Saturday, December 14, 2013

The Nutrition Debate #169: When I told her, “I’m diabetic…”


When I ordered 2 fried eggs and a side of bacon for breakfast in a hotel in New Orleans recently, the waitress said the special came with grits and a muffin. When I declined, she countered (mistakenly) that it would save me money. When I told her, “I’m diabetic,” she just looked back at me with a blank expression.

After she left, my wife said the waitress didn’t understand. “Grits and a muffin are not sugar,” my wife said. People don’t understand that all carbohydrates will break down to simple sugars, mostly glucose. Glucose is “blood sugar,” and a normal amount is only about a teaspoon. If you are diabetic or pre-diabetic, you have insulin resistance. Insulin is your cellular gatekeeper, and the door to your cells is “locked.” (Actually, it’s got a chain on the door that allows you to crack it open only a little.) That means your cells pretty much ignore the insulin and thus won’t “take up” the glucose that is circulating in your blood with it. Result: high levels of glucose continue to circulate, raising your risk of CVD and dementia, damaging your nerves and organs (eyes and kidneys) and also the small blood vessels in your extremities, toes especially. End result: 50% of all newly diagnosed diabetics already have some sort of diabetic complications at the time of diagnosis.  

Ignorance about type 2 diabetes is endemic in the populace. People are abetted in this ignorance in part by self-denial. After all, who wants to “give-up” favorite foods! But it is also aided and abetted by institutionalized obstructions: Government in the pocket of Agribusiness and Big Pharma; the medical associations and societies (the AHA, the ADA medical wing), also largely dependent on Agribusiness and Big Pharma for financial support; and the intransigence, implacability and intractability of the medical associations to accept the “inconvenient truth” that the low-fat, high-carb “prescription” it has been dispensing on a population-wide basis for the last half-century has been a huge, failed experiment in nanny-state government, like the ACA (Obamacare). Sound familiar?

Another aspect of this problem “if I’m to avoid eating carbohydrates” is, “what can I eat?” Implied in this question is that “everybody knows” that we shouldn’t eat saturated fat and cholesterol because “they’re artery clogging.” Well, that’s just not true. Countless studies, from the “very beginning” (Ancel Keys and later George McGovern notwithstanding; Google them if you don’t know what I am referring to) have shown, to no avail, that saturated fat is good for you. In fact it is essential for healthy cells. And the liver makes about 90% of our cholesterol (100% for vegans) to use for the production of cell membranes, bile acids and hormones, including vitamin D. Dietary cholesterol is inconsequential. “The body knows.”

Cholesterol is blamed for clogging the arteries when it’s actually repairing (with plaque) the inflamed artery walls whose erosions are filled with small dense LDL particles. It’s the inflammation and the small dense LDL particles that are the problem – not the cholesterol that came to put out the fire. The way to fix this is to increase the HDL particles in your blood (by eating saturated fat) so they can carry the LDL back to your liver before it gets stuck in your arteries. You can also increase the size/quality of your LDL particles from small-dense to large-fluffy by eating a low-carb diet. Unfortunately, evidence suggests that statins only lower your large-buoyant LDL cholesterol, leaving the small dense ones to get stuck.  

Finally, you can also lower your triglycerides by eating low carb. And lowering your systemic inflammation will result in less damage to the endothelial layer of your artery wall in the first place. The best test for that is the hs C-reactive protein, and the best measure of your risk of CVD is your Trig/HDL ratio. It’s one of the strongest predictors of CVD risk, much better than the total cholesterol to HDL ratio that is commonly reported in the lipid panel on a lab report.

A day or two later, we were having breakfast at a motel in Cajun Country in a place called Thibodaux. I’m told it is home to the 3rd best culinary school in the country. In the breakfast room the “coffee creamer” was “Coffee-Mate,” a sweetened chemical concoction designed to eliminate saturated fat (from milk and cream) and replace it with “sugar” (carbs). I had my usual eggs and bacon but noticed that for the breads they provided “Chef Mark whipped spread,” whose primary ingredient is “partially hydrogenated soybean oil.” “Everybody knows,” don’t they, that that’s trans fat, “Pure” unadulterated poison! 

I had occasion to speak to the motel’s managing partner about these things. He asked, reasonably, as an alternative, what should he be offering his guests? I said “half and half and butter”! When he started to ask about saturated fat, I suggested he talk to the culinary school people about my suggestions. Let’s hope he does and that they give him good advice. They should know better, but who knows, it’s Thibodaux. Sorry, but let this last story illustrate why I am concerned.
The day before we had been on a “Swamp Tour.” With time for lunch before starting out, I asked about a place to eat, mentioning that I was diabetic. Later, our tour guide, who had overheard me, mentioned that he was diabetic too. He told me that he takes orals meds and basal and mealtime insulin. I asked him what he eats. He said his doctor told him he could eat one slice of bread with breakfast. I then asked him what he had just eaten for lunch. He said he had had spaghetti. When I told him what I eat for breakfast and lunch, he just looked back at me with a blank expression. The boat driver told me later his friend had blood sugars in the 300s. And he walked with a limp. This man does not have a good prognosis.

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