Tuesday, April 30, 2019

Retrospective #74: You don’t add salt?

You don’t add salt? Well, maybe YOU shouldn’t. Many prepared and processed foods in cans and boxes already have a lot of added salt. It is added to enhance flavor and make the product more palatable. It’s also a preservative.
On the other hand, if you eat mostly real food, i.e., whole foods – the meats and vegetables found in the cases on the perimeter of the supermarket, you may find them tastier if you add salt in their preparation or at the table. I do. I add lots of salt. I add salt “to taste” to maintain homeostasis and my electrolyte balance. I do it so I can live in that healthy state. If you’re still not sure of our animal requirement for salt, think “horse lick” or “deer lick.”
So then why is salt restriction universally recommended by the public health establishment? There is very little evidence that salt “causes” hypertension. It’s another one of those hypotheses that, according to Gary Taubes in his 2007 book, “Good Calories – Bad Calories” (pg. 146), scientists say is based on “biological plausibility – it makes sense and so seems obvious,” like “eating fat will make you fat.” Taubes first addressed the subject of salt restriction in his award-winning article “The (Political) Science of Salt,” published in Science on August 14, 1998. He revisited the subject with “Salt, We Misjudged You,” an op-ed in the New York Times on June 3, 2012.
There is also evidence that salt restriction in Type 2 diabetics may be harmful. In 2011, The ADA’s Diabetes Care online reported a University of Melbourne study that found “patients with the highest levels of sodium in their urine had the smallest risk of dying over a 10-year period. The study followed “638 people with longstanding Type 2 Diabetes, often accompanied by heart disease and high blood pressure.” “All the patients were in their 60s and nearly half of them were obese.” The researchers reported, “Over the decade the study spanned, 175 patients (27%) died, mostly due to heart disease.  The average amount of sodium in their urine (the ‘gold standard’ for sodium consumption) was 4.2 grams per day. For every extra 2.3 grams of sodium (equivalent to 1 tsp. of table salt) in their urine, their risk of dying during the study dropped by 28 percent.” Doctors who worked on the study said, “It raises the possibility that in people with Type 2 diabetes, low salt intake is not always beneficial.” Do ya’ think?
In his series “Shaking Up the Salt Myth,” Paleo blogger Chris Kresser wrote about, “The Dangers of Salt Restriction,” in which he reported on a 2011 JAMA study that “demonstrates a low-salt zone where stroke, heart attack and death are more likely.” He concludes, “These findings demonstrate the lowest risk of death for sodium excretion is between 4 and 5.99 grams per day”. The 2015 Dietary Guidelines still recommends that Americans “reduce daily sodium intake to less than 2.3 grams (1 tsp). Conclusion: The lowest risk of death is associated with consuming from 2 2/3rds to 4 times more sodium than Type 2s or hypertensives or older adults are being guided to eat.
Then there’s the physiological explanation for why Type 2 diabetics who are following a Low Carb or Very Low Carb diet should not restrict their sodium (salt) intake. Michael Eades, M.D., author with his wife Mary Dan Eades, also M.D., of “Protein Power,” blogs about it in “Tips and Tricks for Starting (or re-starting) Low Carb Part II.” He explains that when your body is depleted of carbs, your blood insulin drops and your insulin sensitivity improves.
The excess insulin that made you store fat also drove your kidney to retain fluid. When the insulin level drops on a low carb diet, “the stimulus to the kidneys to retain fluids also goes away.” Dr. Eades says, “The kidneys begin to rapidly release fluid” (urine) and sodium, changing your electrolyte balance. When this happens, “symptoms often occur: fatigue, headache, cramps, and postural hypertension” (light-headedness). “You simply need to take more sodium, drink more water,” Dr. Eades says. “You’ve got to start thinking differently.  The low carb diet is one that absolutely requires more sodium. A lot more sodium.” “An easy way to get extra sodium, along with magnesium and potassium, is by consuming bone broth.” “You can also use commercially available bouillon,” he adds.
In my opinion, the Dietary Guidelines recommendation that salt should be restricted is just bad advice.  And it certainly should not be a universal recommendation. In particular, it should not be applied to Type 2 diabetics who eat a diet of less than 50 grams of carbohydrate a day, aka a Low Carb Diet. This population should eat more salt

Monday, April 29, 2019

Retrospective #73: Newly Diagnosed Pre-Diabetic or Type 2?

I wasn’t scared. I relied on my doctor, and I paid a price. I did just what my doctor told me to do. I took the pills he prescribed, and I continued going to see him regularly. I ate a “balanced” diet, as his staff nutritionist advised me to, and I tried to lose weight, as they both recommended. But my body didn’t want to starve, so when I ate less, it slowed down and I was tired and hungry until I ate again. The weight loss part didn’t work out so well.
The result: I continued to gain weight and over the years my diabetes got worse. As my blood “sugar” got worse, I was prescribed more types of oral diabetes medications and larger doses. Eventually, I was maxed out on two and starting a third. In those days (2002) the only option, when the third med failed to control my blood glucose, would have been to inject insulin. I was that close until, 17 years ago, I found another way. It was my doctor, actually, who found a way for me to both lose weight and manage my diabetes. My doctor suggested I try eating Very Low Carb.
With a new diagnosis of Type 2 diabetes today, if “diet and exercise” doesn’t work after one or two office visits, physicians frequently prescribe Metformin, and then, some start right in with injected insulin as primary treatment. That might be a good idea if you continue to eat a balanced diet.  It would scare me, though, knowing that there’s a much better alternative. You don’t have to do the same old, same old “restricted-calorie balanced diet” in which you starve your body and are always hungry. It doesn’t work, at least not for long. If you lose weight, you soon gain it back. And exercise just makes me hungry and justifies my eating more as a reward for “good behavior.” Geeez…
Alternatively, many patients who are newly diagnosed with Type 2 Diabetes go home and immediately go on line to learn for themselves how best to treat their condition. They take charge of their own health. In doing this they avoid expensive medications and manage their diabetes through diet alone. I say “manage” because ONCE YOUR METABOLISM HAS BEEN DAMAGED BY BETA CELL LOSS AND INSULIN RESISTANCE, YOU WILL BE CARBOHYDRATE INTOLERANT FOR THE REST OF YOUR LIFE. You MUST accept this. If you want to manage this disease without drugs, or with just Metformin, and without the dreaded Microvascular complications (blindness, amputations and/or end-stage kidney disease), and Macrovascular complication (heart attack, stroke, etc.), you can do it, but you MUST make VERY dramatic changes in your diet. You must drastically reduce the carbs you eat at every meal.
Over the course of a few years eating Very Low Carb (+/- 20 net grams of carbohydrate a day), I managed to lose 170 pounds, all without hunger, because I was NOT starving my body. My body was getting the energy it needed from its own stored fat. Think about it. That’s what your body fat is there for, in the evolutionary sense.
I also needed much less medication. I discovered this in the first week. I had a few episodes of hypoglycemia (very low blood sugars). I called the doctor and he told me successively to lower or eliminate all the diabetes meds I was taking. This happened before I lost weight. And after I lost weight my blood pressure improved a lot (on the same meds), and my blood lipids (cholesterol) greatly improved too, especially my HDL and triglycerides.
The key to losing weight without hunger is getting ACCESS to your body fat. And the key to that is to not eat carbs. All carbs convert to glucose (energy). Glucose needs insulin to accompany it in the blood, so the pancreas secretes insulin and adds it to the blood. When the body perceives the insulin in your blood, it blocks the breakdown of body fat for energy. The insulin signals that you have glucose and don’t need to break down body fat for energy.
So, by eating a VERY LOW CARB diet, my body is happy. My DOCTOR is happy. I always have lots of energy, and I am much healthier than I was when I was fat and heavily medicated.
All I had to do was take charge of my health and use the internet and my glucose meter to learn what to do. Your meter and your scale will give you the feedback you need too. Just decide not to be scared and take control of your health and what you put in your mouth. It’s your life, after all.             

Sunday, April 28, 2019

Retrospective #72: How to Fix Your Cholesterol

Physicians everywhere want to “fix” your “cholesterol.” They’re well meaning, and they know there is a very small benefit, probably due to a reduction in inflammation. But only if have known CVD, and you’re male and under age 65. They know that by lowering your Total Cholesterol (TC), your LDL will be lowered by the same amount. And they know they can do that with a pill. They can get your LDL to within the range recommended by the pharmaceutical industry’s “Standard of Practice” by prescribing a statin drug: Crestor or Lipitor or Zocor, or one of the popular generics like simvastatin. So, what’s wrong with that? The answer: it’s the wrong target!
In the first place, lowering LDL Cholesterol is by far the most common intervention for which your doctor can write a “script” (prescription). That’s why they do it. It must be frustrating for them though, since “high cholesterol” (meaning high Total Cholesterol and LDL) is almost always associated with low HDL and high triglycerides. They are all so common in the same patient. The result, however, is that sales of statins in the U.S. since they were introduced in the 1980s have skyrocketed. Meanwhile, HDL and triglyceride levels have remained unchanged.
It must be doubly frustrating that “high cholesterol” is commonly associated with hypertension (high blood pressure) and obesity. Collectively these are all among the indications of Metabolic Syndrome. See Retrospective #9 for specifics. The particular cholesterol markers associated with Metabolic Syndrome are low HDL and high triglycerides. The medical term for this cholesterol condition is “dyslipidemia,” or dysfunctional blood lipids (fats).
Although progress is being made in treating high triglycerides, unfortunately there is no pill to beneficially raise HDL. But dietary intervention works for both of these. See Retrospective #67 “HDL Cholesterol and the Very Low Carb Diet,” and Retrospective #68, “Triglycerides, Fish Oil and Sardines,” and then Retrospective #27, “…the strongest predictor of a heart attack” for the CVD benefits of dietary intervention for both triglycerides and HDL.
Of course, hypertension can be treated with medications, usually a “cocktail” of two or three. Obesity, however, stubbornly resists medical interventions. It is up to the patient, the doctors say, and the doctors usually report the patient is “non-compliant.” That is, the patient either cannot lose weight on the medically-recommended restricted-calorie BALANCED diet, or the patient who does lose weight soon gains it all back and often “then some.” Hunger wins out. The body, which can’t access its own fat reserves on a high-carb diet, doesn’t want to be starved. When it needs energy, it tells you to eat food-by-mouth for that energy, whenever your blood runs low on glucose.
So “high cholesterol” and hypertension, commonly seen together, are still the targets that most doctors treat together. The problem is: Total Cholesterol is an antiquated and almost useless term. It is only used because it can be easily measured and lowered by statins. HDL and triglycerides remain unchanged. But a Total Cholesterol that would be “too high,” because of its LDL component, would be perfectly okay with your doctor if the LDL was lower but the HDL was much higher and the triglycerides much lower. If that seems confusing, see Retrospective #25, “Understanding Your Lipid Panel,” for two identical Total Cholesterols with different HDL, LDL and TG components.
The reason for this is evident from the formula that was used for 30 years and until recently) for the lab cholesterol test: the Friedewald formula. In it, Total Cholesterol and HDL and triglycerides are assayed (actually measured), but the LDL value was calculated: LDL = TC – HDL – TG/5. A revised formula, Martin/Hopkins, used since Summer 2018, still also uses a calculated LDL, not a direct measurement. It does continue to assay HDL and triglycerides directly.
So, if the best way to “fix” your cholesterol is to raise your HDL and lower your triglycerides, you can do that – by following a restricted-calorie Very Low Carbohydrate diet. You will also lose weight easily and without hunger because your body will be free to burn your body fat. And you will get control of your blood sugar (if you need to), and lower your blood pressure. Your Type 2 diabetes (if you have it, or you’re pre-diabetic) will go into remission.
Your doctor can’t do these things by prescribing statins and blood pressure pills, but YOU CAN. But first you have to know about your cholesterol. Read Retrospectives #9, #25, #27 and #67 and #68 and take charge of your health.

Type 2 Nutrition #482: “What are you teaching these kids?”

In the Schwab TV commercial, Carl, a salesman for a rival stock broker, is addressing an elementary school class. When one of the students asks what his firm has to offer, Carl says, “Good question!” But when the kid replies to the broker’s answer with what Schwab has to offer, Carl asks, “What are you teaching these kids?”
Now THAT’S a good question! Both kids and adults in the U. S. have been subject to the government’s ideas about nutrition for over half a century. It all started in the 50s and 60s and got much worse in 1977 with the McGovern Committee’s Dietary Goals and then in 1980 with the very first Dietary Guidelines for Americans.
The result is plain to see. We for the most part have followed the government's advice. Many have no choice. The military eats what the government cooks for them, and they are getting fatter and fatter. You can’t blame that on a lack of exercise, can you? Our schools and hospitals are subject to these HHS/USDA guidelines too.
So, what have they been teaching us and our kids? To lose weight and be healthy: eat less and move more. Don’t eat red meat or processed meat. Don’t eat meat! Or cholesterol or salt! Don’t eat saturated (solid) fat, found in animal products. Instead, eat processed “vegetable” oils (soybean, corn, Canola, etc.), all of them UNHEALTHY polyunsaturated fats manufactured by Agribusiness and subsidized by the USDA!
Doctors too are having an increasingly difficult time under the influence of government Dictocrats. To survive they are now part of large groups and hospital practices where corporate number crunchers are monitoring your personal medical records to see that the clinician is recording that he advised you to eat a mostly plant-based diet and get the recommended amount of exercise. If your doctor hasn’t advised you to do this, you’re lucky; he or she is still in private practice but is at risk of HHS sanctions and increasing “negative payment adjustments” if this is not in your patient notes. Their Medicare reimbursements will decrease by 9% by 2022.
So, what’s to be done about it? Obviously, the macro solution is to get legislators out of the business of telling people what to eat, but that is not going to happen. There will always be politicians who think they know what’s best for everyone. They will always want to impose their will on the rest of us, by legislation. They will argue that it is the proper role of government to look after the “general welfare” of the citizenry, to justify with legislation anything that is not expressly “enumerated” as powers granted to them by the Constitution.
In this they have been abetted by a Supreme Court which has leaned slightly left and extended power to Congress to legislate away your freedoms, all in the name of the “general welfare.” Some, who espouse a civil libertarian point of view, objected, but others, to right of center, relented to pressure for the “general good.”
Today, however, the tide is changing. In 2002, on the advice of my doctor who just wanted me to lose weight, I started to eat Very Low Carb. He had been nudging me for years, telling me to eat a “balanced” diet, but “eat less and exercise more.” I even worked with his dietician, all to no avail. Then in July of that year he read a NYT Sunday magazine cover story, “What If It's All Been a Big Fat Lie.” He followed the diet himself, quickly lost 17 pounds and suggested I try it. I lost 170 pounds and abruptly stopped almost all my diabetes meds early on.
More and more people (and many doctors) are discovering this Way of Eating. There are now thousands of practitioners worldwide who publicly practice this way, and 10s of thousands more who would tacitly support your decision to change the way you eat. After all, doctors and related health professionals are interested in results and are persuaded by evidence. Not only will you lose weight easily this way, and do it without hunger, your blood tests of metabolic markers, BP and inflammation, will improve dramatically. That’s real evidence.
The tide is also changing on the Supreme Court. The balance of power is now 5 to 4 for a more conservative interpretation of the “general welfare” clause. And soon it could be 6 to 3. Personally, I will be much happier if and when Congress and the Courts decide that government should have less to say about what we eat.

Saturday, April 27, 2019

Retrospective #71: Weight Loss Maintenance (2012)

After losing 170 pounds by eating Very Low Carb, I later regained almost 70. And although I still ate Very Low Carb most of the time, and always at breakfast and lunch and dinners at home, I occasionally binged and usually cheated in restaurants. I also sometimes snacked after dinner even though I was not hungry.
Because of that, I ate more than my body needed. And cheating with carbs led to the loss of both ketosis and blood sugar control. My A1c went from 5.4 to 6.3%, and my blood pressure also went back to 130/90 from 110/70. My HDL and triglycerides were still hugely improved, but my doctor was urging me to start taking a statin again.
So, that is how I regained weight: Too many carbs (taking me out of ketosis), snacking after dinner, and occasional binging. It didn’t take much, but it was enough. It took almost four years to regain the weight, with a few ups and downs along the way. So, I finally decided: Enough is enough! It’s time to turn this boat around again. About a month ago I set a goal to lose 55 pounds: Thereafter, I would strive to keep my weight within 5 pounds of 225.
If this yo-yo sounds familiar, by all accounts it is. My situation is very common. People who find it easy to lose weight by any means, even a Very Low Carb diet, eventually relapse. Most gain back most of the weight they lost because they no longer follow the principles they used to lose the weight. That’s true of Very Low Carb eating too.
So, to lose the weight again, I am going to return to a slightly modified version of the Very Low Carb Ketogenic Diet (VLCKD) is used, starting 10 years ago, to lose 170 pounds. The Way of Eating I will use has 3 components: 1) Very Low Carb (VLC): you need to eat VLC to allow insulin to NOT BLOCK the breakdown of body fat in storage; 2) Restricted Calorie: you need to have a calorie deficit of food-by-mouth to create the need to burn body fat to maintain metabolic balance (homeostasis); and 3) Ketogenic: you need to make your body supply a) ketones from the breakup of body fat, and b) glucose from glycerol from fats and amino acids from protein via gluconeogenesis. These are called “complementary pathways,” where the body synthesizes glucose for some cells that require them.
This diet will be 1,200kcal/day comprised of 5% (15g) of carbohydrate, 20% (60g) of protein and 75% (100g) of fat.
The way I propose to then maintain my “goal weight” is described in Volek and Phinney’s, “The Art and Science of Low Carbohydrate Living.” They specifically describe, in terms of macronutrients, WHAT TO DO to maintain your “goal weight,” once you have reached it. Uniquely, this book also explains why. It describes the mechanisms and processes the body goes through, ESPECIALLY WHEN YOU ARE CARBOHYDRATE INTOLERANT.  The authors use this new “buzz” phrase repeatedly. Accept it. It applies to all Type 2 diabetics, Pre-diabetics, and the majority of overweight and obese people, as well as those who have Metabolic Syndrome. It likely applies to YOU.
The Chapter 16 title of Volek and Phinney’s book tells it all: “The Importance of Dietary Fat in Long-Term Maintenance.”  An excerpt from page 205: “Long term adherence to carbohydrate restriction is an important issue,” they say, “and capturing the benefits of a low carb diet for the management of chronic conditions associated with insulin resistance requires that we address this challenge. Given the dramatic improvements in the dyslipidemia associated with metabolic syndrome, and the marked improvement in diabetes management when adequate carbohydrate restriction is sustained…” – they’re saying, dietary carbohydrate intake cannot be increased in weight maintenance. So, then only protein and fat remain. And since about half of protein is glucogenic, i.e., can convert to glucose via gluconeogenesis, the amount of protein in the maintenance diet can only increase slightly and then only as an equal percentage of total energy intake in the maintenance diet as it was in the weight loss diet. Therefore (page 206), “…to feed the post-weight loss patient adequate energy for weight stability, while maintaining the degree of carbohydrate restriction necessary to sustain the diet’s benefits…the need [to increase} dietary fat while keeping carbohydrates within an acceptable level of tolerance in the long-term maintenance phase of carbohydrate restriction.” THE MACRO THAT MUST INCREASE IN THE MAINTENANCE DIET IS FAT.
I’m thinking maybe snacks of nuts and cheese once in a while. “Sugar plums,” metaphorically speaking.

Friday, April 26, 2019

Retrospective #70: LDL Cholesterol and Statins (2012)

My doctor is hinting that I should start taking statins again. Knowing that I take a strong interest in the nitty-gritty of my own healthcare, and, like most people, have heard about the limited benefits and bad side effects of statins, I expect he knows he has to tread softly with me on the subject. He also knows, however, that I respect his knowledge – he is an internist and cardiologist – and he has worked well with me for over 20 years.
In August 2002, after failing to get me to lose weight on a balanced diet under his nutritionist’s supervision, my doctor suggested I try Very Low Carb (20g/d of carbs). It worked. In 9 months, I lost 60 pounds, and a few years later, after regaining 12, I started on Bernstein and lost 100 more in a year and then later another 22 (170 total).
Upon starting VLC, I immediately – in the first week – needed to greatly reduce and/or eliminate all three classes of oral diabetes medications I was taking. (I had upon beginning VLC been a Type 2 diabetic for 16 years.) Ten years later, after losing 170 pounds, my blood pressure had also gone down from 130/90 to 110/70 on the same meds.
In addition, my lipid health completely turned around. My HDL Cholesterol average more than doubled from 39 to 81, and my triglyceride average went from 137 to 49. (For details of my triglyceride and HDL story scroll down to Retrospectives #68 and #67, respectively.)
During this transformational period, how did my LDL Cholesterol fare? I’d say pretty well. Between 1992 and August 2002, when my doctor suggested I try eating VLC, my LDL had been tested 12 times. The average was 142mg/dl. For reference, from 130 to 159mg/dl LDL is considered “borderline high.” During the next 16 months, while I was eating VLC and losing weight, it was tested 16 more times, and the average was 125mg/dl.
The clinical guidelines consider LDL under 130 “near/above optimal.”  But, for patients who have either high blood pressure, Type 2 diabetes or are obese, the guidelines suggest <100, and if the patient presents with more than one of these conditions, the guidelines are <70mg/dl. And statin drugs lower LDL very effectively. How convenient.
So, since I was obese, hypertensive (on meds) and a Type2 diabetic, in December 2003 my doctor suggested I start on a statin: I started on 80mg of Lipitor, as I recall, and it definitely lowered my LDL Cholesterol. Over the next 5 years the average of 21 LDLs taken was 60mg/dl! I was lucky. I had no side effects that I recall. (However, maybe impaired cognition or memory loss were among them – LOL). Soon after starting them I switched to a generic, and over a period of time took less and less until my doctor finally took me off statins completely in December 2008.
Since that time my LDL has been tested 11 times for an average of 123mg/dl. This 123mg/dl LDL average is virtually the same as my first-year average on Very Low Carb (125mg/dl). It is also under the 130 “near/above optimal” LDL value, and despite significant weight regain, I still weigh today more than 100 pounds less than when I started VLC.
So, I find myself at a crossroads: Either I go back to strict adherence to my Very Low Carb diet, to lose weight, and improve my BP and A1c, or I start to take a low dose statin again (for the LDL only). My doctor wanted me to start with free samples that he had of a new statin, so I told him I would check it out. I did. It did well recently in a trial reported in PubMedCentral. I didn’t, however, notice a section on side effects or “adverse incidents.”
As the subject will arise at my next office visit, I think that my approach should be: So long as I am making improvements in my weight, blood pressure and A1c (glucose control), I will say “no” to starting on a statin again. If I can keep my LDL consistently between 100 and 130 without a statin, as I have for these last 4 years since I have been statin free, and I maintain low triglycerides and high HDLs by Very Low Carb alone, I’m sure I can keep the doctor off my back. He knows how important weight, BP, A1c and those two lipids are.
Besides, the medical literature, and the doctors who make the time to read it (instead of seeing attractive young saleswomen with free samples), know that the TG/HDL ratio (not TC/HDL ratio) …”is the strongest predictor of a heart attack” (See Retrospective #27.) Notice: Neither Total Cholesterol nor LDL cholesterol is mentioned.

Thursday, April 25, 2019

Retrospective #69: In Praise of Small Meals, after 10 years of VLC

Like many Americans I succumbed in my 40s to one of the ubiquitous Diseases of Civilization: Metabolic Syndrome. See Retrospective #9 for the indications. My doctor didn’t diagnose it (yours wouldn’t have either), but the signs were obesity, hypertension (high blood pressure), low HDL and high triglycerides. Note: No mention of high Total Cholesterol or high LDL. I was, however, also diagnosed with Type 2 diabetes. Type 2 diabetes and obesity are epidemics of “epic” proportions. They are so often seen together that they are commonly called “diabesity.”
And like many others, I found, on the suggestion of my doctor, a way of eating that is an effective treatment for diabesity – one that can reverse all the markers of Metabolic Syndrome. And lose weight, without hunger, using the Very Low Carb (VLC) diet advocated in this blog. The benefit of the VLC diet is that it will reverse or ameliorate all the symptoms of Metabolic Syndrome – the obesity, the hypertension, the dyslipidemia and the dysregulation of your blood glucose metabolism – so long as you continue to eat Low Carb.
You can lose weight without hunger. I lost 170 pounds. Your high triglycerides will plummet and your HDL will soar. For evidence of my own improvements, scroll down to Retrospective #68, “Triglycerides, Fish Oil and Sardines” and Retrospective #67, “HDL Cholesterol and the Very Low Carb Diet.” Your blood pressure will also improve. I went from 130/90 to 110/70 (on the same medications). And the best news of all: your blood sugar will greatly improve, eliminating or substantially reducing the need to take oral diabetes medications.
In addition, if strictly adhered to, a Very Low Carb diet will put your T2 diabetes in full remission with no clinical signs of disease. Mine is. And once you have reached your goal weight, all of your gains will be retained so long as you continue to eat Very Low Carb. So long as you keep the weight off, and continue to eat VLC, you will have “normal” blood sugars and lower A1c’s, great lipids, especially triglycerides and HDL, and improved blood pressure.
This Way of Eating is very effective for weight loss and weight maintenance because if you aren’t hungry, you will not eat as much. You can eat a small meal and be satisfied. Not sensing hunger, you will not want to eat between meals, and you will not have the desire to scarf down more food than you need when you do sit down to eat.
Think about it. If a small VLC meal satiates your hunger, you will be satisfied and thus learn to eat it and no more. Similarly, if you are not hungry for 5 or 6 hours after a small VLC meal, you will learn that you do not need to eat a between-meal snack. I have learned these two lessons during 10 years of eating VLC and found it easy to apply them. Small meals and no snacks. Let me illustrate:
For 10 years I have been eating a breakfast of 2 fried eggs, 2 strips of bacon and a cup of coffee with half and half and Splenda. It is about 6 grams of carbohydrate (2 eggs = 1, 2 Splenda = 2, and 2oz H&H = 3). It is mostly protein and fat (21g protein; 27g fat). Total calories: about 350. Believe it or not, this small meal is good for 6 or 8 hours!
For lunch (as a creature of habit) I have a can of Brisling sardines in EVOO, eaten from the can: 13g protein, 24g fat and zero (0) grams of carbohydrate. Calories, including the olive oil in the can: 270. If I have a beverage, it is either a glass of water or diet ice tea. I usually eat this small meal approximately 5 hours after breakfast not because I am hungry (I am not), but because I want to eat some protein, with some good (monounsaturated) fat, at “lunchtime,” to remain Ketogenic without fasting. Because I am not eating carbohydrates for energy, I continue to use dietary and body fat all day long as energy sources.
Dinner, renamed supper, is likewise a small meal of mostly protein and fat. It is a smaller-than-previously-eaten serving of protein plus a non-starchy vegetable (carbohydrate) tossed in butter or roasted in olive oil (again, a healthy monounsaturated fat). Alternately, I sometimes eat a salad with my homemade vinaigrette dressing.
Together, these three meals combined are about 1,200 calories, 75g protein, 90g fat and 20g of carbohydrate. This meal plan is about 25% protein, 70% fat and 5% carbohydrate. And all of these meals are small and very satisfying.

Wednesday, April 24, 2019

Retrospective #68: Triglycerides, Fish Oil and Sardines

The table on the left displays (or will display, when I figure out how to do it in Blogger) my Triglycerides (TG) for the last 34 years. Yesterday’s Retrospective #67, has, or will have when it is fixed, a similar table of my HDL Cholesterol. Another Retrospective later will display TC/HDL and TG/HDL ratios.
The reference range for healthy triglycerides is less than 150mg/dl. Only 10 of my 69 TG tests have been over 150. Seven of those were more than 10 years ago, before I started eating Very Low Carb (VLC), and the other 3 were in the first year of eating VLC.
The “before and after VLC” triglyceride test results are revealing: The average of the 21 TGs before I began VLC was 137. The average of the first 10 months that I ate 20g of carbs a da,y and lost 60 lbs. (but wasn’t taking fish oil), was 103. The average of the last 18 tests during which I continued VLC on Bernstein (30g/day of carbs), and lost another 100 lbs., and was taking four, then three, now 2 grams of fish oil/day, and eating a can of sardines for lunch, is 49mg/dl (range 21 to 88). THIS BEFORE AND AFTER CONTRAST IS INDEED STARK.
I now eat VLC. Seventy percent 70% of my diet is fat -triglycerides! I eat lots of saturated fat. In 2012 I ate 700 mg of cholesterol a day, including, for breakfast, 2 eggs, 2 strips of bacon and half and half in my coffee. Obviously avoiding dietary fat is not the answer. It is indeed a paradox, if you accept the dietary and nutritional advice of mainstream medicine.
It is true, my results are only anecdotal, n = 1, but it would be a mistake to think that this outcome is an isolated result. It is widely reported in the literature under the subject “Carbohydrate Hypothesis.” You can discover this for yourself with an Internet search.
Award-winning science writer Gary Taubes pioneered in popularizing this hypothesis, starting with his game-changing, 2002 NYT Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie.” He later addressed the subject in great detail in his 2007 tome, “Good Calories-Bad Calories” (“The Diet Delusion” in the UK), and later the more ‘accessible’ “How We Get Fat: And What to Do About It.” Taubes has influenced many young clinicians.
A compelling case for the benefits of low triglycerides, combined with high HDL, was made in this 2008 August 63(4) 427-432 PubMed Central peer-reviewed paper. Retrospective #27 refers to it with this quote: the ratio of Triglycerides to HDL (TG/HDL) is “the single most powerful predictor of extensive coronary heart disease among all the lipid variables examined.” Note: neither Total Cholesterol (TC) nor the “bad” LDL, is mentioned.
Using this new (but not yet widely adopted) standard, a TG/HDL ratio ≤ 1.0 is considered ideal, a ratio of ≤ 2.0 is good, a ratio of 4.0 is considered high and a ratio of 6.0 is much too high. So, how do my TG/HDL “before and after” ratios calculate and stack up? Referring to Retrospective #67, “HDL and the Very Low Carb Diet,” for HDL, here are my calculations:
When I was a heavily medicated Type 2 diabetic and eating a “balanced” diet: TG/HDL 3.2. When I first lost 60 lbs. on VLC but was not taking fish oil: TG/HDL =2.2. Later, when I was eating VLC, lost 100 lbs. more, was taking fish oil and eating sardines daily: TG/HDL = 0.67
Maybe the seeming paradox of eating Very Low Carb with lots of fat, including saturated fat and cholesterol, and taking fish oil and eating sardines daily, is NOT a paradox. Maybe it’s a healthy Way of Eating. Ya’ think? These results certainly suggest that to me. More and more folks (including many clinicians) now seem to think so too. So, what’s your ratio?

Tuesday, April 23, 2019

Retrospective #67: HDL Cholesterol and the Very Low Carb Diet

The table on the left displays my HDL cholesterol from 1980 to 2012. Okay, I’m a compulsive record keeper, but sometimes that’s a good thing. Advice is cheap, but lab reports are evidence, and mine are worth looking at. There is definitely a ‘takeaway.’
I was 39 when I had my first HDL test. It was 42, just above the border line “bad” of ≤ 40 for a man. Eleven years later (on my 50th birthday) my HDL was just 41. Of the first 10 HDLs (blue) recorded, 7 out of 10 were under 40, and the average and mean were both 39mg/dl. Not good. It was before or during this time in my life that I ruined my glucose metabolism. I was diagnosed a Type 2 in 1986, using the OLD 140mg/dl (vs.126 today) FBG standard!
For the next 16 years I went on eating as before, gaining weight and taking more and more diabetes meds. Before I started Very Low Carb (VLC) in September 2002, my baseline HDL was 48. My doctor had departed from the Standard of Practice by recommending VLC. But everything else he had asked me to do – the conventional advice for losing weight – had failed. Because I was a heavily medicated Type 2 diabetic when I started VLC, and VLC was outside “practice guidelines,” he saw me once a month for the first year. My average HDL for the next 12 months (yellow) was 47, a modest 20% increase. Eating VLC did, however, have a marked benefit on my weight and blood sugar control. During the first nine months, eating just 20g of carbs a day, I lost 60 pounds and, from the first week, stopped 1 and cut by half twice the other 2 oral diabetes medications that I had been taking for many years.
Then, for the next three years I coasted along, counting carbs and maintaining my weight until, in the summer of 2006, I regained 12 pounds raiding the freezer t night. But I was also lurking on Dr. Richard K. Bernstein’s Diabetes Forum and reading his books. So, I decided to try his 6-12-12 Way of Eating (WOE), 30g of carbs a day. Over the next year I lost 100 pounds. I also got off the last 5mg of micronase (a sulfonylurea), and my HDL shot up to 86 and my blood pressure dropped to 110/70 (on the same meds). My HDL average was 63 (green) during this time. In the next year I lost another 20+ pounds, and for the next 2 years my HDLs were all in the 70’s, 80’s and 90’s including a 98.
The average of the last 10 HDL lab reports (red) is now 81. So, over the last 10 years my HDL average (oldest 10 vs. most recent 10) went from 39 to 81, more than doubling my HDL. That’s hard evidence. My diet was then 5% carbohydrate, 25% protein, and 70% fat.
My doctor used to read this blog. He has since died, but in 2011 he was looking for tips and “practice pearls” and suggested I write about “Foods that Raise HDL.” My answer (See Retrospective #34) is A VERY LOW CARBOHYDRATE diet.  It is this WOE as a whole that has produced the HDL doubling for me, and a 2/3rds reduction in triglycerides. More on that later.
There is no pharmacological solution for raising HDL as there is for lowering LDL. To lower calculated LDL (and Total Cholesterol), you simply have to take a statin. But your doctor can’t just write a script to raise HDL. YOU have to do that by changing what you eat.
That’s okay with me. I think we all should take control of our dietary choices. Eat “healthy” fats (saturated and monounsaturated), and avoid as many carbs as possible. Your “lipid panel” (cholesterol) can be healthy again, without drugs, and this table is evidence.

Monday, April 22, 2019

Retrospective #66: Fasting Glucose Best Predictor of Diabetes Risk (NOT!)

The 2012 headline in Diabetes in Control, a website for medical professionals, declared, “Fasting Glucose Best Predictor of Diabetes Risk.” That is patently false! Okay, it’s true, this was seven years ago, but using a fasting blood glucose as a diagnostic tool for incipient (“new-onset”) Type 2 diabetes is an artifact of the last century. Really!
The report in Diabetes in Control was based on a presentation at the European Society of Cardiology/World Congress of Cardiology in 2011. This report was targeted to clinicians with a misleading and patently wrong headline.  It reminds me of another report I had just read that eggs were nearly as bad for you as cigarettes. I have read so many authoritative dismissals of that report that I am embarrassed for the Canadian researchers who produced it. Shame on them for this “science,” and the journalists and editors who published and promoted it.
The reason for writing this column is to tell you that YOUR FASTING BLOOD GLUCOSE (FBG) IS NOT THE BEST PREDICTOR OF DIABETES RISK. Anyone who is informed in this field knows that. Just for the record, though, the diagnosis of Type 2 USED TO BE two consecutive FBG tests at or above 140mg/dl (lowered ≥ 126mg/dl in 1997).
Sometime in the early 2000’s the hemoglobin (Hg) A1c test replaced the FBG test.  The A1c test is inexpensive and measures the average serum glucose from markers on red blood cells over their two to three-month life cycle.
The best diagnostic tool for Type 2 diabetes, however, is the Oral Glucose Tolerance Test (OGTT).  It is a relatively expensive and time-consuming test because it takes from 2 to 4 hours to administer. In my case, it was ordered in a hospital out-patient setting in 1992 by an endocrinologist. That was also the year he ordered my first A1c test.
You may also have had an A1c test at a recent checkup. The normal range of 4.0 to 4.9.  If your doctor tested yours, he or she probably suspected it was above normal. Most practitioners, like the Low Carb Dietitian’s – see Retrospective #65 below – will not be “too concerned” if your A1c is rising but not yet approaching 6.5%. You’ll be told, “We’ll watch it” and “Lose weight.” YOU SHOULD BE concerned, though, as heart attack risk doubles as A1c rises from 5.5% to 6.5%, the threshold for a Type 2 diagnosis. The Pre-diabetes A1c range is ≥5.7% but <6.5%.
There is a much easier way, however, to find out if you have Impaired Glucose Tolerance (IGT). You can measure it yourself with a glucometer (meter, test strips and a drop of blood). Purchase one in a pharmacy and test before eating and one-hour and two-hours after. That’s how the “Low Carb Dietitian,” discovered she was Pre-Diabetic.
If your blood sugar rises above 140ml/dl 1 hour after eating, or does not drop back to “normal” (in the low 80s) after 2 hours, you are developing Insulin Resistance and are becoming Carbohydrate Intolerant. In other words, YOU ARE PRE-DIABETIC (or DIABETIC) and YOU NEED TO CHANGE YOUR DIET to minimize your intake of carbs to regulate your glucose metabolism and control your blood glucose. If your blood “sugar” (glucose) surges above 140, you need to get a prescription for more strips and test at home regularly to learn how to “eat to the meter.”
So, if your doctor is still doing a Fasting Blood Glucose (FBG), or even an A1c with the advice to “Lose Weight” and “We’ll have to watch it,” you either need to find a new doctor or TAKE CHARGE YOURSELF and find out what foods spike your blood sugar so that you can avoid them. You know that they are mostly simple sugars, starches and refined carbohydrates, but the meter will help you discover your level of carbohydrate intolerance. Pre-diabetes and Type 2 diabetes need to be recognized and diagnosed early and, when it is, they are reversible BY DIET ALONE. The way our bodies react to what we eat tells us we have a problem. And the best and least expensive way to find that out for yourself is to test your own blood sugar right before eating and again one and two hours after a meal.
As the Diabetes in Control headline that is the title of this column indicates, most of the medical community is still hopelessly out of date and behind the times. The solution: TAKE CHARGE of your own health, before it’s too late.

Sunday, April 21, 2019

Retrospective #65: Introducing the “Low Carb Dietitian” (2012)

The “Low Carb Dietitian” is Franziska Spritzler, RD, CDE. The About Me tab on her website in 2012 describes her beginnings as a dietitian some time earlier: “I've always had a strong belief in the power of good nutrition.  After eight years as a court reporter, I became a dietitian because I wanted to help people improve their health by making dietary changes. Once I began working in the outpatient nutrition setting, I quickly developed a passion for diabetes management.  As a Certified Diabetes Educator (CDE), my goal is to provide accurate, useful information and support people's efforts to optimize their blood glucose control and achieve a healthy weight.”
But that’s garden variety stuff. Every dietitian is similarly motivated. But in July 2011, in her first post on her website, Franziska explains why her advice was going to be different. She had a transformative experience. “My purpose in creating this website is to inform people about healthy low carb living.  This site contains information that is likely very different from that which can be found on the websites of other dietitians. However, if you'd told me a year ago that I'd be touting the benefits of a low carb lifestyle, I would have probably said you were crazy!”
Before Franziska saw the light, she followed standard establishment public health community diet and nutrition advice. “I'd been eating a very healthy, semi-vegetarian or pescatarian diet (I consumed dairy, eggs, and fish but no poultry or meat) for many years.  Because of genetically high cholesterol, I limited my saturated fat intake, always ordering egg white omelets instead of regular, eschewing butter and choosing trans-fat-free margarines instead, and avoiding cheese and cream sauces.  I rarely ate desserts, occasionally having just a bite or two of my husband's cake/ice cream/cheesecake, etc., when we were dining out.”
That’s when Franziska, who had recently attained both RD and CDE credentials, got the bad news.
“So, when I received the results from labs that were done for life insurance purposes back in January of this year [2012], I was speechless. Not only was my LDL ("bad") cholesterol elevated, my hemoglobin A1c (a measure of blood sugar levels over a two-to-three-month period of time), although still within normal range at 5.5%, was still far higher than would be expected for someone my size who ate the way I did. Now, while these numbers were not outrageously high, as one who works with people who have diabetes or prediabetes every day, they certainly suggested to me that something was not right with my blood glucose metabolism [emphasis added].  I purchased a glucometer and began testing after meals, and discovered my blood sugar levels at one hour were significantly higher than they should be. Within the next few weeks, I saw that the more carbohydrates I ate, the higher the number would go.  My fasting blood sugar always remained within normal range, however.”
So, since her education and clinical experience had taught her that “something was not right with (her) blood glucose metabolism,” what did she do? Franziska Spritzler tells us the incredible tale of what happened next.
“I made an appointment with an endocrinologist, who wasn't overly concerned since my fasting levels were so normal. He did want to retest my A1c, and by that point, it had increased slightly to 5.6%.  I cut down on the carbs slightly (not too much, though -- I'd been taught that we need enough carbs to keep our brains and other organs working properly), and then I started doing research online about strategies to control postprandial, or post-meal, blood glucose.  It seemed that many people were using low carbohydrate diets with great success in managing their diabetes and postprandial blood sugars. I was skeptical, but once I started reading the available research on carbohydrate restriction, it all started to make complete and perfect sense [emphasis added]. I discovered that the high carbohydrate, low fat diet I'd been taught to believe was ideal was anything but for many people struggling with diabetes, insulin resistance, obesity, and dyslipidemia.  This was quite difficult for me to accept at first, but now that I have, I'm quite excited about the potential to help people struggling with these conditions.”
Franziska has been very successful. After taking charge of her own health, Franziska now travels the world as invited speaker, has written a book, and is now a featured writer on DietDoctor.com. Congratulations, Franziska!

Type 2 Nutrition #483: “…when used with diet and exercise.”

Have you ever noticed how the TV diabetes medication ads always conclude with “…when used with diet and exercise”? That common refrain riles me a bit, but I’ve never examined why. I think it’s time I do.
First off, by self-examination I admit to being something of a curmudgeon. However, I tend to grouse only about the abysmal state of our collective health, including how we (including I) got into this mess. In other respects, I think I have a positive outlook on life, but you’d have to ask the people who know me best if that’s true. Regardless, my readers could fairly describe me as a crusty, grumpy old man. This column, however, is not about me. It’s about why the diabetes ads conclude with the caveat, “…when used with diet and exercise.”
I think it’s a government requirement. The Food and Drug Administration (FDA) has to approve all claims made by drug manufacturers. The FDA also dictates for what and when a drug may be prescribed. That includes as a first course of treatment, as well as any adjunctive therapy if the first medication fails to achieve the primary target. In the case of a drug to treat type 2 diabetes, that would be lowering the patient’s serum blood glucose, usually as measured today by a blood marker, the hemoglobin A1c (hgA1c), or simply, the A1c test.
Metformin is the first drug prescribed today for the treatment of Insulin Resistance (IR), as measured (too late)  by an Impaired Fasting Glucose (IFG). Metformin is generic, cheap and widely accepted as the standard-of-care, almost universally prescribed first after diet and exercise have failed. After Metformin, a generic drug, the clinician has a wide choice of drugs, depending on other risk factors and co-morbidities. That’s when the phrase, “…when used with diet and exercise,” usually appears. The competing drugs all have this in common.
And that’s what gets me riled. Every doc is supposed to tell their overweight and Pre-diabetic patients to “lose weight and exercise” before ANY meds are prescribed.  “Eat less and move more,” “eat a plant-based” or “Mediterranean” diet and get lots of exercise (to lose weight!). And everyone FAILS. They fail to stop or reverse the slow but inexorable slide to drug dependence, eventually “graduating” to Type 2 diabetes. So why do the diabetes ads still advise people to continue this failed strategy?
Answer: The FDA mandates it. But, what does Big Pharma care? It’s a throwaway line because so long as PATIENTS continue to eat what government and their doctor has “prescribed” as a “healthy diet,” T2D WILL BE a “progressive disease,” and the PATIENT will continue to worsen.” BIG PHARMA IS THE BIG WINNER.
There is no downside for Big Pharma. They’re not telling you how and what and when to eat. Certainly no one would say that exercise is not good for you. Besides, exercise is a well-documented way for Type 2 diabetics to slightly improve their insulin sensitivity, which is good. But for weight loss, exercise is not an effective method.
THE ONLY DOWNSIDE IS FOR THE PATIENT. By following the advice to eat what the government “prescribes” as a “healthy diet,” patients are being herded like lemmings into the hands of Big Pharma. Whether this is a corrupt cabal, I’ll leave it for you to decide. But more to the point, in your own self-interest, you might want to ask, why has the advice, “…when used with diet and exercise,” failed? And why does it continue to fail even as you take more medications. Is it because exercise, while a good thing, is not a good way to lose weight
Is it because the “healthy” diet the government prescribes is NOT REALLY A HEALTHY DIET? If eating lots of carbs (like corn) is a good way to fatten beef cattle in a “feed lot,” is it not also a good way to fatten people? Yet, the government’s Nutrition Facts label on all “processed” foods prescribes that the Percent Daily Value (%DV) for carbs recommended for women (on a 2,000kcal diet) is 300g, or 1,200kcal, or 60%. And for men (on a 2,500kcal diet), is 375g, or 1,500kcal, also 60%. Did you know that? Do you think, maybe, that is too many?
If you want to avoid the inevitable “graduation” to a cocktail of anti-diabetic medications, including the ones advertised on TV, you might want to consider dropping your intake of carbs, to 40, 20, 10 or even 5%, like me. 

Saturday, April 20, 2019

Retrospective #64: Very Low Carb Eating: Ten Years Later (2012)

In August, 2002, I had been a morbidly obese Type 2 Diabetic for 16 years. My physician had tried for years without success to get me to lose weight on a “balanced” diet. Then, one day he said to me, “Have I got a diet for you!”
At 375 pounds I had been taking progressively more and more oral diabetes medications since my diagnosis in 1986. I was maxed out on micronase (a sulfonylurea), and Metformin, and had recently started takin Avandia in futile attempts to control my progressively worsening blood sugar. When Avandia didn’t work, I was then (in 2002) going to be left with only one option: to become an insulin-dependent T2, injecting basal and mealtime insulin.
It turns out, though, that my doc had recently read Gary Taubes’s, July 7, 2002, NYT Magazine cover story “What If It’s All Been a Big Fat Lie?”  Out of curiosity he tried the recommended Very Low Carb diet advocated in the story (20 grams of carbs/day), and it worked for him. So, he thought it might work for me too, and as he walked me down the hall to schedule a follow-up appointment, he said, “It’ll probably be good for your diabetes too.”
The result: Within a day on this strict Very Low Carb diet, as a heavily medicated Type 2 diabetic I was experiencing “hypos” (dangerously low blood sugars). I called my doctor, and he told me to stop taking the Avandia. The next afternoon, when I had another hypo, he told me to cut in half the micronase and Metformin. A few days later he said to cut them by half again. He then saw me monthly for a year to monitor my blood and other health markers. In the course of that year I further reduced the micronase from 5mg to 2.5 to 1.25mg and finally completely phased it out. I still take Metformin to suppress gluconeogenesis if, as I sometimes do, I eat too much protein at supper.
In the first 9 months on the Very Low Carb diet I lost 65 pounds (1½ lbs./wk.). I then retired from work and kept that weight off for several years. Then, over the course of a summer, I added back 12 pounds (mostly from eating ice cream before bedtime, as I recall). But by this time, I had also been lurking and learning from Dr. (Richard K.) Bernstein’s online Diabetes Forum. I had also read Bernstein’s “Diabetes Diet” and his “Diabetes Solution,” so I decided to try his program (30grams of carbs a day). It was more focused on blood sugar control for diabetics.
On Bernstein I lost 100 pounds in 50 weeks (2lbs./wk.). Altogether I lost 170 pounds, settling in at 205 pounds. I have since regained some of that weight, but frankly I have been “off the ranch” for a while. I am still, however, much healthier than before. I eat Very Low Carb most of the time and have retained most of the health benefits.
My average HDL has more than doubled (from +/- 39 to +/- 84mg/dL) and my triglyceride average has been cut by 2/3rds (from +/- 150 to +/- 49mg/dl). I try to limit my carb calories to 5% of my calories and my protein to 20%, leaving 75% for fat. I do not limit salt, dietary cholesterol or saturated fat. I eat eggs and bacon and coffee with full cream and pure stevia for breakfast, and just a can of sardines for lunch. For supper, it’s just meat or fish and a low carb veggie with lots of butter or tossed in olive oil and roasted. In a restaurant I’ll have a cocktail (or 2) or two glasses of wine. The only dessert I’ll ever eat is berries (with heavy cream) on a very special occasion. I love a cheese plate (without bread or fruit), but it’s just too much food. I always regret it if I occasionally order it.
After the first year, I continued to see that doctor 3 times a year until his unfortunate demise. I went just to get blood tests to monitor my A1c, lipid profile (cholesterol panel), and other tests he wanted to do (kidney, thyroid, electrolytes and EKG). They were all always normal. And my hsCRP, a chronic systemic inflammation marker, plummeted from “high” to consistently less than 1.0 (very low risk of cardio vascular disease).
My new doctor, after studying my chart on my first visit, suggested I see him once a year. I was pleased that was his initial impression of my health, but I said I wanted to see him three times a year, just to keep track of my success.

Friday, April 19, 2019

Retrospective #63: Impulse Control and Metacognition

Maybe 15 years ago, in an effort to understand how (not why) I had “fallen off the wagon” with respect to my Very Low Carb Ketogenic Diet (VLCKD), I developed an interest in the subject of impulse control. A friend on Dr. Bernstein’s Diabetes Forum (I’m a Type 2 diabetic), suggested I set up a “Google Alert” on the subject, so I did.
One of the first hits introduced me to the term “metacognition,’ which literally means “knowing about knowing.” For my study of impulse control, I translated this to “thinking about thinking.” So, I started a “thread” on “Impulse Control and Metacognition” on the Forum. It got about 50 replies and 3800 views. It was an interesting discussion.
An early reply on the thread from the Forum Moderator suggested that impulse eating might actually be a physiological rather than a psychological issue. She pointed out that Dr. Bernstein has mentioned that with beta cell burnout there is less amylin production, and low amylin levels mean the brain isn’t getting the message that you are not hungry. But I wasn’t interested in finding a pharmacological approach to the problem.
There is also the leptin/ghrelin hormone interaction, but again hormone signaling to/from the hypothalamus is too high brow and still a developing area of science. I wanted to keep my experiment simple and personal, so I started.
In the discussion, I pointed out that when I have been tempted to snack before dinner, or reach into the bread basket in a restaurant, or hit the freezer for ice cream before bedtime, I was aware that a finite idea had entered my mind: “the temptation.” The idea was usually dismissed quickly, but then frequently returned, sometimes quickly and sometimes more than once. On its return, I have sometimes acted on it, always to my later shame and chagrin. I would beat myself up. That was an emotional response. I wanted to explore a more rational response.
My first thought was to put “the idea” out of mind when the temptation first presented. Just deny the thought a foothold. I cleared the brain the way I do when I put my head on the pillow at night to fall asleep. By not “allowing” the thought to stay on the brain, or by substituting another thought for “the temptation,” it went away. It did not persist. If it returned, I just created another distraction. I changed the subject. It could be another idea, a simple distraction, or it could be an action. Whatever it was, the concept was to catch the “bad” thought “in the bud.”
Examples: If I am eating in a restaurant with others and the bread basket is presented, I take it and pass it on. Or I start a conversation (not related to bread). Recently, when eating alone in a restaurant, I distracted myself by becoming engrossed in a newspaper. Another time I watched and listened (unobtrusively) to people at another table. In other words, I quickly took action to side track “the temptation.” Actions are better than abstract ideas like “will power” and “steely resolve.” You have to be limber, imaginative, and prepared for temptation, and act.
Of course, one of the very best ways to suppress “temptation” is for food to be out of sight. If I can see it, I get the idea to eat it! If I don’t see it, I don’t get the idea, usually – even though I know the ice cream is in the freezer or the nuts are in the pantry. The actual sight of food is the “trigger,” and avoiding the sight is the best solution. The difference between seeing the food and not seeing it, for me, is huge. It has nothing to do with hunger or noshing. I can be mildly ketogenic (with low serum insulin) and a stable blood glucose and still cave at the sight of food.
Others have dealt with impulse control in different ways. Some use “healthy fears,” others use the fear of catastrophic outcomes. For me, fears are both too negative and too extreme. But whatever you do to undo or relearn a behavior, even using an irrational fear, it is, in a way, a rational process. It allows you to exercise the mind and be in control of the outcome.
Quickly supplanting the initial temptation with a diversionary response – either thought or action – is my kind of metacognition. Thinking about thinking is the essential precursor, and a diversionary thought is often sufficient. The best outcome, however, is a diversionary action. Quoting Alfred Korzybski from his preface to “Science and Sanity, “…if they are not applied but merely talked about, no results can be expected.”

Thursday, April 18, 2019

Retrospective #62: Meatless Monday Madness

In summer of 2012 a USDA newsletter to employees produced a minor contretemps within the agency and a major uproar across the USA among beef producers and meat eaters. According to a Fox News alert, the newsletter said, “This international effort encourages people not to eat meat on Mondays.” It asks, “How will going meatless one day a week help the environment? According to the UN, “the production of meat, especially beef [and dairy] has a large environmental impact. Animal agriculture is a major source of greenhouse gases and climate change.”
But USDA spokeswoman Courtney Rowe said the USDA does not endorse the “Meatless Monday” initiative. So, Fox had a little fun in the chicken coop, and the brouhaha passed with little notice due to the 2012 Summer Olympics.
The story, for me however, was how the vegan lobby has embedded itself into the interstitial tissue of the ‘corpus governmentalis,’ or body politic. The pathway of infection of this parasitic movement is the ingestion of vegan messages within the hallways of large centralized government agencies like the USDA, wherein it has colonized and reproduced. The United Nations, of course, is always a target, given that by design it is a receptive host to parasitic attacks of every nature and from all quarters. In the U.S., Washington DC is targeted, especially at times of big top-down government with a compromised immune system such as we had with the Obama administration.
The vegan bug is especially virulent when it is introduced into the alimentary canal. It manifests itself in such forms as the Center for Science in the Public Interest (CSPI). Founded in 1971, the CSPI calls itself a consumer advocacy group focusing on nutrition. They are well known for their longstanding opposition to saturated (i.e. animal-based) fats. It also advocates taxing soft drinks. Critics refer to CSPI as "the Food Police."
Walter Olson of the Cato Institute, a Washington D.C.-based libertarian think tank, wrote that CSPI’s "longtime shtick is to complain that businesses like McDonald’s, rather than [people’s] own choices, are to blame for rising obesity." He called CSPI's suit against McDonald's on behalf of a California mother a "new low in responsible parenting. In the 1980’s CSPI maintained that trans fats were “more healthful” than saturated fats and had persuaded many restaurants, including McDonald's, to switch from lard to trans fats in making French fries. Today CSPI has reversed its position on trans fats, but it still campaigns vigorously against animal (saturated) fats.
Then, in 2009 a more virulent strain of veganism began to infect the body politic in the U.S. and internationally. Robert Goodland, PhD, (now deceased), and Jeff Anhang published their seminal treatise on bovine flatulence, “Livestock and Climate Change: What if the Key Actors in Climate Change were Cows, Pigs and Chickens.” 
Goodland retired as lead environmental officer after 23 years at the World Bank. Previously, in the 1970s, he and I worked together – he as staff ecologist and I staff architect – at the Cary Arboretum in Millbrook, NY. Even at Cary, Goodland was a “mover and shaker.” He proposed (and I built) a solar heated headquarters for the Arboretum.
His bovine flatulence gambit aimed to be no less earth shattering than his solar energy initiative. Cleverly, it is itself parasitic. Its vegan premise attaches itself to one of the Left’s most fundamental and passionate causes, global warming. Their report claims, “Our analysis shows that livestock and their byproducts actually account for at least 32,564 million tons of CO2 per year, or 51 percent of annual worldwide GHG emissions.” Never mind that the UN Food and Agricultural Organization claimed 18 percent. Goodland then posits, “If this argument is right, it implies that replacing livestock products with better alternatives would be the best strategy for reversing climate change. In fact, this approach would have far more rapid effects on GHG emissions and their atmospheric concentrations—and thus on the rate the climate is warming—than actions to replace fossil fuels with renewable [solar] energy.”
So, in the end Goodland forsook solar energy for this Meatless Monday Madness! Never mind that 150 years ago in the U.S. 60 million buffalo emitted more CO2 into the atmosphere via bovine flatulence than 9 million dairy and 31 million beef cattle do today. But don’t tell that to NYC’s mayor Bill DeBlasio. Goodland’s legacy lives on in that city’s school system with the recent introduction of Meatless Mondays. The Madness goes on. Robert would be pleased.