Sunday, December 30, 2018

Type 2 Nutrition #465, Diabetic neuropathic complications

If the subject matter of this post turns you off, good! I’m going to get personal, and I’m not especially fond of the idea of your reading about my bladder dysfunction. But the truth is, my urologist thinks, and my internist agrees, that as a 32-year type 2 diabetic, I may have begun to show a sign of diabetic neuropathy. His Dx: that I have a neurogenic bladder that appears to be responsible for a worsening eGFR. What’s that, you ask?
An eGFR, “estimated glomerular flow rate,” is a lab test of kidney function. It is a common marker for Chronic Kidney Disease (CKD) and is evaluated on a scale of declining kidney function (5 stages ending with end-stage kidney disease, and renal dialysis. That “complication” is called nephropathy, the second of three possible microvascular complications  of long-term type 2 diabetes. The third is retinopathy (leading to blindness).
So, what is a normal eGFR? According to Wikipedia, the National Kidney Foundation defines, “a normal GFR for adults as greater than 90 mL/min/1.73m2.” “Because the calculation works best for estimating reduced kidney function, actual numbers are only reported once values are less than 60. Normal GFR values are largely over 60 in healthy subjects, at least before the age of 70 years. However, we know that GFR physiologically decreases with age, and in adults older than 70 years, values below 60 could be considered normal.”
My doctor began to request eGFR tests for me in 2011, one month before I turned 70. For three years, the next nine tests were all ≥60. Then, starting in 2015, 5 of the next 7 were below 60 (mostly low 50s); then, last summer I had a 43, which repeated at 47 and 45 (average of 3 = 45). I also wanted to know why I peed a lot and so little, so my urologist undertook a series of tests and examinations. We think we now know the answer.
I have a very large bladder – over a one-liter capacity – and it doesn’t completely empty despite the urethra having a clear passage through the prostate. The reason, apparently, is neuropathy: the muscle that normally contracts the bladder to make me “void” isn’t getting a signal to contract from my nervous system. Hence, the enlarged bladder and the frequent urge to urinate small amounts that I’ve observed since the beginning of the year. The urologist ordered a prescription to relax the muscle in the neck of the bladder, but it didn’t help.
As a result, his thinking goes, when my enlarged bladder is really full, and not emptying much, urine backs up the ureters to the kidneys; and this back pressure on the kidneys is beginning to cause the reduced kidney function (lower eGFRs). My internist concurred and added that back pressure affects both kidneys, and I only have two! He also stressed that I must drink plenty of fluids because dehydration also causes kidney damage.
My urologist has now twice suggested that the best option for me at this point is self-catheterization. I have reluctantly come to the same conclusion. Ugh! My plan is to live to be 100, and to do that I’ll need my kidneys, such as they are. When I was in my 40s, the idea of taking a pill every day for the rest of my life was anathema. Now, I take a handful twice a day. So be it. At least I can say I am “otherwise healthy,” knock on wood.
The “plan” (the urologist’s ploy to get me to start) was to have me catheterize myself three times a day for a few weeks and then do another eGFR. If my kidney function improves, that is, if my eGFR increases, as he thinks it may, then I will have to continue with catheterization from that point forward (until I get to 100 or otherwise expire), to preserve the benefits. Apparently, no other remedy is available for a neurogenic bladder.
Two subsequent eGFRs, performed at two-week intervals after catheterization began, were improved (53 and 55). A third, 2 months later, was, alas, back down to a disappointing 47. So, now we’ll just have to “wait and see.”
In the meantime, the message here is to take notice of changes in your daily habits (like frequency of urination) and discuss it with your doctor(s) before you too have no choice but to “siphon the python.” Happy New Year!

Sunday, December 23, 2018

Type 2 Nutrition #464: “She was only 75.”

Penny Marshall died at age 75…of “complications from diabetes.” A commentator lamented, “She was only 75.” Nobody explained, which was correct, I suppose. An obituary is about a person’s life and accomplishments. Penny Marshall was brilliant in “Laverne and Shirley” and as a director. “A League of Their Own” is one of my favorite movies, but when I saw a recent picture of her, I knew she was probably diabetic. She was fat.
I don’t want to blame her for that, although I regularly hector and cajole my readers for the very same thing. I do that because, like the rest of us, she probably followed “doctor’s orders,” especially when she knew she was sick and presented with unmistakable markers. But when we simply gain a little weight over the years, and have no symptoms, we (including the doctor!) mark it up to eating too much and moving too little. We are told “diet and exercise” is the way to drop the weight. We try it again and again, and we fail, again and again.
So, it’s our fault. We heeded the doctor’s advice and we tried. We went to the gym (maybe) and tried to eat less of the foods the doctors and the medical associations and government told us not to eat, and we lost some weight. We were always hungry, and eventually we lost resolve and gained it back. We failed. We did as we were told to do, and we failed. Over and over again. Is anyone thinking of the famous Einstein aphorism?
Einstein said, apocryphally, “Insanity is doing the same thing over and over and expecting different results.”
That’s why, I suppose, there are so many different diets out there. It’s so we don’t see ourselves as doing the same thing over and over again. But, don’t you see, we are, really. We are getting the same result! It’s insane.
All these diets have different names and other things that make them seem different, but they are really much more similar than we think. They are mostly “balanced.” What does that mean? They include the ratios of fat, protein and carbs (the “macronutrients”) that government and the medical establishment have recommended, without solid scientific evidence, for over half a century.
These ratios are on the Nutrition Facts panel on every box and bag that we buy at the supermarket. The daily amount recommended for every adult woman is 300g of carbohydrates, 50g of protein, and +/-65g of fat, mostly polyunsaturated fat (PUFA), from “vegetable” (seed and grain) oils. That translates to 1,200kcal of carbs (@4kcal/g), 200kcal of protein (@4kcal/g) and 600kcal of fat (@9kcal/g).
Here’s the truly shocking Percent Daily Value (%DV) of that 2,000kcal diet that “women of a certain age” are counseled to eat: 60% carbohydrate, 10% protein and 30% fat. Did you know that? That’s 60% percent carbs! And for men the percentages are the same; it’s just that we’re allowed 2,500kal a day, as follows: 375g carbs, 62.5g protein and 83g fat. That’s still 60% percent carbs, men! Is that insane, or what?  Bonus trivia: this is an excellent recipe for fattening livestock. No, I’m not joking.
That’s why Penny Marshall was fat. Not because she ate too much and didn’t exercise enough. Her obituary didn’t say that. It didn’t have to. The simple statement “complications from diabetes” said it all. Let that sink in. Then, ask yourself, was it a Microvascular complication? Neuropathy (with amputations), retinopathy (with blindness), or more likely nephropathy: end-stage kidney disease, with dialysis. Or perhaps a Macrovascular complication (stroke, heart failure, or old-fashioned MI (heart attack), increasingly common with diabetics.
In any case, Penny had, and you still have, a choice. Type 2 diabetes is a dietary disease. It is the result of eating a “balanced” diet of way too many processed carbs and foods with added sugar and processed vegetable oils. What does that have to do with being fat? When you greatly reduce the amount of carbs in a meal, starting with “breakfast,” you allow your body to burn its own fat for energy…so you won’t be hungry all the time. You won’t eat as much and put on the extra pounds. In fact, you will start to lose them, quickly. Just have coffee with heavy cream for breakfast, or bacon and eggs. No cereal, no toast, no fruit, no yogurt!

Saturday, December 15, 2018

Type 2 Nutrition #463: “You eat healthy, take statins…”

The TV commercial begins, “You eat healthy, take statins…” and then goes on to describe a new class of drug designed, “to lower LDL-C when added to a high-dose statin” (my emphasis). That’s what gets me riled. Folks, if you’re “eating healthy,” unless you have a very rare condition called “familial hypercholesterolemia,” you shouldn’t need to take a statin, much less another drug in addition to a high-dose statin. Geez…
Of course, this claim all revolves around what you (or they, the drug maker) call “eating healthy.” The drug maker will claim, rightly, that their “eating healthy” is what you have been told to eat by All the Powers that Be in our culture: The USDA/HHS Dietary Guidelines for Americans, from 1980 through 2015, with only minor modifications,  ChooseMyPlate.gov, and the entire medical establishment – the AMA, the AHA, the ADA, etc.
So, if you “eat healthy” in the way they prescribe, you very well may need to take a statin. And if it doesn’t lower your LDL-C sufficiently to satisfy the Total Cholesterol and LDL-C Standards of Medical Practice for a lipid profile, established by the corrupt practices of those government/medical entities, you’re going to be cajoled relentlessly to start taking a statin, and if a high-dose statin doesn’t “do the job,” to start taking this new drug.
In 2002, I had been a diagnosed a T2D for 16 years and was still eating the Standard American Diet. I was on 3 classes of oral antidiabetic drugs (maxed out on 2), and still “out of control.” To help me to lose weight, my doctor suggested I start eating Very Low Carb (VLC), i.e. 20g of carbs a day. The first day I had a hypo, and 2 more that week. He took me off 1 drug and cut the other 2 in half TWICE. And in 9 months I lost 60 pounds.
Then in 2003, following the prescribed standard, my doctor started me on a high-dose statin and in no time got my LDL-C down to “target” (<70mg/dl). In 2006 I rededicated myself to VLC and lost another 100 pounds in a year. By 2008 I had lost 170 pounds total and lowered my blood pressure to 110/70 (on the same BP meds).
But I also transformed my lipid panel. While my Total Cholesterol (TC) and LDL-C remained about the same, I doubled my HDL-C and lowered my triglycerides (TGs) by two-thirds. When my doctor saw these outcomes, he used his clinical judgment and took me off statins completely. That was 2008, 10 years ago. I still basically eat VLC most of the time, and my latest lipids were TC 189; LDL-C* 83; HDL-C 92; non-HDL 97 and TG 56mg/dl.
* Calculated by Quest using Martin/Hopkins; previously Quest calculated LDL-C by the Friedewald method.
A chart below illustrates my TC and LDL-C while off, then on, then off again a statin, from 1980 to the present.

So, I think it’s reasonable to ask, “Is your ‘eating healthy,’ (the way the USDA/HHS and the AMA, AHA and ADA have been telling you to do all your life), the reason your doctor has you on a high-dose statin and is now twisting your arm unremittingly to take yet another drug to lower your LDL-C?” I think so. And my doctor apparently agreed. Do you suppose if you changed the way you eat, you wouldn’t “need” to take a statin?

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.