Wednesday, June 19, 2013

The Nutrition Debate #118: “Nobody Weights 375 Pounds”

I don’t know how to punctuate this quote, because it was said to me as a rejoinder in conversation as I was rattling on about my “discovery” that I weighed so much – but it was said with a slightly upturned lip and a wry smile that I interpreted as something between disbelief and admiration. Regardless, it was true. I weighed 375 pounds when I undertook a Very Low Carb diet to lose weight (not to treat my worsening type 2 diabetes of 16 years) at the suggestion of my doctor, an internist and cardiologist. After he had tried it himself, he suggested I go on the Atkins diet, specifically Atkins Induction.

Admittedly, I came to that appointment with my doctor in August 2002 motivated to lose weight. For about a year his nursing staff had been unable to weigh me. The office scale only went up to 350 pounds. So, a day or two before my scheduled appointment, on my way to work I stopped by the Fulton Fish Market in NYC. I asked permission, took off my jacket, emptied my pockets, and stepped onto a wholesaler’s certified platform scale. I was stunned. The shock was genuine. I thought I might be 360 pounds or so, but the scale told the story. I could no longer be “in denial.”

Then, as I walked into my doctor’s office the next day, my doctor saw me and said, “Have I got a diet for you!” So, I was motivated – to lose weight. It never occurred to me, or to my doctor at first, that this would be beneficial to my blood sugar metabolism or my lipid health; but, as we left his office 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 here have heard this story before, so I will be brief: Immediately upon starting Atkins Induction, having virtually eliminated carbohydrates from my diet, I started getting hypoglycemic episodes every afternoon. I ate a candy bar and called the doctor (in that order). He told me to eliminate first one and then to cut back on the other two oral antidiabetic meds he had prescribed progressively more of over time. I dutifully followed “doctor’s orders.” After eliminating the Avandia, I quickly reduced the Metformin and the Micronase from “maxed out” to half and then one-quarter the original dose. Later, when I switched to the Bernstein diet for diabetics, I titrated completely off the Micronase.

Interestingly, as I stayed on this Very Low Carb diet, my blood lipids (cholesterol panel) also 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 150 to 50, where they have remained for many years now. In addition, as I lost well over 150 pounds (about 170 at one point), my blood pressure came down from 130/90 to 110/70 on the same meds. I subsequently regained some of the weight (I’m currently 232 and dropping again), and my blood pressure is stable at 120/80.  Other markers like C-Reactive Protein also dramatically improved and my A1c’s are now mid-5s and my fasting blood glucose (FBG) usually 80s and 90s.

So, is my Type 2 diabetes cured? I would say no! I have and will always have a broken, damaged, deranged, disregulated glucose metabolism. I 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 practitioner. Typically, because I am still overweight (technically obese; my BMI is 32), a doctor would advise me to eat a restricted-calorie, low-fat, “balanced” diet, and exercise regularly.

THAT would be a prescription for disaster. I would immediately return to out of control blood glucose, again becoming progressively dependent on anti-diabetic oral medications, eventually becoming an insulin-dependent type 2 diabetic. In addition, my lipids, which are now stellar, would return to borderline or worse. Then, my doctor would be aggressively pushing me to start on statins, with all their dubious benefits and consequences. The low-fat diet he would recommend is by definition high carbohydrate (50% to 60% by calorie). The Nutrition Facts panel on processed food packaging is proof of it. It is based on 60% carbohydrate or 1,200 calories on a 2,000 calorie a day diet. Check it out, if you don’t believe me.

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, and it drove that condition into total, complete remission, so long as I continue to eat Very Low Carb. There’s no going back, in case you were wondering…

VLC will do the same for you if you are prediabetic, defined as having two successive fasting blood glucoses between 100 and 125 or an A1c between 5.8 and 6.5 (or 7.0 for general physicians and internists. Endocrinologists are more aggressive.) But if you don’t know what your blood sugars are and you are just overweight, particularly if your waist hip ratio is above .9 (male) or .85 (female) at any weight level, eating VLC will “regularize” your blood sugar, making it more stable; And eating Very Low Carb (and therefore high fat) will improve your blood lipids, especially HDL and triglycerides. So, why not try it?


  1. Thank you for retelling this story, there are so many who still need to hear it. I had dinner a while ago with two friends. One is a very thin lady who is married to a recently diagnosed T2, the other is a very heavy prediabetic lady who has been on an Optifast diet. The thin lady has researched T2 diabetes and come to the same conclusions you and I have. She is helping her husband deal with his problems by cooking low carb for both of them. She is totally dismayed with the information his doctor gave him. The heavy lady is religiously following her doctor's and her dietitian's advice, trying to lose weight so she can eat "normal" again. We tried to explain to her that eating "normal" meant eating junk she really didn't need, but even though she's an intelligent lady, it just didn't sink in. She has bread and pasta on the brain and the starvation diet she's on (which has a lot of sugar in it) just reinforces her desperation. It's so sad. So again, thank you for taking the time to spread the word. You do a good job.

    1. Oh, thanks Jan. You have no idea how much your support means to me. You are a faithful and steadfast supporter.

      I am also glad to hear from you again after I replied to your Metformin-related ketoacidosis. I firmly believe you and I (and the thin lady) are on the right path, but I need to do a little CYA also, if I'm going to be giving "dietary advice."

      It is indeed sad that we are on a teeter totter in the Nutrition Debate. Most people do rely on their doctors for nutritional/dietary advice. How stupid that is! Wait 'till you read my next column:"Lifestyle Intervention is Great Therapy," to be published on Saturday.

      Of course, it will take time, and advocates like me, and supporters like you, to make the difference, but I think we are poised to do it. So, I'll keep trying.

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