Monday, July 15, 2019

Retrospective #149: Feral Cat Feeding Frenzy

We have had a small colony of feral cats for 11 years. When four adolescent siblings appeared on our terrace one fine day, we fed them. They were truly feral and were too old to be domesticated. To make a long story short, after a few litters were produced clandestinely, we eventually caught, spayed or altered them all, and the population stabilized at six adults. We set out food for them twice a day, though we still can’t touch or even get close to any of them.
And every year, as winter approaches in our temperate climate (upstate New York), I’ve observed that our small feral cat colony knows it’s time to fatten up for the long winter ahead. Their appetites seem insatiable. Ordinarily cats know not to overeat. If they are full, they leave food on the plate. But their appetites change when they sense they will need fat reserves to survive a long winter when they “think” they will have to depend on “the hunt.”
Gary Taubes describes this mammalian behavior in “Good Calories – Bad Calories” (pg. 294). It’s an example, he says, of hormonal control of feeding behavior, just as human growth hormones account for the appetites of children. On a good diet, children don’t normally get fat; they get plump briefly and then they grow. They get taller very quickly. And when cold weather is coming, cats eat voraciously to fatten up for winter. It’s a hormonal thing.
The temporary fat that cats put on provides insulation from the cold as well as body fat energy reserves. Of course, these cats don’t “know” why they have rapacious appetites as the days get shorter and colder. Their unconscious brains function autonomically regulating homeostasis on a daily and seasonal basis. Their hormones “tell” them to eat. It’s a survival behavior. When spring comes, and the fat reserves are depleted, their eating behavior will return to “normal.” They will need to be lean again to have the agility to hunt. “Fat cats” don’t get the “early bird.”
What can we learn from these observations? Well, we’re mammals too, and it’s only been 500 generations or so (10,000 years) since we learned to grow food as crops and then harvest and store them for winter. This was at the beginning of the Neolithic Age. The time before that is referred to as the Paleolithic Era, hence what is known today as Paleo dieting. But in today’s world, we live in an environment of abundance in the food supply. Our modern lifestyle allows us to shop at the local super market rather than “hunt and gather” or grow our own food.
The market is filled with a cornucopia of foods all year long, many of them “processed,” which means they have already been “partially digested”! White flour milled from whole grain is a perfect example, as are fruit juices and smoothies. Even fruits, which are primarily sucrose, fructose and glucose – all simple sugars, with a little fiber and pectin – have all been hybridized to make them even sweeter (and larger) than they ever were in ancestral times.
The result: When processed carbs dominate our diet, we eat every day like winter is about to descend at any minute. The same autonomic control system that tells the feral cat to prepare for winter, tells us to “overeat.” Not the same mechanism, but the same effect because, for us, there will be no seasonal change in our food supply.
The alternative to feast and famine is the way we were designed to eat. Our bodies were designed to be for a period in a condition of mild ketosis after a meal is digested. It is a natural state. Food wasn’t always abundant. The cycle then was: feed, digest and absorb, then fast, repeated maybe once or twice a day, if we were lucky.
The feral cat colony feeding frenzy is being driven by the onset of winter. Feeding of the human mammalian colony is now being driven by an over dependence on boxed, bagged, and “predigested” processed foods that we have come to overly rely on “for our convenience.” It is also with the blessing and encouragement of our government whose misguided advice is still being driven by 60 years of bad science, among other things.  The “corrupt bargain” of government funding, well-meaning but overreaching “big government” “fat cats” who want to tell us what we should eat, and the influence of Agribusiness and Big Pharma that profit from it.
As individuals in society we need to learn to think for ourselves and recognize what is really in our best interest. 

Sunday, July 14, 2019

Retrospective #148: Obesity, a Condition of Genetic Susceptibility

Obesity is, for most of us, a condition of genetic susceptibility. I say “most of us” because I want to address in particular NOT the very small number of people who have a rare genetic disorder (e.g.: Prader-Willi syndrome). I want to address the one-third to one-half of us who will gain weight eating the same foods in the same amounts that the rest of us do who do not gain weight. At one time we did eat the same foods and amounts without gaining weight, but then something changed, and that something is not simply behavioral, nor is it less physical activity.
My bias as a member of this cohort is also an advantage. I am amazed by several respected authors in the health and nutrition field who still just don’t get it. It’s too bad. Maybe you just have to be in our shoes to understand how the body responds to carbohydrates once your metabolism has become disregulated by Insulin Resistance, with the resulting hunger/cravings yet complete intolerance for carbohydrates as an energy source without weight gain.
Anyway, I do not seek sympathy. I just want wider understanding and acceptance of the science behind the cause of obesity. That might enable empathy and 1) an interest in advancing the science, and 2) an openness by the medical and public health establishments to accept the evidence presented by so many serious researchers.
Unfortunately, both the medical and public health establishments today are thoroughly corrupted by Agribusiness, Big Pharma and they by government funding for research. So, only independent researchers, most of them younger and unencumbered by conflicts of interest or conscience, can make a difference. I am but a speck in this firmament, but I power on, seeking and broadcasting the truth to a small following. Thank you for reading my blog.
My bias is generally informed by award-winning science writer Gary Taubes. His seminal tome, “Good Calories – Bad Calories,” is a foundational document. In Retrospective #5, “Gary Taubes and the Alternative Hypothesis,” I give his “10 certain conclusions” which lay down the basis for his understanding of the scientific cause of obesity.
In Retrospective #120, “Nutrigenomics,” I wrote: “It is hoped that by building up knowledge in this area, nutrigenomics will promote an increased understanding of how nutrition influences metabolic pathways and homeostatic control, which will then be used to prevent the development of chronic diet related diseases such as obesity and Type 2 diabetes.” Nutrigenomics clearly defines obesity as a condition of genetic susceptibility.
In an NPR piece some time ago, Dr. Lee Kaplan said, “There are thousands of genes in the body, and about 100 of them are involved in making some people more susceptible to weight gain.” “We’re all wired in slightly different ways,” and “those subtle differences are reflected in how the body deals with energy stores and fat.”
The head of the Obesity Clinical Program at the Joslin Diabetes Center said: “The reality is, if you have that genetic susceptibility to gain weight, you will gain weight easily, no matter what. Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients. If you've always loved the sugary taste of ice cream, you may end up eating too much of it simply because an enzyme in your brain fails to halt the chemical that signals your brain to eat as much of the beloved food as you can.”
A 2009 study on the genetic susceptibility to weight gain found that when 12 pairs of identical twins were overfed 1,000 calories a day for three months, each set of twins gained a different amount of weight. Some only gained 8 pounds, while others gained thirty pounds. But within the pairs of twins themselves, the weight gain was the same.
A story in The Telegraph reported that Paul van der Velpen, the head of Amsterdam’s health service, said, “Just like alcohol and tobacco, sugar is actually a drug.” Van der Velpen claims that sugar, unlike fat or other foods, interferes with the body’s appetite creating an insatiable desire to carry on eating, an effect he accuses the food industry of using to increase consumption of their products. Whoever uses sugar wants more and more, even when they are no longer hungry. Give someone eggs and he’ll stop eating at any given time. Give him cookies, and he eats on…”
I can relate to that. I wonder if van der Velpen is fat too, or does he just “get it.” I wonder…

Type 2 Nutrition #494: My Food Rules

My food rules haven’t changed much since I began eating Very Low Carb in September 2002. The “program” I followed then, at the my doctor’s suggestion (to lose weight) was Atkins Induction: 20 grams of carbs a day. It worked in the way my doctor intended. I lost 60 pounds in 9 months. It also worked in another way that was unintended or at least not anticipated. In the 1st week I had to come off nearly all my diabetes meds I was on.
As best I remember, Atkins only  addressed carbohydrates at the time . That’s worth noting. It’s only – okay, well largelyonly carbs that matter. To lose weight (lots of it – I eventually lost 170+ pounds), you only need to restrict – severely, I’ll admit – carbohydrates.
So, if all you need to know is to severely limit the carbs you eat, the first thing you need to learn is: what foods contain carbs. Today, there are many ways to go about doing this: 1) You can “count carbs.” That’s what I did. From the start, I estimated portion sizes, used on-line sources for carb counts and recorded everything I ate in an Excel chart I created; or 2) You can use an on-line service to do the work for you, but be careful; many of these sources are way too lenient in their allowed foods. They think you “can’t” or won’t want to eat in a way that severely limits your carb intake. They’re way too friendly to the weak-willed or insufficiently motivated. Whichever way you choose, once you learn about carbs, remember: you just have to stick with Very Low Carb.
I learned what I needed to know, and then I ate (mostly) in compliance with my new knowledge. The foods I ate, were primarily protein and fat – saturated fat that is an inherent component of animal protein. If you aren’t prepared to do that, you will have a tough row to hoe. Vegetable oils are inherently unhealthy, and you must eat fat with protein. Protein has primarily cellular and hormonal functions. And you need healthy saturated fats to absorb the fat-soluble vitamins: A, D, E and K.
As I lost weight, I discovered I needed less food to feel full.  I wasn’t hungry most of the time. My body was slightly in ketosis, just ketotic enough to burn body fat as an energy source. Fat and carbs are the only two sources of energy.  I didn’t need to eat carbs for energy balance. My body fat provided the needed energy.
That’s when I started to ask myself: If I’m not hungry, why am I eating 3 meals a day. My body runs well on its own fat (and ketones), so why eat just because it’s a certain time of day. I started having just coffee with heavy cream for “breakfast,” and skipping lunch or just being sure it was only protein with some fat so I could stay mildly ketotic and not be hungry. At supper, just eating a small meal of animal protein (with saturated fat) and a portion of low-carb vegetables tossed in butter or roasted in olive oil, was always enough for me.
But I sometimes snacked. My snacking was always just before supper. When I was on anti-diabetes meds (sulfonylureas) that was always the time of day when my blood sugar was lowest. My snacking may be cultural as well. I have always enjoyed a glass of wine, or two. (I only have spirits in a restaurant or when we have guests for dinner.) And with wine I might have radishes with butter or celery with anchovy paste, or olives.
My cheats are 1) once in a while I’ll steal some of my wife’s ice cream from the freezer, or 2) in a restaurant, eat a roll or two with butter or olive oil. Rarely, I’ll share a dessert. These are indulgences. Simple pleasures, from a life almost forgotten. The best part of eating Very Low Carb almost all the time is how well I feel. I am often “pumped,” almost euphoric. The mood difference is palpable. It’s not just knowing I am no longer fat!

Oh, and did I mention...I have saved a lot of money on drugs and food. And my blood pressure is lower. And my HDL doubled and my triglycerides dropped by 2/3rds. And I don’t have to take a statin. And my chronic systemic inflammation is way lower. And I did it without exercise (and saved lots of time and gym costs). And all it requires is that I eat Very Low Carb most of the time. That’s Very Low Carb. It’s all you have to do.

Saturday, July 13, 2019

Retrospective #147:Obesity is a Disease (for billing purposes)

The New York Times article begins, “The American Medical Association has officially designated obesity as a disease…” This ties in nicely with my last two columns, #146, “Medicare to Pay for Obesity Counseling” and #145, “Gastric Bypass vs. Medical Therapy,” and the next, #148, “Obesity, a Condition of Genetic Susceptibility?”
The AMA call was a tough one for a variety of reasons, not least of which is that there is no general agreement in the scientific community on the definition of “disease.” The Times piece explains, “Those arguing against it [the designation of obesity as a disease] say that there are no specific symptoms associated with it, and that it is more of a risk factor for other conditions than a disease in its own right.” In making the designation, the AMA at their convention overrode a recommendation against doing so by a committee that had studied the matter for a year.
The committee said that “obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index (BMI), is simplistic and flawed.” The committee argued that “some people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.” The committee wrote, “Given the existing limitations on BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes.”
According to an article in Forbes by Chris Conover, the AMA finessed the BMI business by “simply defining obesity as an excess of body fat sufficiently large to cause reduced health and longevity.” According to Conover, “they answered the question of ‘should we consider obesity a disease’ largely on utilitarian grounds – that the social benefits of doing so will outweigh the costs.” Conover then went on to brilliantly demolish that argument.
Conover said, “the AMA is (late) to the party.” The National Institutes of Health declared in 1985 that “obesity is a serious health condition that leads to increased morbidity and mortality.” And the National Heart, Lung and Blood Institute commented in 1995 that “obesity is a multifactorial chronic disease developing from multiple interactive influences of numerous factors.” And he cites the Surgeon General’s 2001 Call to Action to Prevent and Decrease Overweight and Obesity. And Michelle Obama’s 2009 Taskforce on Childhood Obesity. Even the IRS considered obesity to be a disease, and Medicaid jumped on the bandwagon in 2010. Medicare has too, for counseling and surgery, but not for reimbursement for weight loss drugs. Why then is the AMA defining obesity as a disease now?
If we needed one, The Times gives us a clue to a motive for the AMA action. One advocate commented, “I think you will probably see from this, physicians taking obesity more seriously, counseling their patients about it.” And it noted, “…it could help improve reimbursement for obesity drugs, surgery and counseling. Two new obesity drugs – Qsymia…and Belviq…have entered the market in the last year,” and “Qsymia has not sold well for a variety of reasons, including poor reimbursement…”
At the Huffington Post, self-described policy wonk and blogger Larry Cohen enthusiastically huffed, “After the AMA announcement, some members of Congress introduced a bill to expand Medicare reimbursements for weight-loss drugs and weight-reduction treatment.” The Washington lobbyists jumped in exaltation.
And then The Times piece cracks the door open just a bit with, “Some doctors say that people do not have full control over their weight,” and “that ‘medicalizing’ obesity by declaring it a disease would define one-third of American as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. But, if the treatment is merely treating a symptom (obesity), rather than the underlying disease, doesn’t that solidify a wrong treatment modality for a non-existent disease? The AMA finessed that too by saying that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like type 2 diabetes and CVD.”
Neither The Times nor the AMA subscribes to Gary Taubes’s Alternative Hypothesis that INSULIN RESISTANCE, the metabolic disregulation that characterizes Type 2 diabetes, is what leads to fat accumulation. (obesity).

Friday, July 12, 2019

Retrospective #146: Medicare to Pay for Obesity Counseling

“Medicare to Pay for Obesity Counseling in the Name of Prevention,” trumpeted What a boon for physicians! And what a mixed blessing for their patients! Medicare finally recognized that obesity prevention in the form of counseling, as public health policy, might be as effective as costly gastric bypass surgery. Reducing obesity through “intensive medical nutrition therapy…could produce similar results,” it concluded. But only if your primary care physician “supervised” its administration. This sounds to me like it’s all about the billing.
Medicare reached this conclusion because “It’s almost impossible for physicians to take care of everything. They don’t have the expertise [how true!] or the time” [also true!]. “Seventy-two percent of primary care physicians surveyed…said nobody in their practices had been trained to deal with weight-loss issues.” Yet they [the physicians] say, “unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so.”
Why is that? Under the Medicare rules, “those with expertise in the field, such as registered dietitians [?!], are not eligible to bill directly.” Medicare, with perhaps a little lobbying from the AMA, “has limited who is able to bill for those services to primary care physicians, including nurse practitioners, clinical nurse specialists and physician assistants. Medicare will cover services from ‘auxiliary’ providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.” Yep, it IS all about the billing.
But the consequences for the patient are dire. Registered dietitians and CDE’s, if they follow the training required for certification, are the least qualified persons to provide obesity training, at least to the Pre-diabetic and Type 2 community. This has been my personal experience from attending group counseling for diabetics provided by a CDE/RN at a local health care facility, and years ago with a registered dietitian, plus more recently with a CDE.
Years ago, my doctor employed a registered dietitian in his “office suite.” I remember well her advice to “Eat a ‘balanced’ diet and exercise.” The truth is that she was as ignorant as my doc about the effect on a Type 2 diabetic of eating a “balanced” diet of from 40% to 60% carbs. But my meter provided plenty of feedback, all of it negative.
Forty-five to sixty-five percent carbs is the amount recommended by the Institute of Medicine for everyone in the 2010 Dietary Guidelines for Americans (Table 2-4, pg. 15). The USDA’s Nutrition Facts panel on processed food packaging is likewise a one-size-fits-all formula. Carbohydrates are 1,200 (60%) of the 2,000 calories in the Standard American Diet (SAD,) for a woman. More for a man. And that, folks, is why Type 2 diabetes is a progressive disease!
My experience with a CDE (employed by a doctor) was the result of a silent auction for a non-profit a few years ago. The bidding started at $20, so I placed the first bid, and it was the only bid. At this point I had been eating Very Low Carb for about 10 years. I had lost 170 pounds and had eliminated virtually all my oral diabetes meds. My blood glucose was normal, my blood pressure (on the same meds) had dropped dramatically, and my blood lipids (both HDL and triglycerides) had totally turned around. I no longer had Metabolic Syndrome or detectible hypertension (with meds) or Type 2 diabetes as long as I refrained from eating carbohydrates.
Okay, those conditional statements are caveats, but that is a price I was and am willing to pay for the complete abatement of my symptoms. In doing so I am now at much lower risk of all the Diseases of Civilization to which I was exposed before I began this Way of Eating. It was a rough session, for the CDE, but she toughed it out. In retrospect, it wasn’t very nice of me to do that to her, but maybe it will pay off. Maybe she will have an epiphany.
So “save your money,” so to speak, if counseling is voluntary as it is with Medicare, or just ignore the advice if obesity counseling, also at government expense, is required by the NHS. Your health will be better served if you listen to your meter and avoid any “one-size-fits-all” diet plan.

Thursday, July 11, 2019

Retrospective #145: Gastric Bypass vs. Medical Therapy

Recently, my Medscape alert brought me a story on “Gastric Bypass vs. Conventional Medical Therapy for Metabolic Syndrome.” I read it, and the full paper in JAMA, and my reaction was that it would be funny if it weren’t so very sad. This study used a “2-group unblinded randomized trial” and is a perfect example of how bloody blinkered the medical community is to the treatment of Metabolic Syndrome and its associated co-morbidities.
This narrow mindedness is best demonstrated by the first bold heading in the abstract: “IMPORTANCE: Controlling glycemia, blood pressure, and cholesterol is important for patients with diabetes. How best to achieve this goal is unknown.” Unknown!!! Let’s face it. This na├»ve statement is just a set-up to obfuscate and camouflage the true purpose of the entire enterprise: to promote gastric-bypass surgery in “mild to moderately obese patients with Type 2 diabetes.” Generally gastric bypass is reserved for the morbidly obese patient (BMIs ≥ 35). The growing number of gastric bypass surgeons, however, requires that there be more “eligible” patients. And the sooner the better, before the unfortunate side effects such as “dumping episodes” and a higher suicide rate are better known. 
Controlling glycemia, blood pressure, and cholesterol are certainly important for patients with diabetes. How best to achieve these multiple goals (collectively known as Metabolic Syndrome), is certainly, however, NOT UNKNOWN. It has been documented innumerable times in countless papers published in the peer reviewed medical literature. The problem is that control is NOT ACHIEVED with “medications for hyperglycemia, hypertension and dyslipidemia (that) were prescribed according to protocol” nor with “surgical techniques that were standardized,” to quote from the specific “interventions” utilized in this trial. Control is achieved by what type of food you eat.
This study had a “lifestyle modification” component modeled on recent “successful clinical trials, they said, particularly the “Diabetes Prevention Program” and the “Look AHEAD Protocol.” The interventions in those trials were to lose 7% of body weight and to exercise 150 minutes (!) a week. The Look AHEAD Protocol also examined whether weight loss reduced the risk of heart attacks and strokes in obese Type 2 diabetics. It did not.
Maybe (Is my sarcasm too thick?) the problem with these studies is what they have in common- a “healthy low-calorie, low-fat diet” that fails to lower blood glucose enough to reduce the risk of diabetic complications, including heart disease. The lifestyle intervention protocol in this trial was similar for participants in both treatment groups.
In the Gastric Bypass study protocol, “Portion controlled diets using meal replacements, structured menus, and calorie counting…encouraged to help participants stay within calorie limits.” “Both groups met regularly with a trained interventionist to discuss strategies for facilitating weight management and increasing physical activity. Topics included self-monitoring, stimulus control, problem solving, social support, cognitive behavior modification, recipe modification, eating away from home, and relapse prevention.”
Maybe I am being too hard on these gastric bypass surgeons. Study participants were, after all, a “failed” cohort. Participants had diabetes for an average of 9.0 years, had a mean BMI of 34.6, and a mean A1c of 9.6%, in spite of medications to control diabetes and cardiovascular disease risk factors (statins). Perhaps I should ignore the fact that the Principal Investigator, or PI, who created the study concept and design, drafted the manuscript, and provided study supervision, received funding for the study from Covidien, a leading manufacturer of surgical devices, as well as serving on the medical advisory boards of Novo Nordisk, USGI, and Medica. Eight other co-authors, all doctors and support staff, also reported receiving grant support from Covidien, including one who received salary support for what, in small print, is called, unabashedly, “The Diabetes Surgery Study.” 
I can ignore these funding facts, just as they ignore an effective dietary therapy for hyperglycemia (carbohydrate intolerance). To achieve control, you need to eat fewer carbs. As your weight drops your blood pressure and cholesterol will improve too. Your weight is under your control because what you eat is under your control.

Wednesday, July 10, 2019

Retrospective #144: Diabetes and Dementia

The “Background” in the Abstract of this August 2013 piece in The Lancet states: “Although patients with Type 2 diabetes are twice as likely to develop dementia as those without this disease, prediction of who has the highest future risk is difficult. We therefore created and validated a practical summary risk score that can be used to provide an estimate of the 10-year dementia risk for individuals with Type 2 diabetes.” Diabetes in Control, a digest for medical doctors to which I subscribe, picked it up. Have I got your attention yet? Well, it gets much scarier.
The researchers were from the University Medical Center Utrecht, Netherlands, the University of Chicago, the University of Washington, and Kaiser Permanente. In 2013 Kaiser Permanente was the largest managed care organization in the U. S., with almost 9 million health plan members, 15k doctors, 170k employees, and $50 billion in annual revenues. Kaiser Permanente, the National Institute of Health, and Fulbright funded the study.
The researchers used data from patients with Type 2 diabetes, aged ≥60 years, with 10 years of follow-up. The risk factors in their analysis that were “most strongly predictive of dementia” were “microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age, and education.”
The outcome of their risk analysis? “The prediction of 10-year dementia risk in patients with Type 2 diabetes mellitus “shows a 5.3% risk for the lowest score and 73.3% for the highest score. The Diabetes in Control piece states, “According to the authors of this study, those in the higher risk category were 37 times more likely to develop dementia than those in the lowest risk category.”
How do they plan to use this information? You’ll love this. They say, “The risk score can be used to increase vigilance for cognitive deterioration and for selection of high-risk patients for participation in clinical trials” (my emphasis). And that’s it! In other words, they watch as you develop dementia, and then perhaps suggest that you sign up for a clinical trial to test another drug to treat your cognitive deterioration. Isn’t that just dandy!
Of course, there is another way. Remember, the researchers who created and tested this risk analysis prediction tool used “data from approximately 30,000 Type 2 diabetic patients aged 60 and greater over a 10-year interval.” These diabetics were presumably being advised to eat a “one-size-fits-all” low-fat, high-carb, restricted-calorie diet, with lots of “healthy fruits and vegetables” (all carbohydrates) with minimum saturated fat and dietary cholesterol.
Most were probably also medicated for hypertension (high blood pressure) and for high cholesterol with statins.
Further, the treatment standard that the clinicians were using was undoubtedly the one supported by the current “Standards of Medical Care in Diabetes” published annually in Diabetes Care, the Journal of the American Diabetes Association. That means that your physician will be safe-guarded from medical liability to simply advise you that your Type 2 diabetes is “under control.” He will not inform you that your elevated blood glucose levels, as allowed by this standard, are progressively damaging your blood vessels, organs and endocrine system.
If you leave the care of your Type 2 diabetes in the hands of your physician, this is what will happen to you: As he observes your A1c rise, he or she will prescribe higher doses and more medications until you are maxed out, and then possibly switch you to injected insulin. Repeat for your elevated cholesterol and high blood pressure.
And when you are unable to lose weight and keep it off on a low-fat, high-carb diet, as he makes a note in your file that the “patient was non-compliant,” you will be reminded again to “eat less and exercise more.”
Don’t be a member of this treatment cohort. Take charge of your own health. Do not accept an A1c of ≤7.0% as “in control.” At this level, your heart attack risk is doubled. Eat a diet that is low in carbohydrates; better yet, VERY low. Don’t sweat the saturated fat and dietary cholesterol. Your body will love it. And so will your doctor. He or she will be pleasantly perplexed with your lab results and weight loss, and will almost certainly lower your meds, and then tell you to “just keep on doing what you’re doing.” That’s an outcome you can both happily live with.