Tuesday, January 21, 2020

Retrospective #339: Low Carb? “It’s not a diet,” I blurted

Those in the know – the cognoscenti – know that eating Low Carb, or Very Low Carb, is not a diet; it’s a Way of Eating (WOE). And in the parlance of the medical establishment (skewed to my purpose), it’s a lifestyle change.
It’s also true that if you make this lifestyle change – that is, follow this WOE – you will lose weight – lots of it – but that’s only a secondary or “side” effect. Of course, you might, as happened when my doctor suggested I try Very Low Carb, make this change for the purpose of losing weight, but, even if that was your primary motivation, the effect on your general health, in many respects beyond weight loss, will be much broader than just the lost weight: e.g., lipids (cholesterol), blood pressure (hypertension), and chronic systemic inflammation markers like hsCRP.
It’s worth noting, however, that in “prescribing” Very Low Carb (VLC) my doctor didn’t know this. The idea may have crossed his mind, though, because as he walked me down the hall to schedule my next appointment, he put his hand on my shoulder and said, “Dan, this might even help your diabetes!” I was then, in 2002, morbidly obese and had been a diagnosed Type 2 diabetic for 16 years. That was 18 years and 150+ pounds ago. But within a day of starting VLC, I had a hypo. Doc immediately took me off the 3rd class of oral meds that he had just started. The next day, after another hypo, he cut the other two “maxed out” orals in half, and a few days later he had to cut them in half again!
So, I guess it’s fair to say the Very Low Carb WOE did help my diabetes, as my doctor thought it might – even though that was NOT the reason either he put me on VLC or I agreed to try to do it. We both wanted me to lose weight – he because he thought (wrongly) that obesity was a “risk factor” and possibly a “cause” of Type 2 diabetes. In fact, as doctors “in the know” now understand, it is Insulin Resistance that causes both Type 2 diabetes and obesity.
If it makes sense that eating low carb is a safe and effective way to lose weight, as is now accepted by most medical researchers, clinicians, food writers and even, lately, the American Diabetes Association (ADA), doesn’t it make sense that eating a high carb diet is how we got fat in the first place? That’s how beef is “finished” (fattened) on the “feed lot.” Surely, you’ve heard that. They are fed corn from a trough for weeks on end! So, why does government still push a high carb diet on everyone – one size fits all – even the Insulin Resistant, Prediabetic and Type 2s among us?!!
If you’re genetically predisposed, a diet very high in carbohydrates –  say 60%, the exact percentage on which the % Daily Value recommendation is based on the USDA’s Nutrition Facts panel – especially carbs that are processed and refined – it will overload the liver and the insulin receptors on the surface of cells that take up glucose. The overload results in backup which results in Insulin Resistance in destination cells, and conversion of carbs to FAT in the liver.
How? The pancreas responds by secreting more insulin to help the destination cells take up the glucose, producing thus an elevated level of insulin circulating in the blood. In the liver, when it’s full glycogen (glucose in the storage form), it makes fat. And when the brain gets the signal that there’s an elevated level of insulin circulating (to help the resistant cells take up the glucose it is transporting), it sends the message that the liver doesn’t need to break down body fat for fuel. It can continue to run on all that glucose “going around.” Instead of burning fat, we add (store) fat.
Then, eventually with all that insulin circulating, the glucose gets taken up and your blood sugar crashes. Your body now needs, indeed it craves more fuel to maintain a steady energy state (homeostasis). But with your insulin still elevated, and access to body fat blocked, your hunger can only be satisfied by eating. Your chance to burn body fat to maintain equilibrium is lost. When you then eat or drink to satisfy your hunger, with your liver already full of stored glycogen, everything that is not burned for energy is converted to fat. The process is called de novo lipogenesis.
If you’re lucky, you’ll just get fatter. If you’re not, you’ll start to develop Non-alcoholic Fatty Liver Disease (NAFLD).

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