Tuesday, December 11, 2018

Type 2 Nutrition #462: The TG/HDL-C ratio and Insulin Resistance

Dr. Jay is Jay Wortman, MD, a Canadian clinician, Very Low Carb and political activist who I first found in 2012 at Franziska Spritzler’s Low Carb Dietitian. Both he and I are among a very good list of links and resources there. That was only two years after I had started blogging, so when I visited Dr. Jay's Blog, I left a comment on his “The Story So Far….” And, as shameless self-promotion, I also left a link to my blog’s website. It has since garnered several hundred hits. I also get lots of page views originating from Franziska’s blog list.
Jay Wortman has become very active on Facebook. A while ago when I offered wishy-washy advice to a newly diagnosed type 2 looking for help on a popular Facebook group, Dr. Jay intervened with a reply comment to mine. He blasted my lame advice, telling the hapless newbie to face facts. The newbie had Insulin Resistance and was therefore Carbohydrate Intolerant. I was embarrassed by my half-baked input, but very grateful he is lurking, or more likely, following the group. Dr. Jay is both passionate and selfless, and dedicated to helping. 
Dr. Wortman also keeps up with the most relevant medical research. He recently posted on Facebook this PubMed Central (PMC) mouse study, “The Failing Heart Relies on Ketone Bodies as Fuel,” which concluded, “These results indicate that the hypertrophied and failing heart shifts to ketone bodies as a significant fuel source for oxidative ATP production.” Translation: the ketogenic diet is good for the failing heart, in mice.
Another Facebook post by Dr. Jay is this study from Malaysia appearing in PMC. Looking for “an easy to use, precise and low-cost diagnostic test to predict Insulin Resistance,” 271 overweight and obese children were “stratified by tertiles using the homeostasis model assessment (HOMA), a good surrogate for the gold standard for measuring IR, the hyperinsulinemic euglycemic clamp.” “The children were analyzed for fasting glucose, lipids, insulin and waist circumference. The children were then stratified by tertile of TG:HDL-C ratio.”
The study’s conclusion: “the odds of having IR was about 2.5 times higher (OR=2.47, 95%CI, p=0.01) for those in the highest tertile of TG:HDL-C ratio. Hence, TG:HDL-C may be a useful tool to identify high risk individuals.” Dr. Jay’s endorsement/imprimatur of this conclusion was, “I calculate this for all my patients.”
Below is a chart of my 82 TG/HDL-C ratios since 1980. The first 17 ratios were while I was eating a Standard American Diet (SAD) and, since dx in 1986, treated for type 2 diabetes with antihyperglycemic drugs. The last 65 ratios are since I began to eat VLC in 2002. A TG/HDL ≤ 1.0 is ideal, a ratio of ≤2.0 is good, anything over 3 is “indicates significant risk of heart attack and stroke.  Note almost all of mine since #17 are ≤1.0.

This metric has been in use by non-cholesterol-phobic physicians for years. I wrote about in 2011 in my #27 “...the strongest predictor of a heart attack.” I hope more physicians, like Dr. Jay, start to routinely use it.




Sunday, December 2, 2018

Type 2 Nutrition #461: Very Low Carb is the Basic Precept


The best diet for a type 2 or pre-diabetic to control blood glucose is Very Low Carb (VLC). How many grams of carbs you eat will depend on your degree of Insulin Resistance (IR). Your meter will tell you. Then, the number of carbs you eat will be up to you. How much do you want to mediate your condition? Do you want to put your diabetes in remission, or do you want to let your doctor manage it as you go on with your old diet?
In the last 16 years I have tweaked how I eat a lot. My doctor started me on Atkins Induction (20 carb grams a day). I few years later I switched to Richard K. Bernstein’s 30 grams a day (6-12-12). I transitioned to LC-HF (low-carb, high-fat), then Very Low Carb (VLC) or VLCKD (“keto”), and finally VLC with lower protein and moderate fat, to allow my body to burn fat, while I fasted or had one-meal-a-day (OMAD) and was “fat-adapted.” This Way of Eating has been called many things, but the basic precept is Very Low Carb.
Besides always being fundamentally Very Low Carb, it has also always been Moderate Protein. It is not high protein as some would have you think. People who say “high protein,” are thinking negatively in two respects: 1) They think “high protein” is harmful to the kidneys and 2) they are afraid to call it or think of it as “high fat,” which it is, because they think high fat, especially saturated, is harmful to the heart, which it is not.
With respect to PROTEIN, a moderate level means from 15% to 30% protein, depending on the carb and fat calories. Mine has been 20% for many years. Second, only a diet that is higher than 30% protein, of total calories (including body fat burned), might be harmful to the kidneys and then only if you already have kidney disease. Third, fear of fat is not supported by sound science, as the world is just now coming to realize. We have all been unwitting subjects in a 60-year, world-wide, low-fat, public health experiment.
As for  FAT, I hope you’ve noticed that the 2015 Dietary Guidelines have quietly dropped the “30% and lower” target in their recommendations. You probably didn’t notice that the Dietary Guidelines Advisory Committee told the full committee that “cholesterol is…no longer a nutrient of concern for overconsumption.” You no longer are being guided to limit your CHOLESTEROL to 300 mg a day! Eat eggs! Eat shrimp! Enjoy!
Unfortunately, the Guidelines still focus – in fact they have doubled down – on the dietary recommendation against SATURATED FAT, found mostly in animal products but also in coconut oil. They – ahem, the United States Department of Agriculture, the co-authors of the Dietary Guidelines with another government agency, HHS – want you to “shift from eating solid fats to oils,” specifically the highly processed grain and seed oils grown, manufactured and “baked into” foods, literally and figuratively, by AgriBusiness. Anyone see a conflict?
Basically, a diet that is very low carb, moderate protein and high fat – or moderate fat if you are fat-adapted and need to lose more weight with fasting or just calorie restriction – is going to work for you to manage your blood sugar and to lose weight without hunger. When my doctor started me on Atkins Induction 16 years ago, for weight loss, it worked. But we were both surprised that I had hypos every afternoon for a week until I stopped all the anti-diabetic meds he had me on. And eventually I lost over 180 pounds!
My blood lipids also improved dramatically, doubling my HDL-C and cutting my triglycerides by 2/3rds. And, with weight loss, my blood pressure went down, as did my inflammation levels. I am so much healthier today than before, and I feel so much better. It all began with VERY LOW CARB. It is the basic precept for type 2s.
My apologies to my regular readers of this blog. I’ve told this story many times; however, since my columns cover a wide range of subjects and aren’t indexed, the majority of my readers find me through a “Google” search.  If that includes you, I hope you will return often and make this one of your favorite sites, or even become a “follower” and send a hyperlink to a friend. I accept no ads because I have no products to promote or sell – only nutritional advice and encouragement for type 2s and pre-diabetics.