Wednesday, September 18, 2019

Retrospective #214: How I Lost 188 Pounds (Part 2)

In Retrospective #213 I told how, by just restricting carbs, and later protein, that I ate for weight loss, my blood sugar control, blood pressure, blood lipids, and inflammation markers all vastly improved. You (and your doctor) would be very happy to have these results (as I and mine are), but the story doesn’t end there. There is more to tell.
Starting at 375 pounds, I lost the first 60 pounds in nine months (1½ pounds a week) by eating just 20g of carbs a day. I wrote down everything I ate every day, estimating carb grams. No measuring – just guessing. It gave me heightened awareness and accountability for what I decided to eat – and I learned a lot about which foods contained carbs and how they affected my blood sugar. When I started Very Low Carb (VLC) in 2002, I had been a progressively worsening Type 2 diabetic for 16 years. I left my diabetes care to my doctor. Now, I rely on self-care for my diabetes health.
After 4 years, however, I began to slip and gained 12 pounds. I wanted to lose those 12 pounds and a lot more. That’s when I decided to count protein. I devised my own method for determining how much protein to eat, which I explain in Retrospective #213. I started at 90 grams of protein a day (1.1g/kg), later dropping in steps to 60 grams (0.9g/kg).
That only left fat and total calories. I chose an online site to do the calculations. All I had to do was to remember, truthfully, everything I ate and enter the estimated amounts. The software did the rest.
I determined how many grams of fat to eat by backing into the calculation. I wanted to lose 2 pounds a week. At 3,500 calories/pound that is 7,000kcal/wk., or 1,000kcal/day. If a mostly sedentary, older male who doesn’t exercise needs 2,200kcal/day to maintain his weight, then I would need to eat just 1,200 kcal/day to lose 2 pounds a week. And 90 grams of protein + 30 grams of carbohydrate = 120 grams, times 4 calories/gram, equals 480 calories. Subtracted from 1200, that leaves 720 calories for fat. At 9 calories/gram for fat, that means my allowance for fat was 80 grams a day.
That’s where I started on Richard K Bernstein’s 6-12-12 program for diabetics. I didn’t care about macronutrient ratios or ketosis. I just ate Very Low Carb and “moderate protein.” Result: I lost 100 pounds in 50 weeks (2 pounds a week, as planned), lowering my protein as I went along. I lowered protein from 90 grams to 75 and then eventually, today, just 60 grams a day, which is 20% of 1,200kcal and still 20% above the USDA’s guidelines (50g/d or 10% of 2,000kcal).
Later, I became interested in Macronutrient ratios. The diet that worked for me (where I lost 100 pounds) was 10% carbs (30g/day), 30% protein (90g/day) and 60% fat (80g/day). Thirty percent protein is the highest percent most experts recommend for protein, and then only if you have no kidney problems. Your blood markers for kidney disease should be tested by your doctor before you start and rechecked annually on any moderately high protein diet.
As I lost weight, and discovered low carb foods that I liked for breakfast and lunch, and ate good fats, and small low carb and protein suppers, I lowered both my protein and carbs, and increased my fat percentages. My macronutrient ratios changed, from 7% carb (20g), 25% (75g) protein and 68% fat (90g) to 5% carb (15g), 25% protein (75g) and 70% fat (90g). Now, they are 5% carb (15g), 20% protein (60g) and 75% fat (98g). All of these ratios are for 1,200kcal/day.
It’s pretty easy to eat this way because “my body” is telling me that it is “happy.” I have come to think of my body as a separate entity that I am living in. I just eat small meals at mealtimes. This is called “non-homeostatic” eating. That is, I am not eating because my body is telling me to; I am not hungry at mealtimes. I am eating because breakfast, lunch and supper are “mealtimes.” My body decides what to do with the food, to add fat or burn fat and maintain muscle.
So, what do I eat? Breakfast is 3 eggs, 1 strip of bacon and a cup of coffee with heavy cream and a little stevia powder. Lunch is usually a can of kippered herring snacks in brine or Brisling sardines (in olive oil!). And supper is a small portion of protein, usually a fatty meat or fish, and a low-carb vegetable, either tossed in butter or roasted in olive oil. If I snack (before supper only), my favorite is celery with anchovy paste. Sometimes I’ll have olives, or radishes with salt and a dollop of butter, or a small portion of nuts. Macadamia nuts have the fewest Omega 6s, while hazelnuts, almonds or pecans have moderate amounts. Cashews are too high in carbs and walnuts much too high in Omega 6s.

Tuesday, September 17, 2019

Retrospective #213: How I lost 188 pounds (Part 1)

At my doctor’s suggestion, I started eating Very Low Carb (VLC) in 2002 to lose weight. At the time I had been a long-term (16yr) Type 2 diabetic. I have been very successful, at one point losing 188 pounds. I also had to give up most of my diabetes drugs while getting “normal” fasting blood sugars (80s mg/dl) on only 1 low-dose Metformin once a day.
When I began VLC 17 years ago, I was “maxed out” on two classes of oral diabetes meds and starting a third. Within a day of starting to eat just 20g of carbs a day, I got my first hypo (BG reading in the 50s). I ate a candy bar and called my doctor. Over the next few days he told me to cut my diabetes meds three times, twice by half . As I lost weight, my BP gradually dropped from 130/90 to 110/70 at the same meds. Over time my HDL doubled and triglycerides dropped by two-thirds. My Hb A1cs are now consistently in the mid-5 range, and both my HDL/TG ratio and my hsCRP, an inflammation marker, are both usually under 1.0. I am never hungry. I have lots of energy, and I feel great. By all these measures I am today (age 78) much healthier than I was 17 years ago. How did this happen? I’m going to tell you.
When I first started eating VLC, for a few years I wrote everything down that I ate but only counted estimated carbs. I didn’t measure anything. I just listed everything I ate and guessed at the carb content. I did this in an Excel table I created that totaled the estimated carbohydrate grams daily. The math was simple and the method not very accurate, but I was learning about low carb eating, and I was being totally accountable and brutally honest. I was learning what foods raised my blood sugar. This is a learning process everyone eating Very Low Carb for blood sugar control must do.
Four years later I became interested in how much protein I should eat. I decided to eat a similarly sized, small-to-medium portion of protein with each meal, and to space the meals at regular intervals, ala Richard K Bernstein, MD. Bernstein also counseled that, to lose weight you reduce the portion size of protein for one meal, and if that wasn’t enough, a second meal each day, due to its “insulin effect.” This would later guide me to the low side on protein.
The “insulin effect” is about how half of every gram or ounce of protein you eat is going to become glucose in your blood. This occurs after the protein is digested into amino acids and, if not taken up by your muscles, etc., is stored in the liver. There, through a process called gluconeogenesis, it is converted to glucose when the body needs glucose. That is one of the main mechanisms of Metformin: “to suppress the up-regulated synthesis of glucose by the liver in the disregulated sugar-based metabolism that many people have developed on a carbohydrate-based diet.” This glucose requires insulin for transport and uptake. Elevated insulin in the blood stops weight loss: the “Insulin effect.”
How much protein you should eat is dependent on several factors: among them age, gender, and level of activity. If you are very active, i.e. you exercise regularly, you will need more protein to repair and maintain the muscle tissue you have developed and use. I don’t exercise at all (except in my daily activities: gardening in New York and kayaking in Florida). I don’t like to sweat, and besides, doesn’t exercise “work up an appetite”? If you’re trying to lose weight, as I am, who wants to do that! So, I began a search to find out how much protein the “experts” say I should eat.
The “experts” recommend a very wide range of protein amounts, all based on “weight.” You need to pick one and go with it. The one critical measure, though, is the “weight” that you use. It should be your hypothetical “lean body weight.” The definition of “lean body weight” is difficult to ascertain and frequently misinterpreted and misguided. But lean body weight is what you should use because protein is not required to maintain your fat mass, or helpful in reducing it.
This latter point is particularly true for the overweight, obese and morbidly obese, like me. For me (old, male, diabetic, morbidly obese, relatively inactive and without excessive musculature to maintain), I chose to define “lean body weight” as the middle weight of “normal” in the WHO’s BMI chart for my height, now shrunken with age to 5’-10.”  
The BMI table says that, at 5’-10”, my middle-of-normal weight should be 150 pounds. In the beginning, though, I thought a “lean body weight” of 150 pounds for me was ridiculous, so I substituted a “goal” or “ideal” weight of 180 pounds. At 0.5g/lb. (1.1g/kg), that worked out to 90g of protein a day. Then, after I had lost over 100 pounds, a “lean body weight” of 150 began to sound realistic, so I reduced it to 0.4g/lb. (0.9g/kg), or 60 grams of protein a day.

Monday, September 16, 2019

Retrospective #212: Everything I (ch)eat turns to fat.

Once you develop diabetes, your metabolism is deeply committed to converting as many calories as it can into fat.”
We’ve all heard this sentiment expressed, or felt this depressing thought, many times, but I was especially affected recently when I read this quote on page 241 of Cate Shanahan’s Deep Nutrition. I urge you to read this book, or at least my review in Retrospective #205 and her deeply troubling observations about the medical “business” in #206.
Shanahan’s book has hundreds of references, so I lament that the above quote is not sourced. I suppose it should be understood as a summation of the totality of the material presented in her book. In any case, the quote can be read as an expression of exasperation that we, overweight and obese Type 2 diabetics, feel in our unremitting efforts to lose weight. It does seem that everything we eat turns to fat, and it is damnably difficult to lose that fat.
As my readers know, I am always interested (from self-interest as well as for educational purposes) in understanding the mechanisms behind our complex metabolic environment, or milieu intérior as the 19th century French physiologist, Claude Bernard, described it. And I have gained some insights into why it is that “everything I (ch)eat turns to fat” and why people with impaired glucose tolerance (IGT) gain weight easily and lose weight with great difficulty.
In lay terms, IGT is the equivalent of “carbohydrate intolerance,” described in Retrospective #84, “Carbohydrate Intolerance – the new ‘buzz’ words.”” They are the outward manifestation of a metabolic change called Insulin Resistance (IR), described in more detail in Retrospective #99, “Natural History of Type 2 Diabetes.”
Bottom line: as our bodies transition from a normal metabolism to a dysfunctional metabolism, very commonly accompanied by weight gain as an effect of this dysfunction, not a cause, our bodies undergo several physiological changes. Laboratory reports detail these changes. The most frequently tested are fasting glucose, hemoglobin A1c (HgA1c), and the lipid panel (Total Cholesterol, LDL, HDL, and TC/HDL ratio) and triglycerides. Sometimes, when these markers are “out of range,” a diagnosis of Metabolic Syndrome is made. All too often, though, the doctor prescribes a statin and tells the patient to “exercise and eat a low-fat diet” to lose weight. There’s no pill for that prescription.
How have I come to this conclusion? Have you had a similar experience? When I have been very good – that is, when I not only talked-the-talk but walked-the-walk, every day – my fasting blood sugars are consistently in the 80s. I can point to weeks, even months, of never or very rarely having a Fasting Blood Glucose over 100mg/dl. And since it is an elevated blood glucose that causes the pancreas to produce insulin, to transport to and facilitate uptake of that blood glucose in their destination cells, it is an elevated blood glucose level that causes an elevated blood insulin level.
As my readers know, and as anyone who has read Taubes’ Good Calories-Bad Calories (The Diet Delusion in the UK), or his more approachable Why We Get Fat, elevated blood insulin CAUSES FAT STORAGE and PREVENTS FAT BREAKDOWN for energy. Retrospective #5 presents Taubes’s “10 certain conclusions” from the GC-BC (pg. 453-454). It is a very succinct and compelling explanation of the functional role of insulin in homeostasis, and a must read.
Anyway, recently my fasting blood glucose readings were in the 100 to 125 range. Obviously, while I have been talking-the-talk, I have not always been walking-the-walk. I admit it. I “cheated” a little almost every day; always just before or at any time after dinner. And I pay the price. It was just a little “cheat,” so I didn’t gain weight, BUT NEITHER DO I LOSE ANY WEIGHT, EVEN THOUGH I AM EATING NO MORE THAN +/- 1200-1800 CALORIES MOST DAYS.
What’s happening is that my serum insulin levels are slightly elevated – elevated just enough to turn everything I (ch)eat to fat and stop the breakdown of body fat in storage even though I am eating below my homeostatic level. My body “gets the message” that as long as I have a supply of quick energy every night (the “cheats” that break down to glucose), it can conserve my body fat, and lay on more with every calorie that isn’t needed to maintain my basal metabolism while I sleep. The “signal” is: the slightly elevated blood insulin circulating my slightly elevated blood glucose. If this is still unclear to you, I urge you to read Retrospective #5 with Taubes’s “10 Certain Conclusions.”

Sunday, September 15, 2019

Retrospective #211: Eggs and Satiety

“Short-term effect of eggs on satiety in overweight and obese subjects,” cited with a link at Authority Nutrition, took me to a 2005 PubMed abstract from the Journal of the American College of Nutrition (J Am Coll Nutr). Curiously, there were no comments on this article in Pub Med, an official governmental organ of ncbi/nlm/nih. Maybe, in 2005, eating eggs, due to their high saturated fat and cholesterol, was still taboo, and no one in the “scientific/medical” community could figure out how to support the idea that whole eggs (yolks included) could be part of a “healthy eating” pattern. Fortunately, that perception has since changed. Whole eggs are one of the healthiest foods on earth.
The OBJECTIVE of this small prospective, randomized, crossover-design study: “To test the hypotheses that among overweight and obese participants, a breakfast consisting of eggs, in comparison to an isocaloric, equal-weight bagel-based breakfast, would induce greater satiety, reduce perceived cravings, and reduce subsequent short-term energy intake.” Thirty women with BMIs of at least 25 between the ages of 25 and 60 years were recruited to participate.
The RESULTS were clear: “During the pre-lunch period, participants had greater feelings of satiety after the egg breakfast, and consumed significantly less energy.” In addition, “Energy intake following the egg breakfast remained lower for the entire day… as well as for the next 36 hours.”
CONCLUSIONS: “Compared to an isocaloric, equal weight bagel-based breakfast, the egg-breakfast induced greater satiety and significantly reduced short-term food intake. The potential role of a routine egg breakfast in producing a sustained caloric deficit and consequent weight loss should be determined.” In other words, they want the NIH to fund more studies like this. Government funded research is a jobs program, and in this case, one that I support (LOL).
I ate a breakfast of 2 eggs and 2 strips of bacon (plus coffee with heavy cream and pure stevia powder) for almost 10 years. Then, a couple of years ago, after reading Paul and Shou-Ching Jaminet’s Perfect Health Diet, I switched to 3 eggs and 1 strip of bacon (plus coffee) to get my daily dose of choline all in one meal. And I have been telling people for years that, when you eat this breakfast (with no fruit or juice or cereal or bread or any carbs), you will not be hungry – not in mid-morning, not at lunch, not even at mid-afternoon. I haven’t been hungry at lunch for years.
“Why, then, do you eat lunch?” That’s a good question. Increasingly I have been asking myself that question too. When I remember to eat lunch, the reason, I suspect, is that I eat a can of sardines in olive oil. And both my editor and I think that is one of the reasons I now have very high HDLs (~90mg/dL) and very low triglycerides (~34mg/dL). But it wasn’t always this way. Previously (before VLC), my HDLs averaged 39mg/dl and my TGs about 135mg/dl.
Another bit of self-promotion: Take a look at Retrospective #91, “Low Carb Breakfasts (and a no-carb lunch)” for more ideas on eggs and breakfast and Retrospective #176, “Eggs, Cholesterol and Choline,” for more about choline.
So, in conclusion, there’s no question (in my mind) of the “short-term effect of eggs on satiety in overweight and obese subjects,” like me. It also “reduce(d) perceived cravings, and reduce(d) subsequent short-term energy intake,” including the viable election not to eat lunch! If fact, on many days it’s only my watch, not my stomach, that tells me I missed lunch. I also agree completely that “the potential role of a routine egg breakfast in producing a sustained caloric deficit and consequent weight loss should be determined.” That’s the big takeaway. Why don’t you try it?
The eggs I buy are raised by a local farmer who also raises beef and pigs and sells them at our local farmers’ market. They use a chicken coop on wheels that they move from pasture to pasture every week after the livestock have been moved on to new grazing. Hens are omnivores (like pigs) and so they (and we) benefit from the insects and larvae that they find in the deposits the animals leave behind. This is all explained in The Omnivore’s Dilemma, a book by Michael Pollan, in which he canonizes the practices of Joel Salatin of Polyface Farm in Virginia’s Shenandoah Valley.
PS: Too busy to eat breakfast? Pack one, two or three hard boiled eggs to eat at your desk. If that’s not enough, add a slice of smoked salmon wrapped around some full-fat cream cheese. There’s a very low carb breakfast-on-the-run.

Saturday, September 14, 2019

Retrospective #210: “Diet and Exercise May Help Prevent Diabetes” – Duh!


I couldn’t believe this headline in my Medscape Alert email, so I opened the link and read the lede: “NEW YORK (Reuters Health) – Lifestyle changes made by people at high risk of diabetes appear to reduce their chance of developing the disease over the next two decades…” This revelation was also made by a group of doctors. However, that Reuters would assign a reporter to it, and then issue the story from New York, was utterly amazing to me.
The study was first reported online in the April 2014 Lancet Diabetes and Endocrinology. The original study began in 1986 and ended in 1992! In it, 568 people in China with “higher-than-normal blood sugar levels but not high enough to be diagnosed with diabetes,” were placed into three intervention groups (diet, exercise, or diet plus exercise), and a control group. The current study, begun in 2009, compared medical records of the 430 participants and 138 controls.
The goal of the original researchers (in 1986) was meritorious: “Diabetes is strongly associated with the increased risk of cardiovascular event and mortality,” the lead investigator of the 2009 study told Reuters. “They wanted to see if lifestyle changes, which included diet modifications and exercise, would help lower death rates.” As it turns out, they did, especially for women. But “because there are no data on people’s lifestyle habits during the (original) study period,” “it’s impossible to say…how the participants responded to the interventions,” the new study said. Okay.
But wait, we do have some data on the diet intervention. It “was meant to help people lose weight and normal-weight people reduce the amount of simple carbohydrate [sugars] they ate and the amount of alcohol they drank.” The Chinese understood in the 1980s the role of carbohydrates in reducing the risk of cardiovascular disease. So, it is all the more bewildering to me that the lead investigator would say today, “We have to do something active to delay the development of diabetes in high-risk populations.” How could that be any plainer? What was he unable to see?
The results of the 2009 study were impressive. “By the end of 2009, they determined that 28% of the intervention group had died, compared to 38% of controls.” “Twelve percent of the intervention group had died of heart-related conditions, compared to 20% of controls.” And, “Almost all of the benefit was found in women – there was very little difference in death rates among men based on whether they went through one of the lifestyle programs.”
The Reuters piece also reported, “The researchers also compared diabetes diagnoses and found that 73% of the intervention group had developed diabetes through 2009,” a very high number indeed but still lower than the control group’s 90%. Reuters related that the Lancet piece reported, “Those finding were similar for men and women.”
The big takeaway from this story, though, was: “The group-based lifestyle interventions over a six-year period have long-term effects on prevention of diabetes beyond the period of active intervention.” The researchers concluded, “It is worth taking active action to prevent diabetes to reduce the risk of cardiovascular disease and mortality.” Now, if only they could figure out what the action should be… Maybe there’s a clue in the paragraph above that begins, “…we do have some data on the diet intervention:” “…THE AMOUNT OF SIMPLE CARBOHYDRATES (SUGARS) THEY ATE…”
The first 3 comments online were “interesting.” The first, by a pharmacist, was “…and they discovered the warm water.” I’m not sure of the allusion, but I’m pretty sure the comment is intended as sarcasm. The second comment is from an advanced practice ob/gyn nurse. It was, “Oh wow, this is groundbreaking!” I’m almost certain (and hopeful) that this is pure mockery. The third comment was from a physician. He said, “Useful study.” If my impressions are correct, and I admit to a confirmation bias here, the pharmacist and the nurse were better informed about diabetes nutrition than the doctor. That, of course, is sad and all the more reason to lament the lack of nutrition education in medical school (see Retrospective #208, “Teach Doctors Nutrition”), and the misinformation being disseminated by our government, the medical/big pharma cabal and the big food manufacturing industries in the world today.
Perhaps the value of reporting over and over again the self-evident truth about low-carb eating to lose weight and improve health outcomes has some value after all. Eventually, more and more doctors will open their minds to the science they should have learned when they were in medical school. I can hope, anyway…

Friday, September 13, 2019

Retrospective #209: “Maureen Dowd is off today,” the NYT said.

Maureen Dowd was off today, the New York Times said at the bottom of a 2014 column. Substituted was “Butter is Back,” by Mark Bittman, the NYT’s food writer. The subject was long overdue, in my opinion, and generally favorable – until near the end.  At that point he steered the writing to a more personal theme, pitching his recent book, VB6: Eat Vegan before 6:00 to Lose Weight and Restore Health. The title makes it pretty clear what his confirmation bias is.
On balance, though, I was enormously encouraged, if only because of my own confirmation bias wrt saturated fats.
Bittman acknowledged that “the worm is turning.” The example that this is “increasingly evident” was the meta-analysis he cited from the journal Annals of Internal Medicine that made headlines around the world. The researchers looked at 72 studies and came to this conclusion: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids and low consumption of total saturated fats.”
Media writers quickly took note of the “total saturated fat” part of this bifocal conclusion. This may be because 1) the saturated fat message has been ringing in our ears for half a century, and 2) many people have missed their favorite saturated fatty foods. Bittman wrote, “…when you’re looking for a few chunks of pork for a stew, you can resume searching for the best pieces — the ones with the most fat.” And, “…the days of skinless chicken breasts and tubs of I Can’t Believe It’s Not Butter may finally be over.” And, “You can go back to eating butter, if you haven’t already.”
Referring to the scientific findings, Bittman, the guy who personally eschews (before 6PM) animal protein and advocates “eat vegan…to restore health,” now says, “there’s just no evidence to support the notion that saturated fat increases the risk of heart disease. (In fact, there’s some evidence that a lack of saturated fat may be damaging.)” So, a guy can change his mind. Or keep an open mind.  In #193, I admired the way Gary Taubes did that in his NYT op-ed.
But Bittman, on the way to his vegan message, took note of the other, less familiar but just as important conclusion of the Annals piece: “Current evidence does not clearly support cardiovascular guidelines that encourage high consumption of polyunsaturated fatty acids…” Polyunsaturated fats are vegetable (seed) oils, folks. In Bittman’s own words, “...many polyunsaturated fats are chemically extracted oils that may also, in the long run, be shown to be problematic.” Okay, I don’t hedge on this. See #203, “A Brief History of Edible Vegetable (i.e. Seed) Oils,” for my take.
The Annals piece, naturally, prompted a firestorm of controversy. Vested interests fed the fire. A good companion piece to Bittman’s aired on National Public Radio (NPR) a week or so later. The accompanying text article, by Allison Aubrey, is titled “Rethinking Fat: The Case for Adding Some into Your Diet.” Google it.  On balance, it’s a good read.
And just before the Bittman op-ed, the magazine Science published an article, “Scientists Fix Errors in Controversial Paper About Saturated Fats. The “errors” reflect a disagreement about whether the evidence is strong enough to advocate eating less saturated fat and substituting instead more polyunsaturated fat, the way the AHA and the Dietary Guidelines for Americans presently advocate. The lead author states that the paper’s conclusions are valid and that the paper was “wrongly interpreted by the media.” Bottom line, as both Bittman and I see it, THE ANNALS OF INTERNAL MEDICINE PIECE EXCULPATES SATURATED FATS AND EXCORIATES POLYUNSATURATED FATS (PUFAs).
In “Butter is Back,” Bittman also takes aim at fake food and extols the virtues of real food. He lashes out at all manner of “highly processed, ‘low-fat’ carbs” like SnackWells. My favorite: “How you could produce fat-free ‘sour cream’ is something to contemplate.”  He was an early supporter of the slow food movement and of writers like Michael Pollan, author of “The Omnivore’s Dilemma” and other best sellers. In Retrospective #17, “Michael Pollan: Pied Piper of Pseudo Paleo Prandial Principles,” I take a poke at Pollan in what, I think, is a fun and enlightening read.
Please Google and read “Butter is Back.” So long as you are informed and armed for the Vegan end-pitch, it’s an entertaining and informative look at the current state of nutritional science in transition. As Bittman says, “The tip of this iceberg has been visible for years, and we’re finally beginning to see the base.” That’s, indeed, very encouraging.

Thursday, September 12, 2019

Retrospective #208: “Teach Doctors Nutrition”

Driving up the New Jersey Turnpike, I saw a bumper sticker that lifted my heart in joy: “TEACH DOCTORS NUTRITION.” At 75 miles per hour, I raised both hands from the steering wheel and shouted in exultation, “Hallelujah!” I don’t think the attractive blonde driver noticed, but my wife did. She grinned and told me to pay attention to the road.
I did, but I was reminded of my last visit, in both senses, to a Florida doctor. He was mentoring a medical student, and except to ask if I needed any prescriptions filled, he had more to say to her than to me. I listened as he pointed out to her my high HDL (90mg/dl) cholesterol, saying that he was among who counted a “high” HDL as “good.”
The report actually cited my HDL as “H” and outside the Reference Range (40-60mg/dl for that lab). But the only things that matter to such doctors are Total Cholesterol and LDL. And that to lower the patient’s “high” LDL, the patient takes a statin. A statin will lower Total Cholesterol to less than 200mg/dL (which they define as “under control”) and by so doing it will lower LDL. My Total Cholesterol was 207mg/dl, and it was flagged as “high” (H).
I jumped into the conversation he was having with his medical student to crow about my low triglycerides (34mg/dL on the last test), and to beam that that low count, and all the other lows I have had (49mg/dL average over 10 years), were due to eating Very Low Carb. The student looked at me blankly for a few seconds, and then said, “Nutrition.” I said, “Yes, I did it by eating a Very Low Carb Ketogenic Diet, 2 grams of fish oil a day and a can of sardines for lunch.”
The doctor grabbed her attention back by pointing out my very good Total Cholesterol to HDL ratio, which at 2.3 was less than his 3.5 benchmark. I commented that I thought the benchmark was 5.0; he replied that, being less than 3.5 meant plaque formation was in regression; a ratio of >5.0 would indicate that plaque was in formation. I hadn’t heard that before, and I admit I was pleased. He turned back to the student and said, “a ratio of 2.3 is really remarkable.”
When I tried to suggest that the explanation for these “remarkable” lab scores was nutrition, asking my doctor if he had looked at my website on nutrition (“The Nutrition Debate”), he replied dismissively “no” and went back to tutoring his student. I felt like a cadaver in an anatomy class, except that cadavers don’t have feelings, do they?
Anyway, I applaud that doctors are interested in results. Too bad the only way they know how to get them is by prescribing drugs. Perhaps my tutoring of the medical student on the role of “good nutrition” in my own lipid panel will “stick.” The challenge now for her will be to see that she gets educated about what “good nutrition” is.
For those to whom this is still not clear, I refer you to two of my most popular columns, Retrospective #25, “Understanding Your Lipid Panel,” and Retrospective #27, “…the strongest predictor of a heart attack.” These are both “accessible” explanations of an alternative view of the lipid (cholesterol) panel and other health markers. Another very good column is Retrospective #187, “Chronic Systemic Inflammation and hsCRP.”
Finally, the extremely troubling view of the modern medical profession as practiced as a business today, described in Retrospective #206 by Dr. Cate Shanahan in the Epilogue of her very good book, Deep Nutrition (reviewed in #205), came into vivid clarity at the beginning of this consult. My doctor was viewing my medical records on his computer and confirming that I was taking my medicines. The first one he asked me if I was taking was a drug I had never heard of. Turns out, it was a statin. I stated my full name and DOB, and he replied “yes.” How could that be, I wondered?  How could he have in my medical records that I was taking a statin that he had prescribed for me?
The answer, I suspect, and as Dr. Shanahan relates, is that in large medical practices/businesses today they have “quality improvement programs that track physician prescribing patterns.” “We call it ‘quality,’ but it’s really about money,” her boss told Dr. Shanahan. “The doctors who prescribe the most get big bonuses. Those who prescribe the least get fired.” I suspect my doctor entered in my chart after my previous office visit that he had prescribed a statin for my “high” cholesterol (207mg/dL). With the medical student looking over his shoulder, he “corrected” my medical record to reflect that I was NOT taking a statin. He probably entered in his doctor’s notes,” “Patient non-compliant.”

Wednesday, September 11, 2019

Retrospective #207: Diabetes Self-Care Just Got a Little Harder

My readers know that I am an advocate for self-management of Type 2 diabetes. Among the reasons: 1) It’s my health and my life, and I want to be responsible for its maintenance, preservation and extension; 2) I am much better educated and informed about nutrition, and I daresay, even about Type 2 diabetes, than any physician with whom I have consulted; and 3) I do not believe that the Standards of Care for Healthy Living, for Type 2 diabetes in particular and for blood lipids and systemic inflammation as well, are designed with the best interests of patients like me in mind. Call it hubris if you like, but over the years that is the way I have come to view these matters.
So, I had my quarterly doctor’s visit this morning, and the first thing I noticed was a new notice in the office that in future a copy of the patient’s medical records of the office visit would be available only by completing an “Authorization for Release” form, leaving it with the office where I had the visit (and where they do their own lab work), and then waiting for them to “forward my authorization form through a secure electronic method” to their contractor in another city, “a leader in medical record request fulfillment,” who would then calculate the cost to me to get a copy of the lab report from them. Then, “once payment is received, (the vendor) will release your records and mail them to your home.”
Thus, the reason I go to the doctor (to monitor my Type 2 diabetes and hypertension) – to get tested and receive a copy of the lab report – so I, as well as my doctor, can monitor my blood markers, has now been made more convoluted, and time consuming, and expensive, for me. Did I mention that if the medical record I am requesting (my lab report of blood tests) was to be sent to another doctor, there would be no charge; but, if it is for my personal use, there is “an administrative cost” of $1.00 per page for the first 25 pages, plus postage fees. (Snail mail. How quaint!) I guess there’s no “administrative cost” to scan and email or fax the records to my physician. 
I do not know if this new policy at the large medical group I have visited twice now in Florida is yet, or will soon be, universal. I do not know if it is related to the new electronic medical records (EMR) laws, or even if the new medical records legislation is a state-by-state thing, or if it is part of the Affordable Care Act (“Obamacare”). I only know that when I complained to my doctor, he said that he was unable to do anything about it. He told me to take the matter up with the American Hospital Corporation, the entity that bought the group in which he now participates.
So, my healthcare just got a little less affordable and less convenient, for ME. No doubt, it will be more affordable for my doctor, my doctor’s large group, and the large corporation that owns them. But the worse part for me is that I am now more detached from my own self-care. My doctor told me that someone on his office’s staff would be calling me in a few days with the results of my labs, and that, if I wanted a copy of the labs, I should take it up with her. He sounded like he could care less, but, as I said in #206, “medicine…is first and foremost a business.”
As an aside, there was a 2nd new notice posted near the reception desk on this office visit. It said that my doctor has been selected to mentor and help train a medical student and that that meant he was top rate (since he was “selected”). During the consultation, a nice young woman in a white coat watched as my doctor went over my medical records, confirmed or rather corrected, actually, my medical records in their computer. Apparently, on my previous visit he had “prescribed” a STATIN for me, without bothering to give me a script; NB: if had he given me a script, I would not have filled it.). He then commented favorably (to her) on my most recent HDL (90mg/dL); I then mentioned my most recent triglycerides (34mg/dL), which he acknowledged was “remarkable.” That gave me an opening to tell the medical student it was all about eating VERY LOW CARB. She had a vague sense that this had something to do with nutrition. It seemed to register, anyway.
I then left a urine sample and went to the desk where I was told they make “your next appointment.” She said, “The doctor would like to see you in 6 months.” I said, “I think not.” I like my doctor up north. Let’s hope getting a copy of my lab report from him will not be so Obamafied. I know. That’s not fair. But I’m all in a huff over this.

Tuesday, September 10, 2019

Retrospective #206: Dr. Cate’s “Health without Healthcare”


“Health without Healthcare” is the sub-title of the Epilogue of Deep Nutrition: Why Your Genes Need Traditional Food, by Catherine Shanahan, MD, and Luke Shanahan. I reviewed that book in Retrospective #205. The book is a very well-reasoned and cogent argument from an epigenetic and biochemical viewpoint. It addresses eating “traditional food,” with do’s (“The Four Pillars of World Cuisine”) and don’ts (“vegetable oils and sugar”). It is not a polemic or a diatribe.
Then, Dr. Shanahan wisely and separately wrote a 2-page Epilogue: Health without Healthcare, a devastating indictment of medicine as it is widely practiced today. There wasn’t a clue it was coming. The only reference to medicine in the first 288 pages was, on page 9, “But medicine is different from other sciences because, more that being a science, it is first and foremost a business.” It is in respect to the business aspect of medicine that Dr. Shanahan “takes the gloves off.”
She begins with a quote from Selling Sickness, by Ray Moynihan and Alan Cassels: “There’s a lot of money to be made telling healthy people they’re sick.” They then quote a retired Merck chief executive, Henry Gadsden, as saying, more than 30 years ago, “it had long been his dream to make drugs for healthy people, because then Merck would be able to ‘sell to everyone.’” “This kind of corporate thinking,” Shanahan says, “trickles down from the boardroom to your local clinic, contaminating local doctors – like yours.”
She goes on to explain with examples from her personal experience. “When I was building my practice, my boss explained to me that to be ‘successful’ I would need more chronic patients in my panel. He explained that putting people on blood pressure and other medications, which would need periodic monitoring, was key to building a practice. I understood that from his perspective keeping my patients healthy – and medication free – was bad for business. The entrepreneurial mentality is endemic in today’s healthcare model.” Okay, you might have suspected as much. It is, after all, a business.
She goes on to relate: “When I interviewed with the chief of family medicine at a large medical corporation on the West Coast, he explained that, since he was part of a team of people who arranged for pharmaceutical companies to issue cash grants, he was in a position to offer me a particularly enticing salary.” The grants, he explained, are for a “quality improvement program that tracks physician prescribing patterns. We call it ‘quality,’ but it’s really about money,” he said. “The doctors who prescribe the most get big bonuses. Those who prescribe the least get fired,” he told Shanahan.
But Dr. Shanahan was just getting started. What follows is so powerful and damning that I want to quote it verbatim:
“Merck CEO Henry Gadsden’s 30-year-old dream was to make healthy people buy drugs they didn’t really need. But he was dreaming small. What I see happening now is more sinister, more profitable, and promises to have longer-lasting repercussions than merely creating diagnoses that lead to unnecessary prescriptions. What I see is a massive campaign of nutrition-related disinformation that has reordered our relationship with food and reprogrammed our physiologies. Industry has moved past selling sickness and learned how to create it. Whether by intent or simply fortuitous coincidence, today’s definition of a healthy diet enables corporations to sell us cheap, easily stored foods that will put more money in their pockets and more people in the hospital. By denying our bodies the foods of our ancestors and severing ourselves from our culinary traditions, we are changing our genes for the worse. Just as corporations have rewritten the genetic codes of fruits and vegetables to better suit their needs, they are now in effect doing the same thing to us.”
She then concluded, “But there’s one thing they’ve overlooked. Fruits and vegetables can’t fight back. We can.”
Wow. If I hadn’t just read her her book, a really intelligent, scientific justification for the epigenetic and biochemical basis of eating “traditional foods” that “people the world over have depended on for millennia to protect their health and encourage the birth of healthy children…,” I might have concluded that she was “mad,” and I don’t mean angry. But I think she is absolutely correct. And the exhortation to us all to fight back is also right on, because I too believe we really do “control the health of our genes,” because you…have control over what may be the most powerful class of gene regulating factors: FOOD.”
In 2001 Dr. Shanahan and her husband moved to Hawaii, where she has a clinic in Family Medicine on the island of Kawai. She also travels across the country to share this information with fellow physicians at lectures and meetings.  Check her out on YouTube as “Dr. Cate.”

Monday, September 9, 2019

Retrospective #205: “Deep Nutrition,” a book review


Deep Nutrition, a book by Catherine Shanahan, MD, and Luke Shanahan, was not a “blockbuster” by today’s standards, but it is a very good read, and I highly recommend it. Cate Shanahan comes to her views on nutrition from her undergraduate studies in epigenetics and biochemistry. After graduating from medical school, she explains in an Epilogue, she departed from conventional medicine to develop this approach to “Deep Nutrition”:
“This book describes the diet to end all diets. The Human Diet,” a phrase she coins to “describe the communalities between all the most successful nutritional programs people the world over have depended on for millennia to protect their health and encourage the birth of healthy children so that the heritage of optimum health can be gifted to the next generation…” Our genetic heritage, she explains, is heritable and depends on what we eat.
CONNECTING BIOCHEMISTRY TO EPIGENETICS, SHE SAYS, YOUR DIET CHANGES HOW YOUR GENES WORK.”
“The greatest gift on earth,” Shanahan says, “is a set of healthy genes.” But, “genes that were once healthy can, at any point in our lives, start acting sick” by “factors that force good genes to behave badly, by switching them on and off at the wrong time.” Epigenetics is about this “genetic expression,” not about genetic mutation. Long time readers will recall that I wrote about a branch of epigenetics in #120, “Nutrigenomics -- an emerging new science.”
“Human health depends on traditional foods,” she avers. “Food is like a language, an unbroken information stream connecting every cell of your body…” “The better the source and the more undamaged the message when it arrives to your cells, the better your health will be.” “The bottom line,” she says, “is clear.” “We control the health of our genes” because “you…have control over what may be the most powerful class of gene regulating factors: FOOD.”
“By simply replenishing your body with the nourishment that facilitates optimal gene expression, it’s possible to eliminate genetic malfunction and, with it, pretty much all known disease. No matter what kind of genes you were born with, I know that eating right can help reprogram them, immunizing you against cancer, premature aging and dementia, enabling you to control your metabolism, your moods, your weight – and much more.” That a big claim, but, she says, you owe it to your children [who inherit your genes] to give them “a shot at reaching for the stars.”
All these quotes are from the Introduction and Chapter One. The next five chapters, on subjects like “Dynamic Symmetry” and “A Mother’s Wisdom,” were of less interest to me (I have no kids). Then, in Chapter Seven, she gets to “the meat” of her ideal “Human Diet”: “The Four Pillars of World Cuisine.” They are: “meat on the bone, fermented and sprouted foods, organs and other ‘nasty bits,’ and fresh, unadulterated plant and animal products.”
With meat, she says, “The secret? Leave it on the bone. When cooking meat, the more everything stays together – fat, bone, marrow, skin – and other connective tissue – the better.” And “Rule Number One: Don’t Overcook It; Rule Number Two: Use Moisture, Time and Parts; Rule Number Three: Use the Fat; Rule Number Four: Make bone stock.” The other three pillars are equally good. Personally, I love organ meats and am coming to love some of the more exotic fermented foods (see #194). And we always eat a fresh, whole vegetable with supper, every day.
The very best part of the book, though, in my opinion, are Chapters Eight and Nine: her attack on “vegetable oils and sugar.” You can see it coming. At the end of Chapter Seven, she says: “Because vegetable oil and sugar are so nasty and their use in processed foods so ubiquitous that they have replaced nutrient-rich ingredients we would otherwise eat, I place vegetable oil and sugar before all others, on the very top of my don’t eat list.” Throughout the book she links these two products of industrial food manufacturing to maladies that she sees in her medical practice.
One of her concluding thoughts: “Vegetable oils and sugar,” she says, “are the real culprits for diseases most doctors blame on chance, or – even more absurdly – on the consumption of animal products that you need to eat to be healthy.” Huzzah, Dr. Shanahan! I wish you could be MY doctor!

Sunday, September 8, 2019

Retrospective #204: A Modern History of Cane Sugar

“In August 1492, Christopher Columbus, enroute to discover America, stopped at La Gomera in the Canary Islands, for wine and water, intending to stay only four days. Instead, he became romantically involved with the governor of the island, Beatriz de Bobadilla y Ossorio, and stayed a month. When he finally sailed, she gave him cuttings of sugarcane, which became the first to reach the New World.” This story is from Wikipedia. Wikipedia continues…
“In the 1500’s British women blackened their teeth [with sugar] to appear wealthy. The truly wealthy hosted “sugar banquets.”  A great expansion in sugar production took place in the 18th century with sugar plantations in the West Indies and Americas. This was the first time that sugar became available to the common people…” Sugar then became popular, and by the end of the 19th century, sugar was considered a necessity.”
Until that time, honey was the sweetener of choice. “This evolution of taste and demand for sugar as an essential food ingredient unleashed major economic and social changes. It drove, in part, colonization of tropical islands and nations where labor-intensive sugarcane plantations and sugar manufacturing could thrive. The demand for cheap labor to perform the hard work involved in its cultivation and processing increased the demand for the slave trade from Africa (in particular West Africa). After slavery was abolished, there was high demand for indentured laborers from South Asia (in particular India). The demand for sugar had a profound influence on our civilization.”
“Until the late nineteenth century, sugar was purchased in ‘loaves,’ locked in ‘sugar chests’ and cut using ‘sugar nips.’ Sugar cubes first appeared in the nineteenth century. In later years, granulated sugar was generally bagged.”
The production or manufacture of sugar is a complex process. The canes are cut and transported to a factory and there “milled” (squeezed under great pressure) to extract the juice; the juice is then “clarified with lime and heated to kill enzymes.” The thin juice is then “concentrated” [boiled] in “evaporators.” It is then seeded with sugar crystals to make “raw sugar.” These crystals can be “used as they are, or they can be bleached by sulphur dioxide or they can be treated in a carbonization process to produce a whiter product.”
Cane sugar then requires further processing to provide the free-flowing white table sugar “required by the consumer.” The process starts all over again. The brown sticky crystals are immersed in a “syrup” that “softens and removes the sticky brown coating without dissolving them.” They are then separated from the liquor, dissolved in water, and treated either by a carbonization or a phosphorylation process. Then the color is removed by another chemical process, the crystals are then dissolved by boiling again, cooled, seeded and spun in a centrifuge, and then hot-air dried. And then the sugar is bagged.
Brazil was the largest producer of sugar in the world in 2011. Then, India, the European Union, China and Thailand. The U.S. was sixth. We produced barely one-fifth as much as Brazil and one-fourth as much as India. Consumption was a different story.  India led the way, followed by the EU, China, Brazil and then the U.S. in fifth place (2012). But the spread is much closer; India’s use, while very high, was just 2.5 times as much as the U.S. Of course, the U.S. population (320 million) is barely a quarter that of India (1.2 billion). In 2008 American per capita consumption of sugar and other sweeteners, mainly high fructose corn syrup (HFCS), was 136 lbs./yr., divided between the two.
Wiki concludes, “Since the latter part of the twentieth century, it has been questioned whether a diet high in sugars, especially refined sugars, is bad for human health. Sugar has been linked to obesity, Type 2 diabetes, cardiovascular disease, dementia, macular degeneration, and tooth decay. Numerous studies have been undertaken to try to clarify the position, but with varying results, mainly because of the difficulty of finding populations for use as controls that do not consume, or are largely free of any sugar consumption.”
Funny, if not so terribly sad. One thing is clear, though. Table sugar is an industrial manufacture. It’s not real food.

Saturday, September 7, 2019

Retrospective #203: A Brief History of Edible Vegetable (i.e. Seed) Oils


A vegetable oil is a triglyceride extracted from the seeds of a plant. Olives and avocados are considered fruits, not seeds. Vegetable oils can be defined as fats that are liquid at room temperature. Many vegetable oils are consumed directly, or indirectly, as ingredients in food. They have been used for multiple purposes: as shortening, to separate ingredients (as in finished pasta), to add flavor, or as a flavor base to carry the flavors of other ingredients that are soluble in oil.
Vegetable (seed) oils are also commonly used as cooking oils, that is, heated to cook other foods. The major cooking oils are soybean oil, Canola oil, corn oil, sunflower, safflower, peanut and cottonseed oil. Today, soybean oil accounts for about half of worldwide edible oil production and about seventy percent of cooking oil in the U.S., although Canola oil use is gaining. Previously, corn oil was the most popular edible oil in the U.S. Vegetable oils are used in salad dressings, margarine, mayonnaise, prepared foods like spaghetti sauce and baking mixes, and to fry potato chips and French fries.
Most vegetable (seed) oils are produced by chemical extraction using a solvent – the most common being petroleum-derived hexane. This technique is used for most of the newer industrial oils such as soybean and corn oil, according to Wikipedia. It “produces higher yields and is less expensive.” The more “traditional” oils, e.g. olive oil and coconut oil, are produced by mechanical extraction. Expeller-pressing extraction is common, and is preferred by most “health-food” customers in the U.S. and Europe. Ghani processing, using a powered mortar and pestle, is common in India.
To replace rendered lard (a saturated animal fat derived from pigs) as a cooking oil, in 1911 Proctor and Gamble introduced Crisco. P&G scientists learned how to extract oil from cotton seeds, a waste product of the ginning mills. After chemical extraction and refining, they then partially hydrogenated it (thereby creating trans fats), causing it to be solid at room temperature and thus mimic natural lard. They then canned it under nitrogen gas, and voila, Crisco. It was cheaper than lard, easier to stir into a recipe, and could be stored for two years at room temperature before turning rancid.
Soybeans were an exciting new crop from China in the 1930s. Soy was protein-rich, and this medium viscosity oil was high in polyunsaturates (58%), like cotton seed oil (52%) and corn oil (55%), vs. coconut oil (3%). By the 1950s and ‘60s, soybean oil had become the most popular vegetable oil in the U.S. The Diet Dictorcrats were ecstatic. They loved everything PUFA.
In the mid-1970s, Canadian researchers developed a low-erucic-acid rapeseed cultivar. In 1998, a new disease resistant cultivar of biotech Canola, an herbicide-tolerant GMO, was developed and now is the fourth most dominant biotech crop globally. Worldwide production increased 17% from 2010 to 2011, with the Canadian share increasing from 94 to 96%. Within the United States, where 90% of the Canola crop is grown in oil and gas rich North Dakota, production declined.
Canola oil is lower in polyunsaturated fat (28%), and lower in saturated fat (7%) than soybean (16%) or corn oil (13%), and much higher in monounsaturated fat (63%) vs. soybean (23%) or corn oil (28%). It is, however, lower in monounsaturated fat (63%) than olive oil (72%). Canola is very thin (unlike corn oil) and flavorless (unlike olive oil), so it is beginning to displace soybean oil, just as soybean oil largely displaced corn oil and before that cottonseed oil.
The following paragraphs were extracted verbatim from “Negative health effects” in Wikipedia’s entry for “Vegetable Oil.”
“Hydrogenated oils have been shown to cause what is commonly termed the "double deadly effect", raising the level of LDLs and decreasing the level of HDLs in the blood, increasing the risk of blood clotting inside blood vessels.”
“A high consumption of oxidized polyunsaturated fatty acids (PUFAs), which are found in most types of vegetable oil (e.g. soybean oil, corn oil – the most consumed in USA) may increase the likelihood that postmenopausal women will develop breast cancer. A similar effect was observed on prostate cancer and skin cancer in mice.”
“Vegetables oils high in polyunsaturated fatty acids cause inflammation of the cells and may lead to a digestive disease and eventually cancer. The main reason is that the polyunsaturated fatty acids in vegetable oils auto-oxidize during food processing when exposed to oxygen and/or UV radiation; resulting in the auto-production of inflammatory peroxides and hydroperoxides from polyunsaturated fatty acids.”
So, what is the excuse you still use for continuing to use high Omega-6, polyunsaturated, rancid, oxidized, vegetable oils at home? Are you ready to clean out your pantry? And give up all fried foods in restaurants? And stop buying prepared foods at the supermarket? What will it take? Breast cancer? Prostate cancer? Chronic systemic inflammation? A heart attack?

Friday, September 6, 2019

Retrospective #202: Obama White House Pastry Chef Quits


When Obama’s White House pastry chef, Bill Yosses, announced that he would be leaving his gig in June 2014, the quote from the New York Times piece that caught my attention was, “I don’t want to demonize cream, butter, sugar and eggs.” His future plans: “(H)e hopes to put together ‘a group and foundation of like-minded creative people’ for promoting delicious food as healthy food. He offered no details about his venture, but said it would be devoted to food literacy from the bottom up.” So, we’ll have to wait and see what he means by that auspicious comment.
In the meantime, “The Diet Doctor,” Andreas Eenfeldt, MD, is getting impatient…and frustrated. A recent post has resorted to the this/this/this hyperlink tactic to cite multiple sources and meta analyses all refuting the idea that saturated fats are harmful to your health. The title of the piece, “Saturated Fat Completely Safe According to New Big Review of All Science,” is a bit hyperbolic, but he makes his point.  The piece begins, “Are butter and other saturated fats bad for us? No,” he says. I couldn’t agree more, and I share The Diet Doctor’s frustration. I have been grousing about this since the inception of The Nutrition Debate in 2010. See this, this, this, and this. (hehe.)
But the Titanic IS turning. It just takes time, and patience, to re-educate an entire society. And it is even more difficult so long as the Diet Dictocrats in government and academic research (funded by Agribusiness, Big Pharma and Big Government), the medical societies and individual medical practitioners (dictated by insurance policies, medical society guidelines and corrupted by Big Pharma) hold the line on policy gone wrong since the 1950s. As Gary Taubes said in a New York Times’s op-ed, cited in Retrospective #192, “Making inroads against obesity and diabetes on a population level requires that we know how to treat and prevent it on an individual level.”
Whole populations are hard to turn, especially since so many nations around the world have unfortunately followed the U. S. lead in matters of “healthy eating.” But not always, and that too is changing. Andreas Eenfeldt makes that point when he says, in the piece cited above, “When are older so-called experts going to give up their outdated and unscientific warnings about butter? It’s time to embrace science.” OUCH!
The Diet Doctor continued, “Today, fear of butter lacks scientific support. It’s based on old preconceptions and on an inability to update knowledge. If you want to be taken seriously as a ‘nutrition expert,’ you’d better keep updated. It’s not good enough to continue spreading ideas from the 80′s about fat, ideas that have long since been refuted. There has to be a limit to how long you can bury your head in the sand.” WOW! Andreas is gutsy. Come to think of it, though, I got fired by an endo about a year ago for telling him he “needed to go back to school.”
Eenfeldt gets his courage, in part, from the lead that his native country (Sweden) took a little over a year ago to advocate a LCHF (Low-carb, high-fat) diet. In announcing the change to his Diet Doctor followers, his excitement and enthusiastic support for that decision was palpable. He exulted, “This could be an historic day in Sweden.”
More recently there has been a lot of excitement about and acclaim for the new draft Brazilian dietary guidelines. Marion Nestle described them (with a link to the Portuguese original) in a February 2014, “Food Politics” blog post. There’s a lot to like about them too. The Diet Doctor calls them “almost perfect.” For one thing, they advocate “real food” and “cooking at home.” It’s a bold and audacious move for a growing segment of the world’s nutrition nabobs. I salute Brazil for “coming out” in favor of “real food,” and Marion Nestle for reporting it.
And then, just one month later Nestle debunked the diet/heart hypothesis with, “Is Saturated Fat a Problem? Food for Debate.” And while Nestle still tows the line and cows to the AHA and the Harvard academics, at least she reported on that shattering development. By towing the line, though, she affirms that she is still just another passenger on the Titanic. n the case of this “Healthy Eating” Titanic, she is still “on board” as the “state-of-our-health-ship” ever so slowly changes course.
Personally, I jumped ship a long time ago. I’d probably be dead now if I hadn’t.

Thursday, September 5, 2019

Retrospective #201: Horton Hears a Who!


In this 2008 movie (I saw it with the “grands”), “Horton the Elephant struggles to protect a microscopic community from his neighbors who refuse to believe it exists,” according to the IMDb synopsis. With the 2013 World Health Organization (WHO) guidance on sugar consumption, the story becomes allegorical. With WHO’s “recent discovery” that we are eating too much sugar, I could now relate it to our gut biota, a “microscopic community”.
“Recent discovery” is in quotes because I am reminded of an excerpt from Weston A. Price’s magnum opus, Nutrition and Physical Degeneration (1939) that I read in Catherine Shanahan’s great book, Deep Nutrition:
“It is of interest that the diets of the primitive groups […] have all provided a nutrition containing at least four times these minimum [mineral] requirements; whereas the displacing nutrition of commerce, consisting largely of white-flour products, sugar, polished rice, jams [nutritionally equivalent to fruit juice], canned goods and vegetable fats [oils] have invariably failed to provided even the minimum requirements.” (brackets by Shanahan; bold by me).
The draft WHO guideline has been widely disseminated in the mass media, and regurgitated by bloviating bloggers everywhere; but, just in case you missed it, I will provide this extract from the abstract in Diabetes in Control:
“WHO's current recommendation, from 2002, is that sugars should make up less than 10% of total energy intake per day. The new draft guideline also proposes that sugars should be less than 10% of total energy intake per day. It further suggests that a reduction to below 5% of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around 6 teaspoons) of sugar per day for an adult.
The suggested limits on intake of sugars in the draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.
Much of the sugars consumed today are "hidden" in processed foods that are not usually seen as sweets. For example, 1 tablespoon of ketchup contains around 4 grams (around 1 teaspoon) of sugars. A single can of sugar-sweetened soda contains up to 40 grams (around 10 teaspoons) of sugar” (again, bold added by me).
I could go on and on about the dangers of “hidden” sugar, and of flour, sugar and vegetable oils.  Suffice it to say: Weston A. Price was prescient! And so many others, whose message is being drowned out today by the tsunami of modern “sort-of-science” that Gary Taubes describes and I report on in Retrospectives #192 and #193.
I am reminded of the prologue to Taubes’s seminal tome, Good Calories-Bad Calories (The Diet Delusion in the UK). In it, he relates how in 1863 William Banting, a portly retired London undertaker, asked his doctor how to lose weight. The doctor had just returned from a lecture in Paris by Claude Bernard, the famed French physiologist. So he told Banting to “scrupulously avoid eating any…food that might contain either sugar or starch.” He “avoided altogether “bread, milk, beer, sweets and potatoes” and dropped 50 pounds in 18 months. And as I relate to my readers in Retrospective #1, the 18-page pamphlet Banting produced and sold became an instant best seller.
The 2020 “Dietary Guidelines for Americans” are now in preparation. Will the USDA/HHS be as sensitive as Horton was to the “microscopic community” that exists, and lives, within each of us? The trillions of human cells, and the trillions more of biota living in our gut, that depend on what we eat for our and their good health and the health of future generations who will populate the earth with the epigenetic inheritance we bequeath them? As Dr. Shanahan points out, we have “intelligent genes” that learn how to express themselves, or not…
It’s up to the Dietary Guidelines Advisory Committee, but if a Mail Online story is a harbinger, I fear it will not. Nottingham University’s Ian Macdonald, chair of the government panel tasked with examining the health impact of sugar consumption, is a paid consultant to both Mars and Coca Cola, according to the story. “We would take note of it [the WHO guidelines], but we would not act on it,” MacDonald said. He added, “The Government would take the recommendations of his own panel, the Carbohydrate Working Group of the Scientific Advisory Committee on Nutrition, rather than those of the WHO.” So, if Horton is not looking out for the WHOs, who is?

Wednesday, September 4, 2019

Retrospective #200: “Healthy Eating”


“Healthy Eating” is in quotes because it has been co-opted by Diet Dictocrats in the Public Health establishment, by their cohorts in Agribusiness and Big Pharma, and by extension, mass media in general. We (followers of The Nutrition Debate/Type 2 Nutrition and like-thinkers), exist in a parallel universe – behind the mirror, as it were. We need to take the phrase back. That’s the reason I write “The Nutrition Debate,” renamed “Type 2 Nutrition,” here.
“Healthy eating” is not just for Type 2 diabetics like me, although it should be self evident that diabetics should not eat a “balanced” diet, high in carbohydrates, as advocated for EVERYONE by the Dietary Guidelines for Americans and the ADA. “Healthy eating,” as I will describe here and henceforth, advocates that EVERYONE eat, in a way that is a major departure from that construct. “Healthy eating,” as I will define it, will be what I would have been able to eat IF I had not “broken” my metabolism by eating the recommended Standard American Diet (SAD). And perhaps, it is what I would have been able to eat if I had taken charge of my own diabetes healthcare when I was first diagnosed. I didn’t know that then, when the “fix” was within my control. The “fix” was to change what I eat.
The “fix” for most people who today appear to have a healthy metabolism but have gained a little weight is simply to shift slightly away from refined carbohydrates, sugary foods, and foods made with or cooked in vegetable oils. This will shift the proportions of macronutrients away slightly from carbs and Omega 6s (in soybean, corn and other vegetable oils) and slightly toward healthy saturated fats and animal protein. Along the way, you will lose weight, you will not be hungry all the time, and you will feel better. Everyone can do this, and should do it, routinely.
For people who are overweight or obese, making these dietary changes, in extremis, will have all the same effects for you, plus your pre-diabetes (diagnosed or not, if you’re overweight, you probably have Insulin Resistance), or your diagnosed Type 2 diabetes will be “in remission.” In reality, you will regain good blood sugar control and be clinically considered “non-diabetic,” in terms of your A1c’s, SO LONG AS YOU CONTINUE TO EAT THIS WAY.
For long term Type 2s, if you change your diet in a radical way (e.g. Very Low Carb, i.e., 20g of carbs a day), you will be able to eliminate most or all of your oral diabetes medications. I did. After 16 years of seeing my diabetes progressively worsen, requiring more and more medications, I made the transformation. As a result, to avoid hypos, I had to stop taking 2 of the 3 oral diabetes meds and today take only a minimum dose of Metformin. In addition, I lost 170 pounds, my blood pressure went from 130/90 to 110/70 on fewer meds, and my HDL and triglycerides (blood lipids) and hsCRP (inflammation) markers dramatically improved.  That was 17 years ago.
I realize that there is a lot of confusing information out there. It’s a problem. Whom do you believe? Extremists like the vegans? Or an extremist like me? “Everything in moderation” is a very appealing concept. It seems reasonable until you realize that “everything” in today’s food environment includes “foods” that are harmful to virtually everyone. Therein lies a clue that might guide you.
Processed (manufactured) foods of whatever stripe are likely to be “unhealthy.” Vegetable oils – all vegetable oils – are a modern invention of the food manufacturing industry. It is only in the last 100 years or so that processing seeds with crushing, cooking to remove “impurities,” then chemically treated to “bleach” them (like white flour is “bleached”) is what we are now eating in large quantities every day in the processed foods we buy and cook.
Why does it not occur to us that this is both unnatural and unhealthy?  How could anyone consider that “healthy eating”? So, in the spirit that we (the general population) are all Pre-diabetic (whether diagnosed or not), or worse, I recommit myself to my definition of “healthy eating”: an animal-based diet that includes healthy saturated fats and dietary cholesterol. My diet is high fat (75% fat), moderate protein (20% protein), and very low carb (5% carbohydrate), the way it has been now for these last 17 years. And, for the record, my latest lipid panel: Total cholesterol: 186; LDL 92; HDL 80 and triglycerides 56, non-HDL cholesterol 106. My hs CRP was 1.7, but I am working to get that lower. My hsCRP goal: <1.0mg/L. My most recent A1c was 5.7%. My A1c goal is 5.0%.