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 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.

Sunday, June 25, 2017

Type 2 Diabetes, a Dietary Disease #386: Max Planck was right…

Max Planck was right when he said, “Truth never triumphs – its opponents just die out.” Planck (1858-1947) was the originator of quantum mechanics and winner of the Nobel Prize in Physics in 1918. A longer version at Wikiquotes is, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”

If you sense my frustration, you’re right. It is discouraging, at times, to realize that the message that food is the best medicine is lost on people who have spent a lifetime writing prescriptions. Medical doctors should be the first to acknowledge this. It was, after all, Hippocrates (460BC-370BC), the “Father of Western Medicine” and author of the Hippocratic Oath that many physicians take when graduating from medical school, who said, “Let food be thy medicine and medicine be thy food.” Yet, they have forgotten. It is very sad indeed.

Examples abound. I recently tried to share the English and Spanish language versions of a 16-page booklet I have written on “Type 2 Diabetes, a Dietary Disease” with the professional staff of a local network of clinics that proclaims “Everyone Welcome” and “Bienvenidos Todos.” The network administrator wouldn’t even give me the courtesy of an appointment. When I sent her the e-file text of both brochures, she said they only “use educational material that is peer-reviewed or has an .edu or .org tag.” When I said I would be happy if only the staff read it (not the patient population), she didn’t reply. I had been stonewalled by the establishment.

In conversation with two women at a party recently, one woman told the other, who is an MD and former head of a large hospital, that her husband had an appointment to be evaluated for cognitive impairment. I know personally and have written about Dr. Mary Newport's experience with exogenous ketones for her husband, and I had just read Amy Berger’s “The Alzheimer's Antidote.” So I suggested that a ketogenic diet has been strongly associated with a delayed onset and even improvements in cognitive function. My doctor friend scoffed at “my” idea and dismissed the suggestion. She said “KETOSIS” was dangerous and to be avoided

I replied, quoting Dr. Richard Veech, the go-to expert on ketones at the National Institutes of Health, that ketosis is the “normal state of man.” We are either in a fed state or a fasting state. When fasting, after the body uses up its hepatic stored glycogen and amino acids, it breaks down body fat to make fatty acids and ketone bodies. I told my doctor friend she was confusing KETOSIS with KETOACIDOSIS. In the former, the level of ketones is 0.5-3mmol/L, a normal, healthy state, whereas in the latter it is >30mmol/L and life threatening.

I said I would not go on and the doctor quipped, “Do you promise?” I walked away and stood at a window for a long time looking at a long row of hostas under mature oaks. I could have told this so out-of-touch doctor how John Hopkins has been using the ketogenic diet to treat intractable childhood epilepsy since 1921 with marked success. Google it: ketogenic diet/Johns Hopkins. It’s NOT dangerous to be in ketosis. It’s normal.

But the other woman said her husband “wouldn’t change his diet anyway.” I guess he’d rather be a vegetable.

Later the doctor came over to me to apologize “for being rude.” I accepted but was still piping hot. I told her she was pig-headed and out-of-touch with recent developments in nutrition and health. Retired doctors apparently still carry a lot of authority, but they can only hurt the ones they love. Those that maintain their licenses without keeping up with continuing education courses in their specialties are doing a disservice to the ones they still serve. That is, until, as Max Planck said, “a new generation grows up that is familiar with” the latest developments in medical science. That includes recognizing that Hippocrates’ 2,500-year-old sage advice, to “Let food be thy medicine and medicine be thy food,” was right on! Some of us are coming to see that now. But for the aging population of physicians and their friends, it may be too late. Too bad, really.

Sunday, June 18, 2017

Type 2 Diabetes, a Dietary Disease #385: My 2nd (and Last) 30-lb Challenge: Half-time Report

This is my 2nd 30-lb Challenge since I started to experiment with full-day fasting after the Super Bowl. This one did not start off well. In the first four weeks, where my goal was to lose 7 pounds, I lost only 1. This period was plagued by a succession of missteps and generally reflected a lack of focus. I just got off to a bad start and never got my head straight. I knew I could do better. So, to jumpstart the 2nd Quarter, I did a 3-day fast. 
Week 5: It was a rough start. We had company Monday night, and I made a delicious dinner…and besides a big drink and 2nds of my roast pork, I had dessert: Gained 2 pounds. FBG Tuesday: 108. That was followed by a 3-consecutive day fast in which I lost 8 pounds. I worked 4 to 6 hours in the garden in scorching heat on all 3 days, drank pickle brine and ice tea to keep hydrated, and felt great. In fact, I mentioned to my wife on the 3rd day that I felt really pumped! Ate 2 meals Friday and gained 2 pounds back (probably water), but all my FBGs this week besides Tuesday were 70s and 80s. My 7-day average was 85mg/dl (4.7mmol/L), and I lost 4 pounds.
Week 6: I started the week still 4 pounds behind plan, and because we have theatre in NYC on Tuesday, I’ll fast (300 kcal/day) just Wednesday-Thursday this week, from Tuesday supper to Friday lunch. That’s a good thing about full-day fasting. You can mix and match, including alternate day or consecutive day. That didn’t occur to me before I started in February, but I discovered it makes no difference when you’re keto-adapted. Result: FBG average 82mg/dl – mostly 70s and 80s with 1 low 90s from a cheat at a pre-theatre restaurant. But, I gained 3 pounds for the week – 4 in the last 2 days. Either my body is resisting its weight loss, or I’m eating too many calories on my “feasting” days. Honestly, I think it’s mostly the latter. So, I resolve to try to eat less.
Week 7: Now, starting the week 9 pounds behind plan and with theatre in NYC 2 times this week, I need to tweak my fasting plan again. Fundamentally, I am never hungry, so when I eat – either too much at supper or to snack before supper – it’s not from hunger. I need to recognize that and act accordingly. That’s my plan. Well…as they say about war, “No battle plan survives contact with the enemy.” On Tuesday I had a 3-course dinner before the theatre. The cheese course, for desert, had more calories and carbs (in accompaniments) than the appetizer and entrĂ©e together. By next morning both my FBG and weight had risen. Thursday’s pre-theatre supper wasn’t much better. But, because I fasted M-W-F this week, I lost 4 pounds and my weight was down to 211. So, I gained 2 on my 9 pound deficit but, 7 weeks in, I am still 7 lbs behind plan. FBG aver. = 91.
Week 8: Halftime is looming and I need a 2nd consecutive week of losses to be in the best position to catch up in the 2nd half and achieve my 2nd 30-pound challenge and reach my teenage weight of 187 pounds. There are few confounding factors this week. I know I can do it. This week I plan to fast M-T-W. Net result: DISASTER! I lost 5 pounds in the 3-consecutive day fast (and accomplished lots in the garden); then, naively ate pasta and 1/3 of my wife’s desert in a restaurant on Thursday, and snacked without discipline at receptions after an art gallery opening and a harpsichord concert on Saturday. Outcome: a shameful and embarrassing gain of 8 pounds in 3 days. FBG aver. = 99. It’s a head shaking setback, but it is what it is. And fasting isn’t the problem.
Conclusion: Halfway into my 2nd 16-week, 30 pound challenge (34 actually, since I started it after a 4-pound gain), I am only 2 pounds (6 actually) down, 13 behind plan. This looks insurmountable BUT, the last 8 is water. So, if I think of it that way, I have only a 5 pound deficit to overcome in the next (final) 8 weeks. That’s doable.
Discussion: Currently, I think I prefer a 3-day, weekday (Mon-Tue-Wed or Tue-Wed-Thu), 300kcal/day, fast. I think my wife does too. She is spared the trouble of cooking for me, and she can prepare foods that she prefers to eat. One night last week she had a micro-waved baked half of a potato, stuffed with butter, sour cream and shredded cheese. In any case she has accepted my full-day fasting. Perhaps it is because, for all my misadventures, she knows that I am losing weight and my blood sugar regulation and other health markers have improved greatly. Or maybe she just misses baked, stuffed potatoes. Anyway, the challenge continues.

Sunday, June 11, 2017

Type 2 Diabetes, a Dietary Disease #384: The Problem with N = 1 (Spoiler: I’m keto-adapted)

Everyone agrees that achieving weight loss is a multi-factorial endeavor. Among the obstacles are cultural issues (e.g., certain staple foods); longstanding habits (e.g., eating 3 meals a day); food preference (e.g., sweet and/or starchy foods and processed foods made to “taste good”); and budget (low-nutrition carbs cost less than high-nutrient foods like protein and fat). But the biggest obstacle to weight loss is a broken metabolism. People who eat the Standard American or Western diet, described below, do it because they are hungry.
Hunger is the primary driver when you eat mostly carbs. But eating mostly carbs is an acquired habit. It’s been abetted by a decades-long campaign of government advocacy, suborned by the influence of Big Agriculture,  advertising and media hype. Should you “eat a big, healthy breakfast to start your day” even if you’re not hungry? Should you eat another meal 4 or 5 hours later, during the “lunch hour,” if you’re still not hungry? The problem is, if you do eat mostly carbs, as above, you will be hungry. In fact, you might even have to sneak in a mid-morning snack because you’re feeling a lack of energy. And the sad truth is: you will be lacking energy!
Why, because you’re eating mostly carbohydrates. Carbohydrates, especially simple sugars, and all fruits, and especially heavily processed carbs in packaged foods like cereals, begin to digest as soon as they are in contact with your mouth. Your blood sugar level peaks within an hour or two and then it crashes. And if you’re just a little insulin resistant, because you’ve been eating VERY high carb for decades, your blood insulin level will be high; thus your body cannot access its own fat for energy and your metabolism slows… until you eat again.
When I advocate to others that they try my Way of Eating (WOE), they frequently say, “I can’t give up (this or that).” I used to reply, “You don’t mean ‘can’t’; you mean ‘won’t’ or ‘aren’t willing to’.” After all, I thought, if they are health-motivated individuals, they would be willing to make the Lifestyle Changes necessary to achieve intentional weight loss. But I don’t think that any more. My thinking has evolved, to wit:
When you say you “can’t,” what you are recognizing (unconsciously) is that your metabolism is driving you to eat because it (your body) has to maintain energy balance to function. If it is denied access to the food (fat reserves) it put away, then it must slow down (reduce your metabolic rate) and TELL YOU TO EAT AGAIN. The question, then, is, how can you break this cycle? Answer: you must change what you eat. Eat in a way that avoids the vicious cycle. Eat in a way that gives your body access to its own fat storesto avoid hunger!
How do I do that? I eat Very Low Carb. Fifteen years ago I started “cold turkey” on strict “Atkins Induction” (20 grams of carbohydrates a day). I lost 60 pounds. Later I switched to Bernstein’s 6-12-12 program (30 grams of carbohydrates a day). I lost another 115. Today, I’m still down 165 pounds. Currently I’m doing full-day fasts to lose another 20+ pounds. I can do this because when I eat Very Low Carb I am KETO-ADAPTED. What’s that?
Keto-adapted means that when you eat very few carbs, both your blood glucose and your blood insulin levels will be low. Insulin is the hormone that the pancreas secretes to transport blood glucose (from carbs) to the cells. So when you eat a lot of carbs, your blood insulin level rises. If you have a touch of Insulin Resistance, you are “pre-diabetic” which means you have a slightly elevated blood sugar and your insulin level stays high.
Insulin is also a signaling hormone. When its level in the blood is low, this tells the brain to break down body fat to maintain energy balance. So, my metabolism continues to runs full tilt. I do not need to snack. I am not hungry because my body has access to another source of “food,” the body fat it put there for the purpose.
But I’m only N = 1. You’ll have to do this to replicate it. Try it for yourself and see how your body works. Human physiology is pretty awesome. It’s been working that way for millennia, til we changed what we ate.

Sunday, June 4, 2017

Type 2 Diabetes, a Dietary Disease #383: Fasting on 300kcal a day while keto-adapted

I have been eating Very Low Carb (VLC) for about 15 years. I lost 170 pounds, but inevitably gained some of it back. Losing it the 2nd time proved to be harder, so I decided to try Intermittent Fasting (IF).
I gave up my breakfast of eggs (I wasn’t hungry anyway) but kept a cup of coffee with heavy cream and stevia powder to take with my pills. I sometimes ate a light lunch (all protein and MY good fats) and then a supper of animal protein and one low-carb vegetable, with more fat (olive oil or butter). I did it for about a year, and it was easy. But, I didn’t lose weight! It was satisfying, but still too much food. I needed to try something else.
Then last fall Megan Ramos, director of Jason Fung’s Toronto IDM Program, suggested full-day fasts, i.e. the “other” kind of fasting. I told Megan that during a 2-month period during the winter I would do it, and I did. In 10 weeks I lost 30 pounds. With that success under my belt – why mess with success, right? – I decided to do it again, this time breaking new ground with the goal of reaching a weight I haven’t seen since my early teens.
How do I do it? What is the secret of my success? Full-day “fasting,” MY way. I put “fasting” in quotes because, on days when I fast, “my way” is not a strict water-only fast, although it is a basically a liquid-only fast. For Breakfast I drink a 12-oz coffee with 1½ oz of heavy cream and a smidgen (1g) of powdered stevia. If I feel dehydrated during the day, I will have just iced tea, sweetened with liquid stevia, and a pickle slice or just a little brine. Then, for Supper I drink 6-oz of red wine in a large glass filled with seltzer (with my evening pills ;-).
Macronutrients: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day total: 298kcal.
This is a departure from the usual “water-only” fast in three respects: 1) it includes dairy, 2) it includes a sweetener (pure stevia, not artificial), and 3) it includes alcohol. Total carbohydrates: Less than 6 grams/day.
The secret for the success of this “fasting” regimen is that on “feasting” days, I eat VLC. I am not hungry because I am “keto-adapted.” Keto-adapted means that my body is almost continuously in “nutritional ketosis.” On “feasting” days my body lives on what I eat, which is high-fat, moderate protein and Very Low Carb. For energy it burns the carbs first, then the unused glucogenic proteins stored in the liver as amino acids, then the dietary fat. Then, if my body needs more energy to maintain homeostasis, it simply transitions to breaking down body fat. My body fat is accessible because of my low blood insulin. That’s being keto-adapted!
At first, even though I’d read Jason Fung’s book, “The Obesity Code,” and another he wrote with Jimmy Moore, I had trepidations about not eating from one day’s supper to “breakfast” (my coffee) two days later. So, I started off with the idea of alternate day fasting (Tuesday and Thursday) every week. But I was surprised how easy it was (being keto-adapted to begin with), since I was not hungry at any time, day or night. In fact, I was not hungry at “breakfast” on the day after. So, I decided to try 2-consecutive-day and then 3-consecutive-day fasting. Again, easy. Absolutely no hunger. Lots of energy. I was alert, pumped, actually. Almost hyper!
I take Metformin twice a day: 750mg ER (extended release). It never occurred to me to reduce my meds, but then after a full day of fasting my FBG dropped into the mid 60s (3.6-3.7mmol/L). Once my FBG dropped to 60mg/dl (3.3mmol/L), but I felt fine. On a 3-consecutive-day fast, my FBG would be in the mid 60s all three days. I mentioned this to my doctor, and with a brush of his hand, he said, “Don’t worry about it. You can never get hypoglycemic on Metformin.” And I never did. The liver makes glucose, via gluconeogenesis, from both dietary protein (amino acids) and body fat (the glycerol molecule when a triglyceride breaks down). And when the lab report came back, my A1c had dropped a full half of a percentage point from 5.8% to 5.3%.