Monday, July 15, 2019

Retrospective #149: Feral Cat Feeding Frenzy

We have had a small colony of feral cats for 11 years. When four adolescent siblings appeared on our terrace one fine day, we fed them. They were truly feral and were too old to be domesticated. To make a long story short, after a few litters were produced clandestinely, we eventually caught, spayed or altered them all, and the population stabilized at six adults. We set out food for them twice a day, though we still can’t touch or even get close to any of them.
And every year, as winter approaches in our temperate climate (upstate New York), I’ve observed that our small feral cat colony knows it’s time to fatten up for the long winter ahead. Their appetites seem insatiable. Ordinarily cats know not to overeat. If they are full, they leave food on the plate. But their appetites change when they sense they will need fat reserves to survive a long winter when they “think” they will have to depend on “the hunt.”
Gary Taubes describes this mammalian behavior in “Good Calories – Bad Calories” (pg. 294). It’s an example, he says, of hormonal control of feeding behavior, just as human growth hormones account for the appetites of children. On a good diet, children don’t normally get fat; they get plump briefly and then they grow. They get taller very quickly. And when cold weather is coming, cats eat voraciously to fatten up for winter. It’s a hormonal thing.
The temporary fat that cats put on provides insulation from the cold as well as body fat energy reserves. Of course, these cats don’t “know” why they have rapacious appetites as the days get shorter and colder. Their unconscious brains function autonomically regulating homeostasis on a daily and seasonal basis. Their hormones “tell” them to eat. It’s a survival behavior. When spring comes, and the fat reserves are depleted, their eating behavior will return to “normal.” They will need to be lean again to have the agility to hunt. “Fat cats” don’t get the “early bird.”
What can we learn from these observations? Well, we’re mammals too, and it’s only been 500 generations or so (10,000 years) since we learned to grow food as crops and then harvest and store them for winter. This was at the beginning of the Neolithic Age. The time before that is referred to as the Paleolithic Era, hence what is known today as Paleo dieting. But in today’s world, we live in an environment of abundance in the food supply. Our modern lifestyle allows us to shop at the local super market rather than “hunt and gather” or grow our own food.
The market is filled with a cornucopia of foods all year long, many of them “processed,” which means they have already been “partially digested”! White flour milled from whole grain is a perfect example, as are fruit juices and smoothies. Even fruits, which are primarily sucrose, fructose and glucose – all simple sugars, with a little fiber and pectin – have all been hybridized to make them even sweeter (and larger) than they ever were in ancestral times.
The result: When processed carbs dominate our diet, we eat every day like winter is about to descend at any minute. The same autonomic control system that tells the feral cat to prepare for winter, tells us to “overeat.” Not the same mechanism, but the same effect because, for us, there will be no seasonal change in our food supply.
The alternative to feast and famine is the way we were designed to eat. Our bodies were designed to be for a period in a condition of mild ketosis after a meal is digested. It is a natural state. Food wasn’t always abundant. The cycle then was: feed, digest and absorb, then fast, repeated maybe once or twice a day, if we were lucky.
The feral cat colony feeding frenzy is being driven by the onset of winter. Feeding of the human mammalian colony is now being driven by an over dependence on boxed, bagged, and “predigested” processed foods that we have come to overly rely on “for our convenience.” It is also with the blessing and encouragement of our government whose misguided advice is still being driven by 60 years of bad science, among other things.  The “corrupt bargain” of government funding, well-meaning but overreaching “big government” “fat cats” who want to tell us what we should eat, and the influence of Agribusiness and Big Pharma that profit from it.
As individuals in society we need to learn to think for ourselves and recognize what is really in our best interest. 

Sunday, July 14, 2019

Retrospective #148: Obesity, a Condition of Genetic Susceptibility

Obesity is, for most of us, a condition of genetic susceptibility. I say “most of us” because I want to address in particular NOT the very small number of people who have a rare genetic disorder (e.g.: Prader-Willi syndrome). I want to address the one-third to one-half of us who will gain weight eating the same foods in the same amounts that the rest of us do who do not gain weight. At one time we did eat the same foods and amounts without gaining weight, but then something changed, and that something is not simply behavioral, nor is it less physical activity.
My bias as a member of this cohort is also an advantage. I am amazed by several respected authors in the health and nutrition field who still just don’t get it. It’s too bad. Maybe you just have to be in our shoes to understand how the body responds to carbohydrates once your metabolism has become disregulated by Insulin Resistance, with the resulting hunger/cravings yet complete intolerance for carbohydrates as an energy source without weight gain.
Anyway, I do not seek sympathy. I just want wider understanding and acceptance of the science behind the cause of obesity. That might enable empathy and 1) an interest in advancing the science, and 2) an openness by the medical and public health establishments to accept the evidence presented by so many serious researchers.
Unfortunately, both the medical and public health establishments today are thoroughly corrupted by Agribusiness, Big Pharma and they by government funding for research. So, only independent researchers, most of them younger and unencumbered by conflicts of interest or conscience, can make a difference. I am but a speck in this firmament, but I power on, seeking and broadcasting the truth to a small following. Thank you for reading my blog.
My bias is generally informed by award-winning science writer Gary Taubes. His seminal tome, “Good Calories – Bad Calories,” is a foundational document. In Retrospective #5, “Gary Taubes and the Alternative Hypothesis,” I give his “10 certain conclusions” which lay down the basis for his understanding of the scientific cause of obesity.
In Retrospective #120, “Nutrigenomics,” I wrote: “It is hoped that by building up knowledge in this area, nutrigenomics will promote an increased understanding of how nutrition influences metabolic pathways and homeostatic control, which will then be used to prevent the development of chronic diet related diseases such as obesity and Type 2 diabetes.” Nutrigenomics clearly defines obesity as a condition of genetic susceptibility.
In an NPR piece some time ago, Dr. Lee Kaplan said, “There are thousands of genes in the body, and about 100 of them are involved in making some people more susceptible to weight gain.” “We’re all wired in slightly different ways,” and “those subtle differences are reflected in how the body deals with energy stores and fat.”
The head of the Obesity Clinical Program at the Joslin Diabetes Center said: “The reality is, if you have that genetic susceptibility to gain weight, you will gain weight easily, no matter what. Genetic susceptibility has to do with hormones and chemical systems in the body that direct appetite, metabolism and the absorption of nutrients. If you've always loved the sugary taste of ice cream, you may end up eating too much of it simply because an enzyme in your brain fails to halt the chemical that signals your brain to eat as much of the beloved food as you can.”
A 2009 study on the genetic susceptibility to weight gain found that when 12 pairs of identical twins were overfed 1,000 calories a day for three months, each set of twins gained a different amount of weight. Some only gained 8 pounds, while others gained thirty pounds. But within the pairs of twins themselves, the weight gain was the same.
A story in The Telegraph reported that Paul van der Velpen, the head of Amsterdam’s health service, said, “Just like alcohol and tobacco, sugar is actually a drug.” Van der Velpen claims that sugar, unlike fat or other foods, interferes with the body’s appetite creating an insatiable desire to carry on eating, an effect he accuses the food industry of using to increase consumption of their products. Whoever uses sugar wants more and more, even when they are no longer hungry. Give someone eggs and he’ll stop eating at any given time. Give him cookies, and he eats on…”
I can relate to that. I wonder if van der Velpen is fat too, or does he just “get it.” I wonder…

Type 2 Nutrition #494: My Food Rules

My food rules haven’t changed much since I began eating Very Low Carb in September 2002. The “program” I followed then, at the my doctor’s suggestion (to lose weight) was Atkins Induction: 20 grams of carbs a day. It worked in the way my doctor intended. I lost 60 pounds in 9 months. It also worked in another way that was unintended or at least not anticipated. In the 1st week I had to come off nearly all my diabetes meds I was on.
As best I remember, Atkins only  addressed carbohydrates at the time . That’s worth noting. It’s only – okay, well largelyonly carbs that matter. To lose weight (lots of it – I eventually lost 170+ pounds), you only need to restrict – severely, I’ll admit – carbohydrates.
So, if all you need to know is to severely limit the carbs you eat, the first thing you need to learn is: what foods contain carbs. Today, there are many ways to go about doing this: 1) You can “count carbs.” That’s what I did. From the start, I estimated portion sizes, used on-line sources for carb counts and recorded everything I ate in an Excel chart I created; or 2) You can use an on-line service to do the work for you, but be careful; many of these sources are way too lenient in their allowed foods. They think you “can’t” or won’t want to eat in a way that severely limits your carb intake. They’re way too friendly to the weak-willed or insufficiently motivated. Whichever way you choose, once you learn about carbs, remember: you just have to stick with Very Low Carb.
I learned what I needed to know, and then I ate (mostly) in compliance with my new knowledge. The foods I ate, were primarily protein and fat – saturated fat that is an inherent component of animal protein. If you aren’t prepared to do that, you will have a tough row to hoe. Vegetable oils are inherently unhealthy, and you must eat fat with protein. Protein has primarily cellular and hormonal functions. And you need healthy saturated fats to absorb the fat-soluble vitamins: A, D, E and K.
As I lost weight, I discovered I needed less food to feel full.  I wasn’t hungry most of the time. My body was slightly in ketosis, just ketotic enough to burn body fat as an energy source. Fat and carbs are the only two sources of energy.  I didn’t need to eat carbs for energy balance. My body fat provided the needed energy.
That’s when I started to ask myself: If I’m not hungry, why am I eating 3 meals a day. My body runs well on its own fat (and ketones), so why eat just because it’s a certain time of day. I started having just coffee with heavy cream for “breakfast,” and skipping lunch or just being sure it was only protein with some fat so I could stay mildly ketotic and not be hungry. At supper, just eating a small meal of animal protein (with saturated fat) and a portion of low-carb vegetables tossed in butter or roasted in olive oil, was always enough for me.
But I sometimes snacked. My snacking was always just before supper. When I was on anti-diabetes meds (sulfonylureas) that was always the time of day when my blood sugar was lowest. My snacking may be cultural as well. I have always enjoyed a glass of wine, or two. (I only have spirits in a restaurant or when we have guests for dinner.) And with wine I might have radishes with butter or celery with anchovy paste, or olives.
My cheats are 1) once in a while I’ll steal some of my wife’s ice cream from the freezer, or 2) in a restaurant, eat a roll or two with butter or olive oil. Rarely, I’ll share a dessert. These are indulgences. Simple pleasures, from a life almost forgotten. The best part of eating Very Low Carb almost all the time is how well I feel. I am often “pumped,” almost euphoric. The mood difference is palpable. It’s not just knowing I am no longer fat!

Oh, and did I mention...I have saved a lot of money on drugs and food. And my blood pressure is lower. And my HDL doubled and my triglycerides dropped by 2/3rds. And I don’t have to take a statin. And my chronic systemic inflammation is way lower. And I did it without exercise (and saved lots of time and gym costs). And all it requires is that I eat Very Low Carb most of the time. That’s Very Low Carb. It’s all you have to do.

Saturday, July 13, 2019

Retrospective #147:Obesity is a Disease (for billing purposes)

The New York Times article begins, “The American Medical Association has officially designated obesity as a disease…” This ties in nicely with my last two columns, #146, “Medicare to Pay for Obesity Counseling” and #145, “Gastric Bypass vs. Medical Therapy,” and the next, #148, “Obesity, a Condition of Genetic Susceptibility?”
The AMA call was a tough one for a variety of reasons, not least of which is that there is no general agreement in the scientific community on the definition of “disease.” The Times piece explains, “Those arguing against it [the designation of obesity as a disease] say that there are no specific symptoms associated with it, and that it is more of a risk factor for other conditions than a disease in its own right.” In making the designation, the AMA at their convention overrode a recommendation against doing so by a committee that had studied the matter for a year.
The committee said that “obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index (BMI), is simplistic and flawed.” The committee argued that “some people with a BMI above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.” The committee wrote, “Given the existing limitations on BMI to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes.”
According to an article in Forbes by Chris Conover, the AMA finessed the BMI business by “simply defining obesity as an excess of body fat sufficiently large to cause reduced health and longevity.” According to Conover, “they answered the question of ‘should we consider obesity a disease’ largely on utilitarian grounds – that the social benefits of doing so will outweigh the costs.” Conover then went on to brilliantly demolish that argument.
Conover said, “the AMA is (late) to the party.” The National Institutes of Health declared in 1985 that “obesity is a serious health condition that leads to increased morbidity and mortality.” And the National Heart, Lung and Blood Institute commented in 1995 that “obesity is a multifactorial chronic disease developing from multiple interactive influences of numerous factors.” And he cites the Surgeon General’s 2001 Call to Action to Prevent and Decrease Overweight and Obesity. And Michelle Obama’s 2009 Taskforce on Childhood Obesity. Even the IRS considered obesity to be a disease, and Medicaid jumped on the bandwagon in 2010. Medicare has too, for counseling and surgery, but not for reimbursement for weight loss drugs. Why then is the AMA defining obesity as a disease now?
If we needed one, The Times gives us a clue to a motive for the AMA action. One advocate commented, “I think you will probably see from this, physicians taking obesity more seriously, counseling their patients about it.” And it noted, “…it could help improve reimbursement for obesity drugs, surgery and counseling. Two new obesity drugs – Qsymia…and Belviq…have entered the market in the last year,” and “Qsymia has not sold well for a variety of reasons, including poor reimbursement…”
At the Huffington Post, self-described policy wonk and blogger Larry Cohen enthusiastically huffed, “After the AMA announcement, some members of Congress introduced a bill to expand Medicare reimbursements for weight-loss drugs and weight-reduction treatment.” The Washington lobbyists jumped in exaltation.
And then The Times piece cracks the door open just a bit with, “Some doctors say that people do not have full control over their weight,” and “that ‘medicalizing’ obesity by declaring it a disease would define one-third of American as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. But, if the treatment is merely treating a symptom (obesity), rather than the underlying disease, doesn’t that solidify a wrong treatment modality for a non-existent disease? The AMA finessed that too by saying that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like type 2 diabetes and CVD.”
Neither The Times nor the AMA subscribes to Gary Taubes’s Alternative Hypothesis that INSULIN RESISTANCE, the metabolic disregulation that characterizes Type 2 diabetes, is what leads to fat accumulation. (obesity).

Friday, July 12, 2019

Retrospective #146: Medicare to Pay for Obesity Counseling

“Medicare to Pay for Obesity Counseling in the Name of Prevention,” trumpeted What a boon for physicians! And what a mixed blessing for their patients! Medicare finally recognized that obesity prevention in the form of counseling, as public health policy, might be as effective as costly gastric bypass surgery. Reducing obesity through “intensive medical nutrition therapy…could produce similar results,” it concluded. But only if your primary care physician “supervised” its administration. This sounds to me like it’s all about the billing.
Medicare reached this conclusion because “It’s almost impossible for physicians to take care of everything. They don’t have the expertise [how true!] or the time” [also true!]. “Seventy-two percent of primary care physicians surveyed…said nobody in their practices had been trained to deal with weight-loss issues.” Yet they [the physicians] say, “unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so.”
Why is that? Under the Medicare rules, “those with expertise in the field, such as registered dietitians [?!], are not eligible to bill directly.” Medicare, with perhaps a little lobbying from the AMA, “has limited who is able to bill for those services to primary care physicians, including nurse practitioners, clinical nurse specialists and physician assistants. Medicare will cover services from ‘auxiliary’ providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.” Yep, it IS all about the billing.
But the consequences for the patient are dire. Registered dietitians and CDE’s, if they follow the training required for certification, are the least qualified persons to provide obesity training, at least to the Pre-diabetic and Type 2 community. This has been my personal experience from attending group counseling for diabetics provided by a CDE/RN at a local health care facility, and years ago with a registered dietitian, plus more recently with a CDE.
Years ago, my doctor employed a registered dietitian in his “office suite.” I remember well her advice to “Eat a ‘balanced’ diet and exercise.” The truth is that she was as ignorant as my doc about the effect on a Type 2 diabetic of eating a “balanced” diet of from 40% to 60% carbs. But my meter provided plenty of feedback, all of it negative.
Forty-five to sixty-five percent carbs is the amount recommended by the Institute of Medicine for everyone in the 2010 Dietary Guidelines for Americans (Table 2-4, pg. 15). The USDA’s Nutrition Facts panel on processed food packaging is likewise a one-size-fits-all formula. Carbohydrates are 1,200 (60%) of the 2,000 calories in the Standard American Diet (SAD,) for a woman. More for a man. And that, folks, is why Type 2 diabetes is a progressive disease!
My experience with a CDE (employed by a doctor) was the result of a silent auction for a non-profit a few years ago. The bidding started at $20, so I placed the first bid, and it was the only bid. At this point I had been eating Very Low Carb for about 10 years. I had lost 170 pounds and had eliminated virtually all my oral diabetes meds. My blood glucose was normal, my blood pressure (on the same meds) had dropped dramatically, and my blood lipids (both HDL and triglycerides) had totally turned around. I no longer had Metabolic Syndrome or detectible hypertension (with meds) or Type 2 diabetes as long as I refrained from eating carbohydrates.
Okay, those conditional statements are caveats, but that is a price I was and am willing to pay for the complete abatement of my symptoms. In doing so I am now at much lower risk of all the Diseases of Civilization to which I was exposed before I began this Way of Eating. It was a rough session, for the CDE, but she toughed it out. In retrospect, it wasn’t very nice of me to do that to her, but maybe it will pay off. Maybe she will have an epiphany.
So “save your money,” so to speak, if counseling is voluntary as it is with Medicare, or just ignore the advice if obesity counseling, also at government expense, is required by the NHS. Your health will be better served if you listen to your meter and avoid any “one-size-fits-all” diet plan.

Thursday, July 11, 2019

Retrospective #145: Gastric Bypass vs. Medical Therapy

Recently, my Medscape alert brought me a story on “Gastric Bypass vs. Conventional Medical Therapy for Metabolic Syndrome.” I read it, and the full paper in JAMA, and my reaction was that it would be funny if it weren’t so very sad. This study used a “2-group unblinded randomized trial” and is a perfect example of how bloody blinkered the medical community is to the treatment of Metabolic Syndrome and its associated co-morbidities.
This narrow mindedness is best demonstrated by the first bold heading in the abstract: “IMPORTANCE: Controlling glycemia, blood pressure, and cholesterol is important for patients with diabetes. How best to achieve this goal is unknown.” Unknown!!! Let’s face it. This naïve statement is just a set-up to obfuscate and camouflage the true purpose of the entire enterprise: to promote gastric-bypass surgery in “mild to moderately obese patients with Type 2 diabetes.” Generally gastric bypass is reserved for the morbidly obese patient (BMIs ≥ 35). The growing number of gastric bypass surgeons, however, requires that there be more “eligible” patients. And the sooner the better, before the unfortunate side effects such as “dumping episodes” and a higher suicide rate are better known. 
Controlling glycemia, blood pressure, and cholesterol are certainly important for patients with diabetes. How best to achieve these multiple goals (collectively known as Metabolic Syndrome), is certainly, however, NOT UNKNOWN. It has been documented innumerable times in countless papers published in the peer reviewed medical literature. The problem is that control is NOT ACHIEVED with “medications for hyperglycemia, hypertension and dyslipidemia (that) were prescribed according to protocol” nor with “surgical techniques that were standardized,” to quote from the specific “interventions” utilized in this trial. Control is achieved by what type of food you eat.
This study had a “lifestyle modification” component modeled on recent “successful clinical trials, they said, particularly the “Diabetes Prevention Program” and the “Look AHEAD Protocol.” The interventions in those trials were to lose 7% of body weight and to exercise 150 minutes (!) a week. The Look AHEAD Protocol also examined whether weight loss reduced the risk of heart attacks and strokes in obese Type 2 diabetics. It did not.
Maybe (Is my sarcasm too thick?) the problem with these studies is what they have in common- a “healthy low-calorie, low-fat diet” that fails to lower blood glucose enough to reduce the risk of diabetic complications, including heart disease. The lifestyle intervention protocol in this trial was similar for participants in both treatment groups.
In the Gastric Bypass study protocol, “Portion controlled diets using meal replacements, structured menus, and calorie counting…encouraged to help participants stay within calorie limits.” “Both groups met regularly with a trained interventionist to discuss strategies for facilitating weight management and increasing physical activity. Topics included self-monitoring, stimulus control, problem solving, social support, cognitive behavior modification, recipe modification, eating away from home, and relapse prevention.”
Maybe I am being too hard on these gastric bypass surgeons. Study participants were, after all, a “failed” cohort. Participants had diabetes for an average of 9.0 years, had a mean BMI of 34.6, and a mean A1c of 9.6%, in spite of medications to control diabetes and cardiovascular disease risk factors (statins). Perhaps I should ignore the fact that the Principal Investigator, or PI, who created the study concept and design, drafted the manuscript, and provided study supervision, received funding for the study from Covidien, a leading manufacturer of surgical devices, as well as serving on the medical advisory boards of Novo Nordisk, USGI, and Medica. Eight other co-authors, all doctors and support staff, also reported receiving grant support from Covidien, including one who received salary support for what, in small print, is called, unabashedly, “The Diabetes Surgery Study.” 
I can ignore these funding facts, just as they ignore an effective dietary therapy for hyperglycemia (carbohydrate intolerance). To achieve control, you need to eat fewer carbs. As your weight drops your blood pressure and cholesterol will improve too. Your weight is under your control because what you eat is under your control.

Wednesday, July 10, 2019

Retrospective #144: Diabetes and Dementia

The “Background” in the Abstract of this August 2013 piece in The Lancet states: “Although patients with Type 2 diabetes are twice as likely to develop dementia as those without this disease, prediction of who has the highest future risk is difficult. We therefore created and validated a practical summary risk score that can be used to provide an estimate of the 10-year dementia risk for individuals with Type 2 diabetes.” Diabetes in Control, a digest for medical doctors to which I subscribe, picked it up. Have I got your attention yet? Well, it gets much scarier.
The researchers were from the University Medical Center Utrecht, Netherlands, the University of Chicago, the University of Washington, and Kaiser Permanente. In 2013 Kaiser Permanente was the largest managed care organization in the U. S., with almost 9 million health plan members, 15k doctors, 170k employees, and $50 billion in annual revenues. Kaiser Permanente, the National Institute of Health, and Fulbright funded the study.
The researchers used data from patients with Type 2 diabetes, aged ≥60 years, with 10 years of follow-up. The risk factors in their analysis that were “most strongly predictive of dementia” were “microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age, and education.”
The outcome of their risk analysis? “The prediction of 10-year dementia risk in patients with Type 2 diabetes mellitus “shows a 5.3% risk for the lowest score and 73.3% for the highest score. The Diabetes in Control piece states, “According to the authors of this study, those in the higher risk category were 37 times more likely to develop dementia than those in the lowest risk category.”
How do they plan to use this information? You’ll love this. They say, “The risk score can be used to increase vigilance for cognitive deterioration and for selection of high-risk patients for participation in clinical trials” (my emphasis). And that’s it! In other words, they watch as you develop dementia, and then perhaps suggest that you sign up for a clinical trial to test another drug to treat your cognitive deterioration. Isn’t that just dandy!
Of course, there is another way. Remember, the researchers who created and tested this risk analysis prediction tool used “data from approximately 30,000 Type 2 diabetic patients aged 60 and greater over a 10-year interval.” These diabetics were presumably being advised to eat a “one-size-fits-all” low-fat, high-carb, restricted-calorie diet, with lots of “healthy fruits and vegetables” (all carbohydrates) with minimum saturated fat and dietary cholesterol.
Most were probably also medicated for hypertension (high blood pressure) and for high cholesterol with statins.
Further, the treatment standard that the clinicians were using was undoubtedly the one supported by the current “Standards of Medical Care in Diabetes” published annually in Diabetes Care, the Journal of the American Diabetes Association. That means that your physician will be safe-guarded from medical liability to simply advise you that your Type 2 diabetes is “under control.” He will not inform you that your elevated blood glucose levels, as allowed by this standard, are progressively damaging your blood vessels, organs and endocrine system.
If you leave the care of your Type 2 diabetes in the hands of your physician, this is what will happen to you: As he observes your A1c rise, he or she will prescribe higher doses and more medications until you are maxed out, and then possibly switch you to injected insulin. Repeat for your elevated cholesterol and high blood pressure.
And when you are unable to lose weight and keep it off on a low-fat, high-carb diet, as he makes a note in your file that the “patient was non-compliant,” you will be reminded again to “eat less and exercise more.”
Don’t be a member of this treatment cohort. Take charge of your own health. Do not accept an A1c of ≤7.0% as “in control.” At this level, your heart attack risk is doubled. Eat a diet that is low in carbohydrates; better yet, VERY low. Don’t sweat the saturated fat and dietary cholesterol. Your body will love it. And so will your doctor. He or she will be pleasantly perplexed with your lab results and weight loss, and will almost certainly lower your meds, and then tell you to “just keep on doing what you’re doing.” That’s an outcome you can both happily live with.

Tuesday, July 9, 2019

Retrospective #143: Fruit Consumption & Diabetes – a Theater of the Absurd Plot

No sooner had I posted #138 in 2013, “Fruit, the 3rd Rail for Prospective Low Carbers,” when my Medscape Alert (not “The Onion”) brought me an absurdist piece: “Consumption of Certain Fruits Linked to Lower Diabetes Risk.” I was dumbfounded. How could the consumption of any food, whose only macronutrient is simple sugars, “lower diabetes risk”? It just made no sense. Am I living in an incomprehensively illogical world? A world without meaning? Has the respected research community abandoned rational thinking, I asked? I had to read the piece.
The report was from the Department of Nutrition, Harvard School of Public Health, and appeared as an online article in BMJ, the British Medical Journal. The Medscape writer wrote, “Increasing fruit consumption has been recommended for the primary prevention of many chronic diseases, including Type 2 diabetes, although epidemiologic studies have generated somewhat mixed results regarding the link with risk of Type 2 diabetes.”
The impetus for the study writer’s hypothesis appears to be, “The inconsistency among these studies may be explained by differences in types of fruits consumed in different study populations as well as difference in participants' characteristics, study design, and assessment methods, although a meta-analysis did not show that the associations differed by sex, study design, or location." Okay, all epidemiological studies inherently have many confounding factors and biases, but the hypothesis proposed to address these factors is, IMHO, also inherently flawed. Just because “differences in types of fruits consumed” was not previously studied, does not lead to the conclusion that the types of fruit consumed are a differentiating criterion. True, the authors cache their hypothesis carefully in the word “may,” but that did not similarly constrain the report’s conclusions, or the gushing headlines.
The authors’ conclusion: "Overall, these results support recommendations on increasing consumption of a variety of whole fruits, especially blueberries, grapes, and apples, as a measure for diabetes prevention." Unbelievable!
The article received funding from the National Institutes of Health and was published on August 29, 2013. It immediately was picked up and ‘broadcast’ in such places as The Guardian, Science Daily, Medical News Today, The Huffington Post, the Daily News, and The lede in the e! Science News piece was, “Eating more whole fruits, particularly blueberries, grapes, and apples, was significantly associated with a lower risk of Type 2 diabetes, according to a new study led by Harvard School of Public Health (HSPH) researchers.” WOW!
Sadly, and invariably, the headline and the lede is all that the mass media market will pick up: “Eat more fruit to lower your risk of diabetes.” I feel at times like a character in an absurdist plot, “facing the chaos of a world that science and logic have abandoned,” to borrow from a Wikipedia passage describing Theatre of the Absurd.
The absurdity is further confounded by the inherent contradiction of the perfunctory conflicts of interest disclaimer: “The study received funding from the National Institutes of Health. The authors have disclosed no relevant financial relationships.” In other words, fruit growers didn’t pay them to say that “eating more whole fruits...was significantly associated with lower risk of Type 2 diabetes.” But the National Institutes of Health did! No conflict of interest there! We taxpayers paid the costs in furtherance of the government’s goals to promote “healthy” fruits and vegetables and avoid animal-based “unhealthy” saturated fats and dietary cholesterol.
Note also that the authors were careful to say that the results were “linked” to the outcomes. The conclusions of all such epidemiological “studies” show only an association, not a causal relationship, and a weak one at that. The confounding factors, including multiple biases assumed, are expressly discussed near the end of such “studies,” inevitably making the conclusions subjective. The final paragraph of such full “studies” then invariably acknowledges that the conclusions are inconclusive and require “further study,” preparing the ground, in the name of “science,” for another grant application to pay for another round of so-called “research.” Call me cynical, if you want, but to me this ongoing charade is phantasmagorical and surreal, if not downright Machiavellian.
Oh, well, at least you can be comforted to know that your humble blogger is not paid for his opinions.

Monday, July 8, 2019

Retrospective #142: “I’m Sorry…” Confessions of a Former Weight Loss Consultant

“An Open Apology to All of My Weight Loss Clients,” sent my way by a friend, caught my attention. It was on the website of Iris Higgins, a “certified hypnotherapist, past life regression specialist, and women’s health coach.”
Ms. Higgins opens with, “I worked at a popular weight loss company for three years…” She then confesses, “I’m sorry that I put you on a 1,200 calorie diet and told you that was healthy.” Now she really had my attention. I currently eat a 1,200 calorie a day diet, and I weigh probably twice what she and most of her clients did, and I’m very healthy (besides being a Type 2 diabetic for 33 years). Is she going to tell her former clients that just eating 1,200 calories a day is unhealthy? Well, she does, but as my readers know, a calorie is not a calorie because…
All calories are not alike. The body metabolizes foods differently, according to their macronutrient composition. A carbohydrate calorie is not processed the same as a protein calorie or a fat calorie. On this, you must be clear.
Higgins’ confession, though, is sincere. And here is where she gets to her point: “that you’ve been played.” “And that’s why I’m sorry,” she says, “because I’ve been played for years…” “And it wasn’t just the company [her employer] feeding them [lies] to me. It was the doctors and registered dietitians on the medical advisory board. It was the media and magazines confirming what I was telling my clients.”
She sold her clients food that helped them “lose weight and then gain it back, so that you thought we were the solution and you were the failure,” she wrote. “You became a repeat client, and we kept you in the game.”
Ms. Higgins’ main thrust is that most of her clients were not really overweight. Recall what we learned in Retrospective 141: In 1997 the World Health Organization redefined obesity with the result that many of her clients obsessed over losing a few pounds to satisfy their mother or some other societal pressure to conform to an artificially created norm of what is considered a “healthy” weight. Amen to that! BMI be damned, I say.
My main disappointment with this confession, however, is that Ms. Higgins failed to understand the cause for the yo-yo weight swings of her clients. “When,” she asks, “did we become ‘professional dieters.’”? “I’m sorry because I get it now,” she says wrongly. “If you’re trying to starve your body because you’re eating fewer calories than it needs, of course it’s going to fight back.” Of course it will, but she fails to see why. Calories are not the problem.
The macronutrient composition of the diet is the problem. What your body does with the calories that you eat – burn them or store them – is the issue. The quality of the calories you eat is the issue. And the quantity of low-quality processed carbohydrate “foods” that we eat is the reason we gain weight. Avoiding these processed and manufactured “foods” is the solution.
At the end of her “confession,” Ms. Higgins does share some good advice. She concludes, “Just eat food. Eat real food, be active, and live your life. Forget all the diet and weight loss nonsense. It’s really just that. Nonsense.” 
Of course, if you’re seriously overweight (obese or morbidly obese), and you have health issues (hypertension and/or ‘high cholesterol,’ you can lose weight naturally by following Ms. Higgins’ “real food” advice, tweaked only to eat many fewer carbohydrates, moderate protein and high fat, even just 1,200 calories a day.
By changing only the type of food you eat, you will lose weight without stress and without hunger. Real food, unprocessed and unmanufactured, is higher in bio-available nutrient value than the refined “foods” that dominate the boxes and bags on supermarket shelves. And they have no added sugars, and fewer “natural sugars” and carbs.
I make no brief for or against “hypnotherapy, past life regression analysis or rediscovering the magic in your life.” They may indeed be good pursuits. But if you need to lose weight (only if you really need to), you might try a LCHF Way of Eating. It’s a way to eat 1,200 nutrient dense calories a day and be healthy without hunger. The rest of the energy your body needs will come from your fat stores. Don’t get played!

Sunday, July 7, 2019

Retrospective #141: “…the ultimate oxymoron: diet food”

An article by Jacques Peretti in “The Guardian,” brought to my attention by now defunct blogger Beth Mazur, used this construct to describe one aspect of the symbiosis that has developed in the food industry in the last sixty years. It’s a provocative piece – well reasoned – and a worthwhile read, especially if your BMI is in the range of 25 to 27.
Peretti begins, “When you walk into a supermarket, what do you see? Walls of highly calorific, intensely processed food, tweaked by chemicals for maximum "mouth feel" and "repeat appeal" (addictiveness). This is what most people…actually eat. Pure science on a plate. The food, in short, that is making the planet fat.
Then, “And next to this? Row upon row of low-fat, light, lean, diet, zero, low-carb, low-cal, sugar-free, "healthy" options, marketed to the very people made fat by the previous aisle and now desperate to lose weight. We think of obesity and dieting as polar opposites, but in fact, there is a deep, symbiotic relationship between the two.”
Diet food then is an oxymoron because it is something you eat (to nourish your body) but which is intended for you to lose weight. How did this come about? Peretti explains: “When obesity as a global health issue first came on the radar, the food industry sat up and took notice. Some of the world's food giants opted to do something both extraordinary and stunningly obvious: they decided to make money from obesity, by buying into the diet industry.”
In Peretti’s words, they “squared the seemingly impossible circle. And we bought it. Highly processed diet meals emerged, often with more sugar in them than the originals, but marketed for weight loss, and here is the key get-out clause, "as part of a calorie-controlled diet". “You can even buy a diet Black Forest gateau if want.”
We got fat by eating high calorie, highly processed (carbohydrate) foods. So, what happened? The result, as we all know: “Government, health experts and, surprisingly, the food industry were brought in to consult on what was to be done. They all agreed that the blame lay with the consumer – fat people needed to go on diets and exercise. We needed to slim down by eating lower calorie (low fat), still highly processed (CARBOHYDRATE) food, but as part of a calorie-controlled diet. The plan didn't work. In the 21st century, people are getting fatter than ever.” How come?
Regular readers here know that what went wrong is that “government, health experts and the food industry” came up with the wrong prescription: The low fat, restricted-calorie diet of highly processed, carbohydrate-loaded foods.
Peretti’s “scenario two,” the first being the food industry’s reaction to obesity, was this: “But, seen purely in terms of profit, the biggest market wasn't just the clinically obese (those people with a BMI of 30-plus), whose condition creates genuine health concerns, but the billions of ordinary people worldwide who are just a little overweight, and do not consider their weight to be a significant health problem.” “That was all about to change,” he said.
“A key turning point was 3 June 1997. On this date the World Health Organisation (WHO) convened an expert committee in Geneva that created a report. The WHO report re-defined obesity: the cut-off point for being overweight went from a BMI of 27 to a BMI of 25. This change wasn’t based on any scientific evidence at all. The authors essentially looked at the data and just arbitrarily decided to take the desirable weight for people who were aged 25 and apply it to everyone. Nevertheless, overnight, millions of people around the globe would shift from the "normal" to the "overweight" category.
The people who funded the WHO report were drug companies. And did they ever ask the authors to push any specific agenda, Peretti asked? "Not at all," they replied. It wasn’t necessary. The WHO report was all they needed.
Peretti concludes with this: “There now exist two clear and separate markets. One is the overweight, many of whom go on endless diets, losing and then regaining the weight, and providing a constant revenue stream for both the food industry and the diet industry throughout their lives. The other market is the genuinely obese, who are being cut adrift from society, having been failed by health initiative after health initiative from government.”

Saturday, July 6, 2019

Retrospective #140: Peanuts, My Nemesis

My name is Dan, and I am a peanut addict. I love peanuts. I am addicted to peanuts, or at least I used to be. I once gave them up (briefly), but I have since caved and eat them opportunistically…for example, at a cocktail party or reception, or when they are on sale at the supermarket (which is often, LOL). Why is another story, and the subject of another column – for someone who has a better understanding of the very complex questions of why we eat and what we eat. But for this humble blogger, I will just tell you why I have concluded that I shouldn’t eat peanuts.
For the irregular reader, I am a 78-year old, 33-year Type 2 diabetic who eats a Very Low Carb Ketogenic Diet (VLCKD) for weight loss and blood glucose control. I am Carbohydrate Intolerant. I treat my broken glucose metabolism just with minimal oral diabetes medications (Metformin). I also eat this way because I can do it without hunger, and greatly improved blood pressure (with weight loss) and blood lipids, especially HDL and triglycerides.
I have been trying to stop eating peanuts for years. So, now that my body is “happy” with the way I eat and what I eat, I have tried to stop eating peanuts again. The page references below are all from a good book, “Perfect Health Diet,” by Paul and Shou-Ching Jaminet, that I recommend for Paleo nutrition principles and practices: I do not recommend this book for its approach to eating for Type 2 diabetics. They have, sadly, missed the mark there.
First of all, peanuts are not nuts; they are legumes. Peanuts grow in the ground, not in trees. The peanut plant grows above ground with a pea-like flower. The long flower stalk then bends to the ground and continues to grow. The mature fruit develops there into a legume pod, the peanut, containing 1 to 4 dry seeds. Other common above-ground legumes include soybeans, fava, kidney, pinto, garbanzo, and lima beans, black-eyed peas, lentils, sweet peas and green beans. As a Type 2 diabetic, with the exception of young green beans, I try to avoid them all.
Legumes are “almost grains” (pg. 209),” just as dangerous as grains when eaten raw and still risky after cooking.” They are on the short list of “DO NOT EAT” foods (pg. xix): grains and cereals, sugars, beans and peanuts, and Omega-6-rich vegetable seed oils (soybean oil, corn oil, safflower oil, peanut oil, and canola oil). It gets a grade of “F” (pg. 172) in the list of “The Best Plant Food Energy Sources,” listed after wheat, corn and other grains.
The Jaminets say, “Many legumes are highly toxic in their raw state: raw kidney beans at 1% of diet can kill rats in two weeks.” “Legumes are toxicologically similar to grains. Like grains, they are eaten by herbivores and have developed toxins against mammals, including humans.” Plants can’t run away from grazing animals, so toxins are their defense system. Of course, ruminants circumvent the plant’s defense with their four-compartment stomach.
The Jaminets “sample of known toxicity effects from legumes: 1) leaky gut, bad digestion, diarrhea, bloating; 2) retarded body growth and shrinkage of organs; and 3) heart disease and tendon damage.” “Leaky gut allowed bacteria and toxins to enter the body, block production of stomach acid and thus prevent proper digestion of proteins. In the gut, the kidney bean lectin PHA induced immature gut cells that were easily exploited by diarrhea-inducing bacteria such as E. coli” (pg. 210). “Feeding rats the alpha-amylase inhibitor found in kidney beans leads to extreme gut bloating,” which lead occasionally to a ruptured intestine.” It gets worse from there. Read Chapter 20.
“Many legume toxins can be destroyed with overnight soaking and thorough cooking, but not all.” “Traditional cuisines that make heavy use of legumes, such as Indian cuisine, used very long cooking times as well as lengthy detoxification methods – overnight soaking, sprouting, and fermentation. Even with such methods, not all toxins are removed. But at the hasty pace of modern lives, few people soak their beans overnight or cook them for hours.
“Peanut and soybean allergies are among the most common allergies” (pg. 212). “People with celiac disease who aren’t healed by removal of wheat often turn out to have antibodies to soybeans or other legumes and need to remove legumes from their diet as well.” “Significantly raised antibody titres were found in the coeliac group…” The Jaminets’ conclusion: “(W)e believe there is little reward and much risk to eating toxin-rich legumes such as beans and peanuts. The only legumes we eat are peas and green beans.” I concur. Now, I just need to comply.

Friday, July 5, 2019

Retrospective #139: Nuts – the Very Good, the Also Good, and the Bad

I love nuts. I mean real nuts – not peanuts (although I love them too). Peanuts are legumes, which I try to avoid, but nuts – true TREE nuts – are different. They’re all good tasting, and all are high in fat. Some, however, are much healthier than others, some are more of a toss-up, and some should be avoided. My basis for determining that is largely the type of fats they contain, and the rule here is the same as it is for all high-fat foods: saturated fat is good; monounsaturated fat is really good, and natural polyunsaturated fats are good or bad depending on their Omega 3 and Omega 6 content.  Unfortunately, many nuts contain too many Omega 6 fatty acids.
Next question: When would you eat nuts? The conventional thinking goes: 1) As a regular between-meal snack 2) If you should “feel” hungry on occasion 3) At a social gathering where nuts are one of the few offerings that are an “allowed” food, Or 4) perhaps as a salad ingredient at a sit-down dinner with guests? Let’s take a closer look.
For me, the answers are, respectively: 1) Never as a between meal snack. They are simply not needed; 2) If I “feel” hungry (before or after supper, the only times I get the urge), I “deny” the feeling. I either tough it out, and/or drink something non-caloric; 3) at a social gathering. If nuts are offered, I will usually succumb. I will regret it later, but I am weak when I SEE – that is, when I am VISUALLY seduced; 4) as an ingredient in a salad. I like this option.
Another issue is raw or roasted, unsalted or salted, and/or otherwise coated. The answer, again for me, is roasted, and unsalted, not coated (as in “honey roasted”!). I also like salted nuts, but check out the ingredients list. To make the salt stick, manufacturers add other stuff I don’t want to eat. To summarize: for me, nuts then are only a “party option” (mea culpa) or a supplementary ingredient in a salad. Snacking and emotional eating are verboten!
Remember, the issue with nuts is which contain the fewest polyunsaturated Omega 6 fatty acids. Here is my list:
·         Low Omega-6 nuts: macadamia nuts and coconut (the fruit)
·         Moderate Omega-6 nuts: hazelnuts (filberts) and avocado (the fruit), almonds and pecans
·         High Omega-6 nuts: walnuts, pine nuts, butternuts, Brazil nuts, pumpkin seeds, sunflower seeds.
Note that cashews and pistachios are not on this list because, while moderate in Omega 6s, they are too high in carbohydrates. Other dietary choices which offer low, moderate and high Omega-6 options as food choices are:
·         Low Omega-6 nut (and fruit) oils: coconut oil, macadamia nut oil, and palm oil
·         Moderate Omega-6 oils: olive oil
·         High Omega-6 nut oil: walnut oil
Nut oils, however, come with certain risks to health: the higher the Omega-6 content, the greater the danger of damage from high heat and chemicals in processing and manufacturing and the more likely they are to become rancid on the shelf. After opening, high Omega-6 nut oils should be refrigerated; they are fragile.
If you’re influenced by the Paleo ideology, as I am, you might find it appealing to think of tree nuts in the same way we should think of fruit: as a local, seasonal treat. In today’s world, of course, that is no longer the case. Fruits, hybridized to make them larger and sweeter, are often produced half-a-world away and are available year-round.
Nuts are too, but in our culture, they tend to be consumed mostly during the holiday season from Thanksgiving to Christmas when they are displayed at the front of the supermarket in large boxes and barrels. These displays suggest to me the way we should think of both nuts and fruit: as something special to be consumed as a treat.
I don’t mean to imply this in the literal sense. That would be orthorexic, and far be it for me to think that way (LOL). I mean it in a way that allows us to enjoy something special on special occasions: something to look forward to, like asparagus in the spring, or a dinner salad with guests of frisée, lardons, and Crimini mushrooms, all tossed in a homemade vinaigrette dressing and topped with chopped hazelnuts and shaved Pecorino Romano. Bon appétit!

Thursday, July 4, 2019

Type 2 Nutrition #493: Why fasting is soooo easy!

I know. It doesn’t ring true. It sounds, literally, incredible. But under the scenario I am going to describe, it IS true. I wouldn’t lie to you. My credibility with my regular readers is too important for me to squander it.
Before telling you why, though, I want to address the thinking that questions this assertion. On hearing this, a person thinks and maybe asks, “Don’t you get hungry? How’s your energy level? Do you feel okay? My answers are: “No, I don’t get hungry,” and “my energy level is high.” In fact, I feel pumped, sometimes euphoric, almost manic. “I actually feel better than okay. I feel great!” And no, I’m not “Tony the Tiger.”
Why then do people ask those questions? Because it’s common sense! It’s empirical; we’ve all experienced it. If you eat less on a “balanced” (carbohydrate-based) diet, you’re going to still be hungry! If you don’t “feed your body,” your body will slow down! And as your metabolism slows, you will have less energy and you will feel weak. You may even feel unwell. That’s all very logical and true. Yes, but notice the big “if.”
This “if” clause contains the phrase “balanced carb-based diet.” Eating less with that diet will produce the effects described because you are starving your body of needed energy because it is unable to access your body’s fat stores. However, your body is designed 1) to be fed by mouth when food is available and 2) to be fed from fat stores when food is not available, for example, when fasting. There’s only one problem. For your     body to work like that, a switch is needed to “turn on” the body’s fat fuel source. Here’s how it works.
When you eat carbohydrates, your blood insulin level rises. Your body secretes insulin to carry energy from the digested/absorbed carbs (as glucose) in your blood to your cells. Insulin then opens the “door” for the energy to be taken up. Then, when the level of glucose in your blood drops, your insulin level drops too. Insulin is thus the switch. Low insulin signals the liver to switch from burning carbs for energy to burning fat.
So, in a normal metabolism, when your carb energy is expended and your blood glucose level drops, your blood insulin level also drops and your body switches to burning body fat for energy. It does this without your feeling hungry, without slowing down your metabolism, and without making you feel unwell. The reason that all this is true should now be obvious: Your body IS still being fed…FED BY OWN YOUR BODY FAT.
You will be fed at the level your body needs for your activity level. You could run a marathon! This energy balance – called homeostasis – will be met by the liver breaking up triglycerides (body fat) as needed. You will be in energy balance so long as you have fat to burn and you don’t eat too many carbs.
Another way to lower both blood glucose and blood insulin is fasting. It is especially effective for people with a disregulated glucose metabolism, e.g. those with Insulin Resistance (Type 2 diabetics and Pre-diabetics). When we don’t eat, blood glucose and blood insulin go down and good things happen: 1) we burn body fat for energy without slowing down our metabolic rate, 2) we lose weight without hunger because our bodies are being fed at the cellular level by body fat, 3) ketone bodies, a byproduct of fat (triglyceride) breakdown, feed the brain, and 4) while fasting, out bodies gather cellular debris (autophagy) and 5) burn old, used up cells (apoptosis). These renewal processes provide great benefit. Burning omental (visceral) fat, including pancreatic fat cells, beta cells (erroneously considered to be ”burned out”) begin to function again.
I’ve been a Type 2 for diabetic 33 years. So, what happens when I eat Very Low Carb with Intermittent Fasting? I lose weight, my glucose metabolism stabilizes, and I’m never hungry because I’m a fat burner. I have loads of energy, I save money on food, and I feel “pumped.” What’s not to like about those outcomes?
Your doctor will love it too. My last A1c was 5.0%. My cholesterol panel is “to die for.” No statins. “Blood pressure of a teenager,” the nurse said.” When you’re not hungry all the time, fasting really is soooo easy.

Retrospective #138: Fruit, the 3rd Rail for Prospective Low Carbers

Whenever I am asked about what foods one “cannot” eat on a Low Carb Diet, eating fruit is always the “3rd rail.” Like 3rd rails, life without fruit to a prospective Low Carber is “fatal.” I love fruit too, just as I love pasta, rice, bread and potatoes, but I have learned that my body can no longer tolerate “sugar,” especially simple sugars, as in fruit. I also “can’t” eat any processed carbs, as in all packaged foods, and I can’t eat all of the starchier and sugary veggies.
After water, fruit is basically sugar. All of the macronutrient nutrition in fruit is sugar. An apple is 86% water, 3% fiber, and 11% simple sugars (0% protein and 0% fat). The sugars are 20% sucrose, 57% fructose and 23% glucose. When the disaccharide sucrose breaks down, an apple is then 67% fructose and 33% glucose. That’s all “sugar”!
It’s true, an apple has some micronutrients (vitamins and minerals in the skin), and the pulp has pectin, but there are other sources for these important components in a basic “real food” diet. Do not use these “good” components as an excuse to eat fruit. Rationalization is just self-deception. Own up to it, my friend.
So, what do you tell someone who loves fruit and who wants to reduce their carbohydrate intake? Three common approaches are 1) don’t snack on fruit. In fact, don’t snack at all, but if you must snack, snack on fat (like nuts, cheese or olives), and 2) if you must eat dessert, eat fruit for dessert instead of ice cream or pie, and 3) eat mostly berries (strawberries, raspberries, blackberries and blueberries), with heavy cream (but no added sugar!). Berries have phytochemicals, fiber, minerals and vitamins too. And avoid grapes, cherries, and dried fruit (like raisins)!
Is it possible to take a more moderate stance on the issue of fruit? Sure. As far as your body is concerned, all carbs are equal. They will all break down to simple “sugars,” mostly glucose. If you are only mildly carbohydrate intolerant, that is, if you have been told you are “pre-diabetic,” you may be able to tolerate more “sugar” (carbs) in your diet. But be careful. This is a very slippery slope. Your meter will tell you what you need to know.
But this is a no-man’s land for both the patient and the clinician. Your doctor most likely adheres to the practices and “Standards of Medical Care in Diabetes,” issued by the American Diabetes Association. If you are overweight, and your A1c test is elevated, your physician will advise you that you are “at risk of diabetes.” Your doctor will then probably tell you to lose weight by eating less (on a “balanced diet”) and “moving” (exercising) more.
Your doctor, however, probably won’t tell you to eat fewer carbohydrates, and they won’t tell you to eat less fruit. And they definitely will not tell you that IF YOU DO NOT CHANGE THE FOODS YOU EAT, THAT YOUR CONDITION IS PROGRESSIVE AND THAT YOU WILL ALMOST CERTAINLY MOVE ON TO BECOME A FULL-BLOWN TYPE 2 DIABETIC.
Doctors just don’t get it, yet. Carbs in your food cause your blood glucose to rise, and if you are insulin resistant, glucose will remain circulating in your blood. The only way to lower your blood “sugar,” and your circulating (serum) insulin that transports the glucose, is to eat fewer carbohydrates, including but not limited to, fruit. It’s that simple!
I was inspired to write this column by two recent incidents. First, I read a Q & A in “Diabetes Today” in which Dr. Richard K. Bernstein referred to “sweet fruit” as something to be eaten sparingly. He has been a Type 1 now for 75 years and has an A1c in the 4s. He regards a 5.7% A1c as a full-blown Type 2 diabetic. You don’t usually hear the phrase “sweet fruit,” so it stuck in my mind. The other incident was an article, “Fruit Restriction for Type 2’s: Good or Not?” in “Diabetes in Control,” a digest for physicians. It compared two groups of newly diagnosed Type 2s: one was told to eat fruit only two times a week and the other “given the more common conventional medical advice to eat no more than 2 fruits a day.” After 3 months they measured A1c’s, weight loss and waist size and found little difference. They concluded, “We recommended that the intake of fruit should not be restricted in patients with Type 2 diabetes.” What idiots! What bleeping idiots! This is “one-size-fits-all” advice (writ large!)  If you want to live a long and healthy life with Type 2 diabetes, eat to your meter! And eat fruit very, very sparingly!