Wednesday, November 20, 2019

Retrospective #277: What is hunger?

“I’m hungry…all the time,” the overweight person frequently says when trying to lose weight on a restricted- calorie, “balanced,” low-fat diet. But is this really hunger? “Wikipedia says hunger “is a condition in which a person, for a sustained period, is unable to eat sufficient food to meet basic nutritional needs.” That is a really bad definition.
The “hunger” a fat person experiences is different from that which a starving person experiences. Any person, fat or otherwise, who for a few days is unable to eat or any food will for a day or two experience stomach rumblings (hunger “pangs”), but then those pangs will go away. As the body adjusts to a total lack of food by mouth, it transitions to another source of “food” for energy: body fat. Body fat, plus water and salt, meets the body’s basic nutritional needs.
However, after all available fat and has been consumed, the body enters starvation” a period of “wasting” in which muscles are broken down for energy and organs begin to fail. But if you are overweight or obese, you want your body to consume your body fat. And when it does, even though you do not eat, you are not hungry because you are “fed.”
In that sense, fat people have a biological advantage over lean: Their bodies can run for a very long time on “stored” energy. It’s part of a normal fed/fasted cycle: The stomach is empty and the ingested ingredients (food by mouth) have been almost completely absorbed from the small intestine into the blood stream for distribution. It’s time to seek more nourishment (first choice), or transition to using backup energy to meet the body’s nutritional needs.
How does the transition occur? What is the mechanism? The glucose that carbs break down into requires insulin to transport it in the blood, and elevated insulin levels tell the liver that stored fat is not needed. In fact, an elevated blood insulin level blocks fat from breaking down. So, if you eat things that break down into glucose (carbohydrates), your body will tell you it needs more “food” to break down. But your body fat is locked up. Ergo, You WILL feel hunger, and if you eat more carbs, when they are used up, you will feel hunger again. YOU are making your body “hungry.”
On the other hand, if you cut back carbs, especially processed, highly refined carbs, and sugar-sweetened beverages, the “sugar” (glucose) in your blood will not be elevated and neither will your blood insulin. In that case, knowing that “sugar” (carbs → glucose) is unavailable, because your blood INSULIN level is low, the liver will release your stored fat.
Your energy will flow as well, if not better, than if you had eaten carbs. Whereas, if you are Insulin Resistant, as almost all fat people are, eating carbs will cause your blood sugar to spike and then crash, leaving you tired and hungry. But when burning body fat, your ENERGY LEVEL will be high and your BLOOD SUGAR LOW AND STABLE (i.e., balanced).
This steady state of fat burning is called ketosis – a condition your body, especially your brain and heart, really likes – you can go for days, even weeks, with high energy levels and stable blood glucose all day long. When I strictly followed the Bernstein program (designed for diabetics) many years ago, I lost 100 pounds in 50 weeks. Before that, in the first 9 months on Atkins Induction, I lost 60 pounds. Over several years, I lost a total of 170 pounds, all without hunger.
It’s hard to give up your favorite foods – foods you’ve eaten for a lifetime. But it isn’t because you need them to stave off hunger. You liked them. They were available and convenient. They’re often prepared, take-out, packaged, drive-up, processed and sweetened, but they’re mostly carbs, and when you eat them, YOU’RE HUNGRY ALL THE TIME.
Once I figured out how to lose weight without hunger, and get control of my blood sugar and Type 2 diabetes – and I learned that by eating a certain way all my health markers would dramatically improve – it was a “no-brainer.”
All I had to do was develop new habits about what I could eat and what I should (try to) avoid. A good way to do that is to get into the habit of eating the same thing for breakfast every day. For me that’s eggs and bacon and coffee with heavy whipping cream and stevia powder. For lunch (if I eat it), it may be a can of kippered herring in brine, or a can of Brisling sardines in EVOO. Supper is usually a protein portion (beef, veal, lamb, pork, chicken or seafood) and one low-glycemic, whole vegetable either roasted in olive oil or tossed in butter. No potatoes, bread, rice, pasta, corn, beets, peas or carrots. And no snacks between meals or after supper. And that’s all folks. You won’t be hungry, I promise.

Tuesday, November 19, 2019

Retrospective #276: “Why do I eat…even when I’m not hungry?”

“Why do I eat, even when I’m not hungry?” I’ve been asking myself this recently. It is also a question that arises in the HBO Documentary series, “The Weight of the Nation,” that I reviewed in Retrospective #275. It is in Part 4, “Challenges,” that dips briefly into science. The answer is hinted at by Rudolph Leibel, MD, Co-Director of the New York Obesity Research Center, Columbia University Medical Center. “Evolution happens slowly. DNA changes slowly.”
I have asked myself, “Why do I eat…,” many times. I think all of us who are prone to overeat have asked it. At the beginning of Part 1, “Consequences” in “Weight of the Nation,” an obese man says, “You try [to eat less] …and you lose hope.” Another says, “I know I should eat the right things. I’m gonna try.” Then in Part 2, despair returns: Another obese man says, “What can I do? I love good food. I love cheeseburgers. Sure, I know what to do; I just can’t do it.”
Commenting on Retrospective #268, “Help with Cravings,” – a serious student of the science of overeating – said to me, “So, you do not experience cravings? If you do not have them, you are lucky. I have had periods without cravings, and periods with cravings. They are a non-rational desire for something, or an insatiable appetite, even on NO carb. This suggests that there is some unknown biological cause, but nobody knows the cause of cravings.”
I posited the idea, suggested by among others the Jaminets in “The Perfect Health Diet,” that we may eat UNTIL our body is satisfied that it has all the essential nutrients it needs (including for example the fatty acids n3 and n6 and certain essential amino acids from protein. Lacking them, we eat more nutritionally poor and non-essential foods (carbs) to the point of obesity.” This specialized craving hypothesis has a certain appeal to me, but it’s only part of a complex answer. As Francis Collins, Director, National Institutes of Health, says in Part 2, “It’s a challenge for sure!”
For me, the bottom line is to acknowledge that MY BODY is in charge of my well being. That’s hard for me to admit; I do not lack for hubris. But in my own “conscious” self-interest, that is what I must conclude if I am to figure out how “I” can help “it” (my body) maintain homeostasis. Think about all the “insults” I throw at my body every day (eating choices and other behaviors that I do or do not do, like physical activity) that challenge my whole-body condition. If “evolution happens slowly,” and “DNA changes slowly,” my body must suffer from such unremitting “insults”.
But without knowing this “unknown biological cause” of craving – what I will call our “biological imperative,” I attempted almost 10 years ago (2010) to address the subject of why I eat, even when I’m not hungry, in a long thread (200 posts, 4000 hits) I started at Dr. Bernstein’s Diabetes Forum  (registration required), called, “Impulse Control and Metacognition.” My idea was to be “conscious of the “cue,” the impulse to eat when I’m not hungry, and then deal with that impulse by another means, e.g. by distraction (reading, writing a column, yard work, etc.).
Right at the start, the Forum’s Global Moderator commented, “Isn’t it likely the problem is actually physiological rather than psychological?” (Georgette was always so gentle with me; Bernstein was a “safe” place to be if you were interested in getting answers from very knowledgeable people about Type 2 diabetes. Anyway, I replied (this WAS 10 years ago): “I am not pursuing this aspect of it, however, because I know of nothing I can do to manage or control the hormone(s) in question. It is, after all, an autonomic function of homeostasis, the body's self-regulatory system.”
In the matter of hormonal regulation, I am today a lot wiser than I was 10 years ago. I still hold, however, that 99% of our body’s activity is autonomic and totally out of my “conscious control. I have a broken glucose metabolism – I have Insulin Resistance and fewer operative beta cells in my pancreas – ergo, I am Carbohydrate Intolerant. All I can do is “listen” to my body very carefully and do what I think is the right thing to minimize the “insults.” That means I need I watch my carbohydrate intake very carefully to keep my serum insulin level low. I use the scale and my glucose meter daily (for a fasting reading), and I use my triennial doctor’s visits for blood tests (HbA1c, CBC, lipid panel, electrolytes, hs-CRP (for chronic systemic inflammation), and other lab tests.). I figure that if I take care of my body, my body will take care of me. After all, except for my “conscious” self, it’s 99% of me. It’s simple self-interest.

Monday, November 18, 2019

Retrospective #275: “The Weight of the Nation”

I learned in 2014 that among the neighbors in my valley community is producer John Hoffman, Founder and CEO of HBO’s “The Public Good Projects.” Among its noted productions is the 2012 series, “The Weight of the Nation.” On the chance that I might meet Mr. Hoffman at a holiday party, I decided to watch the “Main Films” and take notes.  
All four feature-length films, Consequences, Choices, Children in Crisis and Challenges, are available on YouTube. Each feature is divided into chapters capable of being linked and shared. Each film is well produced and deals thoroughly and comprehensively with “the problem” – in the sense that it accurately portrays the obesity epidemic in America, and accurately depicts the timeline in which it developed. There’s also a small segment of very good science on the “ancestral” POV, so again, I was hoping that the producers would reach the logical conclusion and “make the turn.”
I was hoping that, given the agreed-upon time line for the start of the dramatic upswing in weight, and this “ancestral” perspective, the producers would correctly identify the problem: Government’s dictate since 1977 (“The McGovern Commission Report”), and 1980 (the first 5-year iteration of the “Dietary Guidelines for Americans”), that we eat a low-fat diet. McGovern’s “Dietary Goals” and the subsequent 5-year Guidelines are how well-meaning bureaucrats had begun the largest public health experiment in history. While well-intended, it has been a catastrophic failure.
My hopes were high. That pre-disposition is my bias. Besides, if I don’t lean that way, the tsunami of bad nutritional advice out there would “swamp my boat.” So, my ears perked up when I heard, “What makes me frustrated bordering on angry is the fact that this [obesity epidemic] is preventable.” I think it was said by Robert Lustig, MD, the pediatric endocrinologist whose 2009 YouTube video, “Sugar: The Bitter Truth” – the full 90-minute version – has now had over 9 million views. Other quotes of his were, “…insulin is not working well at the level of the cells,” “…juice and juice drinks are as bad as soda,” and “sugar is where you start.” He also asked, “What changed in the last 30 years to make this obesity epidemic happen?” His answer: “In the last 30 years our DNA has not changed, but our environment has.
Lustig was practically the only ray of hope I saw in this four-plus-hour presentation. The preponderance of experts said stuff like, “The reason we have government in the first place is to solve problems collectively that we can’t solve individually.” (Thomas Farley, NYC Health Commissioner); “We could have eaten better. We don’t have to have steak, and we don’t have to have roast beef,” and “Eat less, exercise more, eat a balanced diet.” (Francis Collins, head of the National Institutes of Health); “For all intents and purposes, a calorie is a calorie is a calorie; energy-in equals energy-out.” (Rudolph Leibel, Co-Director of the NYC Obesity Research Center at Columbia University); and “Follow a medically advised diet.” (Kelly Brownell, PhD, Director of the Rudd Center for Food Policy and Obesity at Yale).
My favorite “quote” from my scribbled notes was from Courtney Rowe, Deputy Communications Director of the by-definition-compromised USDA: “While it is unfortunate that some in Congress choose to bow to special interests, the USDA remains committed to practical science-based standards for school meals that improve the health of our children.” N.B.: Rowe was previously Communication Director for the Senate Agriculture Committee.
It would be less ironic if this political-pot-shot from Rowe in Part 3 hadn’t been followed in Part 4 with these facts: 1) Government subsidy programs are heavily tilted toward the large commodity crops of wheat, corn, sugar and dairy, 2) livestock and poultry feed are subsidized indirectly by cheap feed: corn, soy and other grains, 3) “it is government policy to overproduce what we are already overeating,” and 4) 50% of U.S. farmland is planted in corn and soybeans An economist at Duke University, added, “Obesity rates correlate with corn and soy production.”
The increase in calories in our diet, another said, is attributable to “25% added sugars from corn, 25% added fat from soy, and 50% refined grains from corn starches, wheat, and the like.” The result: food costs ↓; health costs ↑.
N.B. The cost of producing “The Weight of the Nation” was paid for in part by the NIH, IOM, CDC and Kaiser Permanente. At least it wasn’t Cargill and Archer Daniels Midland, directly…

Sunday, November 17, 2019

Retrospective #274: “Should Everyone Take Metformin?”

When I read “Everyone” should take Metformin, I assumed wrongly, I thought, that by “everyone” the title of the Medscape article meant as the initial choice of oral glucose-lowering medication for the treatment of Type 2 Diabetes Mellitus. That’s the way the new guidelines for prescribing statins are being interpreted; that everyone over 39 years of age and under 76 with a Total Cholesterol ≥200mg/dl should be on a statin for the very dubious, almost exclusive purpose of lowering LDL-C. To read about that, go to Retrospective #180, “The AHA/ACC Cholesterol Guidelines.”
No, this Medscape story, about a paper in JAMA Internal Medicine, was an “observational cohort study [that] sought to determine the effect of initial oral glucose-lowering class on subsequent need to additional anti-hyperglycemia therapy.” The participants, none of whom had previously been treated for diabetes, were started on 1) metformin, 2) a sulfonylurea, like glyburide, 3) a TZD like Avandia, or 4) a DPP4, like Januvia and Onglyza. “The primary outcome was time to treatment intensification, defined as initiation of a different class of oral glucose-lowering medication.”
“Secondary outcomes included time to composite cardiovascular event (coronary heart disease, congestive heart failure, unstable angina, ischemic stroke, acute myocardial infarction [heart attack], or a revascularization procedure [stent], congestive heart failure alone, an emergency department visit for hypoglycemia, and any other diabetes emergency department visit.” That’s one heck of a scary list of secondary outcomes. Something to think about…
“The Winner, and Still Champion: Metformin,” the Medscape sub-head declared. Well, there should be no surprise there. But if you are Prediabetic, or just diagnosed a Type 2 diabetic, and you weren’t started on Metformin, you might want to print this out – better yet, go to the Medscape and JAMA Internal Medicine stories above, print them out, and give them to your doctor and ask why you were not. I’d be interested to hear his or her answer.
The Medscape piece amplifies this finding: “Relative to Metformin uses, the risk of treatment intensification was 68% greater among SU users, 61% greater among TZD users, and 62% greater among DPP4 users.” That’s really significant.
As to the “secondary outcomes,” Medscape states this dramatic finding: “Also relative to Metformin, SU use was associated with an increased risk for composite cardiovascular events, congestive heart failure, and hypoglycemia.”
Then this Medscape analysis of comparative effectiveness took an interesting turn. It began with this question, posed by another study: “Can People with Type 2 Diabetes Live Longer Than Those Without? A Comparison of Mortality in People Initiated with Metformin or Sulphonylurea Monotherapy and Matched Non-diabetic Controls.” This British study, which appeared in Diabetes Obesity and Metabolism, essentially asked, “Does Metformin Reduce Mortality?” Hmmm… Maybe the title of the Medscape piece was intended to mean “everyone everyone.” I read on to find out.
In this study, “patients initiating Metformin therapy were compared with those initiating treatment with a SU, and both diabetic groups were compared with their matched nondiabetic controls.” Subsequent mortality was tracked for up to 5.5 years. The FINDINGS: “Crude death rates were substantially lower for Metformin users that SU users” and, “All subgroup comparisons favored Metformin over SU and were statistically significant.” But here’s the zinger.
“Perhaps the most striking finding was that survival time for controls [the non-diabetics who were not taking Metformin] was 15% shorter than for matched Metformin users. This finding was consistent across all subgroups, nearly all of which demonstrated statistical significance, and was particularly strong among patients with high comorbidity.”
“The protective effect of Metformin relative to SUs was not a surprise,” the Medscape piece says. The remarkable finding was an apparent protective effect of Metformin compared with nondiabetic individuals. Because of Metformin’s favorable results among people with diabetes, it has been postulated that the drug may also provide benefit to people without diabetes.” Sort of like statin therapy… What are they saying? What am I saying? Everyone should take metformin??!!!

Saturday, November 16, 2019

Retrospective #273: Insulin Resistance = Carbohydrate Intolerance

As I rewrite this post for the Retrospective Series, I note that my readers originally received it on Christmas Eve 2014. On that eve, I was with my family, eating a wonderful Swedish smorgasbord and then watching grandchildren open presents. My message then was one of comity: “…on earth, peace to men of good will” (Luke 2:14; Codex Sinaiticus).
Today, we live in a world even more rent by division, and this applies to the world of nutrition policy as to any other field of human endeavor. This column frequently positions itself fervently in opposition to the “perceived wisdom” in broad areas of public policy respecting a “healthy diet.” We (in the royal sense) were originally motivated to take on the establishment view after the premature death of a friend who was an insulin-dependent Type 2 diabetic who happened also to be my pharmacist. His death, from a comorbidity of Type 2 diabetes, was tragic and unnecessary.
Out of this sense of his loss I was motivated to begin writing this column in 2011. I later wrote about my pharmacist in Retrospective #114. And upon learning of the death of the doctor who introduced me to the Very Low Carb Way of Eating, I also wrote, in Retrospective #95, “an appreciation.” When he suggested I try Very Low Carb, Doc just wanted me to lose weight, but he said, with his hand on my shoulder as he walked me down the hall, “It might just help your diabetes too!” That was more than 17 years ago. Little did he know how profoundly it would change my life. It changed everything, really. I don’t think I would be alive today…had I not taken his advice…and lost 170 pounds.
Besides continuing to breath, all my other health markers changed too. My triglycerides dropped by 2/3rds (to the 50s); my HDL-C more than doubled (from 39 average to 84 average); my A1c’s dropped too; I recently had a 5.0%! And my hs-CRP, a marker of chronic systemic inflammation, previously in the 5s and 6s, has been between 0.1 and 2.7mg/L (aver. of 13: 1.4). And, I feel GREAT! I have LOTS OF ENERGY, and, at age 78, I still have no joint, back, hip or knee issues. Even early signs of arthritis, which began to appear about the time I started this WOE, have disappeared.
Then 5-years ago “yesterday,” at our neighborhood church’s Christmas season concert and tea, I saw an old friend who’s been reading this column for years. He was of “good cheer,” a jolly old soul himself, but alas I’m afraid I quashed his spirit because I lectured him (and his wife). He is still as plump as Saint Nick himself, and I am dispirited. I am forlorn because I worry for him. It’s tough to accept sometimes that the best I can do to help people is sometimes just not enough. I need to remind myself of the American theologian Reinhold Niebuhr’s Serenity Prayer:
“God, grant me the serenity to accept the things I cannot change,
The courage to change the things I can,
And the wisdom to know the difference.
So, my “Annunciation to the Shepherds” message is simple; it is one of “good tidings of great joy, which shall be to all people” (Luke 2:10; King James Version) who would listen:
Insulin Resistance = Carbohydrate Intolerance
If you are rotund, this is probably the “expression” of your genotype, usually characterized by a progressive condition called Insulin Resistance (IR). And if you have IR, you are CARBOHYDRATE INTOLERANT. If you want to live a long, happy and healthy life, you need to give up most of the carbohydrates in your diet. You have time now to consider whether this would make a good New Year’s resolution. If you agree, I will guide you. Read my daily Retrospective blog posts and write to me using the Blogger link or email me directly at I will do my best to support your decision and lifestyle change.
In any case, whether you decide to transform your life or not,

Friday, November 15, 2019

Retrospective #272: Falling asleep at the wheel?

“Falling asleep causes 1 in 5 auto crashes,” The Washington Post story headlined in 2014. The finding was based on research of 14,268 crashes from 2009-2013 in which one vehicle was towed from the scene. The reason this caught my attention is that I could relate. In years past – before I changed the foods I ate – I almost killed myself (and sometimes others) on numerous occasions – too numerous to recount – by nodding off behind the wheel.
The reason, however, was not “fatigue” or lack of sleep in the usual sense; it was low blood sugar (NOT hypoglycemia).  I have been a diagnosed Type 2 diabetic for 33 years, which means I have probably been a Type 2 for 40 years or longer (since I was in my 30s). This also means I was undoubtedly a Prediabetic for years before that, going back to my 20s. Why is this relevant? I will cite a source for the “history” of the development of Type 2 diabetes later in this post, but first I’ll cite some examples of common behavior that everyone can relate to.
We’re now entering the holiday season. In our house, some adults eat almost as many Christmas cookies (and other baked goods full of sugar and butter) as the children. We give ourselves “a pass” a few times a year to indulge in the goodies we would normally pass on. We also have fresh in our memories Thanksgivings and Christmases past when we ate loads of starchy vegetables and stuffing and gravies passed “family style” around the table. It’s a wonderful tradition. And it’s equally a tradition for some overstuffed family members to “feel sleepy” after a “big meal.” Others go for a walk in the cold air to increase their peripheral circulation and stave off that sleepy feeling.
Now we all know that we (most of us, except the cooks!) are not suffering from a lack of sleep, or even a few stressful days leading up to the big meal. We are suffering from a lack of blood in the arms and legs and brain while the blood concentrates in the truncal area to process, digest and absorb all the “energy” we ate. The extremities and the brain get short shrift, as they should. The body does this autonomically. It’s natural. Animals like big cats take a long nap after devouring enough of their catch to carry them days until they are fortunate enough to make another kill.
But the “big meal” syndrome is only part of the picture. People who have, or almost imperceptibly are beginning to have, a compromised glucose metabolism – like I was in my late 20s and early 30s – are simultaneously experiencing a different physiological phenomenon. Our blood sugar routinely becomes elevated above the normal +/- 140mg/dl after a meal. People with a healthy glucose metabolism never have a blood sugar above 140mg/dl, even after a big meal. But people with a compromised glucose metabolism, who eat a lot of carbs, always go higher.
This is partly the result of the loss of the 1st insulin response in which the pancreas produces a spurt of insulin in anticipation of and at the onset of eating and partly the beginning of insulin resistance in which the destination cells for the glucose circulating in our blood – muscles, etc., – have developed resistance to the insulin that is transporting the glucose. The result is that the glucose is not “taken up” as quickly. It continues to circulate and we have “high blood sugar.” So, to help out, the pancreas makes and sends more insulin. Then, eventually, slowly, for the prediabetic or Type 2, (but not the untreated Type 2), the elevated blood sugar lowers. In fact, it crashes, and you “feel tired.”
If you’re interested, the mechanism of how someone who is genetically predisposed to having a dysfunctional glucose metabolism, and who eats the Standard American Diet (SAD) – which is very high (60%+) in carbohydrates, especially processed carbs – is explained by Ralph DeFronzo, MD, the 2008 American Diabetes Association convention keynote speaker and Banting Award winner. It is also described in my Retrospective #99, “Natural History of Type 2 Diabetes.”
But for the less technically inclined, just know this: If you’ve gained weight while eating the diet recommended by the USDA’s Dietary Guidelines, and the medical establishment (AMA/AHA/ACC/ADA), and their members who have no medical school training in nutrition, then consider that it may be that your glucose metabolism is starting to unravel (become disregulated and dysfunctional). If you “feel sleepy” after a big meal, it may be more than just all your blood rushing to the stomach to deal with your excesses. It may be a sign that you need to cut back on sugars and processed starches, i.e. on all processed dietary carbohydrates. The life you save may be your own, or your family’s.

Thursday, November 14, 2019

Retrospective #271 Treating Obesity Today

Many messages appear in my inbox daily, including offers of Continuing Medical Education (CME). One half-hour video from Medscape, supported by an educational grant from Takeda Pharmaceuticals and Orexigen Therapeutics and worth 0.50 AMA credits, arrived recently.  “This activity,” Medscape said, “is intended for primary care clinicians, endocrinologists, diabetologists, and other allied healthcare professionals who manage patients who are obese.” I am always interested in how the medical profession manages to mangle this subject, so I watched it.
“The goal of this activity,” Medscape avers, “is to focus on the public health crisis of obesity and to demonstrate how motivational interview techniques can be used by clinicians to help patients who are overweight or obese establish a partnership with their clinician and foster patient adherence to an individualized weight loss management plan.”
Here’s how I would rephrase that: Scare the patient with the obvious: the prevalence of obesity and its unhealthy consequences and co-morbidities; then, if they are ready, help them by using “motivational interview techniques.” Do this by “partnering” with them to “foster” adherence; failing that, having obtained their confidence, prescribe a drug.”
Motivational techniques can help, I suppose, but “public health statistics” wouldn’t motivate me. Everybody knows that being fat is unhealthy. The key is the patient has to be ready and willing to 1) personally want to try (again) to lose weight, and 2) the patient has to have a level of confidence that the weight loss plan will work. The two critical points are 1) “are you ready?” to lose weight and 2) will the plan work? It’s a combination one-two punch.
That being said, some of the questions the video posed to assess the motivational readiness of the patient were good. Absent the readiness on the part of the patient before the interview, this type of questioning might be fruitful.
     How important to your health is getting your weight under control?
     What is your biggest barrier to losing weight?
     What do you think you could do to lose weight?
     How confident are you in your ability to lose weight?
So, whether you come to your doctor’s appointment already motivated, as I was, or whether your doctor thinks he cajoled you into trying to lose weight again, the key is having a level of confidence that the weight loss plan you follow will work. This is where the video fails miserably and utterly to produce a knock-out punch. In fact, I would say the medical doctor who gave this advice should never even have put on gloves and gotten into the ring.
The match started to “go south” when in response to “what do you think you could do to lose weight?” the video suggests “EXERCISE” and “EAT SMALLER PORTIONS.” And instead of “eating a lot of high calorie foods” (that would be fat, right?), the doctor prompts you to “EAT MORE VEGETABLES” (all carbohydrates!). This doctor may know something about “motivational techniques,” but he clearly knows nothing about effective weight loss plans.
He suggests seeing the patient once a month for 6 to 12 months to “create a partnership” and “foster adherence” to the “individualized” plan that you formulate together. He also suggests using this time to “direct the patient in the direction you’d like them to go.” And there’s the rub. All clinicians who treat the overweight and obese, and their patients, know that that so-called “individualized” direction – to “exercise more, eat smaller portions, eat less fatty food and more vegetables,” is doomed to fail. Their patients are going to be hungry all the time. They are not going to lose weight or if they do, keep it off. (What do they think you’ve been trying to do all this time?)  So, what then? Weight loss drugs? Hmmm… I’m beginning to see why the pharmaceutical companies are providing “educational grants” so that, if the doctor’s efforts fail, having “fostered” a relationship, he or she can “partner” the patient “in the direction ‘you like them to go’.”
So, remember the two key components: 1) The obese patient has got to want to lose weight (that’s easy), and 2) the weight loss management plan has got to work. Both you and your doctor know that “exercise,” “smaller portions,” and “more vegetables” does not work. It just going to lead your doctor to writing a prescription, but drugs are not the way. Cutting out carbohydrates is. It’s a very effective, permanent weight loss management plan. Why not try it?

Wednesday, November 13, 2019

Retrospective #270: “The Skinny on Fats”

Long before I started writing this column – but years after I discovered the Low-Carb, High-Fat (LCHF) Way of Eating – I read an article, “The Skinny on Fats,” and saved it as a “favorite.” The link still works, as do links to other essays, “The Oiling of America,” and “The Truth About Saturated Fat,” by the same authors.  The authors are Sally Fallon Morell and Mary G. Enig, PhD. Sally is the founding president of the Weston A. Price Foundation. Mary, co-founder and vice president, died in 2014. An appreciation by Kaayla Daniel, PhD, her successor, appears on the WAPF website.
“The Skinny on Fats” so influenced me that I cleaned out our kitchen cupboards. The essay is also the first chapter of Nourishing Traditions: The Cookbook that Challenges Politically Correct Nutrition and the Diet Dictocrats. By 2014 the cookbook had sold upwards of half a million copies. Then, a new book, The Skinny on Fats, by David Brownstein, MD, and Sheryl Shenefelt, CN, was published. It was reviewed with a “thumbs up” by Sally Fallon Morell in the Fall 2014 edition of Wise Traditions, the WAPF quarterly publication. Morell’s full book review is reproduced below:
The subject of fats and oils is complicated and fraught with misconceptions – so much so that explaining the myths and truths about fat can be long and complicated. People’s eyes glaze over when you try to explain it all, even though information on fats and oils can be life changing and life saving. Brownstein and Shenefelt have solved these hurdles with this very well put together book on fats and oils.
The authors start with a summary of surprising facts about fats:
1.      We need fat in our diet to live!
2.      Fat does not make us fat!
3.      A low fat diet is not healthy!
4.      Fat performs many essential functions in our bodies!
5.      Some dietary fats are better than others!
6.      Saturated fat is not the enemy!
7.      Saturated fat and cholesterol do not cause heart disease!
8.      Dietary fat is not the culprit of disease!
9.      Canola oil and other refined vegetable oils are not healthy for you!
10.   Low-cholesterol food does not do your body good!
Even if readers go no further than this short introductory section, they will be much wiser than before. But for those who want more information, there follows chapters that detail the structure of fats, the different types of fats and oils, the role of cholesterol in the body and problems with low fat diets. Particularly interesting are discussions on your brain’s absolute dependence on fat and how eating fat can assist with weight loss. Getting enough fat affects mood and behavior, cognitive function, mental acuity, focus and clarity. Low fat diets can lead to depression, reduced mental capacity and behavior problems. Cholesterol is concentrated in the myelin sheath so attempts to reduce cholesterol can lead to serious degenerative disorders of the nervous system, including multiple sclerosis and dementia.
Brownstein and Shenefelt devote a whole chapter to the subject of fats and children – for it is our children who are paying the greatest price for the anti-saturated fat, anti-cholesterol folly. Children’s brains need lots of fat and cholesterol for proper development. Children need butter, eggs, cream, cheese and meat fats, not margarine, spreads and low-fat products.
The book ends with a nice collection of recipes dripping with butter, cream and cheese. Thumbs up.”
The message here, and in Retrospective #269, “Eat Good Fats,” and in #20, “Know Your Dietary Fats,” and in #23, “The Benefits of Saturated Fats,” is the same. The fat-soluble vitamins, A, D, E and K, require dietary fat to absorb optimally. Message Two is that the refined vegetable oils, which are manufactured polyunsaturated fats, are bad for you; Read #21, “The Dangers of Polyunsaturated Fats.” Please Google and read the Fallon and Enig essay, “The Skinny on Fats.”
N.B.: A Senior Membership in the Weston A. Price Foundation is just $25 (Regular Membership $40).

Tuesday, November 12, 2019

Retrospective #269: “Eat Good Fat”

In bold black letters, the “Thank You” note said, “Eat Good Fat.” It was included with my 32oz jar of Ancients Organics ghee. When I sometimes snack before supper, I put a dab of ghee on a radish half. It helps to get my supper k/g (ketogenic) ratio above 1.5, a desired ratio which I easily achieve at breakfast and lunch. Although expensive, I prefer the Ancient Organics brand for its “delicious sweet and nutty flavor” and its “incredible caramelized aroma.” It’s also “cooked in small batches over open flames” and made from “milk of grass fed and pastured cows.” It’s really good fat!
But this is not a column about ghee. It’s about the roiling dispute in the world of nutrition concerning dietary fats in general and saturated fats in particular. Saturated fats are enjoying a Renaissance everywhere except in government and “public health” circles, principally the USDA and AMA, ACC, AHA and ADA. The reason, IMHO, is that these groups have been bought and paid for by their commercial interest supporters. But this column is not another rant about that either. It is about two major scientific papers in influential medical journals that deserve more attention.
The first study was a large, mostly-British meta-analysis of 49 observational studies and 27 randomized controlled trials (643k participants), published March 2014 in the Annals of Internal Medicine. It was funded by the British Heart Foundation. The title: “Association of Dietary, Circulating, and Supplement Fatty Acids with Coronary Risk: A Systematic Review and Meta-analysis.” The CONCLUSION: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of saturated fats.”
The second study appeared in the British Medical Journal (BMJ) in 2013: “Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: Evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis.” “Secondary prevention” is to prevent a heart attack in those who already have heart disease. “Primary prevention” is for those who do not have Coronary Heart Disease (CHD).) This Australian study concluded:
Advice to substitute polyunsaturated fats for saturated fats is a key component of worldwide dietary guidelines for coronary heart disease risk reduction. However, clinical benefits of the most abundant polyunsaturated fatty acid, omega 6 linoleic acid, have not been established. In this cohort, substituting dietary linoleic acid in place of saturated fats INCREASED THE RATES OF DEATH FROM ALL CAUSES, CORONARY HEART DISEASE, AND CARDIOVASCULAR DISEASE. An updated meta-analysis of linoleic acid intervention trials showed no evidence of cardiovascular benefit. These findings could have important implications for worldwide dietary advice to substitute omega 6 linoleic acid, or polyunsaturated fats in general, for saturated fats.”  I wish I could just SHOUT THIS FROM THE ROOFTOPS!
Nevertheless, the 2015 Dietary Guidelines for Americans doubled down on their advice to substitute polyunsaturated fats, from processed vegetable oils, for saturated fats. The committee was led by Alice H. Lichtenstein, D. Sc., Vice-chair of the 2015 Dietary Guidelines Advisory Committee, and Robert H. Eckel, M.D., co-chair and lead author of the “2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.” Together, they are a formidable force.
The 2010 Dietary Guidelines stated, “Saturated fatty acids contribute an average of 11 percent of calories to the diet, which is higher than recommended. Consuming less than 10 percent of calories from saturated fatty acids and replacing them with monounsaturated and/or polyunsaturated fatty acids is associated with low blood cholesterol levels, and therefore a lower risk of cardiovascular disease. Lowering the percentage of calories from dietary saturated fatty acids even more, to 7 percent of calories, can further reduce the risk of cardiovascular disease.” 
Such is the current state of affairs in U. S. dietary matters. Does it sound eerily like the world of domestic politics? And we have to vote every day with the food choices we make. So, choose wisely and remember the roiling dispute is trending away from Polyunsaturated fatty acids (PUFAs) and toward of Saturated fatty acids (SFAs).
Are you afraid to go against the Dietary Guidelines or the practice guidelines your doctor must follow? Do you avoid whole eggs, full-fat dairy, or red meat? Ask yourself why? You doctor is trapped, but you’re not…

Monday, November 11, 2019

Retrospective #268: “Help with Cravings”

‘John,’ the ‘bot who (that?) is the “coach” I selected at Fit2Me, sent me my first “coach email” a while ago. (Fit2Me is a website that I learned about through a TV ad and signed up for. It is sponsored by AstraZeneca, the drug company. So, this post is my critique of ‘John’s’ approach to mentoring me. It’s a fairly short email, with introductory paragraph, three bullet paragraphs, and a summary wrap-up with encouragement.
“Cravings can be tough,” ‘John’ begins. “It’s not just because the food is right there, but many times it comes out of nowhere and that’s really hard to handle. That’s why I thought I would reach out to you with some suggestions.”
Cravings. What are they anyway? For me cravings fall into 2 categories: 1) hunger cravings, which I never, ever have; and 2) ideas about eating something, which I frequently have, usually before or after supper.
Hunger craving are non-existent because I eat a Very Low Carb diet. When you eat this way, you will not be hungry. You will have no “need” (from hunger cravings) to snack between meals because your blood sugar will be stable.
     “It’s not easy,” ‘John’ says, “but a little preparation can really help deal with temptation. Keep some type 2 diabetes friendly snacks with you. There’s plenty at Fit2Me. These can really come in handy when you are tempted because it is much easier to say ‘no’ when you have something to say ‘yes’ to.”
This makes no sense at all to me. In fact, you are not saying “no” at all; you are actually saying “yes.” You are actually caving in to temptation, not hunger. That is NOT the best way to control the beast.
     “If you’re going out to eat with friends or the work crowd, look ahead at the menu and know what you are going to order. It really helps to keep you from having to choose on the spot, plus it gives you more time to hobnob with the ‘in crowd.’” (That’s funny. In social network theory, a type 2 diabetic – who is probably obese – apparently is not part of the ‘in crowd.’ Can’t you just picture this poor soul?
Once again, ‘John’ (I’m talking to a robot!), I think this is a bad idea. If you look ahead at the menu you are just going to be thinking about food too much. Everyone on a diet knows this. It is easy to obsess about food. Just pick up the menu, select an appetizer or a salad and be done with it. Just avoid all fried foods and prepared salad dressings.
     “Remember your trade-offs. If you think you are going to be in a situation where you have to eat more than you want to, just try to keep the portions small, plus plan on how you’re going to burn off some of those extra calories with an exercise. There are lots of activities to use to trade-off some calories on Fit2Me,” ‘John’ says.
Oh great! Plan to fail. Plan to be in a situation where “you have to” eat more than you want, and then rationalize this planned indulgence with a “Hail Mary” around the track. Does anyone think that exercise is a good way to lose weight? Penance is great, but penance doesn’t shed weight; it just sheds guilt. To repeat, the solution is simple: control the beast.
‘John’s’ summation: “Temptation comes in a lot of forms and at all times of the day. Stay ahead of temptations by planning ahead. Use your meal planner, build an activity plan to help you with trade-offs, and keep some healthy snacks ready. It’s all there with Fit2Me. After all, we know that you are going to have to deal with cravings, and that’s why we built Fit2Me to be all about you. Remember, I [the robot speaking here] am behind you every step of the way.”
‘John’ is talking “temptation” again. Temptation is different from “cravings” and different from actual “hunger” (from hormone signaling) or snacking (because you have received those hormonal signals). But cravings are easily managed: 1) eat LCHF and you won’t get “hunger cravings,” period, and YOU WON’T NEED TO SNACK BETWEEN MEALS.
Then, if you want a low-carb appetizer before supper (as I do), eat a few radishes with salt and butter, or anchovy paste with celery, or a few olives. After supper, to break the habit of “nervous eating,” simply control the beast. Plant another idea in your head, or drink water. Last week most of my FBGs were in the 80’s, including an 83 this morning!

Sunday, November 10, 2019

Retrospective #267: A “High Energy Breakfast Shake”

“The world’s healthiest foods” is a website that came to my attention for their “in-depth nutrient profile” of the recipes they feature. I got a few of my favorite recipes, e.g., stovetop poached fish dishes, there. They have no meat recipes, however, keeping with their altruistic, if misguided, mission “to help make a healthier you and a healthier world.” It’s otherwise a good site, so I can live with their bias – except when I think about how they are misleading us.
For example, one day I saw a recipe for a “High Energy Breakfast Shake,” a “quick-and-easy, nutritious and a delicious addition to your Healthiest Way of Eating. And a great way to start the day!” Here are the ingredients and directions:
     1 medium banana
     ½ cup whole strawberries
     1½ cups of low-fat milk
     2½ Tbs almond butter
     2 Tbs ground flaxseeds
     1½ Tbs blackstrap molasses
Blend all ingredients until smooth. Serves 2.
I dare you to make this shake and not drink the whole recipe yourself!
One “serving” (HALF the recipe) contains 363 calories, 11.22g of protein, 18.71g of fat and 42.50g of carbs. The full recipe is an astronomical 85 GRAMS OF CARBS. The shake is low in saturated fats, moderate in polyunsaturated fats and high in monounsaturated fats. The “high energy” comes from the “sugar” jolt, and not just the simple sugars. The total includes polysaccharides (long glucose chains) that are “predigested” by the blender to make them “liquid.”
Quoting from “How do energy drinks work?” in the Science section of How Stuff Works: “Energy drinks are supposed to do just what the name implies – give you an extra burst of energy. As it turns out, most of that ‘energy’ comes from two main ingredients: sugar and caffeine.” Well, the High Energy Breakfast Shake has no caffeine. It’s all sugar.
But what if this shake did contain caffeine (as in Red Bull “energy drink”). How Stuff Works says, “Caffeine works by blocking the effects of adenosine, a brain chemical involved in sleep. When caffeine blocks adenosine, it causes neurons in the brain to fire. Thinking the body is in an emergency, the pituitary gland initiates the body's ‘fight or flight’ response by releasing adrenaline. This hormone makes the heart beat faster and the eyes dilate. It also causes the liver to release extra sugar into the bloodstream for energy. Caffeine affects the levels of dopamine, a chemical in the brain's pleasure center. All of these physical responses make you feel as though you have more energy.”
I’m writing this just after Halloween (All Hallows’ Eve). The kids who went door-to-door in costume that night came home laden with candy, both in their baskets and their tummies. As we all know, sugar gives you that “extra burst of energy” because it is digested first and quickly. And everyone who gets a sugar jolt sees their blood sugar rise.
If your metabolism is working well, your serum insulin also rises and carries the “sugar” into your cells where it is used or stored. What isn’t used in muscles returns to the liver to be stored as glycogen and your “sugar” drops.
So, we expect that binging on sugar, and sugary liquids especially, will quickly produce “high energy.” We joke that kids on sugar highs act like “Energizer Bunnies” until they crash and fall asleep. Adults will too, especially if you start your day with a high energy shake. By mid-morning you will be in a slump… and hungry again. You are a sugar addict.
But if your metabolism ISN’T working well, i.e., you’re Insulin Resistant and Pre-diabetic or already a Type 2, your cells will not “take up” the glucose that insulin is circulating in your blood. As a result, your blood sugar spikes and stays high (even as you make more insulin), and the high blood sugar starts to cause the “dreaded complications.”
Sugar overloads, especially from liquids like this “high energy breakfast shake,” are definitely NOT a “great way to start the day.” Besides, FRUITS ARE VERY HIGH IN FRUCTOSE (DUH!), and, when the liver is already full of stored glucose (glycogen), the liver makes FAT (including fatty livers), via de novo lipogenesis, from big slugs of fructose.

Saturday, November 9, 2019

Retrospective #266: “Food Therapy for Metabolic Syndrome”

The banner on my smart phone read, “Food Therapy for Metabolic Syndrome,” but when I read it on my laptop, the title had morphed into “The Impact of Mediterranean Diets on Metabolic Syndrome.” Okay, I don’t shill for the Mediterranean Diet, or any other, but I do support the idea of “food therapy,” and I am very interested in how diet can affect Metabolic Syndrome, a dysfunctional metabolic state that is present and unrecognized in increasing numbers in the population. I have written about it numerous times starting with Retrospective #9.
The piece begins, “Metabolic Syndrome is characterized by risk factors that increase an individual’s chances for cardiovascular disease. These risk factors include obesity, hypertension, high cholesterol and uncontrolled blood glucose. In addition to cardiovascular disease, those with Metabolic Syndrome are at increased risk for type 2 diabetes.” One problem: The digest in Diabetes-in-Control incorrectly lists only 4 risk factors and mischaracterizes the definition of Metabolic Syndrome; the full medical journal paper referenced correctly describes its components as 5 risk factors and specifically includes high triglycerides and low HDL cholesterol, NOT “high cholesterol.” That’s a BIG difference. By definition, you have Metabolic Syndrome if you present with at least 3 of these 5 risk factors.
What I liked about this piece was the clear message the study design sends. The low-fat diet, that is the one our government and all our medical societies want us to eat, is the control diet; it is the one that the two different Mediterranean diets are being compared to. And guess what? Both Mediterranean diets fare better than low-fat. Another nail in the coffin of the low-fat diet, folks! Even a diet of “fruits, nuts and seeds,” and high in MUFAs, monounsaturated fat (from olive oil and nuts), and low in saturated fat, is BETTER THAN A LOW-FAT DIET.
The two Mediterranean diets being compared to the low-fat diet were supplemented with olive oil and nuts respectively, provided free by the Spanish producers. Each randomly selected sample of several thousand people consisted of “older participants at high risk of cardiovascular disease,” and each diet group regularly “completed a 14-item questionnaire to assess adherence to the intervention” – eating the free liter per week of olive oil or the 30 grams per day of free walnuts, hazelnuts and almonds, and other “fruits, nuts and seeds.”
“Participants were not advised on calorie restriction, and physical activity was not promoted for any intervention group.” They were just “community-dwelling men and women between 55 and 80” years of age with “no previously documented cardiovascular disease and… who had either type 2 diabetes or at least 3 cardiovascular risk factors,”
RESULTS: “Over 4.8 years of follow-up, Metabolic Syndrome developed in 960 (50%) of the 1919 participants who did not have the condition at baseline. The risk of developing Metabolic Syndrome did not differ between participants assigned to the control diet and those assigned to either of the Mediterranean diets.”
DISCUSSION: “The recognized protective effect of the Mediterranean diet was not enough to prevent Metabolic Syndrome in our study population.”
“A Mediterranean diet supplemented with extra-virgin olive oil was associated with a smaller increase in the prevalence of Metabolic Syndrome compared with advice on following a low-fat diet.” It conferred a benefit.
“We found the Mediterranean diet supplemented with extra virgin olive oil to have the most beneficial effect on central obesity and hyperglycemia.” And, “an isocaloric Mediterranean diet rich in extra-virgin olive oil prevented accumulation of central body fat compared with a low-fat diet, without affecting body weight.” Another benefit.
Of course, if they had eaten a Low Carb High Fat (LCHF) diet (including more saturated fat), they would similarly have reduced their truncal (central) obesity, and dramatically RAISED THEIR HDL (Retrospective #67) and LOWERED THEIR TRIGLYCERIDES (Retrospective #68) too, both additional risk factors for Metabolic Syndrome. And they’d surely have lost weight and had lower blood glucose, because Low-Carb High-Fat confers a benefit with ALL 5 RISK FACTORS!

Retrospective #265: “Let’s Start with Food”

A TV commercial targeting people with Type 2 diabetes begins, “Now I’m ready for someone to listen to me.” I didn’t get the pitch at first, but it had a few things I can relate to: 1) my reason (and hope) in writing this blog is that people will “listen to me,” 2) I share the speaker’s frustrated tone, and 3) I like the inference that people with Type 2 diabetes should “take charge” and be more involved in their own management plan. The pitch all became clear to me, though, when the backer of the website, Fit2Me, became apparent. It was AstraZenica, the drug maker.
Then the voiceover says, “Let’s start with food.” I liked that too. The pitch made each one of us an important and unique individual. That’s good marketing, and it reflected the recent clinical guidance from the ADA: “It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.” The ADA has declared, in effect, that low-carb diets are an appropriate “eating pattern” for Type 2 diabetics. Zowee! Fit2Me (AstraZenica) had obviously read the ADA Position Paper and were attempting to cash in.
So, to learn more, I decided to sign up. It was a well-designed interactive website where you provide a little information, and then you pick a “counselor” to choose your style of mentoring. You then choose, with clicks, 1) the foods, 2) activities (exercise) and 3) treatment plan just for you. I answered all their questions and was automatically put into a bi-monthly Sweepstakes program!  I “liked” certain foods and “disliked” others. The result, I was told, was over 1,000 recipes (from over 10k) that fit my “likes.” I “liked” zero (0) “activities,” but that didn’t deter my mentor.
Then I went back to the food and recipes section. It also was very well designed with a keyword search function and a list of 7 additional search dropdown boxes for things like meal, type of cuisine, type of dish, time to make, serving, style and main ingredient. I searched on “eggs” and got over 100 recipes. I clicked on #12, “Sweet Southern Egg Salad,” (132 calories, 6 carbs) to get more details. Among my food choices I had previously selected “gluten free,” and the picture showed two brown slices that looked suspiciously like pumpernickel bread, so I wondered how that could be? And while I was glad to see carbs listed with calories, how could this recipe have only 6 grams of carbs?
Well, obviously, it couldn’t. And the “bread” (if that what is was) was not included in the recipe. Neither was the green leafy veggie under the top slice. But, I said generously, it’s a start-up website, so maybe I should cut them some slack. Then, I read the preparation instructions. It calls for 8 eggs (for 4 servings), but throws out (or sets aside), 4 of the yolks. Yikes! Okay, I’m starting to get the drift here. The secret agenda – well, not so secret if you draw inferences – is that they follow ADA protocol, which follows AHA protocol, which follows the USDA Guidelines on dietary cholesterol.
Further evidence was the “non-fat” plain yogurt and “low-fat” mayonnaise in the recipe. The Nutrition Facts panel provided had all the required items plus more like “exchanges” and “carb servings” for the yo-yo dieters out there who have tried and failed to permanently lose weight. Interestingly, the required “Total Fat” and “Saturated Fat” are there, and it also included “Monounsaturated Fat” which is not required. That’s another clever inclusion, no doubt to appeal to the Mediterranean Diet followers. But how about polyunsaturated fats (PUFAs)? They’re NOT included!!!
I don’t blame AstraZeneca or their diet consultants. It is the USDA that’s behind the curve here, and they are between a rock and a hard place. How can you constantly demonize saturated fat to the point where red meat is verboten and full-fat dairy is getting harder and harder to find in the store, and not include polyunsaturated fats in your eating pattern? Besides, the USDA’s Dietary Guidelines expressly extols PUFAs, while strongly condemning saturated fats, linking them like conjoined twins with artificial trans fats. That only leaves monounsaturated fats unscathed. And frankly, how much olive oil can a person eat?! This recipe has 3g of PUFAs per serving vs. 2g saturated and 2g mono.
So, while this is a very nice interactive website, and it’s easy to get sucked in, it has its limitations and the eating plan sucks. There are, however, many other websites with low carb (even very low carb) recipes and healthy saturated fats.
Anyway, it will be interesting to see if they pitch a medication regimen to me before my next doctor’s appointment. They did ask me for the date and offered to remind me! That makes very clear to me what this website is all about.

Thursday, November 7, 2019

Retrospective #264: “Quiz: Which Foods Affect Diabetes?”

I know I kvetch a lot, but you take the food quiz posted at Medscape Medical News and see if you wouldn’t kvetch about their answers on this “web resource for physicians and medical professionals.” Medscape is owned by WebMD and covers news, information and CMEs (Continuing Medical Education) for almost 2-dozen specialties.
The first question will illustrate, I think, that my caviling is justified:
Q.   Increasing fruit consumption has been recommended for primary prevention of many chronic diseases.
       Which of these fruits is specifically associated with reducing the risk of developing diabetes?
a.       Blueberries
b.      Strawberries
c.       Oranges
d.      All of the above
e.       None of the above
Okay. Something that is good for “many chronic diseases” doesn’t mean it is good for a Type 2 diabetic who is by definition CARBOHYDRATE INTOLERANT. FRUITS ARE CARBOHYDRATES. Increasing fruit consumption is what the entire population has been told to eat, regardless of medical condition. It is in conformance with the government’s Dietary Guidelines, a one-size-fits-all approach to “healthy eating”. The narrative justifying the “correct” answer (blueberries) goes on to mention grapes (although noting their high glycemic index), as reducing diabetes risk. It also touts apples, bananas and grapefruit. I’m surprised it didn’t include cherries, raisins and figs, all higher still in sugars!
I’ve read the research “associating” certain fruits with lower risk of diabetes, but these observational studies are bad science and just confirm the “healthy user” bias of the participants, which combined with so many other confounding factors, such as socio-economic variables, makes them worthless. And while it is true that blueberries do contain healthy phytochemicals, they also contain a lot of sugar, much more than strawberries, for instance. If you have a problem with giving up most fruit, read Retrospective #138, “Fruit, the 3rd Rail for Prospective Low Carbers.”    
The last question was just more of the same, but at least it takes a swipe at the “low-fat” diet. On that, we agree.
Q.    Which of these diets is the most effective for diabetes primary prevention in people with cardiovascular risk?
a.       Mediterranean diet supplemented with extra-virgin olive oil
b.      Mediterranean diet supplemented with nuts
c.       Low-fat diet
d.      All of the above showed similar benefits on diabetes prevention in this population.
The “correct” answer is “a.” Medscape explains: “Among these 3 diets, only the Mediterranean regimen enriched with extra-virgin olive oil reduces significantly the risk for T2DM, and actually cuts it by about one third compared with a low-fat diet.” There’s another nail in the coffin of the low-fat diet, but how much better the study would have been had it compared the “Mediterranean diet supplemented with extra-virgin olive oil” with a Low Carb High Fat diet.
“In summary,” Medscape concludes, “There is no recommendation for a specific diet to prevent T2DM, although the American Diabetes Association has advised people with diabetes to focus on overall healthy eating patterns and personal preference.” I reported this in Retrospective #155, “Cowabunga, the ADA makes the turn.” It was written by Medical Nutrition Therapists, not clinicians, but it was commissioned and endorsed by the ADA Executive Committee.
So, perhaps my kvetching is just an attempt to balance the scale – to teach physicians and medical professionals that the foods that affect Type 2 diabetics are CARBOHYDRATES. And that, It is the position of the American Diabetes Association (ADA) that there is not a “one-size-fits-all” eating pattern for individuals with diabetes.
I took another look at this momentous shift in Retrospective #167, “An Editorial: ‘Making the Turn.’” As I reread it, I was reminded that every yin has its yang. The glass is both half full and half empty, depending on how you look at it.