Sunday, July 29, 2018

Type 2 Nutrition #443: The 1-percenters

A while back, on a nutrition website intended for the cognoscenti, I watched a TED talk that a member had recommended. The talk was said to “help you find your ideal diet,” a “personalized program just for you.” It turned out to just be a businessman’s pitch for his startup’s service to design an “individualized” diet for you, for a fee. It was a sham, designed to appeal to a nutritionally na├»ve audience. Of course, this would include 99% of the public, but I expected better from this nutrition site and especially from its leaders.
People who are unable or unwilling to accept the radical changes that are necessary to make a major “lifestyle change” usually resort to the meme that “everyone is different.” That’s a convenient scapegoat. The truth is we are all human and our biological processes for digesting and absorbing the basic components of food –protein, fat and carbohydrates – are virtually identical. The only differences are the degree that a bundle of glucogenic genes have to a lesser or greater extent been “modified,” over time, by overindulging unnaturally in a diet composed of a very high percentage of processed carbs. That will vary from person to person.
These “over-indulgers” develop a dysfunctional glucose metabolism. Once “modified,” these genes continue to express this Carbohydrate Intolerance on a continuum. It is a path which will lead most people, over a period of many years, to develop type 2 diabetes and become obese. The condition is called Insulin Resistance.
Insulin Resistance is thus a genetic expression of a bundle of genes, in those genetically predisposed, such that the insulin receptors on cells that ordinarily open up to allow glucose energy to enter and nourish them, no longer function properly. When these insulin receptor cells “resist,” and the uptake of glucose is impaired, the pancreas secretes more insulin to help out. Type 2 diabetes is thus a disease of too much INSULIN in the blood stream. Characteristically, type 2s have both elevated blood glucose and elevated blood insulin.
The elevated blood glucose is what clinicians use to detect the presence of incipient pre-diabetes or frank type 2 diabetes. Today the hemoglobin A1c (HbA1c) is the blood test used to make this diagnosis. Previously, an elevated fasting blood glucose (FBG) was used. The gold standard, however, still used by endocrinologists, is the Oral Glucose Tolerance Test (OGTT). It takes 2 hours and is more expensive, but nevertheless the best.
The elevated blood INSULIN is what causes obesity (in about 80% of type 2s). While insulin is elevated in the blood stream, to avert hunger the body must rely on food by mouth for energy. Most people eat carbs at every meal and often between meals. The net result is that we are always hungry and then, when we eat more and more often, we get fat. So, with INSULIN RESISTANCE, your blood INSULIN stays high. It’s only when your BLOOD INSULIN level drops that the liver looks for an alternate energy source and turns to breaking down body fat (the food you’ve already eaten) for energy.
The 1-percenters know this. But knowing it and doing something about it are very different. It is hard to change one’s lifestyle and in particular one’s eating habits, which are both cultural and very personal. Incipient pre-diabetes and frank type 2 diabetes are symptomless conditions.  And it takes decades to kill us, most often indirectly by heart attack, stroke, or Alzheimer’s (aka type 3 diabetes) and many cancers. These days, with better care, blindness, amputation and end-stage kidney disease are less common morbidities.
So, what’s the best motivator to make a “lifestyle change”? Well, how would you like to “kill two birds with one stone”? Lose lots of weight and reverse your slow slide into full-blown type 2 diabetes? You can, but you will either have to eat Very Low Carb most of the time, or fast for a day or two a week, or both. That’s what I did. I started eating Very Low Carb in 2002 and lost 170 pounds. When I plateaued a few times and gained some back, I added fasting. I lost 60+ pounds. I maintain my weight by eating Very Low Carb and fasting.

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