Tuesday, June 25, 2019

Retrospective #130: How Much Protein Should You Eat?

If you’re considering a Very Low Carb (VLC) diet to lose weight, it will help you to get “into the weeds” a little. So, first, a few definitions: Very Low Carb is usually defined as no more than 20 to 30 grams of carbs a day. Low Carb is defined as 50 to 100 grams a day or 20 to 30 grams per meal. And to be clear, Low Carb is not what I’m doing. This post is for serious Very Low Carbers who want to lose serious weight and do it in a healthy way and without hunger.
If you decide you want to try eating this way, you will also need to accept that it is also a limited-calorie diet. That’s not going to be as difficult as it sounds because you won’t mind eating less if you aren’t hungry, and you are burning your body fat for energy. You will not be hungry at or between meals, I promise. In fact, after a few days you will stop thinking about food. You will not be interested snacks, and you will forget it’s lunchtime. Honestly.
So, after deciding to eat VLC, the next thing you need to decide is how much protein should you eat? The answer is: it depends. It is different for everyone because it depends on your weight (not your current weight but your ideal “lean body weight”), your muscular development, your age, your exercise regimen, and your general level of activity. These are all variables, but there is also a constant: your basic need for protein for countless bodily activities. Protein’s component amino acids are necessary – in fact, essential – for life. Everybody needs to eat protein. In fact, everybody needs to eat a variety of protein (with fat) to get all their amino acids, especially the “essential” amino acids that the body cannot make, or easily make, by itself.
The easiest way to get all 22 amino acids, including the essential ones, is to eat a variety of animal proteins. That isn’t the only way, but it’s the easiest way. During the years of my initial weight loss, I was successful following the advice of Richard K. Bernstein, MD, a life-long Type 1 diabetic and author of “Diabetes Solution,” the “bible” for diabetes health care. He is a pioneer in “eating-to-the-meter” – in fact, it could fairly be said he “invented” it.
As a Type 1, Dr. Bernstein advises his patients to eat equal portions of protein in three small meals every day that are equally spaced about five hours apart. That allows the protein, which digests more slowly than carbs or fat, to be absorbed and circulate (as amino acids) in the blood for 4 to 5 hours. They replenish and repair muscle tissue and perform many complex cellular and hormonal activities. That also allows a 14 hour fast between supper and breakfast during which ketogenesis occurs. This means you burn body fat at night to supply your basal metabolic energy needs. So, to lose weight while you sleep, don’t eat too many carbs, or too much protein, at supper.
How much protein should you eat at each meal? You are not eating protein to feed your fat; the protein you eat is related to your lean body mass, that is, your body with only the minimum amount of fat needed to cushion the organs and supply energy stores. For people who have been overweight their entire lives, this will look like an unimaginable ideal. Nevertheless, “lean body weight” is the measure you should use for protein calculations.
Considering all the variables above, I chose 0.9 grams of protein per kilogram of lean body weight. Converted to U.S. units, 0.9 grams per kilo is roughly 0.4 grams of protein per pound of lean body weight. And using the truly unattainable “lean body weight” ideal, from the middle of the “normal” weight range in the BMI table for a person 5’-10” tall, my lean body weight should be 150 pounds. Based on this truly skeletal lean body weight, my protein intake should be 60 grams a day, divided per Bernstein into 3 equal meals of 20 grams each. So that’s what I use. 
My regular breakfast (2 fried eggs, 2 strips of bacon, coffee with heavy cream) is 20 grams of protein, and my usual lunch (a can of sardines in EVOO) is 15 grams of protein. That leaves 25 grams to splurge on supper. And if I eat more protein than that at supper, I better remember to take my Metformin to suppress gluconeogenesis! Or, just eat 25 grams of protein with supper. That 60 grams of protein a day total, by the way, is still 20% more than the 50g/day Percent Daily Value (RDA) recommended in the HHS/USDA Nutrition Fact panel on processed food packages for women (on a 2,000 cal/day maintenance diet) or just about the 62.5g/day recommended for men.

Monday, June 24, 2019

Retrospective #129: Very Low Carb Record Keeping

When I first started to eat Very Low Carb in 2002, I did Atkins Induction. I knew that I needed to eat no more than 20 grams of carbohydrate a day. I followed the Induction phase religiously for nine months and lost 60 pounds (1½ lbs. a week). To be sure that I followed this very restricted diet, I created a chart in Excel and recorded everything I ate each day, estimating the carb content of each portion. In addition, I also weighed myself daily and took fasting and sometimes postprandial blood glucose readings to see how various foods affected my blood sugar.
There were two important aspects to this activity: 1) I kept myself honest and 2) I acquired a knowledge base of what foods contained carbs and how many. I call these two aspects “accountability.” I continued to do this for the entire time I was on strict Atkins Induction and, on and off, for several years thereafter. When, after several years I slacked off, I gained back 12 pounds of the 60 that I had lost. Conclusion, I lost accountability.
Those were the early days of online internet groups. I become interested in several, eventually settling on one, Bernstein’s Diabetes Forum. I also had read several books, and I learned that I should keep track of more than just carbs. So, I subscribed to an on-line calculator and started keeping track of calories, protein and fat, as well as carb grams. This further increased my knowledge base and accountability. Among many other things I learned that a large amount of the protein we eat can become glucose through a secondary process called gluconeogenesis. I therefore needed to count protein and to figure out how much protein I should eat with each meal.
I also learned that even if I am eating Very Low Carb (≤ 20g/day of carbs), if I eat too much fat to the point where I am not in negative energy balance, I will not lose weight because I am not burning body fat – just the fat I eat.  This learning and record keeping paid off. On the Bernstein Diet and lost 100 pounds in 50 weeks (2lbs/week).
Many people who try Very Low Carb don’t lose weight and complain they are not cheating, honestly. When they tell me what they are eating, I point out that this and that are carbs, or that they really don’t need to snack, or that they are just eating too many calories. They respond either that they didn’t know that, or that they just “cannot” give up this or that food. Okay. That’s their choice, but they cannot say they were eating a restricted-calorie Very Low Carb diet. If they were, they would lose weight. You can’t fool your body’s harmonic biological system.
I suppose you have to be a certain kind of person to keep detailed records. Some would say an obsessive-compulsive; but an O-C personality that channels that trait in a positive way will benefit from doing it. Honesty is a slippery bugger. I think I’m pretty smart and pretty honest. Note both words are qualified. I’m also smart enough to fool myself (rationalize). I think most of us are. For us the only check on doing that are the facts. Keeping a chart, and recording everything you eat – even the “cheat” after dinner or the candy bar at the gas station when you fill up – will remind you of the price you paid. It’s pretty easy to “forget” otherwise. That’s how “smart” we can be.
I’ve now been doing this Very Low Carb dieting for 17 years, on and off. When I’m on, I’m losing weight. When I’m off, I’m gaining, “creeping up ever so slowly.” Gaining 1/3 of a pound a week over 4 years is 70 pounds. That’s what happened to me in 2013. Then I started moving down again, but at what price did I gain? Along with my weight, my A1c’s, blood pressure and LDL cholesterol also crept back up.  We’re talking about my health here, folks. So, there’s a lot more at stake here than just weight. Maintaining the weight loss and all the health benefits that accrue with it are equally important. In fact, isn’t that the best reason for losing weight in the first place?
PS: After 10 years of acquiring a solid base of knowledge and experience, and having much better control of my impulse to eat carbs and snack before and after dinner, I transitioned to losing weight without charts. You can do it too, or if you hate keeping records as most people do, do it without having to see it in black and white. The “trick” is keeping honest: accountability. If you eat Very Low Carb strictly, and even do occasional Intermittent Fasting, you won’t be hungry. So, why would you cheat on yourself?

Sunday, June 23, 2019

Type 2 Nutrition #491: Ketogenic Intermittent Fasting

My wife tells me I should tell “newbies” how I started out, not how I manage to maintain a 180-pound weight loss. I tell her I did that in Type 2 Nutrition #419, Reversing Type 2 Diabetes: My Secrets,” I describe the many ways that my Way of Eating has evolved since I began to eat Very Low Carb in 2002.
In this post, however, I’m writing about my current paradigm, the “Ketogenic Intermittent Fast,” as described by Dominic D’Agostino. D’Agostino, a PhD, is probably the leading researcher in ketogenic metabolism in the USA today. He initiated the 2016 Nutritional Ketosis and Metabolic Therapeutics Conference in Tampa, FL, that I attended. By the 3rd year it had morphed into The Metabolic Health Summit in Long Beach, CA, which I also attended. It sold out, and they have announced next year’s January 2020 Summit, also in Long Beach.
D’Agostino appears to be a healthy, very fit, non-diabetic scientist. He follows a Ketogenic Intermittent Fasting diet 95% of the time. Jeff Volek, a PhD physiologist now at Ohio State, is also a world-renowned expert in low carbohydrate research who presented in Tampa. Together with Stephen Phinney, MD, they authored, “The Art and Science of Low Carbohydrate Living,” one of my favorite nutrition books. Phinney is co-founder of  Virta Health, “a clinically proven treatment plan to reverse Type 2 diabetes without medications or surgery.”
At the Tampa meeting Volek spoke to an overflow crowd in a break-out session attended mostly by endurance athletes and bodybuilders. I did not attend. LOL (In Long Beach Volek got a plenary session, which I did attend.) But I gleaned from some Tampa attendees that many of the ultra-lean and ultra-muscular take a therapeutic dose of Metformin, off label, to help get and stay lean. Metformin works by 1) suppressing unwanted gluconeogenesis in those with any degree of Insulin Resistance, and 2) by increasing insulin sensitivity. In this way users keep their blood glucose levels low and thereby their blood insulin levels low…and thus, being in ketosis, burn body fat for energy TO GET AND STAY LEAN.
This would explain the pied piper interest in Volek and Nutritional Ketosis from athletes and bodybuilders. It stands to reason. To burn body fat, they want to be in nutritional ketosis most of the time. To do that they eat low carb, moderate/high protein, and high fat. They keep blood glucose and blood insulin low, eat protein to build muscle, and burn body and dietary fat for energy. To get and stay lean, that is their modus operendi.
So, for “healthy” people who want to stay lean, that is the “ketogenic” part. What does that have to do with fasting? When you fast, your blood glucose lowers, you blood insulin lowers, and you burn body fat for energy. If you were a Low Carber before – low enough to be in “Nutritional Ketosis” – your body easily shifts from “fed” to “fasting” and uses body fat for energy without hunger and without slowing your metabolism.
In addition, according to D’Agostino, fasting has 1) anti-inflammatory effects and 2) epigenetic effects, by the mechanisms of apoptosis and autophagy. Check out the hyperlinks. These effects are why ketogenic nutrition and fasting are such hot research topics today. Researchers are exploring the use of ketogenic nutrition and fasting for the whole panoply of metabolic disorders. All that, however, is OT (off topic) today.
My focus these days is how to maintain my 180-pound weight loss, keep my Type 2 diabetes in remission (with A1c’s in the low 5s), and stay in tip-top physical and mental health and well-being. In other words, how I’m going to continue to thrive. I’ve concluded that Ketogenic Intermittent Fasting is the best way to do that.
As the National Institutes of Health Richard L. Veech told Gary Taubes, “Doctors are scared of ketosis. They’re always worried about diabetic ketoacidosis. But ketosis is a normal physiologic state. I would argue that is the normal state of man.” And D’Agostino says, “It keeps the brain happy,” and “I feel better.” D’Agostino also says he “likes the food,” and he’s “lost his sweet tooth.” I like it too, but like D’Agostino, just 95% of the time.

Retrospective #128: Sugary Drinks and Added Sugars

Twenty-five years ago my doctor employed a dietitian to help his patients lose weight. Her ‘prescription’ was to eat less and exercise more. Needless to say, it didn’t work. But one thing she said still sticks in my memory: “Don’t drink orange juice. It’s just empty calories.” Of course, she was not saying don’t eat fruit (even though she knew I was then, as now, a Type 2 diabetic). She was saying that I should eat the whole fruit instead of fruit juice. That way I wouldn’t eat as many calories as I would drink. And I would get extra benefit from the fiber. That advice (eat vs drink) was novel. In my thinking now, perhaps it was the tip of today’s iceberg about liquid sugar calories.
I remember that it all made sense to me at the time. But that was before my doctor discovered Very Low Carb dieting to lose weight, and not incidentally but also not anticipated, control my blood sugar. Today, I avoid all fruit and many other foods that contain fructose because of the effect that cane sugar (sucrose) has on liver health.
Somehow this message about fruit juice has escaped our nation’s food policymakers. The recommended portion, although it’s not mentioned in the Dietary Guidelines for Americans, is 6 ounces, or about 72 grams of carbs. The message from the Dietary Dictocrats, though, is that added sugar in sugary drinks – “soda, energy drinks and sports drinks” and “fruit drinks” – should be avoided. But fruit juice is alright? Even though the Guidelines admit, …the body’s response to sugars does not depend on whether they are naturally present in food or added to foods”?
The Guidelines do include a fairly comprehensive list of added sugars: “Added sugars include high fructose corn syrup, white sugar, brown sugar, corn syrup, corn syrup solids, raw sugar, malt syrup, maple syrup, pancake syrup, fructose sweetener, liquid fructose, honey, molasses, anhydrous dextrose, and crystal dextrose.”
But wait, where is “organic malted barley”? What’s that? How is that an “added sugar”? Well, it is, although well concealed I must admit. It is the third ingredient listed, after “organic sprouted wheat” and “filtered water” in Food for Life 7 Sprouted Grains bread. This “healthiest” bread has added sugar as its 3rd listed ingredient! Do you feel snookered? Join the crowd. That’s Agribusiness for you. You walk the straight and narrow, and you get sandbagged.
What is “malted barley”? It’s a malted grain. According to Wikipedia, “Malting grains develops the enzymes required to modify the grain's starches into sugars, including the monosaccharide glucose, the disaccharide maltose, the trisaccharide maltotriose, and higher sugars called maltodextrines. It also develops other enzymes, such as proteases, which break down the proteins in the grain into forms that can be used by yeast. Malt also contains small amounts of other sugars, such as sucrose and fructose, which are not products of starch modification but were already in the grain.” And just in case I am not being clear: Every one of those chemical compounds (except protease) in the “malted barley” will quickly digest to a single-molecule sugar, pure and simple.
What’s the point of this? Well, Chapter 3 of the Policy Document from the 2010 Dietary Guidelines for Americans points out that of the “Refined Grains in the Diets of the U. S.  Population,” “yeast breads” are by far the largest category (25.9%). According to the NHANES study (2005-2006) footnote, “yeast breads” constitutes 2.1% of the “Added Sugars in the Diets of the U. S. Population.” Yet, nowhere in the Dietary Guidelines are we guided not to eat bread. I guess this refined grain with added sugar is just too engrained (sorry) in our culture to be shunned. But I challenge you to find any loaf of bread in your supermarket that does not contain some form of sugar as the 3rd ingredient, after flour and water. Even Pepperidge Farm, Arnold or any other so-called “whole grain” (flour) bread.
I don’t mean to pick on Food for Life or any processed or refined food manufacturer. I mean to pick on all of them. If you want to avoid becoming a victim of clever and deceptive marketing, take a chemistry class…or just eat whole foods: grass fed and grass finished meats, eggs from free-range pastured chickens, wild-caught seafood (both fin and shell), especially sardines, wild salmon and other cold water fish, and non-starchy vegetables. Avoid all wheat, excessive fructose, and excessive Omega 6s from processed seed (vegetable) oils. Eat butter, olive oil and coconut oil. Pay no attention to your government or to the media. They are hopelessly misinformed, misled and misguided. 

Saturday, June 22, 2019

Retrospective #127: Fighting Sleep?

“Fighting sleep has become a national pastime,” the headline roars in a late 2013 story by syndicated columnist Mitch Albom. But this story is not a product placement for 5-Hour Energy or SuperBeets or even, for the older newspaper-reading demographic, NoDoz. It is about why many people feel sleepy or drowsy a few hours after eating a meal. Let me be clear: I do not, ever, feel sleepy after a meal anymore (except on Thanksgiving).
The reason why people feel sleepy a few hours after eating a typical meal is physiologic. It is very real. I know because I experienced it frequently myself for most of my life. And it is related to energy, particularly available energy. The body manages homeostasis by summoning energy from available sources. That’s why we eat – to replenish our level of available energy by mouth. Our body also stores energy, as body fat, for this purpose; however, this stored energy is not always available for use.
Of the three macronutrients, protein, carbohydrates and fat, protein is the only one that is not an energy source that can be used directly as a fuel when needed. Protein breaks down to amino acids to be taken up by muscle, for repair, and many other cellular and hormonal uses in the body. Leftover amino acids, if any, are stored in the liver.
Carbohydrates, both simple sugars and complex carbs, digest quickly to make energy. Digestion occurs in just minutes for highly processed carbs found in most food products in today’s marketplace, especially liquid and refined forms. All carbs ultimately enter the bloodstream as the single-molecule glucose, raising the level of “sugar” in the blood. The average body needs just under one teaspoon of sugar in our blood. A meal with 100 carbs is equivalent to 13 teaspoons of sugar, so our blood sugar “spikes.” This “quick energy” doesn’t last. A few hours after eating a meal loaded with carbohydrates, most of the glucose is taken up and the blood sugar level “crashes.”
When high levels of glucose are detected in the blood, the body secretes insulin to take it to where it is needed, to the muscles for example. That’s what exercisers call “carb loading.” After replenishing the cells, the balance of circulating glucose goes to the liver to be stored as glycogen. And when the liver gets overloaded with glycogen, especially when it is deluged with a load of liquid sugar (as in soft drinks and fruit juice), it converts the excess to fat by a process called lipogenesis. That’s right; the sugar overload in your soft/juice drink converts to body fat.
The body does this to protect itself from sugar because table sugar and most of the sugar in fruit is half fructose. Fructose is toxic when it is over consumed.  That’s why fructose is diverted and goes via the portal vein straight to the liver. One of the liver’s functions is to detoxify things. The liver then converts the fructose to glucose and then to glycogen to be stored in the liver. But, if the liver’s glycogen stores are full, it converts it to fat. And some of this fat is stored inside the liver, creating Non-Alcoholic Fatty Liver Disease (NAFLD). NAFLD is near-epidemic today.
Fat, the other energy source among the 3 macros, is also the densest. It has 9 calories per gram versus 4 for carbs. This makes it ideal for “long term” storage. The body is designed to put it away in storage and to make it available when needed. So, where does the body go for energy 1-2 hours after a high-carb meal? In a body with a disregulated glucose metabolism, as in a Pre-diabetic or Type 2, Insulin Resistance results in the level of circulating insulin staying high while the pancreas pumps out more to help glucose be taken up at the cellular level. As a result, the energy in stored body fat it not available for use, and we feel sleepy or drowsy a few hours after a meal.
So, do we have a reliable energy back-up system? You bet we do, but to burn body fat for energy – to maintain a level blood glucose and stable “wake” state – we need to get our blood insulin level low enough to access our fat cells. The only way to lower blood insulin levels in the Insulin Resistant is to eat way fewer carbohydrates.
When I am in this ketogenic state, my body burns fat as its primary energy source. As a consequence, my blood sugars are relatively stable all day long. My blood sugar doesn’t spike after a meal and then crash a few hours later. I do not feel sleepy or drowsy between meals. I don’t need 5-hour Energy or a sugar beet snack for a “pick-me-up.”

Friday, June 21, 2019

Retrospective #126: Do You Live to Eat or Eat to Live?

I love to eat, and I used to live to eat, but I paid a big price for it. Over many years the way my body processed food changed. I developed a disregulated glucose metabolism. The carbs I ate, both simple sugars and so-called complex carbohydrates, were the only fuel my body was using for energy. Fat was stored away in copious amounts. I was a sugar-burner, running high on glucose to prevent and respond to “crashes.” And I became Insulin Resistant (IR).
The insulin my body made could no longer get nutrients into my cells. The fat I ate wasn’t burned for energy because my blood insulin was too high, preventing access to my fat stores. Year after year I got fatter and fatter.
I also became a Type 2 diabetic. I was diagnosed 33 years ago, but I was probably fully diabetic many years before that. Over the years, as I got fatter, my diabetes got worse – until 2002 when my doctor suggested that I try a Very Low Carb diet (20 grams of carbs a day) to lose weight. I lost a lot of weight and was forced to stop virtually all my oral anti-diabetes meds, dramatically raised my HDL, lowered my triglycerides, and lowered my blood pressure.
These are a cluster of risk factors known as Metabolic Syndrome, and they are all gone now! A doctor today would not know that I am (and always will be) a Type 2 diabetic. I am “in remission, clinically “non-diabetic,” but once you have Insulin Resistance, there’s no fixin’ it. You are carbohydrate intolerant for life. You have to live with it.
Accepting this fact is not as difficult as you might think. All you have to do is change what you eat. On a traditional, restricted-calorie, “balanced” diet, recommended by the medical establishment, the hardest thing about dieting is being hungry. Traditional “balanced” diets are just semi-starvation. You eat less than you body needs for energy balance, and your body reminds you of this frequently. If you are hungry, your body will tell you to eat because it doesn’t have access to your fat reserves. It is ‘available’ (around your waist) but this fat is not accessible to burn.
Why? Because, with high circulating insulin, due to IR, your body thinks glucose energy (from carbs) is plentiful, so it should preserve your body fat for leaner days (winter, famine, etc.) So, how then do you lower your circulating insulin? You stop eating most carbohydrates. Lower circulating insulin will signal your body to “release” your body fat to be used for fuel and you will not be hungry. Your body fat will be feeding your body. How cool is that?
So, as much as I love to eat, I now eat to live. I am currently eating less to lose weight. I eat very few carbohydrates (fewer than 20 grams a day), and I am not hungry. I let my body tell me when to eat. If I’m not hungry, I don’t eat.  Frequently I go from breakfast to dinner without any food at all. I eat a good breakfast: 2 fried eggs, 2 strips of bacon and a cup of coffee with heavy cream. If I do eat lunch, I eat a can of sardines. That’s all. Dinner is just meat, fish or fowl and a low-carb vegetable tossed in butter or roasted in olive oil. Easy weight loss without hunger!
All carbohydrates are alike to Type 2’s. That includes the “natural” sugars in fruit and the “complex” carbohydrates. If you’re a Type 2 and follow your doctor’s or dietician’s advice to eat a “balanced” diet with 45-60 grams of carb per meal, your treatment will progressively include more and more medications to control your blood sugar.
The ADA guidelines for “good control” call for an A1c of <7.0% and blood glucose level under 180mg/dl after meals. Unfortunately, damage to organs, nerves and arteries, particularly in the feet, kidneys and eyes, begins when blood glucose is above 140mg/dl. And heart attack risk steadily rises as the A1c level goes above 5.5%, for everyone, diabetic or not. The risk doubles with an A1c of 6.0%.
For diabetics in “good control,” as defined by the ADA, cardiovascular disease is almost a given. Heart disease is the most common cause of death for a diabetic. As heart attack risk rises, so does the risk of other conditions such as erectile dysfunction and many cancers (particularly colon, bladder, liver and breast, 4 of the most common cancers in the US), or one of many other chronic diseases of the Western Diet, including cognitive decline (Alzheimer’s).
This is the prospect you face: The medical establishment will tell you that T2 diabetes is a progressive disease. Rest assured; it will be if you allow them to treat you with a “one size fits all” “balanced” diet. But you do have a choice

Thursday, June 20, 2019

Retrospective #125: Dietary Dictocrats Double Down

As far back as 2010, the Executive Summary of the Dietary Guidelines for Americans, made what I construed was an admission of neglect and attempted to make up for it. The admission: “Dietary Guidelines recommendations traditionally have been intended for healthy Americans ages 2 years and older” (emphasis mine). Previously, I infer from that, their recommendations applied only to “healthy Americans ages 2 years and older,” not to the 86% “other than healthy,” as for example the insulin resistant, overweight, obese, Pre-diabetic and Type 2 diabetic.
This new interest in all of us was further made clear for me by their next statement: “However, Dietary Guidelines for Americans, 2010 is being released at a time of rising concern about the health of the American population. Poor diet and physical inactivity are the most important factors contributing to an epidemic of overweight and obesity affecting men, women and children in all segments of our society. Even in the absence of overweight, poor diet and physical inactivity are associated with major causes of morbidity and mortality in the United States. Therefore, the Dietary Guidelines for Americans 2010 is intended for Americans ages 2 years and older, including those at increased risk of chronic disease”  (emphasis mine again),That’s all of us “unhealthy” Americans, the 86 percent!
When I read this in 2013, I had hope of change. I hoped they would address the special needs of that segment of the population that is insulin resistant, overweight and obese. I hoped they would recognize some special dietary restriction, carbohydrate restriction, for example. I was disappointed. They do address the overweight and obese, but they do not associate it with what is the cause of most obesity: insulin resistance. And they do not associate overweight and obesity with carbohydrates or with Pre-diabetes and Type 2 diabetes. In fact, they don’t even mention Type 2 diabetes or the strong association of overweight or obesity with the Type 2 diabetes epidemic.
In summary, on the next two pages they prescribe the same-old “fix” for the “unhealthy” overweight and obese population as they do for the healthy population: Calorie restriction, with macronutrient balance, and exercise.
“People who are the most successful at achieving and maintaining a healthy weight do so through continued attention to consuming only enough calories from foods and beverages to meet their needs and by being physically active.” This is of course patently untrue. It is a “diet delusion,” as anyone who’s ever done it knows.
“To curb the obesity epidemic and improve their health, many Americans must decrease the calories they consume and increase the calories they expend through physical activity.” The “calories in – calories out” redux.
Then, the “Key Recommendations” begins with “Balancing Calories to Manage Weight”
·         Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors.
·         Control total calorie intake to manage body weight. For people who are overweight or obese, this will mean consuming fewer calories from foods and beverages.
·         Increase physical activity and reduce time spent in sedentary behaviors.
·         Maintain appropriate calorie energy balance during each stage of life – childhood, adolescence, adulthood, pregnancy and breastfeeding, and older age.
The USDA and HHS, who jointly created this document, are jointly IN DENIAL. They decided to just DOUBLE DOWN.
They also recommend we eat less “sodium” (salt), less “dietary cholesterol” and less “solid fats” (read saturated fats). And less added sugars and “refined grains, especially refined grain foods that contain solid fats, added sugars, and sodium.” Notice their associations of saturated fats with sugars. And, NOT A WORD ABOUT CARBOHYDRATES!
I know this is all “old news” to my readers, but I write about it again to illustrate INSTITUTIONAL DENIAL. As long as the Dietary Dictocrats in Washington, together with all the major medical associations, abetted by Agribusiness and Big Pharma with their powerful lobbies, continue to promote these recommendations, and the media trumpets it, we are left to go it alone. Self-treatment is the only choice we have left. Sadly, survival outcomes will eventually reveal the wisdom of our course of action. For many, however, including some of my friends, it will be too late.

Wednesday, June 19, 2019

Retrospective #124: Low Carb vs. Paleo

In July 2013, when this post was originally written, there were two popular movements on the ascendancy among the alternative diets. They were broadly speaking Low Carb and Paleo. Lamentably I think there is confusion among newbies as to which is “right” or “best” to follow and for what reasons. I will attempt to explore and clarify them.
The modern era of the low carb diet is largely attributed to Dr. Robert Atkins. In his 1972 book, “Dr. Atkin’s Diet Revolution,” carbohydrates were severely restricted. In the Induction Phase of his diet, which I followed, carbs were limited to just 20 grams a day). The purpose of the diet was weight loss. It worked very well but was widely criticized as dangerous. Other physicians, notably Dr. Richard K. Bernstein, himself a Type 1 diabetic, developed specialized practices in which very low-carb diets were specifically tailored to diabetics, both Type 1s and Type 2s.
In July 2002, award-winning science writer Gary Taubes revived the Atkins controversy and broadened the debate with his influential New York Times Sunday Magazine cover story, “What If It’s All Been a Big Fat Lie?” In 2007 his “Good Calories – Bad Calories” (“The Diet Delusion” in the UK) further explored his “Alternative Carbohydrate Hypothesis.” Among Taubes’s 10 “certain conclusions” (pg. 454) was, #2: “The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight and well-being.” To mix my metaphors, that pearl is “it” in a nutshell.
There are many practicing clinicians, researchers and bloggers out there today who espouse a low carb or even a very low carb diet for those diagnosed with Metabolic Syndrome, insulin resistance, and carbohydrate intolerance. Severe restriction of dietary carbohydrates will improve glucose regulation and regularize your metabolism very effectively. It will also result in easy, hunger-free weight loss and improved blood cholesterol (lowering triglycerides and raising HDL), and, as a consequence of weight loss, improved blood pressure and inflammation markers.
The low carb diet can still also be used as Atkins originally intended, which was principally for weight loss.  All of the attendant benefits will accrue. Frankly, I would recommend the low-carb Atkins diet to the entire U. S. population.
The modern Paleo movement in the U. S. came along much later than Atkins and about the time of Taubes’s 2002 seminal NYT piece. In a few short years it has made a very big splash, especially in the “real food” niche. An early proponent was Loren Cordain. Rob Wolf, an exercise physiologist who worked with Cordain, followed. Michael Pollan’s “Omnivore’s Dilemma” (2006) gave it a big boost. My favorite exponent in this area was Dr. Kurt Harris, who came along later and then disappeared. He had an epiphany after hearing Taubes and reading his book (GC-BC). His “Archevore program,” originally dubbed Pa-Nu, was to avoid the Neolithic Agents of Disease (NAD): wheat, excess fructose and excess linoleic acid (Omega 6s). Several influential researchers, among them Paul Jaminet (PHD diet), Stephan Guyenet, Peter D. (Hyperlipid), J. Stanton (gnolls.org), and Chris Kresser are regular bloggers.
The Paleo movement, like low carbing, has many variants. However, it is not a program designed for glucose regulation, for people whose glucose metabolism is “broken,” or for people who need to regulate their blood sugar by diet. It is not intended to produce the benefits needed if you are Insulin Resistant, carbohydrate intolerant, have Metabolic Syndrome, are pre-diabetic or have been diagnosed with Type 2 diabetes. Many of the Paleo diet variants, for example, permit root vegetables (very starchy carbohydrates!) and even white rice! Rice is a non-wheat grain and therefore gluten-free, but it is still a very starchy food. If you have insulin resistance and are carbohydrate intolerant, root vegetables and white rice will cause your blood glucose to go through the roof!
To summarize, Paleo is an appealing approach to eating a healthy diet, if you have a healthy glucose metabolism. I would definitely follow it if I did, but you have to know if your metabolism is “broken” before you decide. Get to know your own health markers, and don’t be in denial; if you are pre-diabetic, get a meter and eat to it. If your metabolism is “normal,” then go “whole hog” with Paleo. Eat “real” (unprocessed) food, the way we all used to!

Tuesday, June 18, 2019

Retrospective #123: Intermittent Fasting and “The 23-hour IF Diet”

Even in 2013, when I originally wrote this post, most dieters already knew, “IF” was not a conjunction introducing a conditional clause.” “IF” means Intermittent Fasting. IF had already become a popular method of dieting with those who can tolerate it. They are generally people who are keto-adapted, which permits them to do it easily and without hunger. It also “feels right” to introspective types as a throwback to ancestral times when food was scarce, and hunters and gatherers ate less in the winter and more “in season” and when the hunting was good.
“Intermittent” means “coming and going at intervals,” “not continuous,” or “occasional.” It is open to interpretation “Fasting” is also open to interpretation but generally means a period in which no calories are consumed during the fasting period. In common usage when applied to the human diet, that definition always includes water and is generally includes beverages such as black coffee and plain tea. Personally, I stretch it further to include heavy cream with my morning coffee and liquid stevia with iced tea during the day. That being said, just skipping dinner once or twice a week can have miraculous effects without much effort.
According to the Wikipedia entry, “There is evidence suggesting that intermittent fasting [IF] may have beneficial effects on the health and longevity of animals – including humans – that are similar to the effects of caloric restriction [CR]. The myriad health and longevity benefits have mostly been seen in animals (e.g., rats and worms). They include: reduced serum glucose and insulin levels, increased resistance of neurons to stress in the brain, reduced blood pressure, increased insulin sensitivity, and increased heart rate variability; also: increased resistance of heart and brain cells to ischemic injury and age-related deficits in cognitive function.”
Again, according to Wikipedia, “the benefits of Intermittent Fasting are a direct consequence of the period of fasting, not from the decrease in overall calories consumed.  Fasting has its own specific benefits related to the body’s multiple biochemical adaptations to maintain homeostasis. The body engages in Hormesis, a process of renewal and repair.”  These mechanisms are not fully understood, but they are wondrous!  It never ceases to amaze how “happy” my body is, physiologically speaking, whether I am in either the “fed” or the “fasting” state.
As a weight loss tool, two specific forms of IF are commonly practiced: the alternate day fast in which no food whatsoever (excepting water, black coffee or plain tea, or my version) is ingested for one whole day. This is actually a 36-hour fast, from dinner one day (7:00pm) to breakfast the day after (7:00am). The other form is more moderate and more popular. It is commonly referred to as the 8/16 hour fast in which all food in a 24-hour period is consumed within an 8-hour window. For an office worker, this could be done by skipping breakfast (except for coffee), eating a light meal in mid-morning break (10:00AM), a light lunch at 12:30 (if hungry) and dinner at home at 6:00PM, all within the 8-hour window, and then you begin the 16-hour fast.
I have a favorite 3rd version of IF, as I sometimes practice it; I call it “The 23-hour IF Diet.” I start with coffee with heavy cream when I rise. There is nourishment here, but virtually no carbs. I stay in ketosis. (I just never developed a taste for black coffee or plain tea), so this beverage is the beginning of a 1-hour eating window. Then, when my spouse arises and prepares breakfast, I eat 2 fried eggs and 2 strips of bacon. For variety on weekends we might “hold the bacon and substitute 3 eggs scrambled, with a little cream and/or shredded cheese, or smoked salmon tidbits mixed in. No lunch, no supper, no snacks. Just water or iced tea during the day when the body asks for it.
I created “The 23-hour IF Diet” spontaneously a while back to deal with weight creep. I did it for two days in a row – just breakfast, nothing else for two days. First, I was not hungry because my body was “fat adapted,” but I had built up glycogen stores in the liver from some previous “cheats.” I was primed to return to a fat-burning state as my body used up the glycogen stores for energy and eliminated the water retained by it. So, it worked. The first day I lost 5 pounds – largely water, of course, and on the 2nd day, 2 more. 7 pounds total. As I say, it worked.

Monday, June 17, 2019

Retrospective #122: Macronutrient Ratios and Calorie Restriction

Macronutrient ratios refer to percentages of calories taken by mouth. The three macronutrients are carbohydrates (carbs), protein and fat. Calories are different from food-by-weight-in-grams since fat contains 9 calories per gram, protein 4 calories per gram, and carbs, 4 calories per gram. That is why fat is such a good storage vehicle. It is more than twice as dense in energy as carbohydrates, the other principal energy source after carbs.
For a baseline reference, I will use the Standard American Diet (SAD), conveniently reflected on the HHS/USDA’s “Nutrition Facts” panel on processed food packages. Macronutrient ratios there are based on a 2,000 calorie a day diet for women, what women-of-a-certain-age need to maintain their weight. The men’s baseline is 2,500 calories.
The “% Daily Value” (formerly RDA) is based on the HHS/USDA recommendation for women to eat 300 grams of carbohydrates a day (men 375).  That’s 1200 calories (300 x 4) or 60% of 2,000 calories diet. Surprised? I’ll bet you are. The protein recommendation is 50 grams for women (62.5 for men), which is 200 calories (50 x 4) or 10% of 2,000 calories. The fat recommendation is +/-67 grams or 600 calories (67 x 9) which is 30% of 2,000 calories. 1200 + 200 + 600 = 2,000. For men, the calories count is 1,500kc carbs + 250kc protein + 750kc fat = 2,500kc total.
This reference standard is very high carb, low protein, low-to-moderate fat. Although the government hasn’t revised the Nutrition Facts standards, they appear recently to be lowering the carb percentage a little (without explicitly saying so), but they also still want you to lower your intake of saturated fat and cholesterol.
So, they now refer to fat simply as oils, by which they mean processed vegetable oils (corn, soybean, sunflower, safflower, Canola, etc.). It is these specific polyunsaturated oils that I and like-minded thinkers are recommending be completely avoided due to instability. My cooking fat preferences are coconut oil, butter, ghee, tallow and lard (think bacon fat) – all saturated fats – and olive oil, a monounsaturated fat, for non-cooking use.
As a further reference, in actual practice surveys show that American men eat 16% of calories from protein, and women 15%. Most nutrition experts recommend people eat no more than 30% of calories from protein, and then only when eaten with fat, and then only when blood tests show no evidence of kidney disease.
What then are the other ranges of macronutrients? What, for example, is considered low-carb? There is no definitive percentage but many people now consider 50 to 100 grams/day to be low-carb (vs. 300 and 375g in the SAD). Fifty grams is 200 calories or 10% of a 2000 calorie diet. 100g is 20%. That’s much better than 300g and a sure way to lose weight. Very Low Carb would be less than 50g/day. Personally, I eat about 15g/day but only 1200 calories total, so 15 x 4 = 60 calories which is only 5% of 1200. There is no minimum dietary requirement for carbs.
On a typical day, I eat 5g of carbs with breakfast, zero grams at lunch, and 10g with supper. If I skip supper, I really lose weight. When I eat almost all fat and protein in this way, my body is keto-adapted, and I don’t get hungry.
That’s where calorie restriction comes into play. If you seriously restrict calories and eat a “balanced diet” of carbs, protein and fat, you WILL feel starved because your body IS being starved. You have limited the energy taken by mouth and, by eating carbs, you have limited your body’s ability to access the stored fat on your body. Your body “notices” you have access to “quick energy” (carbs), from readily available carbs (fruits and vegetables, which it “thinks” must be “in season”), so it asks for (“craves”) more “sugar” (glucose) by mouth. As long as you are a “sugar burner,” it “reasons,” you don’t need to access the dense fat reserves stored on your body.
The hormone insulin regulates your body’s “thinking.” It is “telling” your fat cells to stay put and wait for the impending famine. Your body “think” it is doing you a big favor. No matter how hard you try, it won’t let you burn your precious fat stores. You’re going to need them later. It’s wants you to survive the winter that never comes….
When I eat 5% carbs/20% protein/75%fat (5/20/75), I am fat-adapted and I lose weight without hunger (or needing to exercise to lose weight). How? Because my body has access to and can burn its own fat for energy balance.

Sunday, June 16, 2019

Type 2 Nutrition #490: Why, just…why?

I’ve been struggling with this question for a long time. Why what, you ask? Well, that’s the problem. It’s hard to figure out what the question is. And then there’s the answer. That’s even more of a conundrum.
As readers know, I’m not afraid to be honest, even brutally honest. I don’t mind if I offend someone’s sensibilities…if it’s in a good cause. And I believe passionately that the health and well-being of our nation, even the world, both physically and mentally, is a good cause. It’s worth telling the truth, even if at a cost.
I have put the question in various forms: Why don’t people want to change? Why is it so hard for people to change? Can a person change what one eats, or the way or when one eats, at any age? Why don’t people believe that changing what they eat will improve their health? Whom do you believe when it comes to what is a “healthy diet”? Why should a person give up their favorite “comfort” foods? What if it’s all been a big fat lie?
As I approach column #500, I’m frustrated. I’m no closer to the answer as to why others can’t/don’t/won’t change than I was when I started. I can only re-tell how I did it and hope that somehow connects with you.
In 2002, as I approached the end of my work life, I weighed 375 pounds and faced a short retirement; I looked around and didn’t see many obese old people, and those I did see didn’t look to me to be in good health. I had been a diagnosed Type 2 diabetic for 16 years, was maxed out on 2 oral meds and starting a 3rd. My prospects were that I would soon be injecting insulin. And sooner rather than later I would die of diabetic complications.
The common Microvascular ones: 1) end-stage kidney disease with dialysis (nephropathy), 2) being wheelchair bound because of amputation(s) (neuropathy) and 3) blindness (retinopathy). Today, the Macrovascular complications are even more common: heart disease, stroke, Alzheimer’s disease (“type 3” diabetes) and several cancers. I was scared. I didn’t want a “short retirement.” I was motivated to change.
My doctor thought the best way to treat my Type 2 diabetes and high blood pressure, was for me to lose weight. He had urged me to do that for years. All “his” efforts – meaning my attempts – had failed. When I lost weight, following his “prescription” to “eat less and move more,” on a “balanced diet” – I failed. Then, one day, when I walked into his office (at 375 pounds), he said, “Have I got a diet for you!” His timing was perfect.
A few months earlier my doctor had read, “What If It's All Been a Big Fat Lie,” the cover story of The New York Times Sunday magazine. The author, Gary Taubes, who also wrote Good Calories – Bad Calories, proposed an “Alternate Hypothesis” to the “low-fat” (high-carb) “balanced” diet that mainstream medicine has pushed for fifty years. And note well, following it dutifully has made us fatter and sicker.
Taubes, thrice an award-winning science journalist, wrapped up GC-BC with 10 “certain conclusions [that] seem[ed] inescapable” to him. The first 3 follow; the others are in The Nutrition Debate #5, posted here.
1.       Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization.
2.       The problem is the carbohydrates in the diet, their effect on insulin secretion, and thus the hormonal regulation of homeostasis – the entire harmonic ensemble of the human body. The more easily digestible and refined the carbohydrates, the greater the effect on our health, weight, and well-being.
3.       Sugars – sucrose and high-fructose corn syrup specifically – are particularly harmful, probably because the combination of fructose and glucose simultaneously elevates insulin levels while overloading the liver with carbohydrates.
My wife says, “Your diet is too extreme. You don’t have to cut out all carbs. You just have to cut down.” Okay, I say, if that works for you, DO IT. I have friends who’ve cut back on their carbs a little and a lot, and they’ve all lost weight. I found it easier to eat so few carbs that my body burned my body fat for energy. I’ve lost 180 pounds. The trick: Eat few enough to lower your blood insulin levels to signal the body to access your body fat. If you don’t access your body fat for fuel, you will be hungry, and you’ll just wind up back where you started.

Retrospective #121: “Behavior Change is Incredibly Difficult.”

That’s the conclusion of an article by Jason Vassy in “Personalized Medicine” that came up on a 2013 Medscape alert. He was referring to the outcome of two trials that examined whether genotype information was helpful in motivating health behavior changes in a population that was genetically susceptible to Type 2 diabetes. It was “hoped” that knowledge of one’s genetic susceptibility might be a “clinically useful tool” in targeting “primary prevention strategies before the onset of certain diseases,” e.g. Type 2 diabetes and morbid obesity.
Sadly, Vassy concluded: “At present…genetic testing for T2D risk likely does not improve preventive health behaviors in today’s diabetogenic environment.”  Quelle surprise! It also will come as no surprise that this column was one of the least popular with readers that I wrote. Everyone knows this. Behavior change is incredibly difficult.
Vassy hastens to point out, though, that “This [greater susceptibility to T2D risk] contrasts with the much larger effect-sizes of family history: T2D in one or both parents multiplies one’s risk by up to two- and six-fold, respectively.” He does not point out, however, that the association with family history goes far beyond genetics or ethnicity; it includes diet, economics, cultural practices, and many other environmental factors generally too complex to reliably isolate in even large epidemiological studies.
Behavior change, however, was the hoped-for outcome of these two studies and this author’s commentary. They were all disappointed but, I suspect, not surprised. The medical establishment has come to expect failure. Vassy expresses that outcome succinctly: “These results will not surprise clinicians, whose efforts at counseling patients for weight loss and improvement in diet and exercise habits often fail.” The implication is it’s the patient’s fault. The patient is “non-compliant” with the “prescription” because, they say, “behavior change is incredibly difficult.”
It never seems to occur to the practitioner that that expected outcome failed to materialize because of the wrong prescription. A large percentage of the world’s peoples are apparently genetically predisposed and therefore susceptible to both Type 2 diabetes and obesity. The trigger for both is eating a Westernized diet. We become fat not because we eat too much fat and cholesterol (and are too sedentary), but because we (those of us who are genetically susceptible) eat too many sugars and processed carbohydrates. Our metabolism becomes “broken.”
We make and store fat as a consequence of eating sugars, processed carbs and fat. The body uses the sugars and processed carbs for energy and stores the fat for the inevitable famine that it is designed to expect and for which it prepares us. The trouble is the famine never comes. We live in a world oversupplied with cheap carbohydrates in the form of manufactured and processed “foods products.” They taste good, and we eat them for convenience.
This is in contrast to the animal-based dietary of protein and fat, plus seasonal fruits and vegetables (unprocessed carbohydrates), that our ancestors ate. Instead, we now graze on processed carbohydrates all day long as though we lived in a veritable cornucopia (“corn-utopia” ©), LOL. Which, in fact, we do.
If we eat Low Carb or Very Low Carb, and just two or three small meals a day of moderate protein/high fat over an 8 or 10-hour period, and then fast for 16 or 14 hours, we will be living much the way our ancestors did. For most people, the outcome of this Way of Eating is weight loss, high energy levels, improved health markers (even before weight loss), wellbeing, and longevity. But this “prescription” doesn’t occur to our health care providers.
Their “hopes” are still pinned on weight loss following their “prescription” of a “balanced” (high carb), restricted-calorie diet, with less saturated fat and dietary cholesterol, and more exercise. But that’s not what Vassy’s two studies called for: “Overall, participants did not change their dietary fat intake or exercise habits over the study period, although most already had ‘good’ habits at baseline.” (My quotes added on ‘good.’)
Behavior change is incredibly difficult, when it is the wrong lifestyle modification. The right one, Very Low Carb, is easy to follow. Good outcomes – weight loss and improved health, without hunger and without exercise, follow.

Saturday, June 15, 2019

Retrospective #120: Nutrigenomics

According to Wikipedia, “In modern molecular biology and genetics, the genome is the entirety of an organism's hereditary information.”  “The study of the global properties of genomes of related organisms is usually referred to as genomics….”Nutrigenomics,” then, “is the study of the effects of foods and food constituents on gene expression.” “Nutrigenomics [thus] aims to develop rational means to optimize nutrition with respect to the subject's genotype,” which, in the case of humans, colloquially speaking, is the “genetic make-up” of an individual.
I have more than a passing interest in this subject: Thirty-three years ago, I was diagnosed a Type 2 Diabetic. I probably “presented” with all the symptoms of Metabolic Syndrome maybe 40 years ago – half a lifetime. But today this cohort includes half the human race – the half that is overweight or obese and has the indications of Metabolic Syndrome: central obesity, hypertension, dyslipidemia, and a dysfunctional glucose regulation (Pre-Diabetes or “frank” Type 2 Diabetes). To the point, this is the population that now eats a processed food diet.
Wikipedia: “It is hoped that by building up knowledge in this area, nutrigenomics will promote an increased understanding of how nutrition influences metabolic pathways and homeostatic control, which will then be used to prevent the development of chronic diet related diseases such as obesity and Type 2 Diabetes. Part of the approach of nutrigenomics involves finding markers of the early phase of diet related diseases; this is the phase at which intervention with nutrition can return the patient to health. As nutrigenomics seeks to understand the effect of different genetic predispositions in the development of such diseases, once a marker has been found and measured in an individual, the extent to which they are susceptible to the development of that disease will be quantified, and personalized dietary recommendation(s) can be given for that person” [all emphases added].
My Commentary: The prospect that, as this new science develops, “personalized dietary recommendation(s) can be given for that person” is appealing. It would be nice to have some scientific proof that if one changed one’s diet it “would return the patient to health.” It would be nice to know the particulars of the gene and protein expression, and the metabolite production and genetic sequencing, that half  the human race has that gives it a “genetic predisposition in the development of such diseases” and is therefore “susceptible to the development of that [chronic diet-related] disease” (obesity and Type 2 Diabetes). Such “personalized dietary recommendations” could then be given to half the world’s population who have this genotype that predisposes them and makes them susceptible to such diseases.  Yes, it would indeed be nice. I look forward to such erudition.
But, wait a minute! What am I missing here? Am I being obtuse? We already have laboratory “markers” – okay, they’re admittedly “crude” markers compared to a DNA microarray, but they are definitive proof; they are both measurable and repeatable; they are the indications of Metabolic Syndrome: 1) central “truncal” obesity with associated hypertension, 2) dyslipidemia, particularly low HDL and elevated triglycerides, 3) and a broken glucose metabolism, characterized by progressively worsening Insulin Resistance (IR = carbohydrate intolerance), and perhaps even a diagnosis of Pre-Diabetes or frank Type 2; all measurable, all repeatable, and all reversible!!!
Besides these laboratory results, your waist-hip ratio can tell you almost everything you need to know.  And we already know specifically and exactly what “intervention with nutrition can return the patient to health:” REDUCE TO THE FULLEST EXTENT THAT YOU CAN THE CARBOHYDRATES IN YOUR DIET. (How do you like them apples?)
For the last half century, we’ve been getting notoriously bad nutritional advice. Now, finally, many of the establishment’s weight loss “experts” are starting to see the light and are seeking “cover” by offering vague, non-specific advice to just “diet and exercise” and “eat healthy.”  The “old” view that to lose weight everyone should eat a “restricted-calorie, balanced diet,” is acknowledged to be all wrong. It just doesn’t work! As a result, an increasingly skeptical public is open to an approach that actually does work: a low-carb, moderate-protein, high-fat diet. That is my “prescription,” and I aver it would work for half the human race. Is it time for you to try it?

Friday, June 14, 2019

Retrospective #119: “Lifestyle Intervention is Great Therapy.”

Ralph A DeFronzo, MD, Director of the Diabetes Division at the University of Texas Health Science Center, made this comment at the May 2013 American Association of Clinical Endocrinologists (AACE) meeting. His presentation got my attention since Dr. DeFronzo is a favorite of mine for his Banting award lecture at the 2008 ADA convention. In it he said, “By the time that the diagnosis of diabetes is made, the patient has lost over 80% of his/her β-cell function, and it is essential that the physician intervene aggressively with therapies known to correct known pathophysiological disturbances in β-cell function.”
At the AACE meeting he said, “There’s no doubt – when you look at diabetes prevention – if you can get people to lose weight and exercise on a regular basis, lifestyle intervention is great therapy.” “The issue is not whether diet and exercise works. It works. The issue is can you get people to do it on a long-term basis. I think it’s time to face reality. The reality is, it doesn’t work long-term.”
Obviously, I was expecting more, but I shouldn’t have. He is just a physician, albeit a leading one. He is a pill peddler; when pills fail or something better comes along, he’ll push that. He is a prescriber. Whatever big pharma comes up with to treat the “pre-diabetic” or diabetic patient, he’ll prescribe. That’s what doctors do.
There is also the real question of what can a physician do to get you to lose weight. There is no magic pill. If he and you view him as being in charge of your health, that’s a problem. He’s in charge of your healthcare; you’re in charge of your health. You have it in your power to lose weight, and you can do it with the right dietary “prescription.”
I do not deny that lowering the goal posts for diagnosis of pre-diabetes and diabetes to new markers – lower FBG thresholds and adding the A1c’s to the diagnostician’s quiver – are steps in the right direction. I applaud these changes. It’s just that they’re shooting at the wrong target. The target for weight loss should be a Low Carb diet. And the bull’s eye should be Very Low Carb. But, what does a doctor know about nutrition? Nothing! Ask them. They usually are the first to acknowledge they just follow “practice guidelines.” That’s all they’re qualified to do.
Except my doctor went rogue. He went “off label” and “prescribed” Atkins Induction (20g/d of carbs) for weight loss. He did it after reading Gary Taubes’s “What If It’s All Been a Big Fat Lie?” in a 2002 New York Times story. He tried it himself and lost 17 pounds in 6 weeks. Unfortunately, as Dr. DeFronzo said, he didn’t stick with it long term.
But it worked for me. And it still works for me. I lost 170 pounds and put my Type 2 diabetes in remission. It could do the same for you too, if you don’t listen to everyone who tells you it “doesn’t work long-term.” It does work long-term, if you stick to it. What they mean is that people don’t stick to it. Not that it doesn’t work long-term.
Part of the problem is that “Lifestyle Intervention” is intentionally vague. It could be defended as being “inclusive” but is more likely intentionally undefined to avoid controversy and going against the prevailing dogma. It is convenient as a phrase as it includes the idea of exercise. Exercise is good, I suppose, but I don’t do any formal or regular exercise. What works is lowering serum insulin by eating Very Low Carb. That also raises insulin sensitivity.
Because Lifestyle Intervention is so vague, it is left to everyone to interpret it in the way they chose, along with the meaning of the word “moderation.” Government still pushes the Aristotelian virtue of moderation. And that a healthy lifestyle includes a restricted calorie, low-fat “balanced” diet, as the standard “one-size-fits-all” approach.
That this “standard” therapy doesn’t work is what Dr. DeFronzo is talking about. He’s primarily an academician, but he’s right. Many patients don’t stay on a low-carb diet long-term, and the minute they leave the diet, it ceases to work because they have become, are still, and will hereafter always be, carbohydrate intolerant. By eating that “Standard American Diet” for many years, being genetically predisposed, they were susceptible to and underwent an epigenetic change. THAT is the reality it’s time to face. NOT that eating Very Low Carb doesn’t work long-term.