Retrospective #439: “The Drinking Man’s Diet”

Everyone of a certain age has heard of “The Drinking Man's Diet.” But what do you know about it? I asked a friend recently if she knew what kind of diet it was. She shrugged and said something like, “It’s a diet in which you drink alcohol?” I said I thought so too, but we both missed the gist of it. It was the first (modern) low carb diet!!! And at 60 grams of “carbos” a day, it was pretty low carb! Not Very Low Carb (≤30g of carbs a day) but still quite Low.

First published in 1964, in 2 years “The Drinking Man’s Diet” sold 2.4 million copies at $1 apiece.  On the jacket of the 50^th Anniversary Edition, it proudly proclaims, “THE ORIGINAL LOW-CARB DIET.” The subtitle is, “HOW TO LOSE WEIGHT WITH A MINIMUM OF WILLPOWER.” The author nailed it! These are still both accurate claims!

On the occasion of the publication of the 40^th anniversary edition (2004), Forbes Magazine did a column on the book and its author, Robert Cameron. Forbes described Cameron (who wrote using a nom de plume), as “a San Francisco bon vivant whose brilliant title explains the book’s success,” as well as how we were misled by it. The drinking aspect of the contents and title was just a gimmick. The diet works just as well for “teetotalers.”

THE FOLLOWING QUOTES ARE TAKEN FROM “THE DRINKING MAN’S DIET,” 50^TH ANNIVERSARY EDITION:

“This really is a simple diet. It can be summed up in one sentence: Eat no more than 60 grams of carbohydrates a day. That’s all there is to it.”

So, what is a carbohydrate? As you will learn in this book, “Carbohydrates are concentrated in starches and sugars. They are almost absent from hearty foods like meat, fish, poultry, cheese and salads (yes, even the usually forbidden salad with Roquefort dressing is okay.)”

“Now, is it hard to count grams of carbohydrates? No, with the aid of tables at the back of this book you will find it very easy. The tables are derived from publication (sic) of the U. S. Department of Agriculture.”

“What makes this kind of counting more enjoyable as well as easier than calorie counting is that most of the things you like best don’t have to be counted at all: steak and whiskey, chicken and gin, ham, caviar, paté de foie gras, rum and roast pheasant, veal cutlets and vodka, frog’s legs and lobster claws, all count as zero.”

“Remember, you must count everything. A few innocent-looking dates or raisins in the afternoon can fill up your quota for the day. A slice or two of French bread might make your daily carbohydrate ration, but half a dozen slices would be a disaster. But with the great bulk of your diet – the meat and fish, the eggs and fats – counting at very close to zero, you really shouldn’t have much trouble keeping the total down around sixty.”

The Forbes magazine piece recounts how Dr. Frederick Stare, who in 1942 founded Harvard’s School of Public Health, had decried Cameron’s diet as unhealthful –calling it “mass murder” – which he later retracted. The accusation, however, ran everywhere on Page 1, and as Forbes quipped, “…the drinking man’s goose was cooked.”

Robert Cameron wrote his thin book – a  pamphlet really – nine years before Dr. Robert Atkins’s (in)famous, “The Diet Revolution.” Atkins faced similar charges from the public health establishment. The American Medical Association, in public testimony at a congressional hearing, ridiculed and humiliated him, calling his diet “a dangerous fraud.”

But the diet worked. In two months, Cameron said he lost 18 pounds, “…was never hungry, and never missed a martini.” Cameron wrote, “Most everyone has a drink now and then,” and “alcoholic beverages such as gin, whiskey and vodka do not contain carbohydrates. Therefore, it allowed them to lose weight without giving up a daily cocktail” (emphasis added by me). Thus his 1964 pitch: “Did you ever hear of a diet that was fun to follow? A diet that would let you have two martinis before lunch (how 1960s!), and a thick steak generously spread with Sauce Béarnaise?”

The carb tables in this book, like the word “carbo,” are very dated and unreliable, but the principles are still good. By following the Drinking Man’s Diet, you can still “LOSE WEIGHT WITH A MINIMUM OF WILLPOWER.” It’s the “carbos!”

Retrospective #438: Two Degrees of Separation

In Retrospective #437, “Heading toward the cliff,” I described how standard clinical practice 1) treats type 2 diabetes as a progressive disease of insufficient insulin (not unlike type 1 diabetes) and 2) typically uses both oral and injected medications to “activate your body to release its own insulin.” This is still done with sulfonylureas, which should have fallen out of favor as documented in #437. However, a new once-a-week injectable medicine promises to do the same – to “activate your within” to “release its own insulin.” That’s a bad idea!

Why? Because it is a medication that is designed to address a symptom of type 2 diabetes, an elevated blood sugar, and thus is a treatment TWO degrees removed from the CAUSE of the disease: INSULIN RESISTANCE. This treatment increases insulin either from “your within” (your pancreas) or, as the disease progresses (as you doctor believes it will), direct injections of insulin. To be sure, increasing insulin will lower your blood sugar… but at what cost? You’ve exhausted your pancreas and become an “insulin dependent” type 2. That is the WORST thing you can do!

A better treatment, just ONE degree removed, would be to take a medication that suppresses unneeded/unwanted glucose production by the liver and improves your insulin sensitivity (the opposite of Insulin Resistance). That medicine is Metformin. If the dosage is titrated (started as a low dose and slowly increased), the gut tolerates it well. It has virtually no other side effects and some salutary effects (longevity) not yet fully understood.

By lowering glucose production and facilitating glucose uptake at the cellular level, treatment with Metformin accomplishes the same goal (lowering blood glucose) without putting any stress on your already overworked pancreas. This treatment is thus one degree closer to the cause of your type 2 diabetes: INSULIN RESISTANCE. 

The best treatment, a DIRECT treatment, then, would be one that doesn’t cause your blood glucose level to rise in the first place. But, remember, if you’re a typ2e 2 or prediabetic, you have Insulin Resistance. Because of a genetic predisposition and eating for many years a diet very high (60%+) in carbohydrates, especially refined and processed carbs and simple sugars, your body developed resistance to the glucose transporter hormone, INSULIN.

Refined and processed carbs like flour and starches are the worst; they’re almost all glucose. At least cane sugar is half glucose and half fructose. But fructose is processed by the liver to become either glucose, or if your liver is full of stored glucose (glycogen), your body converts it via lipogenesis to fat. Besides added pounds, this produces its own set of problems, including NAFLD, non-alcoholic fatty liver disease, or worse, NASH, non-alcoholic steatohepatitis.

So, if you’re a type 2 or prediabetic, how do you prevent an elevated blood glucose? Clue: It’s NOT a drug, so your doctor can’t write a script for it. It’s a patient-directed treatment. Don’t eat foods that digest quickly and easily to glucose. If you don’t eat foods that digest to glucose (carbs), your blood “sugar” cannot become elevated!

Those foods would be 1) the refined and processed foods and the so-called “complex” carbohydrates (a criminal misnomer if ever there was one). They are just long-chain glucose molecules which break down to simple glucose when digested; and 2) the simple sugars, like sucrose (cane sugar), lactose (as found in milk and yogurt).

As bad as table (cane) sugar is, (and honey and maple syrup and agave), most yogurts are worse, especially the non-fat ones. In place of fat, sugars and other carbs are added, and then fruit syrup and fruit, both virtually 100% “sugar.” If you question this, ask yourself, does fruit contain any of the other two macronutrients, protein or fat? If not, it is 100% carbohydrate (sugar). And breads! Besides, flour (a highly processed carb), and water, the third ingredient in almost every loaf of bread is sugar. Even those “sprouting” breads are maltose, a disaccharide (double sugar).

So, what are your options: 1) WORST: 2 steps removed. You can beat up your pancreas by taking a sulfonylurea or a once-a-week injectable that does the same thing, or 2) BETTER: 1 step removed. You can take Metformin to suppress unwanted glucose, or 3) BEST: directly address your Insulin Resistance. You can eat fewer carbs, to keep your blood glucose level lower and stable, and avoid having to take more meds and face the “the dreaded complications.”

Retrospective #437: Heading for the cliff

“Thelma and Louise,” the 1991 feminist comedy, is most memorable for its ending.  Let me set the scene: Being chased across the desert by a dozen cop cars, with a cliff in front of them, Thelma says to Louise, “Okay, listen; let’s not get caught.” Louise replies, “What’re you talkin’ about?” Thelma replies: “Let’s keep goin!’ Louise replies, “What d’ya mean?” Thelma: “Go” [nods ahead of them]; Louise: “You sure?” Thelma: “Yeah.” And they drive off the cliff.

Now, juxtapose this dialogue, the action that follows, and the consequences, with a current TV commercial for a once-a-week, injectable, type 2 diabetes drug to “activate your within.” This drug works, they say, to “help activate your body to release its own insulin.” Why, they ask? Because “diabetes can be hard to manage. It’s important to remember that diabetes is a progressive disease, which means it usually changes over time. And when it changes, your doctor might have to change your treatment as well.” In other words, your doctor tells you, “Let’s keep goin’!”

But, the pharmaceutical company counsels you, “You are not alone. Millions of people are living with diabetes and going through some of the same things you are.” Now, the image in my mind changes. Imagine you are among millions of lemmings heading for the cliff. “What are you talkin’ about,” you ask? “What d’ya mean?” Well, by the time you’re a candidate for this injectable medicine, you’ve already followed in the footsteps of the lemmings like you who have taken oral antidiabetic medicines, like metformin and sulfonylureas (see below) and have now “progressed” to others. Remember, in the ad, you’ve been assured: “Diabetes is a progressive disease,” and “You’re not alone.”

The medical dogma is that progression of type 2 diabetes from Impaired Fasting Glucose (IFG) to Impaired Glucose Tolerance (IGT), to frank type 2 diabetes is a gradual, decades-long continuum. Ralph A. DeFronzo, described it 12 years ago in his Banting Award keynote speaker address at the 2008 American Diabetes Association meeting.  I chronicled DeFronzo’s remarks 7 years ago in this column, “Natural History of Type 2 Diabetes.” 

 A hyperlink in my old post will take you to the paper in the ADA’s journal, “Diabetes,” in which DeFronzo’s states, “Sulfonylureas are not recommended because, after an initial improvement in glycemic control, they are associated with a progressive rise in A1C and progressive loss of β-cell function”  Why is this relevant? Because this new injectable drug “activates your body to release its own insulin,” which ultimately will lead to the “loss of your β-cell function.”

Sulfonylureas (SU’s) lower blood glucose “by stimulating insulin release from the Beta cells of the pancreas.” The current generation of SUs, still popularly prescribed (because they’re cheap), include the glimepiride (Amaryl), glipizide (Glucotrol), and glyburide (Diabeta, Micronase, and Glynase). In the ADA paper cited, DeFronzo says,

“Insulin resistance in muscle and liver and β-cell failure represent the core pathophysiologic defects in type 2 diabetes. It now is recognized that the β-cell failure occurs much earlier and is more severe than previously thought. Subjects in the upper tertile [upper third] of impaired glucose tolerance (IGT) are maximally/near-maximally insulin resistant and have lost over 80% of their β-cell function” (all emphases added by me).

So, if, as Defronzo says in the first paragraph of his seminal paper in “Diabetes,”

“Sulfonylureas are not recommended because, after an initial improvement in glycemic control, they are associated with a progressive rise in A1c and progressive loss of β-cell function” (emphasis added), then…

Why, pray tell, if you may already have lost 80% of your pancreatic β-cell function on the drugs you have been taking for years, why would you want, or allow your doctor to prescribe a drug that will ACCELERATE the loss of your remaining β-cells?  Wouldn’t that be like letting you (not your doctor, though), like Thelma and Louise, drive over the cliff? Quoting Louise, “Are you sure?”

Or could it be that the maker of this new medicine, Lilly, and your doctor, have you covered? Lilly also makes and sells insulin, a drug with price increases at 10x the rate of inflation.  And all your doctor has to do is get out his or her pad and write a prescription.

Retrospective #436: “Science advances one funeral at a time.”

Below the sub-header “Helped America Eat Better,” my subject’s photo stares me in the face every day when I sit at my laptop. It is a photo from an old NYT’s obituary page, and the newspaper page is there to protect the work table from damage. It is prophetic and motivational, and it inspires me to address “the state of things.”

My parents taught me to “never speak ill of the dead” so, while I’m going to violate that sage advice with this piece, I will try not be hurtful to the departed personally. Before you say, “Bless your heart,” know that my feelings – my enmity, really – toward the myopic vision of my subject, heralded by the NYT with an 18-column-inch obit, is that society still viewed him in such exalted status even as late as 2017. This man, like so many of his colleagues, actually failed to help us “eat better.” But the NYT piece was an obituary, not an opinion piece.

I am reminded of one of my favorite last lines in a movie: Joey Brown’s line in “Some Like It Hot” (see this YouTube video excerpt). Brown proposes marriage to Jack Lemmon, cross-dressing to avoid a mafia hit squad. Lemmon finally replies, in exasperation, that he’s in fact a man, to which Brown replies, “Well, nobody’s perfect.”

From the NYT obit: This doctor, a “surgeon, clinician, researcher, teacher and author, was pre-eminent in the study of obesity and nutrition.” Besides his MD, he had a doctorate in nutritional biochemistry from MIT and “largely spent his career at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston.” He was professor of nutrition at Harvard, and at Beth Israel was chief of the Nutrition/Metabolism Laboratory and Director of the Center of Nutrition Medicine. This man was clearly at the apex of the “nutrition establishment.”

Yet, “what really put him and his colleagues on the world map were publications highlighting inadequate nutritional management of people in the hospital – so-called ‘hospital malnutrition,’” said a former colleague. How did he do that? “He helped develop nutritious liquid diets (Ensure, and others), supplementing them with protein…” In other words, he and Harvard profited handsomely from this misguided commercial collaboration.

He also correlated poor nutrition with obesity – a no-brainer there, but note again this dependency of Harvard nutrition “experts” on epidemiology, or “correlation,” rather than a scientific interest in “causation.” His solution, and this is a quote: “Advocate lower-fat diets and help develop gastric by-pass surgery and nutritional liquid diets.”

I’m not suggesting that this good doctor had a Mephistophelean streak; I’m sure he intended well, but like Ancel Keys before him, and others still in positions of  influence (e.g. Walter Willett, recently retired from Harvard), he rose to power in the politics of the academy by buying into the “eat-less, exercise-more, a calorie-is-a-calorie” meme that is only now beginning to show wear at the edges because of the weakness of the scientific evidence supporting it.

His obituary writer noted that “weight loss benefitted patients with type 2 diabetes.” Now, there’s a scientific breakthrough! His obituary also described five strategies the good doctor “developed during four decades of encouraging patients to shed pounds: 1) Make time to prepare healthy meals, 2) Eat slowly, 3) Consume evenly sized meals, beginning with breakfast, 4) Do not skimp on sleep, and 5) Weigh yourself often.” Not bad advice, but pretty banal accomplishments, if you ask me. Forty years of “encouragement…to shed pounds.”

I also think that evenly sized meals sounds too much like “balanced” to me. And nutritious liquid diets like Ensure, even if supplemented to 15% protein, are still 60% highly processed carbohydrates. “Carbohydrates” are not mentioned even once in the entire encomium. The emphasis instead is on calorie intake: “Even a small decrease in caloric intake could result in healthier weight,” he is quoted as saying. He summed it up: “Sustained weight loss requires a three-pronged approach: Cut the calories, eat quality food and exercise.”

As Max Planck, the German Nobel-prize winning physicist said in 1906, “Truth never triumphs; its opponents just die out.” Another paraphrased variant is, “Science advances one funeral at a time.” May this doctor rest in peace.

Retrospective #435: Hungry or Undernourished?

“Hungry or Undernourished?” is what I would call a BIG question. It is way out of my league to propose a scientific answer or even describe the parameters of a proper study. I will venture, however, to tackle the matter as an opinion piece: I think it can be parsed into at least two different lines of reasoning, and I will attempt to posit and briefly explore them. I welcome informed comments from my erudite readers.

Proposition #1: We will eat until our STOMACH IS FULL. This is the “common sense” hypothesis; we have all experienced it. When we are “full,” we stop eating. Of course, there are lots of exceptions. We sometimes eat for other reasons, e.g., “nervous” or compulsive eating. There’s also taste and palatability. See this link to carbohydrate-induced overeating (in rats). Lay’s potato chips captured this with the memorable meme, “Bet you can’t eat just one!”

There is a large body of new evidence that the “until full” hypothesis is hormonal. Hunger is regulated by a small organ in the brain, the hypothalamus, which gets signals to induce eating from ghrelin, a hormone produced in the lining of the stomach. and shuts down when another hormone, leptin, signals that hunger has been satisfied. Ghrelin was only discovered in 1999 and appears to have other functions as well. And “leptin resistance,” as a cause of obesity, is still a mystery. So, this is why the hormonal hypothesis of “eating until full” is also just a hypothesis.

Proposition #2: We are “driven” to eat until the body has met its requirements for ESSENTIAL NUTRIENTS. If this sounds like a tautology, let me explain. It is, of course, more nuanced, and at this point in the state of nutrition science, little is known. The theory is that it is what we eat, not how much, that determines when the body is satisfied and hunger stops. Ergo, if your diet consists primarily of nutrient-poor components, aka processed carbs, you will need to continue to eat until your body gets everything it needs.

These essential nutrients include the both macronutrients and micronutrients. The macros are fats, broken down to fatty acids: saturated and unsaturated (monounsaturated and polyunsaturated), proteins (broken down to their 22 amino acids), and carbohydrates, including simple sugars and longer chains of glucose (starches). The micronutrients are vitamins, minerals and phytochemicals, many or which are as yet unknown.

A few of the amino acids from protein are essential, meaning the body cannot make them, and we therefore must get them from food. A few of the fatty acids from polyunsaturated fat, specifically Omega 3’s and Omega 6’s, are also essential. We must “eat” them or take a supplement. No carbohydrate – repeat, NO CARBOHYDRATE IS ESSENTIAL.

My recollection is that this second line of reasoning is suggested in such very good books as “The Perfect Health Diet,” by Paul and Shou-Ching Jaminet, and Catherine Shanahan’s “Deep Nutrition.” It is a rational hypothesis, and I am biased in favor of it in part because the science re: essential fats and essential amino acids is pretty well established, particularly how their absence is detrimental to human health. As such, the body takes care of itself until we get them

It also appeals to me because it supports the idea that all dietary carbohydrates, while a good source of quick energy, are not essential nutrients in the human diet. When carbs are not available to eat, our bodies are designed to make all the glucose it needs from protein and fat, through gluconeogenesis. The body also produces ketone bodies (brain food) from fat, and it uses stored glucose (glycogen in the liver) and gets additional glucose from the animal products we eat (intramuscular glycogen and from organ meats like liver some of us eat). Admittedly there still isn’t a lot of evidence to support this hypothesis. Philosophically, though, it appeals to me. I believe the body takes care of itself.

If I had to guess, I’d hedge my bet by speculating that the ultimate answer will involve or combine these two hypotheses. In the meantime, we can be guided by what we “know” and eat with the knowledge that our bodies will determine how much we need to eat and what a healthy diet is. I find my body likes it best when I eat mostly “healthy” fats (saturated and monounsaturated), and moderate amounts of protein from eggs and pastured meats and poultry and wild-caught fish. I try my best to avoid polyunsaturated fats (all “vegetable” oils) altogether and since I am Insulin Resistant (34 years a diagnosed type 2 diabetic), I try to eat as few carbohydrates as possible.

Retrospective #434: Watch out! Your doctor thinks he/she knows about nutrition!

“Do you discuss nutrition with your patients?” the Tufts Friedman School of Nutrition Science and Policy survey asked physicians. Three-quarters of them replied “always” or “most of the time.” “Do you feel qualified to talk about nutrition with your patients?” Again, 3 out of 4 said, “Yes.” To which I say to patients, “Watch out!”

I have cause to be concerned. The Medscape article which reported the findings links them to two pieces: 1) A “recent study” that “associates…a sub-optimal diet” with “a substantial proportion of deaths in the United States due to heart disease, stroke and diabetes,” and 2) another that nudges physicians to “know what advice to give.” It couches this advice as “evidence-based nutritional advice” to help healthcare professionals deal with “information overload” on diet and nutrition. It quickly becomes clear that the whole point – the pretext for the Tufts “survey” – was to “educate” physicians and other healthcare professionals with “know(ing) what advice to give,” i.e., Tufts’ POV.

The generalized statement that there’s an association of “heart disease, stroke and diabetes” with a sub-optimal diet – a very strong association – is true enough. Deaths from heart disease and stroke are much higher among type 2 diabetics and “pre-diabetics.” This association has led to the term “cardiometabolic disease” (CMD). But, again, on which diet did they become diabetic and develop heart disease? The Tufts answer is epidemiological: an “association.”

The study was presented at the American Heart Association Epidemiology and Prevention-Lifestyle and Cardiometabolic Health (EPI-Lifestyle) 2017 Scientific Session. The findings were also commented on in Medscape by researchers from the Johns Hopkins Bloomberg School of Public Health and the Welch Center for Prevention Epidemiology. More epidemiology! Epidemiology suggests hypotheses, not cause and effect!

Why is that significant? Because epidemiology can only address “associated with” and “related to” findings. But that does not deter the epidemiologist. This “poor diet” link, using “comparative risk assessment models,” estimates that 45% of cardiometabolic disease (CMD) deaths were “associated with” 10 dietary factors, and that these factors have “‘probable or convincing evidence’ for causality” (my emphasis). Epidemiologists are shameless in their reckless disregard for a basic tenet of the scientific method: Correlation does not imply causation.

The “10 dietary [death] factors” ranged in descending order from a high of 9.5% for 1) salt (“excess sodium”), to 2) low intake of nuts/seeds, 3) high intake of processed meats, 4) low seafood omega-3 fats, 5) low intake of vegetables, 6) low intake of fruits, 7) high sugar-sweetened beverages, 8) low intake of whole grains, 9) low intake of polyunsaturated fats and finally, at 0.4%, to 10) high intake of unprocessed red meats. Hmmm… Zero point four percent does not strike me as statistically significant, but I guess they just had to include red meat.

We can also be grateful that a low intake of polyunsaturated fats (corn oil, soybean oil, etc.), at 2.3%, ranked only 8^th on the list. A higher intake, AS THEY ADVOCATE, would, IMHO, only have RAISED THE RISK OF DEATH GREATLY.

This is what your doctor, if (s)he was not on the golf course, is learning and says when (s)he say they know about nutrition. To relieve “information overload,” Tufts gives these talking points from the “know what advice to give” link.

●        Choose foods with a wide variety of colors and textures, in their most natural forms. [check]

●        Avoid or dramatically minimize processed foods. [check]

●        Choose realistic, balanced [not low-carb] diets for weight loss and weight maintenance.

●        Consume healthy oils for heart health: fish, olive, avocado. [good, all MONOs, no mention of soybean or corn]

●        Forego red meat [saturated fat and cholesterol] and live longer [a little editorializing? They just couldn’t resist!].

●        Consume fermented foods/probiotics and fiber for gastrointestinal and overall health. [check]

This is just a plant-based, one-size-fits-all, Mediterranean diet that the Dietary Guidelines recommends for everyone.  It doesn’t mention carbs or Type 2 diabetes, or any of the myriad metabolic conditions that plague the majority of the population. For them (us), balanced is just wrong, and avoiding excessive carbs and polyunsaturated fats needs to be stressed. And I would rather embrace carnivory than give up red meat for the claimed 0.4% increase in CMD death.

Retrospective #433: “Lifestyle Programs ‘Could Prevent Diabetes’”

“Lifestyle Programs 'Could Prevent Diabetes, ” Medscape Medical News declared. My heart skipped a beat. Had the medical establishment finally come to accept type 2 diabetes as a dietary disease? Had they decided to repudiate the awful advice they’ve been dishing out for half a century and finally, effectively address the raging epidemic of obesity, type 2 diabetes, hypertension and related metabolic diseases increasingly plaguing our world?

Or, at the very least, had they perhaps figured out a way to finesse the bad advice for treating these diseases by advocating an intervention before the diseases were firmly established. That would be a brilliant strategy that would in effect, to use an American football metaphor, be an “end run” to evade the usual “middle-of-the-line” defenses. While hope springs eternal, my hopes were soon to be dashed. It was neither of the above.

The story was just about “updated guidance [that] will give clinicians the confidence to make prevention their priority, indentify those at high risk, and refer them to the UK’s Diabetes Prevention Program.” It was a press release. It did, however, shed some interesting information on what the NHS considers “those at high risk.”

The NHS (National Health Service) is the British equivalent of U.S.’s HHS. The Diabetes Prevention Program was started in 2016. Its crown jewel is the National Institute for Health and Care Excellence (NICE) pilot initiative to offer a place on “an intensive lifestyle change program” to “people who could benefit from advice on their diet and physical activity levels.” The program is currently scheduled to roll out across all of England by 2020.

“Nice says it is currently cost-effective to target people with a fasting glucose between 5.5—6.9 mmol/l [99—124mg/dl]. However, it says those with a higher reading (6.5—6.9mmol/l) [equivalent to 118—124mg/dl] should be prioritized for inclusion because of their increased risk of developing type 2 diabetes.” Geez! All of these people are at “high-risk” for type 2 diabetes. They all have Insulin Resistance and all are Pre-diabetic with a “progressive” condition!

Many clinicians and researchers concur with this “extreme” prognostication. Consider that in 1997 the ADA Standard for a medical diagnosis of type 2 diabetes changed from 140mg/dl (7.8 mmol/l) to 126mg/dl (7.0 mmol/l). Yet another change is long overdue. There is already a hue and cry to change the definition of “Pre-diabetes,” only first classified in 2002. (In Europe 6.1—6.9mmol/L or 110mg/dl—125mg/dl; in the U.S.: 100mg/dl—125mg/dl.

The Medscape “good news” spin in the header was inaccurate. It was not the purpose of the NHS press release.” The NICE center’s director was more on point: “We know that helping someone to make simple changes to their diet and exercise levels can significantly reduce their risk of developing Type 2 diabetes.” But perhaps because it is Off Topic to the NHS rollout, the director doesn’t explain exactly what those “simple changes” would be.

The story also points out that “while Type 1 diabetes cannot be prevented and is not linked to lifestyle, Type 2 diabetes is largely preventable through lifestyle changes.” Okay, HE KNOWS! T2DM is largely preventable – and reversible – at least in the sense that if you adhere strictly to specific diet changes, Type 2 diabetes can be put into complete remission, that is, completely undetectable by a simple laboratory test such as a fasting glucose or an HbA1c.

To your doctor, that’s a cure! And when this disease is in remission, your risk of kidney failure, preventable sight loss, and amputation is de minimis. And your risk of heart attack and stroke reduced by 50% or more!

Diabetes UK’s head-of-care said, “We know that globally, diabetes prevention programs do work, and we know that with the right advice and support, people with increased risk of developing Type 2 diabetes can take simple but significant steps [dietary changes, ‘ya think?] to prevent the condition from developing.”

The “right advice,” unfortunately was nowhere to be found in this document or in my search of the NICE site. Methinks perhaps it’s just too hot a potato. Or maybe, to be more cynical, they don’t want a “cure.” Maybe they just want a “treatable” condition… to keep their government jobs and the NHS in business.

Retrospective #432: “I’ve never had a hot flash”

My editor said, “I’ve never had a hot flash,” in a comment to me on a linked article she sent me. Her full quote: “So thanks to Bernstein, I’ve never had a hot flash. I just thought it was luck!” She added, “…interesting, how it is always insulin and glucose control.” The article, “Vasomotor Symptoms and Insulin Resistance in the Study of Women’s Health Across the Nation,” appeared in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.

Quoting from the abstract: “Vasomotor symptoms (VMS) are classic symptoms of the menopausal transition, experience by up to 70% of women living in the United States.”  “VMS have important…implications because women reporting VMS consistently show poorer sleep quality, more negative mood, and impaired quality of life.”

The report drew on annual blood draws and questionnaires over 8 years from 3,075 women aged 42-52 at entry who participated in the Women’s Health study. Hot flashes/sweats were examined in relation to two metabolic factors used to define type 2 diabetes: glucose and the homeostasis model assessment (HOMA).

The study made adjustments for BMI (associated with Insulin Resistance), CVD risk factors, medications and hormonal status. It found that, “compared to no flashes, hot flashes were associated with a higher HOMA” and “were similar for night sweats.” “Findings were statistically significant, yet modest in magnitude, for glucose.”

Beyond the scope of this study, but of interest to the researchers, was the association of the link between menopausal hot flashes/night sweats (VMS) and cardiovascular disease (CVD). “The mechanisms underlying these associations are unclear, due to the incomplete understanding of the physiology of hot flashes,” the report says. The investigators then explored the relation between VMS and CVD from the two well-known studies: Women’s Health Initiative hormone therapy trial and the Heart and Estrogen Replacement Study.

These studies “showed an elevated risk for clinical CVD with hormone use among older women with moderate to severe VMS at baseline relative to women with no/mild VMS.” In addition, “In the Study of Women’s Health Across the Nations, VMS was associated with higher subclinical CVD.” But the findings were mixed. Other work has “examined the associations between VMS and CVD risk factors such as blood pressure.” But until now…

“NO WORK HAS EXAMINED THE RELATION BETWEEN VMS AND FASTING BLOOD SUGAR AND INSULIN RESISTANCE.”

This study was well designed, testing the hypothesis with controls for race/ethnicity, CVD risk factors, body mass index (BMI), the reproductive hormones E2 and FSH, and menopausal stage. The take away for me was the association with BMI, which as mentioned correlates with Insulin Resistance. The researches here noted that:

The association “did not persist” after adjustment for BMI. In other words: “You lose the weight, you lose the risk.”

The report concludes, “Considering BMI in relation between Insulin Resistance and VMS is particularly important given that higher BMI is a potent risk factor for Insulin Resistance and is associated with greater VMS reporting in perimenopausal and early postmenopausal women.” So, eat Low Carb and get svelte, like my editor, while there’s still time.

Or, if you’re already postmenopausal, ponder another statement from the study with respect to cognitive impairment.

This citation “postulates alterations in glucose transport across the blood-brain barrier as a trigger for VMS.”

Since glucose is the main brain fuel, and ketones are brain fuel only while eating Very Low Carb or during fasting when blood insulin levels are low and body fat breaks down for energy, a decline in “glucose transport across the blood-brain barrier” leading to VMS could be problematic. Could KETONES substitute for GLUCOSE in this way?

As my editor observed, “…it’s always insulin and glucose control.” Would following Bernstein’s 6-12-12 or another Very Low Carb regimen (≤30 grams of carbohydrates a day) enable you to say, “I’ve never had a hot flash” or, if you’re one of my older readers, I’ve never exhibited any sign of cognitive impairment!

Retrospective #431: May 9th, from a Russian Perspective

Note: This column was originally published on May 9^th a few years ago. The date is significant, for Russians.

Fifteen years ago, I had an eye-opening experience about perspective. On the way to work I stopped at a food cart to order breakfast: coffee with heavy cream and artificial sweetener, 2 fried eggs over easy, and 2 strips of bacon.

The cart was owned by a father and son who were post-1989 immigrants from Russia and who were both excited to be taking a U. S. citizenship course. They quizzed me daily on American History and were always amazed that I correctly answered their questions, except one day…

They asked me, “Do you know what day today is?” I said, “No.” They were both delighted. They had stumped me! They said triumphantly, “It’s May 9^th, the day that World War II ended!” I smiled and replied, “You mean it’s the date WWII ended in Europe.”  They both looked puzzled. I continued, “War continued in the Pacific.” There was a long pause while they thought about that, and then the son said, “Oh, you mean Vietnam!”

I smiled and had to explain that for the United States, WWII was fought on two fronts; that the Japanese had attacked the U. S. at Pearl Harbor, Hawaii, on December 7, 1941; and that the Pacific theater of the war didn’t end until August ‘45 when the U. S. dropped atomic bombs on Hiroshima and Nagasaki. Japan then surrendered, September 3, 1945, on what we call V-J Day. Americans refer to the end of WWII in Europe as V-E Day.

To a degree it’s understandable that Russians have a different perspective of WWII. U.S. military losses in 4 years of war on two fronts were only 5% of Soviet military losses in 4 years of war on one front. Every country has a chauvinist view of history, but there’s no denying that U. S. deaths, none on its own territory, were just over 400 thousand, whereas Russian military and civilian deaths, most on their own territory, were 27 million.

A similar disparity exists today in the battle over a healthy diet. The leaders of the public health and medical establishments, and the civilian population that follows their advice, are dying in droves from a multitude of metabolic diseases brought on by the diet they eat. This diet has produced an epidemic of obesity, type 2 diabetes, cardiovascular diseases, stroke, Alzheimer’s disease, and many types of cancer, particularly pancreatic cancer

The vast majority of these victims – both the leaders and the unwitting populace who follow them – are engaged in a losing battle. And the agricultural-industrial complex that abets them, by producing processed foods in accordance with the advice to eat less saturated fat and dietary cholesterol, and more Omega 6-loaded, oxidized vegetable oils, and a diet largely comprised of refined carbohydrates and simple sugars, is killing them.

I don’t blame the two Russian men for not knowing about the war the U. S. fought in the Pacific both before and after V-E Day. Their government was justly proud of the enormous sacrifice the people of the Soviet Union made to win WWII in Europe. Their government should be faulted, however, for educating them poorly. I doubt that they knew, for example, that U. S. industrial production provided huge amounts of war material, some of it in Soviet flag ships sent from the U. S. west coast to Vladivostok, free from Jap attack due to a Soviet -Japanese non-aggression pact!

Unavoidably, however, one must conclude that the outcome of the “healthy diet” battle will be determined by leaders on the field of battle. I’m just a lowly Lieutenant in that battle, doing my best to educate people about healthy eating from an ancestral perspective. But, if you continue to follow the government’s advice, and go into battle led by General Mills and General Foods, you will have made an unhealthy choice, and will end up…well, up Battle Creek.

 The U. S. had a definite advantage in WWII. We had two oceans to protect us, enormous natural resources, the industrial capacity to produce the means to fight, and the individual, human potential to meet the challenge.  Today, as individuals, we are faced with another challenge: to make the right choices about what to eat, free from influence from an inherently conflicted agricultural-industrial complex. You can still make a decision to improve your chance for survival in this battle. A new perspective can help you make that choice.

Retrospective #430: “I don’t always skip meals…”

“I DON’T ALWAYS SKIP MEALS…BUT WHEN I DO IT’S FOR DAYS AND DAYS AND DAYS.” I had to chuckle a while back when I saw this on a page posted by Mark Gibbons, a member (as I am) of the Jason Fung Fan Club Fasting Support group on the internet. It was Brilliant, as the Brits say. It’s an allusion, of course, to “The Most Interesting Man in the World” meme made famous by the TV commercial for Dos Equis beer some years ago.

The Dos Equis beer commercial has been parodied hundreds of times. What I liked about this one in particular is that is captures the essence of Extended Fasting, a practice that is gaining a small but very devoted following. The reason for the devotion is that, to virtually everyone’s surprise, it works for losing weight, and it’s sooo easy.

Extended Fasting means that for two or three consecutive days you take little or no nourishment by mouth. I prefer the term Extended Fasting to Intermittent Fasting which first gained currency and apparently includes other types of fasting: 16:8, One Meal a Day (OMAD), 5:2, and various other forms such as Alternate Day fasting. In my opinion all of them are understandable attempts to deal with the fears of the unknowns and uncertainties of abstaining from eating for an extended period of time. From time to time I’ve tried them all for weight loss, with mixed results.

I can attest, however, to the safety and efficacy of Extended Fasting. I transitioned to it last spring when I was living alone for two months. I wanted to gin myself up to start it and avoid the flack I knew I would get from my wife if she were here. It was suggested to me the previous fall by Megan Ramos, Director of the Intensive Dietary Management program in Jason Fung’s office in Toronto. To allay my own “fear,” I told her I would start with Alternate Day fasting.

I had already, since 2002, been eating Very Low Carb, so I was keto- or at least fat-adapted. That meant that, when I began a full day fast, I would immediately transition into burning body fat without hunger. Alternate day fasting worked so well I quickly transitioned to consecutive day, at first two-day and then three-day. I know I could easily have gone four days, or even five or more. But, I rationalized, my social calendar simply didn’t permit it.

The metabolic mechanisms at play here are simple. The hormone insulin is the central (but not the only) player. It has at least two roles. The first is to transport glucose from digested carbs and other sources (such as gluconeogenesis) to the cells where it is supposed to open up receptors there to allow the energy to be taken in. Insulin Resistance in Type 2s and Pre-diabetics slows down and blocks that uptake, which is why your blood glucose level rises.

The 2^nd mechanism is that when glucose levels drop, after the glucose has been taken up and/or when few carbs have been taken by mouth, blood insulin levels drop. This sends a “signal” and the liver switches fuels from glucose to fat. That’s what body fat is for, a backup energy source for when you need it. But fat stores are only accessible when your blood insulin level drops. And that’s more difficult for people who have Insulin Resistance (Type 2s and Pre-diabetics) because with IR, as your glucose continues to circulate, blood glucose and insulin levels stay high!

That’s why Extended Fasting works for weight loss. When you eat nothing or very little, and especially don’t eat carbs, particularly if you are already fat-adapted, your body quickly transitions to burning body fat for energy, and you’re not hungry. You can literally go for days on end with no hunger, high levels of energy, and a feeling of being “pumped.”

I started my weight loss journey at 375 pounds in 2002. Over the years I lost 170 pounds following a Very Low Carb (VLC) diet. Like most, however, I regained some. When I started Extended Fasting my goal was to lose 63 pounds, to reach 187 pounds, thus becoming “Half the Man I Once Was.” With Extended Fasting, it took 8 months, but I did it. But I’ve now regained some again, so my current goal is a little less ambitious. It is to get to 195 and stay below 200.

As the Dos Equis beer commercial ended with, “Stay thirsty, my friends,” so I end this post with, “Stay thin, my friends, with… Extended Fasting.” To maintain 195, I plan to eat Very Low Carb/One Meal a Day (VLC/OMAD), supplemented with one or two full day fasts, when and as needed for maintenance.

Retrospective #429: A WebMD issue

The waiting room at my wife’s doctor’s office always has multiple copies of the latest WebMD magazine. Each cover has “Complimentary Waiting Room Copy” imprinted on the cover. Although I brought my own reading material to my wife’s recent visit, I picked up a copy to look for news about Type 2 diabetes.

The November/December 2017 issue had no such content. There was, however, an ad from Big Pharma for a drug to treat Type 2 diabetes. The ad said, “…when [their product was] used with diet and exercise,” it may help to lower your A1c. The placement of the ad was ironic: it was in the middle of the food section.

The “holiday” food section of this issue featured 5 content pieces. Nestled among the first sugar-choked three – on red grapefruit, sweet potatoes, and cranberry sauce – was this 3-page ad for a new injectable medication, “to help Type 2 diabetics lower A1c’s.” The FDA had approved it to be used “with diet and exercise in people who are not controlled” with long-acting insulin…or lixisenatide.” You will not be surprised to learn that the new drug is made by the makers of Lantus, a popular long-acting, injectable insulin. 

Their new drug is another combination drug – this time mixing 100 units of insulin glargine with 33mcg of Lixisenatide, a GLP-1 receptor agonist. This is a SERIOUS medication regimen. It is intended for the Type 2 diabetic whose A1c, EVEN AFTER taking 3 classes of oral meds, AND THEN usually another “non-insulin” injectable, AND THEN usually long-acting (basal) insulin, has “PROGRESSED” and is STILL NOT CONTROLLED, i.e. a totally drug-dependent Type 2.

THAT’S WHY HAS THIS NEW DRUG BEEN INTRODUCED. THINK ABOUT THAT FOR A MOMENT AND ASK YOURSELF:

High blood sugar and high A1c’s are SYMPTOMS that the patient’s Type 2 diabetes is “not controlled.” A doctor is trained to treat symptoms. The doctor knows the medical protocol to treat these symptoms is to prescribe drugs in increasing doses as the patient’s disease “progresses.” They are taught that Type 2 diabetes will progress, and the only thing the doctor can do is prescribe higher doses, stronger medicines and, as the patient’s condition worsens, the latest combination drugs until…? So, what’s a doctor to do? You can’t blame them, can you?

But ask yourself, “Why is the patient’s disease ‘not controlled’”? Did you remember that all the ads are required to say that the patient is supposed to participate in their own treatment with “diet and exercise”? Well, that’s quickly become a worn-out trope, hasn’t it? The only advice in the drug ad is to “Eat healthy foods and exercise regularly.” You can’t blame Big Pharma or your doctor for not getting into the “healthy foods” debate. Ever wonder why?

In the ad a woman holds a sign that says, “A1c, it’s time to take you down!” A man with a little pot belly holds another saying, “I’ve been good, so why is my A1c bad?” On the website, a “GET THE FACTS” link takes the reader to another smiling person whose sign says, “My diabetes changed – so I made a change,” and another, under the heading, “Diabetes is complex with factors beyond your control. Here the sign suggests, “Age? Metabolism? Family History? Well, you can’t blame the patient for things that are beyond the patient’s control, can you? Well, can you?

WRONG! Your metabolism IS within your control. You’re a Type 2 diabetic BECAUSE OF WHAT YOU EAT. If your Type 2 diabetes is not controlled, or getting worse, it is because of what you eat. THAT is THE CAUSE of Type 2 diabetes. AND THAT IS NOT A FACTOR BEYOND YOUR CONTROL; It is within your control and your responsibility to accept that and not be sucked in by your doctor’s drug treatment plan and Big Pharma’s slick ads). CARBs become GLUCOSE in your blood. CONTINUOUSLY HIGH GLUCOSE IN YOUR BLOOD RAISES your A1c (and CAUSES you to gain weight too!)

Contrary to what Big Pharma and your doctor would have you believe, you have NOT been “good” and THAT’S why your A1c is “BAD.” If you want to lower your A1c and control your Type 2 diabetes, you’re going to have to CHANGE WHAT YOU EAT. You’ll need to learn about carbohydrates and eat fewer of them. If you do, this will stabilize your Type 2 diabetes and, if you eat few enough, could even reverse your Type 2 diabetes and put it in remission. You could even, by diet alone, eliminate most, or even in some cases, all your diabetes medications, including insulin. 

Retrospective #428: Portion Control

Weight loss strategies are full of advice to control portion size…but nobody wants to measure! So, instead of a scale, we are counseled to use a clenched fist to estimate a protein portion. We are told to use a small plate because then a full plate makes the serving size look bigger. Both devices work, but if you continue to eat a “restricted calorie,” “balanced” diet, full of nutrient-poor, high-carbohydrate, “processed” foods, you’re still going to be hungry.

Alternatively, if you are eating a Low Carbohydrate diet, you can fill your small plate with energy-dense protein and fat, and one or two low-glycemic veggies (carbohydrates), and you will feel full and remain sated for a longer time.

And if you are eating a Very Low Carb diet, you can eat these same healthy foods…or not. That is, you can skip a meal without hunger and save both time and money. Case in point: I am never hungry at “breakfast.”

Eating three meals a day is a social construct and a cultural habit. We’ve been told (by the cereal and juice makers) that it’s important to “start the day off well with a big breakfast” and “breakfast is the most important meal of the day.” And guess what? It’s usually all carbohydrates, like fruit juice, cereals with milk and added sugar, or sugar-laden yogurt or bread (made from flour, water and sugar), with jelly, or tea with honey.

Result: our blood sugar spikes, then crashes, and it’s mid-morning snack time and then lunchtime, so we scarf down more carbs. By mid-afternoon, our blood sugar crashes again and it’s time for a nap…or a snack (candy bar, anyone?).

Do you see a pattern here? Einstein said, “Insanity is doing the same thing over and over again and expecting a different result.” Well, maybe a diet of 3 carb-heavy meals a day, plus snacks – a diet that is 55% to 60% carbs, or higher – is the problem! Maybe a change in what and when we eat, or even why we eat, would fix that problem.

For me, portion control begins with the 3 precepts (Hat tip to Diet Doctor): 1) Eat strictly a Low Carb Diet, 2) Eat only when hungry and 3) Use Intermittent Fasting as needed to reach and maintain a stable weight.

Here are a few practical tips that I use that you might want to consider:

1) For “Breakfast,” I have “downsized” and just drink a medium-sized mug of coffee with my morning pills.  I add a dash of stevia powder and a small pour of heavy cream to color and flavor the brew. I now get 3 weeks per quart, at about 1½ oz/pour (150kcal). If you eat them (I don’t anymore), eggs & bacon are portion controlled. Cereals are not.

2) For “Lunch,” if I eat lunch, I eat from tins:  a tin of kippered herring in brine, or Brisling sardines in olive oil or water. The small tin limits the meal, and it is all protein and healthy fats. Alternatively, I might have a hardboiled egg or two.

3) During the day I only drink a beverage that will not raise my blood sugar. I drink cold-brewed iced tea, “sweetened” with liquid stevia. I have tested this drink multiple times and it does not raise my blood sugar.

4) For “Supper,” if I am not fasting, I eat two small, pasture-raised lamb chops (an 8-rib rack provides 2 meals for 2 people), or half an 8oz Sam’s Club filet mignon, or one chicken breast or a thin-sliced pork chop. We also share a low-glycemic vegetable, either tossed in butter or roasted in olive oil, or a salad with my homemade vinaigrette dressing.

5) For a supper beverage, I prefer one or two 5oz portions of red wine in a glass filled with seltzer. I know it’s only 5oz because I always get 5 pours from a 750ml (25.36oz) bottle. Sometimes I have our cold-brewed iced tea instead.

6) If I have an “nervous eating” urge to eat after supper, I use the wine glass for a Braggs Apple Cider Vinegar Cocktail: 1 Tbs of vinegar, a few dashes of bitters, and several drops of liquid stevia; add ice, swirl and fill the glass with seltzer.

If you’re not hungry most or virtually all the time, as you are NOT when you eat Very Low Carb, then portion control will be…ahem, a piece of cake. BECAUSE YOU DON’T THINK ABOUT EATING OR PORTION CONTROL WHEN YOU’RE NOT THINKING ABOUT FOOD. And, about that piece of cake; you won’t crave it. You can enjoy cake or ice cream on special occasions, but you won’t NEED a carb snack to keep from falling asleep. You’ll be full of pep and “vinegar.” ;-)

Retrospective #427: The “Fasting Biohack” that is trending in Silicon Valley

A TV story I saw a while back described the “latest trend” in Silicon Valley as a “fasting biohack.” It sounded interesting, so I did a Google search. The first hit I got was from an old Time magazine story about fasting and longevity; however, the story I was looking for in this piece from the September 2017 Guardian newspaper.

The Guardian piece starts off telling about a Silicon Valley CEO who has just eaten a small dinner and will next eat four days later at a fancy sushi restaurant. “In the intervening days it’s just water, coffee and black tea,” the CEO relates. Over the last eight months this CEO has shunned food for periods of from two to eight days and lost almost 90lbs. He told the Guardian, “getting into fasting is transformative.”

How is it “transformative”? The Guardian story quotes the CEO as saying, “There’s a mild euphoria. I’m in a much better mood, my focus is better, and there’s a constant supply of energy. I just feel a lot better.” “Getting into fasting is definitely one of the top two or three most important things I’ve done in my life.” WOW!!!

The Guardian piece added, as filler for context, that “Intermittent Fasting first gained popularity in recent times with the 5:2 diet, where people eat normally for five days a week and then eat a dramatically reduced number of calories (to around 500) on the remaining two days.” However, they say, this CEO and others like him “are pushing that idea further and with a focus on performance over weight loss.” It was incisive that the Guardian picked up on that.

The Guardian made another prescient observation: “Proponents combine fasting with obsessive tracking of vitals including body composition, blood glucose and ketones – compounds produced when the body raids its own fat stores, rather than relying on ingested carbohydrates for energy. This, is not dieting, they say. It’s biohacking.”

“Ketones are a super-fuel for the brain,” said another Silicon Valley CEO, “so a lot of the subjective benefits to fasting, including mental clarity, are from…the ketones in the system. I’m focused on longevity and cognitive performance,” he says. This CEO doesn’t need to lose weight, so he does a weekly 36-hour fast and a quarterly three-day fast.

Another exec says, “The first day I felt so hungry I was going to die. The second day I was starving. But I woke up on the third day feeling better than I had in 20 years.” This is not unexpected if you go into this as a “sugar-burner,” being dependent on carbs for energy. If, however, you are already eating Very Low Carb, as this blogger has been for years, you’re already a “fat-burner,” and you will transition from “fed” to “fasting” easily and without hunger.

The Guardian says, “There is a mounting body of scientific research exploring the effects of fasting. Each year dozens of papers are published showing how fasting can help boost the immune system, fight pre-diabetes, and even, at least in mice, slow aging.” Dominic D'Agostino describes other benefits of fasting here (Retrospective #421).

The Guardian, though, ends on a cynical note. One of the Silicon Valley execs says, “He doesn’t think it will ever be mainstream.” “It seems too extreme. Everyone grew up hearing fasting was dangerous and super-difficult.” “Furthermore, no one makes money when people don’t eat. In this society, usually things that work against every entrenched economic interest are hard to take off,” he said. Alas, how true! And how sad, really.

This CEO concluded, “It sound(s) crazy.” “You need to be a weirdo like me to get into this.” I know what he means. My readership has fallen off since I adopted Ketogenic 2 and 3-day Fasts into my weekly routine. I guess I’ll just have to be content with the 75 pounds I lost with my 300kcal/day fasts and my “transformative state” of “mild euphoria.”

My fasting method is not the namby-pamby 16:8 method that some people practice. Neither is it the One-Meal-a-Day (OMAD) fasting that I previously did for a year. My modified 300kcal/day regimen incorporates a glass of wine, even on fasting days. I now use OMAD for MAINTENANCE, with two glasses of wine, ON NON-FASTING days, and my 2 or 3 full-day 300kcal “modified” fasts, to drop a few pounds each week. If you’re a bibulous imbiber like me, you might want to try it.

Retrospective #426: Extend Bars, for Type 2 Diabetes Management

While standing in the checkout line at my local supermarket, I saw a slightly overweight, middle aged man put some real food on the conveyor belt, and then a passel of Extend Bars. The sight brought to mind that I had recently seen a TV ad for Extend Bars that made some bold claims.  So, since we are all influenced by marketing for manufactured “foods,” and as a long-time Type 2 and unofficial type 2 diabetes educator, I decided to take a closer look.

Extend Bars come in 8 delicious sounding flavors, all 150 calories. The first four have from 5 to 6 grams of fat, half of it saturated. These bars also have from 9 to 10 grams of protein. The balance of the calories (22 to 24 grams) is carbs. Translating the grams to calorie percentages, fat percentages range from 30% to 36%, protein percentages from 24% to 27%, and carb percentages 59% to 64%, except…wait a minute, that adds up to more than100%!

Keeping the fat and protein calories as fully metabolized, and subtracting from 100%, the carbohydrate percentages in the energy calculation for these 4 bars are reduced to from 59/64% to between 40/46%. How? I asked Extend.

Extend explains: “How to Count the Carbs: Fiber, Maltitol, and *Non-Factor Other Carbs (5 grams uncooked cornstarch and 4 grams glycerin) convert slowly, thus have a minimal impact on blood sugar.” So, in their large print calculation on the Extend Bar, they subtract all but 1 gram of carbs (e.g.: 22g - 4g - 8g - 9g = 1 net gram of carbohydrates).

However, in their energy calculation of 150 calories per bar, Extend subtracts only some of the carbs, leaving the uncooked corn starch and the glycerin, plus a little soluble fiber and some sugar alcohol (Maltitol) -- from 15g (40%) to 17.25g (46%) of carbs total -- to “convert slowly, thus have a minimal impact on blood sugar.” Nota bene: carbs that “convert slowly” are still AUC, i.e., Area Under the Curve, i.e., still fully-metabolized as carbohydrates.

So, ignoring that they taste like candy bars, what’s the “virtuous rationale” of eating Extend Bars for diabetes management? The Extend website gives us four reasons: 1) Minimize Spikes and Avoid Blood Sugar Swings, 2) Avoid Low Blood Sugar (Hypoglycemia), even Overnight, 3) Reduce Hyperglycemia in the Morning, and 4) Comfortably Bridge Gaps between Meals. Do you see anything in common in these 4 mechanisms? How do they do that?

You eat one bar in mid-morning, then one in mid-afternoon, then one before going to bed… and behold, you will “minimize spikes and avoid blood sugar spikes, avoid low blood sugar, even overnight, reduce hyperglycemia in the morning, and comfortably bridge gaps between meals” (because you ate a slowly converting, carb-loaded, candy bar between meals). By eating 3 “balanced” (carb-loaded) meals, and 3 carb-loaded “snacks” a day, you will remain a carb-addicted, Type 2 diabetic…even as you thought you were eating just 1 net gram of carbohydrates per candy bar.

All these Extend bars are all based on “juicing” your body with this “food” (sugar), with its reduced 40% - 46% carb content, perhaps because it is slowly converting to glucose in your blood. Uncooked corn starch and glycerin, from 3 Extend bars a day as recommended, is giving you a continuous infusion of carbs, sort of like being on a glucose drip.

Extend Nutrition describes their bars as “sweet,” which I assume they are, with “rich (sugar-free) chocolate” and “creamy peanut butter.” I’m sure they taste good, if you have a sweet tooth, as carboholics do. But just to be clear: when you double down from eating 3 “balanced” (carb-loaded) meals a day to eating 6 carb-loaded “meals” a day, supplementing the meals with “snacks” that intentionally mislead you into thinking you are eating just 1 gram of carbs when they are, in fact, from 40% to 46% carbs with 15 to 17.25 grams of carbs that “convert slowly,” you are not really managing your diabetes wisely. But that’s up to you.

I put my food on the conveyor belt and checked out: eggs, heavy cream, grated cheese, green olives, fresh cod, beef short ribs, celery, yellow onions and garlic. I was tempted to buy crackers and some Macadamia nuts, but I know that if I have them in the house, I will eat them, and my diabetes management plan doesn’t allow for snacks between meals. When I avoid carbohydrates, I don’t need snacks. I’m not hungry between meals, or usually, even at mealtime.

I don’t mean to sound smug or even virtuous. I’m being better informed and doing what’s best for my diabetic health.