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!

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.

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 3^rd 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.

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 www.proteinpower.com/drmike. 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.

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 (proteinpower.com) and Jason Fung (intensivedietarymanagement.com) 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, cholesterolcode.com/

“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.”

THE TAKEAWAY: “MULTI-DAY FASTING BEFORE A CHOLESTEROL TEST WILL LIKELY SPIKE YOUR LDL-C.”

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.

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.

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.

Retrospective #402: IGNORANCE is the biggest problem…

A few years ago I was having a tête-a-tête 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.

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 3^rd oral med, Avandia. Type 2 diabetes is a progressive disease, the medical establishment says, and both my doctor and I knew that when the 3^rd 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!

Retrospective #400: “Not half the man I once was,” my wife quipped

As you can tell from the number above, I have been writing about “Type 2 Nutrition” for a long time. I have been a diagnosed Type 2 diabetic for 34 years and probably pre-diabetic for a decade before that. At my doctor’s suggestion (TO LOSE WEIGHT), I’ve been eating Very Low Carb since 2002. In early 2018, I added Extended (Full-Day) Fasting.

Starting in 2002 at 375 pounds, following Atkins Induction (20g of carbs a day) for 9 months and lost 60 pounds. Four years later I regained 12 and restarted Very Low Carb (Bernstein: 30g/day). In a year I lost 100 pounds. Later I lost 20+, more, reaching 205 pounds in 2008. I regained some later but recently returned to 205 using alternate or consecutive 2 and 3-day fasts. This was possible because, while fat-adapted on VLC, losing weight WITHOUT HUNGER is easy.

My weight has not been below 205 since I was a teenager, maybe since I was pre-pubescent! I’m 78 now. But, feeling as healthy and energized as I do, I decided to go for a new goal: TO BE HALF THE MAN I ONCE WAS. Recapping, I began in September 2002 at 375. My goal was to get to 187, half that weight, by September 2017, 15 years later. Here goes. (Note: If you want to skip the details, don’t bother with the Weekly summaries; just jump down to Results.)

Week 1: I started this challenge at 207, so I needed to lose 20 pounds in 8 weeks. The 1^st 4 was easy. I had regained them overnight, literally, so this week I expected to lose at least 6, leaving 14 for the remaining 7 weeks, or 2 pounds a week. That’s very doable. Result: I lost 5 lbs. FBG aver: 81mg/dl. Wk 2 goal: 5 lbs.

Week 2: Three restaurant meals this week, including a birthday. Fasting only Mon & Wed. Result: took 3 days to lose the 3-pound gain, and the glucose shot up after the birthday bash; alas, I lost only 1 lb. FBG aver: 97mg/dl.

Week 3: Started the week 2 lbs. behind, but I have no excuses. Should be a good week. Goal: lose 4 lbs to reach 197; Plan: fast Mon-Tue-Wed. Result: lost 5, then regained 2 Sat to 198, net lost 3 lbs. FBG aver: 82mg/dl.

Week 4: Started week just 1 lb behind. Goal: lose 3 lbs to reach 195. Fasting Mon-Tue-Wed. Result: Small cheats every day, but I lost 3 lbs. and reached goal of 195, a 180 lb total loss from 2002. FBG aver: 82mg/dl.

Week 5: Eight pounds to go in 4 weeks, 2 lbs per week. Goal 193. However, gained 4lbs each Sun & Mon, so strict fasting this week; I need to lose 10 lbs. Result: Lost 11, fasting 4 days; net lost 3 lbs. FBG aver: 79mg/dl.

Week 6: Now 1 lb. ahead, but goal is still 2 lbs. Eating ‘normally’ Sun & Mon (having company); fasting thereafter. Results: Relaxed a bit and just lost 1 lb. to 191, on target. 4 pounds to go, 2 pounds each week. FBG aver: 71mg/dl!

Week 7: Going to do a modified fast Mon-Tue-Wed, then Fri and/or Sat if required. Thurs: dining with visiting ‘kids.’ Results: Missed the mark; lost just 1 lb. Too much fat, a little cheating, poor choices Thurs night. FBG aver: 88mg/dl.

Week 8: Final week of challenge with 3 pounds to go. Very doable with a little discipline. Let’s see if I have it.

Results: A feast on Sunday added 4 lbs. to the challenge, but I “fasted” until I lost NET 4 lbs. FBG aver: 79mg/dl.

Results: Well, I did it! These words recall for me the line “We did it!” that Elle Woods squeals in her graduation speech at the end of one of my favorite films, the chick-flick “Legally Blonde.” Except in this case, I did it, all by myself! In the last 8 weeks, using a combination of Very Low Carb on days that I ate “normally,” and “fasting,” I lost 20 pounds. That was my goal: to get to be “half the man I once was,” starting at 375 pounds in 2002, when my doctor suggested I eat Very Low Carb to lose weight. It’s been a long journey, with lots of ups and downs, but I finally reached my goal of 187 pounds, HALF THE MAN I ONCE WAS. And I feel great. IT’S WONDERFUL NOT TO BE ALWAYS BE HUNGRY.

Next week my wife and I are taking a vacation. We’re going up to the Shaw Theater Festival at Niagara on the Lake, in Ontario, Canada. We plan to eat dinner every night in a “fine dining” restaurant and to tour one of the wineries in the area. When we return, I will begin one more weight loss challenge: To lose most of the weight I will regain on vacation. And then, THE FINAL CHALLENGE: to maintain a 180-pound weight loss and keep my weight between 195 and 200 pounds. I will use a combination of One-Meal-a-Day (OMAD), VLC of course, plus Extended Full-Day Fasting as needed.

Retrospective #399: WebMD and Walgreens, a new collaboration

While waiting in my wife’s doctor’s office some time ago, I picked up a FREE magazine, “WebMD diabetes, at Walgreens.” I’ve been a Type 2 for 34 years, and treating it as a dietary disease for the last 18, so I didn’t expect that the magazine would have much to offer me, but…was I in for a surprise! It was loaded with material for my blog!

The featured article was “Savor Summer,” with a recipe section: The subtitle was “New ways to bring SWEET corn to your table” (my emphasis). But to a carboholic, the added emphasis is unnecessary. The brain sees “SWEET” and translates it to “SWEET.”  And the food photography was great! Really mouth-watering stuff!

The article begins, “You can almost taste sunshine when you bite into a freshly picked ear of corn,” adding, “It’s also nutritious” because it’s “chockful of Carotenoids.” (No mention of sugar.) But then, unabashed, it says, “It’s also a starchy vegetable, easily rounding out your plate with more fiber than a refined grain.” Okay, so sweet corn is not a refined grain. That’s good. But corn is a starch. It is all sugar. For a diabetic, that’s almost as bad as a refined grain.

And if that weren’t enough, 2 of the 3 corn recipes in the special Web MD magazine for diabetics added honey! Added honey, for diabetics! As if corn wasn’t sweet enough! What’s worse is the recipes had all been reviewed by an MD, the WebMD medical editor, and she could do it with a clear conscience because, by the U. S. Dietary Guidelines “MY PLATE, a healthy meal plan for everyone, even diabetics, – includes ¼ starches. But should a magazine for diabetics, intended to help both type 2 diabetics and pre-diabetics make healthy food choices, suggest and feature recipes that will assure that pre-diabetics progress to full blown diabetes and Type 2 diabetics remains in a diseased state? C’mon!

Why would the medical community and Big Pharma encourage people who are diagnosed Type 2s, with Insulin Resistance, which equates to Carbohydrate Intolerance, suggest, recommend, and even encourage people to eat a diet comprised three-quarters of carbohydrates (¼ starch and ½ non-starchy vegetables)? Why? One-size-fits-all!!! For 37 years the “Dietary Guidelines for Americans” have ordained that one-size-fits-all. The Guidelines have gone through various iterations, from various food pyramids to today’s “My Plate,” but every iteration of the Dietary Guidelines for Americans have one thing in common: by following them, you, the Type 2, most assuredly will get sicker and sicker.

Who benefits from this whack-a-mole recommendation? I know, I know. It’s easy to conclude it’s the doctor’s and the pharmaceutical industry, including retailers like Walgreens. And they certainly do benefit. We all get sick, and they all take care of us. And that’s their business. And it’s a perfect collaboration. And they’re just doing what they are in business for. Altogether, the 23-page Diabetes magazine included 4 pages of corn recipes, 8 pages of other content, and 11 pages of ads, 4 for Walgreens products and 4 for diabetes meds from Lilly and Pfizer, available at Walgreens.

But that’s not where the problem lies. The problem for most Americans accelerated forty years ago when the U. S. government got into the nutrition business. In 1977 a U. S Senate select committee convened and held hearings. So-called “experts” testified. Later, the lay staff of the Committee produced the “Dietary Goals for the United States.” In 1980, and thereafter every five years, HHS has produced the “Dietary Guidelines for Americans.” It’s been a disaster.

The Nutrition Coalition, founded in 2016 by Nina Teicholz, author of “The Big Fat Surprise,” is campaigning for the Guidelines to be reformed. See Retrospective #391. She says, “Americans have followed the Guidelines, but their health has not improved.” “The Guidelines have not always provided the best dietary advice.” “The science is not settled and, in some cases, has been reversed,” and “(T)he process of drafting the Guidelines needs reform.”

I certainly agree. We need Guidelines based on sound scientific evidence. And as the 2020 Dietary Guidelines are now, as we speak, currently in preparation, now is the perfect time for my readers in the U. S. to get involved. Write the USDA/HHS Dietary Guidelines Advisory Committee and tell them what you think about carbs and Type 2 diabetes.

 And there will still be plenty of ways in which WebMD and Walgreens can collaborate. And then my wife’s doctor won’t have the shame of having this awful magazine in his waiting room.

Retrospective #398: My Supplements

I have never been asked by a reader about the supplements I take, nor have I written about them. I guess it’s because I consider it personal, not in the sense of private – I am transparent about my health – but in the sense that they are “individualized.” I think it is also because I have read so much about how none of them are necessary or even helpful. However, a few years ago I began full-day fasting, sometimes alternate day and sometimes extended (multiple) day.

So, the further rationale that justifies taking them is that they are an insurance policy, to be sure I get essential vitamins and minerals when I am not getting them from food. Of course, there’s no real way to prove that they have helped me? A well-designed personal experiment is impossible; there are just way too many confounding factors.

 Besides, most of the supplements I take are vestigial, that is, I take them because I have been a Type 2 diabetic since 1986, and I began many of them since before I was initiated in the ways of eating a Very Low Carb diet, and I just continued taking them. That’s my rationale. Besides, I do believe in some. But, which would I eliminate and why?

I am prompted to write about this now by a presentation by podcast meister, the “Fat Emperor,” Ivor Cummins, that I attended at Keto Fest in New London, CT in July 2017. Near the end – maybe his very last sentence – as though it were a hurried, throwaway line, he said: “Don’t forget to take supplemental magnesium.” No time for an explanation. It was just a given, like everyone knew! Fortunately, I do supplement with magnesium (500mg/day).

Here’s a complete list of my current supplements. Bear in mind, I am/have been a Type 2 Diabetic for 34 years and eat a Very Low Carb (VLC) Ketogenic Diet, with frequent (usually 3 x 42, alternate) full-day “fasting.”

With COFFEE with HEAVY CREAM and POWDERED PURE STEVIA, early in the MORNING

●     1g fish oil, containing 300 EPA and 200 DHA, and 5 IU of vitamin E

●     1 tablet high potency men’s multi-vitamin, with vitamin D3, lutein and lycopene (and 100mg magnesium)

●     100mg capsule of CoQ10, the active form (Ubiquinol)

●     200mg magnesium citrate, chelated for absorption

●     200mcg of elemental chromium (chromium picolinate), with 18mg L-leucine + 2mg vitamin B6

●     100mg biologically active R-Lipoic acid (alpha lipoic acid), with 150mcg D-Biotin

In addition, I take 2 prescription meds: 750mg metformin Hcl and 20mg Enalapril Maleate (for hypertension)

With 6oz RED WINE & 8oz SELZER, about 12 hours later, if FASTING, or with FOOD (my supper meal).

●     1g fish oil, containing 300 EPA and 200 DHA, and 5 IU of vitamin E

●     200mg magnesium citrate, chelated for absorption

●     1 capsule homocysteine modulators: 50mg B6, 400mg folic acid (B9), and 500mcg B12

●     250mg vitamin C, to help with protein uptake

In addition, I take 3 meds: 750mg metformin Hcl and 20mg Enalapril Maleate + 120mg Verapamil (BP meds)

Candidates for deletion: 1) chromium picolinate, 2) R-Lipoic acid and 3) the homocysteine modulators.

Possible additions: 1) a calcium supplement, to help with magnesium uptake.

My labs are very good. My last A1c was 5.3%. My Vitamin D and B12 are high and very high respectively. My TC is below 200, my HDL-C is averages about 80, my LDL-C averages about 100 and my TGs still average around 50, even though I don’t eat a can of sardines for lunch any more. When I do eat lunch, I prefer a can of kippered herring in brine. It’s fewer calories and much less fat, and I’m trying to burn endogenous fat, not exogenous fat!

My fasting food intake is about 300kcal/day and my feasting food intake paradigm is still about 1,200 (15g carbs, 60g protein and 100g fat, mostly saturated/monounsaturated). Finally, my inflammation markers are very low, with my hsCRP usually less than 1.0. Now that I have laid it out for everyone to see, what do you think? I invite comments.