Sunday, January 27, 2019

Type 2 Nutrition #469: Why Pre-diabetes is actually Type 2 Diabetes (T2DM)

I’m not trying to be alarmist here. It’s just that there’s a broad misunderstanding in the patient population perhaps due to misunderstanding or reluctance to counsel patients by most clinicians: The diagnosis (Dx) of Pre-diabetes is prima facie evidence of an already failed glucose metabolism. The biomarkers used, an A1c of ≥5.7% (39mmol/mol) and/or an elevated blood sugar (≥100mg/dl or 5.6 or even 6.1mmol/L) is proof of that.
Most clinicians understand that a Dx of T2DM means that you have Insulin Resistance (IR). IR means that the uptake of glucose by the body is impaired by the inability of the hormone insulin, which accompanies glucose in the blood, to open receptor cells. This results in an elevated glucose. The body fights this dysfunctional response by sending more insulin. And as long as it sends more insulin, your blood glucose stays “Pre-diabetic.”
Here’s the misunderstanding. Your body has been successfully fighting IR by sending more insulin. And because it has been “successful” – keeping your blood glucose levels in the high-normal or even “Pre-diabetic” range – you, and ruefully in most cases your clinician, think you are not diabetic. The truth, however, is: You have IR (the definition of T2DM) and YOUR BODY is CONCEALING it from you.
Your pancreas will fight to make enough insulin to keep your blood sugar “normal,” until it fails. That failure is what constitutes a clinical diagnosis today. The failure of this late symptom of a dysfunctional glucose metabolism is after the fact. You have type 2 diabetes. Your pancreas has exhausted its ability to make enough new insulin. Either the Islet cells have died from fatigue or they so clogged with fat that they are blocked from functioning properly.
So, what should your clinician tell you or you do instead? If you have been told that you have a “slightly elevated” or “high-normal” or even a “Pre-Diabetic” blood glucose, accept that 1) you have Insulin Resistance, and 2) this is the definition of T2DM. NOW is the time to do something about it. Most clinicians will counsel you to “wait and see.” That’s because under clinical guidelines (and Medicare and other insurance rules), they can’t write you an Rx until you have been “clinically diagnosed.” But by then it’s too late. Your pancreas has already failed. It’s a fait accompli.
But up until this point your doctor has been in something of a bind. He can tell you to “diet and exercise,” but government’s idea of a “healthy diet” is to eat a “mostly plant-based” or even a Mediterranean diet. You’ve also been led to think that exercise is an effective weight loss strategy. Your doctor is also unlikely to know or believe that the diet or “lifestyle change” that will work to reverse your dysfunctional glucose metabolism is a low carb diet.
Nevertheless, losing weight is a good prescription, especially losing weight around the waist. Central obesity and belly fat are terms for visceral fat. As distinguished from subcutaneous fat, this is fat within the abdomen, around and within the organs, especially the liver and pancreas. This is why some people who are not obese have T2D. They are “skinny-fat” with a fat-clogged pancreas and probably a fatty liver (NAFLD) as well. This is very common in American children and adolescents. Losing this visceral fat can help restore function to pancreas for the obese, overweight and “skinny-fat” or viscerally obese.
Restoring pancreatic function only addresses the failed insulin production aspect of T2DM. Remember, this is the late symptom of a failed glucose metabolism, not the cause of T2DM, which is Insulin Resistance. What can be done to reverse IR? Well, ask yourself, what caused the resistance to insulin? Too much insulin! And what caused too much insulin? A diet too high in carbohydrates: eating too many carbs all day long, in every meal and in between. Solution: Change what you eat. Cut the refined carbs and simple sugars. Keep an eye on your fasting insulin level.
You got into this mess by eating far, far too many carbs. You can turn this whole thing around by eating far fewer carbs. Personally, I eat a Very Low Carb, Moderate Protein, High Fat (Healthy Saturated Fat, not the PUFA vegetable oils), also known as a LCHF or Keto diet. I also incorporate Intermittent Fasting (IF) from time to time. I’ve lost a lot of weight (170 pounds) and put my T2DM (Dx 1986) in remission. I have very good blood markers and I feel great. I did it without hunger (because fat is satiating), and without exercise. You can too.

Sunday, January 20, 2019

Type 2 Nutrition #468: Drink SuperBeets® for a “boost”?

SuperBeets®? Have you seen the TV commercial? Dana Loesch, a radio and TV host, pushes a powdered beet juice concoction that promises to make you “more healthy.” “Beets contain a nutrient that increases your own natural energy,” she says, but she doesn’t say what it is. It’s sugar. Fact: the body can only get its energy from either sugar (glucose) or fat (fatty acids and ketones from triglycerides), plus protein by gluconeogenesis. But you can bet your sweet bitty that the “natural energy” you get from beets is sugar, not fat or protein.
Don’t you think it’s curious that the TV commercial doesn’t even mention “sugar”? Neither energy source (fat nor sugar) is mentioned in the 1-minute TV commercial. Instead, the commercial extols the alleged benefits of the “boost” you’ll get from “increasing your nitrous oxide level.” It suggests, by inference, that this compound is one that your body lacks and needs more of to be healthy. Did you know that? No? It’s news to me, too.
I did some research, however, and discovered that 20% of the world’s sugar production is derived from beets. Sugar beet production is mostly from temperate climates. Russia, France and the U.S. are top producers, with the U.S. accounting for about 12%. The remaining 80% of world sugar production is from cane sugar, grown in tropical places like Brazil, India, China and Thailand. The U.S. produces about 1.5% of the world’s sugar cane.
Nitrous oxide (N20), known as “laughing gas,” is an analgesic and a weak anaesthetic. The inhaled gas has a half-life of 5 minutes. I was unable to learn how long a “nitrous oxide level” persists in the blood, but glucose persistence in your bloodstream, a much more important fact, depends on your degree of Insulin Resistance.
With normal blood sugar metabolism, the pancreas will produce insulin as needed to convey glucose (the “sugar” in the blood) from the food you eat to the cells. Insulin receptors are supposed to open up to receive the glucose. This quickly produces a spike of energy, and your blood sugar level soon returns to normal.
If, however, you have any degree of Insulin Resistance, the receptor cells will resist opening. The pancreas will then send more insulin until the cells eventually open, your blood sugar crashes, and you need a “boost.”
So, if you have insulin receptors that have been conditioned by a lifetime of eating processed carbs and sugars – both cane and beet, and you drink SuperBeets® for a “boost,” your blood sugar will go and stay high for a long time. But with SuperBeets®, who cares? Your nitrous oxide will be high for 5 minutes. Woo hoo!
“Within 30 minutes of taking it, I felt the difference,” one online testimonial said. That makes sense. That’s the sugar, stupid! Sugar IS a source of quick energy. It gets into your bloodstream in minutes. And with Insulin Resistance, it will cause blood sugar to “boost.” You will feel “the difference” You’ll also feel the crash!
Thus, Dana says she takes SuperBeets® multiple times a day: “in the morning, at the gym, in the afternoon as a pick-me-up.” Can you imagine? If she has any Insulin Resistance at all – and most of us do – her blood sugar curve would be a rollercoaster of ups and downs all day long. Spike, crash, spike, crash, spike, crash…endlessly, for so long and as often as she gets a concentrated hit of beet sugar “as a pick-me-up,” and for whenever she wanted to “feel the difference.” Is that what you want? To be more of a “sugarholic” than you already are?
If not, you could try a “lifestyle modification” and give your pancreas a rest. If you eat less “sugar,” your pancreas will not need to send a double dose of insulin to make the receptor cells work. This will help preserve the pancreatic capacity for years to come, and your energy level will not fluctuate as much. It will remain stable and flat while your body burns fat for energy. Fat doesn’t need insulin to give you energy. It’s actually absorbed through the lymph system and then into your blood to keep your energy level high and level.
If you feel the need for a “boost,” ask yourself, am I already addicted to sugar? If you answered “yes,” then, ask yourself, why on earth would you choose to add more sugar to your diet? Think about that.

Sunday, January 13, 2019

Type 2 Nutrition #467: It’s not fair!

It’s not fair. It’s not fair that, “The weight reduced individual will be requiring about 20% less (sic) calories per day relative to somebody of that weight who’s never lost weight would eat…in order to keep at that weight.” That’s what Rudolf Leibel, MD, Co-Director of the New York Obesity Research Center at Columbia University Medical Center said in “Choices,” one of 4 hour-long videos in the 2014 PBS series, “Weight of the Nation.”
“Individuals losing weight are not metabolically the same as they were before they lost weight,” Dr. Leibel said. I know. It’s not fair, but that’s the way it is…if you believe “a calorie is a calorie,” as Dr. Leibel apparently does. You will be consigned to accept this depressing fact and live with it. Worse still, you must be resigned to either 1) be fat because you will naturally want to eat as much as the person “who’s never lost weight” (because they don’t have to), or 2) you will eat 20% fewer calories and be hungry all the time. Your choice!
Dr. Leibel’s example: “Consider two individuals – same gender, same age, exactly the same body weight – one of whom is at that body weight as a result of let’s say a 10 or 15% weight reduction, the other who’s been at that weight for their entire adult life. If that reduced weight individual goes out to lunch with her friend, and they both order the same meal, that will represent 20% overeating for the weight-reduced individual, and be quite normal for the individual who’s not in that state. Twenty percent might seem like a little, but 20% excess calorie intake a year will account for the inexorable weight gain.” There, he said it again: “excess calories.”
But what if “calories don’t count”? I’m not joking. If you haven’t heard this before, just Google it. I got 20 million hits, many, on the first few pages, from sites that I respect. But I don’t need to search the Internet to know that I don’t need to “count” calories (or eat 20% fewer) to keep the weight off or not regain the weight I’ve lost. I know I can do that by changing the foods I eat; by eating fewer processed carbohydrates; by eating high quality proteins and fats instead. They will be more satiating, and I will naturally eat less without hunger.
Sound too good to be true? Well, if you don’t want to accept this, then you are welcome to wallow in self-pity and eat the “balanced diet” that the USDA and BIG PHARMA and the medical establishment dictate. You can ignore their conflicts of interest. You can also ignore your glucose meter and what is best for YOUR health. You can follow the HHS/USDA Dietary Guidelines for Americans, which continues to closely mirror the catastrophic “diabesity” epidemic trendline since they were first published in 1980, following the “Dietary Goals” of 1977. 
You can also rely on the American Heart Association’s exhortation since 1961 that you avoid saturated fat and dietary cholesterol and instead eat their recommended highly processed vegetable and seed oils produced by the same USDA-subsidized AGRIBUSINESSES that made the trans-fat laden Crisco and corn-oil margarines.
It’s your choice. So, whom are you going to believe, me or your heart doctor? ;-) Okay, THAT’s not fair either. If you already have heart disease, I won’t blame you for following your specialist’s advice, even if he or she doesn’t know sh*t about nutrition. But, just for laughs ask if they know 1) that in 2014 the Dietary Guidelines Advisory Committee declared “dietary cholesterol…is no longer a nutrient of concern for over-consumption” and 2) that Ancel Keys, the author of the “diet-heart hypothesis,” said later in life “we’ve known that all along. Cholesterol in the diet doesn’t matter at all unless you happen to be a chicken or a rabbit.”
Then there’s this quote of “updated findings” from Dr. William Castelli, Director of the famous Framingham Study, published in Archives of Internal Medicine: “In Framingham, Massachusetts, the more saturated fat one ate, the more cholesterol one ate, the more calories one ate, the lower people’s serum cholesterol. . . we found that the people who ate the most cholesterol, ate the most saturated fat, and ate the most calories weighed the least and were the most physically active.” Confounding, isn’t it? Whom are you going to believe?

Sunday, January 6, 2019

Type 2 Nutrition #466: Want help getting into a size 10?

A year or so ago a friend who’d noticed how much weight I’d lost asked me how I did it. I told her, “Very Low Carb.” Like virtually everyone, she admitted she didn’t have a clue about the fine points of what a carbohydrate is and asked for a little guidance. Totally unaware of how much travail it would cause us both, I unwittingly jumped at the opportunity to mentor her…and we succeeded.
I saw her at a garden party last summer. When she asked if I had noticed how much weight she’d lost, I replied, “No, but I noticed how good you look in that dress.” She smiled. “I’ve lost 26 pounds, 1 dress size,” she said. “It’s a size 10.” “I would like to lose another couple of pounds,” she continued, “so a fitted dress would be a little more comfortable through the waist. I’m not shooting for a size 8” though,” she chuckled…which brings me to the subject of this post: MODERATION.
I hate the concept of moderation. Too often it is used as an excuse by those who reject a more radical lifestyle change. “Moderation” is an ideology in itself, but it’s often used as a response to importunate demands for radical change. Just because I lost over 180 pounds and kept most of it off is no reason to think that is the only way to lose weight. This is also true if 1) you don’t need to or want to lose so much weight and 2) you are cut from a “different cloth,” as my friend and perhaps the majority of the overweight people in this nation are.
My friend taught me this lesson. She of course is happy that she lost 26 pounds. She would be happier still if she lost another 6 or 7, which she now knows how to do. In her case, 26 pounds was over 20% of her starting weight, so that IS a singular achievement. Another 6 or 7 pounds would be 5% more of her current weight!
Why the opportunity to mentor my friend was so vexatious is that, to adopt a MODERATE approach to eating LOW CARB (rather than the extreme approach of VERY LOW CARB that I used), required a lot of education and a lot of negotiation. My friend leads a very intense, edgy lifestyle, constantly creating lots of “on the edge” situations as part of her work as a novelist. As a result, she’s inured to living somewhat “on the edge” herself.
A lifestyle that is fraught with anxiety and risk-taking is bound to be a strain on one’s psyche. For balance, such a lifestyle likewise requires rational thinking and counter measures to deal with the day-to-day exigencies. And to deal with this lifestyle, eating becomes both a driver and a crutch. Comfort food is an integral part of her lifestyle, and snacks are an integral part of her eating pattern. Therein lay the challenge.
Snacking is antithetical to a sound Low Carb Eating Plan, but giving snacks up was off the table – not negotiable! It was integral to her modus operendi. Therefore, all that remained was the Low Carb part. Beyond that, the education was pretty simple: She told me what she ate, and I gave her a basic education about which things she ate were the bad choices: both the “complex” carb type and the simple sugars. And that was it!
I’ve always scoffed at the concept of negotiating with a patient as the ADA’s clinical practice guidelines counsel. But in this case, I learned first-hand with my “patient” – with snacking being a part of her working lifestyle, which I totally understood and had to accept – a workaround would be necessary. And it was.
It took dozens of emails over several weeks, including countless recitations of the same principles to refute the same “scientific” articles she sent me which advocated for another Way of Eating or against the Low Carb way. But eventually we modified her “Eating Plan” sufficiently to where she started to see a difference on the scale.
The back and forth ended one day when I gave up on repeatedly defending the science of Low Carb eating. We didn’t “talk” for months afterwards, so I was delighted when we met at the garden party and she asked me if I had noticed her weight loss. That’s when I said, “No, but I did notice how good you look in that dress.” I think we both felt pretty good about that. I think her doctor did too. Of course, I would like to see her go for that size 8 dress. She knows how now and could get there by simply going back and doing “more of the same.”