Monday, January 4, 2016

Type 2 Diabetes, A Dietary Disease #309: “Type 2 Diabetes Q & A”

Vignette 1: What is Type 2 Diabetes?
Answer: Type 2 Diabetes is a metabolic disorder in which insulin, the glucose transporter in the bloodstream, is blocked on the surface of destination cells, preventing the glucose from being taken up for energy. This condition is called Insulin Resistance. As a result of Insulin Resistance, circulating glucose levels become elevated. If untreated, elevated blood sugars eventually cause serious microvascular and macrovascular complications. Secondarily, as the disease develops, when more insulin is secreted to help with the take up, the pancreas increasingly has diminished capacity to make insulin and insulin replacement therapy is required.
Vignette 2: How Did I Get Type 2 Diabetes?
Answer: You, along with about half the population of the Western World, were unlucky. First, you have a certain genetic predisposition such that some complex combination of your genes makes them vulnerable to a genetic modification. This is not the same as a “mutation.” Second, you unwittingly participated in a large uncontrolled government experiment of eating a low-fat, high-carb, dietary pattern and, being genetically predisposed, your genes have “expressed” this modification, causing you to become Insulin Resistant, and thus Carbohydrate Intolerant and a Type 2 Diabetic.
Vignette 3: What Can I Do If I’m Pre-Diabetic?
Answer: If you’ve been told, or you suspect, that you’re “Pre-Diabetic,” to avoid becoming a Type 2 Diabetic you must modify your dietary pattern to reduce, as much as possible, carbohydrates. Carbohydrates are a non-essential macronutrient. There is no minimum requirement for carbs. Carbohydrates include both simple sugars and complex carbohydrates, particularly refined and processed carbohydrates. You must also avoid sugary soft drinks, fruit juices and drinks, and all baked goods, starches, cereals, and desserts. That’s anything with flour, sugar (by any name) or starch. This is of course difficult to do, at first, but it’s an easy way to lose weight without hunger, and, if you do it, you will lose weight and you will avoid developing type 2 diabetes.
Vignette 4: How Can I Prevent Type 2 Diabetes?
Answer: Easy! Type 2 Diabetes is a dietary disease. If you take charge of what you eat, and seriously restrict your carbohydrate intake, you will avoid developing this disease. Even if you are already somewhat overweight and/or have been told you are “Pre-Diabetic,” you can reverse your Pre-Diabetes and put your Insulin Resistance in remission. By seriously restricting your carbohydrates, you will also lose weight rather easily and do it without hunger! And as long as you stick to your carbohydrate restriction/reduction, and eat 2 or 3 small meals a day without snacks, you will remain protected from developing this disease.
Vignette 5: How Can I Prevent Type 2 Diabetes From Being Progressive?
Answer: If you are already a diagnosed Type 2 Diabetic, you must do just one thing: ignore the advice to “eat a balanced diet.” Continuing to eat beaucoup carbs will only assure that your disease will be progressive. You will become dependent on more and more medications, possibly become “insulin dependent,” and eventually develop the dreaded complications. The easy way to prevent Type 2 Diabetes from becoming progressive is to eliminate carbohydrates from your diet: all carbohydrates become glucose in your bloodstream. You have Insulin Resistance, and you are Carbohydrate Intolerant. Your body just can’t handle carbohydrates any more.
 Vignette 6: How Can I Reverse Pre-Diabetes or Type 2 Diabetes?
Answer: The only way to reverse Type 2 Diabetes is to largely eliminate carbohydrates from your diet. They all become glucose in your bloodstream. If you are Pre-Diabetic or have been diagnosed a Type 2 Diabetic, you have Insulin Resistance and you have become Carbohydrate Intolerant. Your body can’t handle carbohydrates any more. So long as you continue to restrict the carbohydrates you eat, your Pre-Diabetes or frank Type 2 Diabetes will go into and remain in remission. You’re not cured, but while your disease is in remission, you are not at risk for the microvascular and macrovascular diseases associated with this disease.

Vignette 7: How Can I Cure My Type 2 Diabetes?
Answer: You can’t. People who use the word “cure” are misleading you. You were genetically predisposed and your genes have “expressed,” i.e., already been modified, permanently, as far as anyone knows at this time. That’s history, and you can’t change your genes back to their “normal” expression. However, you can take those genes “out of play” by avoiding the foods that “express” them: carbohydrates. So long as you eat a diet of primarily fats and limited protein, as your body was designed to do, your body will adapt. You will have plenty of good energy, healthy food for the heart and brain and every other need the body has, and your blood sugar and serum insulin levels will decline to “normal.” Your Type 2 Diabetes will be in remission.

Vignette 8: How Can an Overweight Type 2 Lose Weight Safely?
Answer: That’s easy too, and you can “kill two birds with one stone.” The most difficult part of any “restricted calorie, balanced” weight loss program is being hungry all the time. The reason is that when you eat carbs, insulin circulating in your blood, secreted for the purpose of transporting glucose (the digested carbs) to your cells, blocks your body from using body fat for energy. Your body thinks, “If you have carbs to eat, you don’t need to use your precious body-fat reserves.” So your stored fat is “saved” for a famine or for winter. If you instead restrict carbs, instead of calories, you will naturally eat less and your body, sensing lower blood glucose and transporter-hormone insulin in the bloodstream, will break down your body fat for energy. As a result, your body will be fed your broken down body fat. You will not be hungry, and you will lose weight!

Vignette 9: Is Being Overweight a Cause of Type 2 Diabetes?
Answer: No, it’s the other way around, and the explanation is simple. When you eat a “balanced” diet, as most weight loss programs and “experts” advocate, glucose from digested carbs is accompanied in the bloodstream by the transporter hormone insulin. The liver, which controls metabolic homeostasis, perceives that since you have dietary carbs available for energy, you don’t need body fat to maintain energy balance. So, the fat stays locked up around you belly. As you develop Insulin Resistance (see #1 above), your serum insulin levels remain high so added calories from carbs and fat (and unused protein stored in the liver), are converted by the liver to additional fat stores. You got fat because you’re Insulin Resistant, which means you are a Type Diabetic or at very serious risk of becoming one.

Vignette 10: Is Being a Type 2 Diabetic like being Gluten or Lactose Intolerant?
Answer: Yes and No. Each involves food intolerance. Gluten Intolerance means the body is intolerant of the protein portion of the wheat, barley or rye grain. It rapidly results in intestinal distress. Lactose Intolerance means the body is intolerant of foods containing the milk fat lactose because of the absence of the enzyme lactase to help digest it. Lactose intolerance rapidly results in intestinal distress. Carbohydrate Intolerance, the result of a person developing Insulin Resistance expressed as the metabolic disorder, Type 2 Diabetes, results in long term microvascular and macrovascular complications often leading to death. All three intolerances – gluten, lactose and carbohydrate – are dietary diseases and are best addressed by avoiding the dietary cause.

Vignette 11: Won’t Eating So Much Fat Make Me Fatter?
Answer: No, unless you eat too many carbs and too much fat. Fat, eaten with or without limited protein, is filling. You quickly become satiated (satisfied), so eating fat is self-limiting. You will eat less if you eat just energy dense, real foods containing full fat, limited protein and minimal or no carbohydrates. Carbs that have been processed are depleted of nutrients along the way, including essential fat-soluble vitamins and minerals. Carbs that are eaten to the exclusion of healthy fats will not satisfy your hunger and will lead to cravings. Eating excessive nutrient-deficient processed carbs will lead to overeating carbs, which the liver will convert to body fat. Eating carbs will make you fat. Think about how livestock is fattened before slaughter.
Vignette 12: Won’t Eating Saturated Fat Make My Cholesterol Rise?
Answer: Actually, no! Eating a high-fat, low-carb diet will be good for your cholesterol. It will raise your HDL cholesterol (the “good” cholesterol), in some cases, like mine, more than doubling it. If your Total Cholesterol, an obsolete value in modern lipidology, rises slightly, it will be because your HDL went up. The formula: TC = HDL + LDL + TG/5. Your LDL cholesterol (the “bad” cholesterol) will probably remain constant, but their particle size and density will improve, from “small dense” to “large fluffy.” And your triglycerides, measured at the same time as your cholesterol, will decline dramatically. Mine did, dropping by more than two-thirds.
Vignette 13: Won’t Eating Dietary Cholesterol Block My Arteries?
Answer: Absolutely not! Dietary cholesterol, from animal foods like eggs, shrimp and meat, has nothing to do with serum cholesterol (cholesterol in your blood). Cholesterol is an essential compound. It is present in every cell in your body. Your liver makes cholesterol as your body needs it, accounting for about 90 percent of the cholesterol in your body. If you eat less cholesterol, your body will make more. Cholesterol actually repairs erosion in the surface layer of your veins caused by inflammation, preventing small, dense oxidized LDL particles from being trapped. HDL clears LDL, returning it to the liver for disposal.  In 2014 the Dietary Guidelines Advisory Committee said, “Cholesterol as a nutrient is no longer a concern for overconsumption.”
Vignette 14: Aren’t Carbohydrates Necessary for Energy?
Answer: No. Carbohydrates, however, are a major source of “quick” energy, in that they digest quickly, converting primarily to glucose, a necessary and essential nutrient molecule for certain organs and tissue that do not contain ATP, the little energy factories. However, because only a small amount of glucose is necessary but because it is essential for those parts of the body, the body has developed multiple mechanisms and pathways to make glucose from protein and fat. The liver can make glucose from amino acids that are the breakdown products of protein. In addition, glucose can be made from the glycerol molecule which is cut loose when a triglyceride (fat) molecule is oxidized to free up fatty acids for fuel. Furthermore, the byproducts of this oxidation are ketone bodies which the brain actually prefers to glucose. In the absence of carbs, after a period of adjustment, the body does very well on a diet almost exclusively of fat and protein. Some athletes report big improvements:
Vignette 15: What About Macronutrient Ratios?
Answer: The three macronutrients, carbohydrates, protein, and fat, were eaten in various ratios by different cultures around the world, until governments got involved. Starting in the mid 20th century, epidemiological evidence suggested that dietary saturated fat and cholesterol were a cause of coronary artery disease (CAD) and cardiovascular disease (CVD). In 1977, the U.S. government intervened, and in 1980 it produced the first Dietary Guidelines for Americans. The food packaging laws followed, resulting in the Nutrition Facts panel on processed and packaged foods. To this day, the macronutrient distribution on that panel recommends that the entire American populace (except children under the age of 2) eats a diet consisting of 60% carbohydrate, 10% protein, and 30% fat (of that mostly polyunsaturated fat from vegetable oils like soy bean and corn oil). That, in a nutshell, is why almost half the Western world is now overweight or obese…and has Insulin Resistance.
 Vignette 16: What Is a Low-Carb, High-Fat (LCHF) Diet?
Answer: A Low-Carb, High-Fat (LCHF) diet is designed primarily to lower serum insulin and blood glucose, thus preventing and/or reversing the onset of prediabetes or Type 2 Diabetes. It also enables the adherent to lose weight, if needed, without hunger. Secondary outcomes include higher HDL cholesterol and lower LDL cholesterol, triglycerides, and chronic systemic inflammation.  Definitions vary but generally a LCHF diet entails eating less than 50 grams of carbohydrate a day. That’s 10% carbohydrate vs. 300g/day (60%) carbohydrates in the 2,000 kcal Standard American Diet recommended on the Nutrition Facts panel on processed food in the U.S. Even 100g/day (20% carb) would be a very substantial improvement over the Federal Dietary Guidelines.
Vignette 17: What is a VLC Ketogenic Diet?
Answer: A VLC Ketogenic Diet is a Very Low Carb Ketogenic Diet in which the adherent eats fewer carbohydrates than in LCHF. Generally, the carb count is between 15 and 30 grams a day. Thirty grams is the daily total in the Bernstein 6-12-12 Diet designed for diabetics. Twenty grams per day is the amount in the Atkins Diet Induction Phase. I followed Atkins Induction for 9 months in 2002-2003 and lost 60 pounds. I also, within a few days of starting Atkins Induction, found it necessary, to avoid hypos, to eliminate almost all of the oral anti-diabetes medications I had been prescribed. A few years later, I followed the Bernstein’s 6-12-12 program and lost 100 pounds in 50 weeks. Today, I try to eat ≤ 15g/day of carbohydrates to be in a perpetual state of mild ketosis, producing a low level of ketone bodies from the breakdown (catabolism) of my body fat. I find that my body likes this state best. I am always full of energy, get excellent rest, and am never hungry, even after an overnight fast. So long as I adhere to this program, my blood sugars are stellar, and I lose weight.
Vignette 18: What Foods Must I Strive To Avoid To Stay Healthy?
Answer: Foods that contain carbohydrates, obviously. Carbs include simple sugars, both added and naturally occurring, unfortunately. That means fruit, especially fruit juices and fruit drinks, and all sugary drinks. Baked goods, including all breads, pasta and rice.   The more processed the grain or the sugar, the more damage it can cause.  Flours and sugars are not your friends.  Avoiding inflammatory foods is also very helpful.. Some oils are high in PUFA and these are very inflammatory, doubly so if used for frying. Foods that are deep fried in vegetable oils, corn and soy bean oil in particular, are loaded with Advance Glycation End products (AGE’s) that are known to damage your blood vessels and thus cause CVD.
Vignette 19: Is Type 2 Diabetes a Lifelong Disease?
Answer: Regrettably, once you get Type 2 Diabetes, you’ll have it for life. Your genes have been modified. Whenever you eat a lot of carbohydrates, they will express the Insulin Resistance that has caused your Type 2 Diabetes. However, if you eat an absolute minimum amount of carbohydrates, your body will be able to handle it. Unlike in Type 1 Diabetes, your body still produces some insulin, and in response to ingesting carbs it will produce enough insulin to circulate the glucose and eventually see it absorbed. When eating Very Low Carb your insulin sensitivity will improve. Then, when the glucose is absorbed by your cells and your serum insulin drops, you will return to burning fat for energy; your body will be happy, and you will not be hungry. As long as you follow this Way of Eating (WOE), your Type 2 Diabetes will be in remission.
Vignette 20: When I Reach My Goal Weight, What About Maintenance?

Answer: For me this is still a hypothetical question. I have never (yet) reached my goal weight. In theory, according to the scientists I most admire, you are supposed to keep constant, in terms of grams, both carbohydrates and proteins and increase your fat to stop losing and stabilize your weight. I imagine that increasing fat would be fairly easy. I could snack before dinner on buttered radishes or cream cheese filled celery, or add olive oil to meat and vegetables. For now, however, I am working on getting to my goal weight. 


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