Sunday, June 18, 2017

Type 2 Diabetes, a Dietary Disease #385: My 2nd (and Last) 30-lb Challenge: Half-time Report

This is my 2nd 30-lb Challenge since I started to experiment with full-day fasting after the Super Bowl. This one did not start off well. In the first four weeks, where my goal was to lose 7 pounds, I lost only 1. This period was plagued by a succession of missteps and generally reflected a lack of focus. I just got off to a bad start and never got my head straight. I knew I could do better. So, to jumpstart the 2nd Quarter, I did a 3-day fast. 
Week 5: It was a rough start. We had company Monday night, and I made a delicious dinner…and besides a big drink and 2nds of my roast pork, I had dessert: Gained 2 pounds. FBG Tuesday: 108. That was followed by a 3-consecutive day fast in which I lost 8 pounds. I worked 4 to 6 hours in the garden in scorching heat on all 3 days, drank pickle brine and ice tea to keep hydrated, and felt great. In fact, I mentioned to my wife on the 3rd day that I felt really pumped! Ate 2 meals Friday and gained 2 pounds back (probably water), but all my FBGs this week besides Tuesday were 70s and 80s. My 7-day average was 85mg/dl (4.7mmol/L), and I lost 4 pounds.
Week 6: I started the week still 4 pounds behind plan, and because we have theatre in NYC on Tuesday, I’ll fast (300 kcal/day) just Wednesday-Thursday this week, from Tuesday supper to Friday lunch. That’s a good thing about full-day fasting. You can mix and match, including alternate day or consecutive day. That didn’t occur to me before I started in February, but I discovered it makes no difference when you’re keto-adapted. Result: FBG average 82mg/dl – mostly 70s and 80s with 1 low 90s from a cheat at a pre-theatre restaurant. But, I gained 3 pounds for the week – 4 in the last 2 days. Either my body is resisting its weight loss, or I’m eating too many calories on my “feasting” days. Honestly, I think it’s mostly the latter. So, I resolve to try to eat less.
Week 7: Now, starting the week 9 pounds behind plan and with theatre in NYC 2 times this week, I need to tweak my fasting plan again. Fundamentally, I am never hungry, so when I eat – either too much at supper or to snack before supper – it’s not from hunger. I need to recognize that and act accordingly. That’s my plan. Well…as they say about war, “No battle plan survives contact with the enemy.” On Tuesday I had a 3-course dinner before the theatre. The cheese course, for desert, had more calories and carbs (in accompaniments) than the appetizer and entrée together. By next morning both my FBG and weight had risen. Thursday’s pre-theatre supper wasn’t much better. But, because I fasted M-W-F this week, I lost 4 pounds and my weight was down to 211. So, I gained 2 on my 9 pound deficit but, 7 weeks in, I am still 7 lbs behind plan. FBG aver. = 91.
Week 8: Halftime is looming and I need a 2nd consecutive week of losses to be in the best position to catch up in the 2nd half and achieve my 2nd 30-pound challenge and reach my teenage weight of 187 pounds. There are few confounding factors this week. I know I can do it. This week I plan to fast M-T-W. Net result: DISASTER! I lost 5 pounds in the 3-consecutive day fast (and accomplished lots in the garden); then, naively ate pasta and 1/3 of my wife’s desert in a restaurant on Thursday, and snacked without discipline at receptions after an art gallery opening and a harpsichord concert on Saturday. Outcome: a shameful and embarrassing gain of 8 pounds in 3 days. FBG aver. = 99. It’s a head shaking setback, but it is what it is. And fasting isn’t the problem.
Conclusion: Halfway into my 2nd 16-week, 30 pound challenge (34 actually, since I started it after a 4-pound gain), I am only 2 pounds (6 actually) down, 13 behind plan. This looks insurmountable BUT, the last 8 is water. So, if I think of it that way, I have only a 5 pound deficit to overcome in the next (final) 8 weeks. That’s doable.
Discussion: Currently, I think I prefer a 3-day, weekday (Mon-Tue-Wed or Tue-Wed-Thu), 300kcal/day, fast. I think my wife does too. She is spared the trouble of cooking for me, and she can prepare foods that she prefers to eat. One night last week she had a micro-waved baked half of a potato, stuffed with butter, sour cream and shredded cheese. In any case she has accepted my full-day fasting. Perhaps it is because, for all my misadventures, she knows that I am losing weight and my blood sugar regulation and other health markers have improved greatly. Or maybe she just misses baked, stuffed potatoes. Anyway, the challenge continues.

Sunday, June 11, 2017

Type 2 Diabetes, a Dietary Disease #384: The Problem with N = 1 (Spoiler: I’m keto-adapted)

Everyone agrees that achieving weight loss is a multi-factorial endeavor. Among the obstacles are cultural issues (e.g., certain staple foods); longstanding habits (e.g., eating 3 meals a day); food preference (e.g., sweet and/or starchy foods and processed foods made to “taste good”); and budget (low-nutrition carbs cost less than high-nutrient foods like protein and fat). But the biggest obstacle to weight loss is a broken metabolism. People who eat the Standard American or Western diet, described below, do it because they are hungry.
Hunger is the primary driver when you eat mostly carbs. But eating mostly carbs is an acquired habit. It’s been abetted by a decades-long campaign of government advocacy, suborned by the influence of Big Agriculture,  advertising and media hype. Should you “eat a big, healthy breakfast to start your day” even if you’re not hungry? Should you eat another meal 4 or 5 hours later, during the “lunch hour,” if you’re still not hungry? The problem is, if you do eat mostly carbs, as above, you will be hungry. In fact, you might even have to sneak in a mid-morning snack because you’re feeling a lack of energy. And the sad truth is: you will be lacking energy!
Why, because you’re eating mostly carbohydrates. Carbohydrates, especially simple sugars, and all fruits, and especially heavily processed carbs in packaged foods like cereals, begin to digest as soon as they are in contact with your mouth. Your blood sugar level peaks within an hour or two and then it crashes. And if you’re just a little insulin resistant, because you’ve been eating VERY high carb for decades, your blood insulin level will be high; thus your body cannot access its own fat for energy and your metabolism slows… until you eat again.
When I advocate to others that they try my Way of Eating (WOE), they frequently say, “I can’t give up (this or that).” I used to reply, “You don’t mean ‘can’t’; you mean ‘won’t’ or ‘aren’t willing to’.” After all, I thought, if they are health-motivated individuals, they would be willing to make the Lifestyle Changes necessary to achieve intentional weight loss. But I don’t think that any more. My thinking has evolved, to wit:
When you say you “can’t,” what you are recognizing (unconsciously) is that your metabolism is driving you to eat because it (your body) has to maintain energy balance to function. If it is denied access to the food (fat reserves) it put away, then it must slow down (reduce your metabolic rate) and TELL YOU TO EAT AGAIN. The question, then, is, how can you break this cycle? Answer: you must change what you eat. Eat in a way that avoids the vicious cycle. Eat in a way that gives your body access to its own fat storesto avoid hunger!
How do I do that? I eat Very Low Carb. Fifteen years ago I started “cold turkey” on strict “Atkins Induction” (20 grams of carbohydrates a day). I lost 60 pounds. Later I switched to Bernstein’s 6-12-12 program (30 grams of carbohydrates a day). I lost another 115. Today, I’m still down 165 pounds. Currently I’m doing full-day fasts to lose another 20+ pounds. I can do this because when I eat Very Low Carb I am KETO-ADAPTED. What’s that?
Keto-adapted means that when you eat very few carbs, both your blood glucose and your blood insulin levels will be low. Insulin is the hormone that the pancreas secretes to transport blood glucose (from carbs) to the cells. So when you eat a lot of carbs, your blood insulin level rises. If you have a touch of Insulin Resistance, you are “pre-diabetic” which means you have a slightly elevated blood sugar and your insulin level stays high.
Insulin is also a signaling hormone. When its level in the blood is low, this tells the brain to break down body fat to maintain energy balance. So, my metabolism continues to runs full tilt. I do not need to snack. I am not hungry because my body has access to another source of “food,” the body fat it put there for the purpose.
But I’m only N = 1. You’ll have to do this to replicate it. Try it for yourself and see how your body works. Human physiology is pretty awesome. It’s been working that way for millennia, til we changed what we ate.

Sunday, June 4, 2017

Type 2 Diabetes, a Dietary Disease #383: Fasting on 300kcal a day while keto-adapted

I have been eating Very Low Carb (VLC) for about 15 years. I lost 170 pounds, but inevitably gained some of it back. Losing it the 2nd time proved to be harder, so I decided to try Intermittent Fasting (IF).
I gave up my breakfast of eggs (I wasn’t hungry anyway) but kept a cup of coffee with heavy cream and stevia powder to take with my pills. I sometimes ate a light lunch (all protein and MY good fats) and then a supper of animal protein and one low-carb vegetable, with more fat (olive oil or butter). I did it for about a year, and it was easy. But, I didn’t lose weight! It was satisfying, but still too much food. I needed to try something else.
Then last fall Megan Ramos, director of Jason Fung’s Toronto IDM Program, suggested full-day fasts, i.e. the “other” kind of fasting. I told Megan that during a 2-month period during the winter I would do it, and I did. In 10 weeks I lost 30 pounds. With that success under my belt – why mess with success, right? – I decided to do it again, this time breaking new ground with the goal of reaching a weight I haven’t seen since my early teens.
How do I do it? What is the secret of my success? Full-day “fasting,” MY way. I put “fasting” in quotes because, on days when I fast, “my way” is not a strict water-only fast, although it is a basically a liquid-only fast. For Breakfast I drink a 12-oz coffee with 1½ oz of heavy cream and a smidgen (1g) of powdered stevia. If I feel dehydrated during the day, I will have just iced tea, sweetened with liquid stevia, and a pickle slice or just a little brine. Then, for Supper I drink 6-oz of red wine in a large glass filled with seltzer (with my evening pills ;-).
Macronutrients: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day total: 298kcal.
This is a departure from the usual “water-only” fast in three respects: 1) it includes dairy, 2) it includes a sweetener (pure stevia, not artificial), and 3) it includes alcohol. Total carbohydrates: Less than 6 grams/day.
The secret for the success of this “fasting” regimen is that on “feasting” days, I eat VLC. I am not hungry because I am “keto-adapted.” Keto-adapted means that my body is almost continuously in “nutritional ketosis.” On “feasting” days my body lives on what I eat, which is high-fat, moderate protein and Very Low Carb. For energy it burns the carbs first, then the unused glucogenic proteins stored in the liver as amino acids, then the dietary fat. Then, if my body needs more energy to maintain homeostasis, it simply transitions to breaking down body fat. My body fat is accessible because of my low blood insulin. That’s being keto-adapted!
At first, even though I’d read Jason Fung’s book, “The Obesity Code,” and another he wrote with Jimmy Moore, I had trepidations about not eating from one day’s supper to “breakfast” (my coffee) two days later. So, I started off with the idea of alternate day fasting (Tuesday and Thursday) every week. But I was surprised how easy it was (being keto-adapted to begin with), since I was not hungry at any time, day or night. In fact, I was not hungry at “breakfast” on the day after. So, I decided to try 2-consecutive-day and then 3-consecutive-day fasting. Again, easy. Absolutely no hunger. Lots of energy. I was alert, pumped, actually. Almost hyper!
I take Metformin twice a day: 750mg ER (extended release). It never occurred to me to reduce my meds, but then after a full day of fasting my FBG dropped into the mid 60s (3.6-3.7mmol/L). Once my FBG dropped to 60mg/dl (3.3mmol/L), but I felt fine. On a 3-consecutive-day fast, my FBG would be in the mid 60s all three days. I mentioned this to my doctor, and with a brush of his hand, he said, “Don’t worry about it. You can never get hypoglycemic on Metformin.” And I never did. The liver makes glucose, via gluconeogenesis, from both dietary protein (amino acids) and body fat (the glycerol molecule when a triglyceride breaks down). And when the lab report came back, my A1c had dropped a full half of a percentage point from 5.8% to 5.3%.

Sunday, May 28, 2017

Type 2 Diabetes, a Dietary Disease #382: Can fasting “wake-up” the pancreas?

“Fasting Diet for Diabetes ‘Could Repair Pancreas’” is the full title of a WebMD Health piece by Peter Russell in Medscape Medical News. Note that the ‘could repair pancreas’ is within single quotation marks. Still, the headline is provocative and got my attention.  After all, you only get one pancreas, and by the time most people are diagnosed as Type 2 diabetics, a substantial part (up to 80%) of the insulin producing cells in the pancreas have been destroyed. And the evidence is scant that the pancreas can or does create new beta cells.
Thus, as the lede states, “‘Rebooting’ the organ in this way could help [these] insulin-producing cells to repair themselves and start producing the hormone.” “This way” refers to a diet of “a very limited number of high-fat calories.” The researchers compared this restricted-calorie, high-fat diet with biomarkers associated with a water-only diet and found it had “the same physiological effects on the body as more extreme fasting.” Thus, they called the restricted-calorie, high-fat diet a “fasting–mimicking diet.” Alas, the study was done on mice.
Nevertheless, the study, published in the journal Cell, said that “during periods of fasting, the cells go into ‘standby’ mode. Then when feeding begins again, new cells are produced that have the potential to become insulin-producing.” “New cells” is hopeful; “potential” a lot less so…but it is still worth further investigation.
Medscape also reported: “The research team, led by the University of Southern California, says that laboratory tests on tissue samples from people with type 1 diabetes produced similar effects.” Now that IS promising. But this piece, “intended for a consumer audience,” was pretty thin, so I referred to the full article in Cell. Quote:
“In consideration of the challenges and side effects associated with prolonged fasting in humans, we developed a low-calorie, low-protein and low-carbohydrate but high-fat 4-day fasting mimicking diet (FMD) that causes changes in the levels of specific growth factors, glucose, and ketone bodies similar to those caused by water-only fasting. Here, we examine whether cycles of the FMD are able to promote the generation of insulin-producing β cells and investigate the mechanisms responsible for these effects,” the researchers say.
The diet: “…a low-calorie, low-protein and low-carbohydrate but high-fat 4-day fasting mimicking diet…”
Well, the rest of the article in Cell is way over my head, but some aspects of the premise, the findings, and the discussion were comprehensible to me, so I will try to convey a bit of the essence in these excerpted quotes:
“The ability of animals to survive food deprivation is an adaptive response accompanied by the atrophy of many tissues and organs to minimize energy expenditure.” This is related to autophagy, a well known process.
“Stem-cell-based therapies can potentially reverse organ dysfunction and diseases, but the removal of impaired tissue and activation of a program leading to organ regeneration pose major challenges.”
“In mice, a 4-day fasting mimicking diet (FMD) induces a stepwise expression of [certain genes], followed by [another gene]-driven generation of insulin producing ß [beta] cells, resembling that observed during pancreatic development.” The researchers focused on fetal pancreatic development in both mice and humans.
“FMD cycles restore insulin secretion and glucose homeostasis in both T1 and T2 diabetes in mouse models.”
“Fasting conditions reduce [certain intracellular signaling pathways that are central regulators of cell metabolism] and induce [gene] expression and insulin production”
“These results indicate that a FMD promotes the reprogramming of pancreatic cells to restore insulin generation in islets from T1D patients and reverse both T1D and T2D phenotypes in mouse models.”
So far I’m up to fasting 2 and at times 3 days a week. It’s easy. So, I’m not averse to trying a fasting-mimicking-diet (FMD) cycle that “entails [a] 4-day FMD cycle and up to 10 days of re-feeding.” That’s like every 2-weeks!

Sunday, May 21, 2017

Type 2 Diabetes, a Dietary Disease #381: My Next 30-lb Challenge: 4 weeks in…

After losing 31 pounds in 10 weeks this winter, and learning how easy it is to do a full-day (300 kcal/d) “fast,” without hunger, I relaxed a bit, and I immediately regained 4 pounds in the first week. So, I decided the best way to preserve the weight loss (and A1c benefit: -0.5% from 5.8% to 5.3%), was to start a new challenge: to lose 34 pounds (30 + 4) over 16 weeks, leading up to my next doctor’s visit. For the Design Protocol, see #378.
Week 1: That “first week,” in which I regained 4 pounds after my doctor visit, I let my guard down a bit – not much really – okay, I had a milk shake after seeing the doctor. I deserved it, right? But I paid for it. Even my fasting blood sugars (FBG) were elevated (93 average) with a couple as high as 105mg/dl (5.9mmol/L). Gone were the days of the 60s and 70s. My body stubbornly refuses to take up sugar after such transgressions. I lose insulin sensitivity; my insulin resistance is elevated, at times for many days, even with Metformin. Go figure.
Week 2: I started Week 2 behind the 8-ball. Besides the 4 pound gain in Week 1, my Sunday main meal was a shrimp cocktail and a large bowl of salted peanuts, plus 2 cocktails. See, my body shouldn’t trust me. I gained another 2 pounds (from the salt). The next day I dropped the water weight but was still deep in the hole. And then on Tuesday we ate out before theatre…which didn’t go well. You don’t want to know the details; suffice to say my FBG on Wednesday was 111. So, to start both a FBG drop and weight loss, I began a 2-consecutive day fast. The result: after 1 day, while forgetting my spritzer and my pills (including Metformin and a diuretic), my FBG on Thursday was 94 and I dropped 4 pounds! By Friday, I’d lost 3 more and my FBG was 82. I ended the week with a 5 pound weight loss and a 91mg/dl FBG average. Back on track!
Week 3: Two weeks into this new 30 (34 really) pound challenge, I was down 1, leaving 33 more to lose in 14 weeks. I knew that was doable, so long as I continued with at least 2 days of fasting a week, with perhaps a boost from a 3-consecutive-day fast, or two, if required “by circumstances.” Well, “circumstances” happened. (I love the passive voice; it’s so useful at times.) Monday night we went out to dinner, and I had 3 slices of really good crusty bread, slathered in butter, while waiting for my entrée…and I paid for it. After 4 days in the low 80s, next morning my FBG jumped to 102mg/dl. So, I decided that instead of alternate day fasting this week (Tuesday and Thursday), I would do a 3-consecutive-day fast. I need to protect that new 5.3% A1c!!! Result: The 3-day fast was easy. For the week I lost 4 pounds and posted an 83mg/dl FBG average. Not bad.
Week 4: This week I’m just doing alternate day (Tuesday +Thursday) 300kcal “fasting.” I’m on track to achieve my 4-wek goal, and Wednesday is my birthday. Oops, a premature expectation. I cheated on Tuesday (some junk food in the pantry), and well, Wednesday was my birthday. Okay, so I’m human. My weekly FBG average climbed to 91mg/dl with no day over 100…but the trend line was not good. I also gained 4 pounds (largely water), putting me 6 pounds behind schedule. Clearly, I’m off-message, and I need to do another 3-day fast.
Discussion: My 4-Week goal was to get to 210 (8 weeks to 202, 16 weeks to 187), and I missed it big time. At my August doctor’s appointment, my goal is to rack up another 5.3% A1c and reach 187 lbs. So, I will soon be entering “new territory” here, and we’ll see what’s possible. I remember writing several years ago ("My Goal Weight and the BMI Table") and ("How much Protein Should I Eat?"), that “goal” or “ideal” weights were subjective and basically unattainable for people who have been eating the Standard American or Western Diet for their entire lives. “Lean Body Weight,” on the other hand, was the weight that should be used to compute the body’s protein requirement because overeating protein just puts amino acid stores in the liver which become the building blocks for glucose via gluconeogenesis. That’s a major reason we take Metformin, to suppress this gluconeogenesis. I am now trying to eat just 60 grams of protein a day, and a “lean body weight” of 187 for me, while still “overweight,” now seems achievable:  BMI of 27, vs. BMI of 54, 15 years ago.

Sunday, May 14, 2017

Type 2 Diabetes, a Dietary Disease #380: Newcastle Diet (“Counterpoint Study”)

The “Newcastle Diet,” as it seemingly is practiced today, is not the same as the original diet developed at Newcastle University for their “Counterpoint Study,” conducted in 2009 and published in 2011. I wrote about this study four years ago in "Reversal of Type 2 Diabetes" (#88) and "'Reversal of Type 2 Diabetes' Revisited"  (#89). Column #88 garnered the most page views of any column I have ever published due to the appealing but misleading title. Note: My column titles were in quotes because they are the paper’s authors,’ not mine.
The author’s use of “reversal” in the title is misleading because of their definition of “reversal”: “Reversal of diabetes” was defined by them as “achieving fasting capillary blood glucose < 6.1mmol/l [110mg/dl] and/or, if available, HbA1c less than 43 mmol/mol (6.1%) off treatment.” In my book, that is neither a “reversal” nor a “cure,” as some would claim. A FBG of 110 is smack in the middle of “pre-diabetic” (which begins at 100mg/dl (5.6mmol/L) in the U.S). By way of reference, many doctors consider an A1c of 5.7% (39 mmol/mol) – the threshold for “pre-diabetes” – to be incipient type 2 diabetes. That’s because it’s manifest evidence of Insulin Resistance (IR), the cause of type 2 diabetes. “Pre-diabetes” is simply an arbitrary point on the IR continuum.
Why is the Newcastle Diet called the “600 kcal diet”? Quoting from the Newcastle University 2011 paper, the dietary protocol of the “Counterpoint Study,” “consisted of a liquid diet formula (46.4% carbohydrate, 32.5% protein and 20.1% fat; vitamins, minerals and trace elements; 2.1 MJ/day [510 kcal/day]; Optifast; Nestlé Nutrition, Croydon, UK). This was supplemented with three portions of non-starchy vegetables such that total energy intake was about 2.5 MJ (600 kcal)/day.” That’s why the Newcastle Diet is called the “600 calorie diet.”
However, Diabetes.co.uk, which funded the study and has the only official description of it on the web, now says it is 800 kcal diet, comprised of “Optifast meal replacement sachets, which provided 75% of the calories (600 calories). The other 200 calories came from non-starchy vegetables.” Then, “Note: The diet is referred to as the 600 calorie diet (rather than 800) due to the meal replacement aspect of the diet totaling 600 calories.” Wrong! The Optifast portion is 510 kcal, but I guess NHS doesn’t want Brits trying such a “drastic” (600k cal total) diet, and certainly not “without the help and approval of a dietitian or doctor.” Good luck with that!
Note also the macronutrient composition of the Optifast part of the original Newcastle Diet: 46.4% carbs, 32.5% protein, and 20.1% fat. That’s high carb, very high protein and low fat. And that’s not counting the 3 servings of “non-starchy vegetables,” which if you ate them would boost the carb content higher, to 55% of the 600 kcal diet and 66% carbs in the 800 kcal diet. That is how you developed diabetes in the first place!
In addition, the 32.5% protein is much too high. Virtually no one recommends more than 30%, and hardly anyone eats more than 20%. Americans eat 15% on average, and the Nutrition Facts panel on packaged and processed foods is based on 10% protein. Any protein that your body does not take up in 4 or 5 hours is stored in the liver and is used to make glucose (or fat!). In T2s, suppressing this unwanted gluconeogenesis is one of the things that Metformin does. So, basically, Newcastle is a low-dietary-fat diet, but since your body has access to its own fat for fuel, if you burn a pound a week, it’s a pretty HIGH-FAT diet AT THE CELLULAR LEVEL.
Okay, so why does this diet work? The answer is that it is fundamentally a very low CALORIE diet. On this the authors agree. They conclude, “Normalization of both beta cell function and hepatic insulin sensitivity in type 2 diabetes was achieved by dietary energy restriction alone” (my emphasis). Makes sense. You eat less. You lose weight. In this respect the Newcastle diet is similar, both in mode and outcomes, to bariatric surgery…but tremendously safer. And in lieu of the 300g of carbohydrates that the typical Western 2,000 kcal diet includes, the original Counterpoint Study (600 kcal) version would have 59g of carbs from Optifast and 23.5g added for “non-starchy vegetables” = 82.5g total. So, in addition to being very low in DIETARY fat, the original Newcastle is low carb! In the higher-fiber 800 kcal version recommended by Diabetes.co.uk, the carb count climbs to 132 grams, no longer considered “low-carb,” but it’s still pretty low compared to 300 or 375! Good for the gut too.
300g of carbs is the RDA in a 2,000kcal diet; 375g in 2,500kcal (for men). Surely everyone knows, even if the NHS and the ADA and the public health establishment won’t admit it, TYPE 2 DIABETES IS A DIETARY DISEASE. As such, the best treatment for type 2 diabetes is a HIGH fat, moderate protein, LOW carbohydrate diet.

Sunday, May 7, 2017

Type 2 Diabetes, a Dietary Disease #379: “Man-up, guys!”

Okay, I have been, or should have been, saying this to myself for years, but…let’s face it: straight talk like this is too confrontational when addressed to oneself. And it’s condescending when addressed to others, so it’s usually left unsaid…but not “unthought.” It’s subtext for the way we think of ourselves and others think of us.
In this instance, the context for this exclamation is eating strictly Very Low Carb (VLC). The benefits, which I have realized for 15 years and espoused since I started writing this blog in 2010, are manifest. Besides losing weight easily (my original motivation), and doing it without hunger, I am so very much healthier by every measure my doctor uses…and I feel so much better and am totally energized.
But eating strictly Very Low Carb is difficult… because it requires change. I have for these 15 years considered it my goal, and, it must be said, have adhered to the protocol at times better than at others. As regular readers know, over a few years in the beginning, following first Atkins Induction (20g of carbs/day), then Bernstein’s 30g/day program for diabetics, I lost 170 pounds. Of course, my blood pressure and cholesterol improved dramatically. My triglycerides dropped to <50mg/dl (<2.8mmol/L), and my HDL doubled to the 80s (high 4s).
While I have kept most of the weight off, and my blood lipids continue to be stellar, my A1c has been disappointing, at least to me. In this respect I get no acknowledgment or agreement from my doctor. He is in the business of treating the sick and those whose health and diabetes are poorly managed. He dispenses pills. And most doctors (not mine) dispense bad dietary advice. I don’t blame them. They’re expected to follow the medical establishment’s Standards of Practice and the Medicare and insurance company guidelines.
My A1c has been in the high 5s/low 6s (38-48mmol/mol) for more than 8 years. Of course, from a physician or RD or CDE, this result elicits praise. The ADA considers an A1c of <7.0% “optimal.” They believe that my A1c is proof that my type 2 diabetes is “well managed,” i.e.  “I don’t yet need progressively more medications!”
The high A1c level that the medical establishment has set for the care of type 2 diabetics  -- ≤7% for the general population and ≤ 8% for persons over 75 years – is a disgrace because of the increased health risk associated with it. BUT this low bar is the result of 1) limited success in using drugs to manage the disease, 2) ignoring the fact that type 2 diabetes is a dietary disease and is thus best managed by the patient and 3) the dietary advice given by doctors to the diabetic or pre-diabetic patient is JUST PLAIN WRONG – in fact, it is the polar opposite of what “healthy eating” should be for type 2s: to wit, to restrict carbohydrates.
So, why do I now say, “Man-up, guys”? Because I finally did it! Ergo, this is as much addressed to me as to others. Please don’t view it as condescending. It is not meant to be. It is meant to be just a statement of fact. I finally did it, and two weeks ago, here in #377, I published the result: a greatly improved A1c. My previous A1c was 5.8%, eliciting nothing but satisfaction from all who heard it.  I was hoping to see an A1c ≤5.5%, with an emphasis on the “less than,” and I wasn’t disappointed. My A1c dropped 0.5% from 5.8 to 5.3 (34mmol/mol).
Comment: This result was the outcome of eating strictly Very Low Carb for 10 weeks. I also fasted on two alternate days a week, and a few times on 3 consecutive days. For most of the 10 weeks I prepared my own meals: just a 12oz coffee with 1½ oz of cream for breakfast, and on non-fasting days, usually a “light” lunch, and then supper (including about 6oz of protein: fish, veal, lamb, or offal), in a stove top preparation cooked with vegetables. Sometimes I grilled meat and had a big salad. All suppers were accompanied by 10-12 oz of red wine (in 2 spritzers); on fasting days, just one spritzer. I hardly ever ate out until the last 2 weeks, when I rejoined my wife and we were travelling, but I continued my fasting routine. Altogether, I lost 31 pounds.

Sunday, April 30, 2017

Type 2 Diabetes, a Dietary Disease #378: My Next 30-lb Challenge: Project Design

As everyone who has ever lost a lot of weight knows, the worst thing you can do is waste the effort by gaining it back. And gaining it back it so much easier than losing it. So the best defense to avoid gaining it back is a strong offense, i. e., to immediately launch another campaign to lose weight. And that’s just what I’ve done.
I made this decision exactly one week after the conclusion of my original 10-week, 30-pound challenge (originally 2-month, 20-pound challenge), in which I lost 31 pounds. During this last week, I regained 4 pounds and my FBG average climbed to 93mg/dl. Ugh! So, the new challenge is actually to lose 34 pounds. The length of the new challenge will be 16 weeks, again to coincide with my next doctor’s appointment in early August.
In this new challenge I intend only to report at 4-week intervals. At the mid-point (8-weeks or June 11th), I should have reached 202 pounds, my lowest weight since my original 170 pound weight loss. I lost 170 pounds after starting to eat Very Low Carb, first on Atkins Induction (20g/day), then later on Bernstein (30g/d). That was also my weight at the conclusion of Basic Training in the U. S. Army in 1960, 57 years ago. By the end of this Challenge, I should have reached 187 lbs, exactly half the weight I started at in 2002 (375 lbs).
For reference, 187 lbs is still smack in the middle of the “Overweight” range in the BMI chart. I am starting this new challenge at 217lbs, which is still considered “Obese.” It was also my weight during my teenage years.
CHALLENGE DESIGN: As before, on most “FEASTING DAYS” I will strive to eat about 1,200kcal: 100g of fat, 60g of protein and 15g of carbohydrate. The carbs will actually range up to 30g to accommodate my daily 1 or 2 spritzers, never more. Breakfast on these days will consist of a 12oz coffee with 1½ oz heavy cream and stevia powder. Heavy cream is fat, so any overnight ketosis (if achieved) should continue into the day uninterrupted.
Lunch, if any, or any other food before supper, will be just protein and fat. Examples include a can of Brisling sardines in EVOO, a can (or 2) of kippered herring in brine, or a hard-boiled egg (or 2). And iced tea sweetened with liquid stevia. Occasionally I will lunch on a can of pork liver pâté. A snack break from gardening can be an iced tea and a few spears of dill pickles to restore lost salt and maintain fluids and electrolytes. Before supper, to accompany a (or 2nd) spritzer, I might indulge in some celery or sliced radishes, with added salt.
Supper on feast days will include a small to medium (not large!) serving of protein, with inherent and added saturated fat, and one low-carb vegetable, prepared with added fat (butter or olive oil), or a salad. Vegetables include green beans, asparagus, cauliflower, and broccoli. My salads include romaine, mushrooms, hazelnut pieces or slivered almonds, and aged grated Parmesan Reggiano tossed in a homemade vinaigrette. My beverage, to wash down the pills: 2 red wine spritzers – 5 to 6 oz of red wine in a glass filled with seltzer.
This regimen works because, even though this is a low-calorie meal plan for a “feast” day, at no point in the day will I be hungry. That’s because my metabolism is humming along in high gear, burning body fat for energy so long as both my blood sugar and blood insulin levels remain low and stable. I eat this food because I like it. I am not hungry before “breakfast,” but I enjoy my morning coffee. And I look forward to a break from working in the garden – to rest and refresh myself, have a beverage and sometimes a bite, and then go back to work.
“FASTING DAYS”: On these days (2 or 3 every week), I will consume about 300kcal/d. I will take my morning pills with the usual 12oz coffee, 1½ oz heavy cream and stevia powder. If I feel dehydrated during the day, I will have just iced tea and a slice (or 3) of pickle; and in the evening, just one red wine spritzer with my pills.
Macronutrients: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day total: 298kcal. The secret, I think, for the success of this “feast/fast” regimen, is that since I eat VLC, I am already “keto adapted.”

Sunday, April 23, 2017

Type 2 Diabetes, a Dietary Disease #377: My 10-week, 30-lb Challenge: Final Report

Executive Summary: Primary End Point: Achieved, lost 31 pounds in 10 weeks. Discussion: All day fasting (300kcal/day) – either alternate day or 3-consecutive-day fasting – is an effective way to break a weight loss plateau if you are keto-adapted to start. It is easy because you will not be hungry, and it is effective because you lose weight while your metabolism continues to run in “high gear” as you burn your own body fat. During fasting your fasting blood glucose will fall dramatically (while continuing a Metformin regimen), but not below 60mg/dl. There was no hypoglycemia. Gluconeogenesis from fatty acids and amino acids provided glucose. My FBG average dropped from 119mg/dl before to 81 (10-week average). A1c went from 5.8% to 5.3%. Lipid Panel: Total Cholesterol: 201mg/dl; HDL: 74mg/dl; LDL: 114mg/dl; Triglycerides: 67mg/dl.
Week 6: Lost 0 lbs. Annoying. I thought I might be in trouble when after my first day of fasting this week I had lost only 1 lb and my FGB was 83. The week before my FBG was 61. I also ate out on Friday (3/17), and while lunch was VLC, my supper was 3 Ultras and ad lib peanuts. So, Saturday’s FBG was 107 and my weekly average bumped up to 79 (4.3mmol/L). Still, not bad.
Week 7: Due to the less-than-desired results in Week 6, I decided to try a 3-consecutive-day fast this week (Tue-Wed-Thu). I’m never hungry on fast days, so I thought it would be easy…and it was. No hunger, even on Friday morning. I could have kept it up for longer, easily. I had lots of energy and low but consistent fasting blood sugars (60s & 70s), average 71 mg/dl, and I lost 2 pounds. It was successful so I decided to repeat the 3-day fast the next week.
Week 8: Once again, the 3-day fast was easy. No hunger. Very little thinking about food. When I wasn’t busy with projects, or needed to rest from pushing hard all day, I sat down and read for half an hour. This week I ended the fast with a seminar in NYC that included a talk by Gary Taubes and lunch. I had the salad (with candied walnuts!), a piece of chicken and a spinach side. For supper, I had a petite filet, broccoli rabe side, and a drink. FBG this morning was 87! That raised my weekly average to 74mg/dl. I also lost 5 pounds, bringing my 8-week loss to 25.
Week 9: All good things, as they say…slow down. My weight loss continued, but just 1lb, to 26. My FBG average jumped 15 points, to 89mg/dl (range 74 to 101). Explanation (excuse): I spent most of the week in Florida and on the road. It’s hard to stay on track with so many diversions. I cheated. “No dessert,” I said at the Charleston Grill, but then without thinking ate the offered petit fours. Etc. So, with only 8 days remaining in my 10-week, 30-pound challenge, I will need to employ “the nuclear option” again this week: a 3-consecutive-day fast; still 4 pounds to go.
Week 10: It worked, for the 3rd time. I lost 5 pounds, bringing my 10-week weight loss to 31. And my FBG average was 80mg/dl (4.4mmol/L) – higher than expected, due no doubt to the adjustment period the body needs to down regulate from the previous week’s excesses. The 3-day consecutive fast, I discovered, is just as easy as, and more effective than, the Tuesday-Thursday alternate day fast. You just need to be keto-adapted to avoid hunger altogether.
Conclusion: If you eat VLC (just 15-30 grams of carbs/day), and you are thus keto-adapted, and you reach a weight loss plateau, you can effectively employ full-day fasting (alternate day or consecutive day) to restart weight loss in a healthy way. I did and I lost 31 pounds in 10 weeks.

Sunday, April 16, 2017

Type 2 Diabetes, a Dietary Disease #376: “I have gone off carbohydrates almost entirely.”

A couple of columns back I told the story of a man I had met only once, and then only briefly, at a New Year’s Eve party. I was, shall we say, sort of “juiced”, and probably rattled on a bit about my Way of Eating (WOE). I related how I had lost a lot of weight, and improved many other health parameters, on a Very Low Carb (VLC) diet. I then apparently gave him a card for my website, The Nutrition Debate. I honestly expected nothing to come of it.
A few weeks later he emailed me, “I have gone off carbohydrates almost entirely…and lost 10 pounds.” I replied congratulating him on his success and his motivation. I asked, “What was the trigger for you?” He said, “My doctor had me tested for diabetes and suggested I might be pre-diabetic – hence the urgency for weight loss.” I asked, “Why Very Low Carb?” He had doubts, he said, but “I am hoping I will do myself more good than harm.”
In terms of mental reservation, given the fat phobia most people have learned from bad government guidelines, and from the medical establishment and the media, that was a fair place for him to be; that notwithstanding, however, my casual acquaintance took the next step. In his words, he foreswore “carbohydrates almost entirely.”
THEN, 6 WEEKS LATER I GOT THIS UPDATE: “LOST 40 POUNDS AND AM TAKING ONE-A-DAY ‘SILVER’ DAILY.”
I was thrilled for him and pleased that I had at least been a catalyst. It was just serendipity that I had been there (sort of) at that moment to help him point the gun at the right target, carbohydrates, before pulling the trigger.
My new friend had the 3 keys: 1) the motivation, 2) the courage, and 3) the pertinacity to stay with it. All three are critical, but the “catalyst” for him was my bibulous rant on New Year’s Eve. What’s your trigger?
In my case, in 2002, I had been a diagnosed type 2 diabetic for 16 years and still eating a “balanced” (55-60% carbohydrate) diet as I had been for my whole life. And I had recently gained enough weight that I was too fat to weigh in on the doctor’s scale. So, before a scheduled appointment I stepped on a commercial scale and “discovered” I weighed 375 pounds. I was shocked. That was my motivation. And then serendipity stepped in.
As I opened the door to my doctor’s waiting room, he was standing at the nurse’s station and said, “Dan, have I got a diet for you!!!” Six weeks earlier my doctor had read the New York Times Sunday magazine cover story: Gary Taubes’s ground-breaking, “What If It's All Been a Big Fat Lie.” He tried the diet Taubes promoted. Besides losing 17 pounds in 6 weeks, he liked the effect it had on his lipid profile. So, he suggested that I try it, and I did.
The third factor, your firmness of purpose, or dogged determination, may seem to the uninitiated (or the misled) to be the hardest of the three, but it’s not. After just a few days of adjustment, while you use up your glycogen stores, or immediately if you’re already keto-adapted, it becomes accustomed to eating mostly protein and fat. It no longer craves carbs because your blood insulin level has dropped enough to allow access to your body’s fat stores. It then breaks down body fat when the calories you eat are insufficient to maintain energy balance.
But it can’t do this 1) if you eat enough carbs to raise your blood insulin level and/or 2) you eat more food than you need to maintain energy balance. But you won’t, if you listen to your hunger signals, because when your body is burning its own body fat, you are not hungry. Your body is feeding on its own fat stores, so it doesn’t tell you, “I’m hungry. You must feed me with food-by-mouth.” That’s what makes this easy. You won’t be hungry (after I period of adjustment) because your body is content to feed on its own fat stores. And it makes sufficient essential glucose from amino acids (from digested protein) and from the glycerol molecule freed up when body fat (triglycerides) break down. And in the process it will make ketone bodies, which your brain will love.
So, what’s happening with my new “friend” who lost 40 pounds in two months after “going off carbohydrates almost entirely”? I don’t know, but if he sticks to a Very Low Carbohydrate eating plan, both he and his doctor will be very happy – he a lot healthier and happy with the weight loss and his doctor with his improved lab tests.

Tuesday, April 11, 2017

Type 2 Diabetes, a Dietary Disease #375: A New Year’s Eve Conversation, Part 2 of 2

Part 1 of this 2-part series (#374 here) relates how “Bruce” lost weight easily by “going off carbohydrates almost entirely” for two weeks. I met Bruce casually at a New Year’s Eve party and gave him one of my cards. He decided to check out my website, www.thenutritiondebate.com  and then to try Very Low Carb (VLC) eating. In our earlier conversation that evening, Bruce told me that in those first 2 weeks he had lost 10 pounds. The conversation continues here:
Dateline: January 14th (still later that evening)
You’re welcome, Bruce. Weight loss was my original motivation (in 2002) for eating VLC because, like yours, my doctor thought that being overweight was a cause of T2DMThey were both wrong, as Gary Taubes and many other experts in physiology and medicine have now exhaustively and conclusively proved. See my #5 here or Taubes's "Alternative Hypothesis" in "Good Calories-Bad Calories" (2008), a heavy but solid, evidence-based read.
An easier read would be, "What If It's All Been a Big Fat Lie," the New York Times Sunday magazine cover story of July 7, 2002, here: My doctor read this, tried it himself, and recommended the diet to me. That's when I got interested in low carb for weight loss. And, incidentally, it started the modern revolution in dietary science that so much of the orthodox profession continues to dismiss. That's why Taubes, who won the National Science Writers’ Association award 3 times, wrote GC-BC. Sadly, he was to be disappointed by the medical community’s response. 
Insulin Resistance (IR) is the cause of T2DM. It is also the cause of obesity, not the other way around. Insulin is the transporter of glucose in the bloodstream, and so long as there is enough glucose (from carbs) circulating in the blood, insulin remains elevated and blocks the alternative fuel, body fat, from breaking down to fatty acids to maintain energy balance . The body saves this fat, a more dense source of energy (9kcal/g vs.4 kcal/g for carbs and protein), for long fasts, including famine and winters (from a Paleolithic/historic perspective). I wrote about this in this post: The Nutrition Debate #308, “Introduction to What Causes Type 2 Diabetes,” here.
Since resuming my column a year ago December, my focus has been on "Pre-Diabetics," newly diagnosed Type 2s, and those who, like you, have been told they "might be Pre-Diabetic." The medical societies have been very slow to revise standards for diagnosis, but they have been doing it. They just haven't gone nearly far enough. There are many clinicians today who have, however, and many who just may (I don't know your values, and I'm not an MD) classify you unambiguously as Pre-Diabetic, or even a frank Type 2.
I hope you have a baseline A1c on a recent lab test, because it you stay on your VLC Way of Eating, you will see it drop, perhaps significantly, and perhaps even out of the range of Pre-Diabetic completely to below 5.7%. That should be your goal. "Normal," btw, is between 4% and 5%. Anything above 5% is a sign of Insulin Resistance.
I also hope you have a baseline metabolic panel or at least a lipid panel with which to compare your next lab tests. After doing this Way of Eating for awhile, my HDL more than doubled from 39mg/dl to 84mg/dl (comparing 15 average tests for both). And my triglycerides plummeted by two-thirds (from around 150mg/dl average to below 50 average. Both values have stayed there for many years now. My total cholesterol and LDL cholesterol have been stable and slightly lower. My latest test: TC 184; HDL 91; LDL 84; TG 46.
Google "Metabolic Syndrome." It is the precursor to and the “unifying hypothesis” for all these metabolic disorders. I wrote about it almost 5 years ago in an early column of The Nutrition Debate: Metabolic Syndrome.
Dan
BTW, after one day of eating VLC (a strict version of Low Carb, like Atkins Induction), before losing weight, I had a hypo and called my doctor who told me stop taking one anti-diabetic oral med. The next day he cut the other two in half and soon thereafter in half again, later eliminating the sulfonylurea completely. Now I just take Metformin.
Dateline: February 29th (6 weeks later)
I emailed Bruce to invite him to another party, our annual Winter Wing-Ding. He replied:
Hi Dan,
Thanks much for the invitation, but I am in Jensen Beach for January only.
Lost 40 pounds [my emphasis] and am taking One-a-Day “Silver” daily.

Bruce

Sunday, April 2, 2017

Type 2 Diabetes, a Dietary Disease #374: A New Year’s Eve Conversation, Part 1 of 2

It all started at a New Year’s Eve party after a New Year’s Eve dinner party. I was pretty well juiced by that point.
Email in my inbox dated January 14th:
Hi Dan,
I met you in the community room [at the] New Years Eve [party]. [We talked)], and [I] was inspired to try to lose weight. Since New Year’s I have gone off carbohydrates almost entirely [my emphasis]. I have lost about 10 pounds to date, but I understand the first 10 pounds are inconsequential. Anyway, this diet naturally has a higher ratio of fat than my previous diet/non-diet. I have been reading your blog at
www.thenutritiondebate.com. I am hoping I will do myself more good than harm on this diet. Any tips for the beginner?
My reply later that evening:
Hi Bruce,
First of all: Congratulations! 1) on your being motivated and acting on that motivation, and 2) on you actual success. It's true that the first 10 pounds are the quickest to lose, although not necessarily the easiest.
Some people experience hunger (which seems to go away after a couple of days as the glycogen stores in the liver and muscle are used up and you transition to burning fat (breaking up triglycerides into fatty acids and using them for energy and ketones for brain food.). Also, some people feel weakness, which is addressed by making sure you get extra salt (seriously) to compensate for the loss of salt/water weight (most of those 1st 10 pounds).
Depending on how much you eat, and how much you have to lose, though, you should be able to lose at least 2 pounds a week going forward. At one point (almost 10 years ago) I lost 100 pounds in 50 weeks. 
Thanks for reading my blog. I post every Sunday (at www.thenutritiondebate.com). Please keep me posted on your progress, and feel free to ask questions. I'd be happy to connect you to other resources including an on-line forum for Type 2s. Are you, btw, a Type 2, or Pre-Diabetic, or have you been told you have Metabolic Syndrome?
Dan Brown
His reply, still later that evening
Hi Dan,
Thanks for getting back and thanks for the encouragement. My conversation with you on New Year’s Eve inspired me to get started and that I would have a possibility of success. To answer your questions, my doctor had me tested for diabetes and suggested I might be pre-diabetic – hence the urgency for weight loss.
Bruce
Well, this answer from Bruce put him perfectly in the crosshairs of my new target audience: the Pre-Diabetic and those whose doctors have told them, “You might be Pre-Diabetic” or “We’ll have to watch those blood sugars.” At that point they tell you to lose weight (knowing you’ll most likely fail on the dietary advice given (eat a calorie-restricted, low-fat diet and exercise your ass off) and before starting you on a regimen of pills leading, as your disease inevitably progresses on that diet, to injecting insulin).  
Realizing this, I was motivated to elaborate – unsolicited – on my previous reply. Later that evening I wrote to Bruce again, and that message, and his amazing reply to me (six weeks later), will be the subject of my next column. I can hardly wait to tell you! (Spoiler alert: Bruce’s weight loss continued, big time!)

Sunday, March 26, 2017

Type 2 Diabetes, a Dietary Disease #373: The “blame the patient” game

Let me be clear. I don’t really think your primary care doctor, who is perhaps an internist/cardiologist (like mine) or maybe a family care doctor, is being disingenuous when he or she writes in your file, “patient non-compliant.” They almost certainly, or for the most part, sincerely believe in the advice they have given you. They advised you how to lose weight (exercise a lot and eat a calorie-restricted balanced diet), specifically to eat a “healthy low-fat diet,” And when you failed to get the results they expected, they concluded it was because you didn’t follow their counsel. So, they deduce, you must have cheated. You were “non-compliant.”
Why do they expect this result, you ask? Because the Guidelines for Clinical Practice for each of the practice specialties, and the governing medical associations (the AMA, AHA, ADA, etc.), all told them to. That is the result of virtually all of the patient cohorts who were given this advice before you. So, the explanation – the reason – must be that it was the patient who failed to follow it…who was non-compliant. That’s also when the clinical guidelines tell them to start you on drugs to accomplish what you failed to do.
It never occurs to them that it could be the advice they gave you that failed to produce the outcome they (and you) desired. The advice to eat a low saturated fat, low cholesterol diet has now been in place for over half a century – since the time any doctor in practice today went to medical school. The advice was first popularized by the publicity given to the treatment of Eisenhower after his first heart attack in 1955. Before he died 14 years later, he was to have 7 myocardial infarctions, 14 cardiac arrests, and at least 1 stroke, but never mind….
The advice to eat a low saturated fat, low cholesterol diet was also strongly espoused by a University of Wisconsin physiologist, Ancel Keys. The bad science, publicized in his “Six Country Analysis” (1955), and later compounded in his “Seven Countries Study” (1958), has since been widely discredited, but never mind….
By January 1961, Keys was on the cover of then popular Time magazine and had been invited to join the Board of The American Heart Association. And to this day the AMA still espouses a low saturated fat, low cholesterol diet. The evidence that this advice is faulty – in fact, is the virtual opposite of the heart-healthy diet that you should be eating – has existed from “the beginning.” See this timeline, by Diet Heart Publishing.
The evidence supporting a healthy diet has now been well documented in the last decade in at least three thoroughly researched, landmark books: 1) Gary Taubes’s “Good-Calories, Bad-Calories”; Denise Minger’s, “The Big Fat Surprise”; and Gary Taubes’s new, “The Case Against Sugar.” There are many others, but these three are the best. They’re an easier read than the peer-reviewed scientific journals they’re based upon.
What got me going on this minor rant was this article in Medscape Medical News last month that described the efforts of scientists to “reprogram” alpha cells in the pancreas to regenerate new beta cells in mice. These are the cells that make insulin until they are destroyed by an autoimmune disorder, as in type 1 diabetes, or they just wear out from overuse due to Insulin Resistance in type 2 diabetes.
What set me off in this article was the suggestion that a similar advance (an “artificial pancreas”) “may enable tight glycemic control with minimal patient intervention” (my emphasis). Great news for type 1s, of course, but from my perspective (as a type 2) it just reinforces the notion that “minimal patient intervention” was the only course of treatment available for type 2s in the clinical setting since patients are “non-compliant” and fail to achieve the desired outcomes when they follow their doctor’s advice. THUS, THE PATIENT IS TO BLAME!
But what if you, the patient, took control of your diet and your metabolic health, and ate a healthy, low carb, moderate protein, high fat diet, including heart healthy saturated fat, without concern for dietary cholesterol? What if you did this and the outcome was a big weight loss and a lab report with an improved lipid panel?
 Or you could just follow the dietary advice given to President Eisenhower in 1955. Remember that outcome?

Sunday, March 19, 2017

Type 2 Diabetes, a Dietary Disease #372: My 10-week, 30-lb challenge, 5th wk Progress Report

I’ve changed the title of the Challenge from “2-month, 20-pound” to “10-Week, 30-Pound.” The primary reason is that it became clear I was going to over achieve my goal. This is the new mid-point report.
The second reason is that I have a doctor’s appointment coming up in Week 11, and I wanted to capture the best A1c and weight loss improvements possible. The challenges will be that, for a large part of the final 2½ weeks, the unique circumstances that gave rise to my beginning this gambit will change: 1) I will not be alone and preparing all my own meals, and 2) I will at times be “on the road” and eating most meals in restaurants.
That being said, the necessary adjustments will be good for me. They will allow me to transition to “real life” while at the same time being under the gun to preserve continue the gains. (See how easy it is to undercut one’s confidence and resolve?) Reference: for the Challenge, see #368, for the 1st week’s Progress Report, see #370, and for the 2nd week’s, see #371. Now, back to the 5th Week (new mid-point) Progress Report here:
Week 3: Having gained 1 pound in Week 2 (after losing 11 in Week 1), I was confident the “progress…was not really lost,” and “it [the progress] will show up on the scale this coming week.” Well, I lost 4 pounds in Week 3.
Better yet, my Fasting Blood Glucose (FGB) average also dropped again, from 88mg/dl (3.8mmol/L) to 86 (3.7). The actual readings were 81, 104, 90, 78, 84, 83 & 79. The 104 was a surprise. It came after a supper of veal kidneys cooked in onions and mushrooms with Marsala wine and a salad of Romaine lettuce, mushrooms, hazel nuts, shredded cheese and my homemade vinaigrette made with white wine vinegar. Go figure! Tonight I’m having the 2nd half of that kidney preparation, with the same salad, so we’ll see what happens.
Changes in Week 3: Going forward I’m going to cut my morning coffee from a 16oz mug to a 12oz mug. That should reduce the heavy cream from 2oz to 1½oz. I found that I had swallowed all my supplements with only half a cup and the 2nd half was an indulgence. The idea came to me after reading a blogger who was looking for people to join him in a 30-day coffee fast. I like coffee, but I am not addicted to it, and I don’t want to be.
Week 4: Well, it wasn’t the veal kidney and salad supper that gave me that anomalous 104mg/dl FBG (5.8mmol/L) last week. The same supper the 2nd time produced a FBG of 74mg/dl (4.1mmol/L) this morning. Conclusion: anomalies happen. Now, once again, the big news this week: My FBG average plummeted again, from 86mg/dl (4.8mmol/L) to 77 (4.3). I haven’t seen FBGs like this ever! True, on my own initiative, but with the concurrence of my doctor, about a year ago I increased my dose of Metformin from 500mg/day to 1,500. I had read somewhere that 1,500mg was considered a “therapeutic” dose. The inference I drew from that was that a dose of less than 1,500 was not therapeutic. And since I have been a diagnosed type 2 for 30 years, and on a reduced dose of 500mg for the last 15 since beginning VLC, it seemed appropriate to me that my medication should be therapeutic. But I think my doctor never suggested an increase because he thinks my diabetes is already “in good control.” I’m not blaming him. That’s the guidance he gets from the ADA, Medicare, etc. By the way, in Week 4 I lost 2 more pounds, bringing me to 16 total in the first 4 weeks.
Week 5: I’m settling into a groove. My weight dropped by another 2 pounds, bringing the 4 week total to 18. The big surprise this week is that my FBG continues to drop. This week I had 3 readings in the low 60s, and my FGB average this week dropped to 70 mg/dl (3.9 mmol/L). Recapping my FBG averages: 119 the week before starting, then 100, 88, 86, 77 and now 70. I hope they level off now. If not, I’ll cut my Metformin. My goal, though, is to lower my A1c, so I am willing to have some “low” readings so long as I feel I am in no danger of hypoglycemia. My sense is that my glucose levels are stable. I have some concern about the ones in the 60s, but I feel fine and am unaware of the “lows.” I have tested a few days in the late afternoon, when historically I have been lowest, and my readings have all been in the mid 70s. If my FBGs persist in the 60s, particularly after fasting days, I’ll test at bedtime, and if low, again during the night when my bladder calls.
Conclusion: I can’t believe that I have been so blind in my diabetes self-management for these last 15 years!

Sunday, March 12, 2017

Type 2 Diabetes, a Dietary Disease #371: My 2-Month, 20-lb Challenge, 2nd wk Progress Report

When you read this I will be 5 weeks into my “2-month, 20-pound challenge,” but I write it after 2 weeks “in.”  The first week I lost 11 pounds and lowered my FBG average by 19 points to 100mg/dl (5.6mmol/L). I did this by strictly following a program of eating 5 Low Carb meals prepared at home by me (2 or more at a time) and then fasting on Tuesdays and Thursdays. Note that in the first week I did not dine out once, as I had planned.
This week I report on week 2 of the challenge. Based on my FBGs this week, I have also revised the terms, to extend the duration from 8 weeks to 10½ weeks, to coincide with my next doctor’s appointment (4/18). My goal is to get the best A1c possible, lowering it from 5.8% to 5.5%, or better.  Note, however, that after 8½ weeks I will no longer be preparing my own meals, and my eating pattern will include more “dining out.”
Week 2 began uneventfully, with weight stable and FBGs in the mid-nineties. As the week progressed, my weight and fasting blood glucose (FBG) both dropped until I was down 3 pounds by Friday. I gained one back Saturday and 3 more by Sunday. So, my net for the week was up 1 pound; net for 2 weeks: down 10 pounds.
Saturday was the first day that I ate outside the home in almost 2 weeks, and I ate too much (2 meals – albeit “low-carb”), and I drank too much. I don’t regard the 1 lb. gain as much of a setback, though. The progress I made during the week was not really lost. I am confident that it will show up on the scale this coming week.
The big news, and the main reason I am reporting on this week, is what happened to my FBG (and presumably my serum insulin). My FBGs this week were: 94, 92, 95, 89, 81, 80 & 83. Average: 88mg/dl (4.9mmol/L). Recall that in the 1st week my average was 100mg/dl (5.6mmol/L) and in the week before I began the challenge it was 119mg/dl (6.6mmol/L). With FBGs like this week’s, and a stable blood sugar during the day, I think my A1c goal is reachable – if I continue to follow this Low Carb WOE…and with a little help from Metformin. We’ll see.
Other observations, comments and changes from the original “2 month, 20 pound” challenge:
     Cooking for myself has not been as onerous as I thought it would be. In fact, I’m enjoying it. In the weeks ahead I envision preparing all my meals at home. Since I always make enough for 2 days minimum, that means only making 2 or 3 meals a week, since I will be fasting 2 days (at least) every week.
     All day fasting is easy. The first week on the day after a fasting day I had a “snack” (1HB egg) or a “light lunch” (2 HB eggs). This week I did not. And I was not hungry on the fasting day or the day after.
     The quart of heavy cream lasted only 16-17 days. I use it only in coffee, so, alas, I put 2oz/day in my cup.
     I have a new Snack: a few “whole artichoke hearts in water,” and a Light Lunch: ½ can (60g) of “Sell’s Liver Pate.” Also, Bumble Bee is now packing the same wild caught Brisling Sardines as the King Oscar brand, in the same Baltic Sea factory, in EVOO (and Hot Jalapeno Peppers), and at a lower price point. 
     Virtually all my suppers are stove top. I love fish, especially cod and similar species. It’s usually the least costly “fresh” fish in the case, although it may have been thawed by the fishmonger after having been flash-frozen at sea. I’m going to check out frozen cod next time I see it. I’m fussy about country of origin.
     My veal supplier has given up, so I need to find a new source for my veal stew and veal kidney recipes.
     I loved the tripe dish I made last weekend. The smallest frozen honeycomb tripe package in the butcher’s case was 2 pounds, so I made it and had it 4 days in a row. I don’t mind eating the same thing multiple days in a row; in fact, if I like a dish I made, I look forward to having it again. (I can’t believe Jason Fung in his “Fructose 3” blog post this week said he couldn’t imagine someone eating tripe 2 days in a row. Jeez!)
The next report will catch up with the lag in reporting; it will be at mid-point (5 weeks into) my new, extended duration. Then, the last report (at 10½ weeks) will have a final weigh-in, and hopefully an A1c and lipid panel. My doctor is very good at reviewing the lab report and mailing it to me as soon as his office receives them.

Sunday, March 5, 2017

Type 2 Diabetes, a Dietary Disease #370: My 2-Month, 20-lb Challenge, 1st wk Progress Report

As you read this I will be 4 weeks into my 2-month, 20-pound challenge, but I write after only 1 week “in.” If you don’t know what prompted me to do this challenge, read #368 here to learn my motivation and other particulars. The short report: in the 1st week I dropped 11 pounds and lowered my FBG average by 19 points to 100mg/dl. If you’re overweight (as I am) and prediabetic or a 30-year diagnosed type 2 (as I am), even though theoretically “in remission,” and that outcome doesn’t pique your interest, you may as well stop reading.
The “challenge” is to stay on my current eating pattern 5 days a week and to fast on the other two. My current eating pattern is coffee with pure stevia powder and 1½ oz of 36% full cream in the morning. Then, only if I am hungry during the day, to eat either a light lunch (smoked herring in brine), a “big” lunch (brisling sardines in EVOO), or a snack (HB egg). My main meal (supper) is a stove-top preparation of cod with vegetables or a veal stew. Alternatively, I could make tripe in salsa roja or veal kidney with mushrooms, onions and Marsala.
This week I had cod with tomatoes, green olives and red pepper flakes Sunday and Monday. Then, I bought 2 pounds of tripe and made 4 suppers: Wednesday, Friday, Saturday and Sunday. I fasted on Tuesday and Thursday. On fasting days, besides my morning coffee, I had 1 red wine spritzer at the supper hour, and on the other days I had 2 red wine spritzers.
Next week (M, W) I will do different cod preparations (fennel and/or celery in chicken broth). I’ll also make a romaine salad with mushrooms, hazel nut pieces and shaved Pecorino Romano, with a vinaigrette.
During the last week I ate a light lunch (2 HB eggs) the day after the 1st fast day and a snack (1 HB egg) after the 2nd fast day. Saturday, I had a small can of pork liver pâté for lunch. There was no other need or occasion to have “lunch” or to snack during the day or after supper. Saturday night, after attending a jazz concert, I went “off plan” and stopped at a restaurant on the way home and had 2 stingers in front of a roaring fire.
And that’s all there was to it, folks. Eleven pounds (okay, half or more water), but the pounds just dropped off after each full day of fasting. My body maintained a high metabolic rate (translation: I felt great and had lots of energy and no hunger or cravings). It did this by transitioning from obtaining energy from the food I ate (S, M, W, F, S) to obtaining energy from breaking down and burning my body fat on Tuesday and Thursday.
My perennial goal is to maintain my FBG average below 100mg/dl (and keep it low and steady during the day). I hope thus to reduce my A1c from the current 5.8% to 5.5% or lower. I haven’t seen 5.5% in a few years.
My interim weight goal for this 2 month challenge is to get down to 228 (BMI=32). That’s still considered “obese” in the BMI chart. So, I can’t derive too much satisfaction from the first week. I have to persist and be satisfied with a slower pace going forward, spiked each week no doubt by the 2 full days of fasting.
I have to remind myself that several years ago I lost 100 pounds in a year (without full-day fasting) by strictly adhering to Bernstein. But the fasting part is not difficult since you don’t experience hunger or cravings. As I read in a tweet this week (@SBakerMD), “Beat cravings and you win.” He’s right, of course. That’s the beauty of a Very Low Carb Ketogenic Diet. By the way, Dr. Baker eats an all-meat (grass-fed) diet (“zero carb”).
So, that’s the 1st week’s progress report. I’ll write another next week (2 weeks “in”). I expect progress to slow a lot, but I am hopeful that my FBG average will drop below 100 and that the weight loss will continue apace.
I fully expect to continue to feel great and have lots of energy and no hunger, including on fasting days.

Sunday, February 26, 2017

Type 2 Diabetes, a Dietary Disease #369: “759 Secrets for Beating Diabetes”

I’m not joking; “759 Secrets for Beating Diabetes” is the actual title of a Reader’s Digest book. I saw it (on deep discount) in the vestibule of my local Barnes and Noble. I’m not surprised, really. Of course, the fact that it was published is proof that the “secrets” are no longer secret, whatever they were. I know, calling them “secrets” is a rhetorical trick publishers use to pique your interest. It is possible, though, that no one bought the book.
However, 759 is an awful lot of “secrets” to slog through to learn how to “beat diabetes.” And how would you decide which of 759 “secrets” to try? No one could try them all! Maybe that’s the reason it didn’t sell well.
To tell you the truth, I didn’t open the book. I’m just assuming an editor had the idea to amplify on one aspect of the frequently heard advice that “beating diabetes” requires a LIFESTYLE CHANGE. And lifestyles are multi-factorial. But 759 factors? Maybe the editor read somewhere that, since a “CALORIE IN = CALORIE OUT,” the way to beat diabetes was to “MOVE MORE AND EAT LESS” or “DIET AND EXERCISE” or “EAT HEALTHY.” These are all familiar, if erroneous, memes, and all lacking in specifics. So, the editor thinks, let’s tell the folks 759 ways to make a lifestyle change! Then, let the reader pick. But with so many, isn’t it likely that some will be contradictory?!!!
Okay, I’ve had enough fun with this BS. But the reason I had this reaction to the ridiculous title of that book is: There is just ONE secret to beating diabetes:EAT SMART!” IF EATING CARBOHYDRATES, INCLUDING SIMPLE SUGARS, AND REFINED AND PROCESSED CARBOHYDRATES, AND SUGARY DRINKS, AND FRUIT, MAKES YOUR BLOOD SUGAR RISE, THEN THE SECRET TO BEATING DIABETES IS TO NOT EAT CARBS. THAT’S EATING SMART!
Hey, I lost 170 pounds by just eating, strictly, Very Low Carb (VLC). I lost the first 60 on Atkins Induction (20g of carbs a day). Then, after a few years of maintaining that loss, I gained 12 pounds back over a summer. So, having just read Richard K. Bernstein’s “Diabetes Diet,” I lost another 100 over a year, and then another 20 later. Bernstein’s program is 30g a day. Today, 15 years later, I am still 150 pounds lighter than when I began.
Back in 2002 when I started to eat VLC, to avoid hypos in the first week I had to stop taking most of my oral antidiabetic medications. I was maxed out on two and had just started a third. Today, I only take Metformin. Along the way my HDL doubled, my triglycerides dropped by 2/3rds and my blood pressure improved on the same BP meds. My chronic systemic inflammation marker (hsCRP) is <1.0. My A1c’s are consistently in the 5s.
And the (other) good news is: I’m never hungry or tired. Eating VLC means my metabolism operates at a high level because after my body digests the low-carb foods I eat, to maintain energy balance (“homeostasis”), my body transitions from the “fed” state to breaking down and burning fat that is stored in my body (the “fasting” state). It can do this because, although as a type 2 diabetic I do have insulin resistance (IR), my serum insulin levels remain low because my serum glucose levels remain low because I abstain from eating carbs!
This enables my body to access the body fat for energy without slowing down my metabolism. Body fat is in the form of triglycerides. When a triglyceride molecule breaks down, it forms 3 fatty acid molecules (the main energy source of body fat), plus a glycerol molecule which can be combined with another to make glucose (via gluconeogenesis), and as a by-product, a ketone body. That is why this is called a ketogenic diet. The brain and the heart love ketones. I always feel pumped when my body is keto-adapted. That’s when I’m at my best.
Imagine this. If our “natural” diet was 55% to 60% carbohydrates, as our government tells us it should be, and we ran out of carbs to eat and couldn’t access our fat stores because of an elevated serum insulin, we’d run out of fuel. Our metabolism would slow down. We’d be sluggish and sleepy and hungry all the time. How then would we be able to hunt in this state? Without being lean. Without using fatty acids and ketones for fuel. Eating Low Carb is how our forebears survived. They had to be functioning at their best to hunt. Think about it.

Sunday, February 19, 2017

Type 2 Diabetes, a Dietary Disease #368: My 2-Month, 20-Pound Challenge

I am in a unique situation at the moment. It is of my own making, and it is an opportunity to take sole responsibility for my actions. There are no confounding factors (“excuses”) or impediments to my success (or failure). It should be a good test of my intentions and my integrity in taking responsibility for the outcome.
I am home alone for the next 2 months. After driving my wife to Florida after Christmas, I flew to Bogotá to study Spanish for 3 weeks. While there I got some professional help translating a 16-page “Folleto” on the cause of Type 2 Diabetes and how best to treat it as a dietary disease. I then flew to Aruba to join my wife for a week to celebrate our 25th anniversary, and then home to New York for the rest of the winter. Between one month in Bogotá and Aruba, I lost 2 pounds, but since returning to NY I have regained 4 in less than a week.
So, to fulfill a commitment I made to Megan Ramos, the Intensive Dietary Management Program Director and Clinical Educator in Jason Fung’s office in Toronto, and a Facebook friend, I am going to fast for 2 days a week. I’ve selected Tuesdays and Thursdays. On those days I will only take a 16-oz coffee in the morning with stevia and 1-oz of full cream; then, at night, 1 wine spritzer. Nothing else until the next day. I know this will not be difficult because I am not hungry now. I am apparently already sufficiently keto-adapted for my body to switch easily from whatever I eat (low-carb) to fat-burning to maintain energy balance and a high metabolic rate.
So I am now cooking for myself. This is something, guys, that will teach you how much you under appreciate that you spouse cooks for you every day, as mine does. Thus, on the remaining 5 days, I will cook supper twice, each time preparing food for 2 days. On the 5th day, I will go out to dinner. That day will vary.
On non-fasting days, I will take the same coffee in the morning. Then, if I feel it necessary to eat something before supper, I have some stores in the pantry: 1) Brisling sardines in EVOO and 2) kippered herring in brine, both of which I love. The sardines, in terms of calories and satiating power, are a meal in themselves. The herring is more like a snack. I will use them as a light or late lunch, if I should sense any hunger at all, which is very unlikely. I will also keep on hand a few hard-boiled eggs from a local farmer if I feel the need for them.
Then for supper, my main dish will mostly be stove-top preparations of various cod recipes or a veal stew. The cod is wild caught in the North Atlantic and flash-frozen at sea. My recipes incorporate vegetables like onions, celery, cauliflower and fennel. I cook in coconut oil, butter or olive oil and add garlic, green olives, red pepper flakes, sometimes petite cubed canned tomatoes and always lots of salt and fresh ground black pepper.  As an alternate meal, I will sometimes make a veal kidney dish or a tripe en salsa roja preparation.
The veal is from another local farmer. For the stew, I use bacon, mushrooms, and onions and brown the veal cubes in coconut oil before baking. For the kidneys, I add mushrooms, onions and Marsala wine. Oh, and with each of these supper meals, I will drink 2 red-wine spritzers. I especially like a Spanish Rioja called El Coto.
Just to be clear about this: On my 5 non-fasting days each week, I will take only morning coffee, an occasional “big” lunch (a 3.75 oz. can of sardines + EVOO) or a “light” lunch ( a 3.5 oz can of kippered herring in brine) and the occasional hard-boiled egg or two. Then, supper with 2 wine spritzers. The nutrient breakdown is this:
Fasting days: Calories: 225kcal; Fat: 11g; Pro: 1g; Carbs: 4.75g; Alcohol: 15g
Non-fasting: Calories: 1000-1200kcal; Fat: 45-70g; Pro: 45-85g; Carbs: 15-30g; Alc: 30g 
I write this on Super Bowl Sunday at 248 pounds (FBG: 104mg/dl). I start tomorrow morning. This “manifesto” will first be published on February 19, two weeks hence. Anyone interested to know how I’m doing can use the comments section on either my blog (www.thenutritiondebate.com) or on Facebook, where I usually post.