Sunday, January 28, 2018

Type 2 Nutrition #417: The NEXT 25 Most Popular Posts

Last week, in "Readership Statistics" (just scroll down), I listed the 10 most popular posts I’ve written since I started this blog in 2010. Since most of them were viewed as a result of a search engine query, the result is biased in favor of low-numbered posts. I was disappointed, therefore, that some of my personal favorites were not included.
In an effort to correct the low-number bias and include some of my own favorites, I decided this week to offer you the NEXT 25 most popular. It turns out, however, having now done the search, that most of the next 25 are also low-numbered. Maybe my recent subject matter is of lower-interest. Who knows? Let me know.
The NEXT 25 Most Popular Posts
1 #68 Triglycerides, Fish Oil and Sardines Compelling N=1 evidence; also #281, #282 and #283 to raise HDL-C.
2 #100 Liquid Calories A few good points about digestion, then the Harvard Public Health recommendations.
3 #19 The Archevore Way of Eating, and #18: From Kurt G. Harris: limit wheat, excess fructose and Omega 6s.
4 #32 Artificial Sweeteners Useful, but I and those “in the know” use pure stevia, either powdered or liquid.
5 #25 Understanding Your Lipid Panel Solid, easy to understand basics re: cholesterol; a must read!
6 #64 Very Low Carb Eating, 10 Years Later Good, big picture data; also see #387 for “15 years on VLC.”
7 #35 The Diet Doctor and the LCHF Diet 6 years old but still good. Andreas Eenfeldt is the majordomo of LCHF.
8 #72 How to Fix Your Cholesterol Good basics on the lipid panel & Friedewald formula; see also #25 above.
9 #99 Natural History of Type 2 Diabetes Ralph DeFronzo’s description of the evolution/progression of T2DM.
10 #94 Eating Clean About the manifesto of Singaporeans who subscribe to a “clean” lifestyle, and read me.
11 #194 Live Fermented Foods Just a primer, but informative. See also my reply to an old follower’s comment.
12 #54 Loren Cordain, Robb Wolf, and Kurt Harris A couple of book reviews, and another paean to Dr. Harris.
13 #160 Letterman to Hanks: "...through diet, mostly" An example of how the media usually gets it wrong.
14 #30 Is Fructose Toxic to the Liver? With #29, covers the story; lots of stuff from Lustig’s “The Bitter Truth.”
15 #55 The Beleaguered Gary Taubes A defense of the “Insulin Hypothesis” by the “prime mover” of VLC.
16 #140 Peanuts, my nemesis Mostly relies on the Jaminets’ “Perfect Health Diet.” Note: I am still addicted.
17 #126 Do you live to eat or eat to live? Transitioning is difficult and ongoing, but possible. I am progressing.
18 #59  What I Eat and Why: The VLCKD The title says it all: Why I eat a Very Low Carb Ketogenic Diet (VLCKD)
19 #89 Reversal of Type 2 Diabetes, Revisited This is a sequel to my #1 most popular post #88. See also #380.
20 #33 Omental Adiposity Good basic information, especially for men with beer bellies, who look pregnant!
21 #83 The 8-hour Diet I don’t recommend this huckster’s “diet,” although Intermittent Fasting (IF) is good.
22 #9 Metabolic Syndrome A seminal post, 8 years old, and only 32nd most read. See also #334 and #335.
23 #122 Macronutrient Ratios and Calorie Restriction Loaded with specifics and a good, clear message.
24 #158 Demolishing the Saturated Fat Bogeyman An authoritative review from the British Medical Journal.
25 #152 Set Point Theory This column is much more than Set Point theory. It is loaded with goodies!
I’ve published 223 columns since the highest numbered one on this list! Not one is among my Top 35. Further study of “search engine optimization” will be required to learn why. I need to get more readers for some of what I’ve written in the last few years! There’re lots of good “poop” out there that’s going on a fallow field.

Sunday, January 21, 2018

Type 2 Nutrition #416: Readership Statistics

As I have recently passed 300,000 page views on this blog, it occurred to my editor that my readers might be interested in who besides you reads it. So, using the bare analytics on the Blogger platform, I assembled a few statistics.
Only 41% of my viewers are from the United States. About as many come from the next 9 countries combined, in page view order: Ukraine, Israel, France, Russia, China, United Kingdom, Canada, Poland and Germany. The remaining +/-20% are from dozens of other countries, principally among them India, Australia and Singapore!
Ukraine is 2nd and figures prominently probably because someone there is “stealing” my intellectual property and regularly “hosting” a link to my columns in a health or nutrition-related newsletter. That’s fine with me. I do this for educational purposes, not financial ones. I offer no advertising, so I do not forego “income by hit.”
Israel comes in 3rd because someone there is reading my blog regularly and once in a while provides a link to their readership. And then, wow, 2,500 ‘hits’ in an hour. Same thing happened in Singapore a few years back.
I’ve been publishing this blog for 7 years, most of that time once a week. For a couple of years I posted twice a week and then burned out and took an 8 month break. My average monthly viewership for the last 4 years, including the 8-month hiatus, is over 5,300, or about 180 per day, with a wide monthly range: 9,781 to 2,404. Allowing for the decline during the period when I was not writing, that comes out to about 6k/mo. or 200/day.
Most viewers find this blog through a Google search and are not regular readers. They search by subject using “keywords.”  According to the Blogger analytics, 6 of 10 keywords were searched using an “88 search engine.” In the early years, many page views resulted from my shameless self-promotion, providing a link on sites like Livin la Vida Low Carb(Jimmy Moore), Authority Nutrition, and Canadian low-carb blogger Dr. Jay Wortman.
The 10 most popular posts (incorporating the 88 search engine) since I began writing this blog are as follows:
#88 “Reversal of Type 2 Diabetes” Made #1 by the coincidence of very high interest subject matter and #88.
#31   Carbohydrates and Sugars A decent primer, drawn mostly from the Wikipedia entry on the subject. 
#101 Why I'm Never Hungry A touchstone subject and one that I return to often.
#197 Triglycerides and Alcohol Consumption  A surprising hit; a lot of bibulous tipplers out there, I guess.
#108 "You're eating too much dairy."  This one is a compendium of excerpts from a few experts on the subject.
#38 "The Perfect Health Diet" A book review but, aside from that, probably searched for the subject matter.
#21 The Dangers of Polyunsaturated Fats An important and under-addressed subject. I’m delighted it’s a hit.
#281 HDL-C and Triglycerides With 282 & 283 a series on the transformation of my own HDL and TGLs on Very Low Carb.
#103 Your Mileage May Vary (YMMV) Everyone thinks they are a special case, so they want to believe this.
#61 Stefansson and the Eskimo Diet  Another surprise, popular because of the early link on Dr. Wortman’s site.
In my opinion, many of these top 10 are not my best efforts, but they do show what the reader is searching  for. As such they offer an insight for me to ponder as I contemplate what to write about next. I note, however, the list is heavily biased toward the low numbered posts, reflecting the time that those posts have been “out there” in the blogosphere and available to search engines. As such, many newer ones will eventually catch up.
Many of my personal favs did not make the Top 10 list. Some are among “The NEXT 25 most popular,” to be published next week as “Type 2 Nutrition #417.” If you’re interested, I hope you’ll look for it then. Other favs have hardly been read at all. To find those, you’ll just have to read all 400+ at .

Sunday, January 14, 2018

Type 2 Nutrition #415: Hypoglycemia? I’ve had it only three times

I recently read a scary piece by Beverly Hills endo, Professor of Medicine, and Endocrine Society spokesperson, Anne L. Peters, MD. Title: “Seizures, Vomiting, Fear of Dying: The Threat of Hypoglycemia.” Subtitle: “Patients with Diabetes Explain How They Experience Hypoglycemia.” There’s also a short video here at
Peters wrote, “As a physician, I'm judged on how my patients do with their A1c targets. I always want people to be at less than 7% so that they do not get horrible complications. But day in and day out, patients have to live with the overarching concern of being too low. That can happen anytime, day or night. A patient can go too low if they misjudge insulin by maybe a unit or two, eat too little, or exercise too much” (my emphases).
Those three things will surely do it. But saying, “Eat too little” is disingenuous. She means, “Eat too few carbohydrates,” thus inadvertently not RAISING your blood sugar. Equally, by wanting her patient’s A1c’s to be less than 7%, but not “too low,” she implies it is okay to be in a perpetual disease state (#397), according to the ADA’s “Standards of Medical Care.” A clinical diagnosis of type 2 diabetes requires an A1c ≥6.5%.
This approach to medical care, and NOT INCIDENTALLY medical practice liability, is deemed preferable to the patient being at risk of a blood sugar too low, i.e., at risk of “seizures, vomiting and…dying.” One commenter wrote, “My A1c is always around 6.7- 6.9%, and this is fine with me and my doctor.  I hate hypoglycemia!” I think most doctors would agree. They are, after all, ALL judged on how [their] patients do with their A1c targets, and the “Standards of Medical Care” call for it, too liberally, IMHO, to be just at or less than 7%.  
The message to patients is thus: If I die tomorrow from a low blood sugar, who cares what my A1c is?”
This concern, according to Dr. Peters, is “a real part of the experience” her patients have of “living with diabetes.”  For her part, “A real part of the experience of [her] giving insulin is the fear of hypoglycemia.” Do you see the corollary? “Living with diabetes” and “giving insulin”? One just follows the other, naturally.
Because of the advice you have received, you are in a perpetual disease state, and your type 2 diabetes will PROGRESS to where your doctor will be “giving (you) insulin.” You too WILL become an insulin-dependent type 2 at greater risk of “seizures, vomiting and…dying” and all the micro and macro vascular complications of type 2 diabetes. It will probably also be your cause of death, approximately 8 years earlier than your peers…. But, it doesn’t have to be this way. You can take responsibility for managing your own health
You started reading this post because I told you I have only experienced hypoglycemia three times in my life. All three were in the same week 15 years ago, when I began cold-turkey to eat Very Low Carb on the advice of my doctor. Two months earlier he had read a New York Times Sunday Magazine cover story by Gary Taubes, “What If It's All Been a Big Fat Lie.” My doctor tried the diet that Taubes described and lost 17 pounds. He then suggested I try it too, to lose weight. I’ve been eating a Very Low Carb diet ever since.
At the time I weighed 375 pounds and was eating a “balanced” diet including beaucoup carbs. I was on 3 types of oral anti-diabetic meds and 3 types of blood pressure meds. My fasting blood glucose was still out of control, and my blood pressure was border line. I was soon to become an insulin-dependent type 2.
My first episode of hypoglycemia occurred late on my first day on the new diet. I ate a candy bar and called my doctor. He told me to stop taking the 3rd class of diabetes drug he had recently prescribed. The next day I had another hypo. This time he said cut the dose of the other two drugs in half. But on the 3rd day I had yet another hypo, so he told me to cut the dose in half again! In all the years since then I have never had another hypo. I later dropped the SU (glyburide) altogether and continued with 500mg of Metformin for a decade. Last year I raised my Met to a “therapeutic” dose and, now with fasting, occasionally have FBGs in the 60s, without hypoglycemia. In the ensuing years, I’ve lost 185 pounds (“Not half the man I once was), and my most recent A1c was 5.1%.

Sunday, January 7, 2018

Type 2 Nutrition #414: To LOSE weight, do NOT eat a Ketogenic Diet

Do NOT eat a Ketogenic Diet to lose weight! If you’re “normal” weight, or you have intractable epilepsy and will benefit from a very high dietary fat diet, then okay.  Eat a high fat diet. But if you are overweight and want to burn body fat, you first need to get in a hormonal state conducive to fat burning – by eating Low Carb (LC). Or, if you have Insulin Resistance, eating Very Low Carb (VLC); then, while eating LC or VLC, and “enough” protein, you need to be careful not to over EAT fat because, you want to burn BODY fat.
A Ketogenic Diet, as defined here and elsewhere, is very high in dietary fat. Whatever else it is, the fat in the Ketogenic Diet is thus taken by mouth. But at the cellular level, the body doesn’t care where the fat comes from, and it has to do something with the fat you eat. So, while you’re hormonally in a “fat-burner” state, as your body digests the fat you eat, it’s going to burn what it needs and store what it doesn’t. And if it doesn’t need to burn your body fat, it keeps it in reserve, as it was intended to be. You have defeated your purpose.
So what does this do to the macronutrient ratios I have talked about for years? It doesn’t change the ratios. It just changes where they are sourced. Your biology hasn’t changed, just the way you (or I) pictured it. It’s a little harder to calculate, but the physiology is the same. The difference is that the macronutrient ratios are not measured where it is “taken by mouth” but where your body takes it up for energy – at the cellular level.
Most nutrients from food you eat are absorbed at the small intestine. From there they circulate in the blood or are held in the liver until needed. There are some exceptions: iodine is stored in breast tissue, lutein is stored in the macula of the eye, for example. When you eat VLC, and your hormonal state has transitioned from sugar-burner (glucose-based) to fat-burner, your body will first process all the foods you ate and then, to maintain energy balance (homeostasis), it will break down body fat (triglycerides) into fatty acids for fuel. Fatty acids will then circulate and mix with the other fuels in the blood until taken up wherever needed. It can do this, remember, only so long as you eat LC or VLC and remain in the fat-burner (vs. sugar-burner) state.
Your metabolism will NOT slow down and you will NOT excrete vitamins and minerals before they can be stored. Your metabolism will continue to run at full speed because you are not being “starved” by the absence of “food.” Your body has supplied the “food” it needed from the energy reserves it had stored.
So, in practical terms, what does this do to the macronutrient ratios, as traditionally applied to food ingested (taken by mouth)? The ratios don’t change. The carbs are exactly the same. The protein is exactly the same. Total fat is the same too, only it is divided between eaten fat and stored fat. And YOU will determine the fat ratio by how much fat you eat. To keep in energy balance, the remainder will be body fat that you burn.
Let’s do an example: A certain, mostly sedentary man (me) needs say 2,400kcal/day to maintain his “normal” weight. But, he’s overweight and wants to burn body fat, so he eats a diet with macronutrient ratios that gets his body in a hormonal state conducive to fat burning: 5% carbs. 20% protein and 75% fat. That’s 30 carb grams, 120 protein grams and 200 fat grams a day. If he eats this Ketogenic Diet (k/g ratio: 2.0), he will not be hungry. He will be fat-adapted and in ketosis, but he won’t lose weight. He’s EATING way too much fat.
Now, envision this same man eating the same 30 carb grams and the same 120 protein grams and but just 100 grams of fat. His “diet,” i.e. what he has taken in by mouth, is now 1,500kcal/day, but because he is still eating Very Low Carb, he is still in a hormonal state conducive to fat-burning, and his body will have to break down 100 grams of body fat a day to maintain the 2,400kcal his body requires for energy balance. His metabolism runs full speed, he is not hungry, and he loses weight. His macronutrient ratios (by mouth) are now 8% carb, 32% protein and 60% fat (k/g ratio just 1.4), but it doesn’t matter. At the cellular level – where the energy is used – they are unchanged. Both are Very Low Carb. He is still fat adapted but, at K:G=1.4, he is not ketogenic.