Sunday, September 22, 2019

Retrospective #218: “Diabetes Causes Nerve Pain”


Misleading advertising riles me all the time, almost as much as grammatical errors by news anchors, talk show hosts and United States Senators. And I am especially riled by advertising that claims that others are being misleading while being themselves misleading. They must think we’re all dummies!
My current (2014) favorite is a teachers’ union advocating for the Common Core curriculum. In it, an actor playing a teacher says (I’m paraphrasing), “Those opposed to the Common Core are misleading the public”; she protests, “Common Core does NOT tell teachers HOW to teach” (emphasis mine). “THAT is misleading,” she says. What she DOES NOT say is that Common Core DOES tell teachers WHAT to teach! THAT’S ITS PURPOSE. Grrrrrrrrr!
Another TV commercial I’ve heard over and over says “Diabetes causes nerve pain.” I guess it’s a scare tactic. You’re supposed to rush to your doctor and ask him to prescribe the drug that is being advertised. It unnerves me (hehe) to hear it. Diabetes does NOT cause nerve pain. Uncontrolled diabetes causes nerve pain and will eventually damage the microvascular system, specifically the tiny blood vessels in the extremities (legs usually), the eyes (the retina), and/or the kidneys. These complications can lead to amputations, blindness and end-stage kidney disease.
The mechanism is that when the blood supply is cut off to the tiny blood vessels, they don’t supply the nerves with the oxygen they need to receive and send signals; thus, you become insensitive to pain or injury to your feet. A cut or some other undetected injury of an uncontrolled diabetic can thus lead to infection, then gangrene and amputation.
Uncontrolled diabetes is the culprit, NOT diabetes. The point is that uncontrolled diabetes – am I repeating myself? – is what needs to be avoided – and “treated” when it’s encountered. The worst thing you can do is ignore a blood sugar that is not in control. Over a period of years, it will manifest itself. And you will likely die from it. And that’s scary.
Getting your blood sugar to the point where it never exceeds 140mg/dl at any point after a meal and returns to under 100 mg/dl (if you are pre-diabetic or a diagnosed Type 2) should be your goal. Any after-meal spike above 140mg/dl are going to damage your microvascular system, slowly but surely. And remember that an A1c of 7.0% (the ADA target!!!) is equivalent to an estimated Average Glucose (eAG) of 154mg/dl. If you have an average blood glucose of 154mg/dl (7%), just imagine how much of the time your blood sugar is above 140mg/dl. Now, that’s, really scary.
So, how to you “treat” uncontrolled Type 2 diabetes? Your doctor will probably start you on oral anti-diabetes meds and tell you to lose weight, probably on a low-fat, “balanced” diet. You’ll probably also need blood pressure meds, maybe a cocktail of them. Oh, and of course, a statin, to lower your Total and LDL Cholesterol (because statins will do that, although the benefit of doing so has not been shown). You should know that under this regimen, your Type 2 diabetes will be a “progressive” disease. That is, your condition will worsen; you will take more and more medication, ultimately leading to injecting insulin. And don’t forget the complications. They’re in your future too, including Macrovascular complications (e.g., CVD). This is getting too scary even for me. But there is an alternative. Interested?
YOU could treat your Type 2 diabetes yourself. That’s right, YOU. YOU can control your blood glucose simply by controlling the things you put in your mouth. The foods (and drinks) that make blood sugar rise ALL contain carbs. Carbs, both the simple sugars and the more complex carbohydrates (both processed and unprocessed), when digested, all convert to glucose, or “sugar,” in your blood. The hormone insulin transports and facilitates its uptake.
If you have T2 diabetes (or are prediabetic), your body has over time become resistant to insulin, so the glucose continues to circulate. In essence, you have become carbohydrate intolerant. To control your diabetes, you only need to limit the amount of carbohydrates you eat and drink. It’s that simple.
I’ve been writing about this subject for 10 years. I’ve been a Type 2 diabetic for 33 years, the last 17 eating Very Low Carb, (mostly) healthy foods. My Type 2 diabetes has not progressed. In fact, it has been in remission for 17 years. I am much, much healthier today that I was 17 years ago. You can be too, if YOU take charge of your diabetes health.

Saturday, September 21, 2019

Retrospective #217: Type 2 Diabetic says, “I can eat whatever I want.”


I was seated next to a Type 2 diabetic acquaintance at a church supper recently. As the plates of food were passed around, I took a nice portion of ham and then (guiltily) a serving of cole slaw. I knew it was loaded with added sugar, but I also knew my other choices would be limited. I passed on the scalloped potatoes au gratin and the peas, and the bread basket, and the sweetened ice tea, each time passing the dish to my friend, who took a regular portion of each.
I didn’t say anything, but I thought to myself, how can he do this to himself? This man is somewhere in his eighties, skinny as a rail and looks healthy. Maybe the question should have been, how does he get away with eating like this? Eventually, I managed to open the subject with him. He responded by saying, “I can eat whatever I want.” He then reached down to his belt and, out of a small pouch, raised his pump controller to show me how he does it. My friend, it turns out, is an insulin-dependent Type 2 with a pump that allows him to set the amount of basal and mealtime (bolus) insulin before each meal. So, he knew what was for supper – it’s the same every year – and had given himself a “shot” via the needle imbedded under his skin. Voila! He can now “eat whatever he wants” and “cover it” with insulin.
Managing Type 2 diabetes with injected insulin has heretofore always been the last resort of pharmacotherapy. Type 2s used to be started on a course of oral pharmaceuticals and told to continue to eat a “balanced diet.” As one drug failed to achieve the desired control (A1c’s within the ADA recommended range of 7.0%), the dose was increased and/or another class of oral introduced until the patient, still eating “a balanced diet,” maxed out on three classes.
Then, the dreaded insulin injection was employed for basal (slow acting for 24-hour control) and mealtime “boluses.” Today, the introduction of new classes of orals, and the (GLP)-1 receptor agonists, and more recently the new (SGLT)-2 inhibitor drugs, that work on eliminating sugar in the blood via the kidneys, have enabled some patients to delay multiple daily insulin injections. And “the insulin pump” has replaced them all, for those who use it.
Another approach has been the introduction of injected insulin as a first course of treatment. The rationale is that if you eat a low carb diet, and inject a low dose of basal insulin once a day, you can potentially achieve better control by reducing postprandial spikes (elevated blood “sugars” after meals), thus achieving much lower A1c’s vs. the 7.0%. Better control also means the surviving beta cells of the pancreas, that produce endogenous insulin, get a rest.
An A1c of 7.0%, by the way, is equivalent to an estimated average glucose (eAG) of 154mg/dl, but an A1c of 6.0% is an eAG of 126 and an A1c of 5.0% is an eAG of 97. This improvement will surely reduce the possibility of the complications of poorly controlled diabetes: retinopathy, neuropathy, and nephropathy (translation: blindness, amputations and end-stage kidney disease). Plus, it reduces the possibility of a much greater chance of a heart attack. Any time your blood sugar is above 140, you are causing damage, and an average of 154 means it is above 140 A LOT. It is, in my opinion, bordering on criminal to counsel patients to only strive to achieve an A1c of 7.0%.
I don’t write about insulin dependent Type 2s because I know very little about it. Years ago, I read Richard K. Bernstein’s Diabetes Solution, the definitive source book on the subject (for both Type 1s and Type 2s), but promptly forgot most of the Type 1 details. His latest edition is very highly regarded among those in the know. It is the “bible” for the growing numbers of T2s as well as T1 diabetics who have discovered THE BEST WAY TO MANAGE AND CONTROL THEIR DISEASE IS TO EAT LOW CARB, with or without an insulin regimen.
But because I rely on my dietary choices (plus a daily, single low-dose Metformin) to directly limit the response of my (broken) blood sugar metabolism, I’ll bet my blood sugar is more stable, with fewer excursions, and therefore better controlled, than my friend’s (except at this particular supper: LOL). I’d even venture to wager that my A1c is lower than his. I didn’t ask him his, though. He, and his doctor apparently, are happy with whatever it is, and he was very happy to be able to say, “I can eat whatever I want.”
This column was originally written in 2014. Sadly, my friend died of “complications” (heart disease) in 2015.

Friday, September 20, 2019

Retrospective #216: Is Low-Carb High-Protein or High-Fat?

The cognoscenti (my regular readers, who are “in-the-know”) know that the answer is “high-fat.” But I squirm in my seat when I hear someone, who appears to be informed on the subject, say, “Low Carb is high-protein.”
That occurred one night in while I was watching one of my favorite TV shows. The subject was a Wall Street Journal “Saturday Essay,” titled, “The Questionable Link Between Saturated Fat and Heart Disease.” This person accurately blamed the obesity epidemic on the American (or Western) diet which is very high in carbs and processed foods; but then he proceeded instead to advocate for a diet high in protein! That is WRONG, WRONG, WRONG!
Diets that are very high in carbohydrates and processed foods ARE the reason we as a civilization for 50 years have been getting fatter and sicker.  The Wall Street Journal got it right. They also correctly noted that the beginning of this very large, population-wide, public health “experiment” in eating “low-fat” can be attributed to Ancel Keys. I first wrote about Keys in Retrospective #3, after Gary Taubes (Retrospective #5) brought him to my attention.
Keys was an American physiologist whose “Six Nation Study” (later revised to “Seven Country Study”) was just bad science. This was just a few years after President Eisenhower had his heart attacks and went on the Pritikin diet. Incredibly, however, low-fat quickly became dietary dogma. Keys made the cover of Time Magazine in 1961 and joined the American Heart Association board. It was later revealed that his studies were “cherry picked.”
Meantime, a low-carb diet, which is the antidote to the fattening low-fat diet (you read that right), is high fat and moderate protein. Let’s talk numbers (percentages). Diets can be classified by what are called Macronutrient Ratios:
The Low Fat Diet: The Standard American Diet (SAD, for short!) is high carb, moderate fat and adequate but low protein. The FDA’s Nutrition Facts Panel on processed foods, based on a 2,000 calorie a day diet, is comprised of 60% carbs, 30% fat and 10% protein. The dietary Dictocrats have recently recognized that simple sugars and processed carbs are too high and have moved slightly away from the 60% carb percentage (but not changed the package labeling). Still, they steadfastly maintained a target of less than 30% fat. That can only mean an increase in protein. To the extent carbs are reduced (from 60%) and fats do not exceed 30% (while advocating a lower percentage), only protein can rise. Remember, there are only three macronutrients: carbs, fat and protein. Something’s gotta go up!
In addition, a plant-based diet is increasingly being advocated by the vegan lobby. All plants are carbohydrates. Most protein (not all – there are some proteins in legumes and nuts) is animal-based. So, the struggle to maintain a high-carb, low-protein macronutrient ratio is an unrelenting battle within the establishment.
The Low Carb Diet: The macronutrient ratios for a low-carb diet are not defined. They are all over the place. This is okay with me since 1) people’s metabolic status (degree of carbohydrate intolerance) are different and 2) making the transition from 60% carb to a much lower percentage is a very good thing – but for some (who don’t go “cold turkey” like me), it takes time and a lot of effort. So, let’s say for our purposes that a prototypical Low Carb diet is 20% carb, 20% protein and 60% fat. That’s a very dramatic (2/3rds) reduction in carbs, from 60% to 20% (low), and a doubling of protein from 10% to 20% (moderate) and fat, from 30% to 60% (high). That “high fat” is really scary for some people, especially because there is disagreement (and therefore confusion among the public) about what “good” fats are.
For that discussion, Google “the nutrition debate good fats” for some of my columns on fat. But there is another mitigating factor: All these percentages are in calories, and since fat has more than twice as many calories per gram as both protein and carbohydrates (9 vs. 4), you really are eating less than half as much fat (by weight) than you think.
Very Low Carb: I started “Low Carb” dieting at 20 grams a day, which is Very Low Carb: My first ratios (as it turned out) were 10% carb, 30% protein and 60% fat. I later tweaked that to 7% carb, 25% protein and 68% fat. Today, I aspire to eat 5% carb, 20% protein and 75% fat (by calorie, remember, not weight). Of course, we don’t eat percentages; we eat portions, which are envisioned in the mind’s eye by mass (weight). These quantities and calorie percentages are determined by software that some of the compulsive among us (including me) have used.
Low Carb is really moderate protein and high fat. The lower the carb percentage, the higher the fat. Some call it, Low Carb High Fat (LCHF). What does your Eating Plan look like?

Thursday, September 19, 2019

Retrospective #215: Just Google, “The Nutrition Debate” (in quotes)


I’ve been writing this column since 2010. I started posting once a week, then twice, now, as Retrospectives, daily rewrites at thenutritiondebate(dot)com. Some readers follow me by RSS feed, others on Facebook and twitter, yet others by a link from other sites. Most readers, however, are still introduced to “The Nutrition Debate” by Google searches on topics of interest to them.
Blogger provides me with some simple statistics or my readership by day, week, month and all-time. It also tracks my audience by country, traffic source, and post (column), so I have a broad idea of who, how and what my readership is.
Only 40% of my readers are in the U. S. The Ukraine and Israel garner a little less than 10% each. Russia, France and China come next, then Germany, Canada and the UK. Interestingly, Poland rounds out the top ten. Once in a while I get 1,000 pageviews in a 1-hour period from Israel. Obviously, someone who follow me there posts a link on their site.
I also have loyal followings in Sweden, Hong Kong and Singapore. The Singapore readership in on a site where a very popular and avuncular social network leader writes on the subject of “Clean Eating.” He provides occasional links to my columns and has even posted a few as permanent resources for his followers.
It’s interesting to me that I have so many readers in Ukraine-Russia and China. I suppose that people there have “hijacked” my content (with or without attribution, who knows?) and appear to read everything I write. Some sites are commercial (e.g., department stores), others are pornographic sites. All are in a Slavic language. I don’t object, mind you. I write this column for educational purposes. There is no revenue, and I have no interest in commercializing it.
This might also be a good time to mention that I have a wonderful and intrepid volunteer editor, a person who makes my writing clearer, checks my facts, and whose digital resources are almost as vast as Google’s (slight exaggeration there). Her acumen in all things health and nutrition is only exceeded by her generous heart and her interest in spreading the word about good nutrition and healthy eating. I am unabashedly in awe of her.
So, since Google seems to be the main, continuing source of new readers, I encourage this method of using that search engine. Just as Google has a “feeling lucky” search function, you could do the same. Just type “The Nutrition Debate” (in quotes) in the “window,” (or, thenutritiondebate(dot)com), hit “enter,” and let ‘er rip. I guarantee that my blog will come up on the first page, or in the latter case, first.
Of course, if you want to do a more targeted search, you could do something more “advanced.” Enter “The Nutrition Debate” and another word or phrase of interest to you (or a column number, i.e., #xxx. Let Google do the work! To see how well this works, I just entered “the nutrition debate triglycerides” and all ten (10) Google results were columns that I have written on triglycerides. This works very well in the absence of “tags,” “labels,” or “key words.”
On the other hand, if you’d like to see a list of all the columns I’ve written, in some browsers you can see a list.“The Nutrition Debate List of Columns, appears at the top right corner of the post, listed under “Favorite Links and Videos.” This works in Chrome, but, alas, not in IE.
So, if you are one of those who rely on Google (or another search engine), as I do, I encourage you to try this “advanced search technique.” I am too much of a Luddite, or troglodyte, and too lazy at this point, to go back over 500 columns and enter tags, labels and key words. Use technology to search instead. It works for me. Just Google “the nutrition debate” and another key word or phrase, and press “enter.”
Then, if you like what you have read, go to the RSS feed and get my blog delivered every morning to your hand-held device, tablet, laptop, or work station. And please, send me your comments and ideas. I’m always looking for your feedback and subjects of interest to you, me and my readers. It’s helps me get educated too.

Wednesday, September 18, 2019

Retrospective #214: How I Lost 188 Pounds (Part 2)

In Retrospective #213 I told how, by just restricting carbs, and later protein, that I ate for weight loss, my blood sugar control, blood pressure, blood lipids, and inflammation markers all vastly improved. You (and your doctor) would be very happy to have these results (as I and mine are), but the story doesn’t end there. There is more to tell.
Starting at 375 pounds, I lost the first 60 pounds in nine months (1½ pounds a week) by eating just 20g of carbs a day. I wrote down everything I ate every day, estimating carb grams. No measuring – just guessing. It gave me heightened awareness and accountability for what I decided to eat – and I learned a lot about which foods contained carbs and how they affected my blood sugar. When I started Very Low Carb (VLC) in 2002, I had been a progressively worsening Type 2 diabetic for 16 years. I left my diabetes care to my doctor. Now, I rely on self-care for my diabetes health.
After 4 years, however, I began to slip and gained 12 pounds. I wanted to lose those 12 pounds and a lot more. That’s when I decided to count protein. I devised my own method for determining how much protein to eat, which I explain in Retrospective #213. I started at 90 grams of protein a day (1.1g/kg), later dropping in steps to 60 grams (0.9g/kg).
That only left fat and total calories. I chose an online site to do the calculations. All I had to do was to remember, truthfully, everything I ate and enter the estimated amounts. The software did the rest.
I determined how many grams of fat to eat by backing into the calculation. I wanted to lose 2 pounds a week. At 3,500 calories/pound that is 7,000kcal/wk., or 1,000kcal/day. If a mostly sedentary, older male who doesn’t exercise needs 2,200kcal/day to maintain his weight, then I would need to eat just 1,200 kcal/day to lose 2 pounds a week. And 90 grams of protein + 30 grams of carbohydrate = 120 grams, times 4 calories/gram, equals 480 calories. Subtracted from 1200, that leaves 720 calories for fat. At 9 calories/gram for fat, that means my allowance for fat was 80 grams a day.
That’s where I started on Richard K Bernstein’s 6-12-12 program for diabetics. I didn’t care about macronutrient ratios or ketosis. I just ate Very Low Carb and “moderate protein.” Result: I lost 100 pounds in 50 weeks (2 pounds a week, as planned), lowering my protein as I went along. I lowered protein from 90 grams to 75 and then eventually, today, just 60 grams a day, which is 20% of 1,200kcal and still 20% above the USDA’s guidelines (50g/d or 10% of 2,000kcal).
Later, I became interested in Macronutrient ratios. The diet that worked for me (where I lost 100 pounds) was 10% carbs (30g/day), 30% protein (90g/day) and 60% fat (80g/day). Thirty percent protein is the highest percent most experts recommend for protein, and then only if you have no kidney problems. Your blood markers for kidney disease should be tested by your doctor before you start and rechecked annually on any moderately high protein diet.
As I lost weight, and discovered low carb foods that I liked for breakfast and lunch, and ate good fats, and small low carb and protein suppers, I lowered both my protein and carbs, and increased my fat percentages. My macronutrient ratios changed, from 7% carb (20g), 25% (75g) protein and 68% fat (90g) to 5% carb (15g), 25% protein (75g) and 70% fat (90g). Now, they are 5% carb (15g), 20% protein (60g) and 75% fat (98g). All of these ratios are for 1,200kcal/day.
It’s pretty easy to eat this way because “my body” is telling me that it is “happy.” I have come to think of my body as a separate entity that I am living in. I just eat small meals at mealtimes. This is called “non-homeostatic” eating. That is, I am not eating because my body is telling me to; I am not hungry at mealtimes. I am eating because breakfast, lunch and supper are “mealtimes.” My body decides what to do with the food, to add fat or burn fat and maintain muscle.
So, what do I eat? Breakfast is 3 eggs, 1 strip of bacon and a cup of coffee with heavy cream and a little stevia powder. Lunch is usually a can of kippered herring snacks in brine or Brisling sardines (in olive oil!). And supper is a small portion of protein, usually a fatty meat or fish, and a low-carb vegetable, either tossed in butter or roasted in olive oil. If I snack (before supper only), my favorite is celery with anchovy paste. Sometimes I’ll have olives, or radishes with salt and a dollop of butter, or a small portion of nuts. Macadamia nuts have the fewest Omega 6s, while hazelnuts, almonds or pecans have moderate amounts. Cashews are too high in carbs and walnuts much too high in Omega 6s.

Tuesday, September 17, 2019

Retrospective #213: How I lost 188 pounds (Part 1)

At my doctor’s suggestion, I started eating Very Low Carb (VLC) in 2002 to lose weight. At the time I had been a long-term (16yr) Type 2 diabetic. I have been very successful, at one point losing 188 pounds. I also had to give up most of my diabetes drugs while getting “normal” fasting blood sugars (80s mg/dl) on only 1 low-dose Metformin once a day.
When I began VLC 17 years ago, I was “maxed out” on two classes of oral diabetes meds and starting a third. Within a day of starting to eat just 20g of carbs a day, I got my first hypo (BG reading in the 50s). I ate a candy bar and called my doctor. Over the next few days he told me to cut my diabetes meds three times, twice by half . As I lost weight, my BP gradually dropped from 130/90 to 110/70 at the same meds. Over time my HDL doubled and triglycerides dropped by two-thirds. My Hb A1cs are now consistently in the mid-5 range, and both my HDL/TG ratio and my hsCRP, an inflammation marker, are both usually under 1.0. I am never hungry. I have lots of energy, and I feel great. By all these measures I am today (age 78) much healthier than I was 17 years ago. How did this happen? I’m going to tell you.
When I first started eating VLC, for a few years I wrote everything down that I ate but only counted estimated carbs. I didn’t measure anything. I just listed everything I ate and guessed at the carb content. I did this in an Excel table I created that totaled the estimated carbohydrate grams daily. The math was simple and the method not very accurate, but I was learning about low carb eating, and I was being totally accountable and brutally honest. I was learning what foods raised my blood sugar. This is a learning process everyone eating Very Low Carb for blood sugar control must do.
Four years later I became interested in how much protein I should eat. I decided to eat a similarly sized, small-to-medium portion of protein with each meal, and to space the meals at regular intervals, ala Richard K Bernstein, MD. Bernstein also counseled that, to lose weight you reduce the portion size of protein for one meal, and if that wasn’t enough, a second meal each day, due to its “insulin effect.” This would later guide me to the low side on protein.
The “insulin effect” is about how half of every gram or ounce of protein you eat is going to become glucose in your blood. This occurs after the protein is digested into amino acids and, if not taken up by your muscles, etc., is stored in the liver. There, through a process called gluconeogenesis, it is converted to glucose when the body needs glucose. That is one of the main mechanisms of Metformin: “to suppress the up-regulated synthesis of glucose by the liver in the disregulated sugar-based metabolism that many people have developed on a carbohydrate-based diet.” This glucose requires insulin for transport and uptake. Elevated insulin in the blood stops weight loss: the “Insulin effect.”
How much protein you should eat is dependent on several factors: among them age, gender, and level of activity. If you are very active, i.e. you exercise regularly, you will need more protein to repair and maintain the muscle tissue you have developed and use. I don’t exercise at all (except in my daily activities: gardening in New York and kayaking in Florida). I don’t like to sweat, and besides, doesn’t exercise “work up an appetite”? If you’re trying to lose weight, as I am, who wants to do that! So, I began a search to find out how much protein the “experts” say I should eat.
The “experts” recommend a very wide range of protein amounts, all based on “weight.” You need to pick one and go with it. The one critical measure, though, is the “weight” that you use. It should be your hypothetical “lean body weight.” The definition of “lean body weight” is difficult to ascertain and frequently misinterpreted and misguided. But lean body weight is what you should use because protein is not required to maintain your fat mass, or helpful in reducing it.
This latter point is particularly true for the overweight, obese and morbidly obese, like me. For me (old, male, diabetic, morbidly obese, relatively inactive and without excessive musculature to maintain), I chose to define “lean body weight” as the middle weight of “normal” in the WHO’s BMI chart for my height, now shrunken with age to 5’-10.”  
The BMI table says that, at 5’-10”, my middle-of-normal weight should be 150 pounds. In the beginning, though, I thought a “lean body weight” of 150 pounds for me was ridiculous, so I substituted a “goal” or “ideal” weight of 180 pounds. At 0.5g/lb. (1.1g/kg), that worked out to 90g of protein a day. Then, after I had lost over 100 pounds, a “lean body weight” of 150 began to sound realistic, so I reduced it to 0.4g/lb. (0.9g/kg), or 60 grams of protein a day.

Monday, September 16, 2019

Retrospective #212: Everything I (ch)eat turns to fat.

Once you develop diabetes, your metabolism is deeply committed to converting as many calories as it can into fat.”
We’ve all heard this sentiment expressed, or felt this depressing thought, many times, but I was especially affected recently when I read this quote on page 241 of Cate Shanahan’s Deep Nutrition. I urge you to read this book, or at least my review in Retrospective #205 and her deeply troubling observations about the medical “business” in #206.
Shanahan’s book has hundreds of references, so I lament that the above quote is not sourced. I suppose it should be understood as a summation of the totality of the material presented in her book. In any case, the quote can be read as an expression of exasperation that we, overweight and obese Type 2 diabetics, feel in our unremitting efforts to lose weight. It does seem that everything we eat turns to fat, and it is damnably difficult to lose that fat.
As my readers know, I am always interested (from self-interest as well as for educational purposes) in understanding the mechanisms behind our complex metabolic environment, or milieu intérior as the 19th century French physiologist, Claude Bernard, described it. And I have gained some insights into why it is that “everything I (ch)eat turns to fat” and why people with impaired glucose tolerance (IGT) gain weight easily and lose weight with great difficulty.
In lay terms, IGT is the equivalent of “carbohydrate intolerance,” described in Retrospective #84, “Carbohydrate Intolerance – the new ‘buzz’ words.”” They are the outward manifestation of a metabolic change called Insulin Resistance (IR), described in more detail in Retrospective #99, “Natural History of Type 2 Diabetes.”
Bottom line: as our bodies transition from a normal metabolism to a dysfunctional metabolism, very commonly accompanied by weight gain as an effect of this dysfunction, not a cause, our bodies undergo several physiological changes. Laboratory reports detail these changes. The most frequently tested are fasting glucose, hemoglobin A1c (HgA1c), and the lipid panel (Total Cholesterol, LDL, HDL, and TC/HDL ratio) and triglycerides. Sometimes, when these markers are “out of range,” a diagnosis of Metabolic Syndrome is made. All too often, though, the doctor prescribes a statin and tells the patient to “exercise and eat a low-fat diet” to lose weight. There’s no pill for that prescription.
How have I come to this conclusion? Have you had a similar experience? When I have been very good – that is, when I not only talked-the-talk but walked-the-walk, every day – my fasting blood sugars are consistently in the 80s. I can point to weeks, even months, of never or very rarely having a Fasting Blood Glucose over 100mg/dl. And since it is an elevated blood glucose that causes the pancreas to produce insulin, to transport to and facilitate uptake of that blood glucose in their destination cells, it is an elevated blood glucose level that causes an elevated blood insulin level.
As my readers know, and as anyone who has read Taubes’ Good Calories-Bad Calories (The Diet Delusion in the UK), or his more approachable Why We Get Fat, elevated blood insulin CAUSES FAT STORAGE and PREVENTS FAT BREAKDOWN for energy. Retrospective #5 presents Taubes’s “10 certain conclusions” from the GC-BC (pg. 453-454). It is a very succinct and compelling explanation of the functional role of insulin in homeostasis, and a must read.
Anyway, recently my fasting blood glucose readings were in the 100 to 125 range. Obviously, while I have been talking-the-talk, I have not always been walking-the-walk. I admit it. I “cheated” a little almost every day; always just before or at any time after dinner. And I pay the price. It was just a little “cheat,” so I didn’t gain weight, BUT NEITHER DO I LOSE ANY WEIGHT, EVEN THOUGH I AM EATING NO MORE THAN +/- 1200-1800 CALORIES MOST DAYS.
What’s happening is that my serum insulin levels are slightly elevated – elevated just enough to turn everything I (ch)eat to fat and stop the breakdown of body fat in storage even though I am eating below my homeostatic level. My body “gets the message” that as long as I have a supply of quick energy every night (the “cheats” that break down to glucose), it can conserve my body fat, and lay on more with every calorie that isn’t needed to maintain my basal metabolism while I sleep. The “signal” is: the slightly elevated blood insulin circulating my slightly elevated blood glucose. If this is still unclear to you, I urge you to read Retrospective #5 with Taubes’s “10 Certain Conclusions.”