Sunday, October 15, 2017

Type 2 Nutrition #402: IGNORANCE is the biggest problem…

I was at a gathering recently where I was having a tĂȘte-a-tĂȘte with Dr. Eric C. Westman, co-founder and medical director of the Heal Clinics. I’ve been a diagnosed type 2 diabetic for 31 years, eating Very Low Carb for the last 15 and writing about it here for the last 7, so when Dr. Westman asked me what I thought was the biggest problem in type 2 diabetes today, I responded, simply, “Ignorance.” He nodded his head in agreement.
I told Dr. Westman that I started this WOE after my doctor had read Gary Taubes’ July 7, 2002, New York Times Sunday magazine cover story, “What If It’s All Been a Big Fat Lie?” My doctor wanted me to lose weight, so he tried it himself first to see if it would be safe and effective. When he lost 17 pounds, he suggested that I try it too, to lose weight! As he walked me down the hall to schedule my next appointment, he said, “It might even help your diabetes.” He had no more than a vague notion about that. Turns out, he was spot on!
My doctor told me to start Atkins Induction after he returned from vacation so he could monitor me closely.
He had my blood sugar “under control” (FBG: 155mg/dl!!!) with 3 classes of oral hyperglycemic meds. He knew, however, that by this standard he would soon have to refer me to an endocrinologist to start an insulin regimen, probably a basal injection once a day and maybe mealtime bolus injections, 3 times a day, as well.
Like so many other clinicians, my doctor believed that my morbid obesity (I weighed 375 pounds) was a CAUSE (frequently hedged as a “risk factor”) of type 2 diabetes. But Taubes had not yet written his ground-breaking magnum opus “Good Calories – Bad Calories” (2007), in which he dispels that notion. In fact, in the Epilogue (page 454) he says, “As I emerge from this research,” 10 “certain conclusions seem inescapable to me.” Today, ten years later, every one of his conclusions is still right on point – as true today as the day he wrote them.
In #5 Taubes says, “Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behavior.” If this first part sounds like a tautology, it is not. It is fully explained in #6 thru #10. You really should read all 10 “certain conclusions” in the above link. I’ve read it a dozen times over the years.
6.      “Consuming excess calories does not cause us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger.
7.      Fattening and obesity are caused by an imbalance – a disequilibrium – in the hormonal regulation of adipose tissue and fat metabolism. Fat synthesis and storage exceed the mobilization of fat from the adipose tissue and its subsequent oxidation. We become leaner when the hormonal regulation of the fat tissue reverses the balance.
8.      Insulin is the primary regulator of fat storage. When insulin levels are elevated – either chronically or after a meal – we accumulate fat in our fat tissue. When insulin levels fall, we release fat from our fat tissue and use it for fuel.
9.      By stimulating insulin secretion, carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be.
10.  By driving fat accumulation, carbohydrates also increase hunger and decrease the amount of energy we expend in metabolism and physical activity.”
Gary Taubes’ hormonal explanation of the metabolic science of fat synthesis and breakdown totally refutes the “calories-in, calories-out” (CICO) hypothesis. CICO sounds so logical that it is now “accepted wisdom” without evidence. It’s like that other “truism” of establishment dietary thinking: “Eating fat makes you fat.”
Taubes’s “certain conclusion” #1, “Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization,” deals with that. Of course, he backs up this statement, and all his other conclusions, with 460 pages of convincing research and analysis, 45 pages of links to his sources, and a 66 page bibliography. “Good Calories – Bad Calories” is a bit of a slog, but it’s worth it.

Sunday, October 8, 2017

Type 2 Nutrition #401: “Improve your A1c with a non-insulin option”

Have you seen this diabetes drug commercial on TV? It always makes me laugh. I’ve been a diagnosed type 2 for 31 years, and my last A1c was 5.2%. That was a big improvement from 5.8% eight months ago. The only diabetes medication I took eight months ago and I take now is Metformin. I improved my A1c with another “non-insulin option.” I control my diabetes with Metformin, and I improved my A1c by eating Very Low Carb.
Of course, the TV ad had a different “fix” in mind for you. It was playing on the dread people have for the drudgery of daily insulin injections. Most insulin-dependent type 2s inject a slow-acting basal dose of insulin once a day and then many (most?) inject a fast-acting bolus with each meal. Thus, with this 1 to 4 injections-a-day routine, if you are very careful to avoid hypos, you can achieve “good” blood glucose control. It’s an onerous path to follow.
It doesn’t have to be this way. I weighed over 300 pounds in 1986 when an internist diagnosed me as a type 2 with a high fasting blood sugar (FBS). He started me on an oral anti-diabetic drug of the only class then available in the U.S., a sulfonylurea. Seven years later an endo gave me my first A1c test. It was 8.9%. My FBS was 197. Nine years later (2002) I was maxed out on both the sulfonylurea and Metformin and had started on Avandia.  My FBS was 81, so my doctor had my “progressive” diabetes under control with drugs. But we both knew that when the 3rd class of drugs was no longer effective, I would “graduate” to insulin. I weighed 375 lbs.
So, my doctor now turned his attention to my weight again. He had tried before. I had seen his staff dietician who advocated a “restricted-calorie, balanced diet and exercise.” It didn’t work. I lost weight but promptly regained it. Then, in July 2002 my doc read the New York Times Sunday Magazine cover story, “What If It's All Been a Big Fat Lie,” by the science writer Gary Taubes. He tried the diet described himself, and it worked. When he came back from vacation in September, he asked me to try it too. He wanted to monitor me closely.
The diet was Atkins Induction, which is VERY low carb, just 20 grams a day. On the first day I had a hypo. I called him, and he told me to stop taking Avandia. The next day I had another hypo and he told me to cut the other two drugs in half.  Later that week, when I had yet another hypo, he told me to cut them in half again. So, in just one week, by strictly following a VERY LOW CARB diet, before losing more than a few pounds of water weight, I had dramatically reduced my diabetes meds. My type 2 diabetes had gone into remission.
A year later, in August 2003, I had lost 60 pounds and my A1c was 5.4%. A few years after that, I regained 12 pounds over the summer, so I started on Richard K. Bernstein’s 6-12-12 program for diabetics (30 carb grams a day). Over the course of a year or so, I lost that 12 and another 110 pounds, reaching 205 pounds at the end of 2008. That was my weight when I completed Army Basic Training in 1960! And my A1c was still 5.4%.
Now, 15 years after beginning to eat Very Low Carb, and plenty of “misadventures” (“cheats” with ups and downs), I celebrate by dropping below 200 pounds (186 last week) for the first time since I was in my teens. And although 15 years ago, in 2002, my doctor’s motivation was to get me to lose weight, NOT to treat my so-called “progressive” type 2 diabetes, I have “improved my A1c with a non-insulin option.” Furthermore, I have forevermore avoided progressing to becoming an insulin-dependent type 2. AND MY LATEST A1C WAS 5.2%.
To his credit, although he suggested it to help me lose weight back in 2002, my doctor did have an inkling that eating VERY LOW CARB might help my type 2 diabetes. He said, as he walked me down the hall to schedule my next appointment, “Dan, this diet might help your diabetes too.” Boy, was that an understatement!
Would that more doctors had a similar understanding of the basic relationship between dietary carbohydrates and blood sugar regulation. Type 2 diabetes is, after all, a dietary disease, and the best treatment is self-management by carbohydrate restriction. Your doctor can’t write a prescription for that, BUT YOU CAN!

Sunday, October 1, 2017

Type 2 Nutrition #400: “Not half the man I once was,” my wife quipped

As you can tell from the number above, I have been posting a long time. I have also been a diagnosed type 2 diabetic for 31 years and probably pre-diabetic for a decade or more before that. At my doctor’s suggestion (to lose weight), I’ve been eating Very Low Carb since 2002. About 8 months ago, I added Extended Fasting.
In 2002 I started and stayed on Atkins Induction (20g/day) for 9 months and lost 60 pounds. Four years later I regained 12 and started and then stayed on Bernstein (30g/day) for a year and lost 100 pounds. Later I lost another 20+, reaching 205 in 2008. I regained some later but recently returned to 205 using consecutive 2 and 3-day fasting. This was possible because, while fat-adapted on VLC, I can easily go 2 or 3 days without hunger.
My weight has not been below 205 since I was a teen ager, maybe pre-pubescent! I’m 76 now. But, feeling as healthy and energized as I do, I am going for a new goal: To be half the man I once was. I began in September 2002 at 375. My goal is to get to half that weight, to 187, by end of September 2017, 15 years later. Here goes. (N.B.: If you want to skip the messy parts, don’t bother with the Weekly details; just jump down to Results.)
Week 1: I start this challenge at 207, so I need to lose 20 pounds in 8 weeks. The 1st 4 will be easy. I gained them overnight, literally, so this week I expect to lose at least 6, leaving 14 for the remaining 7 weeks, or 2 pounds a week. That’s very doable. Result: lost 5lb, after regaining 3 Sat. FBG aver: 81mg/dl. Wk 2 goal: 5 lbs.
Week 2: Three restaurant meals this week, including a birthday. Fasting only Mon & Wed. Result: took 3 days to lose the 3 pound gain, and the glucose shot up after the b-day; alas, I lost only 1 pound. FBG aver: 97mg/dl.
Week 3: Starting the week 2 lbs behind, but have no excuses. Should be a good week. Goal: lose 4 lbs to reach 197; Plan: fast Mon-Tue-Wed. Result: lost 5, then regained 2 Sat to 198, net lost 3 pounds. FBG aver: 82mg/dl.
Week 4: Starting week just 1 lb behind. Goal: lose 3 lbs to reach 195. Fasting Mon-Tue-Wed. Result: Small cheats every day, but I lost 3 lbs and reached goal of 195, a 180 lb total loss from 2002. FBG aver: 82mg/dl.
Week 5: Eight pounds to go in 4 weeks, 2 lbs per week. Goal 193. However, gained 4lbs both Sun & Mon, so strict fasting this week; I need to lose 10 lbs. Result: Lost 11, fasting 4 days; net lost 3 lbs. FBG aver: 79mg/dl.
Week 6: Now 1 lb. ahead, but goal is still 2 lbs. Eating ‘normally’ Sun & Mon (company); fasting thereafter. Results: Relaxed a bit and just lost 1 lb to 191, on target. 4 pounds to go, 2 each week. FBG aver: 71mg/dl!
Week 7: Doing a modified fast Mon-Tue-Wed, then Fri and/or Sat if required. Thurs: dining with visiting ‘kids.’ Results: Missed the mark; lost just 1. Too much fat, a little cheating, poor choices Thu. nt. FBG aver: 88mg/dl.
Week 8: Final week of challenge with 3 pounds to go. Very doable with a little discipline. Let’s see if I have it.
Results: A feast on Sunday added 4 lbs. to the challenge, but I “fasted” until I lost NET 4. FBG aver: 79mg/dl.
Results: Well, I did it! These words recall for me the line “We did it!”that Elle Woods squeals in her graduation speech at the end of one of my favorite films, the chick-flick “Legally Blonde.” Except in this case, I did it, all by myself! In the last 8 weeks, using a combination of Very Low Carb on days that I ate “normally,” and Very Low Carb on my so-called “fasting” days, I lost 17 pounds. That was my goal: to get to be “half the man I once was,” at 375 pounds, when I first discovered Very Low Carb in 2002. My doctor suggested I try Atkins Induction (20 carb grams a day) to lose weight. It’s been a long journey, with lots of ups and downs, but I finally reached my goal. Along the way, my health improved greatly, and I feel great. It’s wonderful not to always be hungry.
Next week my wife and I are taking a vacation. We’re going up to the Shaw Festival at Niagara on the Lake. Plans include dinner every night in a nice restaurant and one lunch and a tour of one of the many wineries in the area. When we return, I will begin one more weight loss challenge: To lose another 15 pounds (plus what I gain on vacation) to get down to 171. And then, THE FINAL CHALLENGE: to maintain the 200 pound loss. I will keep my weight between 171 and 175 by a combination of OMAD (VLC), plus Extended Fasting as needed.