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!

Sunday, July 1, 2018

Type 2 Nutrition #439: “The Drinking Man’s Diet”

Everyone of a certain age has heard of “The Drinking Man's Diet.” But what do you know about it? I asked a friend recently if she knew what kind of diet it was. She shrugged and said something like, “It’s a diet in which you drink alcohol?” I said I thought so too, but we both missed the gist of it. It was the first (modern) low carb diet!!! And at 60 grams of “carbos” a day, it was pretty low carb! It might even be called a Very Low Carb diet.
First published in 1964, in 2 years “The Drinking Man’s Diet” sold 2.4 million copies at $1 apiece.  On the jacket of the 50th Anniversary Edition, it proudly proclaims, “THE ORIGINAL LOW-CARB DIET.” The subtitle is, “HOW TO LOSE WEIGHT WITH A MINIMUM OF WILLPOWER.” These are still both accurate claims!
On the occasion of the publication of the 40th anniversary edition (2004), Forbes Magazine did a column on the book and its author, Robert Cameron. Forbes described Cameron (who wrote using a nom de plume), as a San Francisco bon vivant whose brilliant title explains the book’s success, as well as how we were misled by it. The drinking aspect of the contents and title was just a gimmick. The diet works just as well for “teetotalers.”
The following quotes are taken from “The Drinking Man’s Diet,” 50th Anniversary Edition:
“This really is a simple diet. It can be summed up in one sentence: Eat no more than 60 grams of carbohydrates a day. That’s all there is to it.”
So what is a carbohydrate? As you will learn in this book, “Carbohydrates are concentrated in starches and sugars. They are almost absent from hearty foods like meat, fish, poultry, cheese and salads (yes, even the usually forbidden salad with Roquefort dressing is okay.)”
“Now, is it hard to count grams of carbohydrates? No, with the aid of tables at the back of this book you will find it very easy. The tables are derived from publication (sic) of the U. S. Department of Agriculture.”
“What makes this kind of counting more enjoyable as well as easier than calorie counting is that most of the things you like best don’t have to be counted at all: steak and whiskey, chicken and gin, ham, caviar, paté de foie gras, rum and roast pheasant, veal cutlets and vodka, frog’s legs and lobster claws, all count as zero.”
“Remember, you must count everything. A few innocent-looking dates or raisins in the afternoon can fill up your quota for the day. A slice or two of French bread might make your daily carbohydrate ration, but half a dozen slices would be a disaster. But with the great bulk of your diet – the meat and fish, the eggs and fats – counting at very close to zero, you really shouldn’t have much trouble keeping the total down around sixty.
The Forbes piece recounts how Dr. Frederick Stare, who in 1942 founded Harvard’s School of Public Health, had decried Cameron’s diet as unhealthful –calling it “mass murder,” which he later retracted. The accusation, however, ran everywhere on Page 1 and, as Forbes quipped, “…the drinking man’s goose was cooked.”
Robert Cameron wrote this pamphlet nine years before Dr. Robert Atkins’s (in)famous, “The Diet Revolution.” Atkins faced similar charges from the public health establishment. The American Medical Association, in public testimony at a congressional hearing, ridiculed and humiliated him, calling his diet “a dangerous fraud.”
But the diet worked. In two months, Cameron says he lost 18 pounds, “…was never hungry, and never missed a martini.” Cameron wrote, “Most everyone has a drink now and then,” and “alcoholic beverages such as gin, whiskey and vodka do not contain carbohydrates. Therefore, it allowed them to lose weight without giving up a daily cocktail.” Thus his 1964 pitch: “Did you ever hear of a diet that was fun to follow? A diet that would let you have two martinis before lunch (how 1960s!), and a thick steak generously spread with Sauce Béarnaise?”
The carb tables in this book, like the word “carbo,” are dated and unreliable, but the principles are still good.

Sunday, June 24, 2018

Type 2 Nutrition #438: Two Degrees of Separation

In Type 2 Nutrition #437, “Heading toward the cliff,” I described how standard clinical practice 1) treats type 2 diabetes as a progressive disease of insufficient insulin (not unlike type 1 diabetes) and 2) typically uses both oral and injected meds to “activate your body to release its own insulin.” This is still done with sulfonylureas, which should have fallen out of favor as documented in #437. However, a new once-a-week injectable medicine promises to do the same – to “activate your within” to “release its own insulin.” That’s a bad idea.
Why? Because it is a treatment that is designed to address a symptom of type 2 diabetes, an elevated blood sugar, and thus is a treatment TWO degrees removed from the cause of the disease: INSULIN RESISTANCE. This treatment increases insulin either from “your within” (your pancreas) or, with disease progression, direct injections of insulin. To be sure, increasing insulin will lower your blood sugar… but at what cost? You’ve beat up (wasted) your pancreas and become an “insulin dependent” type 2. That is the WORST thing you can do.
A better treatment, just ONE degree removed, would be to take a med that suppresses unneeded/unwanted glucose production by the liver and improves your insulin sensitivity (the opposite of Insulin Resistance). That medicine is Metformin. If the dosage is titrated (started low dose and slowly increased), the gut tolerates it well. It has virtually no other side effects and some salutary effects not yet fully understood.
By lowering glucose production and facilitating glucose uptake at the cellular level, this treatment approach accomplishes the same goal (lowering blood glucose) without putting any stress on your already overworked pancreas. This treatment is thus one degree closer to the cause of your type 2 diabetes: Insulin Resistance
The best treatment, a DIRECT treatment, then would be one that doesn’t cause your blood glucose level to rise in the first place. But, remember, you have Insulin Resistance. Because of a genetic predisposition and a diet very high (60%+) in carbs, especially refined and processed carbs and simple sugars for many years, your body developed resistance to high levels of blood insulin.
Refined and processed carbs are the worst; they’re almost all glucose. At least cane sugar is half glucose and half fructose. (Fructose is processed by the liver to become either glucose, or if your liver is full of stored glucose, via lipogenesis into body fat. Besides added pounds, this produces its own set of problems, not least of which is NAFLD, non-alcoholic fatty liver disease or worse, NASH, non alcoholic steatohepatitis.)
So, if you have Insulin Resistance, how do you prevent an elevated blood glucose? Clue: It’s NOT a drug, so your doctor can’t write a script. It’s a patient-directed treatment. Don’t eat foods that digest quickly and easily to glucose. If you don’t eat foods that convert to glucose, your blood “sugar” cannot become elevated!
Those foods would be 1) the refined and processed foods and the so-called “complex” carbohydrates (a criminal misnomer if ever there was one), which become virtually 100% glucose when digested; and 2) the simple sugars, like sucrose (cane sugar), lactose (as found in milk and yogurt), and maltose (as in breads).
As bad as table (cane) sugar is, (and honey and maple syrup and agave), most yogurts are worse, especially the non-fat ones. In place of fat, sugars and other carbs are added, and then fruit (nature’s candy bar) and fruit syrup. And breads! Besides, flour (a highly processed carb), and water, the third ingredient in almost every loaf of bread is sugar. Even those “sprouting” breads are maltose, a disaccharide (double sugar), all glucose.
So, you can (WORST: 2 steps removed) beat up your pancreas by taking a sulfonylurea or a once-a-week injectable that does the same thing, or you can (BETTER: 1 step removed) take Metformin to suppress unwanted glucose, or you can (BEST: directly address your IR), by eating fewer carbs, to keep your blood glucose level lower and stable, and avoid 1) having to take more meds and 2) “the dreaded complications.”

Sunday, June 17, 2018

Type 2 Nutrition #437: Heading for the cliff

The most memorable scene in the 1991 feminist comedy, “Thelma and Louise,” is at the end.  Let me set the scene: Being chased across the desert by a dozen cop cars, with a cliff in front of them, Thelma says to Louise, “Okay, listen; let’s not get caught.” Louise replies, “What’re you talkin’ about?” Thelma replies: “Let’s keep goin’! Louise: “What d’ya mean?” Thelma: “Go” [nods ahead of them]; Louise: “You sure?” Thelma: “Yeah.”
Now, juxtapose this dialogue, the action that follows, and the consequences, with a current TV commercial for a once-a-week injectable drug to “activate your within.” This drug works, they say, to “help activate your body to release its own insulin.” Why? Because “diabetes can be hard to manage. It’s important to remember that diabetes is a progressive disease, which means it usually changes over time. And when it changes, your doctor might have to change your treatment as well.” In other words, as Thelma said, “Let’s keep goin’!”
But, the pharmaceutical company counsels you, “You are not alone. Millions of people are living with diabetes and going through some of the same things you are.” Now, the image in my mind changes. Imagine you are among millions of lemmings heading for the cliff. “What are you talkin’ about,” you ask? “What d’ya mean?” Well, by the time you’re a candidate for this injectable medicine, you’ve already followed in the footsteps of the lemmings who take oral antidiabetic medicines, like sulfonylureas (see below) and have now “progressed.” Remember, in the ad, you’ve been assured: “Diabetes is a progressive disease,” and “You’re not alone.”
The medical dogma is that progression of type 2 diabetes from Impaired Fasting Glucose (IFG) to Impaired Glucose Tolerance (IGT), to frank type 2 diabetes is a gradual, decades-long continuum. Ralph A. DeFronzo, described it 10 years ago in his Banting Award keynote speaker at the 2008 American Diabetes Association meeting.  I chronicled DeFronzo’s remarks 5 years ago in this column, “Natural History of Type 2 Diabetes.” 
 A hyperlink in my old post will take you to the paper in the ADA’s “Diabetes” in which DeFronzo’s states, “Sulfonylureas are not recommended because, after an initial improvement in glycemic control, they are associated with a progressive rise in A1C and progressive loss of β-cell function  Why is this relevant? Because this new injectable drug “activates your body to release its own insulin.”
Sulfonylureas (SU’s) lower blood glucose “by stimulating insulin release from the Beta cells of the pancreas.” The current generation of SUs, still popularly prescribed, include the glimepiride (Amaryl), glipizide (Glucotrol and Glucotrol XL), and glyburide (Diabeta, Micronase, and Glynase). In the paper cited, DeFronzo says,
“Insulin resistance in muscle and liver and β-cell failure represent the core pathophysiologic defects in type 2 diabetes. It now is recognized that the β-cell failure occurs much earlier and is more severe than previously thought. Subjects in the upper tertile of impaired glucose tolerance (IGT) are maximally/near-maximally insulin resistant and have lost over 80% of their β-cell function” (all emphases added by me).
So, if (repeating myself), as Defronzo says in the first paragraph of his seminal paper in the ADA’s “Diabetes,”
“Sulfonylureas are not recommended because, after an initial improvement in glycemic control, they are associated with a progressive rise in A1c and progressive loss of β-cell function” (emphasis added), then…
Why, pray tell, if you may already have lost 80% of your pancreatic β-cell function on the drugs you have been taking for years, why would you “progress” to a drug that will ACCELERATE the loss of your remaining β-cells?  Wouldn’t that be like Thelma and Louise deciding to drive over the cliff? Quoting Louise, “Are you sure?”
Or could it be that the maker of this new medicine, Lilly, has you covered? It’s also makes and sells insulin, a drug with price increases at 10x the rate of inflation.  Now that’s acceleration!

Sunday, June 10, 2018

Type 2 Nutrition #436: “Science advances one funeral at a time.”

My subject’s photo, below the sub-header “Helped America Eat Better,” stares me in the face every day when I sit at my laptop. My computer shares a table covered with a NYT’s obituary page and a harpsichord keyboard I am fine tuning. It is both prophetic, and motivational; I am inspired to unload a little on “the state of things.”
My parents taught me to “never speak ill of the dead” so, while I’m going to violate that aphorism with this piece, I will not be hurtful to the departed personally. Before you say, “Bless your heart,” know that my feelings – my enmity, really – toward the myopic vision of my subject, heralded by the NYT with an 18-column-inch obit, is that society still viewed him in such an exalted status as late as 2017. This man, like so many of his colleagues, actually failed to lead us to “eat better.” But the NYT piece was an obituary, not an op-ed.
I am reminded of one of my favorite last lines in a movie. It is Joey Brown’s in “Some Like It Hot” (see this YouTube video excerpt). Brown proposes marriage to Jack Lemmon, cross-dressing to avoid a mafia hit squad. Lemmon replies in exasperation that he’s in fact a man, to which Brown replies, “Well, nobody’s perfect.”
From the obit: This doctor, a “surgeon, clinician, researcher, teacher and author, was pre-eminent in the study of obesity and nutrition.” Besides his medical degree, he held a doctorate in nutritional biochemistry from MIT and “largely spent his career at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.” He was professor of nutrition at Harvard, and at Beth Israel was the chief of Nutrition/Metabolism Laboratory and Director of the Center of Nutrition Medicine. He was at the apex of the “nutrition establishment.”
Yet, “what really put him and his colleagues on the world map were publications highlighting inadequate nutritional management of people in the hospital – so-called ‘hospital malnutrition,’” said a former colleague. How did he do that? “He helped develop nutritious liquid diets (Ensure, and others), supplementing them with protein…” In other words, he and Harvard profited handsomely from this misguided commercial collaboration.
He also correlated poor nutrition with obesity – a no-brainer there, but note again this habitual dependency of Harvard nutrition “experts” on epidemiology, or “correlation,” rather than a scientific interest in “causation.” His solution: “Advocate lower-fat diets and help develop gastric by-pass surgery and nutritional liquid diets.”
I’m not suggesting that this good doctor had a Mephistophelean streak; I’m sure he intended well, but like Ancel Keys before him, and others still in positions of  influence (e.g. Walter Willett at Harvard), he rose to power in the politics of the academy by buying into the “eat-less, exercise-more, a calorie-is-a-calorie” meme that is only now beginning to show wear at the edges because of the weakness of the scientific evidence.
His obituary writer noted that “weight loss benefitted patients with type 2 diabetes.” Now, there’s a scientific breakthrough! His obituary also described five strategies the good doctor “developed during four decades of encouraging patients to shed pounds: 1) Make time to prepare healthy meals, 2) Eat slowly, 3) Consume evenly sized meals, beginning with breakfast, 4) Do not skimp on sleep, and 5) Weigh yourself often.” Not bad advice, but pretty banal accomplishments, if you ask me. Forty years of “encouragement…to shed pounds.”
I also think that evenly sized meals sounds too much like “balanced” to me. And nutritious liquid diets like Ensure, even if supplemented to 15% protein, are still 60% highly processed carbohydrates. “Carbohydrates” are not mentioned even once in the entire 2-columned obituary. The emphasis instead is on calorie intake: “Even a small decrease in caloric intake could result in healthier weight,” he is quoted as saying. He summed it up: “Sustained weight loss requires a three-pronged approach: Cut the calories, eat quality food and exercise.”
As Max Planck, the German Nobel-prize winning physicist said in 1906, “Truth never triumphs; its opponents just die out.” Another paraphrased variant is, “Science advances one funeral at a time.” May he rest in peace.

Sunday, June 3, 2018

Type 2 Nutrition #435: Hungry or Undernourished?

“Hungry or Undernourished?” is what I would call a BIG question. It is way out of my league to propose a scientific answer or even describe the parameters of a proper study. I will venture, however, to tackle the matter as an opinion piece: I think it can be parsed into at least two different lines of reasoning, and I will attempt to posit and briefly explore them. I welcome informed comments from my erudite readers.
The first line of reasoning in the “hungry or undernourished?’” debate is that we will eat until our stomach is full. This is the “common sense” hypothesis; we have all experienced it. When we are “full,” hormones signal us to stop eating. Of course, there are exceptions. We sometimes continue to eat for other reasons. I’m a compulsive peanut eater. There’s also taste and palatability. See this link to carbohydrate-induced overeating (in rats). Lay’s potato chips captured this with the memorable meme, “Bet you can’t eat just one!”
There is a large body of new evidence that the “until full” hypothesis is hormonal. Hunger is regulated by the hypothalamus in the brain which gets signals to induce eating from ghrelin, a hormone produced in the lining of the stomach, and shuts down when another hormone, leptin, signals that hunger has been satisfied. Ghrelin was only discovered in 1999 and appears to have other functions as well. And “leptin resistance” as a cause of obesity is still a mystery. So, this is why the hormonal hypothesis of “eating until full” is also just a hypothesis.
The other line suggests that hunger drives eating until the body has met its requirements for essential nutrients. I know this sounds like a tautology and needs more explanation. It is, of course, more nuanced but at this point in the state of nutrition knowledge, the science is unknown. The theory is that what we eat, not how much, determines when the body is satisfied and hunger stops. Ergo, if your diet consists of nutrient-poor components, aka processed carbs, you will need to continue to eat until your body gets everything it needs.
These essential nutrients or components include the macronutrients and micronutrients. The macros are fats (fatty acids, SFAs, MONOs and PUFAs), proteins (and their 22 amino acids, into which protein breaks down), and carbohydrates, (none of which – repeat, none, are essential). The micronutrients are vitamins, minerals and phytochemicals, many as yet unknown.
My recollection is that this second line of reasoning is suggested in such very good books as “The Perfect Health Diet,” by Paul and Shou-Ching Jaminet, and Catherine Shanahan’s “Deep Nutrition.” It is a rational hypothesis, and I am biased in favor of it in part because the known science about the different fats and the amino acids has pretty well established how important they, or their absence, are to human health.
It also appeals to me because it supports the idea that all dietary carbohydrates, while a good source of quick energy, are not essential nutrients in the human diet. When carbs are not available to eat, our bodies are designed to make all the glucose it needs from protein and fat, through gluconeogenesis. The body also produces ketone bodies (brain food) from fat, and it gets glycogen, to make glucose, from storage and from the animal products we eat (intramuscular, subcutaneous, and from organ meats like liver). Admittedly there still isn’t a lot of hard evidence to support this hypothesis. Philosophically, though, it appeals to me.
If I had to guess, I’d hedge my bet by speculating that the answer ultimately will involve or combine these  hypotheses. In the meantime, we can be guided by what we “know” and eat with the knowledge that bodies will determine how much we need to eat and what a healthy diet is. I find my body likes it best when I eat mostly “healthy” fats (saturated and monounsaturated), and moderate amounts of protein from pastured meats and poultry and wild-caught fish. I try my best to avoid polyunsaturated fat (vegetable oil) altogether and since I am Insulin Resistant (32 years a diagnosed type 2 diabetic), I eat as few carbohydrates as possible.

Sunday, May 27, 2018

Type 2 Nutrition #434: Watch out! Your doctor thinks he/she knows about nutrition

“Do you discuss nutrition with your patients?” the Tufts Friedman School of Nutrition Science and Policy survey asked physicians. Three-quarters of them replied “always” or “most of the time.” “Do you feel qualified to talk about nutrition with your patients?” Again, 3 out of 4 said, “Yes.” To which I say, “Watch out!”
I have cause to be concerned. The Medscape article which reported the findings links them to two pieces: 1) A “recent study” that “associates…a sub-optimal diet” with “a substantial proportion of deaths in the United States due to heart disease, stroke and diabetes,” and 2) another that nudges physicians to “know what advice to give.” It couches this advice as “evidence-based nutritional advice” to help healthcare professionals deal with “information overload” on diet and nutrition. The whole point – the pretext for the Tufts “survey” – was  to “educate” physicians and other healthcare professionals with that advice, i.e., their agenda-driven POV.
I agree there’s an association of “heart disease, stroke and diabetes” with a sub-optimal diet…a very strong association. Deaths from heart disease and stroke are much higher among type 2 diabetics and “pre-diabetics.” This association has led to the phrase “cardiometabolic disease” (CMD). But, again, on which diet did they become diabetic and develop heart disease? The Tufts answer (“evidence-base”) is just “association.”
The study was presented at the American Heart Association Epidemiology and Prevention-Lifestyle and Cardiometabolic Health (EPI-Lifestyle) 2017 Scientific Session. The findings were also commented on in Medscape by researchers from the Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention Epidemiology. More epidemiologists! Epidemiology suggests hypotheses, not cause and effect!
Why is that significant? Because epidemiology can only address “associated with” and “related to” findings. But that does not deter them. This “poor diet” link, using “comparative risk assessment models,” estimates that 45% of cardiometabolic disease (CMD) deaths were “associated with” 10 dietary factors, and that these factors have “‘probable or convincing evidence’ for causality” (my emphasis). Epidemiologists are shameless in their reckless disregard for a basic tenet of the scientific method: Correlation does not imply causation.
The “10 dietary [death] factors” ranged in descending order from a high of 9.5% for 1) salt (“excess sodium”), to 2) low intake of nuts/seeds, 3) high intake of processed meats, 4) low seafood omega-3 fats, 5) low intake of vegetables, 6) low intake of fruits, 7) high sugar-sweetened beverages, 8) low intake of whole grains, 9) low intake of polyunsaturated fats and finally, at 0.4%, to 10) high intake of unprocessed red meats. Hmmm… Zero point four percent does not strike me as statistically significant, but I guess they just had to include red meat.
We can also be grateful that a low intake of polyunsaturated fats (corn oil, soy bean oil, etc), at 2.3%, ranked only 8th on the list. A higher intake, as they advocate, would, IMHO, only have raised the risk of death greatly.
This is what your doctor, if (s)he was not on the golf course, is learning and says (s)he knows about nutrition. To relieve “information overload,” Tufts gives these 6 educational talking points from the “advice to give” link.
       Choose foods with a wide variety of colors and textures, in their most natural forms. [check]
       Avoid or dramatically minimize processed foods. [check]
       Choose realistic, balanced [not low-carb] diets for weight loss and weight maintenance.
       Consume healthy oils for heart health: fish, olive, avocado. [good, all MONOs, no mention of PUFAs]
       Forego red meat [saturated fat] and live longer [a little editorializing? They just couldn’t resist!].
       Consume fermented foods/probiotics and fiber for gastrointestinal and overall health. [check]
This is just the Government’s plant-based, one-size-fits-all, Mediterranean diet. It doesn’t mention carbs or type 2 diabetes, and if you are currently lean and healthy and ate this way, you could stay healthy. For the rest of us, balanced would need to be carefully defined, and avoiding all polyunsaturated vegetable oils stressed. Personally, though, I would rather embrace carnivory than give up red meat for a 0.4% increase in CMD death.

Sunday, May 20, 2018

Type 2 Nutrition #433: “Lifestyle Programs ‘Could Prevent Diabetes’”

My heart skipped a beat when I saw, in Medscape Medical News, the header, “Lifestyle Programs 'Could Prevent Diabetes.” Had the medical establishment finally come to accept type 2 diabetes as a dietary disease? Had they decided to repudiate the awful advice they’ve been dishing out for half a century and finally effectively address the raging epidemic of obesity, type 2 diabetes and related diseases increasingly plaguing our world?
Or, at the very least, had they perhaps figured out a way to finesse the bad advice for treating these diseases by advocating an intervention before the diseases were firmly established. That would be a brilliant strategy that would in effect, to use an American football metaphor, be an “end run” to evade the usual “middle-of-the-line” defenses. While hope springs eternal, my hopes were soon dashed. It was neither of the above.
The story was just about “updated guidance [that] will give clinicians the confidence to make prevention their priority, indentify those at high risk, and refer them to the UK’s Diabetes Prevention Program.” It was a press release. It did, however, shed some interesting information on what the NHS considers “those at high risk.”
The NHS (National Health Service) is the British equivalent of US’s HHS. The Diabetes Prevention Program was started in 2016. Its crown jewel is the National Institute for Health and Care Excellence (NICE) pilot initiative to offer a place on “an intensive lifestyle change program” to “people who could benefit from advice on their diet and physical activity levels.” The program is currently scheduled to roll out across all of England by 2020.
“Nice says it is currently cost-effective to target people with a fasting glucose between 5.5—6.9 mmol/l [99—124mg/dl]. However, it says those with a higher reading (6.5—6.9mmol/l)[equivalent to 118—124mg/dl] should be prioritized for inclusion because of their increased risk of developing type 2 diabetes.” Geez! All of these people are at “high-risk”for type 2 diabetes. They all have Insulin Resistance and thus incipient T2DM!
Many clinicians and researchers concur with this “extreme” prognostication. Consider that in 1997 the ADA Standard for a medical diagnosis of type 2 diabetes changed from 140mg/dl (7.8 mmol/l) to 126mg/dl (7.0 mmol/l). Yet another change is long overdue. There is already a hue and cry to change the definition of “pre-diabetes,” first classified in 2002. (In Europe 6.1—6.9mmol/L or 110—125mg/dl; in the U.S.: 100—125mg/dl.
The Medscape “good news” spin in the header was inaccurate. It was notthe purpose of the NHS press release.” The NICE center’s director was more on point: “We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing type 2 diabetes.” But perhaps because it is OT to the rollout, he doesn’t explain exactly what those “simple changes” would be.
The story also points out that “(w)hile type 1 diabetes cannot be prevented and is not linked to lifestyle, type 2 diabetes is largely preventable through lifestyle changes.” Indeed! Largely preventable – even reversible – at  least in the sense that if you adhere strictly to specific diet changes, type 2 diabetes can be put into complete remission, that is, completely undetectable by a simple laboratory test such as a fasting glucose or an HbA1c.
To your doctor, that’s a cure! And when this disease is in remission, your risk of kidney failure, preventable sight loss, and amputation is de minimis. And your risk of heart attack and stroke reduced by 50% or more!
Diabetes UK’s head-of-care said, “We know that globally, diabetes prevention programs do work, and we know that with the right advice and support, people with increased risk of developing type 2 diabetes can take simple but significant steps to prevent the condition from developing.” The “right advice,” unfortunately was nowhere to be found in this document or in my search of the NICE site. Methinks perhaps it’s too hot a potato. Maybe they don’t want a “cure.” Maybe they just want a “treatable” condition… to keep the NHS in business.

Sunday, May 13, 2018

Type 2 Nutrition #432: “I’ve never had a hot flash”

Not me! My editor said this in a comment to a link she sent me. The full quote: “So thanks to Bernstein, I’ve never had a hot flash. I just thought it was luck!” She concluded, “…interesting, how it is always insulin and glucose control.” My editor was referring to the linked article, “Vasomotor Symptoms and Insulin Resistance in the Study of Women’s Health Across the Nation.” It appeared in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism. She routinely reads this kind of stuff. That’s why I want her as my editor (lol)!
“Vasomotor symptoms (VMS) are classic symptoms of the menopausal transition, experience by up to 70% of women living in the United States,” the abstract says. “VMS have important…implications because women reporting VMS consistently show poorer sleep quality, more negative mood, and impaired quality of life.”
The report drew on annual blood draws and questionnaires over 8 years from 3,075 women aged 42-52 at entry who participated in the Women’s Health study. Hot flashes/sweats were examined in relation to two metabolic factors used to define type 2 diabetes: glucose and the homeostasis model assessment (HOMA).
The study made adjustments for BMI (associated with IR), CVD risk factors, medications and hormonal status. It found that, “compared to no flashes, hot flashes were associated with a higher HOMA” and “were similar for night sweats.” “Findings were statistically significant, yet modest in magnitude, for glucose.”
Beyond the scope of this study, but of interest to the researchers, was the association of the link between menopausal hot flashes/night sweats (VMS) and cardiovascular disease (CVD). “The mechanisms underlying these associations are unclear, due to the incomplete understanding of the physiology of hot flashes,” the report says. The investigators then explored the relation between VMS and CVD from the two well-known studies: Women’s Health Initiative hormone therapy trial and the Heart and Estrogen Replacement Study.
These studies “showed an elevated risk for clinical CVD with hormone use among older women with moderate to severe VMS at baseline relative to women with no/mild VMS.” In addition, “In the Study of Women’s Health Across the Nations, VMS was associated with higher subclinical CVD.” But the findings were mixed. Other work has “examined the associations between VMS and CVD risk factors such as blood pressure.” But until now…
No work has examined the relation between VMS and fasting blood sugar and insulin resistance….” This study was well designed, testing the hypothesis with controls for race/ethnicity, CVD risk factors, body mass index (BMI), the reproductive hormones E2 and FSH, and menopausal stage. The take away for me was the association with BMI, which as mentioned correlates with IR. The researches here noted that the association “did not persist” after adjustment for BMI. In other words: “you lose the weight, you lose the risk.” Take note!
The report concludes, “Considering BMI in relation between insulin resistance and VMS is particularly important given that higher BMI is a potent risk factor for insulin resistance and is associated with greater VMS reporting in perimenopausal and early postmenopausal women.” So, eat Low Carb and get svelte, like my editor, while there’s still time.
Or, if it’s too late for you, ponder another statement from the study with respect to cognitive impairment. This citation “postulates alterations in glucose transport across the blood-brain barrier as a trigger for VMS.” Since glucose is the main brain fuel, and ketones are brain fuel only while eating VLC or during fasting when blood insulin levels are low and fat breaks down for energy, a decline in “glucose transport across the blood-brain barrier” leading to VMS could be problematic. Could ketones substitute for glucose in this way? As my editor observed, “…it’s always insulin and glucose control.” Would following Bernstein’s 6-12-12 or another Very Low Carb regimen enable you to say, “I’ve never had a hot flash”? Or even help a guy get slim and stay healthy?

Sunday, May 6, 2018

Type 2 Nutrition #431: May 9th, from a Russian Perspective

Fifteen years ago this week, I had an eye-opening experience…about perspective. As was my daily habit, on the way to work I stopped at a food cart to order breakfast: coffee with heavy cream and artificial sweetener, 2 fried eggs, plain, and 2 strips of bacon.
The cart was owned by a father and son who were post-1989 immigrants from Russia who were both excited to be taking a citizenship course. They quizzed me daily on American History and were always amazed that I correctly answered every question they put to me, except one day…
They asked me, “Do you know what day today is?” I said, “No.” They were both delighted. They’d stumped me! They said triumphantly, “It’s May 9th, the day that World War II ended!” I smiled and replied, “You mean it’s the date WWII ended in Europe.”  They both looked puzzled. I continued, “War continued in the Pacific.” There was a long pause while they thought about that, and then the son said, “Oh, you mean Vietnam!”
I had to explain that for the United States: WWII was fought on two fronts; that the Japanese had attacked the U. S. at Pearl Harbor, Hawaii, on December 7, 1941; and that the Pacific theater of the war didn’t end until August ‘45 when the U. S. dropped atomic bombs on Hiroshima and Nagasaki. Japan then surrendered, September 3, 1945, on what we call V-J Day. Americans refer to the end of WWII in Europe as V-E Day.
To a degree it’s understandable that Russians have a different perspective of WWII. U.S. military losses in 4 years of war on two fronts were only 5% of Soviet military losses in 4 years of war on one front. Every country has a chauvinist view of history, but there’s no denying that U. S. deaths, none on its own territory, were just over 400 thousand, whereas Russian military and civilian deaths, most on their own territory, were 27 million.
A similar disparity exists today in the battle over a healthy diet. The leaders of the public health and medical establishments, and the civilian population that follows their advice, are dying in droves from a multitude of metabolic diseases brought on by the diet they eat. This diet has produced an epidemic of obesity, type 2 diabetes, cardiovascular diseases, including stroke, Alzheimer’s disease, and increased prevalence of many types of cancer, particularly pancreatic cancer
The vast majority of these victims – both the leaders and the unwitting populace who follow them – are engaged in a losing battle. And the agri-industrial complex that abets them, by producing prodigious amounts of processed foods in accordance with the advice to eat less saturated fat, more Omega 6-loaded, processed vegetable oils, and a diet largely comprised of refined carbohydrates and simple sugars, is killing them.
I don’t blame the two Russian men for not knowing about the war the U. S. fought in the Pacific before and after V-E Day. Their government was justly proud of the enormous sacrifice the Soviet Union made to win WWII. Their government should be faulted, however, for educating them poorly. I doubt that they knew, for example, that U. S. industrial production provided huge amounts of war material in Soviet flag ships sent from the U. S. west coast to Vladivostok, free from Jap attack due to a Soviet -Japanese non-aggression pact!
Unavoidably, however, one must conclude that the outcome of the “healthy diet” battle will be determined by the leaders on the field of battle. If you continue to follow the government’s advice, and go into battle led by General Mills and General Foods, and make unhealthy choices, you will end up…well, up the (Battle) Creek.
 The U. S. had a definite advantage in WWII. We had two oceans to protect us, enormous natural resources, the industrial capacity to produce the means to fight, and the individual, human potential to meet the challenge.  Today, as individuals, we are faced with another challenge: to make the right choices about what to eat, free from influence from an inherently conflicted agri-industrial complex. You can still make a decision to improve your chance for survival in this battle. A new perspective can help you make that choice.