Saturday, January 25, 2014

The Nutrition Debate #179: Vitamin D Supplementation

Supplementing with Vitamin D has become all the rage in recent years, but “Low concentrations of 25-hydroxyvitamin D (23[OH]D) are most likely an effect of health disorders and not a cause of illness,” according to a piece by Nancy A Melville here in Medscape Medical News.  Melville’s article on a “comprehensive review of observational studies and randomized clinical trials of vitamin-D status and health outcomes” was published online in Lancet Diabetes & Endocrinology. A previous large-cohort study had shown “strong associations” of low Vitamin D Concentrations (<30nmol/L) with all-cause, cardiovascular, cancer and respiratory disease mortality.

Vitamin D is an odd bird sort of “vitamin.” It is not, strictly speaking, an essential vitamin because, according to Wikipedia, it can be “synthesized in the skin, from cholesterol, when sun exposure is adequate.”However, people who live further from the equator get less exposure to the sun’s rays in winter. And people who work indoors get less exposure. And out of concerns for skin cancer, many people block sun exposure with lotions. In addition, the elderly population (mainly women), and others with limited mobility, have less opportunity to get vitamin-D by natural means.

So, “like other compounds called vitamins, in the developed world, vitamin-D is added to staple foods, such as milk, to avoid disease due to deficiency,” according to Wikipedia. The enthusiasm for Vitamin-D supplementation has been fueled by its “relatively low toxicity, the glimmer of positivity from some trials, and the large body of evidence from prospective observational studies,” according to the Medscape piece. In addition, the vitamin-D supplement industry, the manufacturers of vitamin-D testing products, and the artificial UV tanning industry have all helped fuel the enthusiasm.

“The new analysis,” according to Medscape, “showed moderate to strong associations between lower concentrations of 25(OH)D and higher risk of conditions ranging from cardiovascular disease to infectious disease, glucose metabolism disorders, and mood disorders.” The researchers “found no effect on disease occurrence as a result of supplementation.”“The discrepancy between observational and interventional studies suggests that low 25(OH)D is a marker of ill health.” Quoting the Medscape piece, “In the interventional studies, participants had a baseline mean 25(OH)D concentration of less than 50nmol/L. Supplementation with 50µg/day of vitamin D resulted in no significant improvement in health status.” 50µg/day = 2000 iu.

This carte blanche Medscape excerpt addresses the effect of vitamin-D supplementation’s on diabetes and cancer.

“As part of their review, the authors also conducted a meta-analysis of 16 trials that focused on the effects of vitamin-D supplementation on HbA1c, the standard measure of long-term blood glucose control in diabetes. Although the observational studies showed an association between type 2 diabetes and low vitamin-D levels, supplementation with the vitamin had no effect on reducing HbA1c.

The data also showed that high 25(OH)D concentrations were associated with a protective effect on colorectal cancer, but not other cancers. However, 2 large intervention trials showed no reduced risk of any cancers, including colorectal, with vitamin-D supplementation.

One exception was seen in the elderly population (mainly women), who showed a slight reduction in all-cause mortality if they received vitamin-D supplementation of 20 µg/day (= 800 iu). However, the authors say that the improvement could be related to vitamin-D deficits caused not directly by the illness itself but by lifestyle changes resulting from the illness, such as a lack of mobility, restrictions on exposure to sunlight, or dietary modifications related to treatment.

‘In elderly people, restoration of vitamin-D deficits due to aging and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival,’ they suggest.”

Ms Melville writes, “The authors speculate that a key mechanism that causes lower 25(OH) D concentrations in people with illness is disease-related inflammation.” “They add that ongoing trials will provide more information, but in the meantime they advise against vitamin-D supplementation. In addition, Ms Melville quotes Dr. Autier as saying, “…supplementation, if an individual’s vitamin-D concentration falls below a ‘sufficiency’ threshold of 75nmol/L, (is) an ill-advised practice.”

He added, “The wealth of evidence from randomized trials shows that this medical behavior is not grounded, and taking vitamin-D supplements will make no difference in health status.” “It would be wiser to seek reasons underlying the low vitamin-D level, such as inflammatory processes, or undiagnosed cardiovascular diseases, and fix them.
This was a serious review and an excellent job by Medscape of reporting on it. If you supplement with Vitamin D, you should at the very least read this Medscape piece for a fuller and easy-to-understand summary and analysis of the paper. And get some sun!

Wednesday, January 22, 2014

The Nutrition Debate #178: “Diabetes Rocks!”

David Mendoza wrote a very nice article for Health Central a while ago titled “Grateful for Diabetes.” It was one of 5 short pieces of his that they published that month! Another piece of his that they published was titled “Diabetes without Drugs.” Both are excellent and short, and I recommend you click on the links and read them. But my favorite line from both was the last words of the “grateful” piece: “Diabetes rocks!”

Mendoza explains the “grateful” piece this way: “Knowing that we have diabetes can be good for us.” “You may think I’m crazy,” he says, “but some of us are thankful that we have diabetes. I wish all of us could share this feeling.” Note: it is actually the feeling that he is grateful for, not the diabetes. It is the reaction to the knowledge that he is a diabetic. But what action, having that knowledge, was taken? Mendoza explains that with a story:

“Mary Ann wrote me a few months ago that when a doctor told her that she had diabetes, she didn’t know anything about it. At first, she felt shock, fear, anger, and grief. Then, she realized that she ‘had to be the one to take control of it’ and went on a low-carb diet, which helped her both to lose weight and to reduce her blood sugar. ‘I’m actually grateful for the diabetes diagnosis,’ she told me [Mendoza]. ‘It inspired me to take control of my health’’’ (emphasis mine).

Mendoza then goes on to describe how, “Mary Ann’s journey from a diabetes diagnosis to good health parallels his own journey.” At the time he was diagnosed, he says, “I had an A1c level of 14.4, weighed more than 300 pounds, and lacked energy.” “Today,” he says, “I tested my A1c…and found that it is 5.4. I weighed myself as I do every morning and found that I now weigh 155.6 pounds. I have more energy than I had 20, 30 or even 40 years ago.”

Is that inspirational or what? Do you understand now why David Mendoza says, “Diabetes rocks!”?

The “Diabetes without Drugs” piece fills in more of David Mendoza’s story. The lede of this piece in Health Central, and on his own website, says flat out, “If you have type 2 diabetes, you can manage it without any drugs.” Mendoza doesn’t pull his punches. This is an unqualified statement, and he is an exemplar, to be sure. I wish I did as well.

David Mendoza was diagnosed a type 2 diabetic in 1993. He was treated by his doctor in the conventional way for 14 years, with “experience taking a wide range of diabetes drugs, including two different sulfonylureas, Glucophage (metformin), and Byeta” (a GLP-1 injectable incretin mimetic). Then in 2007, with encouragement from a friend who is a Certified Diabetes Educator, he joined “a group” “and for the past six years I haven’t taken any diabetes drugs, and yet I keep my diabetes in control with an A1c level usually about 5.4. When you manage your diabetes well, it [your A1c] is well controlled. It is normal. We know that the normal A1c is 6.0 or below.”

“An A1c level of 6.0 or below means that your diabetes is in remission,” Mendoza says. “It does not mean that you have cured it. If you relax your vigilance, your A1c level will go above 6.0 again, and you will again put yourself at risk of the terrible complications of uncontrolled diabetes.”

Mendoza doesn’t explain in this piece what “the group” he refers to was, but I’ll venture a guess it was a group of people who were motivated to be educated and seek mutual support to, among other things, undertake a Very Low Carb Way of Eating. “Any lifestyle change this fundamental is difficult,” Mendoza admits. “I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways. The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had 1) to lose weight, 2) eat fewer carbohydrates, and 3) exercise more.”

As my readers know, my story is very similar to Mendoza’s. I was diagnosed in 1986 and was treated in the conventional way with oral meds (maxed out on 2 and starting a 3rd) for 16 years until my doctor suggested I try Atkins Induction (20 net carb grams a day) to lose weight. I had to drop the meds immediately, lost 60 pounds on Atkins and then another 110 a few years later on Bernstein. Mendoza lost at least 100 pounds on the low carb protocol that he followed. My latest A1c was 5.7 but has been as low as 5.4, Mendoza’s latest. And I don’t do a regular exercise routine. It makes me sweaty and hungry. LOL

 I unfortunately have regained about 30 pounds but still maintain a 140 pound weight loss. And I still take 500mg of metformin. I’m not sure why. I tell myself it is to suppress gluconeogenesis, should I eat too much protein (with fat) at dinner, as I am wont to do. Or perhaps it improves my insulin sensitivity, or maybe it is just a vestige of my past life as a heavily medicated type 2. I’d like to think I could do without it, and I’d love to be able to say, as David Mendoza does, “…for the past six years I haven’t taken any diabetes drugs.” Wouldn’t you?
David Mendoza and I are both very lucky that neither of us has had any diabetic complications. No peripheral neuropathy, normal renal function, and no signs of diabetic retinopathy. I also see an urologist and an optometrist once a year.

Saturday, January 18, 2014

The Nutrition Debate #177: The ADA’s Helpful Advice?

Readers here are accustomed to me slamming the ADA for their type 2 diabetes treatment protocol (except when I am singing their praises as I did here in “Cowabunga, the ADA makes the turn”). So if you’ve had enough of that, go read their magazine. That’s what I was doing in the optometrist’s waiting room the other day when I came across this dreadful advice in a feature called, “Mail Call: Ask the Experts,” in a 2011 issue of the ADA’s Diabetes Forecast.

The reader (name withheld by the magazine: hmmm…) wrote that she had recently been having “morning” (fasting?) readings in the 150-180mg/dl range and “…I cannot get them down.” She wanted desperately to know what was happening and what she could do about it. She explained that she was already taking two types oral diabetes meds, metformin and glipizide, a sulfonylurea. The response came from ADA expert “Belinda Childs, ARNP, MN, BC-ADM, CDE.” Wow! (Whew?)

The ADA’s expert told the letter writer (and all the readers of this, the ADA’s official outreach organ, intended to convey helpful information and education to the type 2 diabetic population): “Type 2 diabetes is a progressive disease,” and “over time the body is less able to produce insulin. As your body’s needs change, additional treatments may be needed.”

Then, almost the entire balance of her reply to the letter writer (and the type 2 world “out there”) was seven paragraphs describing in detail by brand name each of the classes of oral and injected diabetes prescription medications which was still available for her physician to prescribe before she might “graduate” (to borrow the words of Tom Hanks' doctor) to becoming, ultimately, an insulin-dependent type 2. That was it. Not a word about food choices. Just leave your care to your doctor and big pharma. They (“your diabetes care team”) will “review all the options” and take care of you.

Of the magazine’s 80 pages, 28 pages (35%) were devoted to advertising, most of it for prescription meds. I must admit, though, that this observation is purely associative; it does not prove causation. Perhaps a randomized controlled trial might be in order to test the hypothesis that the expert advice given and the preponderance of medical advertising accepted has a direct relationship. How about publishing the magazine without any pharmaceutical advertising, with just content advocating medical treatment? As a control, publish an edition in which the content recommends that type 2 diabetes be treated by food choices alone, one edition with and one without big pharma ads. Do you think this rag would survive?

The primary mission of the ADA, as I perceive it, is its own survival. To fund operations, they need to sell advertising for the magazine and obtain tax-deductible contributions from industry. To prosper, they must keep the pharmaceutical companies and the doctors who write the scripts happy. In other words, they need to keep the patient dependent on medications. How else can your doctor keep you coming back if all he/she does is to tell you to eat less (of a low-fat, high-carb diet) and exercise more? You both know you don’t need to hear that 4 times a year, especially if you’re “non-compliant” (‘cause this “conventional” advice failed!). Come to think of it, the last thing my doctor asked me recently was, “Need any renewals?”

As I step back, and consider the mission of the ADA, it is obvious that the ADA’s advice is in perfect harmony with keeping the type 2 diabetic population “in the fold” and entrapped to a life of dependency on medications as the disease “progresses.” The patient who is compliant with his or her doctor’s advice, (given in full accord with the “standards of practice”), will become increasingly dependent on medications. And if “the effects of these drugs goes away,” as the “letter writer” worried, big pharma will come up with new and better medications, when the patents on the older ones run out.

The ADA’s Diabetes Forecast magazine masthead pretty much tells me the story of the ADA itself. There’s an MD in charge of “Medicine and Science” and an RN, MSN, in charge of “Health Care and Education.” Other than that, all the other ADA officers are MBAs, CPAs, or are without specialized credentials. The ADA magazine’s Editor-in-Chief and Associate Editors have medical or related credentials. The magazine does have an editorial board, on which our expert, Ms Childs, serves.

The ADA’s “Our Mission” statement (in the print edition), also on their masthead page, has 3 high-sounding but rather limp tenets, especially #3: “The American Diabetes Association recommends that consumers familiarize themselves with nutritional information about food products.” It sounds like I am not the first to rail and foment about their true mission.

 Perhaps this is simply the natural history of any on-profit organization. See, for example, the “Illustrated History of Heart Disease: 1825-2015” timeline on the Diet Heart Publishing website: “In 1948 the AHA reinvented itself as a fundraising organization.” The parallels are eerily similar, and similarly disturbing. Review this list of corporate donors to the ADA and I think you will understand why I view any advice coming out of the medical side of the ADA with the contempt I think it deserves. I hope you do too.
Notwithstanding this, I hold out hope, as I said in the beginning of this rant. The ADA’s RDs and CDEs, at least the ones who wrote these new dietary therapy guidelines, have “made the turn.” It remains now only for the ADA’s medical care side to have a similar awakening. I am very dubious that they will though, given where their “bread is buttered.”

Wednesday, January 15, 2014

The Nutrition Debate #176: Eggs, Cholesterol and Choline

Eggs have had a checkered history for the last several decades. Why? Well, for one thing – no, the only reason, plain and simple, is that they are high in cholesterol. Ever since Dwight Eisenhower had a heart attack (1955), our government has been telling us that dietary cholesterol is a no-no. Ancel Keys had popularized the notion; later the McGovern Commission’s 1977 “Dietary Goals for the United States” told us in bold headlines to eat less saturated fat and dietary cholesterol. Eggs are “artery clogging” and will cause heart disease. Hogwash! And everybody knows this, but just in case you haven’t heard:

The Nutrition Source website of The Harvard School of Public Health starts off, “Long vilified by well-meaning doctors and scientists for their high cholesterol content, eggs are now making a bit of a comeback. While it’s true that egg yolks have a lot of cholesterol—and so may weakly affect blood cholesterol levels—eggs also contain nutrients that may help lower the risk for heart disease, including protein, vitamins B12 and D, riboflavin, and folate. A solid body of research shows that for most people, cholesterol in food has a much smaller effect on blood levels of total cholesterol and harmful LDL cholesterol than does the mix of fats in the diet.” (Emphasis mine) That may be faint praise, but I’ll accept it, coming from Harvard.

I eat 3 fried eggs a day (18 a week, since I make veal kidneys for breakfast on Sunday). They are cooked in bacon grease from the one strip I add to my plate. Occasionally, we have scrambled eggs, prepared with a little whole milk and cheese. I sometimes add hot sauce. I always add salt and pepper, and I take my coffee with Truvia or stevia and half and half. My latest HDL cholesterol was 85, my triglycerides 49, my total cholesterol 217 and my LDL 122 (Pattern A: large-buoyant).

I mention my blood lipids because the casual reader, upon learning that I eat 3 eggs a day, would reasonably ask, “How about your cholesterol?” The government has recommended from 1977 to the present that we, as a population, eat no more than 300mg of dietary cholesterol a day. Three eggs (the yolks alone) contain 634mgs. And with the half and half and bacon, I’m up to 660mg for breakfast alone. My can of sardines at lunch adds another 50, and then there’s dinner, another 200 maybe? Six ounces of cooked shrimp would add 360 for a grand total for the day of well over 1,000mg of cholesterol!

I buy eggs at our local farmers’ market. The vendor is a local farmer, who also raises grass fed beef and heritage pigs, rotates their chicken-coop-on-wheels from pasture to pasture, Joel Saladin Polyface Farms style. I pay a little more for these eggs, but I know that they are as good as I can get. In Florida, where we winter, I also patronize a vendor at the farmers’ market who only sells free range livestock and pastured poultry. I sometimes buy duck eggs there (619 mg of cholesterol).

Because they contain “complete protein”, eggs are one of the very best foods you can eat, and hens that range freely on the pasture produce the best eggs, nutritionally and in terms of taste. Like people and pigs, chickens are omnivores, so they eat insects and larvae (from fermenting “flops”). Their eggs are higher in, among other things, Omega 3 fatty acids, the “good” polyunsaturated fat that is “essential” for humans. That’s why I also eat sardines (in olive oil) for lunch and supplement with a 1-gram capsule of fish oil twice a day – to get the EPA and DHA in the Omega 3s.  Another reason to eat3 eggs a day, versus 2 before, is to get extra choline, a recommendation of the very good book (except with respect to type 2 diabetes), Perfect Health Diet, by Paul and Shou-Ching Jaminet.

According to Wikipedia, “Choline was classified in 1998 as an essential nutrient by the Food and Nutrition Board of the Institute of Medicine. Choline is the precursor molecule for the neurotransmitter… (that) is involved in many functions including memory and muscle control.” “Choline must be consumed through the diet for the body to remain healthy,” according to the Linus Pauling Institute at LSU. “It is used in the synthesis of the constructional components in the body's cell membranes. Despite the perceived benefits of choline, dietary recommendations have discouraged people from eating certain high-choline foods, such as eggs and fatty meats. The 2005 National Health and Nutrition Examination Survey stated that only 2% of postmenopausal women consume the recommended intake for choline.” Food sources of choline are here.

“A 2010 study tested postmenopausal women with low estrogen levels to see if they were more susceptible to the risk of organ dysfunction if not given a choline-sufficient diet. When deprived of choline in their diets, 73% of postmenopausal women given a placebo developed liver or muscle damage, but this was reduced to 17% if estrogen supplements were given. The study also noted young women should be supplied with more choline because pregnancy is a time when the body's demand for choline is highest. Choline is particularly used to support the fetus's developing nervous system.
I am so accustomed now to eating 3 eggs for breakfast that on vacation recently, without thinking, I opted for powdered eggs in the free breakfast buffet. Then, I got to thinking: powdered eggs? What are they really? They are manufactured and processed foods! So, I looked them up. One tablespoon of powdered egg, mixed with ¼ cup of water, is the equivalent of 1 large egg. The powdered version is 30 calories, vs. 50 for the fresh egg; the powdered version has 2.3 grams of protein versus 6 for the fresh. The powdered version has 2 grams of fat versus 5 for the fresh; and they taste awful, even with salt and pepper and hot sauce. The cholesterol is probably oxidized too. On our next trip I will opt for hard boiled eggs, a real food always offered on the buffet. And maybe an individual serving of full-fat cream cheese, without the bagel, of course.

Saturday, January 11, 2014

The Nutrition Debate #175: “Your blog is primarily for type 2 diabetics, right?”

“Your blog is primarily for type 2 diabetics, right?” I was chatting with a family member before a holiday dinner recently, and I fumbled a bit with my answer. I said, “Yes, but…” and mentioned pre-diabetics and people who are overweight and likely to have all the medical markers for Metabolic Syndrome such as low HDL cholesterol, high triglycerides, and LDL cholesterol particles that are small-dense rather than large-buoyant.

I saw our dinner guest’s eyes glaze over, so I quickly added: “Some people have a genetic predisposition to a disregulation of fat metabolism called Insulin Resistance (IR).” I said, “Losing weight for some people was not just about eating less (of a balanced diet) and exercising more.” At this point, our guest, who is quite thin, replied that that was how he lost weight. I had now lost him on both points. He was clearly looking to change the subject, and I don’t blame him.

But this conversation stuck in my head for a few days, and I realized it was time, after 174 posts, to define my blog more definitively. The Nutrition Debate is about, well, the nutrition debate. It’s true that I have been a type 2 diabetic since 1986 and that for the first 16 years I allowed my doctor to “treat” me with medications. Over the years, the dosages increased until eventually I was maxed out on two and started a 3rd. This was considered “normal” because “type 2 diabetes is a progressive disease,” according to the conventional wisdom. To be fair, my doctor also consistently urged me to lose weight, and he provided the conventional “prescription” for that too: eat a “calorie-restricted, balanced diet and exercise more.” It didn’t work.

Over the years I got fatter and sicker, until in July 2002 my doctor read Gary Taubes’s seminal New York Times Sunday Magazine cover story, “What If It's All Been A Big Fat Lie?,” He tried the very-low carb diet recommended (Atkins Induction), and then suggested that I try it too, to lose weight. What happened, instead, was that from the very beginning I started getting hypos (dangerously low-blood sugars). So I called my doctor, and he told me to stop taking one of the meds. The next day I was still getting hypos, so I called again, and he told me to reduce the other two meds by half. Then, a few days later, he told me to reduce them by half again. Later, I eliminated one, and today I take just 500mg Metformin once a day.

The immediate effect of eating a very low carb diet was that my blood sugar returned to normal. After a while my fasting BSs were in the 80’s and 90s on a minimum dose of 1 med after 16 years of 150s on 3 meds. I also lost a lot of weight (170 pounds eventually), and my blood pressure was much better controlled (from 130/90 to 110/70) on the same meds.

But the effect of this very low carb diet on my blood lipids was even more spectacular. My average HDL cholesterol more than doubled from 39 to 81, and my average triglycerides (blood fats) were reduced by almost two-thirds (from 137 to 49). In addition, while my total cholesterol and LDL remained about the same, the LDL particle size and pattern changed from Pattern B (small-dense) to Pattern A (large-buoyant), and my high-sensitivity C-reactive protein labs (a marker for systemic inflammation) decreased from 6.4 in early 2003 to a low of 0.1 in late 2012.

So, is this blog just about or for type 2 diabetics? I think not. This blog is about healthy eating, for everyone. The Nutrition Debate for me is also not just about carbs. It is much, much broader. Equally important, again for everyone, is the debate over dietary fat: Saturated fats versus inflammatory polyunsaturated fats such as corn oil and soy bean oil. And it is about protein, and sugars (both simple and added) and processed-foods, including liquid foods (milk, fruit juices, and smoothies).

But this sounds like a diet that is against everything, as someone once said. Not true. It is for eating whole, real foods, not processed and manufactured foods. Some people have called this “eating clean.” Others, like Dr. Kurt Harris who developed the Archevore Diet, describe it as avoiding “the Neolithic agents of disease – wheat, excess fructose, and excess linoleic acid” (in vegetable oils). Harris says, “It is becoming clear now that many of the diseases afflicting humanity are not a natural part of the aging process, but are side effects of the technology and other powerful cultural changes in the way we eat and live that have occurred since the dawn of agriculture roughly 10,000 years ago.” A sort-of Paleo manifesto.

“I believe we can make sense of many of the diseases prevalent now and relate them to some simple but profound changes that have occurred with the introduction of agriculture and the more recent industrialization of our foodways,” he says. “These changes are related to how the food environment, including its availability, interacts with the metabolic environment of our bodies,” and “…the diseases of civilization are largely related to the abandonment of the metabolic conditions we evolved under.” Both Gary Taubes and Dr. Kurt Harris are in my pantheon of heroes.
So, are most of my regular readers type 2 diabetics, or pre-diabetic (Metabolic Syndromers), or just IR (Insulin resistant and thus carbohydrate intolerant) and overweight or obese? Maybe, at present, but I hope that more of you will come, as I do, to see that “eating clean” is the best way for everyone to avoid the Diseases of Western Civilization.

Wednesday, January 8, 2014

The Nutrition Debate #174: 23andMe and the Self-Care Brouhaha

According to an article in The Washington Post, last November the FDA ordered 23andMe to stop marketing its $99 genetic diagnosis kit. 23andMe claims to be able to identify 254 conditions based on biological samples (cheek swab). The FDA says that a false negative or a false positive could “mislead consumers and could unwisely convince them to self-treat, with potentially deadly results. Information consumers might learn from emerging science could unwisely convince them to self-treat, according to our government. I’ll be darned! So, we must be content with the information our government has approved, or that the health care establishment has dispensed, with the approval of the government?

Where does one begin to tear this thinking apart? Let’s address the conspiracy theories first. Who brought the complaint about this 6-year old company’s product to the attention of the FDA? According to one on-line commenter on the Washington Post website, who provided a link to Bloomberg News, it was UnitedHealth Group, “the US’s #1 publicly traded insurer.”  To which another commenter replied, “Isn’t the unfettered free market great? To which the original commenter replied, “And now UHG can require patients to use its own in-network Premium Kit, developed by a ‘trusted partner,’ that does less accurate testing for 10 times the price. These savings all brought to you by the FDA.”

Another conspiracy theorist speculates, “Looks like Sergey Brin is using his buddy Obama to exact revenge on his estranged wife, Anne Wojcicki,” to which yet another replies, “Did the Google husband withdraw support from his divorcing wife?” Backstory:  Brin is a co-founder, with Larry Page, of Google, and is worth about $25 billion. His wife, who is divorcing him for his dalliances, is co-founder and chief executive of 23andMe, “in which Google has invested millions.”

According to Wikipedia, Brin’s mother was diagnosed with Parkinson’s in 2008. Brin used 23andMe to find out that he has “a 20 to 80% chance of developing Parkinson’s later in life.” When asked whether ignorance was not bliss in such matters, he stated that his knowledge means that he can now take measures to ward off the disease. An editorial, “Enlightenment Man,” in the print edition of The Economist magazine states that, "Mr. Brin regards his mutation of LRRK2 as a bug in his personal code, and thus as no different from the bugs in computer code that Google’s engineers fix every day. By helping himself, he can therefore help others as well. He considers himself lucky.  But Mr. Brin was making a much bigger point. Isn’t knowledge always good, and certainly always better than ignorance?”

Anyway, my interest in this subject relates to free enterprise, individual liberty and the frontiers of science – not juicy gossip or political intrigue, although I do find them titillating. I have been urging readers to “take charge of their own health” in part as an act of individual responsibility, in part to preserve personal liberty, and in part as a reaction to the horrible dietary advice that our government has been dispensing through its own agencies. Government has enormous control over the private sector through the medical establishment by way of “research” funding and regulatory approvals, which influences clinical practice and dietary practices in institutions and for private citizens.

Another commenter said, “Genetics/Epigenetics is the new frontier in science.” Right on, I say. Read The Nutrition Debate #120, “Nutrigenomics – an emerging new science,” here for definitions and to see how it is related to diet. And “do your research,” another says. “There are many places where you can use 23andMe data. It’s not the data but what you can DO with the data.” And another says, “Anything offered on the23andMe website IS NOT medical advice, is NOT a medical diagnosis, and should NOT be used for such purposes.” And another finishes this off with, “Everyone knows that this is information that needs to be discussed with medical doctors before being actionable.”

And then, on the individual liberty front, one commenter complains, “It’s really sickening we’ve reached the point where the state wants to regulate one’s own ability to access information ABOUT ONESELF…never mind that they want access to and control over all information about YOU.” Another sarcastically put it this way: “This is just the government looking out for us. It’s far better that the health agency has more information about me than I do.” “Thank you, President Obama,” he says, “for putting a stop to my entering willingly into an agreement with a private company. Their research and data could undermine federal initiatives that would be unacceptable.” To put a fine point on it, another says, “Deciding whether I can buy a genetic test to analyze my genome and what I do with it is a place in which the government should have no role.”

Agribusiness and Big Pharma are both happy with this arrangement though. They just develop, manufacture and market products to comply with the government’s “healthy diet,” which is the one making us fat and sick. So, it wouldn’t surprise me that UnitedHealth Group wants to maintain its control of their leading position in the market, or that the current administration would support them in their effort. Of course it wouldn’t surprise me either if there was an element of corruption and revenge involved either. I think it’s too bad, though. Knowledge IS always good, and certainly better than ignorance. I hope that after the divorce in settled, Ann takes the FDA to court. That way both she and we will be free.

Have you entered into a contract with 23andMe?

Saturday, January 4, 2014

The Nutrition Debate #173: “Anyone can be a doctor…”

When I first read, “Anyone can be a doctor…,” my reaction was, this is over the top. It was just a comment, to be sure, on a controversial blog post at Kris Gunnars’ excellent Authority Nutrition website; but still, I thought it went too far. Then, as I read on, I came to see the point: “…so long as you stay away from drugs [pharmaceuticals] and supplements and stick to using food as your medicine.” The commenter, someone named “Wenchypoo,” had got my attention with her trenchant and pithy lede, and while I might take issue with her caveats, she made a very good point. After all, it was Hippocrates, the father of Western medicine, who said, “Let food be thy medicine and medicine be thy food.” So, Wenchypoo was just echoing Hippocrates, who also said, Primum non nocerum,” “First do no harm.”

Okay, I’ll admit that medicine has come a long way since 370 BC, but so has “food,” unfortunately in ways that are mostly detrimental to our health. The prescription to use food as our medicine was more prescient than most will acknowledge today. Yet many clinicians and health care providers, and bloggers like me, are absolutely convinced that the dietary advice our government has been giving us since the days of Ancel Keys’s 1953 “Six Country Analysis” and George McGovern’s 1977 “Dietary Goals for the United States.” is directly responsible for the increasingly ubiquitous modern malady known as Metabolic Syndrome which underlies all of the Diseases of Civilization. These dietary principles still reign today in the “Dietary Guidelines for the United States, 2010,” the most recent iteration of this horribly-gone-wrong intervention.

Crop production, food manufacturing and marketing have been driven by the prescription that our diet be composed of 60% carbohydrates, 30% fat, and only 10% protein. Do the math yourself on the Nutrition Facts panel to see how a 2,000 Calorie a day diet is composed. And read The Nutrition Debate #171, “Dietary Protein and Its Impact on Obesity,” for my most recent exposition on that subject. Further, the guidelines still ordain that animal products, which are higher in saturated fats and cholesterol, be reduced, and vegetable fats, such as corn oil, soybean oil, canola oil, sunflower oil, etc., be increased. These constructs are both totally wrong and, in and of themselves, the cause of our health and obesity mess.

The pharmaceutical industry and the government agencies and medical associations setting the standards of medical practice are still getting it wrong with the latest revised cholesterol recommendations. See The Nutrition Debate #180 and #181 next month for details and analysis from the medical community on these very problematic new AHA/ACC guidelines.

So, under these circumstances, what’s a person to do? The answer, of course, is to take charge of your own health…with respect to your “dietetic prescription.” I claim no omniscience in this field, by the way. I discovered – completely by accident – that changing what I ate “cured” my Metabolic Syndrome. My motivation was simply to lose weight, so when my doctor suggested I try Atkins Induction (a very low carb diet), I tried it. It changed everything. Thank goodness he had read Gary Taubes’s “What If It’s All Been a Good Fat Lie,” a New York Times Sunday Magazine cover story in July 2002.

I wasn’t hungry, my blood pressure dropped from 130/90 to 110/70 on the same meds, my HDL more than doubled, and my triglycerides went down by more than 2/3rds. My total cholesterol stayed about the same, as did my LDL, but my LDL particle size/pattern changed from “small-dense” to “large-buoyant,” meaning they were less likely to get stuck in ruts in my arteries caused by systemic inflammation. The high sensitivity C-reactive protein test (hs-CRP, a measure of inflammation) went from a high of 6.4 in early 2003 to a low of 0.1 in late 2012. Oh, and I lost 170 pounds along the way.

Many people today subscribe to a proverb associated with the prophet Luke, himself a physician: Cura te ipsum ("Take care of your own self!" or "Cure yourself, before dealing with patients.” My doctor, an internist/cardiologist, after reading Taubes, had tried Atkins Induction himself. So I had my doc to guide me. I trusted him implicitly to care for my condition (type 2 diabetes) in a medically responsible way. And I think he did, to the extent he knew how, by training and clinical practice experience, and by following the standards of practice guidelines laid down for him my his medical practice specialty and by the public health and research bodies of our government, such the National Institutes of Health, and the National Heart, Lung and Blood Institute, the National Cholesterol Education Program, etc., etc.

But my doctor at first had followed the 2nd version of the English translation of the Hippocratic Oath before he followed the 1st version: The operable provision of the 2nd version is: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” The operable provision in the 1st version is: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” (Emphasis mine in both quotes) My doctor had “prescribed regimens” before he “applied dietetic measures.”
So, my doctor, in his unending search for a way for me to lose a lot of weight and keep it off, suggested, after reading Taubes, that I apply dietetic measures against the medical establishment’s recommendations. He did it “for the good of his patient” and “according to (his) ability and judgment,” and he “kept me from harm.” He must have recognized a risk, but by monitoring my health closely, we learned that the clinical outcomes clearly justified the risk. Good on him!