Sunday, October 21, 2018

Type 2 Nutrition #455: Are red grapes healthier than green grapes?

I’m not kidding. A new friend, who is a recently diagnosed, insulin-dependent type 2 diabetic, asserted that he ate red grapes in preference to green grapes because they are healthier. When I strongly disagreed, he said, “Red grapes have resveratrol in the skins, and resveratrol has health benefits.” I don’t attribute this misguided point of view to ignorance. He’s a bright, generally well informed guy. I attribute it to a combo of denial and rationalization.
My friend is on insulin injections because he couldn’t tolerate metformin or Januvia (a DPP-4) and a SGLT2 was counter indicated. His fasting blood glucose (FBG) was so high (225mg/dl) his doctor knew she had to get his blood sugar under control as soon as possible, and she thought that injecting insulin was the only, if not the best, way to do it. With fasting blood sugars that high, I couldn’t disagree, but only because they were so high.
(In my own case, in 2002, after having been a diagnosed T2 for 16 years, and maxed out on a sulfonylurea (SU) and metformin and starting a 3rd oral (a TZD), my FBGs were also out of control but just in the 150s. My doctor believed (at the time – it seems like ancient history) that T2D was caused by obesity (I weighed 375 pounds), so he suggested I try eating Very Low Carb, or VLC (20g of carbs a day), to lose weight. He had just read about it in a New York Times Sunday Magazine cover story by Gary Taubes, “What If It's All Been a Big Fat Lie,”
So, I began the VLC program and within the first week I had several hypos. By phone consultation, he ordered me to stop taking the TZD and then the very next day to cut the SU and the metformin in half. Later that week I had another hypo, and he told me to cut them in half again. I later discontinued the SU altogether.)
So, as a newly diagnosed T2, my friend surely has a steep curve to learn about carbohydrates and his glucose metabolism. Type 2 diabetes is a dietary disease. His body’s ability to process glucose, the compound into which all carbs break down, is impaired due to a condition called Insulin Resistance, developed over many years, decades even. As a result, his body doesn’t “take up” glucose easily.  He is thus Carbohydrate Intolerant – intolerant of all carbs. Red and green grapes alike, and all other fruit and all starches too. They are all carbs.
Fruits are just sugar and water. Your body doesn’t give a wit that they contain “natural sugars.” Your body processes “natural sugars” and “added sugars” the same way. Fruit sugars are mostly sucrose, a disaccharide made up of one molecule of glucose and one molecule of fructose, plus some free fructose and free glucose (monosaccharides). The fact that whole fruits have fiber or other micronutrients is just as irrelevant as the color and content of the skin of the grapes. They are inconsequential to you, compared to the glucose content.
To think otherwise is to deny the consequences to your health of ignoring the truth. You are Carbohydrate Intolerant. Red grapes have the same glucose content as green grapes, period. I’m sorry, but that’s the truth.
According to the USDA database, “grapes (red or green), European type, such as Thompson seedless, raw,” are 80% water and 18.1% carbohydrate, of which 15.48% are sugars. The remaining carbs are oligosaccharides. There are also trace amounts of protein, fiber and ash. Each 2.9g grape contains 3.5kcal, or almost 1g of carbs.
Now wine, that’s a different matter. LOL. Most carb counters say that a dry white table wine has fewer carbs than a dry red table wine (3 vs. 4). It depends, of course, on the specific wine, but according to the same USDA database, a typical 5 oz glass of Chardonnay (white wine) is said to contain 3.18g of carbs, and a 5oz glass of Cabernet Sauvignon (red wine) is said to have 3.82g of carbs. But the total calories in each are the same (123 vs. 122kcal). The difference is that the white wine tested had a slightly higher alcohol content (15.7g vs. 15.4g).
And while alcohol has more calories per gram than carbs (7 vs. 4), it does not raise blood sugar, as glucose  does. However, the alcohol in either glass of wine is “empty” calories. Still, it doesn’t affect your glucose metabolism; so, bottoms up, tipplers, but don’t eat grapes, red or green. You’re grape intolerant!

Sunday, October 14, 2018

Type 2 Nutrition #454, “Are vegetable chips okay?”


My wife served a popular brand of “real vegetable chips” as a side dish at a poolside lunch with friends the other day. I helped return the uneaten chips to the bag, and out of curiosity…I looked at the nutrition label.
A one ounce serving contains 16 grams of carbs, including 3 of fiber and 2 of sugar, with 0 grams of “added sugar.” It also contains 1 gram of protein and 9 grams of fat, of which 0.5 grams are saturated.
What the label doesn’t tell you (because they don’t have to) is that the remaining 11 grams of carbohydrates are starches (long chain glucose molecules) from “diverse root vegetables” that have been milled and are easily digested. The 2 grams of sugars inherent in the tuberous ingredients are combinations of monosaccharides (100% glucose) and disaccharides (50% glucose/50% fructose). So carbs from the starches (100% glucose) will raise your blood sugar faster and higher than the 2 grams of sugar. 
The label also doesn’t tell you (because they don’t have to) that the other fats in this manufactured “food” product are all unsaturated fats, the vast majority of them polyunsaturated (PUFAs). The actual percentage is not determinable because the label says the product includes, “expeller expressed Canola oil and/or safflower oil and/or sunflower oil.” So who knows what percentage of which oil was used, or if it was all one of them?
Of course, “expeller expressed” canola oil is listed first because that would be the best of the worst. “Expeller expressed” means it is less processed and refined. And of the three “seed” oils, Canola oil has the highest percentage of the good monounsaturated fats. But the other “and/or” seed oils are not “expeller expressed.”
Rounding out the ingredients list, after tubers, PUFAs and sea salt is “beet juice concentrate (color).” Note: the word “color” is within the quotes lest you think they added “beet juice concentrate” as a sweetener. But just in case you weren’t aware of it, the USDA reports that U.S. beet sugar production is almost 50% greater than cane sugar production, and sugar beets for food use is 1½ times greater than sugar cane for food use. Do you think the beet sugar juice in these chips is used just for color, as they say? I don’t. But the USDA allows it.
It’s just another deception, but I’ll get to that in a moment. First, let’s admit the consumer is a willing dolt. We are prepared to be snookered by clever marketing to assuage the guilt we feel for eating something that we know in our hearts (pardon the double entendre) is bad for us. These days, the bogey man is “added sugar,” so labels now have the new subcategory “added sugar.” This has recently been added to the requirement that it specify “saturated fat,” but not polyunsaturated fat, or refined starches, both arguably much worse for our health than "added sugar."
But here’s the contradiction and irony: “Vegetable chips” are a manufactured food. They are not a whole, unprocessed food with inherent sugars, such as the “taro, sweet potato, batata, yuca or parsnip” from which they are made. So, if you put a label on taro, sweet potato, batata, yucca or parsnip, I could understand how and why you could claim that there were no “added sugars” (although we’d have to ignore the successful efforts of agronomists to hybridize fruits and vegetables.) But these “vegetable chips” are manufactured!
So what have we got here: You take a natural whole food, mill it, process it and refine it, then add a sweetener camouflaged as an additive for color, then cook it in highly processed, inflammatory, oxidized and unnatural fat and you get a snack food with a nutritional halo: “real vegetable chips.” Good marketing, I’d say.
I’m sure the USDA rule that allows a snack “food” manufactured from processed and refined tubers (starchy root vegetables), combined with unhealthy, polyunsaturated seed oils, and salt, and sugar juice concentrate to create a product that has by definition, no “added sugar,” is a common practice. But then, I don’t think adding the sub-category “added sugar” has any meaning or value, except to delude us and help the consumer (and the lobbyists and politicians who made the law) feel good. So, just eat your “vegetables, ” kids, and forget it.

Sunday, October 7, 2018

Type 2 Nutrition #453, Fish oil supplementation, triglycerides and platelet formation

Fifteen years ago, I began taking 4 grams of fish oil a day (plus a can of sardines for lunch) After a few months, I lowered my dose to 3 grams and then to 2, which I have continued to take, until now. During this time I dramatically lowered my triglycerides from 143mg/dl (aver. of 11 tests) to 49mg/dl (aver. of 25 tests) 5 years later. After writing this post, I reduced my daily fish oil to 1 gram.
In discussing fish oil supplementation with a friend recently, the risk of high-dose fish oil “causing bleeding” came up. Googling “fish oil, bleeding” dredged 2 articles at Evidence-Based Medicine Consult (EBM Consult), a free searchable, online medical education database. The first discusses the mechanism for how Omega-3 fatty acids could increase the risk of bleeding; the second discusses the bleeding risk. Both were revelatory for me.
“As it relates to CVD, fish oil is most commonly used to treat high triglycerides. When clinicians refer to the use of ‘fish oil,’ they are generally referring to omega-3 fatty acids (aka as polyunsaturated fatty acids (PUFA)). These specific omega-3 fatty acids include DHA and EPA. For the most part, neither DHA nor EPA causes any major side effects or clinically relevant drug interactions, but they are known to influence platelet formation.”
“As such, some clinicians perceive that this can put the patient at greater risk of bleeding, especially during surgical procedures or while on medications that are known to affect coagulation and platelet aggregation.” So, if you’re going to have surgery, or you have CVD and take Coumadin (Warfarin) or another blood thinner, your doctor might advise you against taking more than 1 gram of fish oil, or to stop taking it before surgery.  
In the mechanism article my revelation was not about bleeding but about platelet aggregation. It turns out “omega-3 fatty acids compete with [the omega-6] arachidonic acid (AA) for incorporation into the platelet cell membrane, thereby increasing the ratio of omega-3 fatty acids:AA.” They inhibit platelet aggregation.
I’ve been writing for years that the Standard American Diet (SAD) is very high in omega-6s, with a ratio of omega-6 to omega-3 of at least 20 to 1 (20:1) vs. the 2:1 or 1:1 ideal. And that supplementation with fish oil alone is not enough to reverse that ratio. We must also avoid fried foods and “vegetable” (seed) oils, baked goods and some nuts. It seems I may have been too successful at taking my own advice! For the last 11 years my Complete Blood Count (CBCs) have consistently been slightly out-of-range on platelet (and related) counts.
The EBM Consult site is intended to educate doctors and other medical professionals, but the gist is still comprehensible to me. Too much DHA and EPA from fish oil supplementation has anti-platelet effects that 1) interfere with intracellular pathways, 2) increase prostaglandin formation and 3) decrease the production of platelet activating factors. Eureka, my overcorrected ratio may be the cause of my out-of-range CBC counts!
The other EBM Consult article, concerning the bleeding risk, concludes with a simple (paraphrased) message:
       The AHA recommends 1 gram of fish oil per day for patients with coronary artery disease and 2 to 4 grams per day for patients with high triglycerides. They also advise those who take more than 3 grams per day do so under the care of a physician “since high doses could cause excessive bleeding in some patients.”
       In an analysis by the National Lipid Association, of 4,357 patients who took 1.6 to 21 grams [not a typo!] of DHA/EPA per day in combination with some type of prescription anti-platelet or anticoagulant, only 1 patient developed blood in their stool and 1 other experienced a gastrointestinal bleed.
       Clinical trial evidence to date does not support an increased risk for bleeding in patients taking fish oil supplements…even when combined with other medications known to increase the risk of bleeding [!].
If you take more than 3 grams of fish oil a day, or have out-of-range CBC labs, or are concerned about bleeding, you should read these two EBM Consult articles. Otherwise, I would conclude that taking fish oil supplementation is a good way to treat high triglycerides. It sure worked with me, to a fare-thee-well.

Sunday, September 30, 2018

Type 2 Nutrition #452: The most common cause of high triglycerides is…

Blood sugar! “The most common reason for having high blood triglycerides (over 199 mg/dL) is blood sugar – its availability and handling. If your cells are resistant to insulin, they cannot take up glucose, and so they turn to fatty acids for fuel. They get these fatty acids from triglycerides, put by the liver into circulation. If you are a diabetic, diabetes can increase triglycerides significantly, especially when your blood sugar is out of control.”
I found this quote in a draft Word file while searching for documentation to answer the question, “Will eating a high fat diet raise my triglycerides?” The question was asked by a recently diagnosed, insulin-dependent type 2 diabetic who has high triglycerides and is naturally concerned with the idea of self-treating his diabetes with a Very Low Carb, High Fat (VLCHF) diet. Unfortunately, the quote is without attribution! 
The goal of VLCHF is to lower both blood glucose and blood insulin. Lower blood glucose obviously means better diabetes control. Lower blood insulin will make the body more insulin sensitive and thus less insulin resistant. Lower blood insulin will also enable the body to access and use (burn) visceral or internal, abdominal fat. Along with weight loss, it will also help to “clear” a fatty liver and restore pancreatic insulin production.
Think about it. High blood sugar means that the refined carbs and simple sugars in your diet are still circulating in your blood (as glucose)! Because of the insulin resistance you developed from eating this way, glucose is not being taken up by your cells for energy. And you can’t access your body fat for energy because of your high blood insulin levels, so…YOUR LIVER has to step in and make triglycerides to burn for energy. Ergo: You have high glucose, high insulin and high triglyceride levels, and low HDL-C to boot! They all go together!
Solution: Treat your high blood glucose with a VLCHF diet. This will lower your blood glucose and your blood insulin. This in turn will allow your body to access your body fat for energy, and eliminate the need for your liver to make triglycerides for energy. You won’t be hungry because your body will be well fed with body fat; you will improve your insulin sensitivity by secreting less insulin because you’re eating VLC; your pancreas and liver will both do less work. Your liver won’t be forced to make triglycerides to circulate for energy.
Eating VLCHF will lower your blood triglycerides. Just be sure not to fast for too long (more than overnight) before testing for triglycerides. Prolonged fasting, especially if you are already eating VLCHF and are “fat-adapted,” will raise your blood triglycerides temporarily. In a prolonged fast you use body fat (triglycerides) for energy and you lose weight.
I have never had “high” triglycerides. Before starting VLC in 2002, my average triglyceride lab score (11 tests) was 143mg/dl and my HDL-C was a low 39mg/dl. Five years later, after I’d lost 170 pounds eating VLCHF, my average triglycerides from 2007 to 2014 (25 lab tests) was 49mg/dl and my HDL-C 75mg/dl. By then of course my type 2 diabetes was in remission, and with the weight loss my blood pressure was greatly improved. My latest labs (Aug 2018): TG 56mg/dl; HDL-C 92mg/dl; TC 189mg/dl; LDL-C 83mg/dl (Martin/Hopkins calculation).
These results are just mine (N=1), but lab reports like these are widely reported by people who eat VLCHF. I’m confident that if you commit to make this permanent lifestyle change, you will see similar results.
Type 2 diabetes and obesity (aka diabesity) are elements of what is now known as Metabolic Syndrome. Look it up. It is the result of the way we have been told to eat. It is called the Standard American Diet, or SAD, appropriately. To reverse your Metabolic Syndrome, get control of type 2 diabetes, lose weight and lower your triglycerides, you need only to change what you eat. A Very Low Carb High (Healthy) Fat diet will do it. Do you have the gumption or the guts to try it? If you do, and you stick with it, you won’t be disappointed.
Remember, lower blood glucose, lower blood insulin and lower triglycerides (plus higher HDL-C) go hand-in-hand. And the only “side effects” are lower weight and lower blood pressure (and fewer expenses for drugs).

Sunday, September 23, 2018

Type 2 Nutrition #451, Is Very Low Carb like the South Beach Diet?

When I describe my Way of Eating (WOE), I’m frequently asked, “Is Very Low Carb like the South Beach Diet?” Definitely not! Here’s a point-by-point comparison, from my (biased) perspective as a strong advocate of the Very Low Carb approach. For reference, I’ve used this description of the South Beach Diet from Wikipedia.
SBD: “high in fiber,” “low glycemic carbs,” “unsaturated fats (mostly monounsaturated),” “lean protein.”
VLC: Very low in fiber. All fiber is carbohydrate. You cannot eat “high fiber” and Very Low Carb because, to get any fiber, you have to eat carbs, and to get high fiber you would have to eat too many carbs. The only fiber you eat in Very Low Carb is the incidental content in some of the low carb vegetables at some meals (supper, mostly), and the occasional snack (e.g. celery with anchovy paste). Typically, I eat maybe 5g of fiber a day.
SBD & VLC: Low glycemic carbs. Generally, both diets advocate “low glycemic carbs.” This would include many above ground vegetables and leafy greens. VLC would exclude corn, beets, peas and carrots (too sugary) and squash. My favorites are broccoli, cauliflower, asparagus, green beans and salad greens. More caveats below.
SBD: Unsaturated fats (mostly monounsaturated): This suggests the “fruit” oils, avocado and olive oil (mostly monounsaturated), but the SBD would necessarily include all processed and refined seed oils: corn, sunflower, Canola, soy bean, etc, all polyunsaturated, all highly processed, and all bad. It would explicitly exclude saturated fat: butter, ghee, coconut oil, tallow, lard, the latter two found in animal meats.
VLC: Includes monounsaturated fats (avocado and olive oil) and saturated fats as found in meats and dairy and used in cooking. No margarine. It is a refined seed oil and may contain trans fats (partially hydrogenated oils). We love to cook with bacon fat. My wife makes pie crusts with lard (not Crisco). I brown meats in ghee.
SBD: “lean protein.” Wikipedia doesn’t even mention the words “red meat” in the SBD piece! Or dairy either.
VLC: For us, the fattier the meat, the better, including ground meats, chicken with the skin on, and pork roast. Salmon and sardines too, and full-fat yogurt (if you can find it!), heavy cream, and full-fat cream cheese.  All saturated fat! It will raise your HDL-C. My last HDL-C was 92mg/dl, my TC 189, my LDL-C 83 and my trigs 56.
SBD: “3 steps,” “emphasis on carbs,” “exercise included”, “3 meals + 2 snacks a day,” a “high-fat” diet.
VLC: The best way to do Very Low Carb is to go all in, “cold turkey.” In 2002, I started on 20g of carbs a day. My motivation, and the reason my doctor suggested it, was to lose weight. But within the first week I had a few hypos and, by telephone my doctor stopped one med and cut the other two in half TWICE. I later stopped one of those and today just take Metformin. And by the way, over a period of years, I lost 170 pounds.
SBD: “with emphasis on carbs.” Wikipedia says Phase 1 includes “many carbs,” and Phase 2 includes “complex carbs” such as “brown rice” and “100% whole grain bread.” I can only imagine what Phase 3 allows you to eat!
VLC: Very Low Carb also emphasizes carbs, but just the opposite: you eat as few carbs as you can, but when you do you eat carbs choose ‘low-carb’ carbs and definitely no rice or bread (or pasta or potatoes, etc.).
SBD: “choose the right fats and the right carbs,” “a ‘high-fat’ diet, not a ‘low-carb’ diet”
VLC: If you are a type 2 diabetic, you are insulin resistant and therefore carbohydrate intolerant. You need to make a permanent change. Very Low Carb is not a temporary diet where you return to eating the foods you ate before. You’re not doing this to lose weight – although if you follow it strictly, you will. You’re doing it to self-treat (through diet) your type 2 diabetes and avoid the dreaded complications.
 When you eat VLC, your body will burn body fat, so it won’t be sending you hunger signals, and you will be able to eat fewer meals (1 or 2 a day), with NO snacks – and you won’t have to exercise if you don’t want to.
VLC  & SBD: Both are “high-fat,” but saturated fats taste much better than those refined “vegetable” oils.

Sunday, September 16, 2018

Type 2 Nutrition #450, When and what to eat, and not eat

In #449 I described how I met and began to mentor a newly diagnosed type 2 (A1c 7.0%) who was prescribed a long-acting basal insulin after he was unable to tolerate or had a counter-indication for three classes of oral anti-diabetic meds. My student was motivated because he didn’t want to be a life-long, insulin- dependent type 2. I thought he was the ideal candidate for a “dietary solution.” I knew that if he followed the precepts of Very Low Carb eating, he would quickly reverse his diabetes and get off insulin.
His healthcare provider’s goal was to mediate or offset his high blood sugar (a symptom of Insulin Resistance from eating a diet high in sugars and refined carbs) with exogenous insulin injections. My goal was to get him off injected insulin by lowering his blood sugar and endogenous (pancreatic) insulin response through diet. Eating Very Low Carb will lower his blood glucose and therefore his endogenous insulin response. Thus, this lower blood insulin will reduce and quickly eliminate the need to inject exogenous insulin.
Aside: I counseled my student to be prepared to learn and to test his blood regularly and whenever he had symptoms of a “hypo.” “What’s a hypo,” he asked? Incredulously, his “doctor,” the NP – the one who “prescribed” insulin injections for him – forgot to mention hypoglycemia. Neither did they discuss an A1c goal, but the American Diabetes Association’s Standard of Care is ≤ 7.0%. His typical fasting blood glucose (with a starting dose of 10 units of basal insulin) is 170mg/dl, so he’s expecting she will soon have to raise his dose.
Insulin, endogenous or exogenous, causes weight gain. When your blood insulin level is elevated, your body cannot access body fat for fuel. Once off exogenous insulin, a LCHF diet will enable him to lose body fat, if he wants or needs to, without hunger. Principally, by burning visceral fat around and within the liver and pancreas), he will ultimately restore beta cell function and endogenous insulin production.
WHEN AND WHAT TO EAT, AND NOT EAT
If you eat a Very Low Carb, High or Healthy Fat diet, sometimes referred to as a LCHF or Keto diet, you will not feel hungry very often because your body is being fed by body fat. It won’t signal you to eat food by mouth as long as when you do eat, you eat Very Low Carb. If you have a lot of body fat to lose (he doesn’t), then you don’t have to eat a lot of fat. Your body will “eat itself” (your stored fat). Without a lot of body fat to lose, he can eat more fat (saturated and monounsaturated) than others. So, my advice when you eat Very Low Carb is, eat only when you’re hungry. After a while, when you always eat this way, your body will be “fat-adapted.”
What does this mean in terms of meals and timing? Mealtimes are cultural and social habits. My student likes to eat a small breakfast: one egg and some Canadian bacon. That’s good. He doesn’t drink coffee. For many years I ate eggs and bacon for breakfast. Now, since I’m not hungry at breakfast, I just have a cup of coffee. It’s a habit. I take it with a little pure powdered stevia and a dollop of heavy whipping cream.
If you’ve got nothing better to do at “lunchtime,” and you’re hungry, eat a small lunch. When I eat the occasional lunch I prefer something portion controlled. It’s usually a can of some kind of fish. I like kippered herring in brine or Brisling sardines in EVOO or water (not packed in refined “vegetable” i.e. seed oils). Salmon, smoked or canned, would be really good too. Some days I’ll have a hardboiled egg, or two. Low-fat cottage cheese and any yogurt are not good choices. But if you do, eat full-fat. Avoid fruit, sugar and all starches.
Supper is just a fatty protein like beef, veal or lamb, fish, pork and chicken, and one low carb vegetable tossed in real butter or roasted in olive oil. Of course, no bread, potatoes, pasta, rice, wheat flour, or root vegetables. I also avoid corn, peas, carrots and beets. They’re all high in natural sugars. And no candy, dessert or snacks. Trust me. If you can control your neurotic cravings (not hunger; you won’t be hungry), you’ll be just fine.

Sunday, September 9, 2018

Type 2 Nutrition #449, “I thought salads were good for you.”

Don’t get me wrong. Salads are okay, but maybe not for the reasons you thought. I recently began mentoring a newbie who was diagnosed a few months back as a frank Type 2 (A1c 7.0%). He was prescribed a long-acting insulin, glargine, when he wasn’t able to tolerate Metformin and then Januvia (a DPP-4 as monotherapy!). Another physician had prescribed a SGLT2, but cancelled it when he saw a counter-indication. So, I started by asking him what he ate, and when he got to lunch, he said, “chicken tenders and a small salad.”
When I said that the chicken tenders were dredged in flour, then breaded and deep fried in oxidized seed oils high in Omega 6’s, he nodded his understanding that I thought there might be a problem. But then I told him that salads were virtually all carbohydrates. That’s when he said, “I thought salads were good for you.”
And herein lies the problem. When I said, “Think about it. Not including ethyl alcohol (spirits), there are only three macronutrients.” “What’s a macronutrient?” he asked. That’s the state of our nutrition education! I told him, “The three macronutrients are protein, fat and carbohydrate. Everything in nature that you eat is essentially a combination of one or more of them, mostly of more than one. Let’s start with the basics.
The only “foods” I can think of that are 100% fat are the manufactured, refined, “vegetable” or seed oils (PUFAs) that I try hard to avoid. Most animal foods are a combination of mostly protein and fat. Most plant-based foods are almost 100% carbohydrates, although some contain some protein and even fat.
Of course there are exceptions. A Haas avocado, for example, is a plant food that is rich in “good” fats and high in fiber (non-digestible carbs). The fats are distributed as monounsaturated 71%, polyunsaturated 13%, and saturated 16% (15% total fat), 9% carb (mostly  fiber), 2% protein, 2% ash, and 72% water. Avocados are a very good plant-based food. So is olive oil (EVOO), another so-called “monounsaturated” fat.
But a salad of leafy greens is almost 100% carb, albeit low-carb; but if your “small salad” had avocados, or hard-boiled eggs, or shredded cheese, or bacon bits, or all of the above, I would say it was a very good salad, because of the protein and fat. But watch out for the dressing. Unless it is just olive oil and vinegar or your own vinaigrette, it is made from one of those refined PUFAs, the manufactured “vegetable” oils – which are all bad for you. Store bought often has sugar added as well. . So, make your own vinaigrette or just use OO & V.
Returning to my mentee, I gave him three books to read while he took a vacation: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney, “The Obesity Code,” by Jason Fung, and “Diabetes 101,” by Jenny Ruhl. Since he apparently has a sensitivity to the oral anti-diabetic medications he had tried, and he really didn’t want to be an insulin-dependent type 2 for the rest of his life, I wanted him to understand the concepts and the logic behind the science of treating type 2 diabetes as a dietary disease. I knew that if he followed the precepts of low carbohydrate eating, he would quickly reverse his diabetes and get off insulin.
He was motivated, and he seemed to me to be the ideal candidate for a “dietary solution.” We agreed we’d meet again when he returned from vacation to talk about when and what to eat and not eat.
This is my area of expertise. I was never on insulin, or any of the new injectables that are frequently prescribed before insulin, but (in 2002) I was simultaneously on three different classes of oral anti-diabetic medications and would soon, my doctor and I both knew, be injecting insulin. My T2 diabetes was progressing (sadly, as mainstream and establishment medicine still says it will). Little did I (we) know that there is another way.
 Interestingly, my student said his caregiver (a NP masquerading as an MD) and her colleague, in another town (an internist masquerading as an endocrinologist), hadn’t mentioned a low carb diet as a self-management treatment. The NP just wanted him to follow orders, take his insulin, and return in 2 weeks for more tests.

Sunday, September 2, 2018

Type 2 Nutrition #448: How “science” gets it wrong

A “basic” scientist proffers an hypothesis and then attempts to prove it wrong. If by experiment it is unable to be proven wrong, it can then be offered as “true.” At this point it is open to other disinterested scientists to prove it “wrong.” If they fail, the hypothesis gains acceptance and eventually becomes “received wisdom.”
Applied science is the application of the “knowledge” discovered in basic science. The search for this “truth,” wherever it is to be found, requires an inquiring mind that is open and skeptical of all such “received wisdom.”
I am just a humble blogger, but I have noticed that the “Insulin Hypothesis” has gained a degree of acceptance in the mainstream media. I began to eat Very Low Carb after my doctor read Gary Taubes’ “What If It's All Been a Big Fat Lie?” in 2002. In 2008, after reading “Good Calories-Bad Calories” (“The Diet Delusion” in the UK), I accepted Taubes’s Insulin Hypothesis as “true.” I had totally reversed my type 2 diabetes, achieved an A1c of 5.0%, and over a period of years lost 170 pounds. “Clinically speaking,” that A1c means that I am now considered (erroneously) to be “non-diabetic.” I will always be Carbohydrate Intolerant.
Mainstream science, though, has yet to get the message. This article, published in The American Journal of Clinical Nutrition, describes a study about a different “received wisdom.” It is predicated on the premise that losing weight by eating a restricted calorie diet (800kcal/day), over a period of time, should improve insulin sensitivity; put another way: that the driver of improved insulin sensitivity is weight loss.
Gabor Erdosi, on his Facebook group Lower Insulin, was skeptical. He wrote, “The general advice to improve insulin sensitivity is to lose weight. However, it doesn’t look like the proper advice when put to the test. In this study, 55% of the participants turned out to be non-responders, meaning that even after similar weight loss on an 800 kcal/d diet, and following weight maintenance, their insulin sensitivity didn’t improve much.”
Erdosi doesn’t need to explain why to his erudite readers, but, for the uninitiated, I will.  It isn’t weight loss that improves insulin sensitivity; it is lower insulin that improves insulin sensitivity. The body doesn’t have to resist being besotted with insulin and so is more receptive. Lower blood insulin, from eating Very Low Carb (VLC), and/or Intermittent Fasting (IF), also permits the body to access its fat stores and lose weight easily, and also maintain weight loss without hunger. Eating an 800kcal/day “balanced” diet does neither of these things.
When you eat a “balanced” (high carbohydrate) diet – one that includes processed carbs and simple sugars in every meal – whether you are non-diabetic, pre-diabetic or a diagnosed type 2, your body will elevate the level of insulin flowing in your blood. Insulin is both the transporter of glucose and the cellular gatekeeper. It signals cellular receptors to open to receive the glucose energy. If you have insulin resistance, the cellular gate is stuck, so your pancreas sends more insulin into your bloodstream. This begins a vicious cycle.
So, to improve your insulin sensitivity, you need to lower your blood insulin. If you have less insulin flowing in your blood, whether you’re non-diabetic, pre-diabetic or a diagnosed type 2, your body’s receptor cells will become more sensitive to the insulin it “sees.” And, if you have less insulin flowing in your blood, your body will also have access to energy from the food you previously ate, and stored as fat, and you will lose weight.
Thus it’s not lower weight that improves insulin sensitivity. It’s lower insulin that improves insulin sensitivity.
But mainstream science continues to ignore the Insulin Hypothesis because government doesn’t fund the kind of research that would test it and accept it as “true.” There are too many corrupting influences. For example, the research cited above was conducted by the Nestlé Institute of Health Sciences, Lausanne, Switzerland. Nestlé makes the 800kcal meal-replacement product (Modifast; Nutrition et Santé) used in the study. In U.S. markets, Nestlé sells Optifast, Boost and Carnation, among many other HIGH-CARB “health science” products.

Sunday, August 26, 2018

Type 2 Nutrition #447, What’s happening to medicine today?

Lots of things are happening to medical practices today, and at an accelerating pace. I remember 40 years ago when my GP quit medicine, giving up a nice practice in an upscale community because of Medicare’s onerous reporting burdens. He was independently wealthy, and had a nice social life, but he was only in his early 40s!
Today, independent private medical practices are disappearing at an even more alarming rate, being sucked up by hospital conglomerates. In my area Health Quest and CareMount are cutthroat competitors. A search on CareMount redirects to “Medical Outsourcing.” Wikipedia explains: “Some small practices have outsourced business functions to management services organizations” (MSOs). “Business functions” includes all office staff. My urologist told me that the benefit to him was that he can now “just practice medicine.”
Two specialists I have seen in the last year now work for one of these MSOs. So does my wife’s GP. My internist in NYC is the exception. He resists the trend and recently, while maintaining a very busy private practice, joined a boutique medical group where he offers his patients, for a fee, more personalized attention. I declined. I told him I wanted to see him 3 times a year for blood work. He suggested I come just once a year.
On a recent final visit to an orthopedic, his receptionist asked me if I wanted to receive an updated printout of his clinical notes. I told her “no.” After unexpectedly receiving and reading an earlier version, they upset me. I thought that they did not fairly reflect what I had told him or his nurse; instead, they read to me like they were written to be read by the MSO or some clinical practice reviewer at HHS (Medicare).
I had a similarly eerie experience in Florida several years ago. I had to fire one physician, who was peddling statins and claimed to be a lipidologist.  Another, an endocrinologist, had justly fired me when I told him he needed to go back to school. They both worked for a large group that dominated that part of Florida where I spend the winter. Their MSO is part of HCA Healthcare based in Nashville, Tennessee. The network includes “178 hospitals and 119 independent surgical centers in 20 states and the UK.” The UK!
The orthopedic – remember, his specialty is skeletal issues, in my case a torn tendon – asked me if I was eating a “mostly plant-based diet.” Earlier, his nurse, recapitulating notes from the previous visit, asked me if I was still walking for exercise. I told her I had NEVER told her that I walked for exercise. I have NEVER walked for exercise. The only exercise I do is garden work. Where, or more to the point, why was it in their clinical notes that I walked for exercise? And why would an orthopedic counsel me to eat a “mostly plant-based diet”?
I protested the counsel to eat a mostly plant-based diet. I replied that I eat a Very Low Carb diet and would be a carnivore if my wife would not go apoplectic. I said the body had a zero requirement for plant-based foods and can make all the glucose it needs via gluconeogenesis from protein and fat. I also told them that I drink a pint of collagen-filled bone broth from pasture-raised beef every day to help repair my torn Achilles tendon (as my brilliant editor had suggested). Tendons are made of collagen. My ortho appeared to listen attentively and replied simply that he admired a person who held such passionate beliefs.
My conclusion, I’m afraid, is that to practice medicine today your MSO MD needs to follow the MSO’s and the government’s “formulary,” not just with respect to medications, but for lifestyle (“diet and exercise”) as well. And if those recommendations are not in your clinical notes, the MD’s medical practice is penalized by lower reimbursement rates from Medicare and thus with a lower rating by the bean counters at the MSO….because the MD is not pushing the government’s “lifestyle formulary.” To not push it risks lower profits for the MSO and even job security for the MD, based in part on “job performance.” That’s the price a doctor has to pay today to “just practice medicine.” And that’s what happening to medicine today. 

Sunday, August 19, 2018

Type 2 Nutrition #446, “Docs’ Beliefs” prevail in 14 of 17 Primary Care practices

Thank goodness for the headline in this Medscape Medical News story by Miriam E. Tucker: “Docs’ Beliefs Guide Prescribing of Glucose Monitoring in Type 2 Diabetes.” It means they still prescribe routine self-monitoring of blood glucose (SMBG) in patients who aren’t treated with insulin (or a sulfonylurea). The danger from insulin or a sulfonylurea (e.g.: micronase, glyburide, glipizide) is hypoglycemia (low blood sugar).
That doctors still do this is enormously encouraging to me, a type 2 for 32 years who takes a fasting reading every day and recently had an A1c of 5.0%. It is troubling to me, however, that several said that they prescribe SMBG less than they did 10 years ago, when their professional societies were encouraging the practice.
The evidence to stop prescribing SMBG, described as “qualitative data,” was presented here in The Annals of Family Medicine by a medical student at the Cleveland Clinic. The student told Medscape that “for patients who do not take insulin, the preponderance of evidence shows it increases cost without improving HbA1c.”
Duh! If you don’t do something with the information. If you don’t use it to make wise choices about what to eat. If you think the only way to treat T2D is with drugs, and that self-management actions have no educational or motivational value. The opponents of SMBG also cited the cost of test strips as barriers. The medical student does say “our study addresses the physician perspective, but there’s also the patient perspective.” Her team’s next step will be to assess patient’s perspectives of SMBG. Brava, I say. There’s hope.
But the abstract, co-authored by half a dozen MD/MPHs at the Cleveland Clinic, make it clear where this study is going. It states, “The majority [of primary care physicians] continue to recommend routine self-monitoring of blood glucose due to a compelling belief in its ability to promote the lifestyle changes needed for glycemic control. Targeting physician beliefs about the effectiveness of self-monitoring of blood glucose, and designing robust interventions accordingly, may help reduce this practice.” This is what medical students are being taught today. That’s been the problem with these damn studies. They’re myopic and, worse, narcissistic. One physician said, “I try to steer non-insulin dependent patients away from testing at home, mainly because it doesn’t change what I do. I monitor their diabetes based on the HbA1c and occasional sugar checks.” It’s me, me, me, me, me… No thought or consideration to what the patient can do to control their blood sugars.
Okay, if you believe that your patient has “low health literacy or physical or cognitive impairment,” then it goes without saying the patient’s diabetes care should be in the hands of a health care provider. This may include those who have daily home health care, are hospitalized or institutionalized. But for the rest of us? Are we not capable of participating in the management of our own health care, especially with a condition that is entirely dependent on what we eat for optimized management? But therein lies most of the problem…
Most physicians to not accept that type 2 diabetes is a dietary disease. Nor do most patients. Doctors know it, or should know it, given their training in human biology and physiology, but to admit it would require that they repudiate everything they have been telling their patients about nutrition for 40 years. I don’t blame them for following the guidelines of their medical associations and the prescribed Standards of Practice. It would be hard to look the patient in the eye and say, “It's all been a big fat lie.” (apologies to Gary Taubes)
However, under the circumstances, wouldn’t it be best to leave the options open for patient-centered care? After all, the clinician only sees the patient a few times a year to monitor their T2D condition, but the patient has the opportunity multiple times every day to make wise choices that will change their condition. Self-Management of Blood Glucose (SMBG) is thus the best way for patients to educate and motivate themselves. If by prescribing SMBG the doc’s beliefs contribute to the patient’s self-care, that’s a good workaround! Bravo!

Sunday, August 12, 2018

Type 2 Nutrition #445: Are doctors in denial?


When a doctor tells me that I am “no longer diabetic,” as a few have informally told me, are they misinformed about what causes type 2 diabetes, or are they just small business men or women in denial and following the government’s definition which dictates a clinical diagnosis? Because they want to get paid and move on…
I mean no offense, honestly. If I seem impudent, well…maybe I am, a little, but as Dr. Michael Eades said, at the end of #406 here, it’s sometimes necessary for “you” (his readers) to “educate your trained professional.”
For example, at a cocktail party recently I was having a tête-à-tête with a friend, a retired MD, when a tray of shrimp was passed around. I took one, but when the doctor declined, I asked him, “Why?” He answered, “Cholesterol.” He apparently hadn’t heard that, back in 2014, the Dietary Guidelines Advisory Committee had declared that “cholesterol [was] no longer a nutrient of concern for overconsumption.” Or that Ancel Keys, the infamous creator of the “diet-heart hypothesis,” was quoted later in his life as saying, “And we've known that all along. Cholesterol in the diet doesn't matter at all unless you happen to be a chicken or a rabbit.”
With respect to the “misinformed” possibility, and the “denial” question, we know that type 2 diabetes is caused by a metabolic dysfunction in which the body is no longer able to handle a diet high in refined carbs and simple sugars due to Insulin Resistance. The hormone insulin, secreted by the pancreas, carries glucose from digested carbs in the blood stream and, in a normal metabolism, “opens the door” by connecting to receptor cells where the glucose is supposed to be taken up for energy. When the connection doesn’t work, the glucose continues to circulate and the pancreas secretes more insulin to help, eventually wearing out.
Most doctors rely on the A1c or a fasting blood glucose to diagnose a type 2 and begin a course of treatment (“diet and exercise”, and 3 months later, when this fails, prescription meds). These simple blood tests show the symptoms of a disregulated glucose metabolism and are cheap and effective as screening methods. Most people who present with an elevated FBG or A1c are pre-diabetic or frank type 2s. And the meds that a doctor prescribes to treat these symptoms will lower your FBG or A1c somewhat, at least temporarily. But your type 2 diabetes will continue to progress, because the clinician is treating a symptom, not the cause, of the disease.
The cause of type 2 diabetes is Insulin Resistance (IR). The best test for IR is an Oral Glucose Tolerance Test (OGTT). In this test, the patient drinks 75g of a glucose solution, and their blood is tested before and at half hour intervals afterwards for 2 hours. It is usually performed by an Endocrinologist and/or in a hospital outpatient setting, so it’s expensive, but the OGTT will reveal if the patient has Insulin Resistance.
But the government, and therefore your doctor, is only interested in treating your symptom, an elevated blood sugar (A1c). If your A1c is ≥6.5%, you are clinically designated a “type 2 diabetic.” If it is <6.5% but ≥5.7%, you are clinically designated “pre-diabetic.” If your A1c is <5.7%, you are, clinically speaking, “non-diabetic.” If your A1c was previously ≥5.7%, but somehow is now lower, your doctor will declare you “non-diabetic” or “cured,” and by the established Standard of Care, the “system” will reward the doctor financially for this favorable outcome. This totally ignores your INSULIN RESISTANCE. You are still Insulin Resistant, and therefore still type 2 diabetic. If you don’t change your diet, YOUR DISEASE WILL PROGRESSIVELY WORSEN.
So, is your doctor misinformed, in denial, or just being callous? He or she is, after all, in business and just following government rules for treatment and payment. As far as keeping your INSULIN RESISTANCE in check, or even putting your type 2 diabetes in remission while losing weight easily and without hunger, that’s up to YOU. YOU decide what foods you eat. Don’t expect your doctor or the government to know how to “eat healthy.” Following their advice is how you gained weight and got sick in the first place. Your doctor can only test your blood and write scripts to “control” your A1c. But you are still INSULIN RESISTANT and therefore CARBOHYDRATE INTOLERANT!

Sunday, August 5, 2018

Type 2 Nutrition #444: “Symptoms are too late”

A while back on Maria Bartiromo’s “Mornings with Maria” on Fox Business, a doctor was asked, “What are the symptoms of pre-diabetes?” He answered emphatically, “Symptoms are too late!” Expecting a different reply, the questioner continued, “But can’t [type 2] pre-diabetes be reversed?” The doctor replied indirectly, but correctly, “Once you are diagnosed diabetic, you are diabetic for life, but you can manage your condition.”
Of course, pre-diabetes and even “clinical” type 2 diabetes, diagnosed with the current blood testing methods (A1c and/or Fasting Blood Glucose), can be “reversed”but only by and with a permanent lifestyle change.
The doctor interviewed on Maria’s show was introduced with a recorded “teaser” from the popular singer Patti LaBelle. She told how her family had suffered terribly from type 2 diabetes and how she, who was now a diagnosed type 2, was determined to avoid those “complications.” She said she had changed her “way of living, eating and thinking.” She’s right, of course, but of the three, Patti just talked about what she eats.
Ways of eating, however, are still open to many interpretations, including ways of eating to lose weight. Arguably, there are countless ways to lose weight, albeit not permanently. As all dieters know, weight loss is usually followed – often quickly – by weight gain. The reason is that the dieter is hungry. The dieter’s body demands more food to return to energy balance. The signals are hormonal and beyond control of the dieter.
There is a way of eating, if adopted permanently, that will manage both pre-diabetes and type 2 diabetes and produce permanent weight loss. That way is Very Low Carb (VLC). Eating VLC both enables the “dieter” to either reverse pre-diabetes or manage type 2 diabetes and lose weight easily and permanentlyso long as you continue to eat VLC. That’s the condition. It’s a trade-off. You get to permanently keep the weight off, and reverse your prediabetes, that is to say, put it in “clinical remission.” Based on the medical Standard of Care for diagnosis and treatment, a doctor will declare you clinically non-diabetic”  Really! Seriously!
Another huge benefit of this “win-win” outcome is that it will cut in half your risk of cardiovascular disease (CVD), and dying from a heart condition or stroke. These macrovascular complications are in addition to the usual microvascular complications long associated with type 2 diabetes: blindness, amputation and end-stage kidney disease (with dialysis). Other “Diseases of Civilization” associated with the high-processed-carb diet are Alzheimer’s (type 3 diabetes) and various cancers, particularly liver, pancreas, endometrial, colon and rectum, breast, and bladder cancers.
The doctor on Bartiromo’s program made another good point: He declared type 2 diabetes to be a scourge of our modern lifestyle that is “self-caused.” He said 1) we overeat, 2) we don’t eat properly, and 3) we don’t exercise. The first two are interrelated, with the 2nd being the cause of the 1st. But to his point: “WE” IS THE PATIENT. “Self-caused” means that WE can do something about it, without intercession by our doctors.
The doctor then lost his way on the eating part. He advocated “fruits and vegetables and lean meat” and avoiding “saturated fat and sugary drinks.” It was essentially, the Mediterranean Diet: Eat processed vegetable oils (PUFAs) and avoid fatty red meat (saturated fat). That’s the government’s pitch. Sad, really, and too bad.
For perspective, just remember that too many processed carbs and simple sugars, and wheat, excessive fructose and excessive linoleic acid (Omega 6s in the polyunsaturated vegetable oils), is how we got sick and fat in the first place. Note that the government’s dietary guidelines no longer limit dietary cholesterol or total fats; they just get it wrong about which fats are bad. For more see #445, “Are doctors in denial?” next week.

Sunday, July 29, 2018

Type 2 Nutrition #443: The 1-percenters

A while back, on a nutrition website intended for the cognoscenti, I watched a TED talk that a member had recommended. The talk was said to “help you find your ideal diet,” a “personalized program just for you.” It turned out to just be a businessman’s pitch for his startup’s service to design an “individualized” diet for you, for a fee. It was a sham, designed to appeal to a nutritionally naïve audience. Of course, this would include 99% of the public, but I expected better from this nutrition site and especially from its leaders.
People who are unable or unwilling to accept the radical changes that are necessary to make a major “lifestyle change” usually resort to the meme that “everyone is different.” That’s a convenient scapegoat. The truth is we are all human and our biological processes for digesting and absorbing the basic components of food –protein, fat and carbohydrates – are virtually identical. The only differences are the degree that a bundle of glucogenic genes have to a lesser or greater extent been “modified,” over time, by overindulging unnaturally in a diet composed of a very high percentage of processed carbs. That will vary from person to person.
These “over-indulgers” develop a dysfunctional glucose metabolism. Once “modified,” these genes continue to express this Carbohydrate Intolerance on a continuum. It is a path which will lead most people, over a period of many years, to develop type 2 diabetes and become obese. The condition is called Insulin Resistance.
Insulin Resistance is thus a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open up to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much INSULIN in the blood stream. Characteristically, type 2s have both elevated blood glucose and elevated blood insulin.
The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or frank type 2 diabetes. Today the hemoglobin A1c (HbA1c) is the blood test used to make this diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, however, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes 2 hours and is more expensive, but nevertheless the best.
The elevated blood INSULIN is what causes obesity (in about 80% of type 2s). While insulin is elevated in the blood stream, to avert hunger the body must rely on food by mouth for energy. Most people eat carbs at every meal and often between meals. The net result is that we are always hungry and then, when we eat more and more often, we get fat. So, with INSULIN RESISTANCE, your blood INSULIN stays high. It’s only when your BLOOD INSULIN level drops that the liver looks for an alternate energy source and turns to breaking down body fat (the food you’ve already eaten) for energy.
The 1-percenters know this. But knowing it and doing something about it are very different. It is hard to change one’s lifestyle and in particular one’s eating habits, which are both cultural and very personal. Incipient pre-diabetes and frank type 2 diabetes are symptomless conditions.  And it takes decades to kill us, most often indirectly by heart attack, stroke, or Alzheimer’s (aka type 3 diabetes) and many cancers. These days, with better care, blindness, amputation and end-stage kidney disease are less common morbidities.
So, what’s the best motivator to make a “lifestyle change”? Well, how would you like to “kill two birds with one stone”? Lose lots of weight and reverse your slow slide into full-blown type 2 diabetes? You can, but you will either have to eat Very Low Carb most of the time, or fast for a day or two a week, or both. That’s what I did. I started eating Very Low Carb in 2002 and lost 170 pounds. When I plateaued a few times and gained some back, I added fasting. I lost 60+ pounds. I maintain my weight by eating Very Low Carb and fasting.

Sunday, July 22, 2018

Type 2 Nutrition #442: Stepping into my new trousers…

About 6 months ago I took several pairs of trousers to a local tailor to have them altered. In the previous 6 months I’d lost a lot of weight (60+ pounds), and there were very few pants in my closet that didn’t bunch up at the waist when I cinched them in. The tailor took a look and told me the truth. “I can take them in,” she said, “but you’ll always have a big baggy seat. You really should buy some new pants.” So, that’s what I did.
My wife cautioned me not to rush into it though. She said, “Buy one pair to see how it fits. Then you’ll know what size to order going forward.” That sounded prudent. But first, so there would be no going back, I went through all my clothes in the closet and the bureau and prepared to take them to the church thrift shop and the Salvation Army. With last year’s tax reform, who knows if I will ever have a chance to deduct them again!
Then I took a bold step: I ordered a pair of trousers with a waist size smaller than I have bought in over half a century. Fact is, I have no idea when I last ordered pants that small. I had nothing in my closet or bureau that small and some of the clothes there were ancient! So, I placed the order and anxiously awaited its arrival.
In the meantime I tried on a few sports jackets. One was a Mageehandwoven Irish tweed that I bought in ’04 in Donegal and had worn only a few times. It was much too large. Then I found another tweed that I bought at Harrods in London in 1969 and that now fit perfectly! It had been relined ages ago and still looks great!
Then I went through my bureau and found a few things that now fit that I hadn’t worn in maybe 40 years. I also found a few things that I had neverworn and that now would never fit. They were much too large.
Finally I went to the front hall closet where we keep our winter clothes. A Woolrich heavy winter car coat that I had hardly ever worn was much too big, but my favorite, a 50-year old, cherry-red ski parka now fit perfectly.
The exercise of “cleaning house” was cathartic. It brought back many fond memories of times and places that I have been and things I have done: shorts and knit shirts from a long ago vacation in Bermuda, an embroidered knit shirt that my brother gave me when I skippered his 45-foot Bristol sailboat for a week. I took my wife and her 3 daughters and their husbands for a sail out in the Bahamas. And the 2-week golf vacation to Ireland, with the “Fat Boys,” where we played 12 rounds in 12 days, more than 1 in the rain without a cart
And all the tee shirts from everywhere, especially those that I wore when I fished for 12 years from my kayak in the ocean and in the Indian River in Florida. Everything that no longer fit went to the thrift shop or the Salvation Army bin. It was very “Jungian” to clear out the past with an eye to “making room” for the future. 
I was also eager to secure the weight loss in my mind and close this “fat period” from my past. I decided I wasn’t going to take out any “insurance policy” that the weight loss would be temporary and that one day I might regain the weight that I had lost. I was confident that once “there,” my weight loss would now be permanent. And I was confident that I knew how to do it, and that I would put that knowledge into practice.
This step may have been the boldest of all. Most people who lose a lot of weight, including me, have put some of it back on. But I knew now that I had found the secret: Very Low Carb all the time, mostly 1-meal a day (OMAD), and 1 or 2 300kcal/full day fasts each week (as needed) to keep my weight within a 3-4 pound range.
A few days later the box with the trousers arrived and, with great anticipation, I opened it.  I removed them and took them out of the plastic bag. I then “stood them up,” opened the waist and held them in front of me with both hands, as though I was preparing to step into them. And…the “hole,” into which I imagined I would step – right leg first – was TINY!How would I…how could I step into such a SMALL OPENING! I smiled to myself as I came to this realization. If I was going to step into my new trousers successfully, it was going to take a little practice. I would have to focus on it – pay full attention. At my age I can’t afford to break a leg or a hip!

Sunday, July 15, 2018

Type 2 Nutrition #441: Have I cured my type 2 diabetes?

“You’re cured,” the clinician told me. “You no longer have type 2 diabetes.” You’d think I would greet this news with a sigh of relief since I was diagnosed 32 years ago; but I did not, because I didn’t believe it.
I was not, however, surprised with that doctor’s response. I had just told her that, because I changed my Way of Eating (WOE), my A1c was now 5.0% and my average FBG in the mid-80s. From the clinician’s point of view, as one who treats patients according to the ADA’s Standards of Medical Care, her goal would be to manage my diabetes to get my A1c to ≤7.0%, or even ≤6.5%, the diabetes threshold. Thus to her, clinically speaking, I am “cured.” I asked her, “Would you then write on my chart that I no longer have diabetes?” She replied, “Yes.”
When I shook my head in dismay, she asked me why I wouldn’t accept this “good news.” I replied, “Because I will always have Insulin Resistance and therefore will always be diabetic.”  She just smirked, not wishing to get into an argument. We were, after all, just chatting in a social setting after a panel discussion in NYC with Gary Taubes. Nevertheless, she said dismissively, and with authority, that what I said was untrue. I left it at that. The divide between us was too great. In her view, unlettered dotards like me shouldn’t be taken seriously.
This doctor wasn’t my doctor and wasn’t going to be. Except for my MD friends who read this blog – and there are a few – I leave the one-on-one re-education of the trained professional to others. But, as the Heal Clinic's Dr. Eric Westman sadly said to me recently (in #402 here), “Ignorance is the biggest problem. Gary Taubes expressed a corollary sentiment to me that night. He said the Low Carb “movement” has increased 100 fold in just a few years from 1/100th percent to 1 percent. That’s a huge relative improvement…yet still an abysmal state of affairs. There is yet so much work to be done to overcome the entrenched positions in the political, agribusiness, big pharma, public health, medical, and other special interest establishments.
But I digress. Insulin Resistance is a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much insulin in the blood stream. Characteristically, type 2s have both an elevated blood glucose and an elevated blood insulin.
The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or type 2 diabetes. Today the hemoglobin A1c (HbA1c) blood test is used for diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes at least 2 hours and is thus more expensive. It is, nevertheless, still the best. The easiest test is to measure your waist/hip ratio; anything over 1.0 (male) or .8 (female) signals insulin resistance.
The elevated blood INSULIN  causes obesity. While insulin is elevated, the body must rely on food by mouth for energy. Most people eat carbs in every meal and frequently between meals. So, if you have a little Insulin Resistance, your blood INSULIN level stays high. That’s why we are always hungry and why, when we eat more and more often, we get fat. Only when your blood INSULIN level drops will  the liver look for an alternate energy source and turn to breaking down body fat for energy. But to do this, a person either must eat VERY LOW CARB most of the time, or FAST for a day or two, or BOTH.
So, while I have no clinical signs of type 2 diabetes, and a doctor may regard me as “cured,” I know that I am still Insulin Resistant. I know that it is only because I eat Very Low Carb most of the time, and fast a few days most weeks, that my Insulin Resistance is not expressed. But my Insulin Resistance will always be there, and that is why I will always be a type 2 diabetic – a (thin) type 2 in remission, but only because of the way I eat.

Sunday, July 8, 2018

Type 2 Nutrition #440: The Drinking Man’s Liquid Fasting Diet

As a drinking man, this post is my approach to eating, drinking and fasting. Last week’s, Type 2 Nutrition #439, describes the original 1964, “The Drinking Man's Diet.” The premise of both is that, as Robert Cameron wrote in 1964, “Most everyone has a drink now and then.” My contention is that it is not necessary, when either dieting or fasting to give up alcohol completely. This should allay the fear, or excuse, for not trying it.
In this 2004 Forbes Magazine piece, commemorating the 40th anniversary of its original publication, Cameron was described as a bon vivant. It’s hard to know at this point whether he was or not, but his little pamphlet is replete with humorous references to various spirits in conjunction with the “high-life.” Reading it today it sounds more like a parody of the ‘50s, but in context, it could very well have been the way some people lived.
In any case, while today’s business man or woman no longer indulges in a 2-martini lunch, it is fair to say that “most (sic) everyone has a drink now and then,” many at home before or with dinner. It has been justified, or rationalized, as a way to relax and relieve stress. There’s a social aspect to it: a chance to sit down with one’s spouse and “communicate” (LOL). As a result, perhaps based on today’s mores, medical advice websites tout the “health benefits” of “light drinking,” usually defined as 1 alcoholic drink per day for women and 2 for men.
Okay, so that’s my set-up. I like a drink. I consider myself a light drinker, fitting the guideline above. I drink spirits (scotch, bourbon, vodka, etc) on special occasions. We go out for dinner on average once a week. In a restaurant I will often have one or sometimes two cocktails, depending on the bartender (the amount of the “pour”). We entertain at home much less often these days, but if we have people over for dinner, I will make just one for me and any guests who will join me. When I make the drink, one is always enough. LOL
On a daily basis, I drink wine at home. When I am NOT fasting, my Way of Eating is generally to eat Very Low Carb: to have just coffee with cream for breakfast, to have, if any, a very light lunch – usually a can of kippered herring – and then to have a small supper. Supper is a portion of protein with a low-glycemic vegetable, either roasted in olive oil or tossed in butter, or a salad. Daily food intake is about 1,200 kcal: 100g fat, 60g protein, and 15g carbs. In addition, I have two 5-ounce pours of red wine, the glass then filled with seltzer: a “spritzer.”
I describe my non-fasting daily eating routine as Very Low Carb, One Meal a Day, or VLC/OMAD. When I am “fasting,” I have the same “breakfast,” I skip lunch, and for “supper” I have just one red-wine spritzer.
If I am working at “hard labor” (in the garden), I will drink diet ice tea sweetened with liquid stevia. For electrolyte balance, I will supplement it with pickle juice, or a large cup of bouillon.  For any oral fixation impulses, especially after supper, I will make a “cocktail” of 1 Tbs of Bragg’s Apple Cider Vinegar (ACV), a few dashes of bitters, and 5 drops of liquid stevia, stirred (not shaken), the glass filled with ice and then seltzer.
The ACV cocktail is satisfying and is said to be good for blood glucose control too. Who knows? I’ve been a type 2 for 32 years and my A1c is now 5.0%, so I would say that I have my “progressive” disease under control. I do it with just a Very Low Carb diet, intermittent fasting, red wine and Metformin (750mg twice a day).
My “Drinking Man’s Liquid Fasting Diet” is about 300 kcal/day, equally divided between “breakfast” and “supper.” Macronutrient Distribution is detailed in Type 2 Nutrition #410. It is Protein: 1.2g; Fat: 16g; Carbs: 5.7g and ethyl alcohol: 18g. Last year, I lost about 60 pounds following this “Liquid Fasting Diet.”
I have been losing weight eating Very Low Carb since 2002. I weighed 375 pounds at the start and twice got down to 205, then stalled and regained some. In early 2017 I started my “Liquid Fasting Diet” to break the log jam. It was not a “water-only” fast, though. It was thisDrinking Man’s Liquid Fasting Diet,” as described. I generally ate 4 days and fasted 3 days a week. So, this would make my WOE a VLC/OMAD/4-3 DIET. Cheers!