Sunday, February 25, 2018

Type 2 Nutrition #421: Heart Benefits of Intermittent Fasting

A recent thank-you email from a neighbor and friend included a link to the Cleveland Clinic’s Heart and Vascular News article, “How Fasting Affects Your Heart.” The subtitle is, “A Cardiologist’s Perspective on Pros and Cons of Fasting.” The Cleveland Clinic is “mainstream medicine,” thus way behind the curve on nutrition, especially saturated fat, but the article makes some excellent points about the benefits of Intermittent Fasting.
Quoting from the article: “Cardiologist Haitham Ahmed, MD, sees many advantages in fasting from food for short periods, and given the promising findings in this ‘emerging area’ of research, he expects that more people will want to try it. Though it depends on what you’re hoping to accomplish (it’s not safe for everyone), it’s beneficial to limit your food intake, in general.  He says, ‘By every measure, eating less is better.’”
The first sub-heading in the article, “CAN EATING LESS STRENGTHEN YOUR HEART?” begins, “Research shows that fasting can lower blood pressure, reduce cholesterol, control diabetes and reduce weight. Dr. Ahmed says, ‘Four of the major risk factors for heart disease are high blood pressure and cholesterol, diabetes and weight, so there’s a secondary impact. If we reduce those, we can reduce the risk of heart disease.’”
Well, I’d call that an endorsement of fasting. The Four Horsemen of the Apocalypse managed. Alas, “One word of caution, though,” Dr. Ahmed says. “Fasting can lead to an electrolyte imbalance. This can make the heart unstable and prone to arrhythmias. So whenever we prescribe a protein-sparing modified fast, we do blood tests…and prescribe potassium supplementation to prevent electrolyte imbalance from occurring.’”
Electrolyte balance is a good cautionary note. I take supplemental potassium…and magnesium too. I also add salt to almost everything I eat. And my Electrolyte Panel is always great, with everything in mid-range.
A “protein-sparing modified fast” is a Very Low Carb (VLC), moderate protein diet with just enough dietary fat to allow the body to burn body fat to make up for the calorie deficit. The body has a reduced need for dietary glucose on VLC because to keep the brain happy it makes ketones from the breakdown of dietary and body fat. The body obtains some of the glucose it needs from carbs and some via gluconeogenesis from proteins not needed and stored as amino acids in the liver, thus “sparing” the breakdown of muscle protein for glucose.
The Cleveland Clinic’s Dr. Ahmed continues, “Is fasting a good way to lose weight? Although it offers health benefits – including reduced heart disease and weight loss – it’s not really the best way to lose weight. While fasting helps you drop pounds quickly, it doesn’t help you stay in shape.” What?!!! Okay, then add exercise! “(Fasting) offers health benefits – including reduced heart disease and weight loss,” for goodness sake! Remember, although exercise definitely has cardiovascular and other health benefits, exercise isn’t for weight loss.
The Cleveland Clinic then says, “The only time we really recommend fasting for weight [loss] is if someone needs rapid weight loss, for instance, for surgery.” So, are they saying it’s okay for fat people to otherwise be fat, until it makes surgery riskier and therefore inadvisable for the patient (and the surgeon). Geez….
The rest of the Cleveland Clinic article is garbage, with advice to eat a “healthy diet” of “low-fat yogurt” and high-carb foods like dates, dried fruit, chick peas and peanut butter before and after attempting a fasting diet.
My summation: Cleveland Clinic concludes that fasting is a “healthy diet” for the overweight and obese for the four benefits they acknowledge – that it “can lower blood pressure, reduce cholesterol, control diabetes and reduce weight,” and thus, “reduce the risk of heart disease.” Given that, I would double down; I would say that fasting is THE optimal lifestyle for the ENTIRE population. Watch this 22-minute video of the Diet Doctor’s Andreas Eenfeldt interviewing Dominic D'Agostino. In it, D’Agostino, a leading researcher today in ketogenic metabolism, says he follows a “ketogenic intermittent fasting diet” about 95% of the time. 

Sunday, February 18, 2018

Type 2 Nutrition #420: BMIs for the “elderly”

BMI’s for the “elderly”? Note: “elderly” is in quotes here deliberately. If I sound a little riled, it’s because I am riled. This post will be a rant. But I am NOT going to dissect all the epidemiological studies that give guidance to the medical establishment with respect to the optimal BMI for the elderly (≥65). I will reference them only and instead deal with n = 1, the specific individual, in other words, “me,” and maybe “you” too. Read on!
First of all, we (in the U. S. anyway) know what a ridiculous chart the BMI table is anyway. It was created by the infamous Ancel Keys in 1972 and adopted by the World Health Organization (WHO) in the 80s. Our NIH and CDC bought into it 1998. Now virtually everyone (the “elderly” anyway) is measured for height and weight and assigned a BMI practically every time they visit the doctor. Medicare and now the entire U. S. health care establishment follows the WHO public health guidelines and will sanction your doctor if (s)he doesn’t record these statistics every time you visit. Put simply: Their reimbursement by the government will be reduced!
The BMI chart is ridiculous for many reasons, among them: it only measures your height and weight. You are assigned a BMI on that basis regardless of your gender, age, frame or body composition (muscle vs. fat). That number is then used as “guidance” to tell them whether you are “normal,” “overweight,” or “obese.”
The flaws of such an arbitrary chart are myriad and manifest. So, even though your BMI number is indelibly inscribed in your permanent medical record, your doctor presumably has the discretion to provide you with individualized guidance, albeit that guidance less certainly noted on your medical chart. To provide guidance, epidemiologists have studiously pored over millions of medical records for the “elderly” and have concluded that the elderly shouldn’t be normal weight (as the young should). The elderly SHOULD be overweight!
This is interesting to me because, in my dotage, I have finally found, if not the Fountain of Youth, the secret to losing weight and improving my general and diabetic health through a lifestyle change (the Very Low Carb Way of Eating with full-day fasting). Now, for the first time since I was a teenager, I have a chance to be “normal” weight, or at least be on the cusp (BMI≤25). And now I’m reading that I’m too old to be normal weight!  My goal, having a while back becomenot half the man I once was,” is soon to maintain my weight between 172 (BMI=24.7) and 175 pounds (BMI=25.1), and thus maintain an altogether 200 pound weight loss.
However, lumping me in with all the other “elderly” in these studies, the WHO/NIH/CDC  tell me that my BMI should be no less than 27.5 (192 pounds), smack dab in the middle of the “overweight” range for my height. I just worked damn hard to lose that last 20 pounds, and they’re telling me I should be 20 pounds FATTER! The reason, they say, is that epidemiologically speaking, my risk of death (“all cause mortality”) is much higher in the “normal” (BMI<25) weight range. They say that for me a BMI of 27.5 is “ideal,” epidemiologically speaking.
My take: This epidemiological data only looks at the death statistics of the entire “elderly” population. It does not take into account wellness vs. frailty, smoking status, activity level, or even “advanced” age. It includes everyone at or over the age of 65, including nursing home populations and many elderly who are still living independently, some of whom indubitably are in declining health. And that’s not me! I’m actually thriving!
Most in this population are also not eating a nutritious low-carb diet of real food and healthy saturated and monounsaturated fats. And they are NOT avoiding “wheat, excessive fructose and excessive linoleic acid” (n6s).
To all this I say, damn the epidemiologists and anyone else who relies on this crapola to provide guidance to the healthy “elderly.” I’m 76 and I’m going for a BMI between 24 and 25, to maintain my weight between 172 and 175 pounds. My new wardrobe cost too much to just hang in the closet. And trust me, there’s still plenty of fat on my body to carry me through a long illness and to make a cushion for my fat butt at the ballpark.

Sunday, February 11, 2018

Type 2 Nutrition #419: “Secret Cure” for Type 2 Diabetes

I was diagnosed a type 2 diabetic in 1986. For the first 16 years my diabetes was treated, according to the ADA’s Standards of Medical Practice, as a “progressive” disease. I ate, according to the Dietary Guidelines for Americans, a “balanced” diet and was encouraged to exercise regularly. My doctor monitored my blood sugar and prescribed oral medications in increasing doses. Eventually, I was “maxed out” on two classes of oral meds and had started a third. I knew that when I maxed out on it, I would “graduate” to injecting insulin. 
Then in 2002, in an effort to get me to lose weight, my doctor, largely by accident, discovered effectively a “cure” for my type 2 diabetes as a side benefit of losing weight easily and without hunger. In this post I will recount the stunning discovery of this “secret cure” and how this “treatment” has evolved over the years.
After reading Gary Taubes’s “What If It's All Been a Big Fat Lie,” my doctor suggested I try the diet Taubes described to lose weight. As I was leaving his office, my doctor said, “This might even help your diabetes.” It did. In the 1st week, to avoid hypos, I had to eliminate or decrease all the anti-diabetic meds I was taking. I eliminated one and decreased the other 2 by half, TWICE. The diet described was a Very Low Carb diet, just 20 grams of carbohydrates a day. I followed it strictly for 9 months and lost 60 pounds.
With that diet, I counted carbs. I created an Excel table, wrote down everything I ate, just estimating the carb content. Four years later, over the summer, I regained 12 pounds, so I began a different program. This time I raised my daily carb intake to 30 grams and also counted protein, fat and total calories, again recording everything I ate. In the next year I lost 100 pounds and, a little later, 20+ more. Then, after a while, I stopped counting. It was a lot of work and no longer necessary. By that time I knew what to eat and what NOT to eat.
Over the ensuing years I re-gained and re-lost some, using the same principles I learned in the beginning. That included Macronutrient Ratios for food ingested that were a part of the Very Low Carb eating patterns that I started on. The ratios varied somewhat but they were always “Ketogenic.” I settled on 5% carb, 20% protein and 75% fat, mostly saturated and monounsaturated.  On 1200kcal/day that’s 15g of carbs, 60g of protein and 100g of fat. On such a Very Low Carb, high-fat diet, hunger disappears. You don’t need to eat more because, with a low blood insulin level, your body has access to its own fat for energy balance. Thus, the weight loss. ;-)
A couple of years ago, while struggling to lose some “re-gain,” I gave up breakfast. I wasn’t hungry anyway. It had been 2 eggs/2 strips of bacon, then just 3 eggs, with coffee and heavy cream. I kept the coffee and cream. Later, I also gave up lunch. Eating VLC, I wasn’t hungry then either. Lunch had been a small tin of sardines in EVOO, or kippered herring in brine. But I stalled, even on One Meal a Day. My “diet” needed to evolve again.
About a year ago I began full-day fasting. It was suggested to me on Facebook by Megan Ramos, IDM Program Director at Jason Fung’s practice in Toronto. Originally on alternate days (Tue & Thu), it soon evolved to 2-day and then 3-consecutive day fasts. My fast is not a true water fast. It includes the coffee with cream taken with morning pills and a red wine spritzer (5oz red wine + 8oz seltzer) with evening pills. I lost 60+ pounds, and my A1c dropped from 5.8% to 5.1%. Occasionally I cheated a little (I’m not perfect), but my Metformin handled it.
Most recently I added an after-supper apple cider vinegar “cocktail” to the mix. I got the idea at a Keto Dudes Festival last summer. In my wine glass I add 1 Tb Bragg’s apple cider vinegar, a dash of bitters and a little liquid stevia. I then add ice cubes, swirl the mix and fill the glass with seltzer. My FBG this morning was 87mg/dl, and 16 years after starting Very Low Carb, I have maintained my “non-diabetic” A1c and a 180 pound weight loss.
Make no mistake about it: Type 2 Diabetes IS REVERSIBLE. To be clear though, while it is REVERSED, it is NOT CURED. It is IN REMISSION. But, by the ADA’s Standards of Medical Practice, there is no simple blood test (fasting or A1c), that can detect it. Your doctor, therefore, clinically speaking, will consider you “cured.”

Sunday, February 4, 2018

Type 2 Nutrition #418: “The dose makes the poison”

The surprising popularity of “Triglycerides and Alcohol Consumption,” written obliquely several years ago for the benefit of my brother, gave me pause to contemplate how many others out there were interested in the subject. Unbelievably it was the #4 all-time favorite in the Readership Statistics list of “10 Most Popular” posts. Coincidentally, but in a completely different context, I read in another blog recently that, “The dose makes the poison.” This syzygy, a conjunction reflective of last year’s solar eclipse, thus provided a topic to write about.
Alcohol consumption, perhaps to excess, runs in my family. My father was probably, and my mother possibly, alcoholic. I have a drink almost every day. Some define alcoholism as the habit of drinking alcohol every day.
Since I began a 3-consecutive-day, modified fasting routine about a year ago, drinking a glass of wine has been part of my “fast” day routine. On “My Modified Fasting Plan,” on fasting days I make “supper” one red wine spritzer (5oz of red wine with 8 ounces of club soda), to take my evening pills. On non-fasting days, I double the dose. This “allowance” for alcohol is pleasing to me and, I know, to others who enjoy a drink (or two).
Unless we have company who also enjoy a drink before dinner, at home I don’t drink ethyl alcohol (“spirits”). And these days, as we get older, “company” happens less and less. In a restaurant, which we do about once a week, I usually have a cocktail or two, depending on the bartender. A few make them as strong as I do at home. Most do not, in which case I have two. Just once, at lunch with my editor and her husband in Nashville, I actually ordered three. I swear they were watered down…which is how I get to “the dose makes the poison.”
Paracelus, (1493-1541), a Swiss scientist and son of a doctor, is credited with this adage “intended to indicate a basic principle of toxicology” (Wikipedia).  He is generally credited as the “father of toxicology.” He told doctors to “study nature and develop personal experience through experiment” and thus to “emphasize the value of observation in combination with received wisdom.” This leads in turn to the concept of Hormesis.
More Wikipedia: “Hormesis is any process in an… organism [like you and me] that exhibits a biphasic response to exposure to increasing amounts of a substance or condition.” The “biphasic” conditions are “stimulation” and “inhibition.” Wiki continues, “The hermetic zone [is] generally a favorable biological response to low exposure to toxins and others stressors.” [I generally have a “favorable biological response” to one or even two glasses of wine or a “well-made” drink.[ “A pollution or toxin showing Hormesis thus has the opposite effect in small doses as in large doses.” This effect has been shown with stressors like fasting and exercise.
I wrote about “Calorie Restriction and Longevity” and “Calorie Restrition in Humans” years ago. W/r/t exercise, Wiki states, “Individuals with low levels of physical activity are at risk for high levels of oxidative stress, as are individuals engaged in highly intensive exercise programs; however, individuals engaged in moderately intensive, regular exercise experience lower levels of oxidative stress. High levels of oxidative stress have been linked by some with an increased incidence of a variety of diseases.” (all my emphases).
“Alcohol is believed to be hermetic in preventing heart disease and stroke, although the benefits of light drinking may have been exaggerated,” Wiki avers. But, “in 2012, researchers at UCLA found that tiny amounts… of ethanol doubled the lifespan of Caenorhabditis elegans, a round worm frequently used in biological studies.” At least all of our taxpayer money isn’t being wasted on useless scientific research!!!
 Wiki admits, though, “The biochemical mechanisms by which Hormesis works are not well understood.” And they conclude, “Hormesis remains largely unknown to the public.” But Paracelus has shown me how to manage the “stimulation” part: “study [your] nature and develop personal experience through experiment.” My personal interpretation: At home, be disciplined and adhere strictly to protocol. With guests, cater to their wishes. In a restaurant, choose your bartender carefully, and remember always, “The dose makes the poison.”