Type 2 Nutrition #425: “Ensure Original,” the “meal replacement”

Ensure Original, sold as a meal replacement, is available in grocery stores everywhere. But caveat emptor! Buyer Beware! Why? Because it is advertised as “complete, balanced nutrition for everyday health.” What does that mean? Well, it’s clever marketing, as I’ll explain. They go on to say that each can contains 9 grams of protein, 220 calories, and 26 essential vitamins and minerals. So far, so good, right? But let’s take a closer look.

As a nutritional claim, the word “complete” is not legally defined, but we know that a healthy diet requires complete protein, meaning a combination of essential amino acids (the things proteins are made of). A healthy diet also requires essential “micronutrients,” so presumably the 26 included in a can of Ensure Original covers those that are generally accepted as essential. The calorie count (220) is also okay, so I’d say, “So far, so good.”

So why then do I say caveat emptor, i.e. let the buyer beware? Because the term means: be careful because the seller knows more than the buyer. Our purpose then is to balance the information so that the buyer (you) knows more than the Ensure Original advertising reveals.

Real foods, and manufactured “foods” like Ensure Original, are composed of proportionate amounts of the three macronutrients: fat, protein and carbohydrate, plus assorted micronutrients (e.g., vitamins and minerals). The ratio of the “macros” in each food varies, as does the combined total for all foods in a meal. Recommendations for what the ideal ratio is also vary, and have changed dramatically in the last half century.

Back in the 1950s and 1960s, in the mistaken belief that saturated fat and cholesterol were harmful to cardiovascular health, U. S. public health officials and the American Heart Association, recommended that we should try to eat less than 30% of our calories from fat, just 10% from protein (in part because the best complete protein comes from animal products), and the remaining 60% from carbohydrates.

In 1977 the McGovern Senate Select Committee on Nutrition and Human needs institutionalized these 30/10/60 percentages in the Dietary Goals of the U. S. In 1980 and every 5 years thereafter the U. S. has published the Dietary Guidelines for Americans. A little later all manufactured foods in boxes, cans and bags included a “Nutrition Facts” panel in which each macronutrient was given in grams and then the percent of the “Minimum Daily Value” of that macro was given, using the 30%, 10%, 60% government recommendations.

These macronutrient recommendations persist to this day, even with the recently enacted “reforms.” So, when Ensure Original touts that it is “balanced nutrition for everyday health,” what does that mean? It means that Ensure Original is balanced the way the government recommends. Let’s look at the Ensure Original label.

A 220 calorie can of Ensure Original contains 6 grams of fat, 9 grams of protein, and 33 grams of carbs. Since fat has 9 calories per gram, that’s 54 calories of fat. Protein has 4 calories per gram so that’s 36 calories, and carbohydrate has 4 calories per gram, so that’s 132 calories. 54 + 36 + 132 = 222 calories, so let’s say 220.

Now, what are the macronutrient ratios in this can of “balanced nutrition for everyday health”? Fat: 54/220 = 24%; Protein: 36/220 = 16%; Carbs: 132/220 = 60%. Voila! Less than 30% fat, higher in healthy protein (as advertised) and exactly 60% carbohydrate. That’s almost exactly what the U. S. government recommended in 1980 and still recommends today. And coincidentally (?) in complete correspondence with the incidence and dramatic increase in obesity and type 2 diabetes in the United States. But, it’s “complete, balanced nutrition.”

So, ask yourself: Is this the kind of “complete, balanced nutrition” that you want to eat for your “everyday health”? Especially if eating this way for the last half century has caused you to put on unwanted pounds and become “pre-diabetic” or a diagnosed type 2 as more than half of us have? Or do you think that you can “ensure” your everyday health by eating a diet that is less than 60% carbs. What do you think? Can you?

Type 2 Nutrition #424: Splenda Endulzante, ideal para toda la familia

You don’t have to be a Spanish student to know that this column concerns the artificial sweetener in the yellow packet. A bunch of them were brought to my table with a cup of coffee after lunch one day last winter in Medellín, Colombia. I didn’t use it, however, because I travel with my own little bottle of pure liquid sucralose, the chemical name for a “non-nutritive sweetener” identified with the commercial product Splenda.

What made this particular packet interesting to me was some information in the small print (in Spanish) that is not shown on otherwise identical packets in the U. S.: the percentages of each of the three ingredients, dextrose, maltodextrin, and sucralose, in order by weight, named on both the U. S. and Colombian products.

Just in case you didn’t know, dextrose and maltodextrin are just chemical names for compounds of the glucose molecule. Dextrose is the naturally occurring D-form of the monosaccharide glucose. Maltodextrin is a polysaccharide. That means it is a compound of between 3 and 17 attached glucose molecules. So, just to be absolutely clear, the two major ingredients of Splenda are both glucose.

But we already knew this. What’s new to me is that the Splenda packets in Colombia actually give the percent by weight of each ingredient: dextrose 95.8%, maltodextrin 3.0% and sucralose 1.2%. Wow, you say. That sucralose stuff must be a pretty powerful sweetener! Well, it is. But I say, wow, Splenda is almost 99%, glucose, the very thing that people who are trying to control their blood sugar should be trying to avoid!

So, now that you know, will you do anything differently? Will you carry a small bottle of liquid sucralose in your purse or pocket? I hope some of you will. I also hope that the others, who won’t, will at least know that you can’t trust anyone, who is invested in selling you something, to tell you the truth. We don’t sell anything on this site except an idea…the idea that good nutrition for type 2 diabetics means avoiding, as much as possible, eating carbohydrates, including glucose. And to do that, you must know where the carbs are.

With this in mind, I wrote a 16-page pamphlet in English, and a folleto en español, that describes, with a 20-part Q & A section, my personal transformation from drug-dependent type 2 diabetic to an almost drug-free type 2, in complete remission (A1c=5.1%). In the course of this transformation I lost 170 pounds and turned around a slew of blood markers including blood pressure, cholesterol, and inflammation. After my HDL-C doubled and my TGL dropped by two-thirds, my doctor took me off the statin drug that I took before I began to eat Very Low Carbohydrate (VLC). Did I mention this Very Low Carb way of eating transformed my health?

I wrote the “folleto en español” with the help of a professor in Bogotá who I also had to educate in this Way of Eating. As in so many countries, public health authorities in Colombia, and the compliant population, have followed the lead of the United States. Our governments have enlisted the population-at-large in a huge, catastrophic, failed public health experiment based solely on epidemiological evidence because, in the words of Senator McGovern, chairman of the 1977 U. S. Senate Select Committee on Nutrition and Human Needs, “Senators don't have the luxury the research scientist does of waiting until every last shred of evidence is in.”

As Jeff Ritterman, MD, says in this truly excellent 2015 Truthout article, “Senator McGovern's comment concerning ‘every last shred of evidence’ was widely off the mark. It was never a question of having supportive, but incomplete, evidence. There simply was no convincing scientific evidence at all in support of the commission's recommendations. There still isn't.” And there was and is lots of evidence to the contrary!

The next column will explore another product, one that is being sold as “balanced nutrition for every day health.” If you’re not careful, you might conclude this too is “ideal for all the family.” That product is “Ensure, Original,” sold as a “meal replacement,” and available in grocery stores everywhere. Caveat emptor!!!

Type 2 Nutrition #423: Okay, I admit it; I’m not perfect

Earlier this winter I spent 6 weeks in Medellin, Colombia, studying Spanish and eating to my heart’s content. Actually, that’s not an apt expression…eating with abandonment would be more accurate. It was not doing my heart or my type 2 diabetes any good to eat “comida tipica,” but in the spirit of cultural discovery, I ate lots of “arepas” (corn cakes) and, just once, “ron con pasas” (rum raisin) supermarket ice cream. No excuses offered.

The container felt light when I took it from the freezer compartment, so my first thought was that it was loaded with air, like whipped butter. But when I got home I discovered it was really loaded with raisins and tasted quite good. It wasn’t until I had finished the container (naturally) that I looked at the ingredients. The first one listed was whole milk, then sugar of course, then “grasa vegetal,” or vegetable oil! “Incredible!”

Needless to say, I didn’t eat any more supermarket ice cream. Notice: I didn’t say that I didn’t eat any more ice cream. On a few occasions, in a fine dining restaurant, I had dessert with my coffee and once in a while it included ice cream – homemade, I assumed – with a wonderful dense chocolate cake (see photo). The supermarket I patronized also sold Haagen Dazs, but for a king’s ransom…by Colombian standards.

This is the second time that I have travelled to Colombia to study Spanish. Travel and study are things I can do in retirement, and I actually have an undergraduate degree in Spanish, so my studies are somewhat advanced and are made easier by having somewhere in the back of my brain all the irregular verbs conjugated in a dozen or so tenses. The hard part is not reading or writing or even speaking – but understanding the spoken word. I’m afraid it’s going to take more than a few weeks a year to improve that…so more travel and study.

Acquiring or re-acquiring a skill does take a lot of practice, and immersion is a well known way to do it. That’s how I came to eat Very Low Carb. I jumped in head first. The story has been told here many times but bears repeating. My doctor – who had been trying to get me to lose weight the conventional way – eat less on a balanced diet and exercise more – was desperate when he suggested I eat just 20 grams of carbs a day.

For my part I was motivated because, being unable to weigh in on his office scale (which only went to 350 lbs), I had gone to the Fulton Fish Market in NYC for a commercial scale and learned I weighed 375. Meanwhile, my doctor had read Gary Taubes’s seminal piece, “What if It's All Been a Big Fat Lie,” in the NYT and tried the diet himself. He lost 17 pounds in a month, so he suggested that I try it too, to lose weight.

Well, I did. I lost sixty pounds in 9 months, and a few years later, on 30 carb grams a day, I lost a lot more. I then maintained a 170 pound weight loss until years later, fasting 2 or 3 days a week, I increased my total to 186 pounds. All of this without exercise and without hunger. But the really incredible part is that, from the first day, to avoid hypos, my cocktail of oral antidiabetic medication had to be greatly reduced, eliminating one altogether and cutting the other two in half, TWICE. And later I eliminated the sulfonyluria (glyburide) too.

My doctor was just as surprised as I was by this outcome. Not the weight loss, mind you, but the fact that my type 2 diabetes, from the first week, was thrown into remission. I still take Metformin (actually, with my doctor’s approval, I upped it to 750mg twice a day), and my latest A1c was 5.1%. Recently, several doctors that I have mentioned this to have told me that, clinically speaking, I am no longer a type 2 diabetic.

All of these outcomes – weight loss, A1c and blood sugar control, plus big lipid, blood pressure and inflammation improvements – were made possible only by what I don’t eat. But establishment medicine still refuses to accept that type 2 diabetes is a dietary disease and can be effectively treated this way. Maybe your doctor – or you – will have to be desperate to come to a similarly logical conclusion. I was, and my doctor was too, but it shouldn’t be that way. But they don’t burn heretics at the stake anymore; they just fade away…

Type 2 Nutrition #422: “energy homeostasis at the cellular level”

A Google search for this quote, written on a Post-It, produced no results. Without the quotes, this snippet got 500k hits, many from Google Scholar. So, my search for attribution appeared to be frustrated. But I had also written down the name Raphael Sirtoli, and another Google search produced “www.breaknutrition.com.”

I opened that hyperlink and discovered a great resource, founded by Sirtoli, aka Raphi Sirt, and Gabor Erdosi. Erdosi has a Master’s in molecular biology and Sirtoli a degree in biochemistry. Together they founded a Facebook page, www.facebook.com/lowerinsulin/, aka “Lower Insulin.” It’s a rather esoteric site that is “…not really intended for the layperson. However, [it’s] excellent for the more biochemically-versed individuals….”  They say they are “expert problem solvers, with engineering brains” and invite folks to “chat with them.”

I had made the note, “It all comes down to energy homeostasis at the cellular level” because I wanted to write about it. I have written about it before, here, among other places. I have explored it primarily in the context of weight loss. Sixteen years ago, when my doctor suggested I eat Very Low Carb to lose weight, he had only a vague understanding of the mechanism, but that is why he and most people do it. Patients are content to let their doctor treat their pre-diabetes or type 2 diabetes, but doctors usually don’t write a scrip for weight loss.

If you’re not conversant with the physiology, this is it in a nutshell: When you consistently eat Very Low Carb (VLC), and your stored liver glycogen (from carbs) is used up, besides lowering your blood sugar, your blood insulin level also drops. This low blood insulin level signals the liver to switch from using glucose for fuel to using fat. Your liver then breaks down body fat and thus maintains energy homeostasis (at the cellular level) without slowing down your metabolism. This ONLY occurs when you have low blood INSULIN by eating VLC.

Without understanding at first the how and why, I’ve been following this principle for 16 years and have lost almost 200 pounds. I started at 375 and maintain my weight well below 200 today. It didn’t happen all at once or in exactly the same way. As circumstances required over the years (#419), the details “evolved”, starting with eating a lot and just guessing at the carbs as I ate fewer of them. Today I also incorporate full-day fasting.

As a bonus that neither my doctor nor I fully recognized or appreciated, from the get go I have been free of all my diabetes meds except Metformin, and my type 2 diabetes remains in remission. My latest A1c was 5.2%.

Another “essential” benefit of this VLC Way of Eating, besides easy weight loss and dramatic improvement in blood glucose control, is that while your body is in this state of “energy homeostasis,” you don’t eat as much because YOU ARE NOT HUNGRY. Your body is “happy” because it has all the energy it needs for whatever you want to do. You could run a marathon! Go ahead, Google it. Research exercise physiologists like Jeff Volek and others describe how you avoid “hitting the wall” as you do when you “carb load” and then your body runs out of stored liver and muscle glycogen. Everyone has enough fat (fuel) in storage to run a marathon (or 2 or 3!).

I’m just a lay bloke, long since retired from an unrelated profession. I was fat as a teenager and got fatter and fatter as I ate “a balanced diet,” as my government, my doctor (and his dietitian), and the Certified Diabetes Educators (CDEs), and the American Diabetes Association, and the American Heart Association, etc, have been telling us to do for half a century: “Eating fat makes you fat.” “Eat fruits and grains.” “Eat a ‘heart-healthy,’ ‘one-size-fits-all,’ ‘mostly plant-based’ diet,” and “avoid saturated fat, cholesterol and added salt” and “eat vegetable oils instead.” We’ve been unwitting guinea pigs in the largest uncontrolled experiment in history!

And it has all gone horribly wrong. In science, when an experiment goes wrong, i.e. when the outcomes are shown to cause harm, the ethically responsible thing to do is to STOP THE EXPERIMENT. A classic example was the ACCORD trial in 2008. So, why doesn’t government stop this experiment now? Why don’t they correct the Dietary Guidelines? In the absence of that unlikely scenario, it’ll have to be up to you. You’ll have to do it!