Sunday, August 13, 2017

Type 2 Diabetes, a Dietary Disease #393, My 2nd 30-lb Challenge (Amended): Final Report

Followers may recall that a few months back, in my 1st 30-lb Challenge, I lost 31 pounds in 10 weeks. They may also remember that I then embarked on a 2nd 30-pound challenge, this one of 16-weeks duration. After 12 weeks, I reported a less than stellar performance and amended the 16-week goal from 30 to 15 pounds. This is the 4thQ/Final report on the amended goal. I started the 4th quarter at 215 lbs. The goal is to return to 202 in 4 weeks, then 197 two weeks later. That’ll be over 50 pounds lost with full-day “fasting.”
Week 13: Attended Keto Fest, a festival in New London, CT, organized by 2 Keto Dudes. It was educational and fun, and I ate too much: Eggs/bacon breakfasts (in a hotel), ketogenic lunches (at the festival) and half-priced cherrystones and white wine (dinner on my own), but too much food/wine. I gained 5 pounds. FBG aver: 103!
Week 14: Fasting Mon-Wed-Fri. I dropped 10 pounds from 220 to 210. Amazing! Including an amazing buffet lunch at the Otesaga Hotel in Cooperstown before seeing “Porgy and Bess.” And I cheated a little each fasting day, but only with a protein/fat snack (bought at Keto Fest) with my happy hour spritzer. FBG aver: 99mg/dl.
Week 15: Fasting Mon-Wed-Thurs this week. Tuesday we’ll again have lunch at the Otesaga Hotel before seeing “Oklahoma” at Glimmerglass, and then a light “all protein” supper at home. All went well ‘till Saturday, the annual neighborhood association picnic. I had just one plate of protein and fat, plus 3 cups of my keto clam chowder, and 3 cups of white wine. Virtually no carbs (except in the wine) and no dessert! Alas, I gained 2 pounds for a net 4 pound loss for the week. Next morning: FBS up 29 points. FBG weekly average: 86mg/dl.
Week 16: Need to lose 4-6 pounds this week to reach my target. Glimmerglass (“Xerxes”) on Tuesday, so I will try “IF” Mon+Wed-Thu and maybe Fri. I have a gallon of leftover keto clam chowder: ergo, I will do a modified OMAD (one ‘mug’ a day) fast this week: for ‘supper’ I’ll substitute 12oz of chowder, plus iced tea, for my usual spritzer (6oz red wine + 8oz seltzer): fewer carbs, more fat, no wine. By week’s end I had lost 3 pounds, down to 203 (1 shy of my target). 26 week total: 45 pounds. FBG average this week: 90mg/dl.
Conclusion
Multiple, consecutive day “fasting” is easy, if you’re “fat adapted.” No hunger. Never was any at “breakfast.” Just coffee with cream. No hunger at “lunchtime.” I usually forget about it if I’m busy in the yard, etc. Supper has proved to be a little harder. In recent years I “snacked” before supper. (I say “supper” to suggest a smaller meal than “dinner.”) It’s usually been solid food, recently plain celery; before that radishes with salt and sometimes butter). Since beginning full-day “fasting,” I have substituted a red wine spritzer (6oz wine + 8oz seltzer) for solid food, to wash down my evening pills. In week 16, for 3 days I replaced the spritzer with iced tea, to save 150 calories while I used up leftover, calorie-rich keto chowder. It worked out okay. No cooking.
Other Related Thoughts
The brain is so facile at rationalizing. I have quickly come to accept that losing less than half the weight I wanted to lose in my 2nd 30-lb Challenge was still a good outcome. After all, a pound-a-week-loss really is respectable. Many healthcare professionals would even describe it as commendable. But I consider it a big disappointment. Not exactly a failure, but then I have high expectations for myself (and others, my wife says).
Going Forward
I have, however, gained another insight from this less-than-desired outcome. I have reasoned that to maintain each weight loss, the challenge must continue. And the best way to do that is to continue to set goals – albeit incrementally smaller goals – in successive weight loss campaigns. There are just two variables: elapsed time and weight. Time was the variable in the two original plans: 30 pounds in 10 weeks and then 30 pounds in 16 weeks. When I faltered in the 2nd plan, I cut the goal to 15 pounds in 16 weeks. Going forward, beyond this 16-week challenge, with 15 more pounds to lose, I will propose to lose 5 pounds in the 1st 2 weeks. And then, the “final” 10 in the last 6. Or something like that. We’ll see how it goes. And then? Another challenge?  Of course.

Sunday, August 6, 2017

Type 2 Diabetes, a Dietary Disease #392: “Broccoli May Help Fight Diabetes”

When I read this headline in Medscape Medical News, in a write-up by an MD, of a real research project, my hopes soared. I thought, doctors were adopting the precept that Hippocrates, “Father of Western Medicine,” had made famous: “Let food be thy medicine and medicine be thy food.” Finally, we had come full circle!
The full title of the Medscape précis of the study, which was published in Science Translational Medicine, was “Antioxidant in Broccoli May Help Fight Diabetes.” Nevertheless, I still believed that these medical doctors – the study authors and the Medscape writer – were advocating that we eat a diet of healthy, whole foods. And that there was a dietary fix for those among us who had already developed a lesser or greater degree of Carbohydrate Intolerance, i.e., were overweight, obese, or had been diagnosed pre-diabetic or type 2 diabetic.
And the first sentence of the Medscape piece did not disabuse me of this vision on the horizon – a mirage or hallucination it turns out. It described the antioxidant as “a new option for treating type 2 diabetes.” The second sentence went on to describe the mechanism that the antioxident used, that it “reduces exaggerated glucose production by the liver in type 2 diabetes,” in much the same way that Metformin does.
Unfortunately, in the sixth paragraph, the full story – and the sad truth – emerged: “The study used highly concentrated broccoli extract, which would be equivalent to eating about 5kg [11 pounds!] of broccoli per day.” “Because it’s almost impossible to eat such large amounts of broccoli [diya think?], [the antioxidant] needs to be taken as an extract or concentrate.” Okay. Now, where does this revelation take us?
“We think broccoli extract could be a very exciting addition to treatments that we already have,” the lead researcher said. “When we gave it to patients and measured their glucose control before and 12 weeks after treatment, we saw significant improvement in fasting blood glucose and HbA1c in obese patients with dysregulated type 2 diabetes,” he averred. The results were ‘very encouraging,’ he added.
So, where does this well designed research in basic science lead? Medscape explained: “Currently, they [the researchers] are working with a farmer-owned organization in Sweden…to make the extract available as a functional food preparation.” Aha! A collaboration: Basic Science → Applied Science + Farmer → $$$$ for all.
Diya think I am being cynical? Just read the accompanying Conflict of Interest Disclosure:
“The study was sponsored by Lund University. Lantmännen [the local farmer-owned organization] provided the broccoli extract and placebo for the study, and Lantmännen Research Fund financed part of the study. Lantmännen reports no influence on the study procedures, data analysis, or data interpretation. Rosengren [the lead researcher] had no relevant financial relationships. Two coauthors are inventors on patent applications submitted by Lund University that cover the use of sulforaphane [the antioxidant] to treat exaggerated hepatic glucose production. The rights to use this patent have been licensed to Lantmännen.”
Okay. I wasted my time reading this piece of garbage from the usually reliable Medscape Medical News. But it is medical business news in the sense that universities, even the best of them like Lund, are not above pecuniary interests. They need “research funds” to survive and prosper, just as “local farmer-owned organizations” need money. But this story is not about eating in a healthy way to avoid developing Insulin Resistance (Carbohydrate Intolerance) or even to treat “obese patients with dysregulated type 2 diabetes.”
But, I got to write another curmudgeonly piece to offset my usual lecture about eating Very Low Carb (VLC), losing weight without hunger, and lowering your blood glucose AND blood insulin levels. That’s a saving grace.
So, have doctors come full circle with respect to eating real food? Not in my lifetime, a friend quipped.

Sunday, July 30, 2017

Type 2 Diabetes, a Dietary Disease #391: The U. S. Dietary Guidelines: “11 Points for Change”

A couple of weeks ago, while cross-fertilizing with attendees at the 2 Keto Dudes’ 1st Annual Keto Fest in New London, CT, I learned about the Nutrition Coalition. Their principal objective is to affect these “11 Points for Change” in the Dietary Guidelines (DGAs). They urge people to sign an on-line petition they’ve created. I took a look at it and did so immediately. They are so right-on, on every point, that they deserve all our support.
My first reaction to the idea was to be cynical. I was skeptical that such an effort would be effective. On reading the manifesto, however, I realized that it was so cogent and so comprehensive that it perfectly embodies and presents the reforms that are needed. It represents the “yang” to the “ying” – in the opposing rather than the complementary sense – of the present Guidelines. Hacked from their site, I list below their “11 Points for Change”: If you agree, PLEASE consider adding your name to their petition. At least you’ll feel good.
1.      Undertake a communications campaign to let Americans know that the low-fat diet is no longer recommended
2.      Ease or lift caps on saturated fats
3.      Offer low-carbohydrate diets as a viable option for fighting chronic disease
4.      Offer a meaningful diversity of diets
5.      Make the DGA diets nutritionally sufficient, with nutrients coming from whole foods
6.      Stop recommending aerobic exercise for weight loss
7.      Stop recommending “lower is better” on salt
8.      Stop telling the public that reaching and maintaining a healthy weight can be accomplished by choosing “an appropriate calorie level”
9.      Stop recommending vegetable oils for health
10.  Recommend regular meat and milk rather than the low-fat/lean alternatives
11.  Don’t issue population-wide guidelines based on weak data
Each of the Coalition’s “Points” is supported by explanatory sentences and is linked to a reference.
How about that! Isn’t that exciting? This plain language “manifesto” encapsulates a fix for everything that is wrong with the dietary advice that we as a nation have been given since the “experts” 40 years ago provided supporting testimony to the politicians at the 1977 Senate Select Committee on Nutrition and Human Needs. That lay committee then produced the “Dietary Goals for the United States,” aka the McGovern Report. The USDA institutionalized these “goals” in the Dietary Guidelines that they have promulgated every 5 years since.
As the Nutrition Coalition points out, these U. S. Guidelines “are the single-most important determinant for how people eat.” They say, “Our Guidelines determine” 1) Federal food programs, 2) Nutritional advice, 3) Military rations (MREs), 4) Packaged foods, 5) K-12 nutrition education, and 6) non-packaged foods.” Their hyperlinked text supports with more detail each of these aspects of Federal food policy. It is far reaching.
The cross fertilization occurred when I was talking to the father of an adult type 2 diabetic, who was just then talking to Richard Feinman, PhD, a conference speaker and nutrition icon. They were discussing a scientific paper from January 2015, popularly titled “12 Points of Evidence,” that Dr. Feinman had published in Nutrition. Directed at medical doctors, the full title is, “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.” As Gary Taubes implied in the Afterward to his paperback edition of Good Calories - Bad Calories, he was disappointed by the medical community’s response to his “Carbohydrate Hypothesis.” As a cynic, I am more inclined to accept Max Planck’s dictum, “Truth never triumphs. Its opponents just die out.” But I did sign the petition, and I encourage you to take action. 

Sunday, July 23, 2017

Type 2 Diabetes, a Dietary Disease #390: My 2nd and Last 30-pound Challenge: 3rd Qtr. Report

The half time report (#385) on my 2nd and last 30-pound weight-loss challenge was a roller coaster of misadventures, but the trend line continued in the right direction, i.e. down, albeit slightly. So, “the challenge continues.” In the beginning I didn’t know how my body would react to full-day fasting. I feared that 1) I would be hungry and 2) my energy level would plummet. I learned that full-day fasting (300kcal/d) is easy because I am keto-adapted and never hungry. And as my energy level has not wavered, my comfort level has increased.
I began with an alternate day routine (Tuesdays and Thursdays, every week) and had good results: weight loss with no hunger and high energy levels. The reason, and I must emphasize this, is that on non-fasting days I adhered (for the most part) to a Very Low Carb (VLC) Way of Eating. I have been doing this since 2002, so I was already adapted to the VLC concept and my food choices. As a result of this increased comfort level, the frequency with which I did full-day, 300kcal fasting also increased.
Although I lost weight easily, when once I fell behind my weekly weight-loss goal, in order to catch up I decided to kick it up a notch. I went to 3-consecutive-day fasting (Tue-Wed-Thu) and it worked! Still no hunger and high energy levels! At the end of the 10-week challenge, I had lost 31 pounds. To stave off regain, I decided to extend my 3 consecutive-full-day, 300kcal/d fasting routine for another 16 weeks, this time to lose another (final) 30 pounds and reach my mid-teen weight. Why mess with success?
Week 9: As reported in #385, the first half of this 2nd and last 30-pound challenge was far from a resounding success. I lost only 2 pounds of the planned 15, but the 8 pound gain in the final 3 days was fleeting. So, thinking optimistically, I was starting the last 8 weeks only 5 pounds in the hole.  And I was now committed to 3-day fasting every week, on consecutive days wherever my schedule permitted. This week it was Mon-Tue and then Thursday. By Wed morning I had lost 7 of the 8 pounds gained in Week 8. But…our social calendar included potluck buffets at gatherings with friends on both Wednesday and Friday, and I ate a small supper Thursday instead of fasting, so I gained 5 back and for the week only lost 2. FBG was also bad: 97mg/dl.
Week 10: Fasting this week Mon-Tue-Wed. Dropped 6 pounds, in spite of a little cheating every day! Had a small lunch Thu (kippered herring from a can) and a big supper (beef short ribs and a very large salad); gained back 1 pound. Fri had the same kippered herring lunch and a similar supper (lamb chops and a large salad); remained at 5 pounds down for the week. On Sat we had dinner out with friends before a concert. I had two low carb appetizers and one cocktail. At Sun weigh-in I was still down 6 pounds for the week. FBG aver: 95.
Week 11: I’m starting the week at 206 and will do another 3-day fast (300kcal/day), Mon-Tues-Thurs. (Lunch at the CIA Wed.) The goal this week is to blast through 205 pounds, the lowest weight I ever achieved on VLC (in 2008 while doing Bernstein). It’s also my weight at the end of basic training in the army in 1960. On Friday I left for a weekend family reunion in Rochester. That was a challenge. I brought with me 100 clams and a case of Michelob Ultras. Before leaving, I weighed in at 202 (FGB: 82), down 4 pounds. Upon my return I weighed in at 213 (FBG: 119). I gained 11 pounds in 3 days. That’s more than the weight of all the food I ate!
Week 12: Another challenging week: My wife’s surgery, hotel and hospital meals, and cooking for my invalid. Gained 2 more pounds to 215, 13 pounds above the 202 low just 9 days earlier! And my FBG average jumped to 107, with more challenges to come in the next week with 5 days/nights away from home. Time for a pause.
Discussion: A plan revision is in order. My new goal is to eat VLC for Week 13, then resume 3-consecutive-day fasting for the succeeding 3 weeks. Starting at 215, my goal is to get to 205 by end of Week 16, then to 203 by the next Tuesday (Dr’s appt.). That’s just half the 30 pound loss I targeted, so again, “the challenge continues.”

Monday, July 17, 2017

Type 2 Diabetes, a Dietary Disease #389: Don’t go to THIS* hospital…

The draft title of this post was, “Don’t go to THIS* hospital for outpatient Type 2 diabetes care,” but space didn’t permit. The warning, however, stands. It will only cause you harm, and as Hippocrates said, “First, do no harm." Beware, therefore, of the clutches of THIS hospital's outpatient department.
I discovered this while visiting my wife as she was recovering from successful back surgery (yeah!). I decided to check out the cafeteria and along the way saw signs for the Diabetes Care Center and decided to visit. The waiting room and reception station were empty, so I just gathered up all the free literature I could find.
There were four types available: 1) 2 3-fold 8½ x 11 glossy sheets promoting the hospital’s Diabetes Care Center, 2) 2 8½ by 11, 3-page, 2-sided color pages about “Healthy Eating” and food “Tips for People with Diabetes,” “brought to you by the AADE (American Association of Diabetes Educators), and “supported by an educational grant from Eli Lilly and Company,” a big pharma company that makes insulin, 3) 2 different 5 x 7 glossy magazines filled with diabetes drug advertisements, and 4) an educational flyer about injecting insulin.
Suffice it to say, the theme that dominated the “individualized” diabetes education program was drugs, specifically “initiation of insulin, instruction on blood sugar monitoring, insulin pump therapy, continuous glucose monitoring sensors, medical nutrition therapy and follow-up education.” But, those “individualized” therapies were the domain of the doctors and RNs. I was interested in seeing their advice for pre-diabetics.
One of the two hospital brochures addressed that. It said, “Dieticians who are Certified Diabetes Educators Serve as Resources,” both for “medical providers” [doctors and RNs] and for “participants” [diabetes patients]. For the diabetes educators’ advice I turned to the 3-page Xeroxed handouts on “Healthy Eating” and “Summer Fun and Food Tips for People with Diabetes.” And therein lies what I am warning you to avoid, like the plague.
Essentially, the American Association of Diabetes Educators (AADE), the organization comprised of CDEs (Certified Diabetes Educators), espouses the same one-size-fits-all diet for pre-diabetics and diabetics (both type 1s and type 2s) that the Dietary Guidelines for Americans (2015) prescribe for everyone else in the U. S. over 2 years old: that is, “the plate method,” or in the “Summer Fun” version, “the paper plate plan”:
·          "Fill ½ the plate with non-starchy vegetables (such as greens, green beans, broccoli, cabbage)
·         ¼ should contain meat or other protein (fish, eggs, low-fat cheese, cottage cheese, beans or legumes)
·         ¼ contains starch (such as a potato or whole grain bread)
·         On the side, include an 8 ounce glass of low-fat milk or a small piece of fruit."
Also, you are reminded that a “healthy meal plan” should include “a limited amount of heart-healthy fats.” Examples given are oils and nuts, all high in unsaturated fats. Meats should be “lean” and cheeses “low-fat.” In other words, avoid as much as possible, red meat, saturated fats and dietary cholesterol. Straight from the “Guidelines.”
Your plate in this “healthy meal plan” is thus ¾'s carbohydrates. Doesn’t the AADE and their CDEs know that Type 2 diabetes is a dietary disease?!!! Apparently they do because elsewhere they want you to “count carbohydrates,” lose weight and exercise. But how are you going to do this on THIS meal plan, plus eating “small snacks between meals…to help keep your body going”? Answer: the hospital outpatient department will help you with 1) “emotional support,” 2) “empowerment,” and 3) “tools for self-care” (“education” and a meter). They will also supply you with oral medications (as needed, up to max dose in 3 different classes), then “initiation of insulin” [injections], insulin pump therapy, continuous glucose monitoring sensors, and eventually – and here’s an area where THIS hospital excels – they’ll help you with bariatric surgery.
* THIS hospital shall be nameless because this outpatient department for Type 2 Diabetes care is neither worse nor better than all the other hospital outpatient departments that deliver the establishment message about “Healthy Eating”. Here’s a clue though. A display in the main corridor proudly proclaims it is ranked among the best in the country for “Bariatric Surgery, Women’s Health and Heart Care.” Telling, isn’t it. Once they get you – the pre-diabetic or type 2 diabetic – in their clutches, you are destined to “progress” along this course: Your glucose disregulation will continue to deteriorate and your heart disease risk will continue to rise. Your Type 2 Diabetes will ipso facto be progressive on THIS “healthy meal plan.” Solution:  Just don’t go there? Don't be a "participant." This is sick care, not health care.

Sunday, July 9, 2017

Type 2 Diabetes, a Dietary Disease #388: “A Piece of Cake!”

Jason Fung’s recent post, “Towards a Cure©” must have garnered a lot of hits. Dr. Fung is a Toronto-based nephrologist with a busy clinical practice. In addition, his office operates in parallel an on-site and on-line clinic, Intensive Dietary Management (IDM), headed by Megan Ramos. Besides this, Dr. Fung blogs weekly under the aegis of the Institute of Kidney Life Science. He’s a busy guy. He is also a thinker whose hypotheses about the etiology and pathophysiology of type 2 diabetes are shaking things up a bit. It’s pretty exciting stuff.
In “Towards a Cure,” after a brief review of his hypothesis, he gets right to the point with these excerpts:
“The treatments that are known to lead to a cure – fasting, bariatric surgery and low carbohydrate diets – all share one feature in common. They are all treatments that lower insulin. Here’s comes the sudden, horrifying realization. The treatments we have been using for type 2 diabetes were EXACTLY wrong. Too much insulin causes this disease. Giving insulin or drugs that raise insulin will not make the disease better. It will only make it worse!
“This is precisely what happened. Type 2 diabetic patients are generally started on one medication at diagnosis. This only treats the symptoms, so over time the disease gets worse, and the dose is increased. Once the maximum dose is reached, a second, then a third drug is added. After that, insulin is prescribed in ever increasing doses in a desperate bid to control the blood sugar. But, if you require higher and higher doses of medications, your diabetes is not getter better, it is getting worse. The treatment was exactly wrong.
“In type 2 diabetes insulin levels are high, not low. Injecting more insulin is not going to help treat it. Yes, in the short-term, the symptom of high blood sugar is better, but the disease, the diabetes, was continually getting worse. How did we expect that giving more insulin to a patient with too much already would help? Our standard accepted treatments were precisely how NOT to treat type 2 diabetes.”
Of the 3 three treatments that “are known to lead to a cure,” bariatric surgery, which he is NOT advocating, is fraught with unnecessary risk. The other two, fasting (for which he is a strong proponent), and low or very low carbohydrate diets, are not risky…and they are patient controlled. You are in charge. You decide what to eat.
Jason Fung doesn’t have an editor (or a proof reader, apparently).  His posts frequently have typos. As my editor counseled me years ago, let a post percolate for a day and then edit it, and then edit it again the next day and the next. Jason Fung doesn’t have the luxury of time to do that. And neither does he have the benefit of an outside editor. For example, I would have counseled him to edit the penultimate sentence of the first paragraph above to read, “Giving insulin or eating foods that raise insulin will not make the disease better.”
I’m not nit-picking or carping really. Jason Fung is the most refreshing voice out there at the moment. And I think he has the best of all worlds. I’m jealous. He has his nephrology practice. He has a broad-reaching clinic focused on weight management and metabolic syndrome, including insulin resistance, pre-diabetes and type 2 diabetes. And he has his Institute in which, as a 1-man think tank he morphs into a research PI (Principal Investigator) each week. What fun! I think his blog title this week, “Towards a Cure,” is less a hook to garner internet hits than a reflection of his own excitement that he may just be on to something.
Maybe his weekly exercise in researching and writing is a ritual that is getting him closer to understanding why “(o)ver 50% of American adults are estimated to have prediabetes or diabetes,” as the lede of this week’s column states. Maybe as more people incorporate low carb or very low carb eating, and fasting, either intermittent or all-day fasting and very low carb eating as I do, it will also enable others to lose weight easily and without hunger, and greatly improve their general health too, as I have. Just maybe…
But that’s up to you. You are in charge of what and when you eat. You decide if you want to try it. I’ll tell you this much: Full-day fasting is easy, when you are KETO-ADAPTED. No hunger. Easy weight loss. “Piece of cake!”

Thursday, June 29, 2017

Type 2 Diabetes, a Dietary Disease #387: 15 Years on a VLC Diet

In August 2002 my doctor asked me to go to a website I’d never heard of, study a diet plan described there, and then start the diet when he returned from vacation two weeks later. He wanted to monitor me closely.
The impetus for his interest in this website was the cover story of the July 7, 2002, New York Times Sunday Magazine that he had read a month before, “What If It's All Been a Big Fat Lie?” by Gary Taubes. The cover photo was of a ribeye steak with a big pat of butter on top. He had tried the diet himself…and it worked.
The website was Atkins and the diet was the startup phase called “Atkins Induction” in which the dieter goes “cold turkey” from eating the Standard American or Western Diet to consuming just 20 grams of carbs a day. That’s very low. Today anything below 50g/d is described as Very Low Carb and up to 100 as Low Carb.
Very Low Carb (VLC) is similar to the Very Low Carb Ketogenic Diet (VLCKD) and also to the Low-Carb, High-Fat (LCHF) diet. LCHF stresses quality saturated and monounsaturated fats. All eschew vegetable and seed oils.
Followers will differ in their precise definitions, but most agree that they are all characterized by being LOW carb, MODERATE protein and HIGH fat. The high fat part is still the most controversial and easily the hardest for neophytes to accept. Despite being a hard sell, high fat is an important part of the plan.
We have been told for more than half a century that consuming fat, especially saturated fat with cholesterol, is a risk factor for heart disease. That guidance was not supported by good science and today is increasingly coming under review and criticism by a growing number of reputable sources. But the AHA, the Standards of Practice of the medical specialties, the government Dictocrats who influence payments by Medicare/Medicaid and private health insurers, and most practicing physicians are still wary and way, way behind the curve, as is the mass media. So, in this context patients generally do what their doctor tells them to do. I did.
And who can blame them? I just got lucky. My doctor had been trying to get me to lose weight for years. I saw his staff nutritionist and tried to follow the low-fat (high-carb!), “BALANCED” diet she prescribed for me. It didn’t work. Whenever I lost weight, my metabolism slowed, I was hungry, and I re-gained. And I felt like crap. My body told me to eat for energy balance. It didn’t like to starve. I didn’t like it either. So I failed, repeatedly.
What was different about this diet (Very Low Carb: 20 grams a day)? I wasn’t hungry. I didn’t crave food. My body was in energy balance and didn’t slow down because, when it needed energy, it switched from the food I ate to the food it had stored. It could do this because the food I ate was VERY LOW CARB. This meant that after the level of glucose (from carbs) in my blood dropped, the level of INSULIN in my blood also dropped. The insulin wasn’t needed to transport glucose to my cells. So, seeing lower blood insulin, the brain got the signal to switch from using glucose for energy to burning body fat for energy.
The key to weight loss w/o hunger: low carb → lower glucose → lower insulin→ access to body fat for energy.
Everybody’s level-of-carb threshold is going to be different. Among other things, it depends on the level of Insulin Resistance (IR) you have developed over a lifetime of eating 60% carbohydrates the way we have been told to do since 1977. That’s 300 grams of carbohydrates a day on a 2,000 kcal diet and 375 grams on a 2,500 kcal diet (for men). So, everyone who eats just 20 grams of carbohydrates a day will lose weight easily and without hunger. In the first 9 months I lost 60 pounds, and kept it off. It was life changing. Life saving, I think.
This is not an endorsement of Atkins, especially since it has changed so much since I did it 15 years ago. I later moved on to Bernstein (30g carbs/day) and lost 110 more. Today I am still 170 lbs. lighter than I was in 2002.