Friday, August 16, 2019

Retrospective #183: My New “Lipidologist” and Me

I had an appointment recently with a “new” doctor – new to me, that is. He’s an established physician in a large group that is part of a larger consortium of groups. He practices “Family Medicine,” which means he’s a generalist.
I met my new doctor in a bar. He was having broiled salmon, and I was having a drink (while my wife shopped). Anyway, he told me he was a physician, and he mentioned the group. I told ­­­­­­­him I had just been “fired” (for being rude) by an endo in that group. His suggested I call his office the next day to make an appointment, so I did.
The appointment didn’t go well. In the clinic I told him I had been off my Very Low Carb eating plan off almost 2 months and had gained more than a few pounds. I expected my A1C would probably go up from 5.7% to +/- 6.0%. “My goal is to get it back to 5.6% or below,” I said. He replied, “That would be ‘non-diabetic.’” He added that if I lost 40 pounds, “You would be non-diabetic.” I replied that a few years ago I was 50 pounds lighter than I was now, and I added, with emphasis, “believe me, I was still diabetic,” because I would still be Insulin Resistant.
I then mentioned that when I am “on” my program, I eat between 10 and 15 grams of carbohydrates a day. He responded with a tone and air of certitude, “Twenty grams of carbohydrate a meal is what you should eat.” This really set me off. My new doctor knew everything there was to know about me without even taking a history. I had been a Type 2 diabetic for 28 years, the last 12 of which I have managed to get off virtually all my oral meds and keep (for the most part) good glucose control by diet alone, and now he was telling me how to manage my diabetes his way. I know. I know. He was just following clinical guidelines, as set down by the ADA, the AHA, etc., etc.
He then brought up the subject of statins, declaring he was a lipidologist. I told him I would refuse a statin if he ordered it, and I told him why. I mentioned my latest lipid panel (at the time): TC: 217; LDL: 122: HDL: 85; TG: 49; TC/HDL ratio: 2.6). I said I considered that stellar. He replied that the National Cholesterol Education Program (NCEP-4) Guidelines recommend a TC < 200 and an LDL < 100 (which was true; those were the old guidelines). The new ACC/AHA guidelines (see Retrospective #181) no longer set LDL targets in absolute numbers. I called the NCEP guidelines pure BS and said the gurus and guidelines that I follow are very happy with my lipid (cholesterol) panel.
Actually, I later recalled that one of my favorite books, Paul and Shou-Ching Jaminet’s “Perfect Health Diet” says, “The ideal serum lipid profile – the one that produces the best health and minimum mortality – looks like this:
·         Total Cholesterol level between 200 and 260 milligrams per deciliter
·         LDL Cholesterol level above 100 milligrams per deciliter
·         HDL Cholesterol level above 60 milligrams per deciliter
·         Triglyceride level around 50 to 60 milligrams per deciliter
I then repeated my exceptional HDL (85) and TG (49) numbers and added that my LDL (122) was Pattern “A.” His response was: “Define ‘Pattern A.’” I replied, “large, buoyant, fluffy, rather than small dense, to avoid having oxidized, small dense LDL particles get stuck in the eroded endothelial layer of my arteries. I added that my very low hs C-Reactive Protein scores suggest that my arteries were not inflamed. I showed him my history of CRPs, and he did admit it was “impressive.” They had gone from 6.4 when I started very low carbing to a recent low of 0.1.
But then he said something that shook my faith that my new doctor and I were going to work out. He said, “The latest science is that all LDL are alike. They all get stuck. I asked him for a citation for that. I said I read a lot of medical journals and scientific papers – probably more than he did. He didn’t like that, and replied I did not. How can he know? Anyway, when I asked him later for the “LDL are all alike” citation, he replied, “Give it up!”
What I gleaned from this appointment is that Family Medicine MDs are trained to diagnose “incipient” Type 2 diabetes and treat it with pharmacotherapy. They’ve learned by rote the clinical definition of “diabetic” and “non-diabetic.” They know what Insulin Resistance (IR) is and believe it can be reversed, and “non-diabetic” status achieved, by weight loss alone. But this one doesn’t understand that THAT DOES NOT REVERSE Insulin Resistance

Retrospective #182: Avoiding “incident” Type 2 diabetes

What is “incident” Type 2 diabetes? The medical definition is the diagnosis and first intervention for the medical condition Type 2 diabetes mellitus. In clinical practice, “incident” diabetes is generally still defined as two successive office visits with fasting blood glucose (FBG) readings of ≥126mg/dl or a single A1c ≥6.5%.
The American Diabetes Association standard for diagnosing incipient Type 2 diabetes has changed over the years and continues to be controversial. In 1997, the FBG threshold was lowered from 140mg/dl to 126mg/dl. In 2009, the inexpensive A1c test, which measures the percent sugar on the surface of red blood cells (whose life is 2 to 3-months), became the new standard, and the A1c incident diagnosis criterion was lowered from 7.0% to 6.5%.
The A1C blood test is now the preferred method because it simulates the continuous level of glucose circulating in our blood, including the “excursions” (spikes) in postprandial blood sugar levels after eating meals and snacks. This “averaging” method is a more accurate measure of insulin resistance (IR) when “challenged” by a carbohydrate load. Insulin Resistance is the underlying mechanism responsible for high blood sugar (Type 2 diabetes).
Most clinicians still follow the guidance of the American Diabetes Association and strive, initially thru “lifestyle intervention” and then pharmacotherapy, to maintain a patient’s A1C at 7.0mg/dl. That translates to an estimated Average Glucose (eAG) of 154mg/dl and assures that the disease, and the pharmacotherapy, will be progressive. That means, eventually, that complications and co-morbidities like cardiovascular disease, kidney disease, neuropathy and retinopathy, are inevitable. In clinical practice most practitioners are complicit in the sense that their hands are tied by “Guidelines.” I don’t mean self-interest, but the trail of breadcrumbs tells a cautionary tale.
Quest Diagnostics lab reports state the current A1C “reference intervals,” as published annually in Diabetes Care, the Journal of the American Diabetes Association, are a guide to the diagnosis of incident Type 2 diabetes. They are:
< 5.7%           Decreased risk of diabetes
5.7-6.0%       Increased risk of diabetes
6.1-6.4%       Higher risk of diabetes
≥6.5%            Consistent with diabetes
A plain speaking translation of this very lax ADA standard for “incident Type 2 diabetes” is : ≥6.5% = You’ve got Type 2 Diabetes, period; 6.1-6.4% = You’re Pre-Diabetic; 5.7-6.0% = You’ve got “impaired glucose tolerance” (IGT); and <5.7% but rising = you’ve got “impaired fasting glucose” (IFG). In each case, it is telling you that you are Insulin Resistant (Carbohydrate Intolerant), and you’ve lost beta cell function, i.e., your ability to make your own insulin.
These stages are the “Natural History of Type 2 Diabetes.” They are described more fully in Retrospective #99, which is based on Dr. Ralph A. DeFronzo’s Banting Award Lecture at the ADA’s 2008 convention.
In the full paper published in the ADA Journal, Diabetes, Dr. DeFronzo says, “In summary, our findings demonstrate that, at the stage of IGT, individuals have lost over 80% of their β-cell function…” In the next section, “Pre-Diabetes,” he adds, “The clinical implications of these findings…are that the physician must intervene early, at the stage of IGT or IFG, with interventions that target pathogenic mechanisms known to promote β-cell failure.”
As a physician/researcher, Dr. DeFronzo cannot be faulted for advocating that “the physician must intervene early.” But how about the patient? The intervention that best targets the mechanism that kills beta cells is dietary. Eating carbs forces the pancreas to work. As you reduce carbohydrates, you spare your pancreas. It’s that simple, folks.
“Lifestyle interventions” can work, but not if the dietary message is wrong. Dietary changes, if initiated and continued by the patient, if the changes are the right ones, will work. If you eat right, in a way that spares your pancreas, it will allow you to burn body fat for energy and maintain stable blood sugars. That “right” Way of Eating is Very Low Carb. Reading this blog, for your amusement/edification, is a far better “lifestyle intervention,” IMHO.

Retrospective #181: The AHA/ACC Statin Guidelines and Type 2 Diabetes

In Retrospective #180, the 3rd category for individuals who should be on a statin, according to the American Heart Association/American College of Cardiology cholesterol guidelines, are the following individuals:
“Those with diabetes aged 40 to 75 years with LDL between 70-189mg/dL and without existing heart disease.”
That’s me, sort of, although I’m now 78 years old. My most recent LDL cholesterol (Martin Hopkins calculation) was 92. Never mind that my HDL was 80 and my triglycerides (TG) 56 and my total cholesterol (TC) was 186mg/dL.
As an important aside, though, I wonder, at my age (>75yo), with the Medicare budget cuts (+/-$750 Billion over 10 years) that were required to fund the Affordable Care Act, aka “Obamacare,” does the medical establishment just turn me out to pasture, as they would in most of Europe? Have I lived, in the government’s judgment, a useful but long enough life? Would I be just left, without treatment, to slowly dissipate…then die of “natural causes?” I ask because category #3, “those with diabetes,” is the only category with age guidelines for statin treatment.
But my issue with category #3 is with the phrase “those with diabetes.” Even Ann Peters, MD, writing about “How do New Statin Guidelines Affect Diabetes Care?” for Medscape Medical News, had to “ponder these guidelines” that “lump people with type 1 and type 2 together.” “I don’t think that type 1 and type 2 diabetes share similar features, at least not similar features with respect to the metabolic syndrome in all patients.” She treads lightly here, but I get her point. The clinician in practice needs to consider their individual patients. Bravo, Dr. Peters!
Dr. Peters describes herself “as one of the authors of the new diabetes position statement on the treatment of hyperglycemia” and “a diabetes specialist.” So, she is a fixture of the medical establishment, with a distinction:
“So, I think I will still monitor lipid panels. Perhaps not for absolute numbers, but to see that a patient is responding to therapy -- maybe as a marker for the fact that my patients are taking their therapy, and also to reinforce patients with some of the benefit from the treatments and lifestyle changes they have made, which I think can still be had along with the use of statin therapy in these high-risk individuals.”
“High risk individuals”? That’s how ALL diabetics are categorized by both these new statin guidelines and Dr. Peters. That includes not only type 1s, but ALL Type 2s as well, regardless of “the benefits of the treatments and lifestyle changes they have made.” By “treatments” Dr. Peters means drugs. And by “lifestyle changes” Dr. Peters means “diet and exercise,” although certainly not the very-low-carb, high-fat (VLCHF) Way of Eating that I espouse.
The medical establishment’s justification for this all-inclusive position for all diabetics is that, as Dr. Peters explains, “…regardless, [all] patients with diabetes are considered to be at high risk.” Thus, “Depending on their 10-year risk for an event, whether or not it’s greater than 7.5% (see category #4 in #180), they are all put on statins if they are between the ages of 40 and 75.” After age 75, in time, with standard nursing home care, they will be injected with basal and mealtime insulin and allowed to die of some other cause, such as heart disease or dementia.
In contrast, by eating a Very Low Carb diet, patients who have well-controlled Type 2 diabetes will have very good A1c’s, with stable blood glucose all day long, low blood pressure, low systemic inflammation, and great lipids including high HDL and low triglycerides, all without “taking their therapy”…since medical treatment for hyperglycemia will be unnecessary and unwarranted. But this doesn’t occur to Dr. Peters because her clinical practice is for people who need a “diabetes specialist.” If you treat yourself by the dietary choices you make, you will not need a diabetes specialist.
If, however, you’re a Type 2 and you follow the Lifestyle Modifications that accompany the new AHA/ACC Cholesterol Guidelines, your diabetes will be progressive as you “…consume a dietary pattern that emphasizes intake of vegetables, fruit and whole grains; includes low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils and nuts, and limits intake of sweets, sugar-sweetened beverages and red meats, ” with  emphasis on lowering saturated fat and sodium intake. And you will need a diabetes specialist… and a cardiologist too!

Thursday, August 15, 2019

Retrospective #180: The AHA/ACC Cholesterol Guidelines

In late 2013, the American Heart Association and the American College of Cardiology (AHA/ACC) issued a new set of cholesterol guidelines that is proving to be as disruptive as the Affordable Care Act (Obamacare). In fact, it is so much so that Medscape Cardiology issued a Special Report titled, “CV Risk Calculator and Guidelines Controversy.” It has six separate links to “News” and six more to “Experts Weigh In.” That’s way too much information for here.
So, succinctly put, what are the new cholesterol guidelines? And what’s all the stir all about?
The main recommendations are that individuals who fall into any of the following categories should be on a statin:
1.      Those with existing heart disease.
2.      Those with LDL levels above 190mg/dL
3.      Those with diabetes aged 40 to 75 years with LDL between 70-189mg/dL and without existing heart disease.
4.      Those without heart disease or diabetes, with an LDL between 70-189mg/dL and as estimated 10-year heart attack risk of above 7.5%.
The above bullets and the following analysis were provided by Ronesh Sinha, MD, at South Asian Health Solution.
“When comparing the old guidelines to this one, the first 3 categories are essentially unchanged. Most doctors would put heart disease patients, diabetics and those with LDLs above 190 mg/dl on statins. There are some advantages to the newer guidelines:
·         The focus of therapy is on statins, which are the default drug of choice. This is a good thing for those who truly need statins and should hopefully avoid cumulative toxicity from multiple drugs.
·         The concept of treating to a specific LDL target number has been eliminated. This is good since it should reduce unnecessary high dose statin therapy to reach low targets which have not been proven to reduce heart attack risk.
·         These guidelines do a better job of highlighting statin adverse side effects which will hopefully make clinicians think twice before pulling the statin trigger.
·         Greater overall emphasis on heart attack risk rather than a focus on the LDL number which makes more sense.”
Dr. Sinha’s main criticism is of the guideline’s 4th category: individuals who have no risk factors other than a 10-year heart attack risk above 7.5%. This is significantly lower than the prior cutoff of 20% and will result in many more people taking statins. Many more! And that’s actually an understatement. I recently saw an interview of a healthy individual on TV in which the doctor said to the 38-year old male, “In 2 years [when the patient achieved the category #3 threshold age of 40], you’ll be on a statin.” So, I decided to apply the “risk calculator” to myself.
The “risk factors” that are the sole basis of the 10-year heart attack risk are: Sex, Age, Race, Total Cholesterol, HDL-Cholesterol, Systolic Blood Pressure, Treatment for High Blood Pressure, Diabetes, and Smoker. I plugged my data into the new risk calculator and came up with a 10-year risk of atherosclerotic CVD of 28.1% (vs. 7.5%). Wow!
Then, I decided to see what I could do to lower my risk.  Age, sex, race were not things I could change. Neither could I improve my systolic blood pressure (110) or my diabetes (yes), treatment for hypertension (yes) or smoking status (no). And my HDL (85) was already outstanding. So, for me, that left only lowering Total Cholesterol (TC) and, using the Friedewald formula, the calculated LDL value. Quelle surprise! That’s what a statin does. So, I decided to ‘prescribe’ a statin for myself to lower my LDL and thus TC cholesterol by 50mg/dL, easily achieved on a statin. That would lower my LDL to 72, aligned to the goal of 70. Result, my 10-year risk of ASCVD was reduced from 28.1% to 25.3%. Hmmm… That reduction, even while taking a statin, was disappointing, to say the least.
Turns out, the only thing I could do that would lower my 10-year risk factor to 8% (near the 7.5% goal), was to lower my age 15 years. Otherwise, if my doctor followed these new guidelines, I would be on a statin.  No way, Jose! Fortunately, my doctor doesn’t follow the 40-year old rule, but your doctor may. Do you see where I’m going?

Wednesday, August 14, 2019

Retrospective #179: Vitamin D Supplementation

Supplementing with Vitamin D has become all the rage in recent years, but “Low concentrations of 25-hydroxyvitamin D (23[OH]D) are most likely an effect of health disorders and not a cause of illness,” according to a piece in Medscape Medical News.  The article reported on a “comprehensive review of observational studies and randomized clinical trials of Vitamin-D status and health outcomes” and appeared in Lancet Diabetes & Endocrinology. The author provided a link to a large-cohort study that had shown “strong associations” of low Vitamin D Concentrations (<30nmol/L) with all-cause, cardiovascular, cancer and respiratory disease mortality.
Vitamin D is an odd bird sort of “Vitamin.” It is not, strictly speaking, an essential Vitamin because, according to Wikipedia, it can be “synthesized in the skin, from cholesterol, when sun exposure is adequate.” However, people who live further from the equator get less exposure to the sun’s rays in winter. And people who work indoors get even less exposure. Plus, out of concern for skin cancer, many people block sun exposure with lotions. Finally, the elderly (mainly women), and others with limited mobility, have less opportunity to get Vitamin-D by natural means.
So, according to Wikipedia, “like other compounds called Vitamins, in the developed world, Vitamin-D is added to staple foods, such as milk, to avoid disease due to deficiency.” So, the Medscape piece said, the enthusiasm for Vitamin-D supplementation has been fueled by its “relatively low toxicity, the glimmer of positivity from some trials, and the large body of evidence from prospective observational studies.” In addition, the Vitamin-D supplement industry, and the artificial UV tanning industry have all helped fuel the enthusiasm.
Medscape related, “The new analysis showed moderate to strong associations between lower concentrations of 25(OH)D and higher risk of conditions from cardiovascular disease to infectious disease, glucose metabolism disorders, and mood disorders.” “The discrepancy between observational and interventional studies suggests that low 25(OH)D is a marker of ill health.” Quoting the Medscape piece, “In the interventional studies, participants had a baseline mean 25(OH)D concentration of less than 50nmol/L. Supplementation with 50µg/day of Vitamin D resulted in no significant improvement in health status.” Unit conversion: 50µg/day = 2000 iu.
This Medscape excerpt also addresses the effect of Vitamin-D supplementation’s on diabetes and cancer.
“As part of their review, the authors…conducted a meta-analysis of 16 trials that focused on the effects of Vitamin-D supplementation on HbA1c, the standard measure of long-term blood glucose control in diabetes. Although the observational studies showed an association between Type 2 diabetes and low Vitamin-D levels, supplementation with the Vitamin had no effect on reducing HbA1c.
The data also showed that high 25(OH)D concentrations were associated with a protective effect on colorectal cancer, but not other cancers. However, 2 large intervention trials showed no reduced risk of any cancers, including colorectal, with Vitamin-D supplementation.
One exception was seen in the elderly population (mainly women), who showed a slight reduction in all-cause mortality if they received Vitamin-D supplementation of 20 µg/day (= 800 iu). However, the authors say that the improvement could be related to Vitamin-D deficits caused not directly by the illness itself but by lifestyle changes resulting from the illness, such as a lack of mobility, restrictions on exposure to sunlight, or dietary modifications related to treatment.
‘In elderly people, restoration of Vitamin-D deficits due to aging and lifestyle changes induced by ill health could explain why low-dose supplementation leads to slight gains in survival,’ they suggest.”
Medscape reports, “The authors speculate that a key mechanism that causes lower 25(OH) D concentrations in people with illness is disease-related inflammation.” “Ongoing trials will provide more information, but in the meantime (we) advise against Vitamin-D supplementation. In addition, says an author, “If an individual’s Vitamin-D concentration falls below a ‘sufficiency’ threshold of 75nmol/L, supplementation (is) an ill-advised practice.” “The wealth of evidence from randomized trials shows that this medical behavior is not grounded, and taking Vitamin-D supplements will make no difference in health status.” “It would be wiser to seek reasons underlying the low Vitamin-D level, such as inflammatory processes, or undiagnosed cardiovascular diseases, and fix them.

Tuesday, August 13, 2019

Retrospective #178: “Diabetes Rocks!”

The late David Mendoza wrote a nice article for Health Central in 2014 titled “Grateful for Diabetes.” Another one that month was titled “Diabetes without Drugs.” Both were excellent and short, and I recommend you search for and read them. But my favorite line from both was the last words of the “Grateful” piece: “Diabetes rocks!”
Mendoza explains “grateful” this way: “Knowing that we have diabetes can be good for us. You may think I’m crazy,” he says, “but some of us are thankful that we have diabetes. I wish all of us could share this feeling.” Note: it is actually the feeling that he is grateful for, not the diabetes. It is his reaction to the knowledge that he is a diabetic. But, having that knowledge, what action was taken? Mendoza explains it with a story:
“Mary Ann wrote me a few months ago that when a doctor told her she had diabetes, she didn’t know anything about it. At first, she felt shock, fear, anger, and grief. Then, she realized that she ‘had to be the one to take control of it’ and went on a low-carb diet, which helped her both to lose weight and to reduce her blood sugar. ‘I’m actually grateful for the diabetes diagnosis,’ she told me [Mendoza]. It inspired me to take control of my health’’’ (emphasis mine).
Mendoza then goes on to describe how, “Mary Ann’s journey from a diabetes diagnosis to good health parallels his own journey” (and mine). At the time he was diagnosed, he says, “I had an A1c of 14.4, weighed more than 300 pounds, and lacked energy.” “Today,” he says, “I tested my A1c…and found it is 5.4. I weighed myself, as I do every morning, and found that I now weigh 155.6 pounds. I have more energy than I had 20, 30 or even 40 years ago.”
Isn’t that inspirational? Do you understand now why David Mendoza, and I, say, “Diabetes rocks!”?
In “Diabetes without Drugs,” Mendoza tells more of his personal story. The lede of this piece in Health Central, and on his own website, says flat out, “If you have Type 2 diabetes, you can manage it without any drugs.” Mendoza doesn’t pull his punches. This is an unqualified statement, and he is an exemplar, to be sure. I wish I did as well.
David Mendoza was diagnosed a Type 2 diabetic in 1993. He was treated by his doctor in the orthodox way for 14 years, with “experience taking a wide range of diabetes drugs, including two different sulfonylureas, Glucophage (Metformin), and Byeta” (a GLP-1 injectable incretin mimetic). Then in 2007, with encouragement from a friend who is a Certified Diabetes Educator, he joined “a group,” “and for the past six years I haven’t taken any diabetes drugs, and yet I keep my diabetes in control with an A1c level usually about 5.4. When you manage your diabetes well, it [your A1c] is well controlled. It is normal. We know that the normal A1c is 6.0 or below.”
“An A1c level of 6.0 or below means that your diabetes is in remission,” Mendoza says. “It does not mean that you have cured it. If you relax your vigilance, your A1c level will go above 6.0 again, and you will again put yourself at risk of the terrible complications of uncontrolled diabetes.”
Mendoza doesn’t explain in this piece what “the group” he refers to was, but I’ll venture a guess it was a group of people who were motivated to be educated and seek mutual support to, among other things, undertake a Very Low Carb Way of Eating. “Any lifestyle change this fundamental is difficult,” Mendoza admits. “I had to make three big changes in my life when I went off the diabetes drugs, and they are hard at first. But now they are a routine part of my life, and I would never go back to my old ways.
The changes that I had to make are those that almost everyone who has diabetes has to make. In order of importance, I had 1) to lose weight, 2) eat fewer carbohydrates, and 3) exercise more.”
As my readers know, my story is similar to Mendoza’s. I was diagnosed in 1986 and treated in the orthodox way with oral meds (3 classes, maxed out on 2)) for 16 years until my doctor suggested I try Very Low Carb (20 net carb grams a day) to lose weight. I had to drop the meds immediately and lost (at one point) over 180 pounds. My latest A1c was 5.6, but it has been as low as 5.0%. But I don’t do regular exercise. It makes me sweaty and hungry. LOL

Monday, August 12, 2019

Retrospective #177: The ADA’s Helpful Advice?

Readers here are accustomed to me slamming the ADA for their Type 2 diabetes treatment protocol (except when I am singing their praises as in “Cowabunga, the ADA makes the turn”). So, if you’ve had enough of that, read their magazine. That’s what I was doing in the doctor’s waiting room the other day when I came across this dreadful advice in a feature called, “Mail Call: Ask the Experts.” It was in a 2011 issue of the ADA’s Diabetes Forecast.
The reader wrote that she had recently been having “morning” (fasting?) readings in the 150-180mg/dl range and “…I cannot get them down.” She wanted desperately to know what was happening and what she could do about it. She explained that she was already taking two types oral diabetes meds, metformin and glipizide, a sulfonylurea. The response came from ADA expert Belinda Childs, ARNP, MN, BC-ADM, CDE. (Whew?)
The ADA’s expert told the letter writer (and all readers of this, the ADA’s official outreach organ, intended to educate the Type 2 diabetic population): “Type 2 diabetes is a progressive disease,” and “over time the body is less able to produce insulin. As your body’s needs change, additional treatments may be needed.”
Then, almost the entire balance of her reply to the letter writer was seven paragraphs describing in detail, by brand name, each of the classes of oral and injected diabetes prescription medications which were still available for her physician to prescribe as her disease “progresses” to becoming, ultimately, an insulin-dependent Type 2. That was it. Not a word about food choices, or carbohydrates. Just leave your diabetes care to your doctor and Big Pharma.
Of the magazine’s 80 pages, 28 pages (35%) were devoted to advertising, most of that for prescription meds. My observation is purely associative, though; it does not prove causation. Perhaps a randomized controlled trial might test the hypothesis that the expert advice given, and the medical advertising accepted, has a direct relationship. How about publishing the magazine without any pharmaceutical advertising, with just content advocating medical treatment? As a control, publish an edition in which the content recommends that Type 2 diabetes be treated by food choices alone, one edition with and one without big pharma ads. Do you think this ADA rag would survive?
The primary mission of the ADA and Big Pharma is their mutual survival. They need to sell ads to Big Pharma. To prosper, they must keep the pharmaceutical companies and the doctors who write the prescriptions happy. And doctors need to keep the patient dependent on medications too. How else can your doctor keep you coming back, besides saying, “Eat less (of a low-fat, high-carb diet) and exercise more”? Especially since that dietary prescription doesn’t work! Come to think of it, the last thing my doctor asked me recently was, “Need any renewals?”
The ADA’s Diabetes Forecast magazine masthead tells me the story of the ADA itself. There’s an MD in charge of “Medicine and Science,” and an RN, MSN, in charge of “Health Care and Education.” Other than that, all the other ADA officers are MBAs, CPAs, or without specialized credentials. The ADA magazine’s Editor-in-Chief and Associate Editors all have medical or related credentials. They also have an editorial board, on which our “expert” serves.
The ADA’s “Our Mission” statement on their masthead page has 3 high-sounding but rather limp tenets, especially #3: “The American Diabetes Association recommends that consumers familiarize themselves with nutritional information about food products.” That sounds to me like I am not the first to rail and foment about their mission.
Perhaps this is simply the natural history of any non-profit organization. See, for example, the “Illustrated History of Heart Disease: 1825-2015” timeline on the Diet Heart Publishing website: “In 1948 the AHA reinvented itself as a fundraising organization.” The parallels with the ADA are similarly disturbing. I think the list of corporate donors to the ADA, at, will help you understand why I view any medical advice coming out of the ADA with the contempt I think it deserves.
The ADA’s RDs and CDEs, as I reported in “Cowabunga…” have made the turn. It remains now only for the ADA’s medical side to have a similar awakening. I am dubious that they will though, given where their “bread is buttered.”

Sunday, August 11, 2019

Retrospective #176: Eggs, Cholesterol and Choline

Recently eggs have had a checkered history. Why? Only 1 reason:  they are high in cholesterol. Ever since Dwight Eisenhower had a heart attack in 1955, our government has been telling us that dietary cholesterol is a no-no. Ancel Keys aggressively promoted the idea, joining the American Heart Association board and making the cover of Time magazine in 1961; and then in 1977, the McGovern Commission’s “Dietary Goals for the United States” institutionalized it. Eggs are “artery clogging” and will cause heart disease. Hogwash! And everybody knows this, but in case you haven’t heard it:
The Nutrition Source website of The Harvard School of Public Health starts off, “Long vilified by well-meaning doctors and scientists for their high cholesterol content, eggs are now making a bit of a comeback. While it’s true that egg yolks have a lot of cholesterol—and so may weakly affect blood cholesterol levels—eggs also contain nutrients that may help lower the risk for heart disease, including protein, vitamins B12 and D, riboflavin, and folate. A solid body of research shows that for most people, cholesterol in food has a much smaller effect on blood levels of total cholesterol and harmful LDL cholesterol than does the mix of fats in the diet.” (Emphasis mine) That may be faint praise, but I’ll accept it, coming from Harvard.
I eat 3 fried eggs a day, 6 days a week, cooked in bacon grease (from one strip). Occasionally, we have scrambled eggs, with whole milk and cheese. I always add salt and pepper, and I take my coffee with stevia and heavy cream. My latest HDL cholesterol was 85, triglycerides 49, total cholesterol 217 and LDL 122 (Pattern A: large-buoyant).
I mention my blood lipids because the uninformed reader, upon learning that I eat 3 eggs a day, might ask, “How about your cholesterol?” The government has recommended from 1977 until the 2015 DGA that people eat no more than 300mg of dietary cholesterol a day. Three eggs yolks contain 634mgs. With the heavy cream and bacon, I’m at 700mg for breakfast alone. With sardines for lunch and maybe shrimp for dinner, I could be over 1000mg!
I buy eggs at our local farmers’ market. The feed is soy-free. The vendor is a local farmer, who also raises heritage pigs and grass fed beef and rotates their chicken-coop-on-wheels from pasture to pasture, Joel Saladin Polyface Farms style. I pay a little more for these eggs, but I know that they are as good as I can get.
Because they contain “complete protein”, eggs are one of the best foods you can eat, and hens that range freely on pasture produce the best eggs, nutritionally and in terms of taste. Like people and pigs, chickens are omnivores, so they eat insects and larvae (from fermenting “flops”). Their eggs are higher in, among other things, Omega 3 fatty acids, the “good” polyunsaturated fat that is “essential” for humans. That’s why I also eat sardines (in olive oil) for lunch and supplement with a 1-gram capsule of fish oil twice a day – to get the EPA and DHA in the Omega 3s. 
Another reason to eat 3 eggs a day is to get extra choline. According to Wikipedia, “Choline was classified in 1998 as an essential nutrient by the Food and Nutrition Board of the Institute of Medicine. Choline is the precursor molecule for the neurotransmitter… (that) is involved in many functions including memory and muscle control.”
“Choline must be consumed through the diet for the body to remain healthy,” according to the Linus Pauling Institute at LSU. “It is used in the synthesis of the constructional components in the body's cell membranes. Despite the perceived benefits of choline, dietary recommendations have discouraged people from eating certain high-choline foods, such as eggs and fatty meats. The 2005 National Health and Nutrition Examination Survey stated that only 2% of postmenopausal women consume the recommended intake for choline.”
“A 2010 study noted young women should be supplied with more choline because pregnancy is a time when the body's demand for choline is highest. Choline is particularly used to support the fetus's developing nervous system.” Can you think of a better reason to eat lots of eggs?

Saturday, August 10, 2019

Retrospective #175: “Your blog is primarily for Type 2 diabetics, right?”

I was chatting with an older friend recently when he said, “Your blog is primarily for Type 2 diabetics, right?”  I fumbled a bit and said, “Yes, but…it’s also for pre-diabetics and people who are overweight and likely to have Metabolic Syndrome, including low HDL, high triglycerides, and small-dense, not large-buoyant LDL particles.”
I saw his eyes glaze over, so I quickly added, “Some people have a genetic predisposition to a disregulation of fat metabolism called Insulin Resistance (IR).” I said, “Losing weight for some people was not just about eating less (of a balanced diet) and exercising more.” At this point, the man, who is quite thin, replied that that was how he lost weight. I had now lost him on both points. He was clearly looking to change the subject, and I don’t blame him.
I have been a Type 2 diabetic since 1986, and for the first 16 years my doctor told me to lose weight and treated me with medications. Over the years, he increased the doses until eventually I was maxed out on two and starting a 3rd. This was considered “normal” because, according to medical orthodoxy, Type 2 diabetes is a “progressive” disease. He also told me how to lose weight; “Eat a calorie-restricted, balanced diet and exercise more,” he said.
This orthodox “prescription” didn’t work for me. Over the years I got fatter and sicker, until in July 2002 my doctor read Gary Taubes’s seminal New York Times Sunday Magazine cover story, “What If It's All Been A Big Fat Lie?” He tried the very-low carb diet (Atkins Induction, just 20g of carbs a day), and then suggested I try it, to lose weight.
What happened, instead, was that on Day 1 I got a hypo. So, I called my doctor, and he took me off the 3rd med. The next day I had another hypo, so I called him again, and he told me to reduce the other two meds by half. Then, a few days later, he had me reduce them by half again. Later, I eliminated one, and today I just take Metformin.
So, the immediate effect of eating a very low carb diet was that, after 16 years of FBGs in the 150s on 3 meds, my blood sugar had returned to normal on a minimum dose of Metformin. I also lost a lot of weight (eventually, over 180 pounds), and my blood pressure was much better controlled (from 130/90 to 110/70) on fewer meds.
In addition, my HDL cholesterol more than doubled from 39 to 81, and my triglycerides were reduced by almost two-thirds (from 137 to 49), and the LDL particles changed from Pattern B (small-dense) to Pattern A (large-buoyant). Finally, my hsCRP test, a marker for systemic inflammation, decreased from 6.4 to a low of 0.1.
So, is this blog just about or for Type 2 diabetics? I think not. This blog is about HEALTHY EATING, for everyone.
It is for eating whole, real foods, not processed and manufactured foods. Dr. Kurt Harris, an early thought leader who developed the Archevore Diet, once described it as avoiding “the Neolithic agents of disease – wheat, excess fructose, and excess linoleic acid” (in vegetable oils). Harris said, “It is becoming clear now that many of the diseases afflicting humanity are not a natural part of the aging process, but are side effects of the technology and other powerful cultural changes in the way we eat and live that have occurred since the dawn of agriculture roughly 10,000 years ago.”
Harris’s manifesto: “I believe we can make sense of many of the diseases prevalent now and relate them to some simple but profound changes that have occurred with the introduction of agriculture and the more recent industrialization of our foodways. These changes are related to how the food environment, including its availability, interacts with the metabolic environment of our bodies. The diseases of civilization are largely related to the abandonment of the metabolic conditions we evolved under.”
Gary Taubes and Dr. Harris, and my doctor who introduced me to Very Low Carb, are in my pantheon of heroes.
So, it’s true, I think: most of my readers are Type 2 diabetics or Pre-diabetics (Metabolic Syndromers), or just IR (Insulin resistant and thus carbohydrate intolerant) and overweight or obese. Today, however, that’s the majority of the U.S, population. For us that’s nearly EVERYONEVery Low Carb is the best way avoid the Diseases of Modern Civilization…including “age-related” (DIET RELATED!) mild cognitive impairment (pre-Alzheimer’s).

Friday, August 9, 2019

Retrospective #174: 23andMe and the Self-Care Brouhaha

According to a November 2013 Washington Post story, the FDA ordered 23andMe to stop marketing its genetic diagnosis kit. 23andMe claimed to be able to identify 254 conditions based on a biological sample (a cheek swab). The FDA says that a false negative or a false positive could “mislead consumers and could unwisely convince them to self-treat, with potentially deadly results.” Damn! So, we must be content with the information our government has approved and that the health care establishment has dispensed, with government’s approval? No way, Jose!
Where does one begin to tear this thinking apart? Let’s address the conspiracy theories first. Who brought the complaint about this company’s product to the FDA’s attention? According to one commenter on the Post’s website, who provided a link to Bloomberg News, it was UnitedHealth Group, “the US’s #1 publicly traded insurer.”  To which another commenter replied, “Isn’t the unfettered free market great? To which the original commenter replied, “And now UHG can require patients to use its own in-network Premium Kit, developed by a ‘trusted partner,’ that does less accurate testing for 10 times the price. These savings all brought to you by the FDA.”
Another conspiracy theorist speculates, “Looks like Sergey Brin is using his buddy Obama to exact revenge on his estranged wife, Anne Wojcicki,” to which yet another replies, “Did the Google husband withdraw support from his divorcing wife?” Backstory:  Brin is a co-founder, with Larry Page, of Google, and was worth (in 2013) about $25 billion. His wife, who is divorcing him for his dalliances, is co-founder and chief executive of 23andMe.
According to Wikipedia, Brin’s mother was diagnosed with Parkinson’s in 2008. Brin used 23andMe to find out that he has “a 20 to 80% chance of developing Parkinson’s later in life.” When asked whether ignorance was not bliss in such matters, he stated that his knowledge means that he can now take measures to ward off the disease. An editorial, “Enlightenment Man,” in the print edition of The Economist magazine states that, "Mr. Brin regards his mutation of LRRK2 as a bug in his personal code, and thus as no different from the bugs in computer code that Google’s engineers fix every day. By helping himself, he can therefore help others as well. He considers himself lucky.  But there’s a much bigger point. Isn’t knowledge always good, and certainly always better than ignorance?”
Anyway, my interest in this subject relates to free enterprise, individual liberty and the frontiers of science – not juicy gossip or political intrigue. I have been urging readers to “take charge of their own health” in part as an act of individual responsibility, in part to preserve personal liberty, and in part as a reaction to the horrible dietary advice that our government has been dispensing through its own agencies. Government has enormous control over the private sector. It acts through the medical establishment by way of “research” funding and regulatory approvals. This in turn influences clinical practice and dietary practices in institutions and for private citizens.
And then, on the individual liberty front, one commenter complains, “It’s really sickening we’ve reached the point where the state wants to regulate one’s own ability to access information ABOUT ONESELF…never mind that they want access to and control over all information ABOUT you.” Another sarcastically put it this way: “This is just the government looking out for us. It’s far better that the health agency has more information about me than I do.” “Thank you, President Obama,” he says, “for putting a stop to my entering willingly into an agreement with a private company. Their research and data could undermine federal initiatives that would be unacceptable.” To put a fine point on it, another says, “Deciding whether I can buy a genetic test to analyze my genome and what I do with it is a place in which the government should have no role.”
Agribusiness and Big Pharma are both happy with this arrangement though. They just develop, manufacture and market products to comply with the government’s “healthy diet,” which is the one making us fat and sick. So, it wouldn’t surprise me that UnitedHealth Group wants to maintain its control of their leading position in the market.
It’s too bad, though. Knowledge IS good, and better than ignorance. I hope that after the divorce in finalized, Ann takes the FDA to court. That way both she and we will be free. NB: It turns out, she did, and 23andME is back.

Thursday, August 8, 2019

Retrospective #173: “Anyone can be a doctor…”

When I first read, “Anyone can be a doctor…,” my reaction was, this is over the top. To be clear, it was just a comment on Authority Nutrition, a website founded by Kris Gunnars and sold to Healthline in 2017. Still, I thought, it went too far. Then, as I read on “…so long as you stay away from drugs and supplements and stick to using food as your medicine,” I came to see the point. And the commenter had got my attention with a trenchant and pithy lede. It was, after all, Hippocrates, father of Western medicine, who said, “Let food be thy medicine and medicine be thy food.” So, it was just echoing Hippocrates, who also said, Primum non nocerum,” “First do no harm.”
Okay, I’ll admit that medicine has come a long way since 370 BC, but so has “food,” unfortunately, in ways that are mostly detrimental to our health. The prescription to use food as our medicine was more prescient than most will acknowledge today. Yet many clinicians and health care providers, and bloggers like me, are absolutely convinced that the dietary advice that our government has been giving us since the days of Ancel Keys’s 1953 “Six Country Analysis” and George McGovern’s 1977 “Dietary Goals for the United States,” has been directly responsible for the  metabolic maladies which underlie the Diseases of Civilization. The “Dietary Guidelines for Americans,” produced every 5 years since 1980, echo this horribly-gone-wrong government intervention and still reign supreme today.
Crop production, food manufacturing and marketing have been driven by the USDA’s prescription that our diet be composed of 60% carbohydrates, 30% fat, and only 10% protein. Further, the guidelines still ordain that animal products, which are higher in saturated fats and cholesterol, be reduced, and artificially manufactured vegetable fats, such as soybean oil, corn oil, canola oil, safflower oil, etc., be increased. These “prescriptions” are totally wrong and, in and of themselves, the cause of our health and obesity crisis.
So, under these circumstances, what’s a person to do? The answer, of course, is to be your own doctor – to take charge of your own health…with respect to your “dietetic prescription. I discovered – completely by accident – that changing what I ate “cured” my metabolic disorders. My motivation was simply to lose weight, so when my doctor suggested I try Atkins Induction (a very low carb diet), I tried it. It changed everything. Thank goodness he had read Gary Taubes’s “What If It’s All Been a Good Fat Lie,” a 2002 New York Times Sunday Magazine cover story.
I wasn’t hungry, my blood pressure dropped from 130/90 to 110/70 on the same meds, my HDL more than doubled, and my triglycerides went down by more than 2/3rds. My total cholesterol stayed about the same, as did my LDL, but my LDL particle size/pattern changed from “small-dense” to “large-buoyant,” meaning they were less likely to get stuck in ruts in my arteries caused by systemic inflammation. My hs-CRP, a lab test which measures inflammation, went from 6.4 in early 2003 to a low of 0.1 in late 2012. Oh, and I lost 170 pounds along the way.
Many people today subscribe to a proverb associated with the prophet Luke, himself a physician: Cura te ipsum ("Take care of your own self!" or "Cure yourself, before dealing with patients.” My doctor, an internist/cardiologist, after reading Taubes, had tried Atkins Induction himself. So, I had my doc to guide me and I trusted him implicitly.
But my doctor at first had followed the 2nd version of the English translation of the Hippocratic Oath before he followed the 1st version: The operable provision of the 2nd (modern) version is: “I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.” The same provision in the 1st translation is: “I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.” (Emphasis mine in both quotes) My doctor, being trained to treat disease with drugs, had “prescribed regimens” before he “applied dietetic measures.”
So, my doctor, in his unending search for a way for me to lose weight and keep it off, suggested, after reading Taubes, that I apply dietetic measures, AGAINST the medical establishment’s recommendations. He did it “for the good of his patient,” and he “kept me from harm.” He must have recognized a risk, but by monitoring my health closely, we learned that the clinical outcomes clearly justified going against big government. Good on him, I say!

Wednesday, August 7, 2019

Retrospective #172: “Everybody knows that…”

Have you seen the Geico commercial that begins with two people and one sees an ad on a billboard and reads it aloud: “Did you know that you can save 15% or more in 15 minutes by calling Geico?” Then the other person says, “Everybody knows that.” This comment implies that the message is oversold.
Well, “Everybody knows that” is what the waitress told me in a lunch place in New Orleans once when I told her I was diabetic and wanted to know if there was breading on the Oysters Bienville. It turns out there was, and I changed my order to raw oysters, but it made me wonder if everyone who is diabetic, pre-diabetic, or overweight knows that they are “carbohydrate intolerant.” And if so, why do they ignore this simple precept of healthy eating?
Of course, even those of us who are totally “carbohydrate intolerant” will allow ourselves some indulgences. At Christmas, my wife bakes a double batch of a dozen types of cookies for gifts and for the Christmas Eve table. I will wait until then to have a few, always making sure the plates are outside my reach on the table. And I’ll have enough cheese beforehand to “count” as an entire meal. My stepdaughter and her husband always bring a nice cheese board. Another stepdaughter and her husband will bring homemade aquavit and pâté, and I’ll drink and eat more than my share. My third stepdaughter and her husband host with a true smorgasbord (a Swedish heritage).
So, how can anybody be a Grinch during the holiday season? It’s just that… everybody knows what “healthy eating” means. Of course, it can mean different things to different people. People with healthy metabolisms can indulge without much ado. Others can just skip dinner for a day when they need to lose a few pounds. Kids will turn a sugar high into hyperactivity and maybe a growth spurt (hopefully a vertical one). Old folks will take a nap when their blood sugar crashes. And people like me will return to “normal” blood sugars (<100mg/dl) in just a few days.
But I am haunted by the Type 2 man I met in Louisiana a while ago whose doctor said it was okay to eat bread with breakfast, and who had spaghetti for lunch, and takes oral diabetes meds plus basal and mealtime insulin and walks with a pronounced limp. I can’t help but think of what his doctor’s dietary prescription portends for him.
I am haunted by the 52-year old 30-year registered nurse (!) whose obituary I read this week and whose family suggested memorial donations be made to the American Diabetes Association. I lot of good that will do her!
And I am haunted by the memory of my pharmacist whom I had known for many years when I went to buy my first blood glucose meter. That’s when he told me that he was an insulin-dependent Type 2 diabetic. We were the same age, and when he died an early death quite a few years ago now from one of diabetes complications or one of its many co-morbidities, his death shocked and saddened me. It was then and remains now the impetus for me to write about my Type 2 diabetes and my weight loss/health benefits experience.  My very low-carb WOE lifestyle change produced, besides the intended effect of weight loss, the added unintended and unanticipated salutary effects of vastly improved lipid (cholesterol) health and blood pressure. It “cured” my Metabolic Syndrome.
These people – even the man in Louisiana, and certainly the Registered nurse and the pharmacist – knew better, or should have known better. Everybody knows, or should know, that carbs, when you have Insulin Resistance, are what make your blood sugar go up and stay up. This damages your body, invariably leading to premature death.
Everybody knows that…so don’t be self-destructive. If you have to indulge,” eat too much fat and protein, or wine! That’s what I plan to do. You should have a plan too. It then becomes a matter of personal integrity; you are accountable to yourself for keeping your resolution. Be reasonable, though. Allow yourself some indulgences.
This was my holiday message at the end of 2013. January 1st will come soon enough, I said, and you can reset your resolve to “fly straight” thereafter. I will. I will set a goal to lose the weight I will have put on over the holidays. January always represents a fresh start for dieters. And the super bowl doesn’t come until February, so there’s plenty of time to get back on track, if you wandered off during the holidays. Don’t be too hard on yourself.

Tuesday, August 6, 2019

Retropsective #171: “Dietary Protein and its Impact on Obesity”

“Dietary Protein and its Impact on Obesity” is the title of an essay in Diabetes in Control, a website for physicians that I monitor. It is yet another “take” on a study published in Obesity Reviews I reported on in Retrospective #170, “Your ‘instinctive appetite’ for protein’.” Medicalese notwithstanding, the takeaway was the same: “Analysis of percent protein in diet versus total energy intake showed that when a person’s diet was decreased from 20% protein to 10% protein, there was a significant increase in non-protein energy consumption and vice versa.”
“Age, study duration, and baseline BMI had no impact in dietary percent protein versus non-protein energy intake, but sex, however, did,” this analysis reported. “Men tended to have a higher dietary protein intake as compared to women.” This correlates with an early meta analysis I read years ago that reported that men averaged 16% dietary protein vs. 15% for women. Interestingly and I think very significantly, the Standard American Diet (SAD) recommends only 10% dietary protein (50g RDA of protein = 200kcal or 10% of a 2,000kcal daily intake for a woman, as illustrated on the Nutrition Facts panel on processed food packaging. A very low 10% recommendation for protein is problematic for me and ties in nicely with the hypothesis of this study, as I shall explain.
“The study also analyzed high protein intake, but diets with >20% protein did not show significant correlation to decline in energy consumption,” the Diabetes in Control piece reported. “According to the authors, maintaining proper proportions of macronutrients is…important not only for our muscles and cellular building blocks, but also to keep overall non-protein [carbohydrate and fat] energy intake down.
The “Practice Pearls” for this Diabetes in Control piece were as follows:
  • Persons who maintain diets with 15-20% protein intake tend to intake less energy from carbohydrates and fats.
  • Macronutrient energy intake should be calculated as a percentage of total diet; actual protein amount doesn't matter as much if it is diluted by the amount of carbohydrates and fats.
  • Persons who fall in low socioeconomic status and women tend to eat less protein.
In the referenced research, “Protein leverage and energy intake,” the authors said, “Increased energy intakes are contributing to overweight and obesity. Growing evidence supports the role of protein appetite in driving excess intake when dietary protein is diluted. Understanding the interactions between dietary macronutrient balance and nutrient-specific appetite systems will be required for designing dietary interventions that work with, rather than against, basic regulatory physiology.
“Percent dietary protein was negatively associated with total energy intake irrespective of whether carbohydrate or fat were the diluents of protein. The analysis strongly supports a role for protein leverage in lean, overweight and obese humans. A better appreciation of the targets and regulatory priorities for protein, carbohydrate and fat intake will inform the design of effective…weight loss diets, food labeling policies, food production systems and regulatory frameworks.”
So, the “protein leverage hypothesis” proffers that 1) increased energy intakes has contributed to overweight and obesity; 2) that protein as a macronutrient in the human diet has been diluted by either or both carbohydrates or fat by the excess intake of one or both; and 3) that the “protein appetite” is driving this excess intake of either or both carbohydrate and fat. The study concluded that the “right” amount of protein is 20%, and that this “protein leverage” applies to everyone.
Conclusion: “…when a person’s diet was decreased from 20% protein to 10% protein, there was a significant increase in non-protein energy consumption and vice versa.” Reminder: the “Standard American Diet” (see the Nutrition Facts panel) prescribes an RDA of 10% protein, 30% fat and 60% carbohydrate. Could it be that our government’s recommendations are what is making us fat? It is comforting to me that my target macronutrient distribution is 20% protein, 75% fat and 5% carbohydrate. What’s yours?

Monday, August 5, 2019

Retrospective #170: Your “instinctive appetite” for protein

Some time ago, I saw an interesting study from the University of Sydney’s Charles Perkins Centre, published in Obesity Reviews. The press release said, the study “shows the overriding drive for dietary protein could be a key factor in the global obesity epidemic.” Further, “Human’s instinctive appetite is so powerful that we are driven to continue eating until we get the right amount of protein, even if it means consuming far more energy than we need.” (bold added)
We found that regardless of your age or BMI, your appetite for protein is so strong that you will keep eating until you get enough protein, which could mean you are eating much more [non-protein, i.e., carbs and fat] than you should,” the lead author said. “As diets shift toward an increased proportion of foods that are higher in carbohydrates or fat, available protein is reduced and energy intake [from carbs and fat] necessarily increases.
Two more: “The strength of your nutritional drive for protein is frightening within our nutritional environment, where there are a large number of low-protein foods consumed on a regular basis.” And, “We have shown that when people are trying to lose weight, they need to look at macronutrient composition, not just calories. If you cut your calories but don’t consider protein intake, you’re going to be hungry and your diet won’t be successful.”
So, the hypothesis is, “Your metabolic drive for protein causes you to eat too much “energy”? To explore that question, we first need to clarify “energy in the context of food. Of the three macronutrients that supply nutrition – carbohydrates, fat and protein – only carbohydrates and fat provide “energy.” Dietary protein is not a source of energy, per se; it breaks down to 21 amino acids, some of which the body can’t make and which are therefore called “essential.” Amino acids are the basic machinery of all cells. We need to eat protein every day.
Carbohydrates and fat are the body’s main sources of energy. The body is designed to use carbohydrates first, both from the carbohydrates we eat and from glycogen, which is glucose stored primarily in the liver and muscles. When carbs, both sugars and starches, are digested, they are converted by the liver to glucose and burned for energy. The excess is stored as glycogen, or if the liver is full of glycogen, convert it to fat. To repeat: So long as the body has glucose available, either from food or stored, it will use it for energy first and store any excess as glycogen or fat.
That is why we have always had such a hard time losing weight when we eat carbs for energy. The body sensibly uses carbs, and signals “hunger” because it can’t access stored fat. The body wants to save stored fat for when carbs, as glucose or glycogen, are not available, as while we sleep (if we’re ketogenic).
But, when glucose and glycogen energy stores are used up, and we eat very few carbohydrates, the body naturally transitions to using fat for energy. When it does this, it continues to make the very limited amount of glucose the body needs for cells that don’t have mitochondria. Glucose is so essential (in small amounts) that the body has devised a couple of ways to do it in the absence of eating carbs or having stored glycogen. One is gluconeogenesis, a process whereby the liver makes glucose from excess amino acids from digested but unused protein stored there. Another is from glycerol molecules freed up when a triglyceride (fat cell) is broken down and used for energy. The body makes ketone bodies as an end product of this breakdown, and ketone bodies are ideal food for the brain.
So, if you don’t eat carbs for energy, the body must rely on fat, both dietary and stored, for energy. That’s good, if you’re trying to lose weight. When your body is burning fat for energy, won’t feel “starved” or “hungry.” You will not get the “craving” message, because your body has transitioned from being a “sugar burner” to a “fat burner.”
That’s not only natural, it’s what you want. You want to lose weight without hunger, and your body wants to be in energy balance. So, providing you don’t eat too much fat, your body will go to your fat reserves for energy.
So, what amount of protein will satisfy our “instinctive appetite”? This is essential to know if protein is the driver for overeating either carbohydrates and/or fat. The answer is revealed in my next post, Retrospective #171.