Type 2 Nutrition #460: The Blind Leading the Blind

No offence intended if this “microaggression” offends any blind person to whom this column is read, but that was my reaction to a “workshop” I attended a few months ago, conducted at a local hospital by two state- trained RDs. There were 13 attendees all looking for help to deal with their type 2 diabetes.

The workshop began with a brainstorming session in which each person was asked how they felt about being a type 2 diabetic. The moderators – I’ll call them Tweedledum and Tweedledee – dutifully wrote the feelings down on a mammoth 20 x 30-inch Post It. Virtually everyone expressed negative emotions, among them anger, confusion and frustration. I was last to be asked, and I said I had no such negative emotions because my type 2 diabetes was now under control. My last A1c was 5.0%, and the only medication I take is metformin.

I was then asked by Dee, reasonably, why I was attending the workshop. I explained that I had been diagnosed a type 2 thirty-two years ago, and my diabetes progressively worsened until I was taking 3 different orals meds – maxed out on 2 – and my fasting blood sugars were still out of control. Then, 16 years ago, to lose weight, my doctor suggested I try a Very Low Carb diet he had read about. The first day, to prevent hypos, he had to take me off 1 med and within the week he cut the other 2 in half TWICE. Over several years I lost 170 pounds.

Although I mentioned the name of the NYT Magazine cover story my doctor had read, nobody – neither Dum nor Dee nor anyone taking the workshop – expressed any interest in how I did it. Of course, they weren’t there to listen to me. They were in this group therapy session because their health-care providers had sent them to help them deal with their anger, confusion and frustration. The free book that everyone got said it all: “Living a Healthy Life with Chronic Conditions.” In other words, give up hope of reversing your T2D; just get used to it.

I really did feel sorry for the hapless participants, each with different issues but one thing in common, T2D. They are all victims of the current healthcare system. The course syllabus, from which the workshop facilitators READ VERBATIM, is based on the Chronic Disease Self-Management Program (CDSMP) developed by Stanford University. The homework assignment for workshop #2 was to read the “food guide” in the text and learn about “healthy eating.”  It is based on is the “Dietary Guidelines for Americans,” as illustrated in the book by ChooseMyPlate.gov, and the American Diabetes Association’s, “Create Your Plate.”

The Dietary Guidelines “Choose My Plate’ plan is ¼ fruits, ¼ vegetables, ¼ grains and ¼ protein, with dairy in a bubble. No fat. The ADA’s “Create My Plate” plan is ½ non-starchy veggies, ¼ starchy foods, and ¼ meat or meat substitute, with 8 oz non-or-low fat milk. Clearly the US Department of Agriculture and the American Dairy Products Association had a hand in developing these essentially identical plans, helped by Big Pharma and Big Food Producers. How all this corruption co-exists is explained in “Root Causes” by Jason Fung, MD.

The penultimate task of the workshop was to come up with an individual Action Plan for the coming week. Mine (I was last again) was two 36-hour total fasts, on alternate days, until I lost the weight I had gained since my last annual doctor’s visit. On the other 5 days I would eat Very Low Carb/One Meal a Day (VLC/OMAD). 

At the conclusion of class, we were all asked for our impression on how things had gone. I think Dum and Dee were hoping to get feedback that we all felt better after having attended our first group therapy session. Once again last to speak, I commented that I thought it odd that most people’s “Action Plans” were to exercise more. “After all,” I said, “diabetes is a dietary disease.” Tweedle Dum responded, “Well, everyone’s different.”

If you click on both “Plate” links above, you will get a visual image you won’t forget. Americans have been following these guidelines and the incidence of diabesity has skyrocketed. Ask yourself if anyone in this workshop will have any hope of self-managing their disease. I think the only thing that this “self-management” program is designed to achieve is acceptance of their feelings. That is truly sad.

Type 2 Nutrition #459: My new favorite snack

I’ve been mentoring a recently diagnosed type 2 about what and when to eat, and not eat. I’ve told him that when you eat Very Low Carb (VLC), you won’t be hungry much, and you should skip meals if you’re not hungry. When you eat VLC, your blood glucose drops and your blood insulin drops too, so you can access and burn body fat. That’s why you’re not hungry. Your body is being fueled by your own stored energy.

So, in general you won’t need to snack for energy, but they are other reasons we snack. We all (most of us) do it, some of us habitually. I usually snack in the late afternoon, before supper, and when I do my favorite new snack is celery with anchovy paste. Celery is low calorie – just fiber and water – and filling. On each bite I add a dollop of paste, squeezed directly from the tube, for savor. But when my mentee tried it, he said, “It’s salty!”

It is salty, of course. Very salty. That’s why I like it. But to a newbie, salt is yet another “forbidden fruit.” For decades we were told to avoid fat, especially saturated fat. Now we know that government’s advice to avoid fat was a mistake. As a result, the Powers that Be in the 2015 Dietary Guidelines omitted the recommended 30% limit on fat. It’s now officially okay to eat more fat (and fewer carbs), just not SATURATED fat.

But from my POV that just takes us from the frying pan into the fryer (LOL). The alternative to saturated is unsaturated fat, either monounsaturated, the “good” fat found most commonly in olive oil and avocados, or polyunsaturated (PUFAs). PUFAs are highly refined and processed “vegetable” (seed) oils – corn oil, soybean, Canola, and sunflower, etc. – that easily oxidize when exposed to light and heat (the fryer). Think French fries.

Government is also slowly backing away from warnings about cholesterol, found in animal foods. Starting with the 2015 Dietary Guidelines, there is no longer a 300mg a day limit. However, the recommendation of the Dietary Guidelines Advisory Committee, that “cholesterol is no longer a nutrient of concern for overconsumption,” was largely ignored by the full HHS committee. They are, however, slowly coming to accept that our livers will make all the cholesterol our bodies and brains need, if we don’t eat it. Think vegans.

So, what’s wrong with eating salt? Nothing, unless you believe that the Public Health recommendation that everyone should eat less salt to protect the very few who have a rare genetic sensitivity to high levels of salt. The 2015 Dietary Guidelines have, however, also dropped the 2010 recommendation that Americans “reduce daily sodium intake to less than 2,300 milligrams (1 tsp salt) and further reduce intake to 1,500mg among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.” Think about half the U.S. population!

In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote an article, “The Dangers of Salt Restriction,” about a study in JAMA in 2011 that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day.” So, the lowest risk of death is associated with consuming from 267% to 399% more sodium than Type 2s or hypertensives or older adults were being “guided” to eat. I’ve been writing about salt since 2012. My column #74 cites Kresser and several other resources as well.

●       Gary Taubes, “The (Political) Science of Salt,” and “Salt, We Misjudged You,” both also cited in #74.

●       Eric Topol, MD, Editor-in-Chief of Medscape Medical News: “Dear Medscape Readers” (my #248)

●       Then there’s this recent rant on the “salt scare” by Jason Fung, MD/IDM. It’s a no-holds-barred tirade!

●       For “Tips and Tricks” on why Low Carbers should eat more salt to maintain electrolyte balance, Michael Eades, MD, has this link to his blog. Eades also explains the physiology. Please read these links about salt.

Losing weight and improving your general health and lipid profiles on a VLC diet will be more beneficial than living with mild hypertension. Ask your doctor if he or she doesn’t agree with this. Mine does, emphatically.

Type 2 Nutrition #458: Is it time to clean out the pantry?

If you’re new to eating Low Carb, and/or especially to Very Low Carb (as I eat), and you’re human (as I am), you probably have a couple of challenges ahead of you. If you live alone, you’re lucky, at least in this respect: The only food in the house is the food you bought. You have no one to blame but yourself for your bad choices.[1] 

Of course, if you blame someone else for the food choices they made, by buying food you’re trying not to eat, you have another problem: taking responsibility yourself for the food you decide to put in your mouth. But we’re all human, as I’ve said, and I’ll have to admit it is sometimes hard for me not to eat the food I’m trying to avoid IF IT’S AROUND ME ALL THE TIME (especially in open boxes, containers and bags), or worse JUST SITTING ON THE COUNTER. Most of my neurotransmitters still work. Have you heard about the cephalic response?

But the fact is, “if you live alone…the only food in the house is the food you bought” includes a vestigial accumulation of “before” foods. In transitioning from eating the Standard American Diet (SAD) to eating Very Low Carb, you still have goods in your pantry (and frig) that remain from those halcyon days of yesteryear when you ate processed foods and sweets to your “heart’s content” (!!!), or more correctly to satisfy your brain’s addiction to foods developed and produced to addict you to them. When you blamed yourself for that, you called it a “craving.” It’ll be awhile before you’re weaned off them and realize you no longer want them.

Until that time you need to take steps to reduce the temptation to stray from the course you have set for yourself. The Way of Eating you have chosen may seem difficult at first, and confusing until you learn when and what to eat, and not eat, but you will eventually sort this out. When you follow a Very Low Carb (VLC) Way of Eating for a period of time (the length varies), and you lower your blood insulin and deplete your liver glycogen supply of stored glucose, you will transition to being a “fat burner.” You will not be hungry then.

But, if you’re like me, that doesn’t mean you won’t be tempted to eat carbs, both the highly processed ones and sweets. So, the best defense is a strong offense. You need to take charge. Clean out your pantry and frig of all things that might tempt you when you “raid” the kitchen looking for something to put in your mouth.

When you were a “sugar burner,” you were probably told you should eat 5 or 6 times a day, that you needed these infusions, or “snacks,” for energy.  That was true. When you followed the SAD, which is 55% to 60% carbohydrate, and you have Insulin Resistance (IR), your blood sugar goes up and down like a roller coaster, but your blood insulin level stays high (because of your IR). And because your blood insulin is still high, you don’t have access to your body fat for energy. So, you need to snack on carbs (or fat), for that “energy boost.”

But when you eat VLC, you’re not hungry. You have access to body fat for energy so you don’t need to snack. If you do snack, it’s just a bad habit. It’s time to face up to it. Eat only when you’re actually hungry, not caving to a bad habit when you’re not actually hungry. Eat only, at most, three small meals a day. Even two, or one (OMAD). EAT ONLY WHEN YOU’RE HUNGRY. Your body will feed itself (on you) the rest of the time. It works.

So, start with the pantry. It will be cathartic, and it will boost your confidence that you have finally crossed the Rubicon and there’s no going back. You can probably throw out almost everything. Think of the space you will create! I started with the “vegetable” oils. They’re all oxidized and rancid anyway. And the Crisco (trans fats).

If you have unopened jars of jelly or honey or boxes of sugar, donate them to a food bank. Virtue signaling will make you feel good.  Fill a garbage bag with open containers from the pantry and frig. That’s what all the sugar-filled, processed “foods” are anyway. Garbage. The exercise of clearing away the past and preparing to go forward into a future that you have envisioned for yourself is very Jungian. It’s the kind of self-therapy that supports the future you have chosen for yourself, a future in which you self manage your type 2 diabetes by treating this disease for what it is: A DIETARY DISEASE. You can eat your way out of it…by eating VLC.

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https://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html

Type 2 Nutrition #457: One foot in two lifeboats…

If you’re recently been diagnosed with type 2 diabetes (T2D), you may feel like you’re lost at sea with one foot in two lifeboats, each pointing in opposite directions. It’s time to make a decision: Which lifeboat do you take?

One lifeboat is occupied by others like yourself and is led by the ship’s captain, who brought you to this point. The other lifeboat has survivors as well…and just a boatswain’s mate to guide you safely to shore. But you can only take one lifeboat. Will it be the captain’s lifeboat or the boatswain’s mate’s lifeboat? How do you decide?

The captain has a lot of education and experience. He’s a commissioned officer and the ship’s master. He is “ultimately responsible for aspects of operation such as the safe navigation of the ship, its cleanliness and seaworthiness, safe handling of all cargo, management of all personnel, inventory of ship's cash and stores, and maintaining the ship's certificates…,” according to Wikipedia. We have confidence in our captain, right?

A boatswain’s mate has the rate of petty officer and also has acquired lots of knowledge and experience, but of a more practical nature. “Boatswain’s mates take charge of working parties; perform seamanship tasks; act as petty officer-in-charge of picket boats, self-propelled barges, tugs, and other yard and district craft,” Wiki says. In other words, a boatswain’s mate has the experience and navigational skill to coxswain a lifeboat.

Which “lifeboat” should you take? Well, the “ship” that brought you here…has sunk. It failed you and all those who followed the McGovern Committee’s Dietary Goals for Americans, published in 1977, and the first Dietary Guidelines for Americans in 1980. The “Titanic” (see my #12 here) first set sail in the 50’s with Ancel Keys’s infamous “Seven Country Study,” bolstered in 1961 when Keys joined the AHA board and was on Time’s cover.

You could get into the “captain’s” lifeboat. He will utilize all the skills he learned in medical school to diagnose and treat your symptom, an elevated blood sugar. He will counsel you to lose weight; he will suggest “diet and exercise” and his “healthy fats.” And he will tell you to do what you have always done on this ill-fated “cruise,” just “eat less and move more.” And if that doesn’t work in a few months, (s)he will start writing prescriptions.

This “boatswain’s mate” will steer you in a completely different direction – one that deals not with a symptom (high blood sugar) but the cause of type 2 diabetes,  a dysfunctional metabolism. Instead of encouraging you to eat a “balanced,” “mostly plant-based” diet, high in refined carbs, sugars and “vegetable” (seed) oils, you will eat a Low Carb diet, with moderate protein and high fat, including saturated, to guide you safely to shore.

But as you can see, I have a bias. I lived the “high life” on the Titanic for 61 years. But I am among the lucky survivors who chose the “boatswain’s lifeboat.” After I made my decision 16 years ago in 2002, I lost 187 pounds) and recently had an A1c of 5.0%. I started my journey to remission and reversal of T2D by strictly eating just 20g of carbs a day. Within a week(!), I got off most of the anti-diabetic medications I was on.

My “coxswains” were mostly on on-line forums; I owe so much to them for their support. Today there are lots of special online support groups. I think the best is DietDoctor.com (subscription: $9/mo.); they get more visitors in 1 day than I’ve had on my blog in 8 years. My favorite books are "The Obesity Code," by Jason Fung, "The Art and Science of Low Carbohydrate Living," by Volek and Phinney, and "Blood Sugar 101," by Jenny Ruhl.

Of course, I’d like it if you decided to read my blog regularly. I publish once a week on Sunday mornings. I have a great editor who helps me make it readable and keeps me honest. She’s so much more qualified than I am, and in so many areas of health and wellness. I am so lucky to have had her help for all these years. As you can see, we do this without advertising. We don’t want or need ad revenues so we don’t sell or promote anything except an idea. After the disastrous voyage you’ve been on, we know that all YOU have to do now, to make it to shore safely, is to be in the right lifeboat and make smart, informed decisions about what to eat and when.