The Nutrition Debate #61: Stefansson and “The Eskimo Diet”

About 100 years ago a Canadian ethnologist, Vilhjallmur Stefansson, spent 11 years living among the Inuit in the frozen North. For 9 of those years he ate substantially a diet composed of meat (including fish), organ meats and fat with just a few carbohydrates (only the glycogen contained in the muscle tissue and liver). In the summer months he ate a few berries. Upon his return to ‘civilization,’ from his observations of the Inuit population with whom he had lived and of his own health, he postulated that such a diet was sufficient for good health. It was, indeed, he averred, a complete diet.

Stefansson’s lectures on his experience with an all meat diet drew derision and cries of charlatan from the scientific and medical community. So, to ‘prove’ his hypothesis, he proposed a daring experiment. He offered himself and a colleague, Karsen Andersen, with whom he had shared his experience in the Arctic, as an in vivo experiment (n=2). In 1928, under the supervision of doctors at New York’s Bellevue Hospital, they volunteered to live for 1 year on meat and fat and offal alone. The results, which I first read in Gary Taubes’s "Good Calories -- Bad Calories," were fascinating.

Stefansson’s own account of his Arctic adventures was published in Harper’s Monthly in November and December 1935; In 2008 David Mendoza posted it at mendosa.com . But I want to dedicate the balance of this blog post to the report of W. S. McClellan and E. F. Du Bois, the lead investigators of the Bellevue study and among the authors of several papers published at the time that studied Stefansson and Andersen for that year. Their paper was brought to my attention by Ginny L who is a frequent poster and valued resource at Dr. Richard K. Bernstein’s Diabetes Forum, diabetes-book.com.

The paper, “Prolonged Meat Diets with a Study of Kidney Function and Ketosis,” was published July 1, 1930, in the Journal of Biological Chemistry. Herewith, in their entirety, are the conclusions of the previously skeptical authors:

1. Two men lived on an exclusive meat diet for 1 year and a third man for 10 days. The relative amounts of lean and fat meat ingested were left to the instinctive choice of the individuals.

2. The protein content varied from 100 to 140 gm., the fat from 200 to 300 gm., the carbohydrate, derived entirely from the meat, from 7 to 12 gm., and the fuel value from 2000 to 3100 calories.

3. At the end of the year, the subjects were mentally alert, physically active, and showed no specific physical changes in any system of the body.

4. During the 1st week, all three men lost weight, due to a shift in the water content of the body while adjusting itself to the low carbohydrate diet. Thereafter, their weights remained practically constant.

5. In the prolonged test, the blood pressure of one man remained constant; the systolic pressure of the other decreased 20 mm. and the diastolic pressure remained uniform.

6. The control of the bowels was not disturbed while the subjects were on prescribed meat diet. In one instance, when the proportion of protein calories in the diet exceeded 40 per cent, a diarrhea developed.

7. Vitamin deficiencies did not appear.

8. The total acidity of the urine during the meat diet was increased to 2 or 3 times that of the acidity on mixed diets and acetonuria was present throughout the periods of exclusive meat.

9. Urine examinations, determinations of the nitrogenous constituents of the blood, and kidney function tests revealed no evidence of kidney damage.

10. While on the meat diet, the men metabolized foodstuffs with FA: G ratios between 1.9 and 3.0 and excreted from 0.4 to 7.2 gm. of acetone bodies per day.

11. In these trained subjects, the clinical observations and laboratory studies gave no evidence that any ill effects had occurred from the prolonged use of the exclusive meat diet.

Stefansson was a very colorful character. He was an early member and twice president of the Explorers Club. He lectured in anthropology at Harvard and was Director of Polar Studies at Dartmouth College. His Wikipedia entry concludes:  “Stefansson is also a figure of considerable interest in dietary circles, especially those with an interest in very low-carbohydrate diets. Stefansson documented the fact that the Inuit diet consisted of about 90% meat and fish; Inuit would often go 6 to 9 months a year eating nothing but meat and fish—essentially, a no-carbohydrate diet. He found that he and his fellow European-descent explorers were also perfectly healthy on such a diet. When medical authorities questioned him on this, he and a fellow explorer agreed to undertake a study under the auspices of the Journal of the American Medical Association to demonstrate that they could eat a 100% meat diet in a closely observed laboratory setting for the first several weeks, with paid observers for the rest of an entire year. The results were published in the Journal, and both men were perfectly healthy on such a diet, without vitamin supplementation or anything else in their diet except meat and entrails.” That may not be very appealing to the Wiki author, but it sounds pretty good to me.                                                               

 © Dan Brown 7/29/12

The Nutrition Debate #60: Dietary Composition: Dr. Ludwig’s (et. al.) Study

Everybody’s talking about it. David S. Ludwig, MD, PhD, and colleagues at New Balance Foundation Obesity Prevention Center (Harvard), and Children’s Hospital, Boston, and Brigham and Women’s Hospital, Boston, and Baylor College of Medicine, Houston, and Vanderbilt University, Nashville, published the results of a well-designed, four-year study on June 27, 2012, in the Journal of the American Medical Association (JAMA). The purpose was to study “the effect of dietary composition on energy expenditure during weight-loss maintenance “(my emphasis).

Almost simultaneously (on June 30, 2012), the New York Times published an opinion piece, "What Really Makes Us Fat," loosely based on the study. In it, award winning science writer Gary Taubes, says, “What was done by Dr. Ludwig’s team has never been done before.” He concludes his piece with, “The public health implications are enormous.”

This study begins after all the participants had achieved a 10% to 15% weight loss by a calorie restricted (60%) “run-in” diet. In random order, each for 4 weeks, the participants ate three isocaloric (2,000kcal/d) diets: 1) a low-fat diet (60% carbs, 20% fat, 20% protein, high glycemic load); 2) a low-glycemic index diet (40% carbs, 40% fat and 20% protein, moderate glycemic load); and 3) a very-low carb (Atkins) diet (10% carb, 60% fat and 30% protein, low glycemic load).

The JAMA authors conclude: “Our study demonstrates that commonly consumed diets can affect metabolism and components of the metabolic syndrome in markedly different ways during weight-loss maintenance, independent of energy content. The low-fat diet produced changes in energy expenditure and serum leptin that would predict weight regain. In addition, this conventionally recommended diet had unfavorable effects on most of the metabolic syndrome components studied herein. In contrast, the very low carbohydrate diet had the most beneficial effects on energy expenditure and several metabolic syndrome components…” (both HDL and triglycerides, I noted).

Energy expenditure, the primary outcome measure of the study, was measured by state-of-the art stable isotope analysis at Baylor. This outcome was especially stunning: “The results of our study challenge the notion that a calorie is a calorie from a metabolic perspective,” the authors state. “Total Energy Expenditure differed by approximately 300 kcal/d between these 2 diets” (very low carb and low fat), “an effect corresponding with the amount of energy typically expended in 1 hour of moderate-intensity physical activity.”

In other words, as Taubes explains in his NYT article, “…when the subjects were eating low-fat diets, they’d have to add an hour of moderate-intensity physical activity each day to expend as much energy as they would effortlessly on the very-low-carb diet. And this while consuming the same amount of calories. If the physical activity made them hungrier – a likely assumption – maintaining weight on the low-fat, high-carb diet would be even harder,” Taubes wrote.

Taubes then posits, “If we think of Dr. Ludwig’s subjects as pre-obese, then the study tells us that the nutrient composition of the diet can trigger the predisposition to get fat, independent of the calories consumed. The fewer carbohydrates we eat, the more easily we remain lean. The more carbohydrates, the more difficult. In other words, carbohydrates are fattening, and obesity is a fat-storage defect. What matters, then, is the quantity and quality of carbohydrates we consume and their effect on insulin.”

Ludwig’s subjects are, frankly, “pre-obese.” As the study states, “only 1 in 6 overweight and obese adults report ever having maintained weight loss of at least 10% for 1 year.” Taubes reasonably says Ludwig’s subjects are “almost assuredly going to get fatter, so they can be research stand-ins for those of us who are merely predisposed to get fat but haven’t done so yet and might take a few years or decades longer to do it.”

Taubes then concludes, “From this perspective, the trial suggests that among the bad decisions we can make to maintain our weight is exactly what the government and medical organizations like the American Heart Association have been telling us to do: eat low-fat, carbohydrate-rich diets, even if those diets include whole grains and fruits and vegetables.”

You could read this report in JAMA and have a different take-away; this blog piece is just the way I see it. Call it my bias, or see it as good science “that has never been done before” (as per Taubes). Like all good science, it is controversial and in need of replication by independent investigators, as Taubes states. I knew that’s why I like this guy. And he gets an Op-Ed (and a couple of Sunday Magazine cover stories) in the New York Times, which must still have a few movers and shakers among its readers.

© Dan Brown 7/22/12

Index of Columns: DanBrown-TheNutritionDebate@blogspot.com

1          A Very Brief (and Necessarily Selective) History of Human Nutrition (and Dieting)

2          Nutrition 101: A Primer on the Fundamentals of Nutrition

3          Ancel Keys and the Lipid Hypothesis

4          Big Government, Big Pharma, and Poor Little Dr. Atkins

5          Gary Taubes and the Alternative Hypothesis

6          “Energy In = Energy Out”: An Alternative Interpretation

7          Are You a “Sugar Burner” or a “Fat Burner”?          

8          Epidemiologically Speaking: Patterns of Health and Illness

9          Metabolic Syndrome, the American Disease of Civilization

10        Carbohydrates, Insulin and Pre-Diabetes

11        Why We Get Fat

12        Turning the Titanic: Who’s in Charge of Your Health           

13        Is Our Diet Really Changing? Have You Noticed Lately?

14        The New “Dietary Guidelines for Americans, 2010”

15        Did Grandma Know About Macronutrients and Phytochemicals

16        Diets and Dieting: Had Enough? Ready to Move On?

17        Michel Pollan: Pied Piper of Pseudo Paleo Prandial Principles

18        Paleolithic Nutrition and the Archevore Diet

19        The Archevore Way of Eating a la Dr. Kurt G. Harris, MD

20        Know Your Dietary Fats: Saturated and Unsaturated

21        The Dangers of Polyunsaturated Fats

22        Too Much Omega 6; Too Little Omega 3

23        The Benefits of Saturated Fats

24        What About Cholesterol?

25        Understanding Your Lipid Panel

26        The Cause and Treatment of Heart Disease

27        “…the strongest predictor of a heart attack.”

28        Sugar in the Diet: What does it mean?

29        Fructose, Formerly Known as Fruit Sugar

30        Is Fructose a Liver Toxin? Is it Really Poison?

31        Carbohydrates and Sugars

32        Artificial Sweeteners 

33        Omental Adiposity

34        Foods that Raise HDL

35        The Diet Doctor and the LCHF Diet

36        Modern Trends in Dieting

37        Therapeutic (vs. Prophylactic) Dieting

38        The Perfect Health Diet

39        Back to the Future

40        What are “Safe Starches”?

41        “Unsafe Starches” and Other Sugars

42        “Unsafe Fats” – probably not what you think

43        Paula Deen, Lessons Learned?

44        Joslin Clinic Fights Back

45        Do You Need to Lower Your Cholesterol

--          Interlude, On a Personal Note

46        How to Treat Heart Disease Risk (a doctor’s prescription)

47        Testing for Heart Disease Risk

48        Inflammation and Atherosclerosis

49        The Dietary Causes of Inflammation

50        Free Radicals and Oxidative Stress   

51        Dietary Cholesterol

52        The Thermic Effect of Food

53        On the Digestion and Absorption of Food     

54        Loren Cordain, Robb Webb and Kurt Harris

55        The Beleaguered Gary Taubes

56        Metabolic Disregulation

57        What is Ketogenic Nutrition

58        What is Dietary Ketosis

59        What I Eat and Why: A VLCKD

60        Dietary Composition: Dr. Ludwig’s (et.al.) Study

61        Steffansson and “The Eskimo Diet”

62        Meatless Monday Madness

63        Impulse Control and Metacognition

64        Very Low Carb Eating: 10 Years Later
65        Introducing the Low Carb Dietitian
66        Fast Glucose Best Predictor of Diabetes Risk (NOT)
67        HDL Cholesterol and the Very Low Carb Diet           
68        Triglycerides, Fish Oil and Sardines
69        In Praise of Small Meals
70        LDL Cholesterol and Statins
71        Weight Loss Maintenance
72        How to “Fix” Your Cholesterol
73        Newly Diagnosed Type 2 or Pre-Diabetic? Scared?
74        No Added Salt? Why?
75        Low Carb Dieting the “Cold Turkey” Way
76        Holiday Indulgences for Low Carbers
77        Low Carb Dieting and Pauline Kale (sic)
78        Metabolic Syndrome and Risk of Cancer
79        Calorie Restriction and Longevity
80        Obesity Caused by Gut Bacterium!
81        Calorie Restriction in Humans
82        A New Dietary Paradigm?
83        "The 8-Hour Diet," based on "brand new science"
84        Carbohydrate Intolerance: the new “buzz” words
85        My Goal Weight and the BMI Table
86        Beta Cell Function and Insulin Sensitivity
87        Optimal Blood Lipid Levels
88        "Reversal of Type 2 Diabetes"
89        "Reversal of Type 2 Diabetes" Revisited
90        The "Easy as 1-2-3 (and 1/2) Diet"
91        Low-Carb Breakfasts (and a No-Carb Lunch)
92        Why We Eat
93        Is The Washington Post Biased?
94        "Eating Clean"
95        My Doctor Died Last Week -- An Appreciation
96        The Pregnant Bachelor's Diet
97        Fructose in Foods
98        The "Dreaded Complications" (of Type 2 Diabetes)
99        "Natural History of Type 2 Diabetes"
100      Liquid Calories
101      Why I'm Never Hungry
102      Denial is not...
103      Your Mileage May Vary (YMMV)
104      It's Not Feckless to Be Fickle
105      My Low Carb Eating -- Then and Now
106      Dinner is Now Supper -- for Us
107      "even...whole grain and fruits and vegetables"
108      "You're Eating Too Much Dairy"
109      "Prisoner for Life"
110      My Body and Me
111      "the usual complaints" of aging
112      Treating the Obese Diabetic
113      What are We, Chopped Liver?
114      My Insulin-dependent Type 2 Pharmacist
115      "My Doctor Never Told Me..."
116      "A Modifiable Risk Factor"
117      "Sugar, Salt and Fat" -- the New "Bad Boy" Linkup
118      "Nobody Weighs 375 Pounds"
119      "Lifestyle Intervention is Great Therapy"
120      Nutrigenomics -- an emerging new science
121      Behavior Change is Incredibly Difficult
122      Macronutrient Ratios and Calorie Restriction
123      Intermittent Fasting and "The 23-hour IF Diet"
124      A Lamentable Confusion Between Diets
125      Dietary Dictocrats Double Down
126      Do You Live to Eat or Eat to Live?
127      Fighting Sleep?
128      Sugary Drinks and Added Sugars
129      Low Carb Diet Record Keeping
130      How much Protein Should You Eat?
131      Bernstein Goes Paleo
132      Why I Despair for the Type 2 Diabetic Patient
133      The Edible Schoolyard (ESY)
134      "You Really Don't Need to Test"
135      What About Physical Energy?
136      "No Butter on Your Corn?!!!"
137      "How Ketogenic (Low Carb-HIgh-Fat) Diets Work"
138      Fruit, the 3rd Rail for Prospective Low Carb Dieters
139      Nuts -- the Very Good, the Also Good, and the Bad
140      Peanuts, My Nemesis, and Why I Don't Eat Them
141      "...the ultimate oxymoron: diet food"
142      "I'm Sorry..." Confessions of a Former Weight Loss Consultant
143      Fruit Consumption & Diabetes -- A Theatre of the Absurd Plot
144      Diabetes and Dementia
145      Gastric Bypass vw. Medical Therapy for Metabolic Syndrome
146      Medicare to Pay for Obesity Counseling
147      AMA: Obesity is a Disease (for billing purposes)
148      Obesity, a Condition of Genetic Susceptibility?
149      Feral Cat Feeding Frenzy
150      Another Milestone, Amid Ramblings and Ruminations
151      Homage to Vilhjalmur Steffansson by His Wife Evelyn
152      Set Point Theory, More Ramblings
153      Salt: Friend or Foe?
154      Salt, Sugar and Fat
155      Cowabunga, the ADA makes the turn
156      The New ADA Nutrition Guidlines: Some Misgivings
157      The ADA's Problematic Position on Dietary Fat
158      Demolishing the Saturated Fat Bogeyman
159      While 'Rome Burns,' the GACD fiddles and the EASD naps
160      Letterman to Hanks: "...through diet, mostly."
161      Why Go to the Doctor?
162      The ADA's Glycemic, Blood Pressure and Lipid Goals
163      So You Think You're Just Pre-Diabetic?
164      The Best Snack?
165      Obesity is Not the Problem
166      What About GMOs?
167      An Editorial: Making the Turn
168      Does Exercise Work?
169      When I told her, "I'm diabetic..."
170      Your instinctive "appetite for protein"
171      "Dietary Protein and its Impact on Obesity
172      "Everybody knows that..."
173      "Anybody can be a doctor..."
174      23andme and the Self-Care Brouhaha
175      "Your blog is primarily for type 2 diabetics, right?"
176      Eggs, Cholesterol and Choline
177      The ADA's Helpful Advice?
178      "Diabetes Rocks!"
179      Vitamin D Supplementation
180      The AHA/ACC Cholesterol Guidelines
181      The New AHA/ACC Statin Guidelines and Type 2 Diabetes
182      Avoiding "incident type 2 diabetes"
183      My New Doctor and Me
184      "VLC = Not So Much Thinking"
185      "Your Diet is Very Restrictive"
186      "Your Diet is Very Restrictive" Part 2
187      Chronic Systemic Inflammation and hsCRP
188      "Older Patients with T2DM and Comorbidities"
189      The Proposed New F.D.A Nutrition Labels
190      "Can (sic) I ask you a personal question?"
191      Insulin-Dependent Type 2s
192      Climate Change and The Nutrition Debate
193      We never changed our mind," he said.
194      Live Fermented Foods
195      "I did it myself, with no help from doctor."
196      The diagnostic power of A1c vs. fasting glucose
197      Triglycerides and alcohol consumption
198      Carbohydrates and Alcoholic Beverages
199      Food Preparation: Tips and Tidbits
200      "Healthy Eating"
201       Horton Hears a Who
202       White House Pastry Chef Quits
203       A Brief History of Edible Vegetable (i.e. Seed) Oils
204       A Modern History of Cane Sugar
205       "Deep Nutrition," a book review
206       "Health without Healthcare"
207       Diabetes Self-Care Just Got a Little Harder
208       "Teach Doctors Nutrition"
209       "Maureen Dowd is off today," the NYT said.
210       "Diet and Exercise May Help Prevent Diabetes" -- Duh!
211       Eggs and Satiety
212       "Everything I (ch)eat turns to fat."
213       How I lost 125 pounds (part 1) 
214       How I lost 125 pounds (part 2)
215       Just Google "The Nutrition Debate"
216       Is Low-Carb High-Protein or High Fat?
217       Type 2 diabetic says, "I can eat whatever I want"
218       Diabetes Causes Nerve Pain -- NOT
219       "Surgery Tops Usual Care in Obese Diabetics"
220       "Eat protein t lower stroke risk"
221       Medscape dropped 2 bombs in my inbox last week
222       Better Diabetes Self-Management with Cognitive Therapy
223       Adding Insulin to Metformin for T2s: A scary "outcome"
224       Diabetic Foot: A Cinderella Condition?!!!
225       Diet and Type 2 Diabetes Risk
226       Improved Glycemic Control and CV Risk 

227      “One in 10 American Adults is Diabetic…”

228      A1c and you estimated Average Glucose (eAG)

229      My Alternate Healthy Eating Index (MyAHEI)

230      Frustrated by Failure? Solution: Lower the Standard of Care

231      Vitamin K-2 and Insulin Sensitivity

232      “A Spoonful of Sugar”

233      Multifactorial Approach to Prevent CVD in T2DM

234      You begin to secrete insulin when…

235      Self- vs. Medical Management of T2DM

236      Inflammation and the Low-Carb Diet

237      “…the why behind my broken blood sugar.”

238      Type 2 Diabetics: Do you take a low-dose aspirin?

239      Low-Carb Diet Should Be First Approach for Diabetes

240      Pottenger, his Cats and his Prophesy

241      “HbA1c Increases with Age”

242      God Favors Animal Fat

243      New York Times good; Fox News bad (coverage) 
244      Diabetes on Rise but Complications Decline (Duh!)
245      "...in patients on sulfonylureas."
246      "Sugar Substance Reduces HDL"
247      Age-Based Universal Screening for T2DM
248      Salt Warnings: Confusing and Contradictory
249      Type 2 Diabetics, You Have a Choice
250      "40% of American Adults Will Develop Diabetes"
251      High-fat dairy 'good'; low-fat dairy 'bad' 
252      "400 Calorie Meals for Fall"
253      The "Diabetes Plateau"
254      Saudi Approach to Diabetes
255      Risk Prediction with Triglycerides
256      Prediabetes: An Existential Question?
257      Non-surgical bariatric medicine
258    "Diagnosed diabetics consumed less sugar and carbohydrates"
259      Cognitive Decline: Driven by Metabolic Processes?
260      "Weight Loss Tips from Our Experts"
261      Non-Caloric Artificial Sweeteners (NAS)
262      Registered Dietician Nutritionists. Should you see one?
263      Ice Cream Games
264      Which Foods Affect Diabetes
265      "Lets Start with Food"
266      "Food Therapy for Metabolic Syndrome"
267      A "High Energy Breakfast Shake"
268      "Help with Cravings"
269      "Eat Good Fat"
270      "The Skinny of Fats"
271      Treating Obesity Today
272      Falling Asleep a the Wheel
273      Insulin Resistance = Carbohydrate Intolerance
274      "Should Everyone Take Metformin"
275      "The Weight of the Nation"
276      "Why do I eat...even when I'm not hungry"
277      What is Hunger?
278      Skipping Breakfast
279      My fasting blood sugar is 85
280      Putting Fat Loss on Autopilot
281      HDL-C and Triglycerides
282      Total Cholesterol, LDL-C and Statin Therapy
283      TC/HDL, TG/HDL and Triglycerides
284      The A to Z Weight Loss Study: a Randomized Trial
285      "When diet and exercise aren't enough..."
286      Avoid wheat, excess fructose and excess linoleic acid (Omega 6s)
287      Can Type 2 Diabetes Be Reversed?
288      Type 2 Diabetics: 10% Protein "May Not Be Enough"
289      Physician: "First, do no harm" (Primum, non nocere)
290      My Healthy, Homemade (Vinaigrette) Salad Dressing 
291      Salad Dressing Oils: The Good, the Bad and the Ugly
292      Type 2 Diabetes: Doctors in Transition
293      The HEAL Clinics: Diabetes and Medical Weight Loss
294      "Saturated Fat and CAD: It's Complicated"
295      Cholesterol: no longer "...considered a nutrient of concern..."
296      Another Nail in the Coffin of the Dietary Guidelines
297      "Obesity in Remission," a short series
298      "Obesity in Remission" Part 2
299      The Set Point: Why Maintaining Weight Loss is So Hard
300      "Sugar" in Food and Blood, a primer on carbohydrates
301      Healthy Food Choices
302      Another pill to prevent Type 2 Diabetes
303      Poor Dr. Walter Willett
304      "I am not making this up."
305      My Troubled Relationship with Food

306      My New Manifesto: Type 2 Diabetes, a Dietary Disease

307      Type 2 Diabetes, a Dietary Disease: A Personal Story (N=1)

308      Type 2 Diabetes, a Dietary Disease: Introduction to What Causes Diabetes

309      Type 2 Diabetes, a Dietary Disease: Type 2 Diabetes Q & A

310      Type 2 Diabetes, a Dietary Disease: Newly Diagnosed Type 2? What’s Next?

311      Type 2 Diabetes, a Dietary Disease: How Can I Manage My Type 2 Diabetes?

312      Type 2 Diabetes, a Dietary Disease: Isn’t Your Very Low Carb WOE…Well, Extreme?

313      Type 2 Diabetes, a Dietary Disease: What Does Insulin Resistance Have to Do With It?

314      Type 2 Diabetes, a Dietary Disease: “I’m so hungry, I could eat a horse!”

315      Type 2 Diabetes, a Dietary Disease: Carbohydrates and Sugars: Redux

316      Type 2 Diabetes, a Dietary Disease: “With So Much Carb Restriction, What Can I Eat?

317      Type 2 Diabetes, a Dietary Disease: Patient, Heal Thyself!

318      Type 2 Diabetes, a Dietary Disease: The Mystery of Antonin Scalia's Sudden Death
319      Type 2 Diabetes, a Dietary Disease: Losing Weight and Keeping It Off
320      Type 2 Diabetes, a Dietary Disease: "Total Fasting Reduces of Eliminates Hunger"
321      Type 2 Diabetes, a Dietary Disease: "Energy In" at the cellular level
322      The Nutrition Debate: Ketosis, the Ketogenic Diet and Supplemental Ketones, An Overview
323      The Nutrition Debate: Supplemental Ketones, a Therapeutic Strategy
324      The Nutrition Debate: Supplemental Ketones, "A Case Study," by Dr. Mary Newport
325      The Nutrition Debate: Supplemental Ketones, a Prophylactic Strategy
326      Type 2 Diabetes, a Dietary Disease: Are you hungry in the morning?
327      Type 2 Diabetes, a Dietary Disease: "Just by changing what I ate..."
328      Type 2 Diabetes, a Dietary Disease: "...the most sustainable diet ever!"
329      Type 2 Diabetes, a Dietary Disease: My FBGs have been transformed, Part 1
330      Type 2 Diabetes, a Dietary Disease: My FBGs have been transformed, Part 2
331      Type 2 Diabetes, a Dietary Disease: Dear Max: Don't eat Oatmeal for breakfast!
332      Type 2 Diabetes, a Dietary Disease: "Pre-Diabetic" or undiagnosed Type 2?
333      Type 2 Diabetes, a Dietary Disease: NAFLD, Supplements, Fructose and PUFAs
334      Type 2 Diabetes, a Dietary Disease: A Unifying Hypothesis of Chronic Disease, Part 1
335      Type 2 Diabetes, a Dietary Disease: Implications of Reaven's Unified Hypothesis, Part 2
336      Type 2 Diabetes, a Dietary Disease: Noakes: "It's the fatty liver disease, stupid."
337      Type 2 Diabetes, a Dietary Disease: Fact and Fallacies About the Nutrition Facts Panel
338      Type 2 Diabetes, a Dietary Disease: Moi? Grumpy or Grouchy?
339      Type 2 Diabetes, a Dietary Disease: Low Carb? It's not a diet," I blurted.
340      Type 2 Diabetes, a Dietary Disease: "Obesity is a hormonal imbalance..."
341      Type 2 Diabetes, a Dietary Disease: "Obesity is protective," says Jason Fung, MD
342      Type 2 Diabetes, a Dietary Disease: Is "cheating" okay?
343      Type 2 Diabetes, a Dietary Disease: My "No-Cheat" Week
344      Type 2 Diabetes, a Dietary Disease: How Diabetic Do You Want to Be (Part 1)
345      Type 2 Diabetes, a Dietary Disease: How Diabetic Do You Want to Be (Part 2)
346      Type 2 Diabetes, a Dietary Disease: "Glucose Lowering in T2D is largely useless."
347      Type 2 Diabetes, a Dietary Disease: Lowering Glucose in T2D is largely useless, unless..."
348      Type 2 Diabetes, a Dietary Disease: Nervous Eating
349      Type 2 Diabetes, a Dietary Disease: Yoga for Diabetes
350      Type 2 Diabetes, a Dietary Disease: My latest lipid panel (cholesterol test)
351      Type 2 Diabetes, a Dietary Disease: Am I a Type 2 Diabetic?
352      Type 2 Diabetes, a Dietary Disease: If you're a Type 2, DON'T READ THIS
353      Type 2 Diabetes, a Dietary Disease: Advice for a friend who is "pre-diabetic."
354      Type 2 Diabetes, a Dietary Disease: Macro and Keto Ratios
355      Type 2 Diabetes, a Dietary Disease: Before and After
356      Type 2 Diabetes, a Dietary Disease: Ten Years Ago, I Had a Relapse
357      Type 2 Diabetes, a Dietary Disease: Ten years ago, I had a relapse (Part 2)
358      Type 2 Diabetes, a Dietary Disease: Ten years ago, I had a relapse (Part 3)
359      Type 2 Diabetes, a Dietary Disease: Ten years ago, I had a relapse (Part 4)
360      Type 2 Diabetes, a Dietary Disease: Ten years ago, I had a relapse (Part 5)

361      Type 2 Diabetes, a Dietary Disease: “Whistlin’ Past the Graveyard”

362      Type 2 Diabetes, a Dietary Disease: A Stricter Prediabetes Definition

363      Type 2 Diabetes, a Dietary Disease: Type 2 Diabetes, a Lifestyle Disease

364      Type 2 Diabetes, a Dietary Disease: “Prediabetes, in other words, is Diabetes”

365      Type 2 Diabetes, a Dietary Disease: The Dual Pincers of Clinical Practice Guidelines

366      Type 2 Diabetes, a Dietary Disease: Academy of Nutrition and Dietetics, a Secret Society

367      Type 2 Diabetes, a Dietary Disease: My Arm’s Length Perspective from Colombia

368      Type 2 Diabetes, a Dietary Disease: My 2-Month, 20-Pound Challenge

369      Type 2 Diabetes, a Dietary Disease: “759 Secrets for Beating Diabetes”

370      Type 2 Diabetes, a Dietary Disease: My 2-Month, 20-Pound Challenge, 1^st wk Report

371      Type 2 Diabetes, a Dietary Disease: My 2-Month, 20-Pound Challenge, 2^nd wk Report

372      Type 2 Diabetes, a Dietary Disease: My 10-Week, 30-Pound Challenge, 5^th wk Report

373      Type 2 Diabetes, a Dietary Disease: The “blame the patient” game

374      Type 2 Diabetes, a Dietary Disease: A New Year’s Eve Conversation, Part 1 of 2

375      Type 2 Diabetes, a Dietary Disease: A New Year’s Eve Conversation, Part 2 of 2

376      Type 2 Diabetes, a Dietary Disease: “I have gone off carbohydrates almost entirely.”

377      Type 2 Diabetes, a Dietary Disease: My 10-Week, 30-Pound Challenge: Final Report

378      Type 2 Diabetes, a Dietary Disease: My Next 30-Pound Challenge: Project Design

379      Type 2 Diabetes, a Dietary Disease: “Man-up, guys!”

380      Type 2 Diabetes, a Dietary Disease: Newcastle Diet (“Counterpoint Study”)

381      Type 2 Diabetes, a Dietary Disease: My Next 30-Pound Challenge, 4 weeks in…

382      Type 2 Diabetes, a Dietary Disease: Can Fasting “Wake-up” the Pancreas?

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

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

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

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

387      Type 2 Diabetes, a Dietary Disease: 15 Years on a VLC Diet

388      Type 2 Diabetes, a Dietary Disease: “A Piece of Cake”

389      Type 2 Diabetes, a Dietary Disease: Don’t go to THIS hospital!

390      Type 2 Diabetes, a Dietary Disease: My 2^nd and Last 30-lb Challenge: 3^rd Qtr. Report

391      Type 2 Diabetes, a Dietary Disease: The U. S. Dietary Guidelines: “11 Points for Change”

392      Type 2 Diabetes, a Dietary Disease: “Broccoli May Help Fight Disease”

393      Type 2 Diabetes, a Dietary Disease: My 2^nd 30-lb Challenge (Amended): Final Report

394      Type 2 Diabetes, a Dietary Disease: “Alternative Preventive Medicine”?

395     Type 2 Diabetes, a Dietary Disease: All my friends are dying...
396      Type 2 Diabetes, a Dietary Disease: "Intransigent Resistance"
397      Type 2 Diabetes, a Dietary Disease: If an A1c of >6.5% is defined as diabetic...
398      Type 2 Diabetes, a Dietary Disease: My supplements
399      Type 2 Diabetes, a Dietary Disease: WebMD and Walgreens, a new collaboration
400      Type 2 Diabetes, a Dietary Disease: "Not half the man I once was," my wife quipped
401      Type 2 Nutrition #401: "Improve your A1c with a non-insulin option"
402      Type 2 Nutrition #402: IGNORANCE is the biggest problem...
403      Type 2 Nutrition #403: Denial is not a river...
404      Type 2 Nutrition #404: "If you're feeling signs of sleepiness..."
405      Type 2 Nutrition #405: LDL-C and TGL while fasting
406      Type 2 Nutrition #406: Triglycerides and LDLC while eating Very Low Carb
407      Type 2 Nutrition #407: Am I non-diabetic now?
408      Type 2 Nutrition #408: Keto-adapted vs. Fat-adapted
409      Type 2 Nutrition #409: When I used to eat eggs...
410      Type 2 Nutrition #410: My 300kcal "Fasting" Diet
411      Type 2 Nutrition #411: "You don't eat!"
412      Type 2 Nutrition #412: "Cover" Story
413      Type 2 Nutrition #413: "End Date"
414      Type 2 Nutrition #414: To LOSE weight, do NOT eat a Ketogenic Diet
415      Type 2 Nutrition #415: Hypoglycemia? I've only had it 3 times -- all in 1 week!
416      Type 2 Nutrition #416: Readership Statistics
417      Type 2 Nutrition #417: The NEXT 25 Most Popular Posts
418      Type 2 Nutrition #418: "The dose makes the poison."
419      Type 2 Nutrition #419: "Secret Cure" for Type 2 Diabetes
420      Type 2 Nutrition #420: BMIs for the "elderly"
421      Type 2 Nutrition #421: Heart Benefits of Intermittent Fasting
422      Type 2 Nutrition #422: "energy homeostasis at the cellular level
423      Type 2 Nutrition #423: Okay, I admit it. I'm not perfect.
424      Type 2 Nutrition #424: Splenda Edulzante, ideal para toda la familia
425      Type 2 Nutrition #425: "Ensure Original," the "meal replacement"
426      Type 2 Nutrition #426: Extend Bars, for diabetes management
427      Type 2 Nutrition #427: The Fasting Biohack, Trending in Silicon Valley
428      Type 2 Nutrition #428: Portion Control
429      Type 2 Nutrition #429: WebMD Nov/Dec Issue
430      Type 2 Nutrition #430: "I don't always skip meals..."
431      Type 2 Nutrition #431: May 9th, from a Russian Perspective
432      Type 2 Nutrition #432: "I've never had a hot flash."
433      Type 2 Nutrition #433: "Lifestyle Programs Could Prevent Diabetes'"
434      Type 2 Nutrition #434: Watch out! Your doctor thinks he/she knows about nutrition.
435      Type 2 Nutrition #435: Hungry or Undernourished?
436      Type 2 Nutrition #436: "Science advances one funeral at a time."
437      Type 2 Nutrition #437: Heading toward the cliff
438      Type 2 Nutrition #438: Two Degrees of Separation
439      Type 2 Nutrition #439: "The Drinking Man's Diet"
440      Type 2 Nutrition #440: The Drinking Man's Liquid Fasting Diet
441      Type 2 Nutrition #441: Have I cured my type 2 diabetes?
442      Type 2 Nutrition #442: Stepping into my new trousers...
443      Type 2 Nutrition #443: The 1-percenters
444      Type 2 Nutrition #444: "Symptoms are too late."
445      Type 2 Nutrition #445: Are doctors in denial?
446      Type 2 Nutrition #446: "Doc's Beliefs" prevail in 14 of 17 Primary Care Practices
447      Type 2 Nutrition #447: What's happening to medicine today?
448      Type 2 Nutrition #448: How "science" gets it wrong
449      Type 2 Nutrition #449: "I thought salads were good for you."
450      Type 2 Nutrition #450: When and what to eat, and not eat
451      Type 2 Nutrition #451: Is Very Low Carb like the South Beach Diet?
452      Type 2 Nutrition #452: The most common cause of high triglycerides is...
453      Type 2 Nutrition #453: Fish oil supplementation, triglycerides and platelet formation
454      Type 2 Nutrition #454: "Are vegetable chips okay"?
455      Type 2 Nutrition #455: "Are red grapes healthier than green grapes?"
456      Type 2 Nutrition #456: "Why am I taking insulin?"
457      Type 2 Nutrition #457: One foot in two lifeboats...
458      Type 2 Nutrition #458: Is it time to clean out the pantry?
459      Type 2 Nutrition #459: My new favorite snack
460      Type 2 Nutrition #460: The blind leading the blind
461      Type 2 Nutrition #461:Very Low Carb is the Basic Precept
462      Type 2 Nutrition #462: The TG/HDL-C ratio and Insulin Resistance
463      Type 2 Nutrition #463: "You eat healthy, take statins..."
464      Type 2 Nutrition #464: "She was only 75."
465      Type 2 Nutrition #465: Diabetic neuropathic complications
466      Type 2 Nutrition #466: Want help getting into a size 10?
467      Type 2 Nutrition #467: It's not fair!
468      Type 2 Nutrition #468: Drink SuperBeets, for a "boost'
469      Type 2 Nutrition #469: Why Pre-diabetes is actually Type 2 Diabetes (T2DM)
470      Type 2 Nutrition #470: A Tale of Two Paradigms
471      Type 2 Nutrition #471: "You mean, sugar is a carb?"
472      Type 2 Nutrition #472: Is the Vedda Blood Sugar Remedy Credible?
473      Type 2 Nutrition #473: IT'S THE VISCERAL FAT, STUPID!
474      Type 2 Nutrition #474: "Taking aim at belly fat"
475      Type 2 Nutrition #475: The Fast Mimicking Diet
476      Type 2 Nutrition #476: Martin/Hopkins, "a better LDL calculation method"
477      Type 2 Nutrition #477: Deprescribing antihyperglycemic meds..."
478      Type 2 Nutrition #478: Have you ever thought about a CGM?
479      Type 2 Nutrition #479: CGMs for Non-Insulin Dependent Type 2s?
480      Type 2 Nutrition #480: "I've lost 30 pounds!" (Time Cook, Apple CEO)
481      Type 2 Nutrition #481: Why I still use stevia.
482      Type 2 Nutrition #482: "What are you teaching these kids?"
483      Type 2 Nutrition #483: "...when used with diet and exercise."
484      Type 2 Nutrition #484: "He needs insulin to control his high blood sugar."
485      Type 2 Nutrition #485: Grocery store bread is processed food.
486      Type 2 Nutrition #486: Too depressing not to write about.
487      Type 2 Nutrition #487: NPR re Coconut Oil
488      Type 2 Nutrition #488: Why, just...why?