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.”
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,  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.
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.


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 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 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.
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!)