Friday, April 3, 2020

Retrospective #413: “End Date” TBD by insurer

A couple of years ago my wife left a post-surgical office visit with a written prescription for physical therapy (PT) and instructions to call for another office visit when the PT was completed. So, I asked my wife how long was the course of physical therapy that the doctor prescribed. She looked at the script and read, “End date: TBD by insurer.”
My first reaction was surprise, then anger at the doctor for abdicating to the insurer on medical decisions, then anger at the insurer for making medical decisions, then anger at government telling insurers how much they will reimburse insurers for making medical decisions. Healthcare decisions that affect a patient’s recovery from surgery should always be a matter between doctor and patient, not insurers, whose principal interest is the bottom line. And not government, where politicians and their staffs are not qualified and are generally corrupted by conflicts of interest.
So, the doctor is not to blame. He or she is in business too – albeit small business, but Retrospective #365 on changes in Medicare demonstrates that even the giant American Medical Association was helpless to alter the course of the “reforms” to Medicare that were enacted to pay for the Affordable Care Act (“Obamacare”). Healthcare represents about 17% of the U. S.’s Gross National Product. It’s a behemoth that overpowers everything else.
So, let’s review: A doctor defaults the duration of physical therapy to the insurer. And insurers are governed by government reimbursement policy written by the staff of politicians who have no business doing it. But ultimately laws are passed and regulations are promulgated in this way. So, it’s a mess, but what’s a patient to do? Answer: Take control.Take your healthcare into your own hands! Seriously, it’s your health!
My doctor offers “Concierge Care.” I suspect he’s looking for a way to get out from under all the restrictions, regulations and reporting (the 3R’s) described in Retrospective #365. With Concierge Care he has less overhead for coding and billing, and he gets paid an annual fee.  It has to be more rewarding, and not just financially.
I declined his Concierge Care offer, though, because under the Medicare as primary and GHI secondary supplemental insurance that I have from being a former NYC manager, I have very good insurance coverage. Virtually everything is covered and paid for. I even get the Medicare Part B premiums, deducted from my pension check, refunded! And my Medicare Part D prescription drug coverage is subsidized by the NYC Management Benefits Fund.  I am also in pretty good health for my age – much, much better than I was 18 years ago, when I was morbidly obese and had “borderline” everything. When my current doctor took over my former doctor’s practice, my new doctor studied my chart and suggested I see him just once a year. Instead, at my insistence, I see him 3 times a year, primarily for blood work.
So, my pitch to you is this: Take responsibility for your own health. Don’t rely on your insurer to tell you what to do or how long to do it. And don’t let the government tell you what to EAT. They’ve been wrong with the dietary advice they’ve been dishing out for the last 60 years, much longer than any government official or practicing physician has been working. Remember, too, your doctor is/was not educated in nutrition, and the RDs and CDEs in practice today obtained and keep their licenses by learning what the government’s huge, failed nutrition experiment dictates.
If you’re overweight or pre-diabetic, ask yourself, how did you get that way? Haven’t you been trying to eat a “healthy diet” the way you’ve been told to do for most of your adult life. And haven’t you been exercising regularly? Then what caused you to gain weight or become pre-diabetic or a diagnosed type 2? Answer: Insulin Resistance. And if you are Insulin Resistant, you are Carbohydrate Intolerant. Does it make sense to continue to eat a “balanced” diet, a diet that is 55% to 60% carbohydrate? That’s what “everything in moderation” means and the way government and the medical establishment told you to eat. But isn’t that how you became Carbohydrate Intolerant? Then why would you continue to do the same thing over and over again and expect a different result? That’s the definition of insanity!
Think about it, seriously And just for reference, think about how feed lot beeves (plural of beef) are fattened up in their final weeks. They are fed grains, and corn, from a trough. A 100% carbohydrate diet. It’s a surefire way to fatten them up! Prime beef, with a thick outer layer of fat and lots of interstitial marbling. Hmmm good.

Retrospective #412: “Cover” Story

With idle time in my wife’s doctor’s waiting room, I picked up WebMD Magazine’s June 2017 issue. The cover story appeared to be an article asking, “Trouble reaching your A1c goals?” Next to a photo of a middle-aged man, the caption invited the reader to: “See how Jerry does it.” I’m always interested in seeing how other people lower their A1c’s, so I eagerly and naively turned the page…to a 3-page ad for Trulicity, a product of the Eli Lilly company.
Somehow, I missed the disclaimer on the false cover. It said, on a black banner, “Special advertising section. This Trulicity promotional cover has been placed on a limited number of WebMD magazines.” – just the ones in doctor’s offices, I’d bet. It continued, “It does not constitute an endorsement by WebMD Magazine, and no endorsement is implied.” Okay, WebMD gets big bucks for the fake cover, but how about the doctor’s office? Are they not complicit in this “non-endorsement” endorsement? I think so, and they (the doctor) doesn’t even get paid for it!
I also missed the small Lilly logo at the bottom of the false cover. But it was impossible to miss the 3 full pages of information about “non-insulin Trulicity, a once-weekly injectable pen for type 2 diabetics to help [your body] release its own insulin.” They’re careful to say, as required by the FDA, that it’s not the first pharmacotherapy med for type 2s. That would be Metformin, introduced in France in 1957, the UK in 1958, and the U.S. in 199X. But Metformin works on the liver to suppress unwanted glucose production and improve to insulin sensitivity (glucose uptake), and it’s safe.
As Lilly implies, Trulicity works on the pancreas, an organ that is already overworked in type 2s, to counter the insulin resistance that is the cause of type 2 diabetes. Does it make sense to put an added burden on the one (and only) pancreas you have to secrete the insulin on which your life depends? Trulicity makes the pancreas work harder; it “helps the body release its own insulin,” to use Lilly’s own words. But Lilly’s not worried about that. When the pancreas eventually is exhausted from overwork and wears out, you will graduate to another injectable drug made by Lilly: insulin glargine. And with all the increases in the last few years, have you seen the price of insulin glargine lately?
But Lilly and all the other drug manufacturers do not intend you harm. Their drugs are all approved by the FDA for the uses intended, and the uses all conform to the American Diabetes Association's Standards of Medical Care. What’s wrong with this picture? Answer: The treatment plan! The treatment treats the most common symptom of type 2 diabetes—an elevated blood sugar – by forcing the pancreas to produce more insulin. More insulin is what your pancreas has been producing for years before and since your impaired insulin response was discovered by your doctor (by an elevated fasting blood glucose, or with an A1c test).
Your impaired insulin response, aka INSULIN RESISTANCE (IR), is the cause of your type 2 diabetes. What caused your Insulin Resistance? Answer: On the government’s advice, in order to avoid eating saturated fat and cholesterol, for 60 years you ate a diet of 55% to 60% carbohydrate, composed of simple sugars and processed, refined, “whole grain” glucose molecules, euphemistically called “complex” carbohydrates. Over time, you became Carbohydrate Intolerant.
So, what’s the best treatment plan for Insulin Resistance? That’s simple too: reduce your intake of carbohydrates, especially the refined, processed ones, and the simple sugars, of course, particularly the liquid ones. From 60% there’s lots of room for lowering. For the generic woman’s 2000kcal/day diet, 60% is 300 grams of carbs/day. Lowering it to 20% would be 100 grams/day. For a man (2500kcal/day =375 grams/day), lowering it to 20% would be 125 grams/day.
With a few more waiting-room minutes on my hands, I searched that entire issue of WebMD magazine in vain for another mention of type 2 diabetes. This is a condition that nearly a third of the people of the U. S. already have, with another quarter pre-diabetic or overweight with Metabolic Syndrome. Alas, there was not a word in the whole issue. There was, however, an article on longevity where it mentioned that Metformin was being investigated as an anti-aging agent. Hmmm. Another reason to 1) eat fewer carbs and 2) take Metformin to help manage your type 2 diabetes.

Thursday, April 2, 2020

Retrospective #411: “You don’t eat!”

When the lab report arrived in the mail, I was expecting to see an increase in my A1c. Instead, my A1c dropped another 0.1% to 5.2%. When I expressed surprise to my wife, she blurted, “I’m not surprised. You don’t eat!”
It’s true. I’m not hungry when I fast because, when I do eat, I eat Very Low Carb (VLC). As I result, my body is fat-adapted. It obtains all the energy it needs from the fat I eat and then the fat my body has stored for the purpose, and I still have plenty of that. So, my energy level, i.e. metabolic rate, remains high because when my body fat breaks down, it is used to maintain energy balance. This fat burning process will continue so long as I eat Very Low Carb. While glucose and insulin levels in the bloodstream remain low, the body will feed freely, as needed, on its own fat.
In retrospect, my concern that my A1c would rise was unfounded. I didn’t take into account that I had only been fasting for 2 days a week – and for just 2 months – when blood was drawn in April. The A1c test measures glucose on the surface of red blood cells over 3 months. So, when the A1c blood was drawn, I still had some “old” red blood cells circulating. Plus, after April I increased my fasting from 2 days a week to 3 days a week.
But my wife, feeling like she was “on a roll,” continued, “That’s why we don’t go out to eat as often as we used to….and you’ve saved a lot of money by our eating out less often. My rejoinder was that I only fast 3 days a week, and that still leaves 4 days a week for eating out! So, my standing offer, to eat “out” as often as she would like, still standsand look at all the money she’s saved by not needing to buy food-for-two for 3 days a week! She agreed, and our “Bickersons” episode ended…strangely, I think, because she usually gets “the last word.”
Bottom line: If you don’t eat, you’re going to 1) lose weight and 2) save money. The secret is: doing it without hunger and without harm. Ketosis is the answer. It is “the normal state of man,” according to the NIH’s Richard L. Veech, (and a host of other researchers in human metabolism). Ketosis begins when your body has finished digesting and absorbing your last meal and begins a period of fasting. The length of time before entering this state differs only by how long it takes to use up the glycogen stored in the liver from previously digested carbs.
In addition, when I don’t eat and continue to take Metformin as prescribed, my blood sugar is better controlled. When I asked my doctor to increase my dose from 500mg once a day to 750mg twice a day – a “therapeutic dose” – and started my 300kcal/day modified fasting regimen, I sometimes got fasting blood glucoses as low as the 60s, without hypoglycemia. When I told my doctor, he laughed. “You can’t get hypoglycemia on Metformin,” he said. Now, when I follow VLC strictly, my FBGs are typically in the 70s and 80s. A recent weekly average was 81mg/dl. And I haven’t had a hypo since 2002 (when I was heavily drugged before I began to eat Very Low Carb).
So, eating Very Low Carb and fasting 2 or 3 days a week is a win-win-win: You lose weight, you save money, and you and your doctor are pleased that your blood sugar control has improved to the point where I am, clinically speaking, now “non-diabetic.” And, when you have better blood sugar control, you reduce your risk of cardiovascular disease (CVD). Type 2s treated with “Standard Care” have twice the risk of CVD as “normal” people. And if you’re been diagnosed with heart disease, you have an even higher risk. See “How Diabetic Do You Want to Be?” to learn more.
Naturally, the question arises: Would it be possible to get an A1c lower than 5.2%? Maybe even in the high 4s? By diet and Metformin alone?  I think it is possible. I also think I can continue to lose weight. When you read this (originally posted in late 2017), I will have lost 185 pounds, and be just about “half the man I once was.” My target final weight (then) was 171-175 pounds* or “200 pounds lost.” And then, presciently, I realized the hardest goal of all would be: Maintaining that weight. I imagined it would involve Very Low Carb, One Meal a Day, and my “300kcal full-day fasts” for 2 or maybe 3 days every week. I’ll call it my VLC/OMAD/4-3 diet. I should be there…in the not-too-distant future.
* My target weight is now 195 to 199 pounds, a permanent loss of 180 pounds. It’s an elusive goal, but, C’est la vie.

Wednesday, April 1, 2020

Retrospective #410: My 300kcal Modified “Fasting” Diet

The day after the Super Bowl a couple of years ago, I began a regimen of full-day “fasting.” Before that I had tried Intermittent Fasting (IF), where I ate within a small window each day (“16-8 fasting”), or I ate just one meal a day (OMAD)and I I maintained my weight, but I didn’t lose. I still wanted to lose a lot of weight, so I decided to just “jump in” with full-day fasting. It was new and unfamiliar to me, so I decided to start with alternate day fasting.
It worked. I lost 62 pounds. I went from 248 to 187, and my BMI went from 36 to 27. Altogether, since starting Very Low Carb at 375 pounds in 2002, I’ve lost 188 pounds. I’m “not half the man I once was,” my wife quipped.
When people ask, “How’d you lose weight?” and I tell them, “Fasting,” they always ask, “How’s your energy?” They imagine, naturally, that they would feel weak because their metabolism would slow down due to the loss of energy “in.” After all, we’ve all been told, “a calorie is a calorie” and “Energy in = Energy out,” meaning if we don’t eat, our body is going to defensively slow down until we eat again. And we believe it because, well…’cause it’s intuitive.
Well, it’s not true. It only applies if your diet is largely composed of AND DEPENDENT ON carbohydrates for energy. It’s not true for people who eat a diet of mostly fat and protein, limiting carbs to very small amounts, in my case just to one vegetable (with fat) at supper. We are “fat-adapted.” We are “fat burners, not sugar burners.” For us, the “Energy in” is not measured by what we put in our mouth; it is measured at the cellular level – where all the nutrients that are circulating in the blood are taken up by the cells. Thus, you do not slow down because your body is being fed.
How is it that when you eat mostly fat and protein, you get to where you can burn body fat? The mechanism is: when you have glucose (from carbs) in the blood, the hormone INSULIN drives everything you eat into storage as body fat and blocks access to your stored body fat for energy. But when the level of your blood glucose (from carbs) drops, the level of your blood insulin also drops. That signals the liver to switch from using glucose for energy to using fat for energy. And then, once the carbs stored as glycogen in the liver are used up, and for so long as you then continue to strictly limit carb intake by mouth to a very small amount, your body will switch to breaking down body fat for energy.
On a “fasting” day, I have a 12oz coffee with a splash of heavy cream (not H&H) and dash of pure stevia for breakfast.  H&H is half milk and is loaded with lactose, or milk sugar. I stay “fat-adapted” with stable blood sugar all morning.
Then, if I’ve been working in the garden and I’m dehydrated, I’ll take some stevia-sweetened iced tea and maybe a little pickle juice for salt and nothing else until “supper.” My “fasting” supper is just a glass of red wine topped with seltzer (a “spritzer”), which I use to wash down pills/supplements. LOL
My 300kcal, Modified “Fasting Diet” Macronutrient Composition:
Coffee w/cream: Fat: 16g (144kcal), Protein: 1.2g (5kcal), Carbs: 1.2g (5kcal); Total: 154kcal.
Spritzer (6oz red wine): Carbs: 4.5g (18kcal), Ethyl alcohol: 18g (126kcal); Total: 144kcal.
Macronutrient totals (“fasting”): Calories: 298kcal, say 300kcal; Protein: 1.2g; Fat: 16g; Carbs: 5.7g; ethyl alcohol: 18g. The secret for the success of this “300kcal Fasting Diet” is, since I always eat VLC, I am ALWAYS “FAT-ADAPTED.”
So, when I return to a “feasting” state, I continue to eat Very Low Carb: The same “breakfast” of coffee with cream and stevia, a small lunch, usually a can (for portion control) of Brunswick kippered herring fillets in brine (160kcal). I drink the brine. It’s a small lunch, but enough. Alternatively, I might have 1 or 2 hardboiled eggs. All protein and fat.
Then, for a “feasting” supper, I have a serving of protein with fat (fatty meat, poultry with skin, or fish) and one low-carb vegetable with fat, either stove-top and tossed in butter or microwaved after being coated in olive oil. With this supper I have 2 glasses of my evening spritzer with my pills. And since I’m not hungry, because I’m fat-adapted, this is plenty. Some days I skip “lunch” and some days I skip both “lunch” and “supper” and fast another day. If you have lots of energy and you’re not hungry (because you’re burning body fat), why not? ;-)

Tuesday, March 31, 2020

Retrospective #409: I used to eat eggs…

I used to eat eggs, or eggs and bacon, for breakfast. My usual lunch then was a can of King Oscar brand, Brisling sardines in EVOO. I usually drank the EVOO (240kcal in total). I also swallowed 2 grams of fish oil a day, and still do. And I ate a Very Low Carb supper. My triglycerides plummeted by 2/3rds and remain very low ( +/-50mg/dl). 
Now, however, I think that a can of sardines, especially with the EVOO, is too much food, especially fat, for lunch, particularly if you are not hungry. And I am not hungry at lunch. Hell, I was never hungry at breakfast!
So these days I don’t eat breakfast any more. I just have a 12oz cup of coffee with a splash of heavy cream and a dash of pure stevia powder. Then, if I eat lunch, I have a can of my new favorite lunch: Brunswick kippered (skinless) herring fillets in brine (160kcal). I drink the brine. It’s a small lunch, but enough. Alternatively, I’ll have 1 or 2 hardboiled eggs. Both the kippered herring and the eggs are less expensive and fewer calories, and less fat, than the sardines in EVOO. And less dietary fat is a good thing if you’d rather burn body fat instead.  I also think that they would be a lot more palatable to the ‘normal’ person’s taste, but I like all three equally.
Why was I never hungry at breakfast? And why am I still not hungry at lunch? Because my body is fat-adapted, meaning it has been in a fasted state since a few hours after supper the night before, some 12 hours earlier. At breakfast, my body is in mild ketosis. In the absence of food, and as a consequence of eating Very Low Carb at supper and having low stores of glycogen in my liver from generally eating Very Low Carb, my body has maintained a high metabolic rate and energy balance by breaking down body fat for energy during the nighttime.
Then, with only heavy cream (NOT half & half) in my coffee, my high metabolic rate and energy balance continue. With my lunch choices being only protein and fat, my ketosis and stable blood glucose continue into the afternoon, still without hunger because my body continues to burn its own fat, and I am in energy balance,
It wasn’t always like this. When I began to eat Very Low Carb in 2002, I kept careful records. From the start, I l estimated carbs, but later I counted protein too, and still later added fat and total calories. And I ate a lot more then than I do now. After all, I was morbidly obese. Today, I don’t keep those records, just FBG and weight, daily.
Keeping records, though, was in my nature, and I learned a lot from it. But I learned much more from other low-carbers. I joined an online group of like-minded people and started asking questions. It was a supportive and safe space. I left another site I visited because all that people wanted to do there was argue about which way of eating was best. On the group I joined, I was very active, daily, for years, first as a student and later as mentor.
When you’re ready to make the shift, there are lots of ways to address a Lifestyle Change. But first you have to become convinced that the one-size-fits-all dietary advice given by the government’s Dictocrats and the “old school” medical establishment, and Big Pharma, has sadly been bad advice. It led to the Diseases of Civilization to which the world has succumbed. So, you have to be ready to break with that and manage your own dietary future. When you are ready, give Very Low Carb (VLC), or even Low Carb, a try. Here’s what you can expect:
       You will lose weight easily because you will not be hungry all the time. You will eat less and feel better.
       You will not need a snack in mid-morning or feel sleepy after lunch, or snack after supper/before bedtime.
       Your health markers will improve dramatically: blood sugar (A1c) and lipids (cholesterol), and blood pressure.
Some people have difficulty making the transition. I went “cold turkey.” I drank lots of water and I added salt. To avoid hypos (I had been on 3 classes of oral anti-diabetic meds when I started), I stayed in close contact with my doctor, who (by the way) suggested VLC for me, to lose weight. Over time (15 years), I lost, literally, half my body weight (188 pounds), and I feel great! I’ve never been healthier or happier. You could be too. Give it a try!

Monday, March 30, 2020

Retrospective #408: Keto-adapted and Fat-adapted

If you eat Very Low Carb (15-30g/d) – not just low carb (50-100g/d) – you undoubtedly will know the term keto-adapted. There’s no formal definition of VLC because it varies according to your metabolism – the degree of your dysregulated glucose metabolism due to your degree of Insulin Resistance. However, VLC is generally meant to be a dietary intake of way less than 50 carb grams a day. It usually means 30 grams or less; for me it is just 15 grams a day.
When someone eats VLC, they generally eat less food because 1) dietary fat is filling, and fat, whether dietary or stored, does not induce the pancreas to secrete insulin, 2) protein digests slowly and make you feel full longer, and 3) carbs are digested quickly and they make your blood sugar rise and fall quickly and thus makes you “hungrier, quicker and oftener.” And finally, if you eat VLC, when your body has used up the energy from carbs you ate (and has stored in the liver as glycogen), the body can turn to fat for energy – the fat you ate and then fat that is stored on your body.
Protein isn’t used for energy directly. Its components, amino acids, have myriad other functions in the body; however, about half of the amino acids in protein can be used to make glucose in a pinch or, in Type 2 diabetics, even when not needed. That’s one of the reasons Type 2s take Metformin, to suppress this unwanted glucose production by the liver.
So then, generally, when a fat cell (a triglyceride) is catabolized (broken down) into its parts, it divides into 3 fatty acid molecules and a glycerol backbone molecule. A ketone body is a byproduct of this fat cell breakdown and oxidation. It’s a normal process. As such, being keto-adapted means that your body is making ketone bodies as part of this normal process where it is breaking down body fat molecules for energy.
When eating a VLC Ketogenic Diet (VLCKD), blood ketone concentrations are generally above the 0.5mmol/L level. When they are from 1.5mmol to 3.0mmmol/L, they are optimal. Eating in such a way as to achieve this level of ketone bodies in your blood is healthy. It is, in fact, the normal metabolic state when fasting…as when we eat just one meal a day or one meal every three or four days, the way our hunter/gatherer forebears did.
My recent personal experience with extended 2 and 3 consecutive day fasting supports this view. Many others report similar outcomes. My metabolism has not slowed down. I am fully energized. When I eat VLC on “feasting” days, I know that my body is fully fueled by stored fat while “fasting.” It can do this because, when consistently eating VLC, my body’s blood insulin levels drop, allowing access to my body fat (and ketones) for use as fuel.
The state of being in ketosis – this normal state – is not the same as having a condition called ketoacidosis. As the name implies, ketoacidosis is a diseased state, a serious form of acidosis. With ketoacidosis, the blood concentration of ketones is generally 20-30mmol/L, a full order of magnitude, i.e. 10x, higher. Ketoacidosis is a life-threatening condition and requires immediate treatment and hospitalization. I point this out because some current pharmaceutical advertising inexplicably uses the term “ketoacidosis” as though it were a condition that you could be walking around with. Acidosis is a serious, acute, unrelated medical condition and requires immediate hospitalization.
Ketosis, on the other hand, while a normal state, is NOT a necessary state to be in in order to be a fat-burner. I have in past somewhat carelessly used the term “keto-adapted.” I do not own nor have I ever used a meter to test ketone levels. I test my blood for glucose, not ketones. Neither have I ever used keto strips to test my urine.
I have just assumed that I was in ketosis when I ate as few as 15 or 20 or even 30 carbs grams a day, and certainly when I was full-day fasting (300kcal/day including only about 5 carb grams a day). If you are eating VLC (and fewer total calories), and your metabolism is operating at full energy, you are burning FAT for energy. You are FAT-adapted, whatever you level of blood ketones. And THAT IS YOUR OBJECT: When fasting – as when between widely separated meals – TO BURN BODY FAT WHILE YOU CONTINUE TO OPERATE AT FULL ENERGY LEVELS. Nature built us this way, to be in “nutritional ketosis.” Otherwise we, as a species, would have become extinct long ago.

Sunday, March 29, 2020

Retrospective #407: Am I now non-diabetic?

I was diagnosed a Type 2 diabetic in 1986, when the standard for diagnosis was two consecutive, office-visit tests of Fasting Blood Glucose ≥140mg/dl. And recently,* after eating Very Low Carb (VLC) for the last 15 years, now with an A1c of 5.2%, a clinician told me, I am no longer diabetic. I disagreed. I said that although my blood sugar control had greatly improved, I was and am still Insulin Resistant and Carbohydrate Intolerant. I told her that I keep my Type 2 Diabetes IN REMISSION by restricting carbohydrates. I eat Very Low Carb, with Extended Fasting as needed.
Then, a saw Megan Ramos, Director of Jason Fung’s Intensive Dietary Management program, say on Facebook that “there are a lot of ‘haters’ out there” who say that, with an A1c of ≈4.5%, she is “not really non-diabetic”; “[She’s] just controlling [her] diabetes with diet.” “Haters”? Well, I am not a hater, but isn’t that how she is controlling her blood sugar?  Does she think she’s cured? I know I am NOT cured. If I ate a lot of carbs again, my A1c would skyrocket!!!  I think hers would too, though she doesn’t want to, and never will, eat that way again (i.e., “pasta 5 nights a week”).
Apparently, people who tell her that she is “just controlling her diabetes with diet” have hit a raw nerve…so I won’t tell her directly, but I am not a “hater.” I just want people to understand that having Type 2 diabetes is a condition that the patient can totally manage, as she has, through diet (and fasting as needed). It’ a POV based on reality.
And it is difficult to manage a condition – in this case, Type 2 diabetes – if one is in denial that what caused that condition was a dietary practice, eating too many processed carbs (pasta) for too long. But, I’m willing to take a fresh look at the subject. Am I “non-diabetic” if a doctor who takes my blood (and doesn’t take a history) sees that my A1c is 5.2%? (In my case, besides eating Very Low Carb, I am also taking 1,500mg of Metformin to suppress unwanted glucose production and improve insulin sensitivity, but taking Metformin is not why I have a “non-diabetic” A1c.)
I am clinically considered “non-diabetic” simply because of my low (<5.7%) A1c. To the physician/practitioner, who is running a business financially dependent on payment from the patients’ insurers, the criteria for prescribing drugs (and tests even) is based on government and medical association sanctioned Clinical Guidelines. The actual Standard of Care a clinician offers can vary from that, but the patient’s medical record better show that they recommended “diet and exercise,” and a statin if your Total Cholesterol is ≥200mg/dl. A Very Low Carb diet is not part of that SofC.
In Megan’s case, age at onset of diabetes was doubtless a factor. Incipient Type 2 diabetes is undoubtedly more treatable and less intractable at an early age before some beta cell function has been lost. Megan notes that she was diagnosed at age 27 and found the right treatment immediately. Under Dr. Fung’s direction, she began to eat VLC and incorporated fasting from the get go. In 6 months, she lost 60 pounds and her A1c dropped to 4.5%. Today, 6 years later, Megan certainly takes no diabetic meds, eats LCHF and, having incorporated fasting, is now 80 pounds lighter.
I was diagnosed at age 45 but continued to eat a Standard American Diet for 16 more years until I was 61. Neither my doctor nor I knew better at the time. I continued to gain weight and my Type 2 diabetes got “worser and worser.” In 2002 I was maxed out on a sulfonylurea (Glyburide) and Metformin and starting on Avandia, a 3rd class of orals. I weighed 375 pounds. Then, in July 2002 my doctor read Gary Taubes’s “What If It's All Been a Big Fat Lie,” the New York Times Sunday Magazine cover story and suggested I try the diet described (20g of carbs a day) to lose weight!!!.
Today, 15 years later, thanks largely to eating Very Low Carb, I weigh 190 pounds. A little over a year ago, ironically thanks to a suggestion from Megan Ramos, I began Extended (full-day) Fasting. I started with alternate day, then 2-consecutive day and occasionally 3-day 300kcal fasts almost every week. I maintain my 185-pound weight loss by accepting that I have intractable Insulin Resistance and will therefore be Carbohydrate Intolerant for life. As such, while I am now clinically “non-diabetic,” I know that if I ate the way I did before, I would quickly become, clinically speaking, diabetic again. Therefore, realistically, my Type 2 diabetes is NOT cured; it is IN REMISSION, and I keep it that way with diet. I will live happily and healthily and hope to remain that way for so long as I accept that reality.
* This post was written in in 2017 and is republished here, with some editing, as part of the Retrospective Series.

Saturday, March 28, 2020

Retrospective #406: Are Your Triglycerides Calculated or “Direct”?

Michael R. Eades, MD, is a blogger, a prolific author, and a voracious reader. He and his wife, Mary Dan (MD), also an MD, were early backers of the LCHF Way of Eating and authors of “Protein Power” (1996), and “Protein Power Lifeplan” (2000), and many other books. He blogs at A recent post that I read was titled, “How to Lower Your Cholesterol, using diet to keep your doctor off your back.”
In that post I had a question about a screen shot of his lab LDL-C so I emailed him, and he replied that his LDL was not “Calculated” by the Friedewald equation but was “Direct.” (The report actually said that; I just missed it.) He then provided me with a link to a post he wrote a few years ago, “Low carbohydrate diets increase LDL: debunking the myth.” This is another post about the effect of Low Carb diets on TGLs and LDL-C. You’ll need to read to the end of Dr. Mike’s long post to get to it, so I’’ get right to the point here. LOL
Eades writes about a study in the American Journal of Clinical Nutrition. “This study…demonstrates that subjects following the low-carb diet experience a decrease in triglyceride levels and an increase in HDL-cholesterol (HDL) levels; and that these changes are accompanied by a minor increase in LDL-cholesterol (LDL)…” This concerns doctors, he says, since “most people who go on low-carb diets do so to deal with obesity issues, and since obesity is a risk factor for heart disease,…this small increase in LDL… could put these dieters at risk” (for heart disease).
So, noting that the benefits to HDL and triglycerides are offset by “this small increase in LDL-cholesterol seen in those following a low-carb diet,” Eades wondered how the LDL in the study was calculated; the “Methods” link in the study provided the answer: the Friedewald equation: LDL = TC – HDL – TGL/5. IT WAS CALCULATED! What’s that? It’s not a DIRECT (assayed) measurement? No, and every standard lab lipid test uses* this method.
Interestingly, when Friedewald, et al. developed that formula in 1972, they made an exception for people who had a triglyceride >400mg/dl; however, since most people’s test results were in the 150 – 250mg/dl range, they made NO exception for TGL values of <100mg/dl. As readers here know, people who follow a Very Low Carb or LC/HF diet usually have TGLs in the range of 40 – 90mg/dl. The average of my last 50 tests (since 2002) was 54mg/dl.
So, Dr Eades searched the archives for scientific papers describing differences between calculated and directly measured LDL-cholesterol in people with low triglycerides. And lo and behold, he found two! One was a case presentation where a 63yo man had a TC of 263, an HDL of 85 and a TGL of 42.  The Friedewald calculated LDL was 170 but it was just 126 when measured directly. Another paper concluded, “Statistical analysis showed that when triglyceride is <100mg/dl, calculated LDL is significantly overestimated (12.17mg/dl average).”
In addition to the over calculation of LDL for low-carbers who have TGLs consistently <100mg/dl, Eades reminds us: LOW-CARBERS TYPICALLY HAVE THE LARGE FLUFFY, GOOD TYPE OF LDL, NOT THE SMALL, DENSE TYPE.
Dr. Mike sums this up better than I could: “The moral of this story is that if you have been following a low-carb diet and your triglycerides are low (or if your triglycerides are just low) and your LDL reading comes out a little high – or even a lot high, don’t let anyone mule you into going on a statin or undergoing any therapy for an elevated LDL.  Demand to have a direct measurement of your LDL done.”
And Dr Eades coup de grace: “Now when you hear people say that low-carb diets may help you lose weight but run your LDL levels up and increase your risk for heart disease, you’ll know this is just so much gibberish.  Sadly, your doctor will probably spout the same thing, and it will be up to you – who after reading this post will know more about this point than 99.9 percent of doctors practicing today – to educate your trained professional.”
*N.B.: This post was originally published in November 2017. Some time in 2018, Quest Labs discontinued using the Friedewald equation and switched to Martin/Hopkins, “a better LDL calculation method,” for lower LDLs. The change is discussed in detail in The Nutrition Debate: Type 2 Nutrition #476, published March 10, 2019.

Friday, March 27, 2020

Retrospective #405: LDL-C and TGL while Fasting

One of the speakers at Keto Fest in New London July 2017 was Dave Feldman, a self-described “engineer, software developer and entrepreneur.” Compared to the other presentations at Keto Fest, Dave made a rather geeky presentation about his high LDL-C hypothesis. These notes are taken from his talk:
“LDL-C has many jobs.” “Its primary job is to distribute energy from fat” (triglycerides or TGL). “MULTI-DAY FASTING BEFORE A CHOLESTEROL TEST WILL LIKELY SPIKE YOUR LDL-C.” That last sentence got my attention.
Then I saw that both Michael Eades ( and Jason Fung ( had also credited Feldman on this hypothesis. It turns out he’s attracted a lot of attention in the Low Carb/High Fat and fasting communities. Here’s a related sample from Feldman’s website,
“There’s just a few of us that think the same thing as I do. That cholesterol is the red herring. That mostly, this is due to higher demand for fat-based energy coming from storage in the form of triglycerides being carried by VLDLs. The cholesterol being measured resides in those VLDL-originating LDL particles, which is why its quantity is inverted from the total amount of dietary fat I eat.
More fat in my low carb diet? Less need for fat-based energy from storage, less VLDLs mobilized, less cholesterol riding along with it. Lower cholesterol score.
Less fat in my low carb diet? More need for fat-based energy from storage, more VLDLs mobilized, more cholesterol riding along with it. Higher cholesterol score.
My doctor’s appointment is typically on a Tuesday, and I generally don’t fast on weekends, but I often do on Monday. So, I made a mental note to be sure to eat fat on any fasting Monday before an appointment. Check!
I should also note that Dave Feldman is also what is known in lipidology medicine as a “hyper-responder.” “The term, ‘hyper-responder,’” Feldman says, “has been used within the ketogenic/low carb, high fat (keto/LCHF) community to describe those who have a very dramatic increase in their cholesterol after adopting a low carb diet.” This is not common, but occurred to Feldman and is the reason he began his investigations and developed “The Feldman Protocol,” a hypothesis to explain this “inverse correlation.”
Dave’s Protocol is much too complex for this blog, but if you happen to be one of the few to whom this has occurred, I strongly encourage you to check out his website and delve into or even participate in his experiments.
For my part, eating just Very Low Carb (without fasting), before I started the occasional use of Extended Full-day Fasting, my LDLs and TGLs have all been very good. I wrote about them a few years ago in Retrospectives #281, #282 and#283. By just eating a strict Very Low Carb diet, my TGLs dropped about 2/3rds and HDL more than doubled.
I also recently did a 14-year TGL average of 50 tests, beginning 1 year after I started VLC, and the result was 54mg/dl. My average of 15 TGL tests in the early years of eating Very Low Carb was 49mg/dl.
Since starting full-day fasting, my Total Cholesterol has gone from 198 to 201 and then 196. My HDL-C has gone from 85 to 74 and 74. My LDL-D has gone from 101 to 114 to 100; my TGLs have gone from 60 to 67 to 108. Hmmm.
Also, my blood pressure has gone from 130/80 to 125/70 and 120/80. And my A1c has gone from 5.8 to 5.3 and 5.2. These improvements in the lipid panel are the “expected” response to switching from the low-fat, very high carb Standard American Diet to a Low-Carb/High-fat diet. Dave Feldman’s hyper-responder response is not typical, but his work on investigating the mechanism is very interesting and may prove useful in explaining these (and my) anomalies, e.g. that unexpected 108 TGL on my most recent lab. I must have fasted on the Monday before the test.

Thursday, March 26, 2020

Retrospective #404: If you’re feeling sleepy after lunch…

In his magazine, “The Good Life,” Dr. Oz’s Rx of the Month (March ‘17), was, “If you’re feeling signs of sleepiness, pull over and take a nap – it’ll help.” D’ya know what would help even more? Don’t eat a carb-loaded lunch!
Dr. Oz’s suggestion is based on the assumption that the driver in his “Rx of the Month” is sleep-deprived. We’re a “chronically sleep-deprived nation,” the article says. “Skipping even a few hours of sleep nearly doubles your risk for an accident,” according to an AAA report cited. But you know what produces “signs of sleepiness” as much and much more frequently? Answer: A METABOLISM THAT HAS CRASHED BECAUSE OF A LOW BLOOD SUGAR.
If you have a bit of Insulin Resistance, as you likely do if you are a little overweight, or you have been told you are either pre-diabetic or a Type 2 diabetic, you have a chronically elevated level of insulin in your blood. In that case, a chronically elevated blood insulin level will block access to energy from body fat, which access a healthy metabolism would have between meals. Your blood insulin level remains elevated because your pancreas continues to make insulin in a vain attempt to overcome the Insulin Resistance to the uptake of glucose (energy) from your blood.
Without access to energy from your body fat, your metabolism will have to slow down to maintain energy balance. Among other things, it will circulate less blood to the brain and extremities, and you will feel “signs of sleepiness.” You’ve crashed. And you will soon be hungry again…and you’ll snack between meals. Yes, it’s a vicious cycle. By continuing to feed your body by mouth, including carbs on a balanced diet, you deny your body fuel from body fat that it needs to be “energized.” That means to remain in energy balance at a higher metabolic rate.
Of course, you do have an alternative: You can gain access to your body fat reserves to give your body the energy it needs to maintain a stable, high metabolic rate: to remain in energy balance (homeostasis) but at a normal, high metabolic rate. Your body will not need to slow down and “crash.” How? Cut back sharply on eating carbs at lunch.
Most people in the U. S. eat their evening meal between 6 and 8pm. Digestion starts almost immediately and is usually complete within an hour or two. Protein takes longer, up to 4 to 5 hours. Then the body rests (and we sleep), and while we sleep it runs on “sugar” (glucose from carbs) circulating in the blood and stored in the liver. When the “sugar” stores are nearly exhausted, your body, in a mild state of ketosis, naturally breaks down body fat for energy.
This is a normal process. It is called the overnight fast before “breakfast.” We all do it. And survive. And we wake up in the morning feeling refreshed from the rest and the fast! The problem began when we started eating a breakfast loaded with carbs, starting with fruit juice. Pure sugar water! Then we ate toast or a muffin or worse, a bagel. Pure “sugar” glucose! Then we ate cereal or oatmeal. All these foods are carbohydrates! And in 2 hours we’re hungry again.
Suggestion: Try 2 eggs, any style, even hard boiled if you don’t have time to prepare breakfast. If you do cook, fry them in bacon grease (enjoy a bacon ‘side’). This “break-fast” is all protein and fat. And no carbohydrates!
Or, if you’re not hungry when you wake up (like me), just have a cup of coffee. I have mine with heavy whipping cream (a ‘fat bomb’) and pure powdered stevia (not in convenient little packets of stevia combined with maltodextrin or dextrose – other words for sugar). If you do this, you are in effect extending your overnight fast. You will be surprised at how your energy level, and your blood sugar, will remain stable all morning long. I’ve been skipping breakfast for many years now, and I often forget to eat lunch. Or don’t think about it until 2 or 3 or even 4 in the afternoon. Really!
I think assigning “signs of sleepiness” to sleep deprivation is a “red herring.” I know that many families have to get up early with the kids, and/or to get to work. And many have to stay up late as well, and that sleep deprivation is a problem for some. But “signs of sleepiness” are much more likely to be attributable to a metabolism that slowed down because access to its own fat stores for energy was blocked by a chronically elevated blood insulin associated with pre-diabetes and type 2 diabetes. But if you are overweight, you either have or are developing Insulin Resistance. And that is why you are hungry mid-morning after a carb-loaded breakfast or get tired after a carb-loaded lunch.

Wednesday, March 25, 2020

Retrospective #403: Denial is not a river…

Someone (a relative) told me recently that their A1c was 6.1%, and they’re not doing anything about it – not even taking Metformin. What are they thinking, I’m thinking! Are they waiting until their doctor tells them, as Tom Hanks was, “You’ve ‘graduated’ to full-blown, Type 2 diabetes.” After observing “high-normal” blood sugars for 20 years, his doctor congratulated him! What is his doctor thinking? I mean, folks, DENIAL IS NOT A RIVER. I know, it’s an old joke, but that Standard of Care is just bizarre…unless, that is, MEDICINE DOESN’T HAVE A BETTER SOLUTION.
That’s what it amounts to, though. Metformin is not generally prescribed to pre-diabetics, although in my opinion it should be. Currently, it’s occasionally prescribed “off-label,” meaning “used in a manner not specified by the FDA.”
But, putting pharmacotherapy aside, what else can a pre-diabetic (and their doctor) do to “delay,” as the medical establishment might say, or totally avert, the onset of frank Type 2 diabetes? The latter as demonstrated in many recent trials, REVERSING incipient type 2 diabetes and putting this modern lifestyle scourge into total remission?
Well, the first thing you have to do is ACKNOWLEDGE THAT YOU ARE PRE-DIABETIC. That means that 1) you had a genetic predisposition and 2) in order to avoid eating saturated fat and cholesterol, you’ve eaten, as you’ve been told, a diet unnaturally low in fat and high in refined carbs and sugars. As a consequence, your body has “expressed” an intolerance for so many carbohydrates. “Pre-diabetic” means YOU ARE NOW CARBOHYDRATE INTOLERANT. The medical condition you have is Insulin Resistance (IR), and the sooner you face it, the easier it will be to manage.
Insulin Resistance is part of Metabolic Syndrome, a constellation of symptoms that put you at much higher risk of heart disease (CVD and CHD) as well as most other chronic diseases of Western Civilization, including Alzheimer’s disease (also known as “Type 3” diabetes) and many types of cancer. But Insulin Resistance can be managed by “lifestyle” (dietary) changes. Resistance is the body’s natural response to too much of something. Carbs, converted to glucose, require insulin to transport it in the bloodstream to destination cells. When you eat fewer carbs, your body will make less insulin and will naturally become more insulin sensitive (the opposite of insulin resistant).
So, the object of self-management of your Insulin Resistance, then, is to keep your blood insulin level low. There is not a common lab test to measure blood insulin, though, but a good surrogate is your blood sugar level, either fasting (FBG) or A1c. Unfortunately, there is no drug to lower blood insulin level, although anaerobic exercise also helps. 
But, if you’re Insulin Resistant, the natural way to lower your blood insulin is to restrict carbohydrates. It is not a “therapy” that will enrich Big Pharma, or Agribusiness, so you’re not likely to hear about it from them. And to avoid financial penalties and sanctions, your doctor is not likely to go against the current Standards of Medical Care either.
So, self-management of your pre-diabetes is something you’re just gonna have to do all by yourself. Perhaps that’s why you’re surfing the web right now and how you came across this site. If so, we hope you’ll come back. We encourage you to try carbohydrate restriction on your own. Test your blood before and after a meal and see how much it improves when you eat fewer carbs. Do it for 3 months, and see your A1c improve and your weight plummet!
Or…here’s an idea. Forget about how much carbohydrate restriction will help your pre-diabetes or Type 2 diabetes. Don’t even think about asking your doctor for “permission” to go on a carbohydrate restricted diet to help control your pre-diabetes or Type 2 diabetes. As my relative does, just ignore the fact that Type 2 diabetes is a dietary disease.
Instead, if you would like to lose a few pounds, and you think your doctor would like that as well, ask your doctor: Would a carbohydrate-restricted diet be a good way to lose weight? I’ll bet you that you’ll get a big “YES.”
Or, don’t even ask your doctor. Help your doctor avoid the risk of financial penalties and sanctions from Medicare and other insurers. Then, when you next have blood work done, ask for a copy and remember your weight and cholesterol – especially triglycerides and HDL-C, and blood pressure and inflammation. Then, when you get your next lab report, bathe in the praise when your doctor sees that all of them have improved. It’ll just be our little secret how you did it.

Tuesday, March 24, 2020

Retrospective #402: IGNORANCE is the biggest problem…

A few years ago I was having a tĂȘte-a-tĂȘte with Dr. Eric C. Westman, co-founder and medical director of the now defunct, unfortunately, Heal Clinics. I have now been a diagnosed Type 2 diabetic for 34 years, eating Very Low Carb for the last 18, and writing about it here for the last 10, so when Dr. Westman asked me what I thought was the biggest problem in Type 2 diabetes today, I replied, simply, “Ignorance.” He nodded his head in agreement.
I told Dr. Westman that I started this Way of Eating after my doctor had read Gary Taubes’ July 7, 2002, New York Times Sunday magazine cover story, “What If It’s All Been a Big Fat Lie?” My doctor wanted me to lose weight, so he tried the diet, described by Taubes, first to see if it would be safe and effective. When he lost 17 pounds, he suggested that I try it too, to lose weight! Then, as he walked me down the hall to schedule my next appointment, he said, “It might even help your diabetes.” He had no more than a vague notion about that. Turns out, he was spot on!
My doctor told me to start on Atkins Induction (20g of carbs a day), and he monitored me closely. He had my blood sugar what he called “under control” (FBG: 155mg/dl!!!) with me taking 3 classes of oral hyperglycemic meds. He knew, however, that by this standard he would soon have to refer me to an endocrinologist to start me on an insulin regimen, probably a basal injection once a day and maybe mealtime bolus injections, 3 times a day, as well.
Like so many other clinicians, my doctor believed that my morbid obesity (I weighed 375 pounds) was a CAUSE (frequently hedged as a “risk factor”) of Type 2 diabetes. But Taubes had not yet written his ground-breaking magnum opus “Good Calories – Bad Calories” (2007), in which he totally dispels that notion. In fact, in the Epilogue he says, “As I emerge from this research,” 10 “certain conclusions seem inescapable to me.” Today, having read them ten years later, every one of his conclusions is still right on point – as true today as they were on the day that he wrote them.
In #5 Taubes says, “Obesity is a disorder of excess fat accumulation, not overeating, and not sedentary behavior.” If this first part sounds like a tautology, it is not. It is fully explained in #6 thru #10. You really should read all 10 “certain conclusions.”  Google: “Type 2 Nutrition: The Nutrition Debate #5.”
6.      “Consuming excess calories does not cause us to grow fatter, any more than it causes a child to grow taller. Expending more energy than we consume does not lead to long-term weight loss; it leads to hunger.
7.      Fattening and obesity are caused by an imbalance – a disequilibrium – in the hormonal regulation of adipose tissue and fat metabolism. Fat synthesis and storage exceed the mobilization of fat from the adipose tissue and its subsequent oxidation. We become leaner when the hormonal regulation of the fat tissue reverses the balance.
8.      Insulin is the primary regulator of fat storage. When insulin levels are elevated – either chronically or after a meal – we accumulate fat in our fat tissue. When insulin levels fall, we release fat from our fat tissue and use it for fuel.
9.      By stimulating insulin secretion, carbohydrates make us fat and ultimately cause obesity. The fewer carbohydrates we consume, the leaner we will be.
10.   By driving fat accumulation, carbohydrates also increase hunger and decrease the amount of energy we expend in metabolism and physical activity.”
Gary Taubes’ hormonal explanation of the metabolic science of fat synthesis and breakdown totally refutes the “calories-in, calories-out” (CICO) hypothesis. CICO sounds so logical that it is now “accepted wisdom” without evidence. It’s like that other “truism” of establishment dietary thinking: “Eating fat makes you fat.”
Taubes’s “certain conclusion” #1, “Dietary fat, whether saturated or not, is not the cause of obesity, heart disease, or any other chronic disease of civilization,” deals with that. Of course, he backs up this statement, and all his other conclusions, with 460 pages of convincing research and analysis, 45 pages of links to his sources, and a 66-page bibliography. His seminal book, “Good Calories – Bad Calories” is a bit of a slog, but it’s well worth it.

Monday, March 23, 2020

Retrospective #401: “Improve your A1c with a non-insulin option”

This advertising copy is effective. People who have been diagnosed with Type 2 diabetes, or Pre-diabetes, are afraid of insulin – having to inject insulin to manage their high blood sugar. And if you are the type of person who relies on your doctor to manage your blood sugar, then you’ll be interested in a way to “improve your A1c with a non-insulin option.” But if you have any common sense, you’d realize that the best way to manage your blood sugar is not to eat those foods that become “sugar” (glucose) in your blood. You’d realize that “those foods” are carbohydrates.
Of course, the TV ad had a different “fix” in mind for you; their drug therapy. They’re playing on the dread people have for the drudgery (and cost) of daily insulin injections. Insulin-dependent Type 2s start with a slow-acting basal dose of insulin injected once a day. When that fails to produce a “satisfactory” A1c, many (most?) eventually inject a fast-acting bolus with each meal. And, with 4 or more injections a day, and constant testing, if you are very careful to avoid hypos, you can achieve “good” blood glucose control, by their Standard of Care guidelines. It’s an onerous path.
But t doesn’t have to be this way. In 1986 I weighed 300 pounds when an internist, based on a hunch (my weight) took a blood sample and diagnosed me a Type 2 diabetic. He started me on an oral anti-diabetic drug of the only class then available in the U.S., a sulfonylurea. Seven years later, when the A1c test first came on the market, an endo discovered my A1c was 8.9%. My dose was increased and I few years later, when it was introduced in the U. S., he started me on Glucophage (metformin). Nine years later (2002) I was maxed out on both the sulfonylurea and met, and I had started on a 3rd oral med, Avandia. Type 2 diabetes is a progressive disease, the medical establishment says, and both my doctor and I knew that when the 3rd class of drugs was no longer effective, I would “graduate” to insulin.
My doctor then turned his attention to my weight. He had tried before. I had seen his staff dietician who advocated a “restricted-calorie, balanced diet and exercise.” It didn’t work. I lost weight but promptly regained it. Then, one day in 2002 my doc read the New York Times Sunday Magazine cover story, “What If It's All Been a Big Fat Lie,” by Gary Taubes. He tried the diet himself, and he lost weight. So, he asked me to try it too, and he monitored me closely.
The diet was Atkins INDUCTION, which is VERY low carb, just 20 grams of carbs a day. On the first day I had a hypo. I called him, and he told me to stop taking Avandia. The next day I had another hypo and he told me to cut the other two drugs in half.  Later that week, when I had a 3rd hypo, he told me to cut the two drugs in half again. So, in just one week, by strictly following a VERY LOW CARB diet, before losing more than a few pounds of water weight, I virtually eliminated all my diabetes meds. My Type 2 diabetes had gone into remission, and I was no longer drug dependent.
A year later, in August 2003, I had lost 60 pounds and my A1c was 5.4%. Four years after that, over a summer I regained 12 pounds, so I started on Richard K. Bernstein’s 6-12-12 program for diabetics (30 carb grams a day). Over the course of a little over a year, I lost that 12 and another 110 pounds, reaching 205 pounds at the end of 2008. That was my early teenage weight. And my weight after I completed 8 weeks of PT in Army Basic Training in 1960!
In 2018, 16 years after beginning to eat Very Low Carb, and plenty of “misadventures” (cheating) along the way, I celebrated by dropping below 200 pounds (186 last week) for the first time since I was in my early teens. And although when he started me on it in 2002, my doctor’s motivation was to get me to lose weight, NOT to treat my so-called “progressive” Type 2 diabetes, I have “IMPROVED MY A1c WITH A NON-INSULIN OPTION.” FURTHERMORE, I HAVE FOREVER AVOIDED PROGRESSING TO BECOMING AN INSULIN-DEPENDENT TYPE 2, and MY LATEST A1C WAS 5.2%.
To his credit, although he suggested it to help me lose weight back in 2002, my doctor did have an inkling that eating VERY LOW CARB might help my type 2 diabetes. As he walked me down the hall that fateful day (to schedule my next appointment), he said, “Dan, this diet might help your diabetes too.” Boy, was that an understatement!
Would that more doctors had a similar understanding of the basic relationship between dietary carbohydrates and blood sugar regulation. TYPE 2 DIABETES IS A DIETARY DISEASE, and the best treatment is SELF-MANAGEMENT by CARBOHYDRATE RESTRICTION. Your doctor can’t write a prescription for that, but YOU can!