The Nutrition Debate #292: Type 2 Diabetes: Doctors in Transition

First off, let me be clear. I am not angry at doctors, in general. Neither am I an apologist for them, although examples of both have occurred in my 291 previous posts. Let’s face it: clinicians who treat Type 2 diabetes are in a tough spot. They are like passengers on the Titanic, cruising along in the dark, comforted by the knowledge that what they were taught in medical school is still the current treatment protocol. They are also aware, however, that how they are required to treat “will trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.”

The Nutrition Debate #12: "Turning the Titanic", written 4 years ago, was a flop (only 30 page views). I guess people aren’t interested in abstract metaphors and allusion. They want concrete solutions. Well, folks, please don’t wait for the medical establishment to substantially change the standard of care for Type 2 diabetes. There are too many forces in play now. I don’t need to go into them all in detail. (It would just be a rant!) Suffice it to say the entire field of “healthy eating” today is dominated by the powerful food processors and manufacturers (“Agribusiness”) and drug manufacturers (“Big Pharma”). They in turn influence public health policy and corrupt drug research. To close the loop, their ads enrich the media and "miseducate" the public.

There are, of course, notable exceptions. In the modern era, Robert Atkins, MD, raised awareness of the benefits of low carbohydrate nutrition. He was attacked by the medical establishment as “a dangerous fraud” (The Nutrition Debate #4). Then, in 2008 Gary Taubes, the 3-times Science in Society award winning journalist, wrote, “Good Calories – Bad Calories” (“The Diet Delusion” in Britain). That book had a huge impact, especially (although less than he’d hoped) on medical practitioners. One MD, Kurt Harris, publicly acknowledged the influence that GC-BC had on him.

Dr. Harris was the creator of the “Archevore” protocol and “PaNu,” but he has since taken down his websites. Interested readers, however, can find some of Harris’s writing at Psychology Today here and The Nutrition Debate #19. Another book I’d recommend is Volek and Phinney’s “The Art and Science of Low Carbohydrate Living.” A very good online site where I “went to school” is Dr. Bernstein’s Diabetes Forum. It’s full of friendly and very helpful people.

Attempts by doctors and others to escape from the current treatment protocol and reach a wider audience via individual practice are by definition very limited. Blogs and other media do reach more people but are not very remunerative. Some have done that anyway with considerable success. The “Diet Doctor,” Andreas Eenfeldt, MD, is one such. “Authority Nutrition,” created by Kris Gunnars, a medical student, is another. And of course long-time blogger Jimmy Moore has a very popular website and many podcasts under his belt. Recently, he’s added a couple of books with Eric Westman, MD, from Duke University.

There are many other emerging "practitioners" who have seen the light, of course, most of whom have now written books, some reviewed here. A recent favorite book, and an easier read than GC-BC, is Nina Teicholz’s “The Big Fat Surprise.” She’s obviously riffing off Taubes’s earth-shaking New York Times July 7, 2002, Magazine cover story, “What If It's All Been a Big Fat Lie.” My internist read Taubes’s piece and suggested I try Atkins Induction. That’s how it all started for me.

Then, last summer, the American Diabetes Association (ADA) officially issued a Position Statement. Their “New Nutritional Guidelines,” state clearly, “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.” It concluded, ““This Position Statement was written at the request of the ADA Executive Committee, which has approved the final document.” My response was, “Cowabunga, the ADA makes the turn” (#155). This “patient centered manifesto” would change everything! One problem: the document was written by, for and from the perspective of the Medical Nutrition Therapist, not the ADA doctor members. Did they even read it?

So, what will it take for more doctors to make “the turn”? If the Titanic is going to “stay the course,” would there not be a business opportunity for enterprising doctors and entrepreneurs to chart another course on a different “ship”? A course that will NOT “trap patients in a lifelong regimen of drug management, obesity and escalating diabetes.” Is there not a business opportunity for a medical practice, led by a recognized leader and backed by solid science, to multiply and expand using existing, established medical groups as well as digital marketing?

Well, such a business plan does exist, in a nascent stage.  In #293 I will tell you more about the HEAL Clinics.

The Nutrition Debate #291: Salad Dressing Oils: The Good, the Bad and the Ugly

While reading the MyFitnessPal article linked to here and in The Nutrition Debate #290: “My Healthy, Homemade (Vinaigrette) Salad Dressing,” I noted their choice of salad dressing oils included “olive oil, grape seed oil, sesame oil, nut oils and avocado oil.” Also, two of the three recipes featured used “olive oil” and the third, the Asian Vinaigrette, “vegetable oil.” To their credit, they did not mention either soybean oil or canola oil, the vegetable oils now most used (previously it was corn oil) in the processed food industry’s bottled salad dressings. So, I decided to do a lipid analysis of the oils they did include, using the very useful USDA's National Nutrient Database. My research produced the following table:

Salad dressing oils (%)	PUFA	Mono	SFA	n-6	n-3	n6/n3
Olive oil	10.5	73.0	13.8	9.8	0.8	12.3
Avocado oil	13.5	70.6	11.6	12.5	1.0	12.5
Canola oil	28.1	63.3	7.4	18.6	9.1	2.0
Peanut oil ('nut oil')	32.0	46.2	16.9	32.0	0.0	∞
Sesame oil	41.7	39.7	14.2	41.3	0.3	137.7
Corn oil	54.7	27.6	12.9	53.2	1.2	45.8
Soybean oil	57.4	22.8	15.7	50.4	6.8	7.4
Walnut oil (nut oil)	63.3	22.8	9.1	52.9	10.4	5.1
Grapeseed oil	69.9	16.1	9.6	69.6	0.1	696.0

For my analysis I have arranged all the oils listed in ascending order of their polyunsaturated fatty acids (PUFAs), The second column is monounsaturated fat content and the third the saturated fatty acid content. Then I list the Omega 6 percent, the Omega 3 percent and the ratio of Omega 6 to Omega 3. Omega 6s and Omega 3s are PUFAs and are “essential fatty acids.”

If you are reducing your consumption of Omega 6s, and improving your Omega 6/Omega 3 ratio, or balance, you are no doubt aware that you should avoid foods fried in vegetable or seed oils, and store-bought baked goods made with these oils. For the same reason you should avoid virtually all popular brand bottled salad dressings. See table below for details.

To make your own salad dressing (see #290), which oil then should you use? Well, olive oil (EVOO) is the clear winner, equally for the reason that it is both highest (73%) in monounsaturated fat (the “good” fat) and lowest (10.5%) in PUFAs (the “bad” fats). Avocado oil and Macadamia nut oil, the latter not listed in the USDA Database, are both very good but also very expensive. Canola oil isn’t bad, but is contains almost 3 times as many PUFAs (and about 10% fewer Mono’s) as olive oil. Besides, Canola Oil is made from a GMO dominated crop (see additional citation about the GMO issue below).

Peanut oil and sesame oil are up to four times as high in PUFAs as olive oil and have ugly n-6/n-3 ratios. (Peanuts are not nuts actually, but legumes.) And corn oil and soybean oil have five times as many PUFAs and only a third as much Mono as olive oil, so why would anyone (except a processed food manufacturer) ever dream of using them?

Walnut oil is laden with over six times as much PUFA as olive oil and less than one third as many monounsaturated fats as olive oil, and then grapeseed oil is the ugliest of them all: almost 70% PUFA with a n-6/n-3 ratio of almost 700.

Popular Brands of Salad Dressing and the oils they use:

Hidden Valley Ranch (The Clorox Company), all varieties*: soybean and/or canola oil

Kraft Salad Dressings (Kraft Food Group), all varieties*: soybean oil

Wish Bone (Unilever), all varieties*: soybean oil

Annie’s Naturals (General Mills), all varieties*: expeller expressed canola and/or sunflower oil

Brianna’s Homestyle (Del Sol Food Co.), Real French Vinaigrette: canola oil

Newman’s Own (Newman’s Own Fndn.), most varieties*: soybean and/or canola oil

Newman’s Own Balsamic Vinaigrette: soybean and/or canola oil, then EVOO

Newman’s Own Olive Oil & Vinegar: Olive oil blend (OliveOil/EVOO), then soybean and/or canola oil

Ken’s Steakhouse (Ken’s Foods): most varieties*: soybean or soybean and/or canola oil, then HFCS

Ken’s Steakhouse: Red Wine Vinaigrette: olive oil, then soybean and/or canola oil, then HFCS

Ken’s says they are “the number three manufacturer of salad dressings in the United States behind Kraft Foods and Wish-Bone,        including contract manufacturing for companies such as Newman's Own.” What happened to Hidden Valley, I wonder?

*  except “lite” and “fat free,” in which corn syrup or HFCS (sugars) are substituted for vegetable oils (soybean and/or canola).

So, why doesn’t Kraft, et al., use olive oil in all their industrially processed bottled salad dressings? Could it be that we don’t grow olives commercially here in the U. S., and we grow lots of soybeans and corn? Could it be that soy bean and canola oil are cheaper than olive oil? Canola oil is produced from a low-acid cultivar of rapeseed, a member of the mustard family. As of 2005, 87% of the canola grown in the US was genetically modified (GMO). That reminds me of a favorite quote:

“People are fed by the FOOD industry, which pays no attention to HEALTH and are treated by the HEALTH industry, which pays no attention to FOOD.” The quote is from Wendell Berry. 

The Nutrition Debate #290: My Healthy, Homemade (Vinaigrette) Salad Dressing

MyFitnessPal recently had a “cooking tip” titled, “How to Make Healthy, Homemade Salad Dressing (+ 3 Simple Recipes to Try).” I liked it for several reasons. 1) It was “relatable” in that it addressed the majority of households who still purchase salad dressing in bottles – doesn’t almost everyone? 2) It was well written and easy to follow; and 3) I make a “killer” salad dressing myself (recipe later). Naturally, therefore, I also found lots to disagree with and offer my own “improvements.”

The lede brought a smile to my face: “As a kid, I would have been happy to drink Hidden Valley ranch dressing out of a sippy cup, and I didn’t discover that salad dressing could be homemade until a college summer abroad in Italy.”Can you relate?

I could relate to both points. Packaged salad dressings are tasty. They’ve been engineered in the processed food giants’ laboratories to be very palatable. And they are ready-made and convenient to use, so the argument against using them has to be strong. I won’t go into that here though. I’ll assume that if you have an interest in making your own salad dressing you already know how BAD bottled salad dressings are from multiple health points of view. (See also #291 coming next.)

And the point about Italy is one that most diners know as well even without having travelled to Italy. We’ll all eaten at the simple Italian Restaurant where flasks of olive oil and vinegar are on the table for you to pour into a small bowl filled with chopped iceberg, cherry tomatoes and shredded carrots. But for my taste, as healthy as that dressing is, it’s not enough.

A simple vinaigrette, as My Fitness Pal point out, is made up of “oils, acids and other flavors.” The oils they list are olive oil, grape seed oil, sesame oil, nut oils and avocado oil; the acids: vinegars (e.g., sherry, red wine, balsamic, rice) and lemon juice; the “other flavors:” mustard, jam/preserves [!], herbs (e.g., parsley, basil), garlic, shallots, ginger, soy sauce, and tahini. To this, My Fitness Pal adds, and I quote, “+standard seasoning” (see below) and salt and pepper.

They illustrate that with a jar filled with 60% oil, 30% acids and 10% other flavors. Here’s where I pick my first bone. That ratio of oil to acid is just 2 to 1 (2:1). A traditional vinaigrette uses a 3:1 ratio, but I suspect My Fitness Pal proposed to cut the oil portion to reduce the calories from fat (oil). The problem is they then go on suggest that their basic vinaigrette dressing be supplemented with “+ standard seasoning,” which they call your “preferred sweetener.” Folks, a basic vinaigrette dressing does not use as a standard seasoning your preferred sweetener, and to suggest jam/preserve is absurd.

Then, they state flatly the reason their basic vinaigrette dressing requires a “sweetener.” They say, “This is used to balance out the tartness of acids.” Readers, if you use a 2:1 ratio of oil to acid, your salad dressing will be tart. If you use a 3:1, ratio it will not. Adding sugar (jam/preserve) to your salad dressing is not a good idea. It’s much better to make less dressing and then toss the salad thoroughly with the dressing to lightly coat the ingredients. Nobody likes a salad drenched in dressing!

Another aspect of the My Fitness Pal article that I liked was the range and variety of the three basic “great vinaigrette” dressings they offered: Sweet, French and Asian. However, as noted above, the first two recipes they offer use that 2:1 ratio of oil to acid. Their Sweet Vinaigrette uses balsamic vinegar (high in carbs!) and adds 2 tsp. of jam to make ¼ cup, more than enough for a dinner salad for 4. Their French Vinaigrette recipe uses red wine or sherry vinegar and includes garlic (minced) and mustard, as does mine. Their Asian Vinaigrette recipe uses a 3:1 ratio of oil to acid, adds soy sauce, and uses rice vinegar and garlic. Sounds good!

My own French Vinaigrette is made from Extra Virgin Olive Oil (EVOO) and tarragon white wine vinegar (3Tbs:1Tbs), 2 or 3 cloves of minced garlic, a heaping teaspoon of Grey Poupon mustard, ½ teaspoon of salt and 50 turns of freshly ground black pepper. I put all the ingredients in a stainless steel bowl and whisk thoroughly to emulsify them. Both the vinegar and the mustard are natural emulsifiers, and the mustard is also a surfactant, so it holds everything emulsified. I then let it rest for 5 or 10 minutes to let the flavors fuse. Then just before serving, we thoroughly toss the dressing with all the ingredients until everything is evenly coated. This dressing recipe serves a large salad (4+ portions).

The salad we make is made up of washed and dried, then torn romaine lettuce, cut endive, sliced mushrooms, and usually some chopped hazelnuts, slivered almonds or toasted walnuts, and cheese. If we’re having company, we may shave some aged pecorino Romano on top, but usually we just add and toss in some grated or shredded Parmesan. I always prefer my salad to be served separately on a side plate, but not in a bowl. At home, we mix the salad in a large wooden bowl which we put it on the table so everyone can serve themselves. Guests always comment on how good it is, and go for seconds. 

The Nutrition Debate #289: Physician: “First, do no harm” (Primum, non nocere)

This aphorism, commonly and apparently erroneously considered to be a part of the Hippocratic Oath, is nevertheless attributed to Hippocrates (Epidemics, Bk. 1 Sect XI, according to PiedType). And “While there is currently no legal obligation for medical students to swear an oath upon graduating, 98% of American medical students swear some form of oath,” Wikipedia says, and a modified Hippocratic Oath was the most common, according to a 1998 survey of Medical Schools.

“Physician, first do no harm,” is nevertheless, “One of the fundamental principles of medicine according to which the physician should not cause harm to the patient” (Mosby's Medical Dictionary). Regardless of the oath taken (or not taken), it is the moral obligation of the physician to do “the right thing” by his or her patient. Who could disagree with that?

It is therefore all the more interesting that in the original oath (as translated in the Wiki citation above), Hippocrates pledges, “With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage.” And it was, after all, Hippocrates, the father of Western medicine, who said, “Let food be thy medicine and medicine be thy food.” I first cited this in “The Nutrition Debate #173.”

In #173 I compared what were then two translations in the Wikipedia entry for the Hippocratic Oath. The first had the sentence, “I will apply dietetic measures for the benefit of the sick according to my ability and judgment.” The current translation in the earlier Wiki revised it to, “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” Notice the difference? “Apply dietetic measures” was replaced by “prescribe.”

I understand, of course, that pharmacotherapy did not exist in ancient Greece, although herbal medicines, salves, etc. have existed since the beginning of time. But so has the enduring and timeless truth: “Let food be thy medicine and medicine be thy food.” And can any doctor not acknowledge that the best medicine for treating type 2 diabetes is “the best diet?” Then, assuming that every doctor would agree with this prescription, the question arises, why would any doctor not prescribe for every patient a diet much lower in carbs than the 60% carbs that is the USDA’s Nutrition Facts Panel standard? (See #288).

If the physician is truly and sincerely acting in the beneficent spirit of the Hippocratic Oath, why would he or she not literally “…apply dietetic measures for the benefit of the sick according to my ability and judgment?”  The answer to this question is, of course, complicated: There’s the question of 1) laziness, 2) a lack of time, 3) patient “non-compliance,” 4) a dietary plan (restricted calorie, “balanced,” low-fat) that is doomed to fail, 5) guidelines that a doctor must comply with to be paid for services paid for by 3^rd party payers (government agencies like HHS/Medicare and Medicaid and private insurance that must conform with government guidelines and 6) low reimbursement rates by those 3^rd party payers for patient services.

As a consequence, writing a script and updating the patient’s electronic medical record are all that most physicians have time to do. Medicine as practiced today in many large offices is at best just a business; at worst, it’s a sham. I’m lucky. I have a caring physician (I hope he reads this) who is glad to see me and give me the time I need. Now if I can just get nurse to treat me the same way. She has been with him so long that to her I am just another product on the office assembly line. Remember Lucille & Ethel wrapping chocolates on a factory conveyor belt? It was one of the funniest pieces they ever did.

You may have noticed that I failed to mention one more possibility for why a physician would not regard a low-carb diet as the “best medicine” for virtually everyone, but especially for people with Metabolic Syndrome, borderline lipids, chronic systemic inflammation, or who are overweight, obese, pre-diabetic or diagnosed with type 2 diabetes. I didn’t include the possibility that the physician may actually believe that a restricted calorie, balanced, low-fat diet is the best way to lose weight and keep it off and see improvement in all these conditions, plus hypertension (high blood pressure) and reduced risk of coronary heart disease, cardiovascular disease, several types of cancer and even Alzheimer’s disease.

The reason I didn’t mention it is that I can’t believe that there are any doctors left who still believe that. The evidence has been piling up from so many sources, and is now aggregated in huge meta analyses - they cannot not have seen it. Just in case, though, this very comprehensive 12-points-of-evidence elucidation in the January 2015 issue of Nutrition, by Richard Feinman et al., covers just about all the bases. So this can’t be the reason anymore. There must be more to it. Could it be that it’s very hard to switch horses in mid-stream (mid-career)? Will we have to wait until the current generation of doctors all die? Will that be too late for you? The doctor who started me on low-carb (Atkins Induction) was semi-retired. Maybe he figured he had not much to lose. He took a chance and put his patient’s health first. Maybe you, the patient, should too.

The Nutrition Debate #288: Type 2 Diabetics: 10% Protein “May Not Be Enough”

This Medscape Multispecialty piece headline (Anne Harding from Reuters Health Information) was actually, “10% Protein Diet May Not Maintain Muscles in Type 2 Diabetes.” The lede was, “New findings suggest it’s especially important for people with type 2 diabetes to eat enough protein.” This is a message with which I am in complete agreement. Regular readers will recall that I have written about it numerous times including in #130, “How Much Protein Should You Eat?”

What reconnected me to the subject this time was the specific mention of 10% (as not being enough protein). Ten percent protein is the exact amount of protein that the Nutrition Facts Panel on every packaged food product in the United States recommends that everyone eat. Our government’s one-size-fits-all dietary recommendations do not take into account the requirements of different cohorts of the population, excepting those under 2 years of age. In that case, you are allowed to eat more saturated fat (as is found in mother's milk) to help in brain development. After 2 years, I guess your brain stops developing – NOT. (Current research suggests age 25.)  And Type 2 diabetics should eat more fat, more protein, and many fewer carbohydrates than is recommended to the general population. EVERYONE, actually, should eat many fewer.

(Anyway, if you haven’t done the math, the RDA percentages on the side panel of packaged foods are based, as the USDA’s footnote says, on a 2,000 calorie a day diet (for a “woman of a certain age”) to maintain her weight. So, if a “serving” has say 30 carbs, that’s  10% of the RDA for carbs. Here’s how to figure it: 30 grams of carbs x 4 calories/gram of carbs = 120 calories, and 120 calories is 10% of 1,200. From this you can correctly conclude that the 2,000 calorie a day diet that the government recommends everyone eats is 60% carbohydrate. I’m not making this up folks!

Do the math yourself for proteins. If the panel lists the serving as 20 grams of protein, it will say that serving represents 40% of your RDA. Since protein has 4 calories per gram, 20 x 4 = 80 calories which is 40% of 200. And since 200 is only 10% of 2,000 (the total daily calorie allowance), 10% is the amount of protein that the government recommends you eat. Q.E.D.

By reverse math, the balance of your diet is supposed to be fats: 1,200 + 200 = 1,400; 2,000 - 1,400 = 600 calories for fat, and since fat has 9 calories per gram, 600/9 = 66.7 grams of fat. And 600/2000 = 30% fat in a 2,000 calorie diet.)

But I digress. The article cited above was written by Dr. Stephanie Chevalier, et al., of McGill University Health Center – Royal Victoria Hospital in Montreal and was published in Clinical Nutrition. “If it [a 10% protein diet] happens over a long period of time, this could lead to loss of muscle mass. That’s really an issue for our aging population,” Dr. Chevalier said.

The study, in organic biochemistry terms, “involved comparing two groups of obese men and women, all type 2 diabetics, eating isocaloric diets, one of 17% protein and the other 10%. “On a 10% protein diet, diabetic adults showed increased sensitivity to insulin suppression of proteolysis, but inadequate stimulation of protein synthesis, resulting in a low net nitrogen balance than similar patients who ate a 17% protein diet.” Okay, this is above my pay grade too.

The reason, put simply, is that “Insulin is required for the metabolism of all macronutrients, not just glucose, and people with type 2 diabetes have been shown to have insulin resistance to glucose, lipid [fat], and protein metabolism,” Dr. Chevalier told Harding. She added, “Studies have shown that older adults with diabetes have greater losses in muscle mass and strength over time.” The takeway for me is that Insulin Resistance applies to fat and protein metabolism too!

She concluded, “For now, it’s probably adequate for people with diabetes to eat diets containing 15% to 20% protein. Ten percent is definitely too low,” she said, definitively. That was comforting to me. My own diet, as my regular readers know, is 20% protein, 5% carbohydrate and 75% fat. My protein plan has been higher in the past (as high as 28%), and usually in fact is higher than 20% since I frequently eat more than the small portion of protein allocated for supper (25g). That’s also why I take a small dose of metformin at supper, to suppress any gluconeogenesis that may result from a larger portion. If you haven’t seen my “ideal” meal plan, this is what it looks like. The breakfast and lunch parts of the plan are always the easiest.

	Fat	Protein	Carbs	Calories	K/G
Breakfast	30	20	4	375	2.07
Lunch	35	15	0	375	3.31
Dinner	33	25	11	450	1.51
Total	98	60	15	1,200	2.02
Percent	75%	20%	5%	100%

The Nutrition Debate #287: Can Type 2 Diabetes Be Reversed?

The Nutrition Debate #88: “Reversal of Type 2 Diabetes,” has proved, to my surprise, to be a very popular post on this blog; it has had over 6,000 page views. Let me be clear: I do not believe that type 2 diabetes can be “reversed,” and so I can understand that someone reading that post (#88) might have felt misled by me. That was not my intention. Nor was I consciously intending to glom readers by attracting them to an appealing prospect through a headline. I was simple reporting on a paper in a peer-reviewed British medical journal that had precisely that title; that’s why my blog title was in quotes.

The paper was interesting. Its “AIMS/HYPOTHESIS” is that “Type 2 diabetes is regarded as inevitably progressive, with irreversible beta cell failure. The hypothesis was tested that both beta cell failure and insulin resistance can be reversed by dietary restriction of energy intake.” Okay, it’s a hypothesis. Its aim is to challenge an assumed truth – one that virtually all medical practitioners espouse – that type 2 diabetes is “inevitably progressive.” And they propose to do it by “dietary restriction of energy intake” alone. To be clear, they mean fewer calories, not fewer carbohydrates. Interesting, huh?

The hypothesis apparently sprang from the observation that “normal glucose metabolism is restored within days after bariatric surgery in the majority of people with type 2 diabetes.”  “There is now no doubt,” they concluded and report in their Counterpoint Study, “that this reversal of diabetes depends upon the sudden and profound decrease in food intake, and does not relate to any direct surgical effect.” To be clear: That’s food (total energy) intake, not carbohydrates.

The CONCLUSION/INTERPRETATION of this study was only a little less assertive than their hypothesis: “Normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone. This was associated with decreased pancreatic and liver triacylglycerol stores. The abnormalities underlying type 2 diabetes are reversible by reducing dietary energy intake.” Okay, they hedge a bit. They say “the abnormalities underlying type 2 diabetes are reversible…” But they still use the word “reversible.” That’s pretty strong, but they are scientists and provide the quantitative data to support their findings: pancreatic and liver fat cells (triglycerides).

My inveterate editor discovered a follow-up study that was done by the same researchers, and I reported on in The Nutrition Debate #89, “‘Reversal of Type 2 Diabetes' Revisited.” Unfortunately, it glommed only 367 page views, but in it the authors reported on “individuals (who) began to feed back their personal experiences of attempting to reverse their diabetes.”  CONCLUSION: “These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes.”

This and other work by these intrepid researchers earned them the high privilege of presenting “The 2012 Banting Memorial Lecture: Reversing the twin cycles of Type 2 diabetes” (full text link here). So, they are clearly not crackpots. They are scientists looking for answers to why and how the “underlying abnormalities” of type 2 diabetes are “reversed.” From my perspective, they have demonstrated to their medical peers that their work was at the very least “interesting.”

The paper based on the Banting Lecture that was published in Diabetes, the organ of the American Diabetes Association. The abstract concludes: “It is now clear that Type 2 diabetes is a reversible condition of intra-organ fat excess to which some people are more susceptible than others.” But they’re talking about “pancreatic and liver triglycerides.” My readers are not particularly interested in their pancreatic and liver triglycerides. They don’t even care that much about their serum triglycerides (although The Nutrition Debate #197: “Triglycerides and Alcohol Consumption,” logs over 1,500 hits). People with Type 2 Diabetes want to know how to “eradicate” the damn disease. Ideally with just a pill!!!

My readers are also interested in what they can do, if anything, to avoid being “more susceptible.” And if they were “more susceptible,” if there is anything they can then do to “reverse” the “condition” to which they have succumbed. My conclusion is that if you are among those who are susceptible, and have succumbed to the condition in the sense that you are diagnosed diabetic or pre-diabetic, and you are sincere about mitigating the risk of diabetic complications (both micro and macro vascular), there is a course of action you can take, and it is stated in the CONCLUSION of the overlooked post #89, to wit:

 “These data demonstrate that intentional weight loss achieved at home by health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal should be a goal in the management of Type 2 diabetes.” And in my book the best way to lose weight is to eat Low Carb, not cans of Optifast, the 47% carb liquid diet formula used in this study.

The Nutrition Debate #286: Avoid wheat, excess fructose and excess linoleic acid (Omega 6s)

Kurt G. Harris, MD, called wheat, excess fructose and excess linoleic acid the Neolithic Agents of Disease (NAD). He was one of my early favorites in my search for a dietary regimen that could be stated as a philosophy of eating rather than by a dependency on counting calories, carbs and other micronutrients. I wrote about him and his PaNu program four years ago in The Nutrition Debate #19 here. Then he dropped out of “the nutrition debate” and later deleted his Archevore website. Today he is a diagnostic radiologist practicing in Sturgeon Bay, WI. Some of his writing is still online at Psychology Today.

Harris didn’t write for type 2 diabetics like me. He aimed his program at people who wanted to eat in a healthy way to avoid disease. Many others followed him in this goal and the field became a tangled mess, leading sadly I suspect to his premature retreat. For awhile I hoped he was writing a book. Alas, it seems not. Harris was inspired, he wrote, by Gary Taubes (as was I). His epiphany, and his openness and training in scientific method, fed his inquiring mind. He liked to write and coin words and phrases too. If this sounds like a eulogy it’s only because I fear he is lost to us, and it is our loss.

The three NADs, which he fully explains in “A Dietary Manifesto - Paleo 2.0,” are just another way of describing his 12-step program (which I list in The Nutrition Debate #19), for “getting started,” and going “as far as you can down the list…” The wheat proscription means gluten, and of course includes the other gluten grains (barley, rye, etc). That’s big.

The excess fructose NAD is also a big one, but here Harris leaves a little room if you’re not diabetic or prediabetic. Harris is infamous (in Paleo circles) for calling apples “bags of sugar” and most modern fruit “candy bars on a tree.” He concludes, however, “If you are not trying to lose fat [or are carb intolerant as in type 2 diabetes], a few pieces of fruit a day are fine.” Fructose, however, is not only found in fruit, as horfilmania (“Who Knew?” 12/21/14) recently discovered with red cabbage. Take a look at “The Nutrition Debate #97” for a list of common sweeteners, fruits and vegetables that contain fructose.

Avoiding excess linoleic acid (Omega 6s) is perhaps the hardest dietary goal of the three NADs because it is so hard to know where they hide. Harris advises, “The way to correct the modern excess of n-6 linoleic acid is to avoid the modern sources of it. Stop eating all temperate vegetable oils and veggie oil fried food- cooking and frying oils like corn, soy, canola, and flax, all of it. And go easy on the nuts and factory chicken. These are big sources of n-6, especially the nuts and nut oils.”

To put some “meat” on those recommendations, I’ve created this table using the USDA’s National Nutrient Database:

Cooking/salad oils & fats (%)	SFA	Mono	PUFA	n-6	n-3	n6/n3
Corn oil	12.9	27.6	54.7	53.2	1.2	45.8
Soybean oil	15.7	22.8	57.4	50.4	6.8	7.4
Canola oil	7.4	63.3	28.1	18.6	9.1	2.0
Olive oil	13.8	73.0	10.5	9.8	0.8	12.8
Butter (incl.+/-16% water)	51.4	21.0	3.0	2.2	0.3	6.9
Coconut oil	85.5	5.8	1.8	1.8	0	∞

All fats are combinations of saturated fatty acids (SFAs), monounsaturated fatty acids (Mono) and polyunsaturated fatty acids (PUFAs), but the composition varies enormously. Corn and soybean oil are over 50% PUFA, while butter and coconut oil are 3% and 1.8% respectively. On average, corn oil and soybean oil have over 25 times as many PUFAs as the saturated fats. Canola oil has 10 times as much; olive oil, 5 times as much. Note: The “saturated fats” still have PUFA content.

As most people know the ratio of n-6 to n-3 is also important, and Canola oil has the best and corn oil the worst ratio. But in terms of absolute numbers, the best advice is to avoid excess Omega 6s (n-6s) altogether, and that is best done by eliminating all seed and vegetable oils. Then, as Harris says in his Manifesto, “Along with n-3, the other type of PUFA, it [n-6] is technically an essential fatty acid, but the actual requirement is so small it might be better considered a micronutrient”(emphasis mine).

So, avoid all vegetable and seed oils altogether (corn, soybean, Canola, sunflower, walnut, flax, etc.), and then avoid all prepared, baked goods and foods fried in any of these oils, then go easy on nuts, nut oils and factory chicken, and maybe supplement with Omega 3 fish oils to help the balance, and you should get your ratio back into pre-Neolithic proportions. If this sounds like Paleo to you, it isn’t really. It’s just a little nostalgic look back at the “ancestral” roots of my dietary journey.