Type 2 Nutrition #413: “End Date”

My wife recently left a post-surgical office visit with a written prescription for physical therapy (PT). She told me the doctor’s assistant said to call for another office visit when the PT was completed. So, I asked my wife how long was the course of PT that the doctor prescribed. She looked, and said, “End date: TBD by insurer.”

My first reaction was surprise, then anger at the doctor for abdicating on the decision, then anger at the insurer for taking control of medical decisions, then anger at government for letting them dictate to insurers. Making healthcare decisions that affect a patient’s recovery from surgery should always be a matter between doctor and patient, not insurers, whose principal interest is the bottom line. And not big government, where politicians and their staffs are not qualified…and besides are generally corrupted by conflicts of interest.

So, the doctor is not to blame. He or she is in business too – albeit small business, but this column on changes in Medicare demonstrates that even the giant American Medical Association was helpless to alter the course of the “reforms” to Medicare that were enacted to pay for the Affordable Care Act (“Obamacare”). Healthcare represents about 17% of the U. S.’s Gross National Product. It’s a behemoth that overpowers everything else.

So, let’s review where we are: A doctor can no longer prescribe the duration of PT, and insurers shouldn’t, and politicians who have no business doing it at all but ultimately do by the legislation their staffs write, they pass, and the indecipherable regulations government minions then produce, so, in this mess, what’s a patient to do? Answer: Take your healthcare into your own hands! Seriously, it’s your health!

My doctor offers “Concierge Care.” I suspect he’s looking for a way to get out from under all the restrictions, regulations and reporting (the 3R’s). He needs less overhead to handle the billing, and he gets paid more promptly.  It has to be more rewarding, and not just financially.

I declined his Concierge Care option because under the primary Medicare and secondary supplemental that I have from being a former NYC manager, I have very good insurance coverage. Virtually everything is covered and paid for. I even get the Medicare Part B premiums, deducted from my pension check, refunded! And my Medicare Part D prescription drug coverage is subsidized by the Management Benefits Fund.  I am also in pretty good health for my age – much, much better than I was 15 years ago, when I was morbidly obese. When my current doctor took over my former doctor’s practice, he studied my chart and suggested I see him just once a year. Instead, at my insistence, I see him 3 times a year, primarily for blood work.

So, my pitch to you at New Year’s is: Take responsibility for your own health. Don’t rely on your insurer to tell you what to do or how long to do it. And don’t let the government tell you what to eat. They’ve been wrong with that advice for the last 60 years, much longer than anyone now in government and certainly longer than anyone in medical practice has been working. Remember, too, your doctor is/was not educated in nutrition, and the RDs and CDEs in practice today obtained and keep their licenses by learning all the wrong things.

If you’re overweight or pre-diabetic, ask yourself, how did you get that way? Haven’t you been trying to eat a “healthy diet” the way you’ve been told to do for most of your adult life. And haven’t you been exercising regularly? Then what caused you to gain weight or become Insulin Resistant (pre-diabetic)? If you are Insulin Resistant, you are Carbohydrate Intolerant. Does it make sense to continue to eat a “balanced” diet? To “eat everything in moderation,” the way the government and the medical establishment told you to do. Isn’t that what caused you to become Carbohydrate Intolerant? Then why would you continue to do the same thing over and over again and expect a different result? Isn’t that the definition of insanity? Think about it. Seriously!

End of hectoring. Happy New Year, and make it a truly NEW one, for YOU.

Type 2 Nutrition #412: “Cover” Story

With idle time in my wife’s doctor’s waiting room, I picked up WebMD Magazine’s June 2017 issue. The cover appeared to feature an article asking, “Trouble reaching your A1c goals?” Next to a photo of a middle-aged man, the caption invited the reader to: “See how Jerry does it.” I’m always interested in seeing how other people lower their A1c’s, so I eagerly and naively turned the page…to a 3-page ad for Trulicity.

Somehow I missed the disclaimer on the “cover.” It said (on a black banner), “Special advertising section. This Trulicity promotional cover has been placed on a limited number of WebMD magazines” – just the ones in doctor’s offices, I’d bet. It continued, “It does not constitute an endorsement by WebMD Magazine and no endorsement is implied.” Okay, WebMD gets big bucks for the fake cover, but how about the doctor’s office? Are they not complicit in this non-endorsement endorsement? I think so, and they don’t even get paid for it!

I also missed the small red-type Lilly at the bottom of the false cover. But it was impossible to miss the 3 full pages of information about “non-insulin Trulicity, a once-weekly injectable pen for type 2 diabetics to help [your body] release its own insulin.” They’re careful to say it’s not the first pharmacotherapy med for type 2s. That would be Metformin, introduced in France in 1957 and the UK in 1958. But Metformin works on the liver to suppress unwanted glucose production and improve to insulin sensitivity (glucose uptake), and it’s safe.

As Lilly implies, Trulicity works on the pancreas, an organ that is already overworked, to counter the insulin resistance that is the cause of type 2 diabetes. Does it make sense to put an added burden on the one (and only) pancreas you have to secrete the insulin on which your life depends? Trulicity makes the pancreas work harder; it “helps the body release its own insulin,” to use their own words. Lilly’s not worried, though. When the pancreas eventually wears out, you will graduate to another injectable drug made by Lilly: daily insulin. Have you seen the price increases for insulin lately?

But Lilly and all the other drug manufacturers do not intend you harm. Their drugs are all approved by the FDA for the uses intended, and the uses all conform to the American Diabetes Association's Standards of Medical Care. What’s wrong with this picture? The treatment plan! The treatment treats the symptom of type 2 diabetes—an elevated blood sugar – by forcing the pancreas to produce more insulin. More insulin is what your pancreas has been producing for years before and since your impaired insulin response was discovered (by an elevated fasting blood glucose, or an A1c test).

Your impaired insulin response, aka Insulin Resistance (IR), is the cause of your type 2 diabetes. What caused your IR? Answer: On the government’s advice, in order to avoid eating saturated fat, for 60 years you ate a diet of 55% to 60% carbohydrate, composed of simple sugars and processed, refined, long-chain glucose molecules, euphemistically called “complex” carbohydrates. Over time, you became Carbohydrate Intolerant.

So what’s the best treatment for IR? That’s simple too: reduce your intake of carbs, especially the refined, processed ones, and the simple sugars of course, particularly the liquid ones. From 60% there’s lots of room for lowering. For the generic woman’s 2000kcal/day diet, 60% is 300 grams of carbs/day. Lowering it to 20% would be 100 grams/day. For a man (2500kcal/day = 375 grams/day), lowering it to 20% would be 125 grams.

Type 2 Nutrition #411: “You don’t eat!”

When the lab report arrived in the mail, I was expecting an increase in my A1c. While eating Very Low Carb December to April, but only following a fasting regimen for the last 2 months, my A1c had dropped from 5.8% to 5.3%. By August I figured my system would get used to my routine and adjust. Instead, my A1c dropped another 0.1% to 5.2%. When I expressed surprise to my wife, she blurted, “I’m not surprised. You don’t eat!”

It’s true. I’m not hungry when I fast because, when I do eat, I eat Very Low Carb (VLC). As I result, my body is fat-adapted and obtains its energy from the fat I eat and the fat my body has stored for the purpose, and I still have plenty of that. So, my energy level, i.e. metabolic rate, remains high because when my body fat breaks down, it is used to maintain energy balance. This fat burning process will continue so long as I eat VLC. While glucose and insulin levels in the bloodstream remain low, the body will feed freely, as needed, on its own fat.

In retrospect, my concern that my A1c would rise was unfounded. I didn’t take into account that I had only been fasting for 2 days a week – and for just 2 months – when blood was drawn in April. The A1c test measures glucose on the surface of red blood cells over 3 months. So, when the A1c blood was drawn, I still had “old” red blood cells in my blood. Plus, after April I increased my fasting from 2 days to 3 days a week.

But my wife, feeling like she was on a roll, continued, “That’s why we don’t go out to eat as often as we used to….and you’ve saved a lot of money by our eating out less often. My rejoinder was that I only fast 3 days a week, and that still leaves 4 days a week for eating out! So, my standing offer, to eat out as often as she would like to, stands…and look at all the money she’s saved by not needing to buy food-for-two for 3 days a week! She agreed, and our “Bickersons” episode ended…strangely, I think, because she usually gets “the last word.”

The point is: if you don’t eat, you’re going to 1) lose weight and 2) save money. The secret is: doing it without hunger and without harm. Ketosis is the answer. It is the normal state of man, according to the NIH’s Richard L. Veech (and a host of other researchers in human metabolism). Ketosis begins when your body has finished digesting and absorbing your last meal and begins a period of fasting. The length of time before entering this state differs only in the amount of glycogen (glucose energy) stored in the liver from previously digested carbs.

In addition, if I don’t eat and continue to take Metformin as prescribed, my blood sugar is going to be better controlled. When I asked my doctor to increse my dose from 500mg once a day to 750mg twice a day – a “therapeutic dose” – and started my 300kcal/day regimen, I sometimes got fasting blood glucoses in the 60s, without hypoglycemia. When I told my doctor, he laughed. “You can’t get hypoglycemia on Metformin,” he said. Now, when I follow VLC strictly, my FBGs are in the 70s and 80s. A recent weekly average was 81mg/dl.

So, eating Very Low Carb and fasting 2 or 3 days a week is a win-win-win: You lose weight, you save money, and you and your doctor are pleased that your blood sugar control has improved. And as promoted by one of the Big Pharma ads on TV, when you have better blood sugar control, you have reduced your risk of cardio vascular disease (CVD). Type 2s have twice the risk of CVD as “normal” people. And if you’re been diagnosed with heart disease, you have an even higher risk. See “How Diabetic Do You Want to Be?” to learn more.

Naturally, the question arises: Would it be possible to get an A1c lower than 5.2%? Maybe even in the high 4s? By diet and Metformin alone?  I think it is possible. I also think I can continue to lose weight. When you read this a week before Christmas, I will have lost 185 pounds, just about “half the man I once was.” My target final weight is 171-175 pounds or “200 pounds lost.” And then the hardest goal of all: Maintaining that weight. I imagine it will involve Very Low Carb, One Meal a Day, and my “300kcal full-day fasts” for 2 or maybe 3 days every week. I’ll call it my VLC/OMAD/4-3 diet. I should be there…in the not-too-distant future.

Type 2 Nutrition #410: My 300kcal “Fasting” Diet

About 10 months ago (the day after the Super Bowl), I began a regimen of full-day “fasting.” I had tried Intermittent Fasting (IF), where I ate within a small window each day (“16-8 fasting”), or I ate just one meal a day (OMAD). I maintained my weight but I didn’t lose. I still wanted to lose a lot of weight, so I decided to just “jump in.” Full-day fasting was new and unfamiliar to me, so I decided to start with alternate day fasting.

It worked. I lost 62 pounds, going from 248 to 186, and my BMI went from 36 to 27. Altogether, since starting Very Low Carb in 2002 at 375 pounds, I’ve lost 189. I’m “not half the man I once was,” my wife quipped.

When people ask, “How’d you lose weight?” I tell them, “Fasting.” Then they ask, “How’s your energy?” They imagine that they would feel weak because their metabolism would slow down due to the loss of energy “in.” After all, we’ve all been told, “a calorie is a calorie” and “Energy in = Energy out,” meaning if we don’t eat, our body is going to defensively slow down until we eat again. And we believe it because, well…’cause it’s intuitive.

Well, it’s not true. It only applies if your diet is largely composed of and DEPENDENT ON carbohydrates for energy. It’s not true for people who eat a diet of mostly fat and protein, limiting carbs to small amounts, in my case just at supper. We are “fat-adapted.” We are “fat burners, not sugar burners.” For us, the “Energy in” is not measured by what we put in our mouth; it is measured at the cellular level – where all the nutrients that are circulating in the blood are taken up by the cells. Thus, you do not slow down because you’re being fed.

How is it that when you eat mostly fat and protein you get to where you can burn body fat? The mechanism is: when you have glucose (from carbs) in the blood, the hormone insulin drives everything you eat into stored body fat and blocks access to your stored fat for energy. But when the level of your blood glucose (from carbs) drops, the level of your blood insulin also drops. That signals the brain to switch from glucose for energy to fat for energy. And then, once the carbs stored as glycogen in the liver are used up, and for so long as you then continue to limit carb intake by mouth to a very low amount, your body will break down body fat for energy.

On a “fasting” day, I have a 12oz coffee with 1½oz of heavy cream (not Half & Half) and 1 gram of pure stevia powder for breakfast. I stay “fat-adapted” with stable blood sugar all morning.

Then, if I’ve been working in the garden and I’m dehydrated, I’ll take some stevia-sweetened iced tea and maybe a little pickle juice for salt. I don’t take anything else by mouth until “supper.” My “fasting” supper is just one 6oz glass of red wine with 8oz of seltzer (a “spritzer”), which I use to wash down pills/supplements.

“300kcal Fasting Diet” Macronutrient Composition: Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal. Spritzer (6oz red wine): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal. Fasting day totals: Calories: 298kcal; Protein: 1.2g; Fat: 16g; Carbs: 5.7g; ethyl alcohol: 18g.

If I sense an impulse to eat or drink something after “supper,” I’ll have an ACV (apple cider vinegar) cocktail: 1 Tbs of Bragg’s unfiltered ACV, a few dashes of bitters, and a few drops of liquid stevia, with ice and club soda. The secret for the success of this “300kcal Fasting Diet” is, since I always eat VLC, I am ALWAYS “fat-adapted.”

So, when I return to a “feasting” state, I continue to eat Very Low Carb: The same “breakfast” of coffee with cream and stevia, a small lunch from a can, either 1) Goya Premium squid in its own ink (240kcal) or 2) Brunswick kippered herring fillets in brine (160kcal). I drink the brine. It’s a small lunch; just enough.

Then, for a “feasting” supper, I have a serving of protein with fat and a portion of low-carb vegetable with fat. With this supper I drink 2 glasses of my evening spritzer with my pills. Since I’m not hungry, because I’m fat-adapted, this is plenty. Some days I skip “lunch” and some days both “lunch” and “supper” and fast another day, or two. If you have lots of energy and you’re not hungry (because you’re burning body fat), why not? ;-)

Type 2 Nutrition #409: When I used to eat eggs…

When I used to eat eggs (or eggs and bacon) for breakfast, my usual lunch was a can of King Oscar brand, Brisling sardines in EVOO (420kcal with the EVOO). I drank the EVOO and usually added salt. I supplemented with 2 grams of fish oil a day, and still do. As a result I had and still have very low triglycerides (about 50mg/dl). 

Now, however, I think that a can of sardines, especially if you drink the EVOO, is too many calories for lunch, particularly if you are not hungry. I am not hungry at lunch. Hell, I was never hungry at breakfast!

So these days I don’t eat breakfast any more. I just have a 12oz cup of coffee with 1½ oz of heavy cream and 1g of pure stevia powder. Then, if I eat lunch, I have one can of either of my two new favorites:

1. A can of Brunswick kippered herring fillets in brine (160kcal). I drink the brine. It’s a small lunch but enough.

2. A can of Goya Premium squid in its own ink (240kcal), packed in sunflower oil. I do NOT drink this PUFA oil.

Both the kippered herring and the squid are less expensive and fewer calories, and less fat, than the sardines. I also think that they would be a lot more palatable to the ‘normal’ person’s taste, but I like all three equally.

Why was I never hungry at breakfast? And why am I still not hungry at lunch? Because my body is fat-adapted, meaning it has been in a fasted state since a few hours after supper the night before, some 12 hours earlier. At breakfast, my body is in mild ketosis. In the absence of food, and as a consequence of eating Very Low Carb at supper and having low stores of glycogen in my liver from generally eating Very Low Carb, my body has maintained a high metabolic rate and energy balance by breaking down body fat during the nighttime “fast.”

Then, with only heavy cream (NOT H&H) in my morning coffee, that high metabolic rate and energy balance continue. With my lunch choices being only protein and fat, my ketosis and stable blood glucose continue into the afternoon while, without hunger because I am in energy balance, my body continues to burn its own fat.

It wasn’t always like this. When I began to eat Very Low Carb in 2002, I kept careful records. In the beginning it was just estimated carbs. Later, I decided to count protein too, and then fat and total calories. I ate a lot more then than I do now. After all, I was twice the man (literally) I am today, but I don’t keep those records today.

Keeping records, though, was in my nature, and I learned a lot from it. But I learned much more from other low-carbers. I joined this Forum of like-minded people and started asking questions. It was a supportive and safe space. I left another site I visited because all that people wanted to do there was argue about which way of eating was best. On the Bernstein Forum, I was very active for years, first as a student and later as mentor.

When you’re ready to make the shift, there are lots of ways to address a Lifestyle Change. But first you have to become convinced that the one-size-fits-all dietary advice given by the government’s Dictocrats and the “old school” medical establishment, and Big Pharma, has sadly been bad advice. It led to the Diseases of Civilization to which the world has succumbed. So, you have to be ready to break with that and manage your own dietary future. When you are ready, give Very Low Carb (VLC), or even Low Carb, a try. Here’s what you can expect:

●       You will lose weight easily because you will not be hungry all the time. You will eat less and feel better.

●       You will not need a snack in mid-morning or feel sleepy after lunch, or snack after supper/before bedtime.

●       Your health markers will improve: blood sugar (A1c) and lipids (cholesterol), and blood pressure.

Some people have difficulty making the adjustment. I went cold turkey. I drank lots of water and I added salt. To avoid hypos (I was on 3 classes of oral anti-diabetic meds), I stayed in close contact with my doctor, who (as it happens) suggested VLC for me, to lose weight. Over time (15 years), I lost, literally, more than half my body weight (190 pounds), and I feel great! I’ve never been healthier or happier. You will be too. Give it a try!