Retrospective #379: “Man-up, guys!”

The context for this exclamation is eating strictly Very Low Carb (VLC). The benefits, which I have realized for 18 years and shared with others since I started writing this blog in 2010, are manifest. Besides losing weight easily (my original motivation), and doing it without hunger, I am so very much healthier by every measure my doctor uses. And, what’s more important, in my opinion: I feel so much better, and I am always totally energized.

But eating strictly Very Low Carb is difficult… because it requires change, permanent change, in what, why and when we eat. As it often said (somewhat cryptically), it’s a “lifestyle change.” I have for these 18 years considered it my goal, and, it must be said, have adhered to the protocol at times better than at others.

In the beginning, I followed Atkins Induction (20g of carbs/day), and lost 60 pounds in 9 months. A few years later I switched to Bernstein’s 6-12-12 program (30g of carbs/day) for diabetics and lost another 100 pounds in a year. Altogether, in those early years I lost 170 pounds, getting down to my weight after Army Basic Training in 1960.

My cholesterol also improved dramatically, with triglycerides dropping to <50mg/dl (<2.8mmol/L) and HDL doubling to the mid-80s average (high 4s). Of course, with all the weight loss, my blood pressure dropped (on fewer meds), my chronic systemic inflammation (hsCRP) marker plummeted to <1.0 and my doctor took me off statins.

While I have kept most of the weight off, and my blood lipids continue to be stellar, my A1c has been disappointing to me. In this respect I have the encouragement and support of my doctor, to me, to “keep on doing what you’re doing.” My doctor is in the business of treating the sick, i.e., those whose diabetes is poorly managed because of the poor dietary advice of the medical establishment’s Clinical Guidelines and resulting Standard of Care required for doctors to obtain Medicare and insurance company reimbursement. So, he just does labs. He doesn’t tell me what to eat.

My A1c had been in the high 5s/low 6s (38-48mmol/mol) for more than 8 years. Of course, from a physician or RD or CDE, this result elicits praise. The ADA considers any A1c of <7.0% “optimal.” They believe that my A1c is proof that my Type 2 diabetes is “well managed.” So, in their thinking, I don’t yet need progressively more medications!

The high A1c level that the medical establishment has set for the care of Type 2 diabetics -- ≤7% for the general population and ≤ 8% for persons over 75 years – is a disgrace because of the increased health risk associated with it. BUT this low bar is the result of 1) limited success in using drugs to manage the disease, 2) ignoring the fact that TYPE 2 DIABETES IS A DIETARY DISEASE and is thus best managed BY THE PATIENT and 3) the dietary advice given by doctors to the diabetic or pre-diabetic patient is JUST PLAIN WRONG – in fact, it is the POLAR OPPOSITE of what healthy eating should be for Type 2s. Type 2’s are carbohydrate intolerant and need to RESTRICT CARBOHYDRATES.

So, why do I now say, “Man-up, guys”? Because I finally did it! LOL. Two days ago, in Retrospective #377, I published the results: a greatly improved A1c. My previous A1c was 5.8%, eliciting nothing but satisfaction from all who heard it.  I was hoping to see an A1c ≤5.5%, In actual fact, my A1c dropped 0.5% from 5.8% to 5.3% (34mmol/mol).

Comment: This result was the outcome of eating strictly Very Low Carb for 10 weeks. I also fasted on two alternate days a week, and a few times on 3 consecutive days. For most of the 10 weeks I prepared my own meals: just a 12oz coffee with 1½ oz of heavy cream for breakfast, and on non-fasting days, usually a “light” lunch, and then supper (including about 6oz of protein: fish, veal, lamb, or offal), in a stove top preparation cooked with vegetables. Sometimes I grilled meat and had a big salad with a homemade vinaigrette dressing. All suppers were accompanied by 10-12 oz of red wine (in 2 spritzers); on fasting days, I had just one spritzer. I hardly ever ate out until the last 2 weeks, when I rejoined my wife and we were travelling, but I continued my fasting routine. Altogether, I lost 31 pounds.

Okay, I have been, or should have been, saying “man up” to myself for years, but…let’s face it: straight talk like this is too confrontational, especially when addressed to oneself. And it’s condescending when addressed to others, so it’s usually left unsaid…but not unthought. It’s subtext for how we think of ourselves and others, and others think of us….