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.


  1. Your comment on why doctors "dispense bad dietary advice" in that they are "expected to follow the medical establishment’s Standards of Practice and the Medicare and insurance company guidelines" is right on point as to why the Nutrition Coalition's Petition to revise the government's nutritional guidelines is so important. Standard protocols (the bad dietary advice) will not change until the US guidelines are changed. I am looking forward to your post on the Petition, as well as continuing to absorb your older posts.

    1. Thanks, Bruce. I signed the Nutrition Coalition's petition this morning and perused the site to conceptualize a column. We're making day long day trips 3 days this week but I expect I will be able to hack a rough draft before we start out tomorrow. Don't expect to see it posted for a couple of weeks though.

    2. Thanks so much. I looked forward to you take on the Petition.