Sunday, June 30, 2019

Type 2 Nutrition #492: Weight Maintenance on VLC

As I re-approach (LOL) a 180-pound weight loss and my goal weight of 195 pounds, I’m again giving serious thought to how I am going to maintain that weight. Truth be told, most people who lose a lot don’t maintain it. So, how am I going to do it this time? Ironically, this is a problem I never thought I’d have. Who among the morbidly obese ever achieves their goal weight? Well, after 17 years, and many “misadventures,” I’m there.
Over the years I’ve read lots of bad advice on the subject. Then one day I read something that made sense. The advice was in Volek and Phinney’s, The Art and Science of Low Carb Living. A few years later, when I met Stephen Phinney – at Banff in 2016 at the 5th Global Symposium on Ketogenic Diet Therapies – I told him, “Yours was the first time I had read a prescription for weight maintenance that made sense to me.” He replied, “That’s because we told the truth.” He then added, “When our publisher told us, “If you say that in your book, it won’t sell,” we replied, “We don’t care. It’s the truth.” That’s why it is one of my favorite books.
From Chapter 16: “The Importance of Dietary Fat on Long-Term Maintenance.” On pg. 206, Volek and Phinney say, “(T)he purpose of this chapter [is] to address the need for added dietary fat while keeping carbohydrates within an acceptable level of tolerance in the long-term maintenance phase of carbohydrate restriction.”  Then, on pg. 210, they address protein: “There’s no metabolic reason why increasing [protein] would be beneficial,” and “too much protein…has a modest insulin stimulating effect that reduces ketone production.”
From Chapter 18: “10 Clinical Pearls,” pg. 238: During the Induction Phase of Very Low Carb dieting, the “weight loss occurs because you are eating much less energy that your body is burning.” “Typically, early on up to half of your daily energy needs are coming out of your love handles. However, one’s protein needs (expressed as grams per day) are about the same across all phases of carbohydrate restriction, whether it’s your first week in Induction on your second year in weight maintenance.” Then, the coup de grace, on pg. 239:
“Simply put, there is no option for weight maintenance that is simultaneously low in carbohydrates and low in fat. Your energy has to come from somewhere, and for people with carbohydrate intolerance, their best (and long-term) energy source is dietary fat. Practically speaking, that means purposefully seeking out enjoyable sources of fat and routinely including them in your diet.” “You must get comfortable eating fat as your primary source of dietary energy if you want to succeed in low carb maintenance.” That’s pretty clear.
Now that day, for me, is near. I will soon be at my maintenance weight, again. I will then continue to eat the same Very Low Carb way I have striven for over the years. I will still have one cup of coffee at “breakfast” with a dollop of heavy cream and a pinch of pure stevia powder. For lunch, if I eat lunch, I will still eat a small tin of Brunswick kippered herring snacks, or a can of Bumble Bee Brisling sardines in water or EVOO, or occasionally a Haas avocado with Brianna’s vinaigrette in the cavity. To drink, Lipton cold-brew iced tea with liquid stevia.
For supper, I will eat the same small meal of a moderate protein portion and a low-carb vegetable tossed in butter or roasted in olive oil. On occasion, before supper, I will snack on radishes with butter and salt, or celery with anchovy paste, or olives, or nuts. I will also have two glasses of red wine, usually as a spritzer.
I will continue to weigh myself every day. When I rise to the top of my range (195-199), I will “fast” for a day. My “fast” will consist of my morning coffee (with cream and stevia) and one red wine spritzer for supper.
I find that my weight varies more due to water retention, from carb cheats, than from too many calories. Weight lost during a one-day “fast,” due to the diuretic effect, usually returns me to the bottom of my range.
I like what I eat on my VLC diet, and I feel great. I mean pumped! The older and leaner I get, the better I feel! And people tell me I look good in my new wardrobe. It’s actually fun being almost “half the man I once was.”

Retrospective #134: “You Really Don’t Need to Test”

“You really don’t need to test,” my new doctor, an internist and cardiologist, told me as I was leaving his office. It was only my second visit, and it was at my suggestion that I will see him 3 times a year instead of once, as he suggested. So, I think it was a nice gesture on his part to give me assurances and comfort that my health in general, and in particular my Type 2 diabetes, was “under control,” as conventionally defined by the medical community.
He was also telling me that my other labs, specifically my A1c, blood pressure, Lipid (cholesterol) Panel, thyroid, kidney and inflammation markers, all suggested – to him – that the therapeutic regimens that his predecessor had ordered and that he was continuing, had me in good shape. I got the impression that seeing me, for him, was something of a relief – that I was healthy compared to most of the patients he saw on a daily basis. That made his time with me easier for him. He seemed to be having fun! I liked that. It made me feel good too.
But here’s the rub: He was telling me that my condition didn’t warrant the level of blood glucose testing that I had requested he prescribe: two times a day. His rationale was that my A1c, 5.6%, was considered “non-diabetic,” as it was less than 5.7%. The Quest report describes it as a value consistent with an “Decreased Risk of Diabetes.” This “Reference Range,” the report said, was “supported by the current Standards of Medical Care in Diabetes.”
So, that’s that. He was ‘covered’ because the ADA said that I am at “decreased risk of [incipient] diabetes,” so ipso facto daily testing was not warranted. For new readers I had been, at that time, a Type 2 diabetic for 27 years.
So, how can this seeming paradox exist? Why is it that my diabetes is no longer discoverable by a lab test or a clinician’s interpretation? With a full medical history, of course, it would be, but my new doctor is just getting to know me. A good sign: he wanted to be added to the email distribution of The Nutrition Debate. How cool is that! My previous (now deceased) doctor also was on the list and occasionally emailed me with comments.
Anyway, I digress. My reason for writing this post is to make the point that the patient who has taken control of his Type 2 diabetes health care, and treats it (almost entirely) by diet alone, can achieve these results EVEN IF HE OR SHE IS INSULIN RESISTANT. When you eat very few carbohydrates, your blood insulin level goes down, and your insulin sensitivity goes up. And importantly, your blood glucose stabilizes in the “non-diabetic” range.
And when you achieve these results through strictly eating Very Low Carb, YOUR TYPE 2 DIABETES WILL BE IN REMISSION. The lab report can’t tell that you’re a full-blown Type 2 diabetic. Neither can your doctor, if he doesn’t know your history. But that doesn’t mean you can rely on the assurances that you’re in “good control” just because you are well below the thresholds of the American Diabetes Association. YOU DON’T WANT TO BE THERE. You don’t want your Type 2 diabetes to be a PROGRESSIVE DISEASE, as the ADA defines it. And as your physician will too, if he/she follows the “Standards of Medical Care” in Diabetes, as he or she most will almost certainly do.
YOU can treat YOURSELF through diet. The best way to do that is to learn about the carb content of the foods you eat and how your metabolism handles them. And the only way to do that is to TEST.  Test before and 1-hour after a suspect meal. Adjust the menu to meet your goals. Test in the morning before eating (fasting blood glucose). Test to keep yourself honest – to remind yourself that you are a Type 2 diabetic AND WILL ALWAYS BE CARBOHYDRATE INTOLERANT. You cannot cure this disease. You can only treat it to put it IN REMISSION. And the ONLY way to do that is with diet. Vigilance and discipline are required. But the food choices are endless, and very good. As your body adapts to using ketones, you will have increased physical energy. You will feel better. And if you need to lose weight, you can do it easily and without hunger.  How do you like them apples? 

Saturday, June 29, 2019

Retrospective #133: The Edible Schoolyard (ESY)

“…and the abandoned school cafeteria became the kitchen classroom.” Wow! That’s transformative. I read this in a history of the Edible Schoolyard Project at the Martin Luther King, Jr. Middle School in Berkeley, California. Alice Waters, the legendary doyenne of California Cuisine, was the impetus behind ESY in 1995 and now supports it through her Chez Panisse Foundation. “California Cuisine is a style of cuisine marked by an interest in fusion cuisine (integrating disparate cooking styles and ingredients) and in the use of freshly prepared local ingredients,” according to Wikipedia. New American Cuisine derives from California Cuisine. Alice Waters’ influence on cooking with fresh, local ingredients is undeniable. Would that teaching our children about food were as transformative.
I was directed to this site, and another, Edible Schoolyard New Orleans (ESYNOLA), by Randy Fertel, a neighbor. As co-chair of the ESYNOLA Task Force, Randy told me that in just the last 7 years New Orleans has established an offshoot of ESY in 5 First Line public open-enrollment charter schools. In his words, paraphrasing, “…when children are engaged in the growing, harvesting, and preparing of food, they are far more likely to eat it.” According to their website,Edible Schoolyard New Orleans changes the way children eat, learn, and live...” “Our mission is to improve the long-term well being of our students, families, and school community by integrating hands-on organic gardening and seasonal cooking into the school curriculum, culture, and cafeteria programs.” What a great idea!
I have never been a parent, so my exposure to the policies and politics of school lunch programs is nil, but I do read the paper and listen to and watch the news. On the local level, the issues revolve around whether flavored milk should be banned from the cafeteria. Eight ounces of white milk contains 14 grams of natural sugar or lactose; fat-free chocolate milk has six grams of added sugar for a total of 20 grams, while fat-free strawberry milk has a total of 27 grams — the same as eight ounces of Coca-Cola. Flavored milk is like candy. Others argue that vending machines in schools should be banned altogether, or just allowed if they are limited to “healthy” snack foods. Healthy is defined as low in saturated (solid) fats and made with just enough partially hydrogenated vegetable oils to escape having to be labeled as containing dangerous trans fats. Defining “healthy” is an uphill fight.
At the Federal level, in 2010 the U.S. Government reentered the fray with the latest version of the USDA’s 167-page National School Lunch and School Breakfast Program. It advocates more fresh fruits and vegetables and less added sugar, but the most worrisome part of the new school lunch program is the emphasis on reduced saturated fat. Regardless of what you think about saturated fat in the adult diet, children need saturated fat in their diet.
·         Cell Membranes – 50 percent of the fats in cell membranes must be saturated for the cells to function properly.
·         Lung Function – The lungs cannot function without saturated fats, which explains why children fed butter and whole milk have much less asthma than children fed margarine and low-fat milk.
·         Kidney Function – The kidneys operate through a process that requires saturated fat.
·         Brain and Nervous System – The normal brain is especially rich in saturated fat (and also cholesterol).
·         Immune System – Saturated fats are needed for healthy immune function.
·         Protection against Infection – Some kinds of saturated fats (found in coconut oil and butter) help fight pathogenic bacteria, viruses and parasites. Children fed skim milk suffer from infection five times more frequently than children fed whole milk.
·         Heart Function – Saturated fats are the preferred food for the heart. Children on low-fat diets actually develop blood markers indicating proneness to heart disease.
·         Vitamin Carriers – Saturated animal fats serve as unique sources of nutrients such as vitamins A and D, and CLA.
So, the Edible Schoolyard is a breath of fresh air. The curriculum is fully integrated into the school day and teaches students how their choices about food affect their health, the environment, and their communities.” I like it. What are you doing about nutrition in your school’s lunch program? Or what would you do if the government stayed out of what foods you could serve/not serve in your school instead of pimping for Agribusiness in Washington DC?

Friday, June 28, 2019

Retrospective #132: Why I Despair for the Type 2 Diabetic Patient

Chatting with an MD Internist friend of mine, my hopes for the medical care of his Type 2 diabetic patients sunk to an abysmal low. Admittedly it was a social situation, and in fairness my friend did not express much interest as I proselytized about my Very Low Carb, Type 2, self-treatment regimen. However, I felt despair as he referred to how he treats his Type 2 patients. When he used the terms “good diet” and “under control,” I rudely interrupted him as I was sure he and I had totally different concepts of their meaning. I must have seemed insufferable to him.
This is an immense and important problem. Until the entire public health and medical establishment comes to see these two terms differently, I fear that the world-wide epidemic of obesity and diabetes (“diabesity”) will continue to worsen. But small-town practitioners are not the problem. They just follow what they have been taught and continue to learn on an on-going basis from their medical societies. And the patient accepts the scripts his or her doctor writes, as well as the assurances he or she gives the patient, because it conforms to the messaging from the corrupt Government/Big Pharma/Agribusiness/Media consortium. Just follow the money.
I challenged “good diet” when my Internist friend mentioned it since I was sure he meant a “balanced” low-fat diet, specifically the one-size-fits-all diet that government advocates: 60% carbohydrate, 30% fat, and 10% protein. It’s on the HHS/USDAs Nutrition Facts label on processed and packaged “food.” The fat category subdivides into saturated fat (bad), trans fats (worse), and unsaturated fat, which they advocate. “These unsaturated “vegetable” oils (corn and soybean) are unstable and inflammatory. See Retrospective #21. They are not healthy for anyone.
Under control” is the other phrase over which I became exercised. By this point my friend was backing away from the conversation (LOL) so I didn’t get a chance to ask whether he was referring to an A1c of 7.0% (the ADA standard), or 6.5% which is the standard of the AACE, the endocrinologist’s society. If I had had the opportunity, I would have mentioned that Dr. Ralph DeFronzo, MD, stated in his Banting Award lecture at the 2008 ADA convention in San Francisco, that “good control” should be defined as an A1c <6.0%.
Even better, an A1c of 5.6% (the “normal non-diabetic range), is achievable and can be maintained by a “good diet” alone, as I would have it defined it: to wit, a Very Low Carbohydrate or perhaps even just a Low Carb diet.
And Dr. Richard K. Bernstein, himself a Type 1, holds that diabetes patients (Type 1s and Type2s) should be entitled to “normal” A1c’s, in the 4.0% to 5.0% range. Remember, heart disease risk rises steadily with an A1c above 5.5%. 
“Good Control,” of course, from a doctor’s perspective, means controlled with medications, either oral or injected. And good control as defined by the associations (ADA and AACE) assures that the patient will take progressively more and more of these medication as the disease “progresses.” Type 2 diabetes is defined as a “progressive disease,” DUE ENTIRELY TO THE TREATMENT REGIMEN THAT MEDICAL ASSOCIATIONS ADVOCATE. Why is that?
“That’s a very hard question to answer,” replied Jay Wortman, MD, a Canadian activist and low-carb blogger, to Andreas Eenfeldt, MD, the Swedish doctor who founded the very successful, in a 2013 interview:
Wortman: “I think there’s a multiple answer to that question. I think there’re a lot of people in organizations and positions that are funded by the drug industry, and the drug industry doesn’t want people doing this [“a simple dietary change”]. They’d get off the drug.” Eenfeldt: “Bad for Business?” Wortman: “Yeah. Bad for business – totally bad for business. And these big organizations [ADA, AHA, etc.] depend on drug industry funding.” Wortman, later in the interview: “The other problem is there’s nothing to patent there. There’s nobody going to get wealthy from patenting this [a simple dietary change]. Our system runs on something that can be patented and marketed, and turn a profit, and that’s how the funding goes through the system in terms of both the research agenda and also how recommendations are generated, and there’s nothing to patent.” Eenfeldt: “Right. It’s all free information, right?” Wortman: “It’s freely available.” Folks, think about that for a moment, please…

Thursday, June 27, 2019

Retrospective #131: Bernstein Goes Paleo, sort of…

Richard K. Bernstein, MD, a Type 1 diabetic, single-handedly innovated and championed the wide-spread use of the personal glucose monitoring device. It all began fifty years ago when he was a practicing engineer and his wife an MD. So, he had access to her medical equipment, “in the old days” the only way to measure blood glucose. Up to that point Bernstein had been following medical guidelines for Type 1s and was able to see his elevated glucose. He was also dismayed that, in his early 30’s, he was developing diabetic “complications” (neuropathy and retinopathy). Using his wife’s machine, he learned that certain foods caused his blood sugar to rise a lot, and others less so, so he got the idea that he could control his blood sugar by what he ate. Sounds reasonable, right?
From that Bernstein went on to advocate that every Type 1 diabetic should be testing before and after meals and at other critical times of the day and night. When Bernstein did, he gained control over his blood glucose and reversed his complications. Ever since, his over-arching philosophy has been that “people with diabetes are entitled to the same blood sugar as people who don’t have the disease.” His A1c’s today are always in the 4s.
So, Bernstein went to school, both literally (to medical school) and figuratively, and has been promoting very low carbohydrate eating ever since. In a 2013 article in the magazine “Diabetes Health,” Bernstein said, “To get normal blood sugars you have to do certain things, and one of the key things is a very low carbohydrate diet. This is because nothing else works. I’ve tried other approaches throughout my 69 years of having diabetes. I got my first meter in 1969, so I’ve had plenty of time to experiment and see what works.”
Over the years Bernstein developed the Bernstein Diet. In it, you eat 30 grams of carbohydrates a day: 6 grams at breakfast, 12 at lunch, and 12 at dinner. The lower amount at breakfast is due to Dawn Phenomenon (DP): Upon waking the body makes a little glucose and circulates it for quick energy to get you started (before caffeine).
Bernstein recommends that you eat 3 small meals a day, evenly spaced about 5 hours apart. Because a large part of protein’s components (amino acids) are glucogenic (i.e., will make glucose), Bernstein recommends roughly equal amounts in each meal and not too much. Gluconeogenesis can sabotage very low carbohydrate (VLC) eating. Metformin suppresses this unwanted glucose production by the liver from eating too much protein in one meal.  
His encyclopedic book, “Diabetes Solution,” has gone through several editions and is a best seller. Beware though: it’s heretical. Bernstein says in the Diabetes Health article, “There’s no way the ADA diet or any high-carbohydrate and low-fat diet will enable you to control blood sugars. He’s very definite on that. No bones about it.
But here’s what blew me away about the 2013 Bernstein article in “Diabetes Health.” Bernstein said, “It turns out that the kind of diet I recommend is essentially a Paleolithic diet, which is what humanity evolved on. Our ancestors did not have bread, wheat, sweet fruits, and all of the delicious things we have today. These have been specially manufactured for us nowadays. For food, our ancestors ate a paucity of roots, some leaves, and principally meat. If they lived near the shore, they had fish.”
Bernstein then concluded, “My dietary recommendations boil down to what our ancestors ate. The ADA repeatedly says that while low-carbohydrate diets may work, they’re an experiment, and we haven’t had enough years of trial of these diets to see if they do any harm. But in reality, the ADA diet is an experiment that was never based on any history. In fact, it is the cause of the epidemic of obesity and diabetes that is currently shaping our nation. Whereas the original diet, the Paleolithic diet, has been tested for hundreds of thousands of years, and it’s the only one when you deviate from it that you end up where we are now.” He’s absolutely right, of course.
Seventeen years ago, I bought a meter and used it to “eat to the meter” and thereby learn what foods impacted my blood sugar and by how much. It was an invaluable adjunct to the general principles and guidelines of eating VLC. It enabled me to fine tune my eating habits to the point where I was able lower my A1c’s from the mid-8s, while maxed out on 2 oral diabetes meds and starting a 3rd, to the mid-5s, by diet alone, except for Metformin. 

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 (, 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.