Sunday, April 29, 2018

Type 2 Nutrition #430: “I don’t always skip meals…”

I had to chuckle the other day when I saw a page posted by Mark Gibbons, a member (as I am) of the Jason Fung Fan Club Fasting Support page on the net. The full quote was, “I DON’T ALWAYS SKIP MEALS…BUT WHEN I DO IT’S FOR DAYS AND DAYS AND DAYS.” Brilliant, as the Brits say. It’s an allusion, of course, to “The Most Interesting Man in the World” meme made famous by the TV commercial for Dos Equis beer some years ago.
This beer commercial has been parodied hundreds of times. What I liked about this one in particular is that is captures the essence of Extended Fasting, a practice that is gaining a small but very devoted following. The reason for the devotion is that, to virtually everyone’s surprise, it works for losing weight, and it’s sooo easy.
Extended Fasting means for two or three consecutive days taking little or no nourishment by mouth. I prefer the term Extended Fasting to Intermittent Fasting which first gained currency and apparently includes other types of fasting: 16:8, One Meal a Day (OMAD), 5:2, and various other forms such as Alternate Day fasting. In my opinion all of them are understandable attempts to deal with the fears and uncertainties of abstaining from eating for an extended time. From time to time I’ve tried them all for weight loss, with mixed results.
I can attest, however, to the efficacy of Extended Fasting. I transitioned to it last spring when I was living alone for two months. I wanted to gin myself up to start it and avoid the flack I knew I would get from my wife if she were here. It was suggested to me the previous fall by Megan Ramos, Director of the Intensive Dietary Management program in Jason Fung’s office in Toronto. I told her I would start with Alternate Day fasting.
I had already been eating Very Low Carb (since 2002), so I was keto- or at least fat-adapted. That meant that, without taking nourishment by mouth, I would immediately transition into burning body fat without hunger. Alternate day fasting worked so well I quickly transitioned to consecutive day, first two and then three-day. I know I could easily have gone four days, or five or more. Our social calendar simply doesn’t permit it, for now.
The metabolic mechanisms at play here are simple. The hormone insulin is the central (but not the only) player. It has at least two roles. The first is to transport glucose from digested carbs and other sources (such as gluconeogenesis) to the cells where it is supposed to open up receptors there to allow the energy in. Insulin Resistance in type 2s and pre-diabetics slows down and blocks that uptake.
The 2nd mechanism is that when glucose levels drop, after the glucose has been taken up and/or when few carbs have been taken by mouth, blood insulin levels drop. This sends a signal to the liver to switch fuels from glucose to fat. That’s what body fat is for, a backup energy source. But fat stores are only accessible when your blood insulin level drops. And that’s more difficult for people who have Insulin Resistance (type 2s and pre-diabetics) because with IR, as your glucose continues to circulate, blood glucose and insulin levels stay high!
That’s why Extended Fasting works for weight loss. When you eat nothing to speak of, and especially don’t eat carbs, particularly if you are already fat-adapted, you body transitions to burning body fat for energy, and you’re not hungry. You can literally go for days on end with no hunger, high levels of energy, and a feeling of being “pumped.”
I started at 375 pounds in 2002. Over the years I lost 170 pounds following a Very Low Carb (VLC) diet. Like most, however, I regained some (45 pounds). When I started Extended Fasting my goal was to lose 63 pounds, to reach 187 pounds, thus becoming “Half the Man I Once Was.” With Extended Fasting, it took 8 months, but I did it. But I’ve now regained some again, so my new goal is less ambitious. It is to get to 195 and stay below 200.
As the commercial ended with, “Stay thirsty, my friends,” so I end this post with, “Stay thin, my friends, with… Extended Fasting.” To maintain 195, I plan to eat VLC/OMAD and one or two day fasts, when and as needed.

Sunday, April 22, 2018

Type 2 Nutrition #429: WebMD Nov/Dec 2017 issue

The waiting room at my wife’s doctor’s office always has multiple copies of the latest WebMD magazine, with “Complimentary Waiting Room Copy” imprinted on the cover. Although I brought my own reading material to a recent visit, I picked up the current copy to look for news about type 2 diabetes.
The November/December 2017 issue had no such news, except for pets. There was, however, an ad from Big Pharma to treat type 2 diabetes. The ad said, “…when [their product was] used with diet and exercise,” it may help to lower your A1c. The placement of the ad was prognostic: it was in the middle of the food section.
Beginning on page 87, the “holiday” food section featured 5 content pieces. Nestled among the first sugar-choked three – on red grapefruit, sweet potatoes, and cranberry sauce – was this 3-page ad for a new injectable medication, “to help type 2 diabetics lower A1c’s.” The FDA had approved it to be used “with diet and exercise in people who are not controlled” with long-acting insulin (<60 units daily), or lixisenatide.” The new drug is made by the makers of Lantus, a popular long-acting, injectable insulin (insulin glargine). 
This new drug is a combination drug – mixing 100 units/ml of insulin glargine with 33mcg/ml of Lixisenatide, a GLP-1 receptor agonist. This is a serious medication regimen. Think about it. It is for the type 2 diabetic whose A1c, even after taking up to 3 classes of oral meds, then usually another “non-insulin” injectable (you’ve seen the ads), then usually long-acting (basal) insulin, has progressed over the years…and after all this, is still “not controlled”. That’s why has this new drug been introduced. Take a moment to ask yourself this:
What’s a doctor to do? A doctor is trained to treat symptoms. High blood sugar and high A1c’s are symptoms that the patient’s type 2 diabetes is “not controlled.” The doctor knows the medical protocol to treat these symptoms: prescribe drugs in increasing doses as the patient’s disease “progresses.” They are taught that type 2 diabetes will progress, and the only thing the doctor can do is prescribe higher doses, stronger medicines and, as the patient’s condition worsens, the latest combination drugs until…? You can’t blame them, can you?
But why is the patient’s disease “not controlled”? All the ads are required to say that the patient is supposed to participate in their own treatment with lifestyle modifications, specifically “with diet and exercise.” Well, that’s quickly become a worn out trope, hasn’t it? The only elucidation in the drug ad is, “Eating healthy foods and exercising regularly.” You can’t blame Big Pharma for not getting into the “healthy foods” debate, can you?
In the ad a woman holds a sign that says, “A1c, it’s time to take you down!” A man with a little pot belly holds another saying, “I’ve been good, so why is my A1c bad?” On the website, a “GET THE FACTS” link takes me to another smiling person whose sign says, “My diabetes changed – so I made a change,” and another, under the heading, “Diabetes is complex with factors beyond your control. Here the sign suggests, “Age? Metabolism? Family History? Well, you can’t blame the patient for things that are beyond the patient’s control, can you?
Wrong! Your metabolism IS within your control. You’re a type 2 diabetic because of what you eat. If your type 2 diabetes is not controlled, or getting worse, it is because of what you eat NOW. That is THE CAUSE of your type 2 diabetes, and that is NOT a factor beyond your control; It is ENTIRELY within your control, and you have only yourself to blame (in spite of your doctor’s treatment protocol and Big Pharma’s slick ads) if you don’t understand that. CARBs become glucose in your blood. They RAISE your A1c and CAUSE you to gain weight.
Contrary to what Big Pharma and your doctor would have you believe, you have NOT been “good” and that’s why your A1c is “BAD.” If you want to lower your A1c and control your type 2 diabetes, you’re going to have to change what you eat. You’ll need to learn about carbohydrates and eat fewer of them. If you do, you will stabilize your type 2 diabetes and could even reverse it and put it in remission, to the point where, by diet alone, you could eliminate most, or even in some cases, all diabetes medications, including insulin. 

Sunday, April 15, 2018

Type 2 Nutrition #428: Portion Control?

Weight loss strategies are full of advice to control portion size…but nobody wants to measure! So, instead of a scale, we are counseled to use a clenched fist to estimate a protein portion. We are told to use a small plate so that a full plate makes the serving look bigger. Both devices work, but if you continue to eat a “balanced” diet loaded with nutrient-poor, high-carbohydrate, “processed” foods, you’re still going to be hungry.
Alternatively, if you are eating a Low Carbohydrate diet, you can fill your small plate with energy-dense protein and fat, and a few low-glycemic veggies, and you will feel full and remain sated for a longer time.
And if you are eating a Very Low Carb diet, you can eat these same healthy foods…or not. That is, you can skip a meal without hunger and save both time and money. Case in point: I am never hungry at “breakfast.”
Eating three meals a day is a social construct and a cultural habit. We’ve been told (by the cereal makers) that it’s important to “start the day off well with a big breakfast” and “breakfast is the most important meal of the day.” And guess what? It’s usually all carbohydrates, like fruit juice, cereals with milk and added sugar, and sugar-laden yogurt or bread with jelly or tea with honey.
Result: our blood sugar spikes, then crashes and it’s snack time or lunchtime, so we scarf down more carbs. By mid-afternoon, our blood sugar has crashed again and we’re ready for a nap…or a snack (candy bar, anyone?).
Do you see a pattern here? Einstein said, “Insanity is doing the same thing over and over again and expecting a different result.” Well, maybe a diet of 3 meals a day, plus snacks, that is 55% – 60% carbs, or higher, is the problem! Maybe a change in what and when we eat, or even why we eat, would fix that problem. D’ya think?
For me, diet and portion control begin with 3 precepts (H/T to Diet Doctor): 1) Eat strictly a Low Carb Diet, 2) Eat only when hungry and 3) Use Intermittent Fasting as needed to reach and maintain a stable weight.
Here are a few practical tips that I use that you might consider:
1) For “Breakfast,” I have “downsized” and just drink a medium-sized mug of coffee to take my pills. Thus, I need a smaller pour of heavy cream to color and flavor the brew. I now get 3 weeks from a quart, at about 1½ oz/pour (150kcal). If you eat them (I don’t anymore), eggs & bacon are portion controlled. Cereals are not.
2) For “Lunch,” if I eat lunch, I eat from tins:  a tin of kippered herring in brine, or squid parts in its own ink, or Brisling sardines in olive oil or water. The small tin limits the meal, and it is all protein and healthy fats.
3) During the day I only drink a beverage that will not raise my blood sugar. I drink cold-brewed iced tea, “sweetened” with liquid stevia. I have tested this drink multiple times and it does not raise my blood sugar.
4) For “Supper,” if I am not fasting, I eat two small, pasture-raised lamb chops (an 8-rib rack provides 2 meals for 2 people), or half an 8oz Sam’s Club filet, or some similar premeasured portion of protein. We also share a low-glycemic vegetable, either tossed in butter or roasted in olive oil, or a salad with my homemade dressing.
5) For a supper beverage, I prefer one or two 5oz portions of red wine in a glass filled with seltzer. I know it’s only 5oz because I always get 5 pours from a 750ml (25.36oz) bottle. Sometimes I have iced tea instead.
6) If I have a “nervous eating urge” after supper, I use the wine glass for a Braggs Apple Cider Vinegar Cocktail: 1 Tbs of vinegar, a few dashes of bitters, and several drops of liquid stevia; add ice, swirl and fill with seltzer.
If you’re not hungry most or virtually all the time, as you are NOT when you eat Very Low Carb, portion control is…ahem, a piece of cake. BECAUSE YOU DON’T THINK ABOUT EATING OR PORTION CONTROL WHEN YOU’RE NOT THINKING ABOUT FOOD. And, about that piece of cake, you won’t crave it. You can enjoy it on special occasions, but you won’t NEED that carb snack to keep from falling asleep. You’re full of pep and “vinegar.” ;-)

Sunday, April 8, 2018

Type 2 Nutrition #427: The Fasting Biohack, Trending in Silicon Valley

A TV story I saw peripherally described the latest trend in Silicon Valley as a “fasting biohack,” so I did a Google search. The first hit I got wasfrom an old Time magazine story about longevity; however, it was the lasttrend in that articleI found the story I was looking for in this piece from the September 2017 Guardian
The fasting that the Guardian wrote about has been variously calledExtended Fasting, Intermittent Fasting, or consecutive full-daywater fasting. It is not my namby-pamby, modified 300kcal/day regimen. And it is not One-Meal-a-Day (OMAD) fasting, as I did unsuccessfully for a year. In fact, I now use OMAD for MAINTENANCE ON NON-FASTINGdays, and my 2 or 3-consecutive day 300kcal fasts to drop a few pounds when I gain a few.
The Guardian piece is well written and worth reading. It starts off telling about a Silicon Valley CEO who has just eaten a small dinner and will next eat four days later at a fancy sushi restaurant. “In the intervening days it’s just water, coffee and black tea,” they relate. Over the last eight months this CEO has shunned food for periods of from two to eight days and lost almost 90lbs. He describes getting into fasting as transformative.”
How is it “transformative”? The Guardian story quotes the CEO as saying,There’s a mild euphoria. I’m in a much better mood, my focus is better, and there’s a constant supply of energy. I just feel a lot better.” “Getting into fasting is definitely one of the top two or three most important things I’ve done in my life. WOW!!!
The Guardian relates that Intermittent Fasting first gained popularity in recent times with the 5:2 diet, where people eat normally for five days a week and then eat a dramatically reduced number of calories (around 500) on the remaining two days.” However, they say, this CEO and others like him are pushing that idea further and with a focus on performance over weight loss.” It’s very significant that the Guardian picked up on that.
I can also relate to another comment: “Proponents combine fasting with obsessive tracking of vitals including body composition, blood glucose and ketones – compounds produced when the body raids its own fat stores, rather than relying on ingested carbohydrates for energy. This, they insist, is not dieting. It’s biohacking.”
Ketones are a super-fuel for the brain,” says another, “so a lot of the subjective benefits to fasting, including mental clarity, are from…the ketones in the system. I’m focused on longevity and cognitive performance,” he says. This CEO doesn’t need to lose weight, so he does a weekly 36-hour fast and a quarterly three-day fast. 
Another exec says, “The first day I felt so hungry I was going to die. The second day I was starving. But I woke up on the third day feeling better than I had in 20 years.” In my caseI have no hunger while transitioning from fed to fasting because I have been Very Low Carb for years, and thus transition easily from fed to fasting.
The Guardian says, “There is a mounting body of scientific research exploring the effects of fasting. Each year dozens of papers are published showing how fasting can help boost the immune system, fight pre-diabetes, and even, at least in mice, slow aging.” Dominic D'Agostino describes other benefits of fasting here (#421).
The Guardian, though, ends on a cynical note. One of the Silicon Valley execs says, “He doesn’t think it will ever be mainstream.” It seems too extreme. Everyone grew up hearing fasting was dangerous and super-difficult. Furthermore, no one makes money when people don’t eat. In this society, usually things that work against every entrenched economic interest are hard to take off,” he said. Alas, how true! And how sad, really.
This CEO concluded, It sound(s) crazy. You need to be a weirdo like me to get into this.” I know what he means. My readership has fallen off since I took up Ketogenic 2 and 3-day Fasting. I guess I’ll just have to be content with the 75 pounds I lost with my 300kcal/day fasts and mytransformative state of mild euphoria.

Sunday, April 1, 2018

Type 2 Nutrition #426: Extend Bars, for diabetes management

The other day, while standing in the checkout line at my local supermarket, I saw a slightly overweight, middle aged man put some real food on the conveyor belt, and then a passel of Extend Bars. The previous day I had seen a TV ad for Extend Bars that made some bold claims.  So, since we are all influenced by marketing efforts for manufactured “foods,” and as a long-time type 2 and unofficial diabetes educator, I decided to take a look.
Extend Bars come in 8 delicious sounding varieties, all 150 calories. The first four have from 5 to 6 grams of fat, half of it saturated. These bars also have from 9 to 10 grams of protein. The balance of the calories (22 to 24 grams) is from carbs. Translating the grams to calorie percentages, fat percentages range from 30 to 36%, protein percentages from 24 to 27%, and carb percentages 59 to 64%, except…wait a minute, that >100%.
Keeping the fat and protein calories as fully metabolized, and subtracting from 100%, the carbohydrate percentages in the energy calculation for these 4 bars are reduced to from 59/64% to between 40/46%. How?
Extend explains: “How to Count the Carbs: Fiber, Maltitol, and *Non-Factor Other Carbs (5 grams uncooked cornstarch and 4 grams glycerin) convert slowly, thus have a minimal impact on blood sugar.” So, in their large print calculation on the Extend Bar, they subtract all but 1 gram of carbs (e.g.: 22g - 4g - 8g - 9g = 1 net gram).
However, in their energy calculation of 150 calories per bar, Extend subtracts only some of the carbs, leaving the uncooked corn starch and the glycerin, plus a little soluble fiber and some sugar alcohol (Maltitol) -- from 15g (40%) to 17.25g (46%) of carbs total -- to “convert slowly, thus have a minimal impact on blood sugar.” Nota bene: carbs that “convert slowly” are still AUC, i.e., Area Under the Curve, i.e., still fully-metabolized.
So, ignoring that they taste like candy bars, what’s the “virtuous rationale” of eating Extend Bars for diabetes management? The Extend website provides 4: 1) Minimize Spikes and Avoid Blood Sugar Swings, 2) Avoid Low Blood Sugar (Hypoglycemia), even Overnight, 3) Reduce Hyperglycemia in the Morning, and 4) Comfortably Bridge Gaps between Meals. Do you see anything in common in these 4 mechanisms? How do they do that?
You eat one bar in mid-morning, then one in mid-afternoon, then one before going to bed… and behold, you will “minimize spikes and avoid blood sugar spikes, avoid low blood sugar, even overnight, reduce hyperglycemia in the morning, and comfortably bridge gaps between meals” (because you ate a slowly converting, carb-loaded, candy bar between meals). By eating 3 “balanced” meals, and 3 carb-loaded “snacks” a day, 6 high carb "meals" a day, you will remain a carb-addicted, type 2 diabetic…even as you thought you were eating just 1 net gram. 
The mechanism, then, is to “juice” your body with CARBS, even with the Extend bar's reduced 40% - 46% carb content, perhaps because it is slowly converting to glucose in your blood. Uncooked corn starch and glycerin, from 3 Extend bars a day as recommended, is giving you a continuous infusion of carbs, sort of like being on a glucose drip.
Extend Nutrition describes their bars as “sweet,” with “rich (sugar-free) chocolate” and “creamy peanut butter.” I’m sure they taste good, if you have a sweet tooth (and who doesn’t). But just to be clear: when you double down from eating 3 “balanced” (carb-filled) meals a day to eating 6 times a day, supplementing the carb-laden meals with “snacks” that intentionally mislead you into thinking you are eating just 1 gram of carbs when they are, in fact, from 40% to 46% carbs with 15 to 17.25 grams of carbs that “convert slowly,” you are not really managing your diabetes wisely. But that’s up to you.
I put my food on the conveyor belt and checked out: eggs, heavy cream, grated cheese, green olives, fresh cod, beef short ribs, celery, yellow onions and garlic. I was tempted to buy crackers and some Macadamia nuts, but I know that if I have them in the house, I will eat them, and my diabetes management plan doesn’t allow for snacks between meals. When I avoid eating carbohydrates, I don’t need snacks. I’m not hungry.