Sunday, September 30, 2018

Type 2 Nutrition #452: The most common cause of high triglycerides is…

Blood sugar! “The most common reason for having high blood triglycerides (over 199 mg/dL) is blood sugar – its availability and handling. If your cells are resistant to insulin, they cannot take up glucose, and so they turn to fatty acids for fuel. They get these fatty acids from triglycerides, put by the liver into circulation. If you are a diabetic, diabetes can increase triglycerides significantly, especially when your blood sugar is out of control.”
I found this quote in a draft Word file while searching for documentation to answer the question, “Will eating a high fat diet raise my triglycerides?” The question was asked by a recently diagnosed, insulin-dependent type 2 diabetic who has high triglycerides and is naturally concerned with the idea of self-treating his diabetes with a Very Low Carb, High Fat (VLCHF) diet. Unfortunately, the quote is without attribution! 
The goal of VLCHF is to lower both blood glucose and blood insulin. Lower blood glucose obviously means better diabetes control. Lower blood insulin will make the body more insulin sensitive and thus less insulin resistant. Lower blood insulin will also enable the body to access and use (burn) visceral or internal, abdominal fat. Along with weight loss, it will also help to “clear” a fatty liver and restore pancreatic insulin production.
Think about it. High blood sugar means that the refined carbs and simple sugars in your diet are still circulating in your blood (as glucose)! Because of the insulin resistance you developed from eating this way, glucose is not being taken up by your cells for energy. And you can’t access your body fat for energy because of your high blood insulin levels, so…YOUR LIVER has to step in and make triglycerides to burn for energy. Ergo: You have high glucose, high insulin and high triglyceride levels, and low HDL-C to boot! They all go together!
Solution: Treat your high blood glucose with a VLCHF diet. This will lower your blood glucose and your blood insulin. This in turn will allow your body to access your body fat for energy, and eliminate the need for your liver to make triglycerides for energy. You won’t be hungry because your body will be well fed with body fat; you will improve your insulin sensitivity by secreting less insulin because you’re eating VLC; your pancreas and liver will both do less work. Your liver won’t be forced to make triglycerides to circulate for energy.
Eating VLCHF will lower your blood triglycerides. Just be sure not to fast for too long (more than overnight) before testing for triglycerides. Prolonged fasting, especially if you are already eating VLCHF and are “fat-adapted,” will raise your blood triglycerides temporarily. In a prolonged fast you use body fat (triglycerides) for energy and you lose weight.
I have never had “high” triglycerides. Before starting VLC in 2002, my average triglyceride lab score (11 tests) was 143mg/dl and my HDL-C was a low 39mg/dl. Five years later, after I’d lost 170 pounds eating VLCHF, my average triglycerides from 2007 to 2014 (25 lab tests) was 49mg/dl and my HDL-C 75mg/dl. By then of course my type 2 diabetes was in remission, and with the weight loss my blood pressure was greatly improved. My latest labs (Aug 2018): TG 56mg/dl; HDL-C 92mg/dl; TC 189mg/dl; LDL-C 83mg/dl (Martin/Hopkins calculation).
These results are just mine (N=1), but lab reports like these are widely reported by people who eat VLCHF. I’m confident that if you commit to make this permanent lifestyle change, you will see similar results.
Type 2 diabetes and obesity (aka diabesity) are elements of what is now known as Metabolic Syndrome. Look it up. It is the result of the way we have been told to eat. It is called the Standard American Diet, or SAD, appropriately. To reverse your Metabolic Syndrome, get control of type 2 diabetes, lose weight and lower your triglycerides, you need only to change what you eat. A Very Low Carb High (Healthy) Fat diet will do it. Do you have the gumption or the guts to try it? If you do, and you stick with it, you won’t be disappointed.
Remember, lower blood glucose, lower blood insulin and lower triglycerides (plus higher HDL-C) go hand-in-hand. And the only “side effects” are lower weight and lower blood pressure (and fewer expenses for drugs).

Sunday, September 23, 2018

Type 2 Nutrition #451, Is Very Low Carb like the South Beach Diet?

When I describe my Way of Eating (WOE), I’m frequently asked, “Is Very Low Carb like the South Beach Diet?” Definitely not! Here’s a point-by-point comparison, from my (biased) perspective as a strong advocate of the Very Low Carb approach. For reference, I’ve used this description of the South Beach Diet from Wikipedia.
SBD: “high in fiber,” “low glycemic carbs,” “unsaturated fats (mostly monounsaturated),” “lean protein.”
VLC: Very low in fiber. All fiber is carbohydrate. You cannot eat “high fiber” and Very Low Carb because, to get any fiber, you have to eat carbs, and to get high fiber you would have to eat too many carbs. The only fiber you eat in Very Low Carb is the incidental content in some of the low carb vegetables at some meals (supper, mostly), and the occasional snack (e.g. celery with anchovy paste). Typically, I eat maybe 5g of fiber a day.
SBD & VLC: Low glycemic carbs. Generally, both diets advocate “low glycemic carbs.” This would include many above ground vegetables and leafy greens. VLC would exclude corn, beets, peas and carrots (too sugary) and squash. My favorites are broccoli, cauliflower, asparagus, green beans and salad greens. More caveats below.
SBD: Unsaturated fats (mostly monounsaturated): This suggests the “fruit” oils, avocado and olive oil (mostly monounsaturated), but the SBD would necessarily include all processed and refined seed oils: corn, sunflower, Canola, soy bean, etc, all polyunsaturated, all highly processed, and all bad. It would explicitly exclude saturated fat: butter, ghee, coconut oil, tallow, lard, the latter two found in animal meats.
VLC: Includes monounsaturated fats (avocado and olive oil) and saturated fats as found in meats and dairy and used in cooking. No margarine. It is a refined seed oil and may contain trans fats (partially hydrogenated oils). We love to cook with bacon fat. My wife makes pie crusts with lard (not Crisco). I brown meats in ghee.
SBD: “lean protein.” Wikipedia doesn’t even mention the words “red meat” in the SBD piece! Or dairy either.
VLC: For us, the fattier the meat, the better, including ground meats, chicken with the skin on, and pork roast. Salmon and sardines too, and full-fat yogurt (if you can find it!), heavy cream, and full-fat cream cheese.  All saturated fat! It will raise your HDL-C. My last HDL-C was 92mg/dl, my TC 189, my LDL-C 83 and my trigs 56.
SBD: “3 steps,” “emphasis on carbs,” “exercise included”, “3 meals + 2 snacks a day,” a “high-fat” diet.
VLC: The best way to do Very Low Carb is to go all in, “cold turkey.” In 2002, I started on 20g of carbs a day. My motivation, and the reason my doctor suggested it, was to lose weight. But within the first week I had a few hypos and, by telephone my doctor stopped one med and cut the other two in half TWICE. I later stopped one of those and today just take Metformin. And by the way, over a period of years, I lost 170 pounds.
SBD: “with emphasis on carbs.” Wikipedia says Phase 1 includes “many carbs,” and Phase 2 includes “complex carbs” such as “brown rice” and “100% whole grain bread.” I can only imagine what Phase 3 allows you to eat!
VLC: Very Low Carb also emphasizes carbs, but just the opposite: you eat as few carbs as you can, but when you do you eat carbs choose ‘low-carb’ carbs and definitely no rice or bread (or pasta or potatoes, etc.).
SBD: “choose the right fats and the right carbs,” “a ‘high-fat’ diet, not a ‘low-carb’ diet”
VLC: If you are a type 2 diabetic, you are insulin resistant and therefore carbohydrate intolerant. You need to make a permanent change. Very Low Carb is not a temporary diet where you return to eating the foods you ate before. You’re not doing this to lose weight – although if you follow it strictly, you will. You’re doing it to self-treat (through diet) your type 2 diabetes and avoid the dreaded complications.
 When you eat VLC, your body will burn body fat, so it won’t be sending you hunger signals, and you will be able to eat fewer meals (1 or 2 a day), with NO snacks – and you won’t have to exercise if you don’t want to.
VLC  & SBD: Both are “high-fat,” but saturated fats taste much better than those refined “vegetable” oils.

Sunday, September 16, 2018

Type 2 Nutrition #450, When and what to eat, and not eat

In #449 I described how I met and began to mentor a newly diagnosed type 2 (A1c 7.0%) who was prescribed a long-acting basal insulin after he was unable to tolerate or had a counter-indication for three classes of oral anti-diabetic meds. My student was motivated because he didn’t want to be a life-long, insulin- dependent type 2. I thought he was the ideal candidate for a “dietary solution.” I knew that if he followed the precepts of Very Low Carb eating, he would quickly reverse his diabetes and get off insulin.
His healthcare provider’s goal was to mediate or offset his high blood sugar (a symptom of Insulin Resistance from eating a diet high in sugars and refined carbs) with exogenous insulin injections. My goal was to get him off injected insulin by lowering his blood sugar and endogenous (pancreatic) insulin response through diet. Eating Very Low Carb will lower his blood glucose and therefore his endogenous insulin response. Thus, this lower blood insulin will reduce and quickly eliminate the need to inject exogenous insulin.
Aside: I counseled my student to be prepared to learn and to test his blood regularly and whenever he had symptoms of a “hypo.” “What’s a hypo,” he asked? Incredulously, his “doctor,” the NP – the one who “prescribed” insulin injections for him – forgot to mention hypoglycemia. Neither did they discuss an A1c goal, but the American Diabetes Association’s Standard of Care is ≤ 7.0%. His typical fasting blood glucose (with a starting dose of 10 units of basal insulin) is 170mg/dl, so he’s expecting she will soon have to raise his dose.
Insulin, endogenous or exogenous, causes weight gain. When your blood insulin level is elevated, your body cannot access body fat for fuel. Once off exogenous insulin, a LCHF diet will enable him to lose body fat, if he wants or needs to, without hunger. Principally, by burning visceral fat around and within the liver and pancreas), he will ultimately restore beta cell function and endogenous insulin production.
WHEN AND WHAT TO EAT, AND NOT EAT
If you eat a Very Low Carb, High or Healthy Fat diet, sometimes referred to as a LCHF or Keto diet, you will not feel hungry very often because your body is being fed by body fat. It won’t signal you to eat food by mouth as long as when you do eat, you eat Very Low Carb. If you have a lot of body fat to lose (he doesn’t), then you don’t have to eat a lot of fat. Your body will “eat itself” (your stored fat). Without a lot of body fat to lose, he can eat more fat (saturated and monounsaturated) than others. So, my advice when you eat Very Low Carb is, eat only when you’re hungry. After a while, when you always eat this way, your body will be “fat-adapted.”
What does this mean in terms of meals and timing? Mealtimes are cultural and social habits. My student likes to eat a small breakfast: one egg and some Canadian bacon. That’s good. He doesn’t drink coffee. For many years I ate eggs and bacon for breakfast. Now, since I’m not hungry at breakfast, I just have a cup of coffee. It’s a habit. I take it with a little pure powdered stevia and a dollop of heavy whipping cream.
If you’ve got nothing better to do at “lunchtime,” and you’re hungry, eat a small lunch. When I eat the occasional lunch I prefer something portion controlled. It’s usually a can of some kind of fish. I like kippered herring in brine or Brisling sardines in EVOO or water (not packed in refined “vegetable” i.e. seed oils). Salmon, smoked or canned, would be really good too. Some days I’ll have a hardboiled egg, or two. Low-fat cottage cheese and any yogurt are not good choices. But if you do, eat full-fat. Avoid fruit, sugar and all starches.
Supper is just a fatty protein like beef, veal or lamb, fish, pork and chicken, and one low carb vegetable tossed in real butter or roasted in olive oil. Of course, no bread, potatoes, pasta, rice, wheat flour, or root vegetables. I also avoid corn, peas, carrots and beets. They’re all high in natural sugars. And no candy, dessert or snacks. Trust me. If you can control your neurotic cravings (not hunger; you won’t be hungry), you’ll be just fine.

Sunday, September 9, 2018

Type 2 Nutrition #449, “I thought salads were good for you.”

Don’t get me wrong. Salads are okay, but maybe not for the reasons you thought. I recently began mentoring a newbie who was diagnosed a few months back as a frank Type 2 (A1c 7.0%). He was prescribed a long-acting insulin, glargine, when he wasn’t able to tolerate Metformin and then Januvia (a DPP-4 as monotherapy!). Another physician had prescribed a SGLT2, but cancelled it when he saw a counter-indication. So, I started by asking him what he ate, and when he got to lunch, he said, “chicken tenders and a small salad.”
When I said that the chicken tenders were dredged in flour, then breaded and deep fried in oxidized seed oils high in Omega 6’s, he nodded his understanding that I thought there might be a problem. But then I told him that salads were virtually all carbohydrates. That’s when he said, “I thought salads were good for you.”
And herein lies the problem. When I said, “Think about it. Not including ethyl alcohol (spirits), there are only three macronutrients.” “What’s a macronutrient?” he asked. That’s the state of our nutrition education! I told him, “The three macronutrients are protein, fat and carbohydrate. Everything in nature that you eat is essentially a combination of one or more of them, mostly of more than one. Let’s start with the basics.
The only “foods” I can think of that are 100% fat are the manufactured, refined, “vegetable” or seed oils (PUFAs) that I try hard to avoid. Most animal foods are a combination of mostly protein and fat. Most plant-based foods are almost 100% carbohydrates, although some contain some protein and even fat.
Of course there are exceptions. A Haas avocado, for example, is a plant food that is rich in “good” fats and high in fiber (non-digestible carbs). The fats are distributed as monounsaturated 71%, polyunsaturated 13%, and saturated 16% (15% total fat), 9% carb (mostly  fiber), 2% protein, 2% ash, and 72% water. Avocados are a very good plant-based food. So is olive oil (EVOO), another so-called “monounsaturated” fat.
But a salad of leafy greens is almost 100% carb, albeit low-carb; but if your “small salad” had avocados, or hard-boiled eggs, or shredded cheese, or bacon bits, or all of the above, I would say it was a very good salad, because of the protein and fat. But watch out for the dressing. Unless it is just olive oil and vinegar or your own vinaigrette, it is made from one of those refined PUFAs, the manufactured “vegetable” oils – which are all bad for you. Store bought often has sugar added as well. . So, make your own vinaigrette or just use OO & V.
Returning to my mentee, I gave him three books to read while he took a vacation: “The Art and Science of Low Carbohydrate Living,” by Volek and Phinney, “The Obesity Code,” by Jason Fung, and “Diabetes 101,” by Jenny Ruhl. Since he apparently has a sensitivity to the oral anti-diabetic medications he had tried, and he really didn’t want to be an insulin-dependent type 2 for the rest of his life, I wanted him to understand the concepts and the logic behind the science of treating type 2 diabetes as a dietary disease. I knew that if he followed the precepts of low carbohydrate eating, he would quickly reverse his diabetes and get off insulin.
He was motivated, and he seemed to me to be the ideal candidate for a “dietary solution.” We agreed we’d meet again when he returned from vacation to talk about when and what to eat and not eat.
This is my area of expertise. I was never on insulin, or any of the new injectables that are frequently prescribed before insulin, but (in 2002) I was simultaneously on three different classes of oral anti-diabetic medications and would soon, my doctor and I both knew, be injecting insulin. My T2 diabetes was progressing (sadly, as mainstream and establishment medicine still says it will). Little did I (we) know that there is another way.
 Interestingly, my student said his caregiver (a NP masquerading as an MD) and her colleague, in another town (an internist masquerading as an endocrinologist), hadn’t mentioned a low carb diet as a self-management treatment. The NP just wanted him to follow orders, take his insulin, and return in 2 weeks for more tests.

Sunday, September 2, 2018

Type 2 Nutrition #448: How “science” gets it wrong

A “basic” scientist proffers an hypothesis and then attempts to prove it wrong. If by experiment it is unable to be proven wrong, it can then be offered as “true.” At this point it is open to other disinterested scientists to prove it “wrong.” If they fail, the hypothesis gains acceptance and eventually becomes “received wisdom.”
Applied science is the application of the “knowledge” discovered in basic science. The search for this “truth,” wherever it is to be found, requires an inquiring mind that is open and skeptical of all such “received wisdom.”
I am just a humble blogger, but I have noticed that the “Insulin Hypothesis” has gained a degree of acceptance in the mainstream media. I began to eat Very Low Carb after my doctor read Gary Taubes’ “What If It's All Been a Big Fat Lie?” in 2002. In 2008, after reading “Good Calories-Bad Calories” (“The Diet Delusion” in the UK), I accepted Taubes’s Insulin Hypothesis as “true.” I had totally reversed my type 2 diabetes, achieved an A1c of 5.0%, and over a period of years lost 170 pounds. “Clinically speaking,” that A1c means that I am now considered (erroneously) to be “non-diabetic.” I will always be Carbohydrate Intolerant.
Mainstream science, though, has yet to get the message. This article, published in The American Journal of Clinical Nutrition, describes a study about a different “received wisdom.” It is predicated on the premise that losing weight by eating a restricted calorie diet (800kcal/day), over a period of time, should improve insulin sensitivity; put another way: that the driver of improved insulin sensitivity is weight loss.
Gabor Erdosi, on his Facebook group Lower Insulin, was skeptical. He wrote, “The general advice to improve insulin sensitivity is to lose weight. However, it doesn’t look like the proper advice when put to the test. In this study, 55% of the participants turned out to be non-responders, meaning that even after similar weight loss on an 800 kcal/d diet, and following weight maintenance, their insulin sensitivity didn’t improve much.”
Erdosi doesn’t need to explain why to his erudite readers, but, for the uninitiated, I will.  It isn’t weight loss that improves insulin sensitivity; it is lower insulin that improves insulin sensitivity. The body doesn’t have to resist being besotted with insulin and so is more receptive. Lower blood insulin, from eating Very Low Carb (VLC), and/or Intermittent Fasting (IF), also permits the body to access its fat stores and lose weight easily, and also maintain weight loss without hunger. Eating an 800kcal/day “balanced” diet does neither of these things.
When you eat a “balanced” (high carbohydrate) diet – one that includes processed carbs and simple sugars in every meal – whether you are non-diabetic, pre-diabetic or a diagnosed type 2, your body will elevate the level of insulin flowing in your blood. Insulin is both the transporter of glucose and the cellular gatekeeper. It signals cellular receptors to open to receive the glucose energy. If you have insulin resistance, the cellular gate is stuck, so your pancreas sends more insulin into your bloodstream. This begins a vicious cycle.
So, to improve your insulin sensitivity, you need to lower your blood insulin. If you have less insulin flowing in your blood, whether you’re non-diabetic, pre-diabetic or a diagnosed type 2, your body’s receptor cells will become more sensitive to the insulin it “sees.” And, if you have less insulin flowing in your blood, your body will also have access to energy from the food you previously ate, and stored as fat, and you will lose weight.
Thus it’s not lower weight that improves insulin sensitivity. It’s lower insulin that improves insulin sensitivity.
But mainstream science continues to ignore the Insulin Hypothesis because government doesn’t fund the kind of research that would test it and accept it as “true.” There are too many corrupting influences. For example, the research cited above was conducted by the Nestlé Institute of Health Sciences, Lausanne, Switzerland. Nestlé makes the 800kcal meal-replacement product (Modifast; Nutrition et Santé) used in the study. In U.S. markets, Nestlé sells Optifast, Boost and Carnation, among many other HIGH-CARB “health science” products.