Sunday, June 16, 2019

Type 2 Nutrition #490: Why, just…why?

I’ve been struggling with this question for a long time. Why what, you ask? Well, that’s the problem. It’s hard to figure out what the question is. And then there’s the answer. That’s even more of a conundrum.
As readers know, I’m not afraid to be honest, even brutally honest. I don’t mind if I offend someone’s sensibilities…if it’s in a good cause. And I believe passionately that the health and well-being of our nation, even the world, both physically and mentally, is a good cause. It’s worth telling the truth, even if at a cost.
I have put the question in various forms: Why don’t people want to change? Why is it so hard for people to change? Can a person change what one eats, or the way or when one eats, at any age? Why don’t people believe that changing what they eat will improve their health? Whom do you believe when it comes to what is a “healthy diet”? Why should a person give up their favorite “comfort” foods? What if it’s all been a big fat lie?
As I approach column #500, I’m frustrated. I’m no closer to the answer as to why others can’t/don’t/won’t change than I was when I started. I can only re-tell how I did it and hope that somehow connects with you.
In 2002, as I approached the end of my work life, I weighed 375 pounds and faced a short retirement; I looked around and didn’t see many obese old people, and those I did see didn’t look to me to be in good health. I had been a diagnosed Type 2 diabetic for 16 years, was maxed out on 2 oral meds and starting a 3rd. My prospects were that I would soon be injecting insulin. And sooner rather than later I would die of diabetic complications.
The common Microvascular ones: 1) end-stage kidney disease with dialysis (nephropathy), 2) being wheelchair bound because of amputation(s) (neuropathy) and 3) blindness (retinopathy). Today, the Macrovascular complications are even more common: heart disease, stroke, Alzheimer’s disease (“type 3” diabetes) and several cancers. I was scared. I didn’t want a “short retirement.” I was motivated to change.
My doctor thought the best way to treat my Type 2 diabetes and high blood pressure, was for me to lose weight. He had urged me to do that for years. All “his” efforts – meaning my attempts – had failed. When I lost weight, following his “prescription” to “eat less and move more,” on a “balanced diet” – I failed. Then, one day, when I walked into his office (at 375 pounds), he said, “Have I got a diet for you!” His timing was perfect.
A few months earlier my doctor had read, “What If It's All Been a Big Fat Lie,” the cover story of The New York Times Sunday magazine. The author, Gary Taubes, who also wrote Good Calories – Bad Calories, proposed an “Alternate Hypothesis” to the “low-fat” (high-carb) “balanced” diet that mainstream medicine has pushed for fifty years. And note well, following it dutifully has made us fatter and sicker.
Taubes, thrice an award-winning science journalist, wrapped up GC-BC with 10 “certain conclusions [that] seem[ed] inescapable” to him. The first 3 follow; the others are in The Nutrition Debate #5, posted here.
1.       Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization.
2.       The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight, and well-being.
3.       Sugars – sucrose and high-fructose corn syrup specifically – are particularly harmful, probably because the combination of fructose and glucose simultaneously elevates insulin levels while overloading the liver with carbohydrates.
My wife says, “Your diet is too extreme. You don’t have to cut out all carbs. You just have to cut down.” Okay, I say, if that works for you, DO IT. I have friends who’ve cut back on their carbs a little and a lot, and they’ve all lost weight. I found it easier to eat so few carbs that my body burned my body fat for energy. I’ve lost 180 pounds. The trick: Eat few enough to lower your blood insulin levels to signal the body to access your body fat. If you don’t access your body fat for fuel, you will be hungry, and you’ll just wind up back where you started.

Retrospective #121: “Behavior Change is Incredibly Difficult.”

That’s the conclusion of an article by Jason Vassy in “Personalized Medicine” that came up on a 2013 Medscape alert. He was referring to the outcome of two trials that examined whether genotype information was helpful in motivating health behavior changes in a population that was genetically susceptible to Type 2 diabetes. It was “hoped” that knowledge of one’s genetic susceptibility might be a “clinically useful tool” in targeting “primary prevention strategies before the onset of certain diseases,” e.g. Type 2 diabetes and morbid obesity.
Sadly, Vassy concluded: “At present…genetic testing for T2D risk likely does not improve preventive health behaviors in today’s diabetogenic environment.”  Quelle surprise! It also will come as no surprise that this column was one of the least popular with readers that I wrote. Everyone knows this. Behavior change is incredibly difficult.
Vassy hastens to point out, though, that “This [greater susceptibility to T2D risk] contrasts with the much larger effect-sizes of family history: T2D in one or both parents multiplies one’s risk by up to two- and six-fold, respectively.” He does not point out, however, that the association with family history goes far beyond genetics or ethnicity; it includes diet, economics, cultural practices, and many other environmental factors generally too complex to reliably isolate in even large epidemiological studies.
Behavior change, however, was the hoped-for outcome of these two studies and this author’s commentary. They were all disappointed but, I suspect, not surprised. The medical establishment has come to expect failure. Vassy expresses that outcome succinctly: “These results will not surprise clinicians, whose efforts at counseling patients for weight loss and improvement in diet and exercise habits often fail.” The implication is it’s the patient’s fault. The patient is “non-compliant” with the “prescription” because, they say, “behavior change is incredibly difficult.”
It never seems to occur to the practitioner that that expected outcome failed to materialize because of the wrong prescription. A large percentage of the world’s peoples are apparently genetically predisposed and therefore susceptible to both Type 2 diabetes and obesity. The trigger for both is eating a Westernized diet. We become fat not because we eat too much fat and cholesterol (and are too sedentary), but because we (those of us who are genetically susceptible) eat too many sugars and processed carbohydrates. Our metabolism becomes “broken.”
We make and store fat as a consequence of eating sugars, processed carbs and fat. The body uses the sugars and processed carbs for energy and stores the fat for the inevitable famine that it is designed to expect and for which it prepares us. The trouble is the famine never comes. We live in a world oversupplied with cheap carbohydrates in the form of manufactured and processed “foods products.” They taste good, and we eat them for convenience.
This is in contrast to the animal-based dietary of protein and fat, plus seasonal fruits and vegetables (unprocessed carbohydrates), that our ancestors ate. Instead, we now graze on processed carbohydrates all day long as though we lived in a veritable cornucopia (“corn-utopia” ©), LOL. Which, in fact, we do.
If we eat Low Carb or Very Low Carb, and just two or three small meals a day of moderate protein/high fat over an 8 or 10-hour period, and then fast for 16 or 14 hours, we will be living much the way our ancestors did. For most people, the outcome of this Way of Eating is weight loss, high energy levels, improved health markers (even before weight loss), wellbeing, and longevity. But this “prescription” doesn’t occur to our health care providers.
Their “hopes” are still pinned on weight loss following their “prescription” of a “balanced” (high carb), restricted-calorie diet, with less saturated fat and dietary cholesterol, and more exercise. But that’s not what Vassy’s two studies called for: “Overall, participants did not change their dietary fat intake or exercise habits over the study period, although most already had ‘good’ habits at baseline.” (My quotes added on ‘good.’)
Behavior change is incredibly difficult, when it is the wrong lifestyle modification. The right one, Very Low Carb, is easy to follow. Good outcomes – weight loss and improved health, without hunger and without exercise, follow.

Saturday, June 15, 2019

Retrospective #120: Nutrigenomics

According to Wikipedia, “In modern molecular biology and genetics, the genome is the entirety of an organism's hereditary information.”  “The study of the global properties of genomes of related organisms is usually referred to as genomics….”Nutrigenomics,” then, “is the study of the effects of foods and food constituents on gene expression.” “Nutrigenomics [thus] aims to develop rational means to optimize nutrition with respect to the subject's genotype,” which, in the case of humans, colloquially speaking, is the “genetic make-up” of an individual.
I have more than a passing interest in this subject: Thirty-three years ago, I was diagnosed a Type 2 Diabetic. I probably “presented” with all the symptoms of Metabolic Syndrome maybe 40 years ago – half a lifetime. But today this cohort includes half the human race – the half that is overweight or obese and has the indications of Metabolic Syndrome: central obesity, hypertension, dyslipidemia, and a dysfunctional glucose regulation (Pre-Diabetes or “frank” Type 2 Diabetes). To the point, this is the population that now eats a processed food diet.
Wikipedia: “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. Part of the approach of nutrigenomics involves finding markers of the early phase of diet related diseases; this is the phase at which intervention with nutrition can return the patient to health. As nutrigenomics seeks to understand the effect of different genetic predispositions in the development of such diseases, once a marker has been found and measured in an individual, the extent to which they are susceptible to the development of that disease will be quantified, and personalized dietary recommendation(s) can be given for that person” [all emphases added].
My Commentary: The prospect that, as this new science develops, “personalized dietary recommendation(s) can be given for that person” is appealing. It would be nice to have some scientific proof that if one changed one’s diet it “would return the patient to health.” It would be nice to know the particulars of the gene and protein expression, and the metabolite production and genetic sequencing, that half  the human race has that gives it a “genetic predisposition in the development of such diseases” and is therefore “susceptible to the development of that [chronic diet-related] disease” (obesity and Type 2 Diabetes). Such “personalized dietary recommendations” could then be given to half the world’s population who have this genotype that predisposes them and makes them susceptible to such diseases.  Yes, it would indeed be nice. I look forward to such erudition.
But, wait a minute! What am I missing here? Am I being obtuse? We already have laboratory “markers” – okay, they’re admittedly “crude” markers compared to a DNA microarray, but they are definitive proof; they are both measurable and repeatable; they are the indications of Metabolic Syndrome: 1) central “truncal” obesity with associated hypertension, 2) dyslipidemia, particularly low HDL and elevated triglycerides, 3) and a broken glucose metabolism, characterized by progressively worsening Insulin Resistance (IR = carbohydrate intolerance), and perhaps even a diagnosis of Pre-Diabetes or frank Type 2; all measurable, all repeatable, and all reversible!!!
Besides these laboratory results, your waist-hip ratio can tell you almost everything you need to know.  And we already know specifically and exactly what “intervention with nutrition can return the patient to health:” REDUCE TO THE FULLEST EXTENT THAT YOU CAN THE CARBOHYDRATES IN YOUR DIET. (How do you like them apples?)
For the last half century, we’ve been getting notoriously bad nutritional advice. Now, finally, many of the establishment’s weight loss “experts” are starting to see the light and are seeking “cover” by offering vague, non-specific advice to just “diet and exercise” and “eat healthy.”  The “old” view that to lose weight everyone should eat a “restricted-calorie, balanced diet,” is acknowledged to be all wrong. It just doesn’t work! As a result, an increasingly skeptical public is open to an approach that actually does work: a low-carb, moderate-protein, high-fat diet. That is my “prescription,” and I aver it would work for half the human race. Is it time for you to try it?

Friday, June 14, 2019

Retrospective #119: “Lifestyle Intervention is Great Therapy.”

Ralph A DeFronzo, MD, Director of the Diabetes Division at the University of Texas Health Science Center, made this comment at the May 2013 American Association of Clinical Endocrinologists (AACE) meeting. His presentation got my attention since Dr. DeFronzo is a favorite of mine for his Banting award lecture at the 2008 ADA convention. In it he said, “By the time that the diagnosis of diabetes is made, the patient has lost over 80% of his/her β-cell function, and it is essential that the physician intervene aggressively with therapies known to correct known pathophysiological disturbances in β-cell function.”
At the AACE meeting he said, “There’s no doubt – when you look at diabetes prevention – if you can get people to lose weight and exercise on a regular basis, lifestyle intervention is great therapy.” “The issue is not whether diet and exercise works. It works. The issue is can you get people to do it on a long-term basis. I think it’s time to face reality. The reality is, it doesn’t work long-term.”
Obviously, I was expecting more, but I shouldn’t have. He is just a physician, albeit a leading one. He is a pill peddler; when pills fail or something better comes along, he’ll push that. He is a prescriber. Whatever big pharma comes up with to treat the “pre-diabetic” or diabetic patient, he’ll prescribe. That’s what doctors do.
There is also the real question of what can a physician do to get you to lose weight. There is no magic pill. If he and you view him as being in charge of your health, that’s a problem. He’s in charge of your healthcare; you’re in charge of your health. You have it in your power to lose weight, and you can do it with the right dietary “prescription.”
I do not deny that lowering the goal posts for diagnosis of pre-diabetes and diabetes to new markers – lower FBG thresholds and adding the A1c’s to the diagnostician’s quiver – are steps in the right direction. I applaud these changes. It’s just that they’re shooting at the wrong target. The target for weight loss should be a Low Carb diet. And the bull’s eye should be Very Low Carb. But, what does a doctor know about nutrition? Nothing! Ask them. They usually are the first to acknowledge they just follow “practice guidelines.” That’s all they’re qualified to do.
Except my doctor went rogue. He went “off label” and “prescribed” Atkins Induction (20g/d of carbs) for weight loss. He did it after reading Gary Taubes’s “What If It’s All Been a Big Fat Lie?” in a 2002 New York Times story. He tried it himself and lost 17 pounds in 6 weeks. Unfortunately, as Dr. DeFronzo said, he didn’t stick with it long term.
But it worked for me. And it still works for me. I lost 170 pounds and put my Type 2 diabetes in remission. It could do the same for you too, if you don’t listen to everyone who tells you it “doesn’t work long-term.” It does work long-term, if you stick to it. What they mean is that people don’t stick to it. Not that it doesn’t work long-term.
Part of the problem is that “Lifestyle Intervention” is intentionally vague. It could be defended as being “inclusive” but is more likely intentionally undefined to avoid controversy and going against the prevailing dogma. It is convenient as a phrase as it includes the idea of exercise. Exercise is good, I suppose, but I don’t do any formal or regular exercise. What works is lowering serum insulin by eating Very Low Carb. That also raises insulin sensitivity.
Because Lifestyle Intervention is so vague, it is left to everyone to interpret it in the way they chose, along with the meaning of the word “moderation.” Government still pushes the Aristotelian virtue of moderation. And that a healthy lifestyle includes a restricted calorie, low-fat “balanced” diet, as the standard “one-size-fits-all” approach.
That this “standard” therapy doesn’t work is what Dr. DeFronzo is talking about. He’s primarily an academician, but he’s right. Many patients don’t stay on a low-carb diet long-term, and the minute they leave the diet, it ceases to work because they have become, are still, and will hereafter always be, carbohydrate intolerant. By eating that “Standard American Diet” for many years, being genetically predisposed, they were susceptible to and underwent an epigenetic change. THAT is the reality it’s time to face. NOT that eating Very Low Carb doesn’t work long-term.

Thursday, June 13, 2019

Retrospective #118: “Nobody Weighs 375 Pounds”

This quote was said to me in conversation as I was rattling on about my “discovery” in August 2002 that I weighed 375 pounds. It was said with a slightly upturned lip and a wry smile that I interpreted to mean both disbelief and admiration. Regardless, it was true. I once weighed 375 pounds, and it was the beginning of a beautiful story.
For about a year my doctor’s nursing staff had been unable to weigh me because the office scale only went to 350 pounds. So, on my way to work on the day of my next scheduled appointment, I stopped at the Fulton Fish Market in NYC and asked permission to weigh myself on a wholesaler’s certified platform scale. I was stunned. The shock was genuine, and I came to my appointment with my doctor that day motivated to lose weight. 
Then, as I walked into my doctor’s office, he saw me and said, “Have I got a diet for you!” So, I was motivated – TO LOSE WEIGHT. It never occurred to me, or him at first, that this would be beneficial to my blood sugar regulation, or my lipid (cholesterol) health. But as we walked down the hall to schedule my next appointment, he put his hand on my shoulder and said, “Dan, this might be good for your diabetes too.” Boy, was that an understatement!
Regular readers have heard this story before, so I will be brief. Six weeks earlier my doctor had read the New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie,” by Gary Taubes. He tried the diet described and lost 17 pounds, so he recommended I try it too, TO LOSE WEIGHT. The diet was Very Low Carb (20g/d), which virtually eliminated carbohydrates from my diet. On the first day I had a hypo and called my doctor. In the course of that first week, he told me first to eliminate one med and then to cut the other two meds, on which I was maxed-out, in half, TWICE. A few years later, I completely titrated off one of the two but continued on Metformin (500mg).
As I stayed on this Very Low Carb diet, cholesterol panel improved very dramatically. My HDL cholesterol more than doubled from average 39 to average 84, and my triglycerides were reduced by two-thirds from about 135 to 49, where they have remained ever since. Oh, and did I mention? I LOST 170 POUNDS. As a result, of course, my blood pressure also came down from 130/90 to 110/70 on the same meds, and my inflammation marker (C-Reactive Protein) greatly improved. Finally, my A1c’s are now mid-5s with fasting blood glucose (FBG) usually 80s and 90s.
So, is my Type 2 diabetes cured? No! Metabolically speaking, I will always have a broken, disregulated glucose metabolism. I still have Insulin Resistance “in spades.” There’s no denying that. I could weigh 375 pounds again. But, so long as I continue to eat Very Low Carb, my type 2 diabetes is and will remain in remission, undetected and virtually undetectable to any clinician or laboratory test routinely administered in an office visit by an unsuspecting clinician. And a knowing clinician, would say, because my A1c is less than 5.7%, that I am clinically non-diabetic.
But, if I returned to eating a “balanced” diet, as the Dietary Guidelines recommends, my blood glucose would go immediately “out of control,” and I would again become progressively dependent on anti-diabetic medications, eventually becoming an insulin-dependent Type 2. The “balanced” diet is high carbohydrate (55% to 60% by calorie). The Nutrition Facts panel on processed food packaging shows it. The RDAs are based on 60% carbs, or 1,200 carb calories, on a 2,000 calorie a day diet. Check it out, if you don’t believe me. In addition, my lipids, which are stellar, would return to borderline or worse, and my doctor would be aggressively pushing me to take a statin.
But best of all, I think, is the certainty that eating Very Low Carb, which unavoidably means eating high fat, is a very good way to lose weight. That is why my cardiologist doctor, who tried it himself, recommended it to me. It worked as a WEIGHT LOSS DIET, for him and for me. It just happens that I was also a Type 2 diabetic.
If you are Pre-diabetic, or a diagnosed Type 2, or even just a little overweight, Very Low Carb, or even Low Carb, will do the same for you. Eating VLC will “regularize” your blood sugar, making it more stable, and thus make it easy to lose weight without feeling hungry. Spoiler alert: you aren’t hungry because your body is satisfied when it is feeding on its own fat stores. And eating Very Low Carb (and therefore high fat) will improve your blood pressure and your blood lipids (cholesterol), especially HDL and triglycerides. So, dear reader, why not try it?

Wednesday, June 12, 2019

Retrospective #117: “Sugar, Salt and Fat”—the new “Bad Boy” Linkup

Have you noticed lately that the dietary Dictocrats have declared “sugar, salt and fat,” (in any order) the new trio of “bad boys”? Notice they are linking sugar to the previously demonized salt and fat. Adding sugar is a clever way for them to pivot and I commend them for that, but salt and saturated fat have never been on my “bad boy” list.
Mary Enig had trumpeted the dangers of artificial trans fats since the McGovern Select Committee hearings of 1977. In that, of course, she was “spot on,” as the government finally acknowledged in 2003. But, not without wrongly linking the danger of artificial trans fats (made from corn and other vegetable oils) to saturated fats from animals. They also conveniently ignored the natural trans fat (conjugated linoleic acid or CLA) that is found in animal fats and is very good for our health. Chemically these two fats are very different. Natural CLA is good.
Further differentiation among fats has occurred more recently: our government has declared that SOLID FATS (again lumping together both the naturally occurring saturated fats and the artificial trans fats) are “bad,” but VEGETABLE OILS, which are highly processed food products, made from seeds and grains, are “good” for you. You’re asked to ignore the fact that the United States Department of Agriculture is the federal agency responsible for both promoting corn and soybeans, the mainstays of the U. S. agricultural and food manufacturing industries, and protecting the public health, in that order. It’s pretty scary, when you think about it.
Anyway, sugar has now been added to this nefarious group and with good cause –sugar is indeed a “bad boy.” Note, however, that sugar is not identified as a carbohydrate. It is a simple carb, either a mono or disaccharide. Glucose is the most common component of the molecule. It is easily used for energy. The body “prefers” to burn glucose first so it can conserve fat in storage for the coming famine. Don’t we all know this? If we become “sugar burners” by grazing on carbs all day, we (our body, through the action of insulin) will not burn any of our stored body fat. As long as there’s sugar aplenty, it will pile more fat on our bodies to prepare for the “lean times” ahead.
Fructose is another component of the common sugar molecule sucrose. Consumed in large amounts it is also a “bad boy.” A chronic toxin, it isn’t burned like glucose. It is shunted to the liver to be detoxified. If the liver can’t handle the load, it converts it, in steps, to fat by lipogenesis, and we get NAFLD – nonalcoholic fatty liver disease.
So, what’s wrong with the new triumvirate the government has created? If you believe that salt and saturated fats are bad for you, then nothing. The government has invested billions in vilifying salt and fat, and lumping sugar (sorry) together with salt and fat condemns it by association. The problem is that salt and saturated fats are not bad for you, but excessive simple sugars are. And if you’re a Type 2 diabetic, as I have been for 33 years, then anything that becomes glucose in the blood (simple or complex carbs) has to be eaten in very limited quantities.
I hew to the injunction articulated for me by Kurt Harris, MD, in his defunct Archevore Diet: avoid as much as possible the “NADs (Neolithic Agents of Disease): wheat, excess fructose and excess linoleic acids.” The latter are “the grain and seed derived oils (cooking oils): Eat or fry with ghee, pastured butter, animal fats, or coconut oil. Avoid temperate plant oils like corn, soybean, canola, flax, walnut, etc. Go easy on the nuts, especially soy and peanuts.” For me, this translates to a different triumvirate: Wheat, corn and soy. And legumes, except green beans.
Harris adds: Eat “whole foods from animals. Favor grass-fed ruminants like beef and lamb for your red meat. Animal fats are an excellent dietary fuel and come with lots of fat-soluble vitamins. It can work very well to simply replace your sugar and wheat calories with animal fats. If you are not diabetic, you can eat more starch and less animal fat. A low carb diet can rely more on ruminant fat and pastured butter.”
I add salt to most things. An argument in favor of this practice is made by Michael Eades, MD, and by Volek and Phinney in their excellent book, “The Art and Science of Low Carbohydrate Eating.” See Retrospective #74.
So, by all means, avoid sugar, but not salt and saturated fat. Both are good and necessary for your health.

Tuesday, June 11, 2019

Retrospective #116: “A Modifiable Risk Factor”

A Letter to the Editor in my online Lancet subscription contained the comment: “Physical inactivity should be considered as a modifiable risk factor. IMPROVING OF POPULATION HEALTH SHOULD NOT SIMPLY BE MADE THE WORK OF DRUG COMPANIES.” “Bravo!” I say. And this advice is especially apt for OBESITY AND T2 DIABETES too!
But not through exercise! Obesity is also “a modifiable risk factor,” and “improving of population health” – both through weight loss and the concomitant remission of type 2 diabetesis achievable simply by modifying the macronutrient composition of the diet. It stands to reason, doesn’t it, that if carbohydrates increase the amount of glucose in the blood, particularly among those who have become Insulin Resistant and thus Carbohydrate Intolerant, then reducing the carbs in the diet will reduce the glucose in the blood? I mean, who doesn’t get this?
For our government to ignore this “obvious truth,” with a “one size fits all” prescription in its Dietary Guidelines for Americans, amounts to gross negligence and, for clinicians, medical malpractice on a humongous scale.
I say “concomitant” because remission of type 2 diabetes is a phenomenon that naturally accompanies or follows adoption of a Very Low Carb diet. In 2002, my doctor, who had been trying to get me to lose weight for years, read about a Very Low Carb (20g/day) diet program in the New York Times Sunday magazine. The story, “What If It’s All Been a Big Fat Lie,” was written by the acclaimed science writer Gary Taubes. What attracted my doctor to the story, though, was the photo of the ribeye steak on the cover. As a cardiologist, he hewed to the “company line” to avoid saturated fats. But the visual image got his salivary juices started, so he decided to try the diet himself. He lost 17 pounds in a month and decided to suggest it to me…TO LOSE WEIGHT, NOT TO TREAT MY TYPE 2 DIABETES!
He did suggest, as an afterthought as we walked down the hall of his office to make an appointment for another visit in a month (to monitor me closely), that the low-carb diet “might be good for your [Type 2] diabetes too.” In retrospect, I have to say, how clueless could he be?!!!!! Anyway, he didn’t have to wait a month to see how the dramatic reduction in carbohydrates affected my diabetes; within a day, I had my first hypo. A hypo (hypoglycemia) is a dangerously low blood glucose condition. When I felt the sweating, I went to the newsstand and bought a candy bar. This was perhaps a bit of an overreaction, I admit, but this was my first ever hypo, and I was scared.
Next, after the sweating stopped, I called my doctor. He told me to immediately drop one of the oral anti-diabetic medications he had prescribed for me. Next day late afternoon I had my 2nd hypo, another candy bar, and called my doctor again. This time he said to cut the other two oral anti-diabetes meds I was on (at maximum doses) in half. I did, but then a few days later, I had my 3rd hypo. This time my doctor told me to cut both meds in half AGAIN.
I’ve been following a Very Low Carb diet now for 17 years, and I’ve never had another hypo. I eventually titrated off one of the two remaining meds (Micronaise, a sulfonylurea), and lost 170 pounds. I still take Metformin though, to improve insulin sensitivity and suppress unwanted glucose production by my liver.
Along the way, my blood pressure improved from 130/90 to 110/70 on fewer meds. My triglycerides dropped from about 135 to 54 average, and my HDL (good) cholesterol more than doubled from 39 to 84 average. My total cholesterol is under 200 while my latest LDL was 92. And my fasting blood glucoses are usually under 100 and my A1c’s under 5.7% (lowest 5.0%). You would never know I was diagnosed a Type 2 diabetic 33 years ago.
So, obesity is “a modifiable risk factor” and the concomitant benefits of losing weight on a Very Low Carb diet are 1) remission of type 2 diabetes, 2) improved lipid profiles and 2) improved blood pressure. Indeed, “Improving of population health should not simply be made the work of drug companies.” This eloquently stated and obvious truth has been ignored by health-care professionals for many years. But, just as the obvious truth that eating fewer carbs will lower serum glucose levels in the insulin resistant patient, it is also a very effective way to lose weight in the patient whose glucose metabolism is normal. The blood lipid and blood pressure benefits will follow, even where blood glucose regulation is not required, “improving…population health” concomitantly. No Rx required!