Thursday, April 9, 2020

Retrospective #418: “The dose makes the poison”

The surprising popularity of  Retrospective #197, “Triglycerides and Alcohol Consumption,” written obliquely several years ago for the benefit of my brother, gave me pause to contemplate how many others out there were interested in the subject. Unbelievably, it was the #4 all-time favorite in the Readership Statistics list of “10 Most Popular” posts. See Retrospective #416. Coincidentally, but in a different context, I recently read elsewhere that, “The dose makes the poison.” This syzygy, a conjunction like a solar eclipse, thus provided me today’s subject.
Drinking alcohol to excess runs in my family. My father was probably, and my mother possibly, alcoholic. I usually drink almost every day. Some people define alcoholism as the habit of drinking alcohol every day.
Since I began a 3-consecutive-day, modified fasting routine about a year ago, drinking one glass of wine has been part of my “fasting” routine. On “My Modified Fasting Plan” (Retrospective #383), on fasting days I make “supper” one red wine spritzer (5oz of red wine with 8 ounces of club soda), to take my evening pills. On non-fasting days, I double the dose. This “allowance” for alcohol is pleasing to me and, I know, to many others who enjoy a drink (or two).
Unless we have company who also enjoy a drink before dinner, at home I don’t drink ethyl alcohol (“spirits”). And these days, as we get older, “company” happens less and less often. In a restaurant, which we do about once a week, I usually have a cocktail or two, depending on the bartender. A few make them strong enough, as I do at home. Most do not, in which case I order two. Just once, at lunch with my editor and her husband in Nashville, I actually ordered three. I swear they were watered down…which is how I get to “the dose makes the poison.”
Paracelsus, (1493-1541), a Swiss scientist, son of a doctor, and “father of toxicology,” is credited with the adage, “The dose makes the poison,” a basic principle of toxicology. He told doctors to “study nature and develop personal experience through experiment” and thus to “emphasize the value of observation in combination with received wisdom.” This leads in turn to the concept of Hormesis.
More Wikipedia: “Hormesis is any process in an… organism [like you and me] that exhibits a biphasic response to exposure to increasing amounts of a substance or condition.” The “biphasic” conditions are “stimulation” and “inhibition.” Wiki continues, “The hermetic zone [is] generally a favorable biological response to low exposure to toxins and others stressors.” [I generally have a “favorable biological response” to one or even two glasses of wine or a “well-made” drink. [“A pollution or toxin showing Hormesis thus has the opposite effect in small doses as in large doses.” This effect has been shown with stressors like fasting and exercise.
I wrote about “Calorie Restriction and Longevity” (#79) and “Calorie Restriction in Humans” (#81) years ago. With respect to exercise, Wikipedia states, “Individuals with low levels of physical activity are at risk for high levels of oxidative stress, as are individuals engaged in highly intensive exercise programs; however, individuals engaged in moderately intensive, regular exercise experience lower levels of oxidative stress. High levels of oxidative stress have been linked by some with an increased incidence of a variety of diseases.” (all my emphases).
“Alcohol is believed to be hermetic in preventing heart disease and stroke, although the benefits of light drinking may have been exaggerated,” Wikipedia avers. But, “in 2012, researchers at UCLA found that tiny amounts…of ethanol doubled the lifespan of Caenorhabditis elegans, a round worm frequently used in biological studies.” At least all of our taxpayer money isn’t being wasted on useless scientific research!!!
 Wikipedia admits, though, “The biochemical mechanisms by which Hormesis works are not well understood.” And they conclude, “Hormesis remains largely unknown to the public.” But Paracelsus has shown me how to manage the “stimulation” part: “study [your] nature and develop personal experience through experiment.” My interpretation of my personal experience: At home, be disciplined and adhere strictly to established protocol. With guests, cater to their wishes. In a restaurant, choose your bartender carefully, and remember always, “The dose makes the poison.”

Wednesday, April 8, 2020

Retrospective #417: The NEXT 25 Most Popular Posts

Yesterday, in Retrospective #416, “Readership Statistics,” I listed the 10 most popular posts I’ve written since I started this blog 10 years ago in 2010. Since most of them were found by a search engine query, the result is biased in favor of low-numbered posts. I was disappointed, therefore, that some of my personal favorites were not included.
In an effort to correct the low-number bias and include some of my own favorites, I decided today to offer you the NEXT 25 most viewed posts. Most of these, it turns out, are also low-numbered. Maybe my recent subject matter is of less interest because it’s less basic. Well, that’s good, in a way. There are lots of overweight, Prediabetic and frank Type 2s out there who still need to learn the basics about optimizing nutrition. Type 2 diabetes IS a dietary disease.
The NEXT 25 Most Popular Posts
1 #68 Triglycerides, Fish Oil and Sardines Compelling N=1 evidence; also #281, #282 and #283 on how to raise HDL-C.
2 #100 Liquid Calories   A few good points about digestion, then the Harvard Public Health recommendations.
3 #19 The Archevore Way of Eating, and #18: Kurt G. Harris’s mantra: limit wheat, excess fructose and Omega 6s.
4 #32 Artificial Sweeteners Useful, but I and those “in the know” use pure stevia extract, either powdered or liquid.
5 #25 Understanding Your Lipid Panel Solid, easy-to-understand basics about cholesterol; a must read!
6 #64 Very Low Carb Eating, 10 Years Later Good, big picture data; also see #387 for “15 years on VLC.”
7 #35 The Diet Doctor and the LCHF Diet 6 years old but still good. Andreas Eenfeldt, MD, is the majordomo of LCHF.
8 #72 How to Fix Your Cholesterol Good basics on the lipid panel & Friedewald formula; see also #25 above.
9 #99 Natural History of Type 2 Diabetes Ralph DeFronzo’s, MD, description of the evolution/progression of T2DM.
10 #94 Eating Clean About the manifesto of Singaporeans who subscribe to a “clean” lifestyle, and used to read me.
11 #194 Live Fermented Foods Just a primer, but informative. See also my reply to an old follower’s comment.
12 #54 Loren Cordain, Robb Wolf, and Kurt Harris A couple of book reviews, and another paean to Dr. Kurt Harris.
13 #160 Letterman to Hanks: "...through diet, mostly" An example of how the media usually gets it wrong.
14 #30 Is Fructose Toxic to the Liver? With #29, covers the story; lots of stuff from Robert Lustig’s “The Bitter Truth.”
15 #55 The Beleaguered Gary Taubes A defense of the “Insulin Hypothesis” by the pioneer science writer of VLC.
16 #140 Peanuts, my nemesis Mostly relies on the Jaminets’ “Perfect Health Diet.” Note: I am still addicted.
17 #126 Do you live to eat or eat to live? Transitioning is difficult and ongoing, but possible. I am still working on it.
18 #59  What I Eat and Why: The VLCKD The title says it all: Why I eat a Very Low Carb Ketogenic Diet (VLCKD)
19 #89 Reversal of Type 2 Diabetes, Revisited This is a sequel to my #1 most popular post #88. See also #380.
20 #33 Omental Adiposity Good basic information, especially for men with beer bellies, who look pregnant!
21 #83 The 8-hour Diet I don’t recommend this huckster’s “diet,” although Intermittent Fasting (IF) is good.
22 #9 Metabolic Syndrome A seminal post, now 10 years old, and only 32nd most read. See also #334 and #335.
23 #122 Macronutrient Ratios and Calorie Restriction Loaded with specifics and a good, clear message.
24 #158 Demolishing the Saturated Fat Bogeyman An authoritative review from the British Medical Journal.
25 #152 Set Point Theory This column is much more than Set Point theory. It is loaded with goodies!
I’ve published hundreds of columns since the highest numbered one on this list! Not one is among my Top 35. Further study of “search engine optimization” will be required to learn why. I need to get more readers for some of what I’ve written in the last few years! There’re lots of good “poop” out there that’s being laid on a fallow field.

Tuesday, April 7, 2020

Retrospective #416: Readership Statistics

As I pass 300,000 page views on this blog, it occurred to my editor that my readers might be interested in who besides you reads it. So, using the bare analytics on the Blogger platform, I assembled a few statistics.
Only 41% of my viewers are from the United States. About as many come from the next 9 countries combined, in page view order: Ukraine, Israel, France, Russia, China, United Kingdom, Canada, Poland and Germany. The remaining +/-20% are from dozens of other countries, principally among them India, Australia and Singapore!
Ukraine is 2nd and figures prominently probably because someone there is “stealing” my intellectual property and regularly “hosting” a link to my columns in a health or nutrition-related newsletter. That’s fine with me. I do this for educational purposes, not financial ones. I offer no advertising, so I do not forego “income by hit.”
Israel comes in 3rd because someone there is reading my blog regularly and once in a while provides a link to their readership. And then, pop, 2,500 ‘hits’ in an hour. Same thing happened in Singapore a few years back.
I’ve been publishing this blog (as of January 2018) for 7 years, most of that time once a week. For a couple of years, I posted twice a week and then burned out and took an 8-month break. My average monthly viewership for the last 4 years, including the 8-month hiatus, is over 5,300, or about 180 per day, with a wide monthly range: 9,781 to 2,404. Allowing for the decline during the period when I was not writing, that comes out to about 6k/mo. or 200/day.
Most viewers find this blog through a Google search and are not regular readers. They search by subject using “keywords.”  According to the Blogger analytics, 6 of 10 keywords were searched using an “88 search engine.” In the early years, many page views resulted from my shameless self-promotion, providing a link on sites like Livin la Vida Low Carb (Jimmy Moore), Authority Nutrition, and Canadian low-carb blogger Dr. Jay Wortman.
The 10 most popular posts (incorporating the “88” search engine) since I began writing this blog are as follows:
#88 “Reversal of Type 2 Diabetes” Made #1 by the coincidence of very high interest subject matter and #88.
#31   Carbohydrates and Sugars A decent primer, drawn mostly from the Wikipedia entry on the subject.
#101 Why I'm Never Hungry A touchstone subject and one that I return to often.
#197 Triglycerides and Alcohol Consumption  A surprising hit; a lot of bibulous tipplers out there, I guess.
#108 "You're eating too much dairy."  This one is a compendium of excerpts from a few experts on the subject.
#38 "The Perfect Health Diet" A book review but, aside from that, probably searched for the subject matter.
#21 The Dangers of Polyunsaturated Fats An important and under-addressed subject. I’m delighted it’s a hit.
#281 HDL-C and Triglycerides With 282 & 283 a series on the transformation of my own HDL and TGLs on VLC.
#103 Your Mileage May Vary (YMMV) Everyone thinks they are a special case, so they want to believe this.
#61 Stefansson and the Eskimo Diet  Another surprise, popular because of the early link on Dr. Wortman’s site.
In my opinion, many of these top 10 are not my best efforts, but they do show what the reader is searching for. As such they offer an insight for me to ponder as I contemplate what to write about next. I note, however, the list is heavily biased toward the low numbered posts, reflecting the time that those posts have been “out there” in the blogosphere and available to search engines. As such, many newer ones will eventually catch up.
Many of my personal favs did not make the Top 10 list. Some are among “The NEXT 25 most popular,” to be published next week (tomorrow, now) as “Type 2 Diabetes #417.” If you’re interested, I hope you’ll look it over. Other favs have hardly been read at all. To find those, you’ll just have to read all 400+ at www.thenutritiondebate.com .
The original #414 was posted in January 2018. Page views have now surpassed 415k. Current hot spot: Hong Kong.

Retrospective #415: Hypoglycemia? I’ve had it only three times


I recently read a scary piece by Anne L. Peters, MD, Beverly Hills endo, Professor of Medicine, and Endocrine Society spokesperson. Title: “Seizures, Vomiting, Fear of Dying: The Threat of Hypoglycemia.” Subtitle: “Patients with Diabetes Explain How They Experience Hypoglycemia.” There’s also a short video at Medscape.com.
Peters wrote, “As a physician, I'm judged on how my patients do with their A1c targets. I always want people to be at less than 7% so that they do not get horrible complications. But day in and day out, patients have to live with the overarching concern of being too low. That can happen anytime, day or night. A patient can go too low if they misjudge insulin by maybe a unit or two, eat too little, or exercise too much” (all emphases mine).
Those three things will surely do it. But saying, “Eat too little” is misinformation. She really means, “Eat too few carbohydrates,thus not RAISING their blood sugar enough. Equally, by wanting her patient’s A1c’s to be less than 7%, but not “too low,” it is reasonable to infer it is okay for a patient to be in a perpetual disease state, according to the ADA’s “Standards of Medical Care,” because clinical diagnosis of Type 2 diabetes is defined as an A1c ≥6.5%.
This approach to your medical care is because of medical practice liability. It is preferable to the doctor that the patient on insulin not be at risk of a blood sugar too low, i.e., at risk of “seizures, vomiting and…dying.” One patient wrote, “My A1c is always around 6.7- 6.9%, and this is fine with me and my doctor.  I hate hypoglycemia!” Most doctors would agree. They are, after all, ALL judged (her words) on how [their] patients do with their A1c targets, and the “Standards of Medical Care” call for your A1c, much too liberally IMHO, to be JUST AT OR LESS THAN 7%.  
Peter’s patient perspective was If I die tomorrow from a low blood sugar, who cares what my A1c is?” This concern, she said, is “a real part of the experience” her patients have of “living with diabetes.”  For her part, “A real part of the experience of [her] giving [prescribing] insulin is the fear of hypoglycemia.” One just follows, literally, the other.
But it’s the dietary advice you have received that will put you are in a perpetual disease state, in which your Type 2 diabetes will PROGRESS to where your doctor will be “giving (you) insulin.” You WILL become an insulin-dependent Type 2 at risk of “seizures, vomiting and…dying” including all the micro and macro vascular complications for Type 2 diabetics with A1c’s ≥6.5%, or for that matter ≥5.5%. Your death will, actuarily speaking, be 8 years earlier than your peers…. Think about that. But it doesn’t have to be. You can take responsibility for managing your own diabetes. 
You started reading this post because I told you I have only experienced hypoglycemia three times in my life. All three times occurred in the same week 18 years ago. It was the week I began cold-turkey to eat Very Low Carb on the advice of my doctor. Two months earlier he had read a New York Times Sunday Magazine cover story by Gary Taubes, “What If It's All Been a Big Fat Lie.” My doctor tried the diet described in that article (20 grams of carbs a day) and lost 17 pounds. He then suggested I try it too, to lose weight, and I’ve been eating a Very Low Carb diet ever since.
At the time I weighed 375 pounds and was eating a “balanced” diet including beaucoup carbs. I was on 3 types of oral anti-diabetic meds and 3 types of blood pressure meds. My fasting blood glucose, at 155mg/dl, was still out of control (it was before the A1c test), and my blood pressure was border line. I would soon be an insulin-dependent Type 2.
My first episode of hypoglycemia occurred late on my first day on the new diet. I ate a candy bar and called my doctor. He told me to stop taking the 3rd class of diabetes drug he had recently prescribed. The next day I had another hypo. This time he said cut the dose of the other two drugs in half. But on the 3rd day I had yet another hypo, so he told me to cut the dose in half again! In all the years since then (2002) I have never had another hypo. I later dropped one of the two remaining drugs (Glyburide) altogether and continued taking 500mg of Metformin for a decade. Last year I raised my Metformin to a “therapeutic” dose and occasionally have FBGs in the 60s, without hypoglycemia. In the ensuing years, I’ve lost 185 pounds (See, “Not half the man I once was”), and my most recent A1c was 5.1%. Clinically speaking, I am now considered “non-diabetic” and in the normal risk range for co-morbidities and complications.

Friday, April 3, 2020

Retrospective #414: To LOSE weight, do NOT eat a Ketogenic Diet

A Ketogenic Diet, as generally misunderstood by the lay reader, is a diet very low in carbohydrates and very high in dietary fat. That is, the fat in that Ketogenic Diet is taken by mouth. It is the fat you eat. But if you want to lose weight, you do not want to eat a Ketogenic diet very high in dietary fat. If you want to lose weight, you want the fat that your body burns to be the fat on your body that it has stored there for the purpose.
At the cellular level, the body doesn’t care where the fat comes from. So, while you’re hormonally in a “fat-burner” state (by eating a diet very low in carbohydrates), your body will burn the few carbs you ate first and then the fat you ate. It’s going to burn what it needs and store what it doesn’t. And if it doesn’t need to burn your body fat to maintain energy balance, it won’t. And you have defeated your purpose. You need to be careful not to OVEREAT fat, because you want to burn BODY fat.
So, what does this do to the macronutrient ratios I have talked about for years? It doesn’t change the ratios. It just changes where the fat component is sourced. It is sourced in the liver where your metabolism breaks down the triglycerides (fat) you’ve stored instead of the triglycerides (fat) you ate. It’s a little harder to calculate, but the physiology is the same. The difference is that the macronutrient ratios of the “food” you use for energy are not measured where it is “taken by mouth” but where your body takes them up for energy – in the bloodstream.
Most nutrients from food you eat are absorbed into the bloodstream from where they are digested in the small intestine. From there they circulate until they are taken up by your cells. When you eat Very Low Carb, and your hormonal state has switched from sugar-burner (glucose-based) to fat-burner (fatty-acid based), your body will process the foods you ate and then, to maintain energy balance (homeostasis), it will break down your body fat (triglycerides) into fatty acids for fuel. Fatty acids will then circulate and mix with the other fuels in the blood until taken up wherever needed. It will do this so long as you eat Very Low Carb and remain in the fat-burner state.
Your metabolism will NOT slow down. Your metabolism will continue to run at full speed because you are not being “starved” for lack of “food.” Your body has supplied the energy it needed from the “food” reserves it had stored.
So, in practical terms, what does this do to the macronutrient ratios, as traditionally applied to food ingested (taken by mouth)? The ratios don’t change. The carbs are exactly the same. The protein is exactly the same. Total fat is the same too, only it is divided between fat eaten and stored fat. And YOU will determine the eaten/stored fat ratio by how much fat you eat.
Let’s do an example: A certain, mostly sedentary man (me) needs say 2,400kcal/day to maintain his current weight. But he’s overweight and wants to burn body fat, so he eats a diet with macronutrient ratios that gets his body in a hormonal state conducive to fat burning: 5% carbs. 20% protein and the balance 75% fat (by calories, not grams). That’s 30 carb grams (120kcal), 120 protein grams (480kcal) and 200 fat grams (1,800kcal) a day. That’s 2,400kcal total. If he eats this Ketogenic Diet (k/g ratio: 2.0), he will not be hungry. He will be fat-adapted and in ketosis, but he will not lose weight because he’s EATING too much fat.
Now, envision this same man eating the same 30 carb grams (120kcal) and the same 120 protein grams (480kcal) and BUT JUST 100 GRAMS OF FAT (900KCAL). His “diet,” i.e. what he has taken by mouth, is now 1,500kcal/day, but because he is still eating Very Low Carb, he is still in a hormonal state conducive to fat-burning, and HIS BODY WILL HAVE TO BREAK DOWN 100 GRAMS OF BODY FAT a day to maintain the 2,400kcal his body requires for energy balance. His metabolism runs full speed because it is being fed with body fat, he is not hungry, and he loses weight. His macronutrient ratios (by mouth) are now 8% carb, 32% protein and 60% fat (k/g ratio just 1.4), but it doesn’t matter. At the cellular level – where the energy is taken up and used – the macronutrient components are unchanged. Both are Very Low Carb and Very High Fat and protein is the same. He is Fat Adapted, but by mouth, he is not eating a Ketogenic diet. But, at the cellular level, he is Ketogenic. I hope I’ve cleared up that misunderstanding. 

Retrospective #413: “End Date” TBD by insurer

A couple of years ago my wife left a post-surgical office visit with a written prescription for physical therapy (PT) and instructions to call for another office visit when the PT was completed. So, I asked my wife how long was the course of physical therapy that the doctor prescribed. She looked at the script and read, “End date: TBD by insurer.”
My first reaction was surprise, then anger at the doctor for abdicating to the insurer on medical decisions, then anger at the insurer for making medical decisions, then anger at government telling insurers how much they will reimburse insurers for making medical decisions. Healthcare decisions that affect a patient’s recovery from surgery should always be a matter between doctor and patient, not insurers, whose principal interest is the bottom line. And not government, where politicians and their staffs are not qualified and are generally corrupted by conflicts of interest.
So, the doctor is not to blame. He or she is in business too – albeit small business, but Retrospective #365 on changes in Medicare demonstrates that even the giant American Medical Association was helpless to alter the course of the “reforms” to Medicare that were enacted to pay for the Affordable Care Act (“Obamacare”). Healthcare represents about 17% of the U. S.’s Gross National Product. It’s a behemoth that overpowers everything else.
So, let’s review: A doctor defaults the duration of physical therapy to the insurer. And insurers are governed by government reimbursement policy written by the staff of politicians who have no business doing it. But ultimately laws are passed and regulations are promulgated in this way. So, it’s a mess, but what’s a patient to do? Answer: Take control.Take your healthcare into your own hands! Seriously, it’s your health!
My doctor offers “Concierge Care.” I suspect he’s looking for a way to get out from under all the restrictions, regulations and reporting (the 3R’s) described in Retrospective #365. With Concierge Care he has less overhead for coding and billing, and he gets paid an annual fee.  It has to be more rewarding, and not just financially.
I declined his Concierge Care offer, though, because under the Medicare as primary and GHI secondary supplemental insurance that I have from being a former NYC manager, I have very good insurance coverage. Virtually everything is covered and paid for. I even get the Medicare Part B premiums, deducted from my pension check, refunded! And my Medicare Part D prescription drug coverage is subsidized by the NYC Management Benefits Fund.  I am also in pretty good health for my age – much, much better than I was 18 years ago, when I was morbidly obese and had “borderline” everything. When my current doctor took over my former doctor’s practice, my new doctor studied my chart and suggested I see him just once a year. Instead, at my insistence, I see him 3 times a year, primarily for blood work.
So, my pitch to you is this: Take responsibility for your own health. Don’t rely on your insurer to tell you what to do or how long to do it. And don’t let the government tell you what to EAT. They’ve been wrong with the dietary advice they’ve been dishing out for the last 60 years, much longer than any government official or practicing physician has been working. Remember, too, your doctor is/was not educated in nutrition, and the RDs and CDEs in practice today obtained and keep their licenses by learning what the government’s huge, failed nutrition experiment dictates.
If you’re overweight or pre-diabetic, ask yourself, how did you get that way? Haven’t you been trying to eat a “healthy diet” the way you’ve been told to do for most of your adult life. And haven’t you been exercising regularly? Then what caused you to gain weight or become pre-diabetic or a diagnosed type 2? Answer: Insulin Resistance. And if you are Insulin Resistant, you are Carbohydrate Intolerant. Does it make sense to continue to eat a “balanced” diet, a diet that is 55% to 60% carbohydrate? That’s what “everything in moderation” means and the way government and the medical establishment told you to eat. But isn’t that how you became Carbohydrate Intolerant? Then why would you continue to do the same thing over and over again and expect a different result? That’s the definition of insanity!
Think about it, seriously And just for reference, think about how feed lot beeves (plural of beef) are fattened up in their final weeks. They are fed grains, and corn, from a trough. A 100% carbohydrate diet. It’s a surefire way to fatten them up! Prime beef, with a thick outer layer of fat and lots of interstitial marbling. Hmmm good.

Retrospective #412: “Cover” Story


With idle time in my wife’s doctor’s waiting room, I picked up WebMD Magazine’s June 2017 issue. The cover story appeared to be an article asking, “Trouble reaching your A1c goals?” Next to a photo of a middle-aged man, the caption invited the reader to: “See how Jerry does it.” I’m always interested in seeing how other people lower their A1c’s, so I eagerly and naively turned the page…to a 3-page ad for Trulicity, a product of the Eli Lilly company.
Somehow, I missed the disclaimer on the false cover. It said, on a black banner, “Special advertising section. This Trulicity promotional cover has been placed on a limited number of WebMD magazines.” – just the ones in doctor’s offices, I’d bet. It continued, “It does not constitute an endorsement by WebMD Magazine, and no endorsement is implied.” Okay, WebMD gets big bucks for the fake cover, but how about the doctor’s office? Are they not complicit in this “non-endorsement” endorsement? I think so, and they (the doctor) doesn’t even get paid for it!
I also missed the small Lilly logo at the bottom of the false cover. But it was impossible to miss the 3 full pages of information about “non-insulin Trulicity, a once-weekly injectable pen for type 2 diabetics to help [your body] release its own insulin.” They’re careful to say, as required by the FDA, that it’s not the first pharmacotherapy med for type 2s. That would be Metformin, introduced in France in 1957, the UK in 1958, and the U.S. in 199X. But Metformin works on the liver to suppress unwanted glucose production and improve to insulin sensitivity (glucose uptake), and it’s safe.
As Lilly implies, Trulicity works on the pancreas, an organ that is already overworked in type 2s, to counter the insulin resistance that is the cause of type 2 diabetes. Does it make sense to put an added burden on the one (and only) pancreas you have to secrete the insulin on which your life depends? Trulicity makes the pancreas work harder; it “helps the body release its own insulin,” to use Lilly’s own words. But Lilly’s not worried about that. When the pancreas eventually is exhausted from overwork and wears out, you will graduate to another injectable drug made by Lilly: insulin glargine. And with all the increases in the last few years, have you seen the price of insulin glargine lately?
But Lilly and all the other drug manufacturers do not intend you harm. Their drugs are all approved by the FDA for the uses intended, and the uses all conform to the American Diabetes Association's Standards of Medical Care. What’s wrong with this picture? Answer: The treatment plan! The treatment treats the most common symptom of type 2 diabetes—an elevated blood sugar – by forcing the pancreas to produce more insulin. More insulin is what your pancreas has been producing for years before and since your impaired insulin response was discovered by your doctor (by an elevated fasting blood glucose, or with an A1c test).
Your impaired insulin response, aka INSULIN RESISTANCE (IR), is the cause of your type 2 diabetes. What caused your Insulin Resistance? Answer: On the government’s advice, in order to avoid eating saturated fat and cholesterol, for 60 years you ate a diet of 55% to 60% carbohydrate, composed of simple sugars and processed, refined, “whole grain” glucose molecules, euphemistically called “complex” carbohydrates. Over time, you became Carbohydrate Intolerant.
So, what’s the best treatment plan for Insulin Resistance? That’s simple too: reduce your intake of carbohydrates, especially the refined, processed ones, and the simple sugars, of course, particularly the liquid ones. From 60% there’s lots of room for lowering. For the generic woman’s 2000kcal/day diet, 60% is 300 grams of carbs/day. Lowering it to 20% would be 100 grams/day. For a man (2500kcal/day =375 grams/day), lowering it to 20% would be 125 grams/day.
With a few more waiting-room minutes on my hands, I searched that entire issue of WebMD magazine in vain for another mention of type 2 diabetes. This is a condition that nearly a third of the people of the U. S. already have, with another quarter pre-diabetic or overweight with Metabolic Syndrome. Alas, there was not a word in the whole issue. There was, however, an article on longevity where it mentioned that Metformin was being investigated as an anti-aging agent. Hmmm. Another reason to 1) eat fewer carbs and 2) take Metformin to help manage your type 2 diabetes.