Sunday, July 30, 2017

Type 2 Diabetes, a Dietary Disease #391: The U. S. Dietary Guidelines: “11 Points for Change”

A couple of weeks ago, while cross-fertilizing with attendees at the 2 Keto Dudes’ 1st Annual Keto Fest in New London, CT, I learned about the Nutrition Coalition. Their principal objective is to affect these “11 Points for Change” in the Dietary Guidelines (DGAs). They urge people to sign an on-line petition they’ve created. I took a look at it and did so immediately. They are so right-on, on every point, that they deserve all our support.
My first reaction to the idea was to be cynical. I was skeptical that such an effort would be effective. On reading the manifesto, however, I realized that it was so cogent and so comprehensive that it perfectly embodies and presents the reforms that are needed. It represents the “yang” to the “ying” – in the opposing rather than the complementary sense – of the present Guidelines. Hacked from their site, I list below their “11 Points for Change”: If you agree, PLEASE consider adding your name to their petition. At least you’ll feel good.
1.      Undertake a communications campaign to let Americans know that the low-fat diet is no longer recommended
2.      Ease or lift caps on saturated fats
3.      Offer low-carbohydrate diets as a viable option for fighting chronic disease
4.      Offer a meaningful diversity of diets
5.      Make the DGA diets nutritionally sufficient, with nutrients coming from whole foods
6.      Stop recommending aerobic exercise for weight loss
7.      Stop recommending “lower is better” on salt
8.      Stop telling the public that reaching and maintaining a healthy weight can be accomplished by choosing “an appropriate calorie level”
9.      Stop recommending vegetable oils for health
10.  Recommend regular meat and milk rather than the low-fat/lean alternatives
11.  Don’t issue population-wide guidelines based on weak data
Each of the Coalition’s “Points” is supported by explanatory sentences and is linked to a reference.
How about that! Isn’t that exciting? This plain language “manifesto” encapsulates a fix for everything that is wrong with the dietary advice that we as a nation have been given since the “experts” 40 years ago provided supporting testimony to the politicians at the 1977 Senate Select Committee on Nutrition and Human Needs. That lay committee then produced the “Dietary Goals for the United States,” aka the McGovern Report. The USDA institutionalized these “goals” in the Dietary Guidelines that they have promulgated every 5 years since.
As the Nutrition Coalition points out, these U. S. Guidelines “are the single-most important determinant for how people eat.” They say, “Our Guidelines determine” 1) Federal food programs, 2) Nutritional advice, 3) Military rations (MREs), 4) Packaged foods, 5) K-12 nutrition education, and 6) non-packaged foods.” Their hyperlinked text supports with more detail each of these aspects of Federal food policy. It is far reaching.
The cross fertilization occurred when I was talking to the father of an adult type 2 diabetic, who was just then talking to Richard Feinman, PhD, a conference speaker and nutrition icon. They were discussing a scientific paper from January 2015, popularly titled “12 Points of Evidence,” that Dr. Feinman had published in Nutrition. Directed at medical doctors, the full title is, “Dietary carbohydrate restriction as the first approach in diabetes management: Critical review and evidence base.” As Gary Taubes implied in the Afterward to his paperback edition of Good Calories - Bad Calories, he was disappointed by the medical community’s response to his “Carbohydrate Hypothesis.” As a cynic, I am more inclined to accept Max Planck’s dictum, “Truth never triumphs. Its opponents just die out.” But I did sign the petition, and I encourage you to take action. 

Sunday, July 23, 2017

Type 2 Diabetes, a Dietary Disease #390: My 2nd and Last 30-pound Challenge: 3rd Qtr. Report

The half time report (#385) on my 2nd and last 30-pound weight-loss challenge was a roller coaster of misadventures, but the trend line continued in the right direction, i.e. down, albeit slightly. So, “the challenge continues.” In the beginning I didn’t know how my body would react to full-day fasting. I feared that 1) I would be hungry and 2) my energy level would plummet. I learned that full-day fasting (300kcal/d) is easy because I am keto-adapted and never hungry. And as my energy level has not wavered, my comfort level has increased.
I began with an alternate day routine (Tuesdays and Thursdays, every week) and had good results: weight loss with no hunger and high energy levels. The reason, and I must emphasize this, is that on non-fasting days I adhered (for the most part) to a Very Low Carb (VLC) Way of Eating. I have been doing this since 2002, so I was already adapted to the VLC concept and my food choices. As a result of this increased comfort level, the frequency with which I did full-day, 300kcal fasting also increased.
Although I lost weight easily, when once I fell behind my weekly weight-loss goal, in order to catch up I decided to kick it up a notch. I went to 3-consecutive-day fasting (Tue-Wed-Thu) and it worked! Still no hunger and high energy levels! At the end of the 10-week challenge, I had lost 31 pounds. To stave off regain, I decided to extend my 3 consecutive-full-day, 300kcal/d fasting routine for another 16 weeks, this time to lose another (final) 30 pounds and reach my mid-teen weight. Why mess with success?
Week 9: As reported in #385, the first half of this 2nd and last 30-pound challenge was far from a resounding success. I lost only 2 pounds of the planned 15, but the 8 pound gain in the final 3 days was fleeting. So, thinking optimistically, I was starting the last 8 weeks only 5 pounds in the hole.  And I was now committed to 3-day fasting every week, on consecutive days wherever my schedule permitted. This week it was Mon-Tue and then Thursday. By Wed morning I had lost 7 of the 8 pounds gained in Week 8. But…our social calendar included potluck buffets at gatherings with friends on both Wednesday and Friday, and I ate a small supper Thursday instead of fasting, so I gained 5 back and for the week only lost 2. FBG was also bad: 97mg/dl.
Week 10: Fasting this week Mon-Tue-Wed. Dropped 6 pounds, in spite of a little cheating every day! Had a small lunch Thu (kippered herring from a can) and a big supper (beef short ribs and a very large salad); gained back 1 pound. Fri had the same kippered herring lunch and a similar supper (lamb chops and a large salad); remained at 5 pounds down for the week. On Sat we had dinner out with friends before a concert. I had two low carb appetizers and one cocktail. At Sun weigh-in I was still down 6 pounds for the week. FBG aver: 95.
Week 11: I’m starting the week at 206 and will do another 3-day fast (300kcal/day), Mon-Tues-Thurs. (Lunch at the CIA Wed.) The goal this week is to blast through 205 pounds, the lowest weight I ever achieved on VLC (in 2008 while doing Bernstein). It’s also my weight at the end of basic training in the army in 1960. On Friday I left for a weekend family reunion in Rochester. That was a challenge. I brought with me 100 clams and a case of Michelob Ultras. Before leaving, I weighed in at 202 (FGB: 82), down 4 pounds. Upon my return I weighed in at 213 (FBG: 119). I gained 11 pounds in 3 days. That’s more than the weight of all the food I ate!
Week 12: Another challenging week: My wife’s surgery, hotel and hospital meals, and cooking for my invalid. Gained 2 more pounds to 215, 13 pounds above the 202 low just 9 days earlier! And my FBG average jumped to 107, with more challenges to come in the next week with 5 days/nights away from home. Time for a pause.
Discussion: A plan revision is in order. My new goal is to eat VLC for Week 13, then resume 3-consecutive-day fasting for the succeeding 3 weeks. Starting at 215, my goal is to get to 205 by end of Week 16, then to 203 by the next Tuesday (Dr’s appt.). That’s just half the 30 pound loss I targeted, so again, “the challenge continues.”

Monday, July 17, 2017

Type 2 Diabetes, a Dietary Disease #389: Don’t go to THIS* hospital…

The draft title of this post was, “Don’t go to THIS* hospital for outpatient Type 2 diabetes care,” but space didn’t permit. The warning, however, stands. It will only cause you harm, and as Hippocrates said, “First, do no harm." Beware, therefore, of the clutches of THIS hospital's outpatient department.
I discovered this while visiting my wife as she was recovering from successful back surgery (yeah!). I decided to check out the cafeteria and along the way saw signs for the Diabetes Care Center and decided to visit. The waiting room and reception station were empty, so I just gathered up all the free literature I could find.
There were four types available: 1) 2 3-fold 8½ x 11 glossy sheets promoting the hospital’s Diabetes Care Center, 2) 2 8½ by 11, 3-page, 2-sided color pages about “Healthy Eating” and food “Tips for People with Diabetes,” “brought to you by the AADE (American Association of Diabetes Educators), and “supported by an educational grant from Eli Lilly and Company,” a big pharma company that makes insulin, 3) 2 different 5 x 7 glossy magazines filled with diabetes drug advertisements, and 4) an educational flyer about injecting insulin.
Suffice it to say, the theme that dominated the “individualized” diabetes education program was drugs, specifically “initiation of insulin, instruction on blood sugar monitoring, insulin pump therapy, continuous glucose monitoring sensors, medical nutrition therapy and follow-up education.” But, those “individualized” therapies were the domain of the doctors and RNs. I was interested in seeing their advice for pre-diabetics.
One of the two hospital brochures addressed that. It said, “Dieticians who are Certified Diabetes Educators Serve as Resources,” both for “medical providers” [doctors and RNs] and for “participants” [diabetes patients]. For the diabetes educators’ advice I turned to the 3-page Xeroxed handouts on “Healthy Eating” and “Summer Fun and Food Tips for People with Diabetes.” And therein lies what I am warning you to avoid, like the plague.
Essentially, the American Association of Diabetes Educators (AADE), the organization comprised of CDEs (Certified Diabetes Educators), espouses the same one-size-fits-all diet for pre-diabetics and diabetics (both type 1s and type 2s) that the Dietary Guidelines for Americans (2015) prescribe for everyone else in the U. S. over 2 years old: that is, “the plate method,” or in the “Summer Fun” version, “the paper plate plan”:
·          "Fill ½ the plate with non-starchy vegetables (such as greens, green beans, broccoli, cabbage)
·         ¼ should contain meat or other protein (fish, eggs, low-fat cheese, cottage cheese, beans or legumes)
·         ¼ contains starch (such as a potato or whole grain bread)
·         On the side, include an 8 ounce glass of low-fat milk or a small piece of fruit."
Also, you are reminded that a “healthy meal plan” should include “a limited amount of heart-healthy fats.” Examples given are oils and nuts, all high in unsaturated fats. Meats should be “lean” and cheeses “low-fat.” In other words, avoid as much as possible, red meat, saturated fats and dietary cholesterol. Straight from the “Guidelines.”
Your plate in this “healthy meal plan” is thus ¾'s carbohydrates. Doesn’t the AADE and their CDEs know that Type 2 diabetes is a dietary disease?!!! Apparently they do because elsewhere they want you to “count carbohydrates,” lose weight and exercise. But how are you going to do this on THIS meal plan, plus eating “small snacks between meals…to help keep your body going”? Answer: the hospital outpatient department will help you with 1) “emotional support,” 2) “empowerment,” and 3) “tools for self-care” (“education” and a meter). They will also supply you with oral medications (as needed, up to max dose in 3 different classes), then “initiation of insulin” [injections], insulin pump therapy, continuous glucose monitoring sensors, and eventually – and here’s an area where THIS hospital excels – they’ll help you with bariatric surgery.
* THIS hospital shall be nameless because this outpatient department for Type 2 Diabetes care is neither worse nor better than all the other hospital outpatient departments that deliver the establishment message about “Healthy Eating”. Here’s a clue though. A display in the main corridor proudly proclaims it is ranked among the best in the country for “Bariatric Surgery, Women’s Health and Heart Care.” Telling, isn’t it. Once they get you – the pre-diabetic or type 2 diabetic – in their clutches, you are destined to “progress” along this course: Your glucose disregulation will continue to deteriorate and your heart disease risk will continue to rise. Your Type 2 Diabetes will ipso facto be progressive on THIS “healthy meal plan.” Solution:  Just don’t go there? Don't be a "participant." This is sick care, not health care.

Sunday, July 9, 2017

Type 2 Diabetes, a Dietary Disease #388: “A Piece of Cake!”

Jason Fung’s recent post, “Towards a Cure©” must have garnered a lot of hits. Dr. Fung is a Toronto-based nephrologist with a busy clinical practice. In addition, his office operates in parallel an on-site and on-line clinic, Intensive Dietary Management (IDM), headed by Megan Ramos. Besides this, Dr. Fung blogs weekly under the aegis of the Institute of Kidney Life Science. He’s a busy guy. He is also a thinker whose hypotheses about the etiology and pathophysiology of type 2 diabetes are shaking things up a bit. It’s pretty exciting stuff.
In “Towards a Cure,” after a brief review of his hypothesis, he gets right to the point with these excerpts:
“The treatments that are known to lead to a cure – fasting, bariatric surgery and low carbohydrate diets – all share one feature in common. They are all treatments that lower insulin. Here’s comes the sudden, horrifying realization. The treatments we have been using for type 2 diabetes were EXACTLY wrong. Too much insulin causes this disease. Giving insulin or drugs that raise insulin will not make the disease better. It will only make it worse!
“This is precisely what happened. Type 2 diabetic patients are generally started on one medication at diagnosis. This only treats the symptoms, so over time the disease gets worse, and the dose is increased. Once the maximum dose is reached, a second, then a third drug is added. After that, insulin is prescribed in ever increasing doses in a desperate bid to control the blood sugar. But, if you require higher and higher doses of medications, your diabetes is not getter better, it is getting worse. The treatment was exactly wrong.
“In type 2 diabetes insulin levels are high, not low. Injecting more insulin is not going to help treat it. Yes, in the short-term, the symptom of high blood sugar is better, but the disease, the diabetes, was continually getting worse. How did we expect that giving more insulin to a patient with too much already would help? Our standard accepted treatments were precisely how NOT to treat type 2 diabetes.”
Of the 3 three treatments that “are known to lead to a cure,” bariatric surgery, which he is NOT advocating, is fraught with unnecessary risk. The other two, fasting (for which he is a strong proponent), and low or very low carbohydrate diets, are not risky…and they are patient controlled. You are in charge. You decide what to eat.
Jason Fung doesn’t have an editor (or a proof reader, apparently).  His posts frequently have typos. As my editor counseled me years ago, let a post percolate for a day and then edit it, and then edit it again the next day and the next. Jason Fung doesn’t have the luxury of time to do that. And neither does he have the benefit of an outside editor. For example, I would have counseled him to edit the penultimate sentence of the first paragraph above to read, “Giving insulin or eating foods that raise insulin will not make the disease better.”
I’m not nit-picking or carping really. Jason Fung is the most refreshing voice out there at the moment. And I think he has the best of all worlds. I’m jealous. He has his nephrology practice. He has a broad-reaching clinic focused on weight management and metabolic syndrome, including insulin resistance, pre-diabetes and type 2 diabetes. And he has his Institute in which, as a 1-man think tank he morphs into a research PI (Principal Investigator) each week. What fun! I think his blog title this week, “Towards a Cure,” is less a hook to garner internet hits than a reflection of his own excitement that he may just be on to something.
Maybe his weekly exercise in researching and writing is a ritual that is getting him closer to understanding why “(o)ver 50% of American adults are estimated to have prediabetes or diabetes,” as the lede of this week’s column states. Maybe as more people incorporate low carb or very low carb eating, and fasting, either intermittent or all-day fasting and very low carb eating as I do, it will also enable others to lose weight easily and without hunger, and greatly improve their general health too, as I have. Just maybe…
But that’s up to you. You are in charge of what and when you eat. You decide if you want to try it. I’ll tell you this much: Full-day fasting is easy, when you are KETO-ADAPTED. No hunger. Easy weight loss. “Piece of cake!”