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?!!!
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 ( or on Facebook, where I usually post. 

Sunday, February 12, 2017

Type 2 Diabetes, a Dietary Disease #367: My Arm’s Length Perspective from Colombia

As I prepare to leave the beautiful city of Bogotá, after 3 weeks of studying Spanish, a few thoughts related to T2DM come to mind. This is a burgeoning city, growing leaps and bounds, transitioning from “a feudal society” (to quote the husband of my teacher) to a modern, invigorating, stimulating place. I loved it, and it’s exciting to see the changes coming about, but also shocking to see the stark contrasts. For grounding and perspective, the husband reminded me that women only gained the right to vote in 1957.
For me personally the most surprising discovery was that the brand new, modern apartment I rented, that has multiple USB connections in the kitchen and bedroom, has no central heat! Further, there is no hot water in the kitchen – only in the bathroom, with an electric in-line hot water heater for the sink and shower.
At first, I thought that this was a factor of the neighborhood (services are taxed by “estrado”). This method of taxing services by socio-economic status is designed to give preference (“subsidies”) to the less advantaged. Unfortunately, it also results in stagnation and immobility by stigmatizing the poorer neighborhoods.
Later, I discovered that the modern, well-designed apartment of my teacher and her husband (both PhD’s teaching at the National University) also has no central heating and no hot water in the kitchen. ¡Qué sorpresa! They live in an upscale neighborhood in the northern reaches of the city. The “no heat” explanation relates in part to the climate. Bogotá has a moderate climate year round. It is located close to the equator but at a very high elevation (8,675 feet or 2,644 meters), so temperatures are constant all year round. It never snows.
So this partially explains the central heating issue, but not the lack of kitchen hot water. “How do you wash dishes,” I asked the husband as he did them. “I scrub them well,” he said.  Does that give you perspective?
Type 2 diabetes is similarly just emerging from the dark ages. One hundred and fifty years ago type 2 diabetes was understood as a dietary disease (see my #1 with reference to Claude Bernard and William Banting). It was known as a disease of excessive consumption of carbohydrates and was treated by reducing carbohydrates in the diet. Then, in 1921, Frederick Banting (bizarrely, a distant relation!) discovered how to make insulin in the laboratory, and since then type 2 diabetes has been treated like type 1 diabetes, a disease of too little insulin.
When our insulin receptor cells resist the uptake of glucose, i.e. they express Insulin Resistance (IR), the pancreas produces more and more insulin until it eventually wears out. Doctors hasten this catastrophic failure of the pancreas by adding pharmaceuticals, like sulphonyureas (Micronase, glyburide, glipizide, et al.) to push the pancreas to exhaustion. Then, the doctors add injected insulin to the patient’s regimen. This medieval practice, not unlike “bleeding the patient,” is still the standard of treatment of the medical and government overseers in the United States.
But we are finally entering a Renaissance. Increasingly type 2 diabetes is being understood again as a disease of Insulin Resistance, resulting in too much insulin. The goal in treating type 2 diabetes should be not only to lower the glucose level in the blood (by diet instead of drugs), but also to lower the insulin level in the blood.
This will occur, and will only occur, when the glucose level lowers, because that is how the body “knows” that it needs to begin to burn fat (our triglycerides, in the form of body fat stored around the “trunk,” to maintain energy balance and a fully active metabolism. The body, including heart and brain, loves these fatty acids and the ketone bodies that are produced as a side effect of lipolysis (the catabolism of triglycerides to fatty acids).
And, for anyone interested, this is also best way to LOSE WEIGHT, easily and without ever feeling hungry.
Bogotá is rapidly transforming itself. ¡Ojalá que el mundo de los diabéticos se haga lo mismo! Y pronto.

Sunday, February 5, 2017

Type 2 Diabetes, a Dietary Disease #366: Academy of Nutrition and Dietetics, a Secret Society

Surfing the web recently, I came across the Academy of Nutrition and Dietetics (AND). It turns out that for almost 100 years, until 2012, this organization was named the American Dietetic Association, unfortunately sharing the same acronym with the more recognized American Diabetes Association. With my interest piqued, and having a long-time interest in the subject, I delved into the membership categories. Here’s where I bumped into my first road block: membership is restricted to only RDNs and other dietetics’ professionals.
Still, being interested in their message, I clicked on their “Advocacy” button, then “Disease Treatment and Prevention” and finally “Diabetes Prevention Legislation.” I was pleased to see that the AND “has been actively involved in developing and generating support for five pieces of legislation that would help prevent type 2 diabetes.” Great, I thought, let’s have a look. Unfortunately, that too was not possible. To see more I’m told to “log-in or join.” But, as I am not eligible to join, and therefore can’t log in, the legislation for which they advocate will have to remain secret legislation. Only those indoctrinated in the Academy are eligible to view it.
So, I went to Wikipedia. I knew of course that many Wiki sites are written by the searched organization, but I thought I might learn something more about AND, as I would never be eligible to join. Here’s what I learned:
      The Academy "maintains that the only way to lose weight is through a healthy, well-balanced diet and exercise."[20]
      The Academy opposed mandated labeling of "trans fats" on food packaging.[28]
     The Academy has given low ratings to the “high-protein, low-carb” diet known as the Atkins Diet, insisting that the diet is "unhealthy and the weight loss is temporary."[29]
     The Academy maintains that carbohydrates are not responsible for weight gain any more than other calories.[30]
Okay, I no longer needed to see the five pieces of legislation that AND has developed. I know where they’re coming from. But why? What motivates them to be so obtuse? And so backward? I needed to look further.
Here’s what Wikipedia says: “To help better communications with the US government, the Academy of Nutrition and Dietetics has offices in Washington, DC. They also operate their own political action committee.[13] The Academy spent $5.8 million lobbying at the state and national level from 2000–2010.[46]
And “A 1985 report noted the Academy has supported licensing for dispensing nutritional advice,[47]” and “In addition… [has] support[ed] legislation regulating the professional nutrition field in [various] states.”
And finally, the coup de grace: “A 1995 report noted the Academy received funding from companies like McDonald’s, PepsiCo, The Coca-Cola Company, Sara Lee, Abbott Nutrition, General Mills, Kellogg’s, Mars, McNeil Nutritionals, SOYJOY, Truvia, Unilever, and The Sugar Association as corporate sponsorships.
“The Academy also partners with ConAgra Foods, which produces Orville Redenbacker, Slim Jims, Hunt’s Ketchup, SnackPacks, and Hebrew National hot dogs, to maintain the American Dietetic Association/ConAgra Foods, ‘Home Food Safety...It's in Your Hands’ program.” Additionally, “the Academy earns revenue from corporations by selling space at its booth during conventions, doing this for soft drinks and candy makers.”
Wikipedia continues with this trenchant comment from nutrition expert Marion Nestle. She “opined that she believed that as long as the AND partners with the makers of food and beverage products, ‘Its opinions about diet and health will never be believed [to be] independent.’”[54] 
And, “Public health lawyer Michele Simon, who researches and writes about the food industry and food politics, has voiced similar concerns stating, ‘AND [is] deeply embedded with the food industry, and often communicate[s] messaging that is industry friendly.’"[60] 
I guess it’s a good thing for both of us (AND and me) that they won’t let me join this lucrative business. I would just “rock the boat” or “upset the (rotten) apple cart,” to use a more apt metaphor.