Tuesday, December 11, 2018

Type 2 Nutrition #462: The TG/HDL-C ratio and Insulin Resistance

Dr. Jay is Jay Wortman, MD, a Canadian clinician, Very Low Carb and political activist who I first found in 2012 at Franziska Spritzler’s Low Carb Dietitian. Both he and I are among a very good list of links and resources there. That was only two years after I had started blogging, so when I visited Dr. Jay's Blog, I left a comment on his “The Story So Far….” And, as shameless self-promotion, I also left a link to my blog’s website. It has since garnered several hundred hits. I also get lots of page views originating from Franziska’s blog list.
Jay Wortman has become very active on Facebook. A while ago when I offered wishy-washy advice to a newly diagnosed type 2 looking for help on a popular Facebook group, Dr. Jay intervened with a reply comment to mine. He blasted my lame advice, telling the hapless newbie to face facts. The newbie had Insulin Resistance and was therefore Carbohydrate Intolerant. I was embarrassed by my half-baked input, but very grateful he is lurking, or more likely, following the group. Dr. Jay is both passionate and selfless, and dedicated to helping. 
Dr. Wortman also keeps up with the most relevant medical research. He recently posted on Facebook this PubMed Central (PMC) mouse study, “The Failing Heart Relies on Ketone Bodies as Fuel,” which concluded, “These results indicate that the hypertrophied and failing heart shifts to ketone bodies as a significant fuel source for oxidative ATP production.” Translation: the ketogenic diet is good for the failing heart, in mice.
Another Facebook post by Dr. Jay is this study from Malaysia appearing in PMC. Looking for “an easy to use, precise and low-cost diagnostic test to predict Insulin Resistance,” 271 overweight and obese children were “stratified by tertiles using the homeostasis model assessment (HOMA), a good surrogate for the gold standard for measuring IR, the hyperinsulinemic euglycemic clamp.” “The children were analyzed for fasting glucose, lipids, insulin and waist circumference. The children were then stratified by tertile of TG:HDL-C ratio.”
The study’s conclusion: “the odds of having IR was about 2.5 times higher (OR=2.47, 95%CI, p=0.01) for those in the highest tertile of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.” Dr. Jay’s endorsement/imprimatur of this conclusion was, “I calculate this for all my patients.”
Below is a chart of my 82 TG/HDL-C ratios since 1980. The first 17 ratios were while I was eating a Standard American Diet (SAD) and, since dx in 1986, treated for type 2 diabetes with antihyperglycemic drugs. The last 65 ratios are since I began to eat VLC in 2002. A TG/HDL ≤ 1.0 is ideal, a ratio of ≤2.0 is good, anything over 3 is “indicates significant risk of heart attack and stroke.  Note almost all of mine since #17 are ≤1.0.

This metric has been in use by non-cholesterol-phobic physicians for years. I wrote about in 2011 in my #27 “...the strongest predictor of a heart attack.” I hope more physicians, like Dr. Jay, start to routinely use it.




Sunday, December 2, 2018

Type 2 Nutrition #461: Very Low Carb is the Basic Precept


The best diet for a type 2 or pre-diabetic to control blood glucose is Very Low Carb (VLC). How many grams of carbs you eat will depend on your degree of Insulin Resistance (IR). Your meter will tell you. Then, the number of carbs you eat will be up to you. How much do you want to mediate your condition? Do you want to put your diabetes in remission, or do you want to let your doctor manage it as you go on with your old diet?
In the last 16 years I have tweaked how I eat a lot. My doctor started me on Atkins Induction (20 carb grams a day). I few years later I switched to Richard K. Bernstein’s 30 grams a day (6-12-12). I transitioned to LC-HF (low-carb, high-fat), then Very Low Carb (VLC) or VLCKD (“keto”), and finally VLC with lower protein and moderate fat, to allow my body to burn fat, while I fasted or had one-meal-a-day (OMAD) and was “fat-adapted.” This Way of Eating has been called many things, but the basic precept is Very Low Carb.
Besides always being fundamentally Very Low Carb, it has also always been Moderate Protein. It is not high protein as some would have you think. People who say “high protein,” are thinking negatively in two respects: 1) They think “high protein” is harmful to the kidneys and 2) they are afraid to call it or think of it as “high fat,” which it is, because they think high fat, especially saturated, is harmful to the heart, which it is not.
With respect to PROTEIN, a moderate level means from 15% to 30% protein, depending on the carb and fat calories. Mine has been 20% for many years. Second, only a diet that is higher than 30% protein, of total calories (including body fat burned), might be harmful to the kidneys and then only if you already have kidney disease. Third, fear of fat is not supported by sound science, as the world is just now coming to realize. We have all been unwitting subjects in a 60-year, world-wide, low-fat, public health experiment.
As for  FAT, I hope you’ve noticed that the 2015 Dietary Guidelines have quietly dropped the “30% and lower” target in their recommendations. You probably didn’t notice that the Dietary Guidelines Advisory Committee told the full committee that “cholesterol is…no longer a nutrient of concern for overconsumption.” You no longer are being guided to limit your CHOLESTEROL to 300 mg a day! Eat eggs! Eat shrimp! Enjoy!
Unfortunately, the Guidelines still focus – in fact they have doubled down – on the dietary recommendation against SATURATED FAT, found mostly in animal products but also in coconut oil. They – ahem, the United States Department of Agriculture, the co-authors of the Dietary Guidelines with another government agency, HHS – want you to “shift from eating solid fats to oils,” specifically the highly processed grain and seed oils grown, manufactured and “baked into” foods, literally and figuratively, by AgriBusiness. Anyone see a conflict?
Basically, a diet that is very low carb, moderate protein and high fat – or moderate fat if you are fat-adapted and need to lose more weight with fasting or just calorie restriction – is going to work for you to manage your blood sugar and to lose weight without hunger. When my doctor started me on Atkins Induction 16 years ago, for weight loss, it worked. But we were both surprised that I had hypos every afternoon for a week until I stopped all the anti-diabetic meds he had me on. And eventually I lost over 180 pounds!
My blood lipids also improved dramatically, doubling my HDL-C and cutting my triglycerides by 2/3rds. And, with weight loss, my blood pressure went down, as did my inflammation levels. I am so much healthier today than before, and I feel so much better. It all began with VERY LOW CARB. It is the basic precept for type 2s.
My apologies to my regular readers of this blog. I’ve told this story many times; however, since my columns cover a wide range of subjects and aren’t indexed, the majority of my readers find me through a “Google” search.  If that includes you, I hope you will return often and make this one of your favorite sites, or even become a “follower” and send a hyperlink to a friend. I accept no ads because I have no products to promote or sell – only nutritional advice and encouragement for type 2s and pre-diabetics.

Sunday, November 25, 2018

Type 2 Nutrition #460: The Blind Leading the Blind

No offence intended if this “microaggression” offends any blind person to whom this column is read, but that was my reaction to a “workshop” I attended a few months ago, conducted at a local hospital by two state- trained RDs. There were 13 attendees all looking for help to deal with their type 2 diabetes.
The workshop began with a brainstorming session in which each person was asked how they felt about being a type 2 diabetic. The moderators – I’ll call them Tweedledum and Tweedledee – dutifully wrote the feelings down on a mammoth 20 x 30-inch Post It. Virtually everyone expressed negative emotions, among them anger, confusion and frustration. I was last to be asked, and I said I had no such negative emotions because my type 2 diabetes was now under control. My last A1c was 5.0%, and the only medication I take is metformin.
I was then asked by Dee, reasonably, why I was attending the workshop. I explained that I had been diagnosed a type 2 thirty-two years ago, and my diabetes progressively worsened until I was taking 3 different orals meds – maxed out on 2 – and my fasting blood sugars were still out of control. Then, 16 years ago, to lose weight, my doctor suggested I try a Very Low Carb diet he had read about. The first day, to prevent hypos, he had to take me off 1 med and within the week he cut the other 2 in half TWICE. Over several years I lost 170 pounds.
Although I mentioned the name of the NYT Magazine cover story my doctor had read, nobody – neither Dum nor Dee nor anyone taking the workshop – expressed any interest in how I did it. Of course, they weren’t there to listen to me. They were in this group therapy session because their health-care providers had sent them to help them deal with their anger, confusion and frustration. The free book that everyone got said it all: “Living a Healthy Life with Chronic Conditions.” In other words, give up hope of reversing your T2D; just get used to it.
I really did feel sorry for the hapless participants, each with different issues but one thing in common, T2D. They are all victims of the current healthcare system. The course syllabus, from which the workshop facilitators READ VERBATIM, is based on the Chronic Disease Self-Management Program (CDSMP) developed by Stanford University. The homework assignment for workshop #2 was to read the “food guide” in the text and learn about “healthy eating.”  It is based on is the “Dietary Guidelines for Americans,” as illustrated in the book by ChooseMyPlate.gov, and the American Diabetes Association’s, “Create Your Plate.”
The Dietary Guidelines “Choose My Plate’ plan is ¼ fruits, ¼ vegetables, ¼ grains and ¼ protein, with dairy in a bubble. No fat. The ADA’s “Create My Plate” plan is ½ non-starchy veggies, ¼ starchy foods, and ¼ meat or meat substitute, with 8 oz non-or-low fat milk. Clearly the US Department of Agriculture and the American Dairy Products Association had a hand in developing these essentially identical plans, helped by Big Pharma and Big Food Producers. How all this corruption co-exists is explained in “Root Causes” by Jason Fung, MD.
The penultimate task of the workshop was to come up with an individual Action Plan for the coming week. Mine (I was last again) was two 36-hour total fasts, on alternate days, until I lost the weight I had gained since my last annual doctor’s visit. On the other 5 days I would eat Very Low Carb/One Meal a Day (VLC/OMAD). 
At the conclusion of class, we were all asked for our impression on how things had gone. I think Dum and Dee were hoping to get feedback that we all felt better after having attended our first group therapy session. Once again last to speak, I commented that I thought it odd that most people’s “Action Plans” were to exercise more. “After all,” I said, “diabetes is a dietary disease.” Tweedle Dum responded, “Well, everyone’s different.”
If you click on both “Plate” links above, you will get a visual image you won’t forget. Americans have been following these guidelines and the incidence of diabesity has skyrocketed. Ask yourself if anyone in this workshop will have any hope of self-managing their disease. I think the only thing that this “self-management” program is designed to achieve is acceptance of their feelings. That is truly sad.

Sunday, November 18, 2018

Type 2 Nutrition #459: My new favorite snack

I’ve been mentoring a recently diagnosed type 2 about what and when to eat, and not eat. I’ve told him that when you eat Very Low Carb (VLC), you won’t be hungry much, and you should skip meals if you’re not hungry. When you eat VLC, your blood glucose drops and your blood insulin drops too, so you can access and burn body fat. That’s why you’re not hungry. Your body is being fueled by your own stored energy.
So, in general you won’t need to snack for energy, but they are other reasons we snack. We all (most of us) do it, some of us habitually. I usually snack in the late afternoon, before supper, and when I do my favorite new snack is celery with anchovy paste. Celery is low calorie – just fiber and water – and filling. On each bite I add a dollop of paste, squeezed directly from the tube, for savor. But when my mentee tried it, he said, “It’s salty!”
It is salty, of course. Very salty. That’s why I like it. But to a newbie, salt is yet another “forbidden fruit.” For decades we were told to avoid fat, especially saturated fat. Now we know that government’s advice to avoid fat was a mistake. As a result, the Powers that Be in the 2015 Dietary Guidelines omitted the recommended 30% limit on fat. It’s now officially okay to eat more fat (and fewer carbs), just not SATURATED fat.
But from my POV that just takes us from the frying pan into the fryer (LOL). The alternative to saturated is unsaturated fat, either monounsaturated, the “good” fat found most commonly in olive oil and avocados, or polyunsaturated (PUFAs). PUFAs are highly refined and processed “vegetable” (seed) oils – corn oil, soybean, Canola, and sunflower, etc. – that easily oxidize when exposed to light and heat (the fryer). Think French fries.
Government is also slowly backing away from warnings about cholesterol, found in animal foods. Starting with the 2015 Dietary Guidelines, there is no longer a 300mg a day limit. However, the recommendation of the Dietary Guidelines Advisory Committee, that “cholesterol is no longer a nutrient of concern for overconsumption,” was largely ignored by the full HHS committee. They are, however, slowly coming to accept that our livers will make all the cholesterol our bodies and brains need, if we don’t eat it. Think vegans.
So, what’s wrong with eating salt? Nothing, unless you believe that the Public Health recommendation that everyone should eat less salt to protect the very few who have a rare genetic sensitivity to high levels of salt. The 2015 Dietary Guidelines have, however, also dropped the 2010 recommendation that Americans “reduce daily sodium intake to less than 2,300 milligrams (1 tsp salt) and further reduce intake to 1,500mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.” Think about half the U.S. population!
In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote an article, “The Dangers of Salt Restriction,” about a study in JAMA in 2011 that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day.” So, the lowest risk of death is associated with consuming from 267% to 399% more sodium than Type 2s or hypertensives or older adults were being “guided” to eat. I’ve been writing about salt since 2012. My column #74 cites Kresser and several other resources as well.
       Gary Taubes, “The (Political) Science of Salt,” and “Salt, We Misjudged You,” both also cited in #74.
       Eric Topol, MD, Editor-in-Chief of Medscape Medical News: “Dear Medscape Readers” (my #248)
       Then there’s this recent rant on the “salt scare” by Jason Fung, MD/IDM. It’s a no-holds-barred tirade!
       For “Tips and Tricks” on why Low Carbers should eat more salt to maintain electrolyte balance, Michael Eades, MD, has this link to his blog. Eades also explains the physiology. Please read these links about salt.
Losing weight and improving your general health and lipid profiles on a VLC diet will be more beneficial than living with mild hypertension. Ask your doctor if he or she doesn’t agree with this. Mine does, emphatically.

Sunday, November 11, 2018

Type 2 Nutrition #458: Is it time to clean out the pantry?


Of course, if you blame someone else for the food choices they made, by buying food you’re trying not to eat, you have another problem: taking responsibility yourself for the food you decide to put in your mouth. But we’re all human, as I’ve said, and I’ll have to admit it is sometimes hard for me not to eat the food I’m trying to avoid IF IT’S AROUND ME ALL THE TIME (especially in open boxes, containers and bags), or worse JUST SITTING ON THE COUNTER. Most of my neurotransmitters still work. Have you heard about the cephalic response?
But the fact is, “if you live alone…the only food in the house is the food you bought” includes a vestigial accumulation of “before” foods. In transitioning from eating the Standard American Diet (SAD) to eating Very Low Carb, you still have goods in your pantry (and frig) that remain from those halcyon days of yesteryear when you ate processed foods and sweets to your “heart’s content” (!!!), or more correctly to satisfy your brain’s addiction to foods developed and produced to addict you to them. When you blamed yourself for that, you called it a “craving.” It’ll be awhile before you’re weaned off them and realize you no longer want them.
Until that time you need to take steps to reduce the temptation to stray from the course you have set for yourself. The Way of Eating you have chosen may seem difficult at first, and confusing until you learn when and what to eat, and not eat, but you will eventually sort this out. When you follow a Very Low Carb (VLC) Way of Eating for a period of time (the length varies), and you lower your blood insulin and deplete your liver glycogen supply of stored glucose, you will transition to being a “fat burner.” You will not be hungry then.
But, if you’re like me, that doesn’t mean you won’t be tempted to eat carbs, both the highly processed ones and sweets. So, the best defense is a strong offense. You need to take charge. Clean out your pantry and frig of all things that might tempt you when you “raid” the kitchen looking for something to put in your mouth.
When you were a “sugar burner,” you were probably told you should eat 5 or 6 times a day, that you needed these infusions, or “snacks,” for energy.  That was true. When you followed the SAD, which is 55% to 60% carbohydrate, and you have Insulin Resistance (IR), your blood sugar goes up and down like a roller coaster, but your blood insulin level stays high (because of your IR). And because your blood insulin is still high, you don’t have access to your body fat for energy. So, you need to snack on carbs (or fat), for that “energy boost.”
But when you eat VLC, you’re not hungry. You have access to body fat for energy so you don’t need to snack. If you do snack, it’s just a bad habit. It’s time to face up to it. Eat only when you’re actually hungry, not caving to a bad habit when you’re not actually hungry. Eat only, at most, three small meals a day. Even two, or one (OMAD). EAT ONLY WHEN YOU’RE HUNGRY. Your body will feed itself (on you) the rest of the time. It works.
So, start with the pantry. It will be cathartic, and it will boost your confidence that you have finally crossed the Rubicon and there’s no going back. You can probably throw out almost everything. Think of the space you will create! I started with the “vegetable” oils. They’re all oxidized and rancid anyway. And the Crisco (trans fats).
If you have unopened jars of jelly or honey or boxes of sugar, donate them to a food bank. Virtue signaling will make you feel good.  Fill a garbage bag with open containers from the pantry and frig. That’s what all the sugar-filled, processed “foods” are anyway. Garbage. The exercise of clearing away the past and preparing to go forward into a future that you have envisioned for yourself is very Jungian. It’s the kind of self-therapy that supports the future you have chosen for yourself, a future in which you self manage your type 2 diabetes by treating this disease for what it is: A DIETARY DISEASE. You can eat your way out of it…by eating VLC.





https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

Sunday, November 4, 2018

Type 2 Nutrition #457: One foot in two lifeboats…

If you’re recently been diagnosed with type 2 diabetes (T2D), you may feel like you’re lost at sea with one foot in two lifeboats, each pointing in opposite directions. It’s time to make a decision: Which lifeboat do you take?
One lifeboat is occupied by others like yourself and is led by the ship’s captain, who brought you to this point. The other lifeboat has survivors as well…and just a boatswain’s mate to guide you safely to shore. But you can only take one lifeboat. Will it be the captain’s lifeboat or the boatswain’s mate’s lifeboat? How do you decide?
The captain has a lot of education and experience. He’s a commissioned officer and the ship’s master. He is “ultimately responsible for aspects of operation such as the safe navigation of the ship, its cleanliness and seaworthiness, safe handling of all cargo, management of all personnel, inventory of ship's cash and stores, and maintaining the ship's certificates…,” according to Wikipedia. We have confidence in our captain, right?
A boatswain’s mate has the rate of petty officer and also has acquired lots of knowledge and experience, but of a more practical nature. “Boatswain’s mates take charge of working parties; perform seamanship tasks; act as petty officer-in-charge of picket boats, self-propelled barges, tugs, and other yard and district craft,” Wiki says. In other words, a boatswain’s mate has the experience and navigational skill to coxswain a lifeboat.
Which “lifeboat” should you take? Well, the “ship” that brought you here…has sunk. It failed you and all those who followed the McGovern Committee’s Dietary Goals for Americans, published in 1977, and the first Dietary Guidelines for Americans in 1980. The “Titanic” (see my #12 here) first set sail in the 50’s with Ancel Keys’s infamous “Seven Country Study,” bolstered in 1961 when Keys joined the AHA board and was on Time’s cover.
You could get into the “captain’s” lifeboat. He will utilize all the skills he learned in medical school to diagnose and treat your symptom, an elevated blood sugar. He will counsel you to lose weight; he will suggest “diet and exercise” and his healthy fats.” And he will tell you to do what you have always done on this ill-fated “cruise,” just “eat less and move more.” And if that doesn’t work in a few months, (s)he will start writing prescriptions.
This “boatswain’s mate” will steer you in a completely different direction – one that deals not with a symptom (high blood sugar) but the cause of type 2 diabetes,  a dysfunctional metabolism. Instead of encouraging you to eat a “balanced,” “mostly plant-based” diet, high in refined carbs, sugars and “vegetable” (seed) oils, you will eat a Low Carb diet, with moderate protein and high fat, including saturated, to guide you safely to shore.
But as you can see, I have a bias. I lived the “high life” on the Titanic for 61 years. But I am among the lucky survivors who chose the “boatswain’s lifeboat.” After I made my decision 16 years ago in 2002, I lost 187 pounds) and recently had an A1c of 5.0%. I started my journey to remission and reversal of T2D by strictly eating just 20g of carbs a day. Within a week(!), I got off most of the anti-diabetic medications I was on.
My “coxswains” were mostly on on-line forums; I owe so much to them for their support. Today there are lots of special online support groups. I think the best is DietDoctor.com (subscription: $9/mo.); they get more visitors in 1 day than I’ve had on my blog in 8 years. My favorite books are "The Obesity Code," by Jason Fung, "The Art and Science of Low Carbohydrate Living," by Volek and Phinney, and "Blood Sugar 101," by Jenny Ruhl.
Of course, I’d like it if you decided to read my blog regularly. I publish once a week on Sunday mornings. I have a great editor who helps me make it readable and keeps me honest. She’s so much more qualified than I am, and in so many areas of health and wellness. I am so lucky to have had her help for all these years. As you can see, we do this without advertising. We don’t want or need ad revenues so we don’t sell or promote anything except an idea. After the disastrous voyage you’ve been on, we know that all YOU have to do now, to make it to shore safely, is to be in the right lifeboat and make smart, informed decisions about what to eat and when.

Sunday, October 28, 2018

Type 2 Nutrition #456: “Why am I taking insulin?”

You’re a newly-diagnosed type 2, and you’ve proved to be intolerant of a couple of oral prescription meds, so you’ve been prescribed a basal (once-a-day) insulin injection to lower your blood glucose levels. You know this, but it seems to contradict the advice you’ve heard that the dietary goal of eating Very Low Carb (VLC) to self-treat type 2 diabetes is to lower your blood insulin, so you ask, “How will this “lower your blood glucose?”
Treating an elevated blood glucose with injected insulin will lower your blood glucose, temporarily, but by continuously keeping your blood insulin level high, with a long-acting (24hr) insulin, 1) your insulin will “progress” to larger doses, 2) your Insulin Resistance will worsen, leading to the dreaded complications, and 3) you will gain weight – remember, “insulin is the fat storage hormone.” And that’s the establishment’s advice.
You reply, “So If reducing insulin according to this is the answer, then more sugar will be channeled into the bloodstream.” Do you see the fallacy? You’re making a logical error. “More ‘sugar’ [glucose] will be channeled into your blood stream only if you eat more ‘sugar’ [carbohydrates]. On a VLC diet, you eat far fewer carbs.
If you are eating far fewer carbs, your blood glucose and blood insulin will both naturally lower, because endogenous insulin (secreted by the pancreas) is the transporter of glucose in the blood. But if you are injecting a long-acting insulin, your blood insulin level will remain high all day and night, even as your blood glucose level comes down. Eventually, if you eat VLC at all meals, your blood glucose level will be so low that you will have to reduce the amount of insulin you inject to prevent hypoglycemia (too low blood sugars).
If you don’t eat VLC and continue to inject insulin (the establishment way), you will have all the consequences described above: 1) worsening IR, 2) higher insulin doses and later complications, and 3) weight gain.
So, you’re “taking insulin” now to lower your blood glucose because your doctor knows that untreated high blood glucose is very dangerous for your health, long term. She is treating your symptom (high blood “sugar,” caused by Insulin Resistance). By self-treating your disease at the cause, a diet high in “sugars” and refined carbs, your aim is to reverse the metabolic dysfunction caused by your diet and put the disease in remission.
And you can do it yourself.  Here’s how: 1) accept that you need to change your “lifestyle” (at least with respect to what and when you eat), and 2) learn about carbs and other things that raise your blood sugar, 3) commit to adopt this Way of Eating, and then, 4) #justdoit. This last is perhaps the hardest, but there’s lot of help out there: mentors, books, blogs, and Facebook pages and groups. For the last 16 years I’ve used them all, to great advantage.
Two of the very best websites are 1) Andreas Eenfeldt’s www.dietdoctor.com (500,000+ subscribers) and 2) the Intensive Dietary Management (IDM) program run by Megan Ramos out of Jason Fung’s Toronto office. Fung’s book, “The Obesity Code,” is one of my favorites. Another: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney. Another, Richard Feinman’s, “The World Turned Upside Down.” All good reads.
Two programs I can recommend are Eric Westman’s healclinics.com at Duke Health, and Phinney and Volek’s Virta program (virtahealth.com). Eenfeldt, Fung, Phinney and Westman are MD’s. Volek is a widely published PhD exercise physiologist, Feinman is a PhD researcher/activist, and Ramos started out as Fung’s patient.
Tweeters I try to follow include: Nina Teicholz (@bigfatsurprise), Franziska Spritzer (@lowcarbRD), Dr. Eric Westman (@drericwestman), Dr. Feinman (@DrFeinman), Dr. Zoe Harcombe (@zoeharcombe), Dr. Jason Fung (@drjasonfung), Dominic D’Agostino (@DominicDAgosti2), Andreas Eenfeldt (@DietDoctor1), Thomas Dayspring (@Drlipid), Tim Noakes (@ProfTimNoakes), Tom Naughton (@TomDNaughton), gary taubes (@garytaubes), Georgia Ede MD (@GeorgiaEdeMD), Adele Hite (@ahhite), Marika Sboros (@MarikaSboros), Dr. Jay Wortman (@DrJayWortman), Amy Berger (@tuitnutrition), Dr. Aseem Malhotra (@DrAseemMalhotra).

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.