Wednesday, June 12, 2013

The Nutrition Debate #116: “A Modifiable Risk Factor”

Letters to the Editor in the online edition of my Lancet subscription are usually interesting, and the 11 May 2013 letters were no exception. One on the subject of “Statins and Exercise Prescription” 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.” The authors of the article agreed. They replied: “…we concur with the eloquently stated and obvious truth that has been ignored by health-care professionals for many years: ‘improving of population health should not simply be made the work of drug companies.’” And I say, would that this were said of obesity and T2 diabetes as well!

Obesity is also “a modifiable risk factor,” and “improving of population health” – both through weight loss and the concomitant remission of type 2 diabetes – is achievable through 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 the population that has become carbohydrate intolerant by reason of insulin resistance, then reducing the number of carbs in the diet will reduce the concentration of glucose in the blood? I mean, who doesn’t get this? And for our government to ignore this “obvious truth,” with what amounts to a “one size fits all” prescription in its Dietary Guidelines for Americans, amounts to gross negligence and 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. That’s what happened to me. Eleven years ago my doctor, who had been trying to get me to lose weight for years, read about the Atkins Diet (Induction Phase) in a cover story in the New York Times Sunday magazine. The article, “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 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 was getting hypos. A hypo (hypoglycemia) is a dangerously low blood glucose condition which if not treated can lead to coma and death. When I felt the sweating, tingling and loss of mental acuity, I got up from my desk and went to the building lobby and bought and ate a Chunky candy bar at the newsstand. A bit of an overreaction, I admit, but this was my first ever hypo, and I was scared.

The next thing I did was call my doctor. I had never done that before either. He told me to immediately drop one of the oral anti-diabetic medications he had prescribed for me (Avandia). I did, but the next day the situation repeated itself. I bought and ate a Reese’s Peanut Butter Cup, as I recall, and called my doctor again. This time he said to cut by half the other two oral anti-diabetic meds I was on (at maximum dosage actually: 2000mg metformin and 20mg micronase, a sulfonylurea). I did, but the next day, or a few days later, I was still getting hypos (and eating Reese’s Cups), and I called him again. This time he told me to cut the dosage of both meds by half again.

Over the years (I have been doing this now for 11 years), as I adhered strictly to a Very Low Carb diet, I lost 170 pounds and  dropped the remaining 5mg micronase to 2½ and then to 1¼ (cutting the pill in half), and then went off it completely. I still take 500 metformin with supper, though, just to be sure no unwanted glucose in made in the liver.

Along the way, my blood pressure improved from 130/90 to 110/70 on the same meds. And my blood lipids dramatically improved. My triglycerides dropped from about 150 to about 50 and my HDL (good) cholesterol more than doubled from about 40 to about 80. My total cholesterol remained pretty constant (at about 215) while by LDL increased slightly (to about 130). But because of my very good triglycerides and HDL, my doctor advised me “your cholesterol results…are good” and “currently conform to (NCEP-3) guidelines.” I would say so! I would say most of his patients would love to have my lipid profile! And my fasting blood glucoses: average mid-80s. You would never know I was diagnosed diabetic 27 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.” We concur. 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 weight loss occurs regardless. The blood lipid and blood pressure benefits will follow, even where blood glucose regulation is not required…”improving… population health” concomitantly. No Rx required!

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