Sunday, December 22, 2019

Retrospective #309: Diabetes Q & A

Q #1: What is Type 2 Diabetes?
Answer: Type 2 Diabetes is a metabolic disorder in which insulin, the glucose transporter in the bloodstream, is blocked on the surface of destination cells, preventing the glucose from being taken up for energy. This condition is called Insulin Resistance. As a result of Insulin Resistance, blood glucose levels become elevated. If untreated, elevated blood glucose eventually causes serious microvascular and macrovascular complications. And, as the disease worsens, the pancreas develops a diminished capacity to make insulin, and insulin replacement therapy is required.
Q #2: How Did I Get Type 2 Diabetes?
Answer: You, along with about half the population of the Western World, were unlucky. First, you have a certain genetic predisposition such that some as yet mostly unknown combination of genes makes them vulnerable to a genetic modification. This is not a “mutation.” Second, you (and I) unwittingly participated in a large uncontrolled government experiment of eating a low-fat, high-carb, dietary pattern and, being genetically predisposed, our genes have “expressed” this modification, causing us to become Insulin Resistant, and thus Carbohydrate Intolerant.
Q #3: What Can I Do If I’m Pre-Diabetic?
Answer: If you’ve been told, or you suspect, that you’re “Pre-Diabetic,” to avoid becoming a Type 2 Diabetic you must change what you eat to reduce, as much as possible, carbohydrates. Carbohydrates are a non-essential macronutrient. There is no minimum requirement for carbs. Carbohydrates include both simple sugars and complex carbohydrates, particularly refined and processed carbohydrates. You must also avoid sugary soft drinks, fruit juices and drinks, and all baked goods, starchy vegetables, cereals, and desserts. This, of course, is difficult to do, but if you do it, it’s a sure and certain way to lose weight without hunger, and besides losing weight, you will avoid developing type 2 diabetes.
Q #4: How Can I Prevent Type 2 Diabetes?
Answer: Easy! Type 2 Diabetes is a dietary disease. If you take charge of what you eat, and seriously restrict your carbohydrate intake, you will avoid developing this disease. Even if you are already somewhat overweight and/or have been told you’re “Pre-Diabetic,” you can reverse Pre-Diabetes and put Insulin Resistance “in remission.” And by continuing to restrict carbohydrates, you will also lose weight rather easily and do it without hunger! As long as you stick to your carbohydrate restriction/reduction, you will remain protected from developing this disease.
Q #5: How Can I Prevent Type 2 Diabetes from Becoming Progressive?
Answer: If you are already a diagnosed Type 2 Diabetic, you must do just one thing: ignore the advice to “eat a balanced diet.” Continuing to eat beaucoup carbs will virtually guarantee that your disease will be progressive. You will become dependent on more and more expensive medications, and possibly become an “insulin dependent type 2” and eventually develop the dreaded complications. The only way to prevent Type 2 Diabetes from becoming progressive is to largely eliminate carbs from your diet: all carbohydrates become glucose in your bloodstream.
Q #6: Can I Reverse Pre-Diabetes or Type 2 Diabetes?
Answer: The only way to reverse Type 2 Diabetes is to largely eliminate carbohydrates from your diet. All carbs become glucose in your blood. If you are Pre-Diabetic or have been diagnosed a Type 2 Diabetic, you have Insulin Resistance and you are therefore Carbohydrate Intolerant. Your body can’t handle carbs any more. So long as you restrict the carbohydrates you eat, your Pre-Diabetes or Type 2 Diabetes will be “in remission.” You’re not cured, but while your disease is in remission, you are not at risk for the microvascular and macrovascular complications.
Q #7: Can I Cure My Type 2 Diabetes?
Answer: No, you can’t. Anyone who uses the word “cure” is misleading you. If you are a Type 2 diabetic, it is because you were genetically predisposed and your genes have “expressed,” i.e., been modified, permanently, as far as anyone knows at this time. That’s history, and you can’t change your genes back to their “normal” expression. However, you can take those genes “out of play” by avoiding all the foods that “express” them: carbohydrates. So long as you eat a diet of fats and protein, as your body was designed to do, your body will adapt. You will have plenty of good energy, healthy food for the heart and brain and every other need the body has, and your blood sugar and insulin levels will decline to “normal.” Your Type 2 Diabetes will be “in remission.”
Q #8: How Can an Overweight Type 2 Lose Weight Safely?
Answer: That’s easy, and you can “kill two birds with one stone.” The most difficult part of any “restricted calorie, balanced” weight loss diet is being hungry all the time. The reason is: most overweight people have Insulin Resistance. So, insulin circulating in your blood, secreted by the pancreas to transport glucose (digested carbs) to your cells, blocks your body from using body fat for energy. Your body thinks, “If you have insulin circulating, so you have carbs in your blood, so you don’t need your precious body-fat reserves.” So, stored fat is “saved” for another day. If you instead restrict carbs, instead of calories, your liver will sense lower blood glucose and blood insulin in the bloodstream, and will start to break down body fat for energy. You will feed on yourself, you will not be hungry, and you will lose weight!
Q #9: Is Being Overweight a Cause of Type 2 Diabetes?
Answer: No, it’s the other way around, and the explanation is simple. When you eat a “balanced” diet, as most weight loss programs and “experts” advocate, glucose from digested carbs is accompanied in the bloodstream by the transporter hormone insulin. The liver, which controls metabolic homeostasis, perceives that since you have dietary carbs available for energy, you don’t need body fat to maintain energy balance. So, the fat stays locked up around your waist. As you develop Insulin Resistance (see #1 above), your serum insulin levels remain high so added, unused  calories from carbs, protein and fat, stored in the liver, are converted by the liver to additional fat stores. You got fat because you’re Insulin Resistant, which means you are either a Type 2 Diabetic or at serious risk of becoming one.
Q #10: Is Being a Type 2 Diabetic like being Gluten or Lactose Intolerant?
Answer: Yes and No. Each involves a food intolerance. Gluten Intolerance means the body is intolerant of the protein portion of the wheat, barley or rye grain. It rapidly results in intestinal distress. Lactose Intolerance means the body is intolerant of foods containing the milk fat lactose, because of the absence of the enzyme lactase to help digest it. Lactose intolerance rapidly results in intestinal distress. Carbohydrate Intolerance, the result of a person developing Insulin Resistance expressed as the metabolic disorder, Type 2 Diabetes, is at first asymptomatic but results in serios long term microvascular and macrovascular complications, usually the eventual cause of death. All three intolerances – gluten, lactose and carbohydrate – are dietary diseases and are best addressed by avoiding the dietary cause.
Q #11: Won’t Eating So Much Fat Make Me Fatter?
Answer: No, unless you eat too many carbs and too much fat. Fat, eaten with or without protein, is filling. You quickly become satiated (satisfied), so eating fat is self-limiting. You will eat less if you eat just meals of energy-dense, full-fat, real foods, moderate protein and minimal carbohydrates. Carbs that have been processed have been depleted of nutrients in processing, including essential fat-soluble vitamins and minerals. Carbs that are eaten to the exclusion of healthy saturated and monounsaturated fats will not satisfy your hunger and will lead to cravings. Eating too many nutrient-deficient processed carbs will lead to overeating carbs, which the liver will convert to body fat via a process called de novo lipogenesis. Eating carbs will make you fat. Think about how livestock is fattened before slaughter.
Q #12: Won’t Eating Saturated Fat Make My Cholesterol Rise?
Answer: Actually, no! Eating a high-fat, low-carb diet will be good for your cholesterol. It will raise your HDL cholesterol (the “good” cholesterol). Mine more than doubled. If your Total Cholesterol (TC), an obsolete value in modern lipidology, rises slightly, it will be because your HDL went up. The formula is TC = HDL + LDL + TG/5. Your LDL cholesterol (the “bad” cholesterol) will probably remain constant, but the LDL particle size and density will improve, from “small dense” to “large fluffy.” And your triglycerides (TG), measured at the same time as your cholesterol, will decline dramatically. Mine dropped by more than two-thirds.
Q #13: Won’t Eating Dietary Cholesterol Block My Arteries?
Answer: Certainly not! Dietary cholesterol, from animal foods like meat, eggs and shrimp, has nothing to do with serum cholesterol (cholesterol in your blood). Cholesterol is an essential compound. It is present in every cell in your body. Your liver makes cholesterol as your body needs it, accounting for about 90 percent of the cholesterol in your body. If you eat less cholesterol, your liver will make more. Cholesterol in the blood actually repairs erosion in the surface layer of your veins caused by inflammation, preventing small, dense oxidized LDL particles from being trapped in the fissures. HDL “clears” LDL, returning it to the liver for disposal.  In December 2014, the Dietary Guidelines Advisory Committee reported that “Dietary cholesterol is no longer a nutrient of concern for overconsumption.”
Q 14: Aren’t Carbohydrates Necessary for Energy?
Answer: No. Carbohydrates, however, are a major source of “quick” energy. They digest quickly, converting primarily to glucose, which is an essential nutrient, in small amounts, for certain organs and tissue. However, because only a small amount of glucose is necessary but because it is essential for certain parts of the body, the body has developed mechanisms and pathways to make glucose from both protein and fat. The liver can make glucose from amino acids that are the breakdown products of protein. And glucose can also be made from the glycerol “backbone” when a triglyceride (fat) molecule is broken down to fatty acids for fuel. Furthermore, the byproducts of this oxidation are ketone bodies which the brain actually prefers to glucose. In the absence of carbs, after a brief period of adjustment, the body does very well on a diet exclusively of fat and protein. Some marathoners prefer fat to carbs for fuel.
Q 15: What About Macronutrient Ratios?
Answer: In 1961, the American Heart Association determined, from epidemiological studies, that dietary saturated fat and cholesterol were a cause of cardiovascular disease (CVD).  In 1977, a U.S Senate Select Committee agreed, and in 1980, the USDA/HHS produced the first Dietary Guidelines for Americans. Food packaging laws followed, resulting in the Nutrition Facts panel on processed and packaged foods. To this day, except for children under the age of 2, the macronutrient ratios on those panels recommend that the entire American population eats a diet consisting of 60% carbohydrate, 10% protein, and 30% fat, and that mostly polyunsaturated fat from vegetable oils like soybean and corn oil. That, in a nutshell, is why half the Western world is now overweight or obese…and has Insulin Resistance.
Q 16: What Is a Low-Carb, High-Fat (LCHF) Diet?
Answer: A Low-Carb, High-Fat (LCHF) diet is designed primarily to lower both blood glucose and blood insulin, thus preventing the onset of Prediabetes or Type 2 Diabetes or reversing Prediabetes due to incipient Insulin Resistance. It also enables the adherent, if needed, to lose weight without hunger. Definitions vary but generally a LCHF diet entails eating less than 50 grams of carbohydrate a day. That’s 10% carbohydrate of a 2,000kcal a day meal plan vs. 300g/day (60%) carbohydrates of the Standard American Diet (SAD) on the Nutrition Facts panel on processed food in the U.S.
Q 17: What is a VLC Ketogenic Diet?
Answer: A VLC Ketogenic Diet is a Very Low Carb Ketogenic Diet in which the adherent eats fewer carbohydrates than in LCHF. Generally, it’s about 5% or between 15 and 30 grams of carbs a day (on a 1200 or 2400kcal/day diet.) Today, I try to eat ≤ 15g/day of carbohydrates to be in a perpetual state of mild ketosis, producing a low level of ketone bodies from the breakdown of my body fat. I find that my body likes this state best. I am always full of energy, get excellent rest, and am never hungry. So long as I adhere to this program, my blood sugars are always <100, and I lose weight.
Q 18: What Foods Must I Strive to Avoid to Stay Healthy?
Answer: Processed carbohydrates, simple sugars and vegetable and seed oils. Carbs include simple sugars, both added and naturally occurring, unfortunately. That means avoiding: fruit, especially fruit juices and fruit drinks; baked goods, cereals, pasta and rice and root vegetables. The more processed the grain or the sugar, the more damage it can cause.  Flour and sugar are not your friends.  Also, avoid inflammatory foods. Vegetable oils, particularly corn and soybean oil, are high in polyunsaturated fats (PUFAs) and are very inflammatory, doubly so if used repeatedly for deep frying.
Q 19: Is Type 2 Diabetes a Lifelong Disease?
Answer: Regrettably, once you get Type 2 Diabetes, you’ll have it for life. Your genes have been modified. However, if you limit the carbs you eat, and avoid processed carbs and sugars, your body will be able to handle it. And when eating Very Low Carb your insulin sensitivity will improve. And your body still produces some insulin, so in response to eating carbs it will produce enough insulin to circulate the glucose and eventually absorb it. Then, after the circulating glucose is absorbed and your blood insulin drops, you will return to burning body fat for energy; your body will be happy, and you will not be hungry. As long as you follow this Way of Eating, your Type 2 Diabetes will be in remission.
Q 20: When I Reach My Goal Weight, What About Maintenance?
Answer:  I have only reached my goal weight once, and I later regained some. In maintenance, you are supposed to keep both carbs and proteins constant and, to stop losing, increase your fat. Increasing fat should be fairly easy. I could snack before dinner on buttered radishes or cream cheese filled celery, or add olive oil or butter to meat and vegetables. For now, I am working on getting back to my goal weight and maintaining my Type 2 diabetes in remission.

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