a Very Low Carb (VLC) diet. I then apparently gave him a card for my website, The Nutrition Debate. I honestly expected nothing to come of it.
A few weeks later he emailed me, “I have gone off carbohydrates almost entirely…and lost 10 pounds.” I replied congratulating him on his success and his motivation. I asked, “What was the trigger for you?” He said, “My doctor had me tested for diabetes and suggested I might be pre-diabetic – hence the urgency for weight loss.” I asked, “Why Very Low Carb?” He had doubts, he said, but “I am hoping I will do myself more good than harm.”
In terms of mental reservation, given the fat phobia most people have learned from bad government guidelines, and from the medical establishment and the media, that was a fair place for him to be; that notwithstanding, however, my casual acquaintance took the next step. In his words, he foreswore “carbohydrates almost entirely.”
THEN, 6 WEEKS LATER I GOT THIS UPDATE: “LOST 40 POUNDS AND AM TAKING ONE-A-DAY ‘SILVER’ DAILY.”
I was thrilled for him and pleased that I had at least been a catalyst. It was just serendipity that I had been there (sort of) at that moment to help him point the gun at the right target, carbohydrates, before pulling the trigger.
My new friend had the 3 keys: 1) the motivation, 2) the courage, and 3) the pertinacity to stay with it. All three are critical, but the “catalyst” for him was my bibulous rant on New Year’s Eve. What’s your trigger?
In my case, in 2002, I had been a diagnosed type 2 diabetic for 16 years and still eating a “balanced” (55-60% carbohydrate) diet as I had been for my whole life. And I had recently gained enough weight that I was too fat to weigh in on the doctor’s scale. So, before a scheduled appointment I stepped on a commercial scale and “discovered” I weighed 375 pounds. I was shocked. That was my motivation. And then serendipity stepped in.
As I opened the door to my doctor’s waiting room, he was standing at the nurse’s station and said, “Dan, have I got a diet for you!!!” Six weeks earlier my doctor had read the New York Times Sunday magazine cover story: Gary Taubes’s ground-breaking, “What If It's All Been a Big Fat Lie.” He tried the diet Taubes promoted. Besides losing 17 pounds in 6 weeks, he liked the effect it had on his lipid profile. So, he suggested that I try it, and I did.
The third factor, your firmness of purpose, or dogged determination, may seem to the uninitiated (or the misled) to be the hardest of the three, but it’s not. After just a few days of adjustment, while you use up your glycogen stores, or immediately if you’re already keto-adapted, it becomes accustomed to eating mostly protein and fat. It no longer craves carbs because your blood insulin level has dropped enough to allow access to your body’s fat stores. It then breaks down body fat when the calories you eat are insufficient to maintain energy balance.
But it can’t do this 1) if you eat enough carbs to raise your blood insulin level and/or 2) you eat more food than you need to maintain energy balance. But you won’t, if you listen to your hunger signals, because when your body is burning its own body fat, you are not hungry. Your body is feeding on its own fat stores, so it doesn’t tell you, “I’m hungry. You must feed me with food-by-mouth.” That’s what makes this easy. You won’t be hungry (after I period of adjustment) because your body is content to feed on its own fat stores. And it makes sufficient essential glucose from amino acids (from digested protein) and from the glycerol molecule freed up when body fat (triglycerides) break down. And in the process it will make ketone bodies, which your brain will love.
So, what’s happening with my new “friend” who lost 40 pounds in two months after “going off carbohydrates almost entirely”? I don’t know, but if he sticks to a Very Low Carbohydrate eating plan, both he and his doctor will be very happy – he a lot healthier and happy with the weight loss and his doctor with his improved lab tests.

Tuesday, April 11, 2017

Type 2 Diabetes, a Dietary Disease #375: A New Year’s Eve Conversation, Part 2 of 2

Part 1 of this 2-part series (#374 here) relates how “Bruce” lost weight easily by “going off carbohydrates almost entirely” for two weeks. I met Bruce casually at a New Year’s Eve party and gave him one of my cards. He decided to check out my website, www.thenutritiondebate.com  and then to try Very Low Carb (VLC) eating. In our earlier conversation that evening, Bruce told me that in those first 2 weeks he had lost 10 pounds. The conversation continues here:
Dateline: January 14th (still later that evening)
You’re welcome, Bruce. Weight loss was my original motivation (in 2002) for eating VLC because, like yours, my doctor thought that being overweight was a cause of T2DMThey were both wrong, as Gary Taubes and many other experts in physiology and medicine have now exhaustively and conclusively proved. See my #5 here or Taubes's "Alternative Hypothesis" in "Good Calories-Bad Calories" (2008), a heavy but solid, evidence-based read.
An easier read would be, "What If It's All Been a Big Fat Lie," the New York Times Sunday magazine cover story of July 7, 2002, here: My doctor read this, tried it himself, and recommended the diet to me. That's when I got interested in low carb for weight loss. And, incidentally, it started the modern revolution in dietary science that so much of the orthodox profession continues to dismiss. That's why Taubes, who won the National Science Writers’ Association award 3 times, wrote GC-BC. Sadly, he was to be disappointed by the medical community’s response. 
Insulin Resistance (IR) is the cause of T2DM. It is also the cause of obesity, not the other way around. Insulin is the transporter of glucose in the bloodstream, and so long as there is enough glucose (from carbs) circulating in the blood, insulin remains elevated and blocks the alternative fuel, body fat, from breaking down to fatty acids to maintain energy balance . The body saves this fat, a more dense source of energy (9kcal/g vs.4 kcal/g for carbs and protein), for long fasts, including famine and winters (from a Paleolithic/historic perspective). I wrote about this in this post: The Nutrition Debate #308, “Introduction to What Causes Type 2 Diabetes,” here.
Since resuming my column a year ago December, my focus has been on "Pre-Diabetics," newly diagnosed Type 2s, and those who, like you, have been told they "might be Pre-Diabetic." The medical societies have been very slow to revise standards for diagnosis, but they have been doing it. They just haven't gone nearly far enough. There are many clinicians today who have, however, and many who just may (I don't know your values, and I'm not an MD) classify you unambiguously as Pre-Diabetic, or even a frank Type 2.
I hope you have a baseline A1c on a recent lab test, because it you stay on your VLC Way of Eating, you will see it drop, perhaps significantly, and perhaps even out of the range of Pre-Diabetic completely to below 5.7%. That should be your goal. "Normal," btw, is between 4% and 5%. Anything above 5% is a sign of Insulin Resistance.
I also hope you have a baseline metabolic panel or at least a lipid panel with which to compare your next lab tests. After doing this Way of Eating for awhile, my HDL more than doubled from 39mg/dl to 84mg/dl (comparing 15 average tests for both). And my triglycerides plummeted by two-thirds (from around 150mg/dl average to below 50 average. Both values have stayed there for many years now. My total cholesterol and LDL cholesterol have been stable and slightly lower. My latest test: TC 184; HDL 91; LDL 84; TG 46.
Google "Metabolic Syndrome." It is the precursor to and the “unifying hypothesis” for all these metabolic disorders. I wrote about it almost 5 years ago in an early column of The Nutrition Debate: Metabolic Syndrome.
Dan
BTW, after one day of eating VLC (a strict version of Low Carb, like Atkins Induction), before losing weight, I had a hypo and called my doctor who told me stop taking one anti-diabetic oral med. The next day he cut the other two in half and soon thereafter in half again, later eliminating the sulfonylurea completely. Now I just take Metformin.
Dateline: February 29th (6 weeks later)
I emailed Bruce to invite him to another party, our annual Winter Wing-Ding. He replied:
Hi Dan,
Thanks much for the invitation, but I am in Jensen Beach for January only.
Lost 40 pounds [my emphasis] and am taking One-a-Day “Silver” daily.

Bruce

Sunday, April 2, 2017

Type 2 Diabetes, a Dietary Disease #374: A New Year’s Eve Conversation, Part 1 of 2

It all started at a New Year’s Eve party after a New Year’s Eve dinner party. I was pretty well juiced by that point.
Email in my inbox dated January 14th:
Hi Dan,
I met you in the community room [at the] New Years Eve [party]. [We talked)], and [I] was inspired to try to lose weight. Since New Year’s I have gone off carbohydrates almost entirely [my emphasis]. I have lost about 10 pounds to date, but I understand the first 10 pounds are inconsequential. Anyway, this diet naturally has a higher ratio of fat than my previous diet/non-diet. I have been reading your blog at
www.thenutritiondebate.com. I am hoping I will do myself more good than harm on this diet. Any tips for the beginner?
My reply later that evening:
Hi Bruce,
First of all: Congratulations! 1) on your being motivated and acting on that motivation, and 2) on you actual success. It's true that the first 10 pounds are the quickest to lose, although not necessarily the easiest.
Some people experience hunger (which seems to go away after a couple of days as the glycogen stores in the liver and muscle are used up and you transition to burning fat (breaking up triglycerides into fatty acids and using them for energy and ketones for brain food.). Also, some people feel weakness, which is addressed by making sure you get extra salt (seriously) to compensate for the loss of salt/water weight (most of those 1st 10 pounds).
Depending on how much you eat, and how much you have to lose, though, you should be able to lose at least 2 pounds a week going forward. At one point (almost 10 years ago) I lost 100 pounds in 50 weeks. 
Thanks for reading my blog. I post every Sunday (at www.thenutritiondebate.com). Please keep me posted on your progress, and feel free to ask questions. I'd be happy to connect you to other resources including an on-line forum for Type 2s. Are you, btw, a Type 2, or Pre-Diabetic, or have you been told you have Metabolic Syndrome?
Dan Brown
His reply, still later that evening
Hi Dan,
Thanks for getting back and thanks for the encouragement. My conversation with you on New Year’s Eve inspired me to get started and that I would have a possibility of success. To answer your questions, my doctor had me tested for diabetes and suggested I might be pre-diabetic – hence the urgency for weight loss.
Bruce
Well, this answer from Bruce put him perfectly in the crosshairs of my new target audience: the Pre-Diabetic and those whose doctors have told them, “You might be Pre-Diabetic” or “We’ll have to watch those blood sugars.” At that point they tell you to lose weight (knowing you’ll most likely fail on the dietary advice given (eat a calorie-restricted, low-fat diet and exercise your ass off) and before starting you on a regimen of pills leading, as your disease inevitably progresses on that diet, to injecting insulin).  
Realizing this, I was motivated to elaborate – unsolicited – on my previous reply. Later that evening I wrote to Bruce again, and that message, and his amazing reply to me (six weeks later), will be the subject of my next column. I can hardly wait to tell you! (Spoiler alert: Bruce’s weight loss continued, big time!)

Sunday, March 26, 2017

Type 2 Diabetes, a Dietary Disease #373: The “blame the patient” game

Let me be clear. I don’t really think your primary care doctor, who is perhaps an internist/cardiologist (like mine) or maybe a family care doctor, is being disingenuous when he or she writes in your file, “patient non-compliant.” They almost certainly, or for the most part, sincerely believe in the advice they have given you. They advised you how to lose weight (exercise a lot and eat a calorie-restricted balanced diet), specifically to eat a “healthy low-fat diet,” And when you failed to get the results they expected, they concluded it was because you didn’t follow their counsel. So, they deduce, you must have cheated. You were “non-compliant.”
Why do they expect this result, you ask? Because the Guidelines for Clinical Practice for each of the practice specialties, and the governing medical associations (the AMA, AHA, ADA, etc.), all told them to. That is the result of virtually all of the patient cohorts who were given this advice before you. So, the explanation – the reason – must be that it was the patient who failed to follow it…who was non-compliant. That’s also when the clinical guidelines tell them to start you on drugs to accomplish what you failed to do.
It never occurs to them that it could be the advice they gave you that failed to produce the outcome they (and you) desired. The advice to eat a low saturated fat, low cholesterol diet has now been in place for over half a century – since the time any doctor in practice today went to medical school. The advice was first popularized by the publicity given to the treatment of Eisenhower after his first heart attack in 1955. Before he died 14 years later, he was to have 7 myocardial infarctions, 14 cardiac arrests, and at least 1 stroke, but never mind….
The advice to eat a low saturated fat, low cholesterol diet was also strongly espoused by a University of Wisconsin physiologist, Ancel Keys. The bad science, publicized in his “Six Country Analysis” (1955), and later compounded in his “Seven Countries Study” (1958), has since been widely discredited, but never mind….
By January 1961, Keys was on the cover of then popular Time magazine and had been invited to join the Board of The American Heart Association. And to this day the AMA still espouses a low saturated fat, low cholesterol diet. The evidence that this advice is faulty – in fact, is the virtual opposite of the heart-healthy diet that you should be eating – has existed from “the beginning.” See this timeline, by Diet Heart Publishing.
The evidence supporting a healthy diet has now been well documented in the last decade in at least three thoroughly researched, landmark books: 1) Gary Taubes’s “Good-Calories, Bad-Calories”; Denise Minger’s, “The Big Fat Surprise”; and Gary Taubes’s new, “The Case Against Sugar.” There are many others, but these three are the best. They’re an easier read than the peer-reviewed scientific journals they’re based upon.
What got me going on this minor rant was this article in Medscape Medical News last month that described the efforts of scientists to “reprogram” alpha cells in the pancreas to regenerate new beta cells in mice. These are the cells that make insulin until they are destroyed by an autoimmune disorder, as in type 1 diabetes, or they just wear out from overuse due to Insulin Resistance in type 2 diabetes.
What set me off in this article was the suggestion that a similar advance (an “artificial pancreas”) “may enable tight glycemic control with minimal patient intervention” (my emphasis). Great news for type 1s, of course, but from my perspective (as a type 2) it just reinforces the notion that “minimal patient intervention” was the only course of treatment available for type 2s in the clinical setting since patients are “non-compliant” and fail to achieve the desired outcomes when they follow their doctor’s advice. THUS, THE PATIENT IS TO BLAME!
But what if you, the patient, took control of your diet and your metabolic health, and ate a healthy, low carb, moderate protein, high fat diet, including heart healthy saturated fat, without concern for dietary cholesterol? What if you did this and the outcome was a big weight loss and a lab report with an improved lipid panel?
 Or you could just follow the dietary advice given to President Eisenhower in 1955. Remember that outcome?

Sunday, March 19, 2017

Type 2 Diabetes, a Dietary Disease #372: My 10-week, 30-lb challenge, 5th wk Progress Report

I’ve changed the title of the Challenge from “2-month, 20-pound” to “10-Week, 30-Pound.” The primary reason is that it became clear I was going to over achieve my goal. This is the new mid-point report.
The second reason is that I have a doctor’s appointment coming up in Week 11, and I wanted to capture the best A1c and weight loss improvements possible. The challenges will be that, for a large part of the final 2½ weeks, the unique circumstances that gave rise to my beginning this gambit will change: 1) I will not be alone and preparing all my own meals, and 2) I will at times be “on the road” and eating most meals in restaurants.
That being said, the necessary adjustments will be good for me. They will allow me to transition to “real life” while at the same time being under the gun to preserve continue the gains. (See how easy it is to undercut one’s confidence and resolve?) Reference: for the Challenge, see #368, for the 1st week’s Progress Report, see #370, and for the 2nd week’s, see #371. Now, back to the 5th Week (new mid-point) Progress Report here:
Week 3: Having gained 1 pound in Week 2 (after losing 11 in Week 1), I was confident the “progress…was not really lost,” and “it [the progress] will show up on the scale this coming week.” Well, I lost 4 pounds in Week 3.
Better yet, my Fasting Blood Glucose (FGB) average also dropped again, from 88mg/dl (3.8mmol/L) to 86 (3.7). The actual readings were 81, 104, 90, 78, 84, 83 & 79. The 104 was a surprise. It came after a supper of veal kidneys cooked in onions and mushrooms with Marsala wine and a salad of Romaine lettuce, mushrooms, hazel nuts, shredded cheese and my homemade vinaigrette made with white wine vinegar. Go figure! Tonight I’m having the 2nd half of that kidney preparation, with the same salad, so we’ll see what happens.
Changes in Week 3: Going forward I’m going to cut my morning coffee from a 16oz mug to a 12oz mug. That should reduce the heavy cream from 2oz to 1½oz. I found that I had swallowed all my supplements with only half a cup and the 2nd half was an indulgence. The idea came to me after reading a blogger who was looking for people to join him in a 30-day coffee fast. I like coffee, but I am not addicted to it, and I don’t want to be.
Week 4: Well, it wasn’t the veal kidney and salad supper that gave me that anomalous 104mg/dl FBG (5.8mmol/L) last week. The same supper the 2nd time produced a FBG of 74mg/dl (4.1mmol/L) this morning. Conclusion: anomalies happen. Now, once again, the big news this week: My FBG average plummeted again, from 86mg/dl (4.8mmol/L) to 77 (4.3). I haven’t seen FBGs like this ever! True, on my own initiative, but with the concurrence of my doctor, about a year ago I increased my dose of Metformin from 500mg/day to 1,500. I had read somewhere that 1,500mg was considered a “therapeutic” dose. The inference I drew from that was that a dose of less than 1,500 was not therapeutic. And since I have been a diagnosed type 2 for 30 years, and on a reduced dose of 500mg for the last 15 since beginning VLC, it seemed appropriate to me that my medication should be therapeutic. But I think my doctor never suggested an increase because he thinks my diabetes is already “in good control.” I’m not blaming him. That’s the guidance he gets from the ADA, Medicare, etc. By the way, in Week 4 I lost 2 more pounds, bringing me to 16 total in the first 4 weeks.
Week 5: I’m settling into a groove. My weight dropped by another 2 pounds, bringing the 4 week total to 18. The big surprise this week is that my FBG continues to drop. This week I had 3 readings in the low 60s, and my FGB average this week dropped to 70 mg/dl (3.9 mmol/L). Recapping my FBG averages: 119 the week before starting, then 100, 88, 86, 77 and now 70. I hope they level off now. If not, I’ll cut my Metformin. My goal, though, is to lower my A1c, so I am willing to have some “low” readings so long as I feel I am in no danger of hypoglycemia. My sense is that my glucose levels are stable. I have some concern about the ones in the 60s, but I feel fine and am unaware of the “lows.” I have tested a few days in the late afternoon, when historically I have been lowest, and my readings have all been in the mid 70s. If my FBGs persist in the 60s, particularly after fasting days, I’ll test at bedtime, and if low, again during the night when my bladder calls.
Conclusion: I can’t believe that I have been so blind in my diabetes self-management for these last 15 years!

Sunday, March 12, 2017

Type 2 Diabetes, a Dietary Disease #371: My 2-Month, 20-lb Challenge, 2nd wk Progress Report

When you read this I will be 5 weeks into my “2-month, 20-pound challenge,” but I write it after 2 weeks “in.”  The first week I lost 11 pounds and lowered my FBG average by 19 points to 100mg/dl (5.6mmol/L). I did this by strictly following a program of eating 5 Low Carb meals prepared at home by me (2 or more at a time) and then fasting on Tuesdays and Thursdays. Note that in the first week I did not dine out once, as I had planned.
This week I report on week 2 of the challenge. Based on my FBGs this week, I have also revised the terms, to extend the duration from 8 weeks to 10½ weeks, to coincide with my next doctor’s appointment (4/18). My goal is to get the best A1c possible, lowering it from 5.8% to 5.5%, or better.  Note, however, that after 8½ weeks I will no longer be preparing my own meals, and my eating pattern will include more “dining out.”
Week 2 began uneventfully, with weight stable and FBGs in the mid-nineties. As the week progressed, my weight and fasting blood glucose (FBG) both dropped until I was down 3 pounds by Friday. I gained one back Saturday and 3 more by Sunday. So, my net for the week was up 1 pound; net for 2 weeks: down 10 pounds.
Saturday was the first day that I ate outside the home in almost 2 weeks, and I ate too much (2 meals – albeit “low-carb”), and I drank too much. I don’t regard the 1 lb. gain as much of a setback, though. The progress I made during the week was not really lost. I am confident that it will show up on the scale this coming week.
The big news, and the main reason I am reporting on this week, is what happened to my FBG (and presumably my serum insulin). My FBGs this week were: 94, 92, 95, 89, 81, 80 & 83. Average: 88mg/dl (4.9mmol/L). Recall that in the 1st week my average was 100mg/dl (5.6mmol/L) and in the week before I began the challenge it was 119mg/dl (6.6mmol/L). With FBGs like this week’s, and a stable blood sugar during the day, I think my A1c goal is reachable – if I continue to follow this Low Carb WOE…and with a little help from Metformin. We’ll see.
Other observations, comments and changes from the original “2 month, 20 pound” challenge:
     Cooking for myself has not been as onerous as I thought it would be. In fact, I’m enjoying it. In the weeks ahead I envision preparing all my meals at home. Since I always make enough for 2 days minimum, that means only making 2 or 3 meals a week, since I will be fasting 2 days (at least) every week.
     All day fasting is easy. The first week on the day after a fasting day I had a “snack” (1HB egg) or a “light lunch” (2 HB eggs). This week I did not. And I was not hungry on the fasting day or the day after.
     The quart of heavy cream lasted only 16-17 days. I use it only in coffee, so, alas, I put 2oz/day in my cup.
     I have a new Snack: a few “whole artichoke hearts in water,” and a Light Lunch: ½ can (60g) of “Sell’s Liver Pate.” Also, Bumble Bee is now packing the same wild caught Brisling Sardines as the King Oscar brand, in the same Baltic Sea factory, in EVOO (and Hot Jalapeno Peppers), and at a lower price point. 
     Virtually all my suppers are stove top. I love fish, especially cod and similar species. It’s usually the least costly “fresh” fish in the case, although it may have been thawed by the fishmonger after having been flash-frozen at sea. I’m going to check out frozen cod next time I see it. I’m fussy about country of origin.
     My veal supplier has given up, so I need to find a new source for my veal stew and veal kidney recipes.
     I loved the tripe dish I made last weekend. The smallest frozen honeycomb tripe package in the butcher’s case was 2 pounds, so I made it and had it 4 days in a row. I don’t mind eating the same thing multiple days in a row; in fact, if I like a dish I made, I look forward to having it again. (I can’t believe Jason Fung in his “Fructose 3” blog post this week said he couldn’t imagine someone eating tripe 2 days in a row. Jeez!)
The next report will catch up with the lag in reporting; it will be at mid-point (5 weeks into) my new, extended duration. Then, the last report (at 10½ weeks) will have a final weigh-in, and hopefully an A1c and lipid panel. My doctor is very good at reviewing the lab report and mailing it to me as soon as his office receives them.